in the intervals, incident to mechanical irritation of the skin by pinching, or to a vaginal examination, or to a uterine contraction, or to the use of an injecting-pipe, or by calling her by name with a high pitch of voice, and quickly after a paroxysm the stertor lapses into restful ordinary sleep, though she is not capable of being fully roused, and if she retains the power of deglutition, or vocalization, though incoherent, and especially if the pulse and temperature keep within the range normal to such violent physical effort as is involved in the repeated convulsions, all unmistakably indicating that the brain is experiencing no imperilling engorgement, or giving way of structure, or exhaustion, or the kindlings of inflammation, the prognosis must be regarded hopeful. When, with this favoring condition of the brain, there is maintained a fair degree of general nerve energy and muscular strength, the muscles keep round and feel firm, and there is but little settling or sinking down in bed, expressed by the term decubitus, and in the intervals the respiratory muscles act equably and lift the ribs full up, and the tonicity of the sphincters of rectum and bladder is retained, a most hopeful prognosis may be rationally entertained.

On the other hand, in case the consciousness becomes quickly and wholly obliterated, the coma so profound nothing can rouse her, and a heavy stertor rests upon the respiration from one seizure to another, and her color grows more and more cyanotic, her pupils become unequal and lose their contractility, her pulse frequent, irregular, or slow and intermittent, her temperature unequal, cold feet and hands, head hot, and the thermometer shows abnormal exaltation and increase of blood-heat; then, as we survey the general nerve and muscular centres, we find traces of increasing exhaustion, though tardily unfolded, the muscles losing their roundness and firmness, the chest morbidly collapsed and the breathing largely abdominal, deglutition impossible, the sphincters relaxed, urine suppressed, posture in complete decubitus, hæmiplegia, or, what is sometimes observed, an uncontrollable restlessness supervenes, a wild tossing of the arms and limbs and even of the body, our prognosis is wellnigh hopeless. Indeed, this last symptom I have never seen in eclampsia, follow

ing in the train of other grave symptoms, where the patient did not soon die.

2d. The frequency of the recurring paroxysms.

Each paroxysm is like a severe blow, and though it may not break down any molecule, or cell, or capillary, it consumes, by its resultant shock and expenditure of muscular and nervous energy, a certain degree of vital resistance. This consumption of power goes on, not pari passu with the repetition of the attacks, but with an accumulative force; each paroxysm taking away more and more of the resistance. If, therefore, they occur widely apart, giving thereby opportunity to the nervous and muscular spheres to rest and recuperate, they furnish an element of hopefulness, unless the severity of the paroxysms, when they recur, more than overbalance this advantage. On the other hand, if the paroxysms recur at brief intervals, as they sometimes do, scarcely affording any time for recovery from their entailed shock and exhaustion, the prognosis is correspondingly rendered ad

verse.

3d. The duration of the malady.

Though any individual case may present great severity of paroxysms, and these recur with great frequency, yet, if they may be limited in number, all other things equal, the prognosis is thereby made more favorable. Whereas, if, through a continuance of the causative conditions, the malady persists any great length of time, the prognosis becomes correspondingly grave. There is a limit, mercifully bestowed upon our mortal bodies, of endurance of so terrible assaults of disease as these paroxysms of eclampsia, and though in their protracted recurrence the brain escapes any appreciable breaking down of its integrity of structure, yet shock and exhaustion are sufficiently potent, and will sooner or later, if unstayed or uncontrolled, destroy life and close the appalling scene.

APPENDIX.

DISCUSSION.

SECOND DAY-AFTERNOON SESSION.

DR. H. N. GUERNSEY, of Philadelphia: Mr. President, I really do not look upon this grave disease, eclampsia, with so much fear and trembling as one might suppose. Dr. Sanders's paper was very interesting. I have seen a great deal of this affection, and my success in treating it has been very satisfactory in any stage, either before the completion of pregnancy, just before parturition, during or after it. The only successful treatment consists in deciding on and giving the appropriate remedy at infrequent intervals and in a high potency. My first case I was called to in the middle of the night, thirty years ago. The first symptom of approaching confinement was a severe convulsion, and when I reached the house, some three or four miles distant, there was no hope, nothing did her any good. All my other cases from that day to this, in which I was called in the beginning, I have never failed to cure.

I will hastily speak of the remedies I use. I have given but a few lines of indications in my writings for the following:

Arnica, Belladonna, Hyoscyamus, Argentum nitric., Cuprum, Lycopodium, Ignatia, etc. Now, really, gentlemen, I am as much at home with my remedies in this disease as my friends the surgeons are in their specialties. This has been doubted here, but I know that I cured. While a lengthy discussion is not desirable, I wish to encourage those who practice homoeopathy to adhere firmly and persistently to its principles, to dare to give the single remedy, and allow time for it to act.

