THE BOARD OF MEDICAL EXAMINERS IN NEW JERSEY during the year just gone by has examined eighty-seven applicants for medical license, sixty-three of whom were licensed and twenty-four rejected, making the percentage of rejections 27.58; twenty-three applicants for midwifery license were examined, sixteen of whom were licensed and seven rejected, making the percentage of rejections thirty.

THE Committee on pathologic exhibit for the American Medical Association, which meets at Saratoga, N. Y., June 10th to 13th, inclusive, is anxious to secure material for the coming session. Last year the materials included not only pathologic specimens, but also others illustrating bacteriology, hematology, physiology, and biology. New apparatus, charts, etc., will be appreciatively welcomed, and exhibits will be given the best of care.

FEES IN FRANCE vary, and the question is now, What should be the charge for a surgical operation by one of the princes of the art? This ticklish query has just been occupying the Seine civil tribunal. Dr. Albarran sought to recover $1200 from a Nanterre grocer as a fee for performing laparotomy on the latter's wife. The court considered the charge exorbitant and reduced the same to $500, stating that it is a medical man's duty to fix his fees in proportion to the patient's means.

THE twenty-fifth anniversary of the Homœopathic Medical Society of Western Massachusetts, held at Springfield, Mass., March 19, was a great success and largely attended. The officers elected for the ensuing year are: President, Dr. Samuel E. Fletcher of Chicopee; first vice-president, Dr. Plumb Brown of Springfield; second vice-president, Edward Beecher Hooker of Hartford; secretary and treasurer, Dr. Alice E. Rowe; censors, Dr. O. W. Roberts of Springfield, Dr. F. A. Woods of Holyoke, and Dr. E. W. Copeland of Northampton. Steps were taken to enter a protest in the Legislature against the bill making physicians eligible to serve on juries.

THE NEW ENGLAND MEDICAL GAZETTE

No. 6.

JUNE, 1902.

VOL. XXXVII.

ORIGINAL COMMUNICATIONS.

SOME DRUG STUDIES IN RELATION TO RHEUMATISM, GOUT, AND LITHEMIA.

BY RICHARD HUGHES, M. D., ENGLAND.

I am apprised that the annual meeting of the Massachusetts Homœopathic Medical Society holds its first session this year on April 8th, and that on this occasion the Bureau of Clinical Medicine will report on "The Arthritic Diseases: Rheumatism, Gout, and Lithemia." I am asked to acquit myself of the obligations involved in the honorary membership the Society long ago conferred upon me, by contributing a paper to that report, and occupying myself in it with the relations of drugs to the morbid states in question.

In undertaking such a task, which I do with pleasure, I am arrested at the outset by the assumption involved in the title -that rheumatism, gout, and lithemia are "arthritic diseases."

Arthritic," as its etymology implies, denotes a malady which has joint inflammations among its pathognomonic features. This can justly be said of rheumatism and gout, but hardly so of lithemia, which can only induce arthritis by acting as the predisposing cause of gout, in respect of which it holds. much the same relation as scrofula does to tuberculosis. I would not, therefore, classify these three diseases as "ar

thritic," nor would I rank them on a common level. The resemblance of rheumatism to gout is phenomenal only, and this very imperfect; and the former seldom, if ever, has lithemia as a substantial predisposing cause, at any rate, of its acute form. Still more unlike are the exciting causes of the two maladies, which with rheumatism are atmospheric, with gout mainly dietetic.

As in so speaking I am rather opposing the trend of present-day pathology, let me substantiate my view by a quotation from a recent authority - the article on gout by Dr. Frederick Roberts in the second edition of Quain's Dictionary of Medicine.

