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Cleveland Medical and Surgical Reporter.

Contributions are solicited upon any subject connected with the practice of medicine or the allied sciences, and the only restrictions placed upon them are that they shall be free from personalities and given to the REPORTER exclusively. The Editor of the REPORTER is not responsible for any opinion expressed by contributors.

Vol. XII.

NOVEMBER, 1904.

No. 11.

Original Articles.

POTENTIZED REMEDIES ILLUSTRATED BY FACTS.

By W. H. Kirkland, M. D., Massillon, Ohio. The Therapeutics of Homeopathy are based on the results of the exhibition of potentized remedies of 30th and higher attenuations. Almost without exception our authors have been demonstrators of the efficiency of high potencies, and if we accept as facts their statements as to results, or expect to obtain like results from the remedies they used, according to the indications they have given, we must use them in the attenuations with which they accomplished such cures as have made them famous for efficiency.

The founder of the Law of Similars sought long for the proper degree of dynamic force to most successfully cope with disease in all of its forms and finally concluded that the 30th potency was the most generally efficient. Also that it was not always sufficient in dynamics to meet every case; that still higher potencies were sometimes necessary to secure perfected results. Jahr's Forty Years' Practice, is a most successful exhibit of potency results. Probably no work by any of our authors has been more studied and the prescribed indications followed than the 300 page work of this author. I have always found it a work to safely tie to, when his suggestion of the 30th potency was followed. Bell in his Brochure gives preference to the 200th potencies. All of the earlier authors used and advocated the same. That there is efficiency in lower potencies goes without saying. I use as many below the 30th as above, but candidly assert that the finest effects I have ever obtained were with 30ths, 200ths and higher. The most remarkable results of a potency, was the complete elimination of two pounds of Hypertrophied Muscular Tissue from the walls of my own stomach in 1888 by the use of the 30th potency of Secale. The quickest result I secured from any remedy in any potency was in a case of eczema on the hands of twenty-five years' duration and almost continuous treatment. The patient said he had tried everything he had ever heard of with no benefit. I gave him a vial of pellets with directions to take a dose every morning. The principal indication being:“After retiring the itching, burning, stinging and smarting would be so violent that nothing short of hurting the hands by tearing them with the nails would stop the suffering or permit of sleep." The man failed to report for two months, so I presumed the pellets had been a failure. When the report did come it was to the point: “Doctor, the very first dose of that medicine killed that eczema so dead that it never itched afterward." I gave him the 55 M. of sulphur (I have some of the same kind left, and it has done me good service in other cases, not all of them cases of eczema). In Rheumatism I usually exhibit the 30th and higher and have obtained more satisfactory results than with the lower. In as severe a case of Relapsing Typhoid as I ever treated, the 30th of Stram. carried the patient to recovery. The shade of difference between the indications for Stram. and Heyos. was so slight that the difference in the delirious profanity was the determining factor as to the choice between the two.

A puzzling case of incipient paralysis was never successfully prescribed for until the fact of the patient, having used her right hand very strenuously for several days polishing the outside of a sea shell, gave the key to the remedy. Rhus tox, cc for the affliction of the hand and arm improved the case a little, while Rhus 1.0M completely relieved the condition. The cerebral symptoms that seemed to antedate the Rhus condition from overexertion, and that pointed plainly to Hemiplegia, were improved a little by Arsen. cc and completely relieved by Arsen. 40M, with a little help from Bell. of same potency. A case of complete Paralysis of the left side; with strict regulation of the diet, and the indicated use of Arsen., Bell., Rhus, always in the 200th, gave the patient twenty-five months of life where three could not be reasonably expected.

There is a safe rule in the selection of the potency: The more certain you are that the remedy is the right one the higher you can go for the potency. I believe the rule to be infallible. I do not always feel so certain as to my judgment in selection. Whether the converse is true that the less certain you are that you have the right remedy, the lower potency you may use, I am not prepared to affirm. While I think the greater efficiency is usually with the potencies, I can gladly testify to the virtues of the lower attenuations.

In 1875 I saw an article in a Dental Journal extolling the virtue of crude or pure Salycilic acid for destroying the odor in decaying teeth. I had never seen the drug, but reasoned that if it would destroy the effects of fermentation in the cavity of an offensive tooth, there *“must be something in it.” I procured some of the remedy, prepared the 1st, 2nd, and 3rd triturations and waited for my case. It was not long in putting in an appearance. A victim of the most aggravating form of Fermentative Dyspepsia called for relief. The condition was such that no form of food, solid or liquid, could remain in the stomach five minutes without the teeth being set on edge by the intensely sour, acrid regurgitations that always followed. Even a little water would become sour. After carefully noting the effect of the remedy, I found that the 2X of acid Sal. gave better results than the 3X, or even the 1X. The same potency, a few tablets in an ounce of hot water, will relieve a cramp of the stomach due to acidity almost as quickly as that dose of Sulphur settled the case of Eczema.

In a very few cases I have had excellent results from Rhus 2X, : also in “Stomach Trouble.” A desperate case of dropsy, due to an affected heart by Rheumatism in a magnificent specimen of mastiff, was benefited more by Rhus, middle and low potencies, than any other remedy exhibited.

While many physicians doubtless can get better results from low potencies than I can from the high, I am fully persuaded that they could do very much better work in many of their cases if higher potencies were used.

