experiments made with natrum mur. as well as the great majority of clinical results obtained therewith, speak decisively and distinctly for these preparations." "Several of our most cautious provers have obtained from them characteristic symptoms."

By the same Provers Union ten experiments were made in proving bryonia, with dilutions, from the first decimal to the 203rd. Two provers got unequivocal symptoms from the tenth and thirtieth dilutions. Forty-one days were allowed to elapse after proving with the tincture, before the 203rd dilution was taken, yet this appeared to produce decided symptoms. A later proving with the 203rd developed the same. Other provers have employed higher agencies to develop the pathogenesis of drugs. Dr. Fincke on January 19th, 1859, made a proving of spongia tosta with the thirtieth potency on a highly sensitive lady, 60 years of age, producing with hoarseness, the characteristic constrictive spasm of the larynx in paroxysms starting her out of sleep.

Dr. Fincke has also developed the characteristic symptoms of several other powerful medicinal agents, including lachesis, in verv high potencies.

Because of the heightened sensitiveness and susceptibility of the diseased body, and of the specially affected organs, the action of the requisite dose is most penetrating and pervading.

Hahnemann says, "the higher we carry the attenuation accompanied by dynamization (by succussion), with so much the more rapid and penetrating action does the preparation seem to affect the vital force, and to alter the health; with but slight diminution of strength, even when this operation is carried very far, when, for instance, instead of the ordinary dilution, the thirtieth, which is mostly sufficient, it is carried to the sixtieth, the 150th, the 300th, or even higher."

During the twenty years that I have used the higher potencies instead of, as during the earlier years of my practice, the low, the 200th and higher potencies have been more prompt and rapid, either to relieve pain, sometimes within five or ten minutes, or, after producing a primary aggravation, to be followed by a continuous improvement or cure.

The first essential is the homeopathic selection, the second, administration of the dose adapted to the sensibility and susceptibility of the patient, the third sine qua none is its repetition or omission, according to the degree and duration of its effect.

By his process of comminution and dilution, thereby reducing the dose for the purpose of preventing or moderating aggravated effects of the drug, Hahnemann discovered the progressive evolution of dynamic, curative power under the scientific principles of the infinite divisibility of matter and the indestructibility of force.

It was after twenty years of Hahnemann's experiment and studious thought that he promulgated the thirtieth potency. Boenninghausen, after seven years devoted to experiments with the high potencies, at first upon animals, and afterwards, when encouraged by the results, very carefully upon his patients, finally became convinced of the superiority of the higher over the lower, and for

twenty-two years, up to the time of his death, used only the high, the 200th exclusively in all cases. In 1862 he informed Dr. Dunham that he had just begun the 112th volume of his Clinical Record. Of these it is safe to estimate, says Dunham, that at least eighty vollumes contain records of cases treated almost exclusively with the high potencies. He adhered closely to Hahnemann's practical rules. He was careful never to repeat the dose until the effects of that already given were exhausted. He reprobated the practice of combining two or more remedies in the same prescription. It has often been observed that cures are effected or completed by transition from a lower to a higher potency; rarely, though with exceptions, from a higher to a lower. During the years 1850 to 1859 very careful experiments in the treatment of pneumonia were made in the Leopoldstadt Hospital. These nine years were divided into periods of three years each; during the first, in which the genius. epidemicus was found to indicate the greatest severity and spread of the pneumonia, all cases were treated with the thirtieth decimal potency; during the second period, least severe and least favorable. to its spread, all cases received the sixth decimal potency, and during the third period, the fifteenth decimal. The results showed an average duration of the disease in fifty-five cases for the thirtieth potency, of eleven and three-tenths days; with the sixth decimal in thirty-one cases, nineteen and five-tenths days each; in fifty-four cases with the fifteenth decimal, an average duration of fourteen and six-tenths days each. The total number was 107, and each was made the subject of careful investigation to eliminate every source of fallacy. The experimenters were not radicals. Dr. Eidherr, editor of the Oesterreichische Zeitschrift for 1862, who publishes the analytical report, bears testimony that while the thirtieth dilution was the standard used in the hospital, Dr. Wurmb frequently expressed his belief that the statistics would decide in favor of the lower dilutions; Dr. Eidherr's analysis shows that the action of the thirtieth decimal in so acute and dangerous a disease as pne11monia was more certain and rapid than that of the fifteenth or sixth.

Far from being too small, not infrequently the primary aggravations of the similar symptoms often occur from taking the high potencies; to be followed by improvement or cure, if allowed to act without interruption. A person affected with an acute inflammation, a carbuncle, an erysipelas or a fever, may suffer for a period, aggravation from the first high-potential dose of the remedy; and more prolonged and increased constitutional disturbance, pain and local aggravation if the dose be too soon repeated; and disaster will be averted if we wait for the first even slight indications of normal vital reaction and improvement; and still wait during as many hours and days as this improvement continues; thus will we often cure a fever, a diphtheria, a carbuncle, or an erysipelas, an impetiginous eczema, or a psoriasis inveterata, by a single dose of the indicated remedy, or, at most, two or three, at very long intervals.

