stronger, took no more medicine and in six weeks from the time she was operated she left the hospital a well woman with no trace of albumin in the urine. Here was a case hopeless, almost, cured by the use of medicines alone, illustrating the deep action of medicine in acute cases, and demonstrating the necessity of continuing a drug for some time when it arrests the malady even though improvement is not at once noted.

The second case which I will use for the purpose of illustrating my point is one classed under the general heading of scarlet fever:

A little fellow, eight years of age, was attacked with this very common ailment and in two days after the onset developed marked symptoms of systemic poisoning and an alarming malignant local condition in the throat; the fever was high, the eruption well developed and an extensive false membrane covered the tonsils, the throat and extended to the nose.

For the reason that some years previous an older brother of the child suffering from the same disease had died from the malady while under the treatment of an old school physician and the ordinary methods used in such cases, the parents determined that I should handle the case to the end, let the result be as it would; the older child had died from total suppression of the urine and I knew the same danger threatened the case in hand.

It is my practice not to use antitoxines in cases where the kidneys are defective, hence I decided here that its use was out of the question and although seemingly well indicated the father volunteered the information that he did not want "that stuff used unless I insisted."

Here was a hard complication; poor kidneys, a most malignant case of disease, long lasting and no chance to use the antitoxines.

The remedy that seemed to fit the case most nearly was Mercury Cyan. and this I gave in the third trituration; having previously used some others among which was Belladonna.

Here now began a hard struggle for the mastery, the case was at times a little better but for the most part not and to this was added the exhaustion from the malady, feeding, nursing, washing and swabbing everything that could be done was done and consultations were held to no avail; while the case grew no better, it grew preceptibly worse as soon as a new remedy was tried, and in spite of my own feelings and forebodings doubts and anxiety, I continued the remedy; at length the throat began to clear and the epidermis to peel from the body and my hopes ran high, but with the bettering of the symptoms the urine began to decrease, the thing feared most of all had fallen upon me; in a short time it ceased altogether; truly the time for the use of mercury was passed and try other remedies as I would, I could not correct the difficulty, it seemed as if we had seen the boy saved from one demon only to succumb more quickly to another. We seemed to be at the end of our row. At the end of twenty-four hours, finding that the urine was still suppressed, Dr. G. H. Morrill was summoned as an additional consultant, and after due deliberation he advised a return to the Belladonna to this we readily concurred, and Bell. the 6x was given every half hour.

Now note the results: In three hours our patient passed a tablespoon

ful of urine, in an hour more the same quantity and at the end of twentyfour hours from the time the prescription was made he had voided fourteen ounces and was on the high road to recovery.

From this time the recovery was uninterrupted, save for the formation of an abscess on the neck and the convalescence was fairly rapid.

Here was a second case where the medicine held in check the morbid forces and effected a cure for who will say that with no other means left for our assistance as we were in this case, that it was not the medicine that assuaged the disease and cured the patient.

By way of apology, for this feeble effort let me say that it was begun in the hope of refuting in some measure the oft expressed and growing sentiment, That "in a bad case medicine will do but little good and it will be better to try one of the more radical, surer, quicker methods," forgetting that these in too many cases terminate the disease and the patient at the same time: Will you not choose your remedy well and then give it a little time and a fair show, affording it all the help possible, of hygiene, of diet and feeding, of nursing and if needed stimulation.

DIAGNOSIS Of kidney leSIONS.*

BY WILLIS YOUNG, M. D., ST. LOUIS.

The title of this paper is not well chosen, since it would indicate an attempt to consider the diagnosis of kidney lesions generally, whereas its object is merely to relate some observations of a condition which was difficult to diagnose; due to its unusual character.

The obscure, unusual or misleading symptoms will, it is trusted, extenuate to some extent the detail with which the case is presented.

On July 11th, 1903, there was referred to me a case for operation for Nephrolithiasis. The diagnosis was provisional, and made by Dr. Paillou, through whose courtesy I saw the patient. A little further along it will be seen why the diagnosis was provisional. The history is as follows: Mrs. M- -, aged 38, a tall, slender Englishwoman, the mother of seven children, all born within a period of eight years-the youngest two years old. Family history negative.