I have cured most cases with Belladonna, of which I usually use the 41 potency.

DR. BAILEY, of Detroit, Mich. : I would like to ask Dr. Guernsev if he were called to a case and found the rectum distended with fecal matter and the bladder also enormously distended, he would

give a single remedy in the 41 or 42m, and then sit down and wait for it to take effect?

DR. GUERNSEY: That would be the same thing as being called to a case of fractured limb or dislocation, and expecting to set it with a powder of the forty thousandth. I have had that senseless notion thrown in my face before. DR. BAILEY: I thank the gentleman for his answer. I got that idea, and I believe nine-tenths of the members did, from his remarks.

DR. GUERNSEY: Of course if there is a mechanical obstruction it must be removed at once. I would, of course, in such a case draw the urine and relieve the distension of the bladder, and thus I would relieve all difficulties taking rise from a mechanical cause, and I beg to here deny the assertion that I would not.

DR. BAILEY: I am pleased to learn that such diseases can be treated with the highest attenuations. We must all live and learn, and that is our object in coming here, and while this is one of the greatest things I have ever learned, I still have my doubts about it. I have in my practice had very few cases of the trouble; with them I have used low potencies; that is, from the sixth to the thirtieth. I have not reached the remedies prepared by letting water run through a small vial for six days. I hope I may some time be convinced of their efficacy. The doctor who read the first paper spoke of using from the first to the fourth decimal, while Dr. Guernsey treats his cases with the forty-first thousandth. If we can cure disease equally well with either high or low potencies so much the better. I liked Dr. Sanders's paper. I think it is our first duty to remove obstructions, and the sooner this measure is resorted to the better it will be for the patient.

We have a number of ladies present competent to speak or write on this subject, from whom we have not heard a word; why can we not hear from them?

:

DR. W. C. BARBER, of Waukegan, Ill. I am much interested in this discussion. My first case of eclampsia the friends got frightened about, and calling an allopath in consultation, my patient, although in convulsions, sank into a comatose state, which lasted about three days, and then she died.

The cases I have since had I have managed myself. When the convulsions were in the form of hysteria, Ignatia always relieved. When there was a lack of uterine excitement, I would hasten the delivery with forceps. When there was great excitement, when after-pains had come on, and the pain suddenly left the uterus and went to the head, with a twitching of the eyes and an approach to convulsions, I used Secale, always suc

cessfully. I have never seen the apoplectic form of convulsions.

THE PRESIDENT: I like the suggestion about hearing from the ladies. The courtesy can be extended to them of allowing them to speak from where they sit, if they feel a delicacy about coming to the platform.

DR. C. PEARSON, of Washington, D. C.: I heard but imperfectly the remarks of Dr. Ormes, but if I heard his prescriptions correctly my idea was, when he sat down, that he had read a very good allopathic paper. I respect the doctor and wish to say nothing to hurt his feelings, but I must say his paper was peculiar as a homoeopathic production. I understood him to say that he gave Belladonna and Aconite in eclampsia from the first to the third. I suppose he alternated these with Veratrum viride. I understood him to recommend chloroform and bleeding. That treatment is not new, for it was practiced very many years ago; almost any physician at that time would have done the same thing. I protest against such reports. I did not hear what became of the patient. Did she recover, doctor?

DR. ORMES: To which one do you refer?

DR. PEARSON: The women you treated by bleeding, etc., under the homoeopathic practice.

DR. ORMES: That was when I was an allopathic physician. DR. PEARSON: I beg your pardon, I thought it was homoeopathic treatment.

DR. ORMES: I will explain. I first commenced to practice medicine as an allopath. The first thing after seeing the patient was to bleed, and the case I was describing I bled freely. That was on Monday morning; on Wednesday she appeared a little better; on Thursday she became conscious. I gave the allopathic treatment according to Dewees, and the patient made a good re

covery.

DR. PEARSON: I beg the doctor's pardon. I am glad to correct a nisstatement, but I certainly understand that when he comes to this Institute as a homoeopath, he should not give us allopathic treatment, as he has in these cases. I protest against it.

DR. ORMES: I used the Veratrum viride when I was an allopath, but I have used it since I became a homœopath.

DR. PEARSON: I cannot understand how the doctor used it. DR. WILLIAM GALLUPE, of Bangor, Maine. These cases of puerperal convulsions are cases of emergency and very unpleasant; something must be done at once for the sufferer.

I have not had a great many cases, but such as I have seen have got well after one or two doses of a single remedy.

I once drove very quickly for five miles to see a case, and it