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answers these requirements admirably. From reports from those using it, in the absence of nitrous oxide gas, Kelene is worthy of trial.

Various instruments have been devised for performing a divulsion of the sphincter muscles, but none compare with digital manipulation in accuracy of results obtained, and in the intelligent application of the proper amount of force requisite in each case that presents itself.

In describing the performance of divulsion, I can do no better than quote from article presented before this Society by Dr. T. L. Adams: "The patient having been placed in the Sims position and anæsthetized, with the index, middle and third fingers of each hand well lubricated, we commence our operation by the introduction of the index finger, making gentle traction. As we feel the relaxing effect of such manipulation, the middle and third fingers are successively introduced and the traction continued with necessary force, its direction being midway between the antero-posterior and the transverse diameters, thus avoiding the coccyz behind and the pubes in front, and the tuberosities of the ischia on either side, in this manner obtaining the greatest possible amount of space in which to work. The divulsion having been carried to a point at which we feel the resiliency of the muscle about to give way, we finally with the aid of the thumb on the cutaneous surface, evert the entire pile-bearing inch, when the operation is complete."

Our object is not to paralyze the muscle, but rather to destroy its irritability, leaving it abundantly able to perform its physiological functions.

The pain following divulsion is insignificant, and I have seen no cases in which hot water applied would not give prompt relief. An evacuation of the bowels can be had the following day with but slight discomfort and there is no return of the agonizing pain, if the divulsion has been well performed.

It has been said that to divulse a sphincter for a fissure is "like using a club to kill a mosquito." However true this statement may be, it is equally true that when a mosquito is hit with a club wielded by a properly applied and intelligent force, it is seldom capable of giving further annoyance, and a fissure seldom if ever returns to life after a divulsion has been properly performed.

In conclusion, and partly in recapitulation, in view of the extraordinary length of time persons suffer with this trouble, I would urge the early recognition of this disease, and, when suspected, that an inspection be insisted upon, in order to determine whether the trouble suspected exists, and, if found, that appropriate treatment be applied. I would urge that wherever possible, a divulsion instead of other treatment be instituted, as not only will the pain be promptly dissipated,

quick healing of the ulcer insured, but the irritability of the muscle, which may have been present before the fissure, will be destroyed, and by so doing the obstruction to the circulation, caused by sphincteric irritability will be relieved, thus tending to prevent the formation of hemorrhoids. In addition, any reflex symptoms caused by the sphincterismus, will be relieved.

SYMPTOM CHASING, WITH REMARKS AND ILLUSTRATIONS
IN PASSING.

By J. Arthur Bullard, M. D., Wilkesbarre, Pa.

There is no study that will give a homoeopathic doctor (that rare bird) such wholesome delight as that which results from hunting down, cornering and bagging of a "characteristic," well-groomed and authenticated, many times proven drug symptom, and marrying it on the spot to some elusive, bashful, morbid, retiring disease symptom brought to our attention by some hopeless and forsaken somebody, who has been pronounced incurable and perhaps doomed to perish, with possibly the day and date fixed.

Speak of the joys of the hunter, sing if you will of the glories of automobiling or yachting. Pouf! there is nothing in any of them when put side by side with the exhilaration we "symptom chasers" experience after giving life and years of health to one of these poor unfortunates as a result of an hour or more spent chasing through the pages of a good materia medica, where by comparing drug and disease symptoms, we have made such results possible.

What if our books are faulty and verbose; what if we do have to discard and ignore many things stated to be true yet found to be wanting; what if we do get sidetracked almost hopelessly at times. Start again! Keep up courage! The golden grain of fact is there for every one who seeks earnestly for it; failure is often the mother of success, if we only keep doing and working; and we must never for one moment, if we wish to succeed, have the slightest doubt of the wisdom of Providence or the healing powers of homoeopathy.

Every successful practitioner of our school who has practiced for as many years as I have, must have perforce, by this time either largely have made his own materia medica, or drifted so far away from his Alma Mater and her teachings as to have become an indeterminate and extremely yellow prescriber, who for commercial reasons only calls himself a Homœopath.

Now there is no excuse for this backsliding, except indolence or perhaps humility; indolence because he is too lazy to study, humility

because our cures are so quietly beautiful that they are made without the flourish of banners and the blare of trumpets; the maker consequently escapes the notoriety that the man of blood and bile has thrust upon him by an admiring populace, and you all know how extremely hard it is for some to exist without notoriety.

To those, however, who are disposed to criticize our materia medica, I wish, while admitting its defects, to go upon record as saying and believing that if there had not been a drug proven, nor a single addition made to this same old list of remedies of seventy years ago or more; if we had nothing but the polychrests and with no better knowledge of drugs than did the founders of our school, we would still by means of possession of these old, time-tried and partially proven drugs, be enabled to take a position second to none as a school fitted for the cure of disease.

I tell you, fellow doctors, I care not where you stand, the Homoopathy of Hahnemann stands today, stood yesterday, and will stand tomorrow as the foundation BED ROCK supporting the true temple of healing, and no matter how we squirm, no matter how we labor to manufacture strange Gods, no matter how we hunt for other easier paths and seek short cuts across fields we should go around, no matter what cunning tricks of surgery and necromancy of chemistry, and most wondrous theorizing we indulge in at times—notwithstanding all this, I say, if we have practiced enough Homœopathy to get a realizing sense of what it really means, we will yet find ourselves harking back to the old bed rock HOMOEOPATHY, that rock of ages immortalized by Samuel Hahnemann, whose every cleft is a polychrest, whose every polychrest is a life saver, and every life saved a glorious advertisement to the honor of our school of medicine.

