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is perfectly consistent with known facts and is probably merely a way of expressing the means employed in reaching the goal of all medicine, the production of immunity. Or in other words, the production of immunity is the name given to the end attained, homeopathy to the means of attaining it. This means, therefore, that the goal of all physicians is the same and the roads to it are very similar. In one, drugs are recognized as important, (possibly by some too important) in the other, hygienic measures exclusively, drugs being practically discarded.

Where lies the truth? As usual, somewhere between the two. In the past it is possible that some of our associates in their ardent and continuous study of the drug immunization have lost sight of what we might call hygienic immunization. If such has been the case it has been most unfortunate and unwise. It has been, I believe, very limited, however.

It is also not only possible, but almost positive that the dominant school in its work with drugs have met with almost uniform failure. So nearly complete has this been that we are now said to be in an age of drug nihilism, merely because the drugs have been incorrectly used. It is not unlike the introduction of tuberculin. This agent was supposed to be the long-looked-for specific for tuberculosis. In the first few years it was widely used in large doses and was found to be often not only useless but actually unsafe. It was accordingly cast aside as valueless and the nihilistic period came on. Later, after careful study the dose was reduced to an almost in- . finitesimal amount and in this form it is now recognized as a distinctly beneficial agent. In a similar manner, but very slowly, is general medicine progressing. Gradually a more correct appreciation of the sphere of drug action is coming and the size of the dose and the principle of action are being more accurately determined.

And as this progress in our knowledge becomes greater and greater we see, as never before, that it tends to substantiate the claims advanced many years ago by Hahnemann. Homeopaths have been reproached by their opponents for being narrow and sectarian, for accepting all things that agree with their dogma and for overlooking all that tends to refute it. Why was Hahnemann sectarian? Why were Talbot Chase and the other New England homeopaths in 1876 sectarian? Why are we all sectarian? Was it the wish of the earlier pioneers in the profession? Is it our own wish now! Hahnemann attempted to reform the medicine of his day, but that refusing to be reformed, expelled him from its midst. But one thing

remained to do, to live and act in accordance with what he thought was right, and if companionship was refused him, to live alone.

Talbot, Chase and those others who having become convinced of the truth of the homeopathic use of drugs were expelled from the Massachusetts Medical Society in 1876 after practically no opportunity for defense, did not become sectarian by their own desire but by stern necessity. The Medical School of Boston University as well as all other homeopathic medical schools was founded merely because in no other way could homeopathy be taught. Privileges of such instruction that these men believed to be vital were entirely denied in the then existing medical institutions. Hence there was only one thing possible: to establish its own schools of instruction. In this manner these schools were also compelled to teach all the other branches of medicine in order that their graduates might profit by truly well equipped physicians in all departments. Thus, homeopathy was forced to the change from a specialty in therapeutics, (where it did then and still does belong) to a sectarian aggregation.

What more natural than that some of those exiled practitioners, fighting earnestly for their beliefs and with their eyes constantly fixed on their motto of similars, should place undue emphasis upon that motto to the exclusion of all other forms of treatment? This is merely what always happens to those who introduce a new idea in medicine. It is but a temporary attitude where time always safely cures.

It is true that we have faddists and fanatics still with us. Where can we not find them in any forms of study? These do not, or at least should not, influence one for or against a cause.

We are asked by the “old school” society whether we practice any exclusive system of medicine. At the present time, with our knowledge of sanitation and hygiene, of dietetic measures, of thermo-therapy, electro-therapy, serum therapy, vaccine therapy, hydrotherapy, of surgery, gynecology and of preventive medicine as well as of the action of drugs, how can any honest and intelligent physician in general practice claim that he practices any one exclusive method ?

Not every case can be treated homeopathically any more than can every one be subjected to surgical procedures or to treatment by vaccines or serum. Just as by surgery, however, or by vaccines or various forms of sera, certain conditions can be brought about that will increase the resistance of the patient, so by the proper use of drugs can this resistance be raised in those diseases where the other means are inadequate or where for one reason or another they can

not be used. To repeat then, homeopathy is a specialty in medicine, not a sect, and should be so considered. It differs less from other forms than do many of the specialties from each other. Its aim is the same as is that of the others, the production of acquired immunity to disease, by a definite law, similia similibus curentur. This law first applied to drug action is now recognized to be of even wider application and to include that which we otherwise denominby our friends across the line, when they will allow us to hold them ourselves and to treat them as something of which we should not be ashamed, and when they are willing to accord to them the same recognition as is received by other specialties, in which many of their own number may not believe, then and not till then let us consider the possibility of amalgamation. It is an indication of gross ignorance to assert that we retain the name merely as an advertisement to the public, no longer believing in the principles of our faith, for this might be true in some few instances; it could not hold good in the thousands of honest, earnest and conscientious practitioners who to-day hold the banner of Hahnemann. Our belief rests on a base formed by long and successful clinical experience.

