Medical Library Association regarding the use of their new auditorium as a meeting place. Dr. Jno. E. White, of Colorado Springs, read one of the ablest papers on the subject of "Tuberculosis" we have ever heard. It will be found in part in another part of this journal. Rev. Harris Cooley gave an interesting talk on the work of the present city administration in establishing a tuberculosis sanatorium at Warrensville. Dr. A. B. Schneider discussed the "Early Diagnosis of Pulmonary Phthisis," and we wish space would, in the interest of our readers, permit us to publish his remarks in full. Dr. H. F. Staples read an able paper on "Sanitation in Tuberculosis." Drs. Alexander La Vigne and Carl Rust discussed special points in diagnosis. Dr. G. B. Haggart's paper was read by title, the doctor not being present in person. After a lively, general discussion and a demonstration of the tent used at Nordrach Ranch by Dr. White, the Society adjourned.

Materia Medica Notes

THE PRINCIPLES OF PRESCRIBING.

By Dr. W. A. Yingling, Emporia, Kans.

Homeopathic prescribing is scientific prescribing and is based on the Science of Symptomatology, which includes or is based upon the Law of Similars. Unless one comprehends the Science of Symptomatology homeopathic prescribing is very difficult and unsatisfactory. and even with the broadest comprehension of true Symptomatology it is often no easy task, as none of the sciences are in their art. The farther we get from the teaching of the Organon of the healing are as taught by Hahnemann the more uncertain and the more unsatisfactory becomes the art of healing the sick. Homeopathic Symptomatology is not a mere array of the signs of sickness as expressed by the patient. Nor is it the aggregate of the subjective and objective expressions of disease. The mere symptom coverer is not a true homeopathician. Yet to-day the tendency with homeopathic physicians is to cover symptoms, as nosological prescribing is with our allopathic fraters. There is more to a sick condition than the mere name, as there is more to a homeopathic symptom than the simple sensation. The homeopath must be a broad-minded man as well as philosophical. He is to consider the "totality of symptoms." This "totality of symptoms" is misconceived by a certain part of the profession. It has not to do with the aggregate of symptoms so much as with the completeness or entirety of symptoms. Totality means whole, entire, full, complete,

not divided, and its synonyms are "whole, entire, complete." Wholeness implies freedom from deficiency, not defective or imperfect, integral. The "totality of symptoms" means, then, the completed symptom, the symptom in its entirety, with all its integral parts.

There is much confusion regarding the keynote. Some physicians conceive it to be a mere oddity or a prominent action of the remedy. It is this, but much more. The keynote is a peculiarity as well as an uncommon symptom, but the setting, the association, makes it the guide in the selection of the homeopathic remedy. Remember, I say, makes it the guide in the selection of the homeopathic remedy, and not the sole basis of the selection. What is a peculiarity or keynote in one case may be a very common or unworthy symptom in another case. The keynote peculiarity does not merely refer to the pathogenetic symptom of the remedy, but must correspond equally to the totality of the symptom list in the patient. It must not only be present in the symptom picture of the case, but it must be strikingly, forcibly present and show its peculiarity by its setting and relative association in the symptom complex. This peculiarity may be such from its location, from its sensation, from its concomitants, from the modalities, or from its association alone.

The keynote is not the only note in a given piece of music. The keynote would not make harmony if sounded alone; it requires other notes to make a tune. While it is the principal note of the piece of music, other notes may be more essential to musical harmony, yet these other notes revolve around and about the keynote. Those who prescribe on one symptom because it is known to be a peculiar one to the remedy, err and fail simply from the fact that they forget that the remedy must be suited to the peculiarities of the patient and not the patient to the peculiarities of the remedy. The patient must be examined to ascertain the individual peculiarities and then the remedy adjusted to the symptom picture as a whole.

Finally, of the two classes of symptoms, the subjective and objective, the former is of the greater importance. The subjective or mental symptoms are those of the patient's own consciousness, those not knowable to the physician except as the patient reveals them. The objective are those symptoms observed by the physician and are, hence, more material and of less value from this reason. The objective symptoms refer more to the diagnosis and pathology of the disease. The diagnostic symptoms are of little value in the selection of the homeopathic remedy because they are common to the disease and not peculiar to the individual patient as are the subjective or mental symptoms. The objective symptoms have more or less value in prescribing

and may be of great value in the absence of the mental symptoms, but usually not of great value, whereas the subjective symptoms are always of the highest value.

It is no easy task to be a successful and scientific homeopathic prescriber, but it pays to seek the highest ideal.-Homeop. Recorder.

Among the Journals.

PROGNOSIS OF MITRAL INSUFFICIENCY.

I. The Degree of Compensatory Hypertrophy.-There are cases which may go unrecognized for years, there being no signs indicative of a heart lesion. This is particularly true of cases in childhood, where the lesion is completely compensated.

II. The rapidity with which the lesion develops.

(a) When Slow.-Usually the development is insidious and slow, the heart thus being able to overcome the circulatory disturbance with a more favorable outlook.