"Follow the Flag" and live up to the spirit of strict individualization. Study your Materia Medica.

In this latter day of Homœopathy, and especially among the graduates of recent years, there is, I regret to notice, a growing tendency to ridicule the men of our school of medicine who study and strive to prescribe according to the more strict homœopathic law. These newcomers sneer sarcastically at what they are pleased to designate "symptom chasing" and regard "Keynotes" and "Characteristics" as something decidedly unnecessary to the making of a successful prescription.

Now, as a matter of fact, all the symptoms we can elicit, subjective or objective, in a given case, should be and I may say are the only correct guides in deciding upon the homeopathic remedy and the "Characteristic" or "peculiar" symptoms, are the "keynotes" to the

complete harmony of the remedy and the patient; without this harmony, we have not a homœopathic prescription.

If, however, we can find this harmonious comparison in its fullness, a single dose of the thus selected remedy given preferably in high potency will cure our patient. Some one has said, and I believe truly, that there is one "characteristic" or peculiar feature belonging to every one of our seventy millions of people which is for each one a distinguishing mark from all the other sixty-nine millions nine hundred and ninety-nine thousand nine hundred and ninety-nine; now not one of these millions can be ignored, nor will any one of them be complete without his or her "characteristics" or peculiar symptoms; so it is with the medicinal substances composing our Materia Medica, not one drug symptom can be dispensed with, nor can any one of their "characteristics" be laid aside as worthless, in justice to the patient or the remedy.

The symptoms common to a given disease and which are necessary in order to determine its name so as to make a correct diagnosis are of much less importance in deciding the choice of a medicine for the cure of said disease, than are the symptoms which are peculiar to that particular patient who has it.

Take a case illustrative of what I claim in the first part of this hurriedly written but no less earnest paper in favor of "symptom chasing."

In the early days of September, 1903, there came to me a man aged thirty, thin and evidently poorly nourished, health fairly good for years until recently; bad family history, including cancer and consumption, a man of active habits; is a user of both coffee and tobacco; has been addicted to the use of laxatives for as long as he can recollect; is temperate so far as intoxicants are concerned.

His present history is that of more or less pain and soreness in rectum for months; pain throbbing, smarting and burning in character; would often have passages containing quantities of jelly-like mucus; was suddenly attacked with severe pain in rectum, so severe in fact as to compel him to sit down when it came on, no matter where he happened to be; he had little control over the sphincter at these times, so little that when a strong desire was felt for stool, he sometimes soiled himself before he could reach a water closet.

Examination through an extremely irritable and painful muscle disclosed among other things, a rectal ulcer and a fissure, the lower portion of which could be distinguished when the nates were well separated.

On questioning him carefully I learned that he lived mostly upon

meat, of which he was very fond; that he had excessive dryness of the scalp and skin generally; that his appetite was very poor for breakfast, and he frequently went without; that he was obliged to pass water very often, and at times it was difficult to retain; that these symptoms were always worse during the fore part of the night, but he was withal a sound sleeper; he had dark circles under his eyes and he complained of feeling bruised.

Now here was surely a case calling for surgical treatment, but how much more loudly it called for a remedy that was pictured in letters a foot long all over his poor, emaciated body. How they came to me these peculiar "characteristic" symptoms; the striking and somewhat uncommon symptoms, the "keynote" symptoms; and what did they call for? Why, ALOE, and he received one dose of Aloe cc on his dirty tongue and two weeks' placebos. Improvement was almost immediate and continued without interruption until the latter part of February, when there seemed to be somewhat of a standstill. I then gave him one dose of Alo 8m, with blank tablets to follow, and on the first of the present month he reports and declares himself entirely well and, weighed by my office scales, is twenty-two pounds heavier than when he began treatment. An examination shows to all appearances a perfectly healthy rectum.

Just one more case of recent interest,—a woman aged eighty-four, had always been well, was taken with lagrippe, which ran its usual course, the patient responding beautifully to Allium cepa and Bryonia. After the acute symptoms had left her, however, there developed a weakness and debility to which she had ever before been a strangera debility apparently due entirely to weak heart, its action being very slow and labored. As I was seeing other patients in the same house, I contented myself by thinking that in so aged a person a prescription on general principles was all that was necessary, so for this cardiac weakness which, by the way, was most marked in the early morning, I prescribed Nux Vom, tincture, two drop doses before meals in a little water. To my surprise there was no improvement whatever, and if anything the patient grew more and more debilitated and discouraged.

On being asked if something more could not be done to relieve her, I took the case more carefully in hand, as, indeed, I should have done in the initial prescription, and after a little "Symptom Chasing" I learned that there was a tough, stringy, ropy mucous accumulation in head and throat which necessitated a very hard, tiresome cleaning out time every morning.

The patient described this discharge as "strings that were very hard to get out." Now here was a keynote symptom, and I at once

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