SOME CONSIDERATIONS UPON DILATATION OF THE STOMACH.

By W. B. Hinsdale, M. D., Ann Arbor, Mich. If we were to pass in review, even briefly, the several sub-divisions of the subject as classification, definition, etiology, pathology, symptomatology, diagnosis, prognosis and treatment, more time would be consumed and forbearance exercised than one should presume to ask. Rather than undertake a systematic survey, I am disposed to make what may be called some "miscellaneous remarks.” Before one can proceed, with any conjecture as to outcome, upon the conduct of a given case, he must form some idea of the acting cause, the probability of controlling it and of repairing the damage. A dilated stomach may or may not be relieved or cured according to whether the cause is removeable and the function restorable.

A stomach which, as a usual thing, does not empty itself from supper to breakfast is probably dilated or likely to become so soon.

There is not a very accurate measure of capacity for stomachs. Like - other features of the body, the inner organs vary in size with individuals. Usually a stomach is assumed to be dilated if it has been irritable for some time and is found to contain more than two quarts upon

measurement. The time occupied by digestion and in emptying itself is the proper measure of a stomach's activity or insufficiency. The term dilatation, if applied accurately, means enlargement, of course. In medicine we frequently employ words in peculiar senses owing to the fact, usually, that at first they were considered descriptive of conditions supposed to be existing, but afterwards found to be different from the original conception.

A stomach that is not empty any time during the twenty-four hous is probably laboring against an obstruction or is embarrassed by what we may call primary food stagnation. No matter what the measured cubic capacity of such a stomach may be, it has lost its tone. Its. motile and contractile power is impaired. Of course the motility and contractility of a stomach resides in its muscular fibres. When these fibres become exhausted their stretching and relaxation is imminent and, once occurring, dilatation has taken place in the physiological sense. The muscles of the stomach may become temporarily exhausted and relaxed or the exhaustion and dilatation may become continuous. An engorgement with a great excess of heavy food or brew-house liquors may temporarily fatigue the gastric musculature and put it. upon the stretch. A resisting pylorus pinched down by stenosis, stiffened by cicatrix or plugged by tumor, may convert a stomach into a mere reservoir of swallowed food with slight ability to empty itself except by back flow. The muscular walls may relax from their own exhaustion without any special mechanical cause or from the intrinsic gastric insufficiency and irritation.

It is important to determine whether a stomach that has not the sufficiency to empty itself within the physiological period is atonic or laboring to overcome a pyloric resistance. The authorities upon the subject seem to give greater prominence to pyloric hindrance, if we may use the term, than to intrinsic conditions of the gastric sack itself. Numerically, the pyloric cases are the greater and perhaps becoming more so as cancer of the pylorus, the cause of many of them, is very common and apparently on the increase. In case the stomach attempts to overcome a closure of the pylorus and dilates, it is only a. secondary matter and is symptomatic. It will get worse or better, according as the obstruction increases or diminishes; relief depends: upon removing the obstruction. If it is cancerous, it is purely surgical, the dilatation will be progressive and is only one symptom of the complex of what, sooner or later, becomes virtually a constitutional disease.

It would be interesting to consider the several causes of obstruction to overcome which the stomach goes through the same series of events that the heart does in case of a leaky valve. If the development of the conditions be not too rapid, there will be a period of noticeable muscular hypertrophy and then failure of compensation with loss of elasticity and contractility of the muscle fibres, associated with degeneration. To this feature of the subject I can not at this time make further reference, unless indirectly, as its treatment is likely to involve surgical problems that I am not prepared to discuss. I shall confine my remarks to gastric relaxation due to causes not residing in or beyond the pylorus.

The lack of tonicity of peristalsis can be measured by degrees. "The first degree would be myasthenia or atony of the muscularis without absolute retention but delay in the expulsion of the ingesta. It remains too long in the stomach but is finally pushed on into the intestines.

As the defect in nutrition or the enervation of the muscular layer advances, the second stage, that of almost constant presence of food in the stomach intervenes. In some cases the viscus, not being sufficient to the task of discharging its contents normally, is never so nearly empty as after vomiting. Sub-tonicity permits distension, distension permits dilatation. Accumulated food in the stomach, by its weight as well as by its mass, operates with gas, the product of fermentation, as constant mechanical dilators to maintain and advance the weakening of the walls.

The primary sub-tonicity may be due to several dynamic causes. Any debilitating disease may give the start. Muscular fibres become diseased and inelastic in all conditions in which blood impoverishment is marked. Tuberculosis and chlorosis are examples. Diabetics, on account of the superabundance of food and chronic gastritis, are apt to have enlarged stomachs. The lack of nerve power and the associated general debility of neurasthenics are very liable to entail a chronic dilatation upon the sufferer, even after the nerve irritability has subsided. Convalescents from acute fevers, especially typhoid, may have as a sequel a myasthenia tending towards and sometimes attaining to muscular weakness.

There is one acute disease of which I wish to speak in particular, and that is influenza. If influenza, as it has appeared for the past ten or more years, has any distinguishing feature it is general weakness, amounting almost to paresis. The effects of such weakness are once in a while lasting and contribute to chronic glandular and muscular insufficiency. From an attack of such disease to the final gastric dilatation may be many years. Sometimes varying stages of improvement and decline, with the latter in ascendency, lead on slowly from

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