roughened from the deposition of calcareous material. In some of the post-mortem examinations small spots of necrosis are found with the formation of minute abscesses. More or less fatty degeneration of the internal and middle coats is shown by microscopic examination. Then the growth of connective tissue is a marked feature.

Symptoms. As has just been stated, the disease may exist for a long time without any very definite symptoms. The first knowledge we may have of this condition may be a cerebral hemorrhage, the arteries being weakened by this overgrowth of connective tissue and fatty degeneration, give way when some exciting cause is brought into play, for example, violent exercise, rapid hill-climbing, heavy lifting, excessive vomiting, and in fact anything that produces a great rise in the blood pressure.

The picture we may first see is as follows: We are called to a person who has been pretty well, and we learn that he was suddenly attacked with a marked dyspnea, with the radial pulse very full and tense. If the urine is examined we may find albumen. Many cases of arteritis are associated with chronic nephritis and it is often difficult to determine which was the primary trouble, the arteritis or nephritis; when nervousness and sleeplessness are continually present, it is always well to look into the condition of the arteries as a probable cause. Many of these persons suffer from the irregular distribution of blood to different organs and tissues, and from fre-· quent attacks of contraction of their arteries. If the cerebral vessels are principally the seat of the disease, persistent dizziness, headache, tinnitus aurium, and sometimes attacks of syncope, are the symptoms of which they complain. When the brain is not properly nourished symptoms of anemia are present. In other cases too much blood is carried to portions of the cerebrum, and they have symptoms of cerebral hyperemia, and this hyperemia may be active or passive.

If the disease is most pronounced in the coronary arteries of the heart, or aorta, then they are prone to attacks of angina pectoris, precordial pain, pain extending down one or both arms, and a great deal of constriction through the chest.

In other cases the first symptoms that will be brought to the physician's notice may be gangrene of an extremity, the blood supply being cut off by the obstructed arteries, the tissues not receiving enough nourishment die. It can be readily seen that the symptoms may be varied, and the true diseased condition may manifest itself in a variety of ways, and we may not be able to diagnose arteritis until one or more of these sequelæ manifests.

Prognosis.-As to cure, unfavorable; treatment may modify the condition and prolong life.

We now come to that part which is of most interest to the physician.

Treatment. It is a recognized fact that two-thirds of the sick people over fifty years of age suffer from some form of chronic productive inflammation. As we, as yet, do not know what irritants or substances are at work to cause the inflammation, it must be treated from the results of clinical experience, empirically, or by the law Similia Similibus Curantur. Experience has shown that a temperate life, lived in the open air as much as possible, the avoidance of alcohol and rich food, plenty of pure water drank, close attention to the excretory organs, bowels, kidneys, skin, etc., all tend to favorably modify the trouble.

As most pathologists agree that there is fatty degeneration going on in the walls of the vessels, I have repeatedly followed the advice of the late Dr. Richard Hughes, and administered phosphorus in different dilutions, during the past five years with considerable degree of success. As phosphorus causes fatty degeneration, our law of practice suggests that this remedy be administered. The more perfect the totality of the symptoms are covered by the drug, the more we should expect from its employment. When the kidneys show an overgrowth of connective tissue, symptoms of chronic interstitial nephritis, plumbum should be considered. It will be remembered that lead poisoning was supposed to be one of the etiological factors, and we, who use drugs for their similar effects, immediately think of plumbum for this complication of arteritis.

If there is a clear history of syphilis, the iodide of potash should' be given in material doses, and by many physicians the iodide of potash or soda is considered of undoubted benefit in cases of nonsyphilitic origin. Others pin their faith to the chloride of gold and soda. Some use the iodide of arsenic in these cases, also the bromide of soda and potash are given together.

When the cerebral vessels are principally involved, the following remedies have been found useful by the writer:

Belladonna for cerebral hyperemia, dizziness, red face, throbbing of vessels in the neck and pulsating pain in the head, especially on the right side, great hyperesthesia of special senses; every little sound startles, eyes sensitive to light and lachrymate; bending forward or stooping over aggravates, and amelioration follows prop

ing up in bed.

Glonoine is given for symptoms similar to these of belladonna, but

more acute in character. The throbbing is more intense, and there is more general arterial tension.

Gelsemium for passive congestion. Cases with occipital pain, drawing in nape of neck, trembling of hands, weak legs and knees particularly, with drooping of eyelids make up a picture that this remedy paints.

Baryta carb. seems of undoubted benefit when the brain does not act nor receive the proper nourishment, marked signs of senility, loss of memory, etc.

Zincum met. for cases that show signs of cerebral anemia; the brain is sluggish, with a dull, apathetic look; the characteristic fidgety condition of feet may be present, or pressure symptoms, as paralysis from effusion of serum into the ventricles.