E will assume that no gynecological surgeon, actuated by his

WE

sible loss of structure, will knowingly remove any part of the reproductive organs that can be saved, or that offers even a remote prospect of being restored to health. Ablative surgery is at the best an opprobrium of the healing art; an admission that we can cure, only by ridding the system of a diseased part, but at the same time it is a frank acknowledgment of the limits of our art, an attempt to accomplish by mechanical means that which dynamic forces cannot bring about through metabolism.

Concerning the ovaries and their removal, little doubt exists that there has been unnecessary mutilation. In the early days of oophorectomy, when the germinal glands were looked upon as the focus of a large proportion of gynecological diseases, over zeal frequently led to a blurring of differential diagnostic lines, and healthy ovaries were sacrificed, upon the belief that in some obscure manner they were the cause of the derangement. As might be expected, such operations resulted in failure, the sufferer receiving no benefit from the ordeal through which she had passed; in some instances her condition was even aggravated.

With more accurate diagnosis, and a better proportioning of the causes that go to the making up of the essentials of the female organism, such experiences are happily becoming less frequent. The gynecological surgeon of to-day, if he opens the abdomen under the impression that an ovary is to be removed, and finds, through the more certain diagnostic means of sight and touch thus furnished, that he is mistaken, and must look elsewhere for the pathological cause of suffering, has the courage to close the incision, with at least the comforting assurance that an exploratory operation has eliminated the pelvic organs from among possible etiological factors.

Slightly different problems, but in some respects less easy to solve, are encountered when we contemplate the wisdom of removing "the other ovary." That is to say, one ovary is beyond doubt diseased the relation of this to the seat of pain will be discussed later and the necessity of its removal admits of no question; but "the other ovary" is apparently a healthy organ, or at all events it does not present macroscopic lesions sufficiently pronounced to interfere with its functional activity. What shall be done with such an ovary?

The propriety of including it in the ablation would upon these premises alone not be a matter for discussion, but would be a question requiring only negative consideration; any other treatment being an unnecessary and unjustifiable mutilation. It does not seem wise, however, or in accordance with the best conservative surgery, always to leave, even the comparatively healthy 'other ovary' in the pelvis, for clinical records show, that frequently a cure is not effected until this also has been removed.

Our chief concern when confronted with this problem will be, how to determine the general conditions, and the local state, that not only warrant us in removing "the other ovary," but make it obligatory upon us as conservative surgeons, to include it in our operative technique.

Approaching this subject for discussion, we will keep before us, as of paramount importance in helping to a decision, the fact, that an entirely healthy ovary cannot be the source of either local or reflex disturbances, and that when such conditions are traceable to the ovaries, they are of necessity associated with a more or less definite pathology in the reproductive glands. We, therefore, will dismiss as entirely untenable the proposition that a healthy ovary, or one that is functionating normally, can in any manner give rise to conditions. that will demand its removal, and accept as a corollary the proposition, that a gland diseased, either histologically or functionally, must sooner or later express itself in local or remote disturbances.

So expressed, this statement seems almost too trite for repetition; but it is not many years ago that surgeons would propose a double oophorectomy in some cases of neurasthenia, believing that the patient's health would be improved by arresting the nervous and physical drain that attend the recurring menstrual function, without defending the operation upon the ground that the ovaries were pathological centers, and as such the cause of the malady. But while this treatment of obscure gynecological cases is now obsolete, we must still guard against too much generalizing in diagnosing and

treating the diseases of women. We will do well to remember that women have other organs than the ovaries connected with their reproductive system, that are capable of giving rise to local and reflex manifestations of unhealth, and no conditions, however closely they may appear to be associated with the genital glands, or their function, can be put forward as reasons for their removal, unless a positive pathology can be demonstrated, or reasonably inferred.

Another fact that will bear heavily upon the treatment of "the other ovary," and will cause us to exercise every possible means to determine the state of the gland before removing it, is that by its removal we bring about certain changes in the system, that may affect its metabolism to such a degree as to result in permanent and lasting harm. I do not here refer to unsexing the woman. This sentimental cry has little to substantiate it, for once the reproductive system is developed, and the nervous system become adapted to its functionating, removal of the germinal glands can produce, and in fact does cause, little if any alteration in the matured psychic state. The nervous system still retains its racial reproductive instinct. Removal of the ovaries before maturity-puberty-, before they have established a recognition of their function in the nervous system, may pervert the female sexual characteristics, but when this is done late in life, it is not liable to be followed by any such changes.

I have in mind the essential glandular function of the ovaries, glandular in the broadest sense, whereby these organs elaborate within their structures, and give out into the system, something, a secretion, that assists in maintaining health, and is necessary to its continuance. The withdrawal of this secretion is of more import than a possible unsexing of the individual, and follows the surgically induced menopause, rather than the natural functionalfolding-up of the reproductive system, for there is no reason to believe that the function of secretion ceases with the cessation of ovulation. It probably continues, at least for a certain length of time after the germ cells become inactive, and then it may be, gradually fails, the system thus by gradations accustoming itself to the withdrawal.

Opposed to the spirit of conservatism that would be slow to recognize sufficient disease in "the other ovary" to demand its removal, some rather stubborn clinical data confront us. In many of the cases of single oophorectomy done for the relief of pelvic pain in which "the other ovary" has not seemed to present sufficient pathology to justify total ablation, the results have been disappointing, and within a variable length of time it has been found necessary