"Acute rheumatism," he writes, "unlike gout occurs most frequently for the first time in early life, from sixteen to twenty years of age, and is not uncommon even in young children. Though most common in males, it often attacks females, which gout does not. It is not favored by the habits which generate or promote gout, and affects all classes of persons, but especially those who from their occupation are liable to exposure to cold and wet. Such exposure, or some other definite cause originating a chill, usually accounts for an attack of acute rheumatism, and it is not preceeded, as gout generally is, by any particular premonitory symptoms. The joints involved are the middle-sized or the larger ones, several of which are generally implicated in succession during the illness, the rheumatic inflammation having an erratic character, in all this differing from gout. The local symptoms also tend to be less severe, there is less marked edema about the joints, and no enlargement of the veins or subsequent desquamation. Pyrexia is high as a rule in acute rheumatism, and is often quite out of proportion to the extent of the articular affection, while profuse acid perspiration is almost always a prominent phenomenon. These features are absent in gout. The urine is simply febrile. The attack lasts a considerable time, perhaps several weeks if it at all severe, while during it course some acute cardiac inflamma

tion is very liable to supervene.

In addition to other differences, chronic rheumatism is at once distinguished from gout by the entire absence of uratic deposits."

All this, I think, is indubitable, and it points to the essence of acute rheumatism as standing in a poison distinct from, though analogous to, that of gout. The latter is admitted to be uric acid, an excess of which in the blood its predisposing causes manifestly favors, while its presence, as urate of soda, in the gouty joints is demonstrable. I am at a loss to know

why the theory that lactic acid plays a similar part in acute rheumatism should nowadays find so little acceptance. The etiology of the disease favors it I mean the frequent supervention of the symptoms on a check to perspiration, but we have more cogent evidence still in their actual development by the ingestion of the acid on the part of non-rheumatic subjects. Kuelz has once, and Balthazar Foster twice, observed this in diabetics treated by full doses of the acid, as may be read in the "Cyclopedia of Drug Pathogenesy." It will also be seen there that Richardson has found the cardiac and pleural inflammations characteristic of the disease in animals into whose peritoneal cavity the acid had been injected. During life there were evident signs of pain and tenderness in the joints.

These facts have a negative bearing, but also a positive one. They dissuade us from employing lactic acid as a similar in the treatment of rheumatic fever, for in all probability this substance is the actual materia morbi, and is present in considerable quantity in the circulation. On the other hand, they give us a truly homoeopathic remedy for arthritic and cardiac conditions otherwise occurring, and one which ought to find more employment. A Dr. Zolatoria has been led, I know not why for he is not a homœopathist, to try it in the stubborn affection known as "arthritis deformans." (chronic rheumatoid arthritis). The case was one of ten years' standing and the patient, a woman, had been bedridden for a twelvemonth; but she got up and walked after three weeks'

treatment and so improved, thereafter that no further care was required and ordinary duties could be resumed. The dosage is not specified.*

This is a digression, that we may know what we are thinking about when we speak of rheumatism, gout, and lithemia. Let us turn now to the aid which medicines supply in dealing with these affections.

Of the lectures I had the honor of delivering in 1884 before the Boston University School of Medicine,† I devoted two to "Rheumatism and the Anti-Rheumatics." I passed in review bryonia, with aconite, colchicum, pulsatilla and propylamine; rhus, with dulcamara, rhododendron, kalmia and spigelia; cimicifuga, with caulophyllum, ledum, ruta and viola; mercurius, with kali bichromicum and phytolacca ; arsenic and sulphur. I have nothing to add to what I have there said, save as regards colchicum. Whether my remarks on this drug had anything to do with it I cannot say, but there has been a revived interest of late in this medicine as an anti-rheumatic. Dr. Goodno, of Philadelphia, in his excellent "Practice of Medicine," speaks of more than eighty cases treated by him with a solution of Merck's colchicine in the proportion of a grain to an ounce. Of this 5 to 10 drops were given for a dose. "Relief of pain," he says, speaking of acute rheumatism, "follows in most cases within twentyfour hours, and within forty-eight hours the patient is generally comfortable, the swelling, fever, sweats, etc., much diminished. By the third or fourth day it is evident that the case is thoroughly in hand. By the fifth to the seventh day it is difficult to keep the patient in bed."

Dr. Colby has communicated to the NEW ENGLAND MEDICAL GAZETTE of March, 1895, an equally favorable experience in sub-acute cases. "It is of course," he says, "specially useful in gouty subjects, but even apart from this it is well indicated when the inflammation attacks chiefly the hands and feet, shows central tenderness on palpation, moderate

American Homeopathist, Jan 15, 1899.

† Published as "The Knowledge of the Physician." Otis Clapp & Son, Boston.