During the fourth or fifth month of her second pregnancy, about ten years ago, she was suddenly attacked with a severe pain in the left lumbar region, which she tells me was at the time believed to be caused by a displaced left ovary. This pain has been constant every since, varying in severity. This pain is burning or throbbing in character and follows along the course of the left ureter. It is often suddenly augmented to a degree described as agonizing, and on these occasions is accompanied by vomiting. Micturition is painful and very frequent during the daytime. At night she is not disturbed in this respect. The urine is occasionally bloody and the patient says that the urine often precipitates an abundant red sandy deposit and once contained a coffee-grounds-like substance, which was probably blood in large quantities.

*Read before the Missouri Institute of Homeopathy, April, 1904.

During the two years she has been under her present physician's care he has made many urinalyses, sometimes finding the urine normal, but usually very heavily loaded with urates, earthy phosphates, uric acid and an amorphous substance looking like wet blotting paper-the true nature of their substance was never determined. There was never any casts or albumin.

The patient suffered an attack of malarial fever six weeks ago and an attack of peritonitis, brought about from exposure to wet and cold, one month ago, from both of which there was prompt recovery under medical treatment. These two attacks are of much significance when the further developments are considered. The peritonitis supposed to be caused by -cold and the malarial (?) fever immediately preceding it suggested that the pelvis be examined. This was accordingly done and a pyosalpinx, left, and a large left ovarian abscess were discovered. This discovery cast a just doubt on the malarial character of the fever of six weeks ago and the supposed simple character of the peritonitis.

It was deemed advisable to remove this tube and ovary before making a surgical attack on the kidney-for several reasons to get rid of a large collection of pus; to improve her general health, which was not at all bad, considering her many years of suffering, and to afford opportunity to view the interior of the abdomen to obtain if possible some further information of the left kidney and ureter-as well as to determine the presence of a kidney, or kidneys.

These last two objects were not attained, for the purulent condition in the pelvis prohibited me from handling any viscus that could be left unhandled. As it was she suffered a sharp attack of sepsis, but recovered very well.

Her general condition improved materially in the next few weeks; the pain in the kidney, ureter and the bladder continuing as before.

November 5th, 1903-four months after the first operation-the ureters were catheterized-that the presence of two kidneys might be demonstrated in view of the possible removal of one of them. This also permitted an examination on the urine of each kidney separately. The only difference in the two urines was that the right presented a sg. of 1024-the left a sg. of 1022; the right containing approximately one-half a gram more of urea to the 30 cc. The average twenty-four hour quantity was 24 ounces.

Nov. 6th, the left kidney was exposed for exploration-a nephrotomy or nephrectomy being left to the discretion of the operator.

Fatty capsule was removed entirely.

The kidney was very long, approximately five inches. It was more or less perfectly divided into five lobes. This condition suggested that the organ was a horseshoe kidney or some other malformation, with two ureters.

I introduced a needle into the kidney from the convexity to the pelvis in no less than ten different places in an unsuccessful search for stone. The ureter was palpated-no stone. Desiring to inspect the kidney substance the true capsule was divided along the convexity. The kidney fairly popped

out of the divided capsule, so tightly was it enclosed, and as the capsule was further divided and peeled off the kidney substance, the apparent lobulations disappeared, as they were caused by constrictions of the capsule.

Having broken up the natural anchorage the organ was anchored by suturing the capsule to the lumbar fascia and the wound closed and drained with a small gauze drain.

The patient upon recovering from the anaesthetic at once announced herself free from pain.

The quantity of urine in the next twenty-four hours was 411⁄2 ounces, normal; in the next twenty-four hours, 47 ounces and normal; for the next week averaging 45 ounces, and always normal.

The patient made an uneventful recovery, and I learned by inquiry made on Tuesday last, is still free from pain and health perfect.

The only reason for doubting that the constricted capsule was responsible for the pain and the condition of the urine, is the well-known fact that nephralgia, often perfectly simulating stone in its symptomology, is occasionally permanently relieved by exploration and needleing.

2344 Park Ave.

SANITATION IN THERAPEUTICS-FLUSHING THE BODY SEWERS.

