JOURNAL f

LOYALTY TO THE LAW.

WHEN

HEN we were small as a party and pressed by persecutions on all hands loyalty to one another and the law, was sure and natural. Now that we have grown to be a great party, a power in the land, there is much evident danger that under misguiding notions of tolerance and liberality we may leave our standard while we browse about in our enemy's presence. The laws of the land recognize three sects or parties in the practice of medicine. Practically there are but two, the allopaths and the homoeopaths; as the difference now between the eclectics and allopaths is one of name rather than any material difference in practice. Each uses much the same class of remedies and make selections upon the plan of

empirical experience, and have common ground in having no law governing the selections of the single suitable remedy. All three parties are agreed perfectly in the collateral branches or departments of medical knowledge. Then the only difference between us and other practitioners is as to the law governing the selection of the remedy. Does this law embrace a very large element of valuable and important truth, or is it a mere plausible speculation with which we have for the last hundred years amused ourselves? If the affirmative of this proposition be true let us show a professional manhood in its defense and in its application to practice. If the negative be true. let us surrender and go over to the enemy, "body, boots and breeches."

attack of professional hypochondria. We are led into this view of thought by what is quite apparent in certain quarters. Editors and college professors are voluble and fluent enough in theoretic teaching as to the law, but we suspect are woefully at fault in practice, if we may judge by the discussions in our societies and in the observance of a crude unscientific polypharmacy in prescriptions. We solemnly believe that nothing in the world's history save and except the promulgation of the doctrines of the Christian religion, has had such a beneficent influence on human health and human destiny as the law and teaching as promulgated by Hahnemann. Now if this proposition be true let us come to the fore in the defense of the truth in practice as well as in theory.

Let us not be led astray by a sen timental show of tolerance and liberality toward men who will at any time turn upon and spurn us.

Let us not be enticed away into forbidden paths by the easy modes of an undiscriminating polypharmacy, leaving the disease to make the selection which we should make in prescribing.

WE

MEETING.

E embrace this as the last opportunity to call attention to this meeting which takes place in St. Louis the 12th, 13th, and 14th of November.

The meeting promises to be a representative one of representative men and women of the South and West. Doubtless there will be a goodly attendance by doctors north and east of our convention city. By common consent St. Louis is the great center for all representative meetings whether medical, scientific, literary, political or religious. The auditorium facilities, the great hotels, wonderful street car system, magnificent parks have each and all given the city her

prestige in this line. prestige in this line. For fear we

might grow prolix we will not trust ourselves as to our palatial residences, hospitality and pretty girls.

We hope every homeopathic physician in or near the city will feel it his bounden daty to contribute in one way or another to the success and interest of the occasion. Come and furnish a paper, participate in the discussion or lend help by your presence.

VALVULAR diseases of the heart

are of particular importance, not so much due to the local disorder, as secondary troubles, likely to appear in remote organs, and which often lead to a fatal termination.

These troubles rise from the disturbed equilibrium of the circulation, which results from the insufficient action of the valves. Congestive troubles, as bronchitis, enphysema, cerebral hyperaemia, apoplexy, chronic nephritis, engorgement of liver, these affections and many others are often brought into existence by insufficient valvular action.

They are also important because of their frequency, their course is chronic, and invariably progressive unless arrested by proper hygienic and remedial agencies.

Any of the four valves may become the seat of this affection, most likely the valves on the left side of the heart-first in liability is the mitral, and then the aortic, on account of this side having more active and vigorous work to perform.

Diseases of valves of right side are more frequent in infancy, and are generally produced during intrauterine life by endo-carditis; this is the case from the increased activity of this side of the heart during gestaion.

The majority of valvular diseases in adults are secondary to acute endo-carditis, and this affection is usually a complication of acute inflammatory rheumatism which is the most prolific of all serious diseases of heart. Other affections may produce endo-carditis. Acute infectious diseases pyæmia, septiocemia, nephritis, syphilis, arthero meatous conditions and others, and violent muscular efforts are likely to rupture the chorda tendinæ of the valves.

Diseases of Valves come under one of two heads either Obstructive or Regurgitant.

The pathological condition in obstructive lesions or stenosis is one of thickening of free borders of valve, resulting most often from acute endocarditis. During the inflammatory process there is some swelling of the valves and after the acute stage has subsided more or less hyperplasia of tissues remain. It is not so freely opened, as when in a normal condition, and consequently offers considerable resistance to blood current. The thickening may be so great, and the segments become in such close apposition, as only to leave an opening the size of a small pencil or even a bristle which almost invariably results in a degenerative condition. Artheromatous patches may occur on

the surface of valve and weaken its segments and produce a bulging and thereby insufficiency of valve is the result.

