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pus, excoriating the cheeks. Though its power to cope with an iritis is questioned by some, others have found it efficacious; the pains are very severe and are of a tearing, boring character.

Mercurius corrisivus is indicated in inflammatory conditions of the most violent type, the burning pains around the eyes are agonizing, with excessive photophobia, the lachrymation is so excoriating that it leaves a raw surface where it comes in contact with the skin. Corneal ulcers tend to perforate. It is considered almost a specific for syphilitic iritis.

We would select mercurius dulcis in diseases of the eye occurring in scrofulous children who have glandular enlargement and whose skin is flabby and ill-nourished. The local indications are similar to merc. vivus.

Ear.-In catarrhal conditions of the ear merc. vivus is found to be beneficial, when suppuration is threatened; also in chronic suppurative processes where destruction of tissue is not great and the discharge is purulent, fetid and blood-streaked.

The mercurius iodides suggest themselves in catarrhal inflammations secondary to a pharyngitis, accompanied by their respective indications in that locality.

Mouth. - In the mind of the homeopathic practitioner, stomatitis and merc. vivus are always associated, the condition of the one so simulates the action of the other; it is indicated in the simple and ulcerative forms, when the gums are red, spongy and receding; there is constant drooling from the mouth, the breath has a fetid cadaverous odor.

Merc. cor. should be thought of in more violent conditions, with large aphthous patches, and the mouth greatly swollen and tender.

Throat.-Pharyngitis and tonsillitis are conditions in the treatment of which mercury is very often of great service; the glands are swollen and there is excessive salivation, causing a constant desire to swallow, giving rise to sharp and sticking pains. When ulceration is present it is superficial and tends to spread rapidly.

When the symptoms are so severe that swallowing is prevented and suffocation is threatened, merc. cor. is indicated.

Merc. prot. presents the following picture: the fauces are inflamed, especially the right side and right tonsil, the tongue is coated a thick yellow at the base, with clean tip and edges, the salivary glands are swollen.

The indications for biniodide resemble those of the protoiodide, but it affects the left side; there is more glandular enlargement, more headache, and higher fever.

The local lesion in diphtheria being the formation of a pseudomembrane (neither a catarrhal nor an ulcerative process), merc. vivus has little or no effect upon the disease, but its various preparations are of great value.

The indications for the iodides of mercury in the pharynx we have already considered.

Mercurius cyanatus is exceedingly valuable in the malignant types with extreme prostration; the membrane is dark and gangrenous.

Stomach. - In the therapeutics of diseases of the stomach and small intestines mercury plays a small part.

We must make an exception in the case of merc. cor., which is found useful in chronic gastric catarrh.

In the large intestine and rectum we find a striking contrast; it is here mercury plays its most important role and its effects are among the most brilliant things in the archives of medicine.

Diarrhoea.—The diarrhoea indicative of merc. vivus is preceded by violent and frequent urging, its passage is accompanied by great tenesmus, which continues after its evacuation. The stools contain much mucus, are slimy and of a dark color.

Merc. cor. is also a specific in dysentery; the conditions resemble merc. vivus greatly intensified. The tenesmus and excoriation are extreme; there is associated tenesmus of the bladder, with intense burning on urinating.

In hepatic disorders, with enlargement and induration of the liver, which is very sensitive to pressure, jaundice of the skin and clay-colored stools, we would select merc. vivus.

In peritonitis, merc. cor. takes the lead; it is indicated in the stage of effusion, with intense burning and cutting pains, vomiting and dysenteric stools.

Merc. vivus is curative in cystitis when there is tenderness over the bladder, with tenesmus upon urinating; the stream is small and the urine contains mucus, albumin and pus.

In aggravated forms of cystitis and parenchymatous nephritis merc. cor. is the more preferable selection; the symptoms are more intense, the urine is scant or suppressed.

Except in the nares, the mercurial preparations occupy a minor place as remedies for affections of the respiratory mucous membrane.

In the “running colds," with a thin, excoriating, offensive discharge, merc. vivus is very valuable.

If the condition becomes more violent, with more burning and soreness, with tendency to nosebleed, merc. cor. is indicated.

- When, however, the condition runs into the chronic form, involving the sinuses and eustachian tubes, one of the iodides come in.

The cough, which is cured by merc, vivus in laryngeal and bronchial difficulties, is a hard, dry, ringing one, usually associated with sore throat and coryża.

When the laryngitis is more severe, and there is a sensation as though a knife was cutting, with great oppression of the chest, merc. cor takes first place.

There is a variety of pneumonia, characterized by marked hepatic symptoms, the dry cough with the other general symptoms indicating mercury. The vivus proves a happy selection in such cases.

Hypersecretion of the sudoriferous glands, is an indication we find usually associated with every condition in which mercury is curative.

Superficial ulcers having a tendency to spread, with a foul, thin and excoriating discharge, would suggest the vivus; also eczematous lesions, which tend to suppurate.

