HOMEOPATHIC PRESCRIBING.

BY M. W. VAN DENBURG, A.M., M.D.
Mount Vernon, N. Y.

DOCTORS are not more free from the force of habit than

On the contrary, they are

among the foremost of that class who always do as they have done before on similar occasions because it is so much easier than to think the thing out again from the beginning. This "routine prescribing" has been both the practice and the theory of the "regular" school from time immemorial. "I want you to learn to prescribe on general principles," was a pet phrase with which the honored professor of Materia Medica in the "regular" school from which I was graduated, used to begin his lecture on "The Art of Prescribing."

It is needless to add that this is the exact antithesis of a "truly homœopathic prescription." But all homœopaths do not omit the habit-method of prescribing by any manner of means. A homoeopath who has rounded out his studies in Paris, Berlin or Vienna will, from the nature of his associations, absorb more or less of the routine and "on-general-principles" method.

The homœopath who believes in getting along with as little work as possible will also adopt the same plan. Aconite for catarrhal cold; mercurius vivus for diarrhea; ipecac for vomiting; colocynth for colic; rhus for eczema; pulsatilla for indigestion and delayed menses; calcarea carb, for infantile vomiting; belladonna for headache; bryonia for rheumatism; quinine for malaria; hepar. sulph. for abscess; squills for cough. Now these are all good prescriptions in the cases to which they are applicable. But there are a hundred and one cases where they do not ap

ply.

However, the doctor will have some good cures to his credit where they do apply, and these will overbalance his failures in "obscure cases," especially if he is well versed in the fads of the day; such as antisepsis, hygiene, diet and urinary analysis. If in addition he can make, or has judiciously placed for him, any of the numerous microscopic tests, and is himself good at physical diagnosis, he will get along well, or even remarkably well. Of such a course it may be said all these things he ought to have done, and not to have left the other and most essential thing undone.

I say most essential. Why? Because nine-tenths of the doc

tor's practice will lie in the field of drug prescribing if he makes the best use of the means he possesses to relieve sickness. Homœopathic prescribing, if it means anything, requires the individualizing of each case of sickness. It means differentiation from the general disease concept by a careful observation of all the phenomena that in any way show a departure from the state of health. It means a close study of the resemblances and differences between the case in hand and other concrete cases where successful prescriptions have been made. It means all the measures the most thorough "regular" would take in treating the case, plus a more intimate knowledge of drugs and their physiological effects than he has, or can have; for he has not the same careful, accurate and extended drug-histories for reference.

We need not echo the greatness of the past masters of druggiving. We have all they had and much more. We should do better than they did, for we have better tools and more of them. It goes without saying that individualizing the case will do little good unless the prescriber also individualizes his drugs. Here we have an immense advantage over the "regular." It is possible for the homœopath to prescribe a drug in a given case, say of pneumonia, that he has never used before in treating that disease, nor has known to be used by others; and furthermore, to give it with strong assurance that he will get good and indubitable effects from its use. The only requisite to this end is that the drug shall, in its marked, leading and peculiar manifestations, closely resemble the marked, leading and peculiar manifestations of the disease. Herein lies the art of prescribing. And its foundation stone is good discrimination, but its superstructure is workceaseless, energetic work. No shirk, no dullard, no skin-the-surface-quickly student of drug action can hope to be successful except by good luck.

In the place of routine, of fixed habits in treatment of diseases of the same genus, the conscientious drug-prescriber will have clear, fixed conceptions of drug-action confirmed by experi ence. These well-defined drug pictures will not need revision when once completed; they will stand as ready tools at the hand of the skilled workman, with which he will work wonders and accomplish seeming impossibilities

Instead of standing helplessly by when he has used all the negative means of "removing the cause," of improving the hygiene and diet, he will add to these a positive and effective force, the power of well selected drug-action.

Editorial Department.

EUGENE H. PORTER, A. M., M. D.,

ASSOCIATES:

EDITOR.