In many cases vegetations spring up from the diseased valve. They are generally multiple, and their rubbing against the hard substance of the walls of the heart or vessels, as the case may be, gives rise to irritation and produces small vegetations at point of contact. These vegetations in time undergo calcareous degeneration, and this chalky deposit may be so extensive as to form a firm long ring around the valvular orifice and thereby produce a means of obstruction.

The pathological changes of insufficiency are practically the same as changes that produce obstruction. With the difference in obstruction the valvular edges retract. Dilatation of heart walls may separate the segments and produce regurgitation, by not allowing the segments to come in a position and regurgitation results in ventricular systole.

Insufficiency may occur in a perfectly healthy valve, while obstruction or stenosis always in a diseased valve. Valvular diseases whether obstructive or regurgitant, give rise to secondary nutritive changes in heart muscles. They put a greater amount of work on heart, this increased exertion calls for increased strength, and this produces increased thickness of that portion of heart upon which the extra labor is put. The walls become hypertrophied; this condition may be maintained for years, and not cause distressing inconvenience to patient. At the same time the circulation of the coronary arteries may be interfered with and

the hypertrophied condition will soon disappear and dilatation will be the result. As soon as dilatation begins to predominate over hypertrophy the equilibrium of circulation would be destroyed and symptoms of disease necessarily show themselves.

In all valvular troubles the arteries are robbed of their normal amount of blood while the veins are overfilled. This veinous congestion soon produces changes in remote organs of the body and interferes with a proper performance of their function.

There is produced a primary engorgement of left auricle in mitral disease, often the pulmonary vessels, and gives rise to chronic bronchial catarrh, attended with excessive secretion of mucous and obstinate cough, not relieved by expectoration as are most other like conditions. At times rupture and hemorrhage into alveoli occurs and blood streaked expectorant is observed. This condition favors phthisis pulmonalis. Under all such circumstances breathing is rendered very difficult, at times dyspnoea is so very great patient cannot lie down without almost suffocating.

The liver suffers from venous congestion and gives rise to hypertrophied condition. In later stages it becomes shrunken and smaller, which is due to atrophy of hepatic cells; patient is likely to be found jaundiced and also have catarrhal condition of bile ducts. Ascites may and often does result from the atrophy.

Urine becomes scanty and loaded with excrementitious salts, relative amounts of urea and urates increased and usually form a heavy deposit as soon as urine cools. At a later period albumen is found.

Passive congestion of brain as venous system is engorged with blood and is accompanied in later stages by oedema. Serum often transudes into the ventricles. Cerebro spinal fluid is increased and chronic hydrocephalus may occur in many instances. Hemorrhage may occur from artheromatous condition of arteries. The formation of an embolus constitutes one of the most serious troubles. Becoming detached from a vegetation and entering the circulation is very apt to pass into left common carotid and then find its way into left middle cerebral artery and lodge in some of its ramifications. Such an event is characterized by a stroke, the patient is stricken suddenly with unconsciousness and as volition returns he finds that the right side of his body is paralyzed and that he cannot speak. Aphasic hemiplegia results in typical cases of embolism. The embolus shuts off the circulation to a limited area of of brain tissue and unless the collateral circulation is speedily established, softening and degeneration ensue. The paralysis is generally permanent. The mechanical obstruction to circulation by accumulation of blood in veins leads to dropsy and in mitral and tricuspid diseases is likely to become general.

Ascites-from obstruction of portal circulation is common and may be great in amount. All the serous cavities contain serum when the dropsy becomes general and we find hydro-pericardium, hydro-thorax and effusions into the ventricles. These dropsical conditions interfere with breathing. The skin in these affections has a peculiar livid hue, which distinguishes it from renal disease. accompanied by dropsy.

Hematemesis is also often produced by insufficiency of tricuspid valve.

We will now consider briefly the symptoms or signs elicited by application of the methods of physical diagnosis. First we must know the physiological action of the heart to be able to distinguish one sound from another. In a normal pulsation of the heart the first sound is the systolic, which is produced by the contraction of the ventricles, and composes about of the pulsation; next comes the diastolic produced by dilatation of ventricles and composes about of the pulsation. Then we have the period of rest occupying the remainder of the complete pulsation or about of the whole. At the commencement of examination, every means should be taken to determine in each particular case, the actual size and position of heart together with its relation to the thoracic walls and to the surrounding organs, the exact point of the apex beat, and the character of the impulse.

The rhythm of a murmur; under this head we ascertain the relation of a murmur to the different physiological acts which constitute a cardiac pulsation.

Having identified the two sounds and traced their relation to the apex beat and radial pulse the rhythm is easily determined for all valvular murmurs, either precede or take the place of or immediately follow, one of the heart sounds.

First a murmur may precede the first sound, the murmur is simultaneous to the contraction of auricles and is necessarily a mitral obstruction. It is produced on either side