When a syphilitic taint is present, giving rise to ulceration or eruptions, merc. prot. is the remedy.

Merc. vivus is beneficial in articular rheumatism, usually confined to one joint; the pains are tearing in character.

When the pains are muscular, only felt when lying down, never felt during active motion, they are met by the biniodide.

Mercury exerts a curative power over functional cardiac disorders.

We are reminded of merc, vivus when the heart's action is weak, with cardiac anxiety and palpitation on the slightest exertion.

Merc. cyanatus, in conditions of ulcerative endocarditis, rapid heart failure, especially in threatened paralysis due to zymotic diseases.

Mercury may be thought of in anemia when its typical cachexia is present.

Mercury is little adapted to the treatment of intermittent fever. But in the early stages of typhoid the vivus is useful when the hepatic symptoms are prominent, together with the other indications for the drug, which we have already studied.

Later in the disease merc. cyan. will be the choice, if there be extreme prostration of the vital forces, weak and rapid pulse, and the skin cold and moist.

In the exanthemata one of the mercurial preparations is often needed, especially in measles; their several indications we have already considered.

The curative power of mercury in neurotic disorders is rather disappointing, though it produces a typical and violent chorea and tremor, yet clinical experience has proven it to be of little value.

Specific Diseases-Syphilis. The therapeutic relationship between syphilis and mercury has long been a vexed one in both schools of medicine. From our knowledge of its physiological action, which is to cause inflammation, suppuration and liquefaction of tissue, we know there is nothing in its curative sphere to correspond to the indurated sore of the primary or the gummy infiltrations of the tertiary stages. It is otherwise in the secondary manifestations; here we find a close analogy between syphilitic pyrexia, chloro-anemia, exanthemata and mucous patches on the one hand and the action of mercury on the other.

The various preparations of the drug, by virtues of their acquired properties from combination with other agents, have a wider sphere, embracing all stages of disease.

Thus merc. cor. for the Hunterian chancre, with swelling and inflammation.

Merc. dulcis comes in for the copper-colored eruption, with much glandular enlargement.

When the bone pains are intense, accompanied by mucous patches, and ulcers in the mouth and pharynx, merc. prot. would be the choice.

For rapidly spreading ulceration, with splinter-like pains, mercurius nitrosus is indicated.

Chancroid.—The reasons which deter us from using merc. vivus for the Hunterian chancre are the very ones which direct us to its choice in the chancroid or suppurating bubo.

Gonorrhea.-In gonorrhea merc. vivus is indicated by a swollen penis, an acid muco-purulent discharge, intensified by cold.

If the degree of inflammation be very great, with an abundant greenish-colored discharge, causing great burning, mercurius corrosivus would take first place.

The combination of mercury with the halogens form therapeutic agents, the curative powers of which we are well aware; but of the remaining members of the group our homeopathic literature tells is little.

Should we not as loyal followers of Hahnemann thoroughly prove and study these "lesser lights?" By so doing perchance we may find among them gems capable of vying for therapeutic honors with the greatest of our polychrests.

Original Articles in Surgery.

CONDUCTED BY

SIDNEY F. Wilcox, M.D.

WILLIAM TOD HELMUTH, M.D., LL.D.

George W. ROBERTS, Ph.B., M.D.

AN UNUSUAL CASE OF ABDOMINAL HEMORRHAGE.*

By WILLIAM B. VAN LENNEP, A.M., M.D.,

Philadelphia, Pa.

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SEE by your secretary's announcement that but fifteen minutes

will be allowed for the reading of any paper, and I understand that the president intends to rigidly enforce this rule. It certainly would be in very bad taste for a guest of this society to presume upon your good nature by the slightest violation of these orders, and I, therefore, beg to assure you that my remarks will claim your indulgence at least on this fundamental requisite-brevity.

About a year ago I met with an intra-, or more correctly perhaps, retro-abdominal hemorrhage, which so closely simulated an ectopic gestation that I believe it deserves being placed upon record.

The history of the case is briefly as follows:

Mrs. , a patient of Dr. D. W. Shoemaker, of Philadelphia, thirty-six years old, had been twice pregnant, the last confinement six years previously, and had twice miscarried; she had never required treatment for intra-pelvic disease. Early in September, 1897, she fell from her wheel, the handle-bar striking and bruising her lower abdomen. Considerable pelvic tenderness resulted, but nothing of sufficient moment to confine her to bed; nor did the accident produce any especial prostration or fainting. (After the accident and subsequently she was continuously under the supervision of Dr. Shoemaker.) At about the same time she menstruated rather profusely; the October menses were missed, and three weeks later a metrorrhagia appeared, together with pains simulating abortion. The flow continued for ten days, when (Nov. 3) she suddenly went into a profound collapse. Slight recurrences of the latter took place two and four days later (Nov. 5 and 7), and a very severe one at the end of a week (Nov. 10). Aside from the symptoms of hemorrhage,

* Read before the Homeopathic Medical Society of the State of New York at Syracuse, Sept. 22, 1898.

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