By DAVID R. OVERMAN, M. D., ST. LOUIS, MO.

The title of this paper may appear ambiguous, but a few words will explain. It has been arranged to conform to the Bureau for which it was solicited, rather than to forcast its scope and object. Its object is to provoke discussion upon the use and I might say the abuse of Cathartics, laxatives, intestinal antiseptics, etc., more than to exploit any theory or opinions the author may hold upon the subject. It is commonly believed by the laity that the Homeopathic physicians neither "puke nor purge" their patients. But is it a fact? And can we in our daily routine of practice do the best for our patients and ignore or avoid the use of these ligitimate agents. If I remember correctly my preceptor diligently taught me that they had no place in our therapeutics-that the skilful and full-handed Homeopathic therapeutists had no more need of them than he had for Blisters or sinapisms, which according to Father Hahnemann were worse than useless. But Homeopathy has grown in both wisdom and stature since then, and that doctrine is now covered over with the mosses of more than a half a century of contradictions, even. from its own converts. A retrospect of the history of medicine brings to view many innovations in both Theory and Practice that seem diametrically opposed to the teachings of the Organon, but which can by the light of modern discoveries be easily explained and harmonized. From a popular standpoint the whole structure of Medicine has been revolutionized since the law of similars was written, which of itself is not strange, because the science of Medicine is by its very nature the most progressive of all sciences. A few sentences from the Master's own pen will suffice to show its chaotic state during his time. The first words in his introduction to the Organon, entitled "A Review of Physic" as Hitherto Practiced,"

etc., are as follows:-"With the development of the human race into communities, the causes of diseases and the necessity for methods of cure; inIcreased with even pace. A countless variety of opinions on the nature of diseases and their remedies, sprang from a great variety of minds and the theoretical products of their fancies were called systems, each contradicting the others as well as itself".

The criticism is today just as applicable to the past as compared with the present status of medicine as when it was written. But not so with the following interdictum which appears in the preface to the Fifth edition of the Organon, namely "Homeopathy sheds not a drop of blood, prescribes no emetics, purgatives, laxatives nor sudorifices. It removes no external disease by local application; it orders no medicated baths, no enemas, and makes no use of blisters, sinapisms, setons nor fontanells; it objects to salivation and does not sear the flesh to the bone by moxa or heated iron. The Homeopathist dispenses only self made, simple medicines, whose effects he has accurately and carefully studied, and he avoids all mixtures, and needs no opium to soothe pain, etc." This may have been the best of wisdom when it was uttered, but let me reiterate that since the Organon was written, the science of medicine has been reconstructed from top to bottom, or as it were, from basement to attic. The superstructure (Theory and Practice) now as never before, rests upon a foundation of facts. The facts are the newly found truths about the causes of diseases as revealed by the microscope and its modern accessories. This search-light after truth in physics, has laid bare the secrets in organic chemistry, and with its marvelous revelations in the realm of bacteria has. made a pathology and has created a new science (Bacteriology) of which Hahnemann and his contemporaries knew nothing. But had the illustrious founder of Homeopathy been able to obtain all these advantages in his day, I can not but believe that he would have been the father of microbes as well as of Homeopathy; and would have been the first to declare the doctrine of autoinfection, and gugulation and elimination of diseases, by use of the very means and measures that he has so strenuously interdicted; because his doctrine of "psora", the dynamis", and "morbific agencies inimical to life", (terms by which he often expresses the "Causa Morbi",) more nearly correspond to our modern theory of infection, than that of any of his co-workers or opponents.

So we might say one reason why he did not believe in saline evacuants and antiseptics was, that our pathogenesis for their use was not then in vogue, which is a very good and sufficient reason. Furthermore their crude and nauseous mixtures so used should not be compared to the ready-made "arms of precision" we have now-a-days.

Again glancing at his "Review of Physic" we find that the prevailing idea of diseases in general, was that they were due to "plethora of blood", "the existence of some morbid matter perceptible by means of the senses, (particularly because the patients easily inclined to such an idea,) having discovered which, nothing remained to be done, but to procure the requisite guaranties of remedies to clean the juices", and rid the body of the