GEORGE F. LAIDLAW, M. D., WALTER SANDS MILLS, M. D.

Contributions, Exchanges, Books for Review and all other Communications Relating to the Editorial Department of the NORTH AMERICAN should be addressed to the Editor, 181 W. 73d Street. It is understood that manuscripts sent for consideration have not been previously published, and that after notice of acceptance has been given will not appear elsewhere except in abstract and with credit to the NOFTH AMERICAN. All reject manuscripts will be returned to writers. No anonymous or discourteous communications will be printed. The editor is not responsible for the views of contributors.

FETAL, CONGENITAL AND INFANTILE TYPHOID.

MORSE, of the Harvard Medical School, read an interesting

paper with the above title before the New York Academy of Medicine a short time ago. Abortion occurs in from 50 to 70 per cent. of the cases of typhoid in pregnant women. Most of the cases are probably due to death of the fetus. Death of the fetus, in turn, being due to the high temperature, or, more likely, to intra-uterine typhoid.

In considering the question of intra-uterine typhoid infection, Morse has collected from the literature only those cases about which there seems to be no question. Fifteen were proven by autopsy and cultures, one by autopsy and an increasing serum reaction. Ten were born dead, six died in from five minutes to three weeks after birth. These cases prove, without question, that the typhoid bacillus can pass from the mother to the fetus through the placenta. None showed any special symptoms beyond fever, but simply did not thrive and died. Morse says it seems reasonable to attribute their death to typhoid, although prematurity may have played a part.

Morse believes that the fetus most often dies in utero as the result of the typhoid infection. If born alive it usually succumbs to an acute cachexia without special characteristics. If it lives longer, it may develop some of the classic symptoms of extra-uterine typhoid and may possibly survive the disease.

In twelve of the cases the organs were carefully examined. In

four the spleen was somewhat enlarged; in two of these it was slightly soft, and in one congested. In one there were a few prominent follicles in the lower ileum, but they did not contain bacilli, and in one which lived about three weeks there were healed ulcers and enlarged mesenteric glands. Some changes were found in other organs, but none regularly. Morse sums up this part of the subject by saying: "It is evident, therefore, that the lesions of the intestine and mesenteric glands so characteristic of typhoid in extra-uterine life do not occur in intra-uterine typhoid unless the patient survives some time after birth. These organs are almost invariably normal. The liver and spleen are sometimes enlarged, however, and hemorrhages may take place into different organs."

The differences in the pathology of extra- and intra-uterine typhoid Morse considers as due to the difference in the method of infection, and to the fact that the intestine is not functionating in fetal life. He finishes this part of his paper thus:

The following conclusions regarding fetal and congenital typhoid seem justified:

1. The typhoid bacillus can transverse the abnormal, and possibly the normal, placenta from mother to fetus. Other organisms may also pass in the same way.

2. Infection of the fetus results. Because of the direct entrance of the bacilli into the circulation, intra-uterine typhoid is from the first a general septicemia. For this reason, and probably also because the intestines are not functionating, the classical lesions of extra-uterine typhoid are wanting. 3. The fetus usually dies in utero or at birth as the result of typhoid infection.

4. It may be born alive, but feeble and suffering from the infection. If so, death usually occurs in a few days without definite symptoms.

5. If it lives longer it may develop some of the classical symptoms of extra-uterine typhoid infection and at death may show some of its pathological lesions. Death is the usual result, but certain imperfectly reported cases suggest, if they do not prove, that recovery may take place.

6. It is possible that the fetus may pass through the infection in utero and be born alive and well. There is, however, no proof that this happens. 7. Infection does not always occur. The pregnant woman does not necessarily transmit the disease to her child.

In speaking of infantile typhoid, Morse states that no one now doubts its existence. From the available literature he is forced to the conclusion, either that typhoid is relatively uncommon in the first two years of life; or that it is not recognized when it does occur. He is inclined to the former opinion.