(b) When Rapid.-When the development is acute, as in rupture of the valve, evidenced by violent pain, cyanosis, cold, clammy sweat, dyspnea, suffocation, delirium cordis, the prognosis is extremely grave, duration of life ranging from a few days to several months.

III. The extent of the affection of the myocardium.

IV. The care which the patient is able to take of himself. Many cases with good care reach old age, but life in many cases is menaced by the development of intercurrent diseases.

V. The association of mitral stenosis which renders the prognosis more grave.

Prognosis (comparative).-The prognosis of mitral insufficiency is the most favorable of all the valvular lesions.-Gatchell, in Clinique.

MATERIA MEDICA.

Faith is the great curative principle. In order to be cured, when you are sick, you need have faith in something; in yarbs, or prayer, or

serum.

Yarbs seem to be pretty much out of it.

Prayer is cleaner than serum. You can have faith in prayer without contracting blood poison.

Prayer is naturally inexpensive, but this disadvantage is being rapidly overcome by Christian Science. Some day, perhaps, it will cost about as much to believe in prayer as to believe in serum.-Life.

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 Editors of the REPORTER are not responsible for any opinion expressed by contributors.

Vol. XIII.

AUGUST, 1905.

No. 8.

Original Articles.

ACUTE INTESTINAL OBSTRUCTION IN INFANCY AND CHILDHOOD. * By Hudson D. Bishop, M. D., Prof. of Surgery, Cleveland Homeopathic Medical College.

No more serious condition in the practice of medicine ever confronts the physician than an acute intestinal obstruction, and this is especially true during infancy and childhood. The early recognition of the symptom, the accurate diagnosis, if possible, of the mechanical cause which is operating, and the choosing of the proper treatment, are matters requiring fine discrimination and great responsibility.

Acute intestinal obstruction, within the limitations of this paper, may be due to a number of conditions, the least frequent of which will be considered first.

(1.) In early infancy, congenital malformations of the intesinal tract, particularly the anus and rectum, may cause stenosis and lead to acute obstruction. There may be stenosis or artresia of some part of the small intestine, more often the duodenum, in which the symptoms of obstruction are marked from birth.

(2.) Fetal, peritonitis may cause bands or adhesions which are active factors in producing angulation or twisting of the intestine and acute obstruction.

(3.) Acute obstruction may be caused by intestinal worms (ascaris lumbricoides) and by foreign bodies.

(4.) A rather frequent cause of obstruction is the remains of the omphalo-mesenteric duct (Meckel's diverticulum). It may produce obstruction in the following ways:

a. When the diverticulum terminates in a fibrous cord (the remains of the omphalo-mesenteric vessels) which is attached to the mesentery or to the intestine, a number of forms of strangulation may occur. The cord may form a loop into which a coil of intestine may

This and the two following papers were read as a part of a Symposium on "Intestinal Obstruction" at the meeting of the Ohio State Homeopathic Medical Society, May, 1905.

pass; a coil of intestine may loop itself about the cord; a volvulus may form at the part of the ileum from which the diverticulum arises.

b.-A frequent form of obstruction is the invagination of the bowel into the free end of the diverticulum, which is dilated to a pouch-like form.

c. A very rare form of obstruction is one in which an enteric intussussception passes into and through the diverticulum, or the diverticulum itself forms a part of an intussusception.

d. Another rare form of obstruction is due to the possibility of diverticulum being patent at the umbilcus and the danger of including it or a portion of the bowel in the ligature of the umbilical. cord.

(5.) Obstruction due to strangulated hernia is by no means uncommon in early infancy. Lilienthal (Medical Record, 1901, Vol. 50, p. 855) reports a case in an infant eight days old. White (Medical Record, August 22, 1903), reports a case in an infant eleven days old. Of 110 cases of strangulated hernia reported by Thoburn (British Medical Journal, April 25th, 1903), ten were in infants.

It is important to remember all of the above causes as possible etiological factors in cases of acute obstruction and while they are by no means as frequent as intussusception, yet they are often found. In the majority of cases their accurate diagnosis can only be made by exploratory operation. Cases due to the diverticulum are most often mistaken for appendix cases. Strangulated hernia does not differ in any respect from the same condition in adults, except that the presence of tumor is more likely to escape notice if the child has not walked.

(6.) The most frequent cause of acute obstruction at all ages, excluding hernia, is intussusception. In 1652 cases of obstruction, hernia excluded, 657 or about 40 percent were cases of intussusception (Lichtenstein and Bryant). Over 90 per cent of the cases of intussusception are in children under ten years of age (Battle and Corner, International Clinics, Vol. 4, 1903, page 194). The majority of cases occurring in childhood are in infants under one year of age. In 593 cases of all ages, 131, or 23 per cent were in infants under one year of age (Lichtenstein). In 358 cases under ten years of age, 230 or 64 per cent were under one year of age (Holt).

Etiology. The histories of the majority of cases of intussusception do not show any important predisposing causes. The condition is most likely to develop in a previously healthy infant, usually breast fed, with no history of bowel disturbance. It is just this class of healthy children who are most often victims of indiscreet mothers in the matter of feeding them indigestible substances. It is the occa