For the cases that manifest angina pectoris as a prominent symptom, amyl nitrite pearls containing two drops of the drug, broken on a handkerchief, relieve the suffering of severe attacks. Chloroform inhalations answer the same purpose. When the attacks are often repeated, glonoine in the 2d or 3d x dilution should be administered daily, especially where spasm is the principal feature of the In the cases where pain is a marked symptom spigelia often benefits. Some cases, however, require some preparation of opium to relieve.

Cactus helps the cases that complain of a sense of constriction about the heart, or when fainting is a prominent symptom.

In advanced cases, when the heart weakens and the compensation fails, shown by weak, irregular pulse, diffuse apex beat, venous congestion of the viscera, mucous membranes and skin, with edema of feet and ankles, and scanty urine, the cardiac stimulants are in-, dicated.

Digitalis tincture, of ix dilution is indicated in cases that present these symptoms.

Convallaria maj., is indicated in cases that show hypostatic congestion of the lungs; the right side of the heart seems to be principally affected.

Strychnine sulph., is useful when the nervous system is depressed, sluggish, and the heart lacks force. There is a regular pulse, but it is poor in quality.

By following out the above outline of treatment the lives of many have seemed to have been prolonged and made comfortable. I will cite three cases that have been under my care, as follows: CASE 1.-Woman of eighty years, with good general health. When called to see her she complained of pain and throbbing in left

foot. Foot was red, swollen and hot. Suspected gangrene. Examined urine for sugar with negative results. Symptoms pointed strongly to belladonna and it was prescribed in 2d x dil., in water every two hours. Symptoms rapidly increased in severity; foot and ankle became purple and covered with blisters. It was now evident that there was gangrene, and it was decided to amputate, and Steven Smith's operation was performed at the knee joint. Experience in these cases shows that where disarticulation can be performed, the shock is very much less, and the chances of recovery are more probable; and Dr. Moulin of Dublin has proved that old people stand such an operation fully as well as younger. The knee healed perfectly without any suppuration and left a fairly good stump. This happened over six years ago, and this patient is enjoying fairly good. health to-day, except occasional slight attacks of angina pectoris, induced by the chronic arteritis which was responsible for the ganOn examining the stump after the operation it was found that the popliteal artery was as stiff as a stick of macaroni, and the lumen of the vessel almost occluded.

grene.

The remedies which I found beneficial in this case for the occasional symptoms since the operation, were arsenicum, cactus, glonoine, phosphorus, and strychnine.

CASE 2.—A woman, age fifty-six, symptoms of gangrene appeared similar to Case I, and leg was amputated at middle third of tibia, and she died from shock two days later. Evidently the gangrene in this case resulted from a chronic arteritis.

CASE 3.—A man sixty-one years of age, has cerebral arteritis very marked. There is much throbbing in head, vertigo greater part of the time, staggers when he walks, and at times has weakness of legs in a marked degree. Sometimes pain is most severe in occipital region. The retina show where hemorrhages have occurred from the diseased condition of the retinal arteries, with impairment Belladonna and gelsemium have helped this patient much,

of sight.

and although he has employed empirical treatment from several sources he has learned that these two remedies, homeopathically administered, relieve him best. At present he is quite comfortable and attending to his regular occupation, which is clerical in its

character.

Original Articles in Surgery.

CONDUCTED BY

WILLIAM TODD HELMUTH, M.D.,

GEORGE W. ROBERTS, PH.B., M.D,

INTUSSUSCEPTION INVOLVING THE COLON AND A PORTION OF THE ILEUM.*

J.

BY HENRY EDWIN SPALDING, M.D.,
Boston, Mass.

L. was a healthy robust child of eight months. July 1, 1901, there commenced a profuse, green, offensive vomiting accompanied by slimy, bloody discharges. Nevertheless, he nursed well. The child was taken from the seashore to the office of a Boston physician. The disease was diagnosed dysentery and astringents prescribed. Periodical profuse vomitings continued. After these attacks several hours would elapse without any vomiting. There were frequent small discharges of mucus, pink or brownish in color, with much straining. About the fifth day the mother noticed a protrusion of bowel from the anus. Another Boston physician was called to the child. Without examining the rectum, he advised the mother that the prolapse was of little moment, since it was the result of straining incident to dysentery, and prescribed pepsine and bismuth for indigestion.

Not improving, a local physician was called, who accepted the diagnosis of his predecessors and gave, as he told me, a compound rhubarb cathartic to relieve a supposed fecal obstruction. The next day there were at least two discharges of fecal matter blackened by the bismuth previously taken. The relief was only partial and that but temporary. The vomitings recurred at intervals of a few hours, while the distress and straining came usually every few minutes, the prolapse recurring with each effort. The mother could easily return the protruding mass but it soon came down again. Oil and other soothing injections were used. July 13 the physician for the first time examined the rectum and discovered the true condition, an intussusception, and advised immediate surgical interference.

The parents hesitated and summoned Dr. Rotch, the well-known *Written especially for the NORTH AMERICAN.