This foundation is now being tested by the laboratory investigator and thus far, at least, has not been proven to be anything other than what is claimed. However, all of us are fallible and must expect to make some mistakes in our application of truth. Let us not have undue assurance that in homeopathy we have all the truth, for we certainly have not. Let us also not claim that every feature of our claims is beyond criticism and consider that every thing is definite law, for undoubtedly we are making mistakes as are all others in this world. Let us, however, be assured that in our law we have a good and reliable guide for the use of drugs, a guide that is now being verified in the laboratory by the pathologist even as it has been verified at the bedside by the clinician for the past many years.

And in closing let me borrow a quotation from the paper of Dr. Sutherland already referred to: “The separated sect of homeopathy as such, will have fulfilled its use when the truths of homeopathy have achieved the world over explicit and honorable recognition and acceptance at the hands of traditional medicine; and when Samuel Hahnemann, with all his human fallibilities seen and admitted, shall be assigned by traditional medicine, his true place as a scientific thinker and experimenter and a benefactor to the cause of medicine. This day has hardly dawned; yet here and there the watchers on the walls see a lightning in the skies of opposition

and misrepresentation that have been for a century so dark, and cry to us who listen:“The morning cometh!” So far as this faint dawn foretells the true morning, in whose light all men shall fearlessly see the truth, and by whose light all men shall fearlessly follow the truth till all division is merged in brotherly co-operation for the healing of mankind, speed that dawn! For in the day it heralds, When no man shall work for pleasure and no man shall work for

gain But each for the joy of the working and each in his separate star Shall lift the truth as he sees it to the God of Truths as they are."

TUBERCULAR PERITONITIS.

BY ERDIX T. SMITH, SPRINGFIELD, MASS., ASSOCIATE SURGEON TO WESSON

MEMORIAL HOSPITAL.

Tubercular peritonitis occurs at any period of life but usually prior to the age of forty. The fallopian tubes, appendix, caecum and

lower ileum are the common foci of invasion. Infection may occur • through the intestinal wall with or without ulceration, but more fre

quently it occurs secondarily, conveyed from some remote organ by the lymphatics to the mesenteric glands and thence to the peritoneum. In females infection of the fallopian tubes may occur secondarily, or the bacilli may travel upward by way of the vaginal and uterine canal.

There are two principle varieties: the miliary and the fibro plastic, and in addition to these or later stages of the same forms, are the ulcerative and suppurative varieties.

The miliary type has for its focus usually an involvement of the appendix or fallopian tubes, and extending outward from this point of invasion are numerous small tubercles scattered over the adjacent peritoneum with more or less serous exudate filling the abdominal cavity.

The fibrinous type results in the formation upon the diseased peritoneum of a fibrinous exudate which glues the opposing intestinal coils together, often enclosing large quantities of serum, thus forming irregular, cyst-like masses throughout the abdomen.

The ulcerative variety may follow either of the former condi

(Read before the Homeopathic Medical Society of Western Massachusetts, March 17, 1909.)

tions. The diffuse peritonitis having subsided, local areas remain where the inflammation has gone on to ulceration, and caseous degeneration and masses of broken down tubercular tissues are formed usually firmly encapsulated, sometimes perforating the viscera.

Pus infection may follow any of the preceding forms or be a mixed infection from the start. In the mildest suppurative form the effusion in the peritoneal cavity may take on a sero-purulent character without adhesions or destruction of the endothelium, while in the more virulent infections the abdominal cavity may be filled with innumerable circumscribed suppurating pockets and the case be absolutely hopeless.

The symptoms of tubercular peritonitis in its different stages and varieties are so varied that the diagnosis is often extremely difficult and even at times impossible. In very acute cases the symptoms may appear so suddenly and so violently as to simulate an ordinary attack of appendicitis, while in the sub-acute cases the progress may be so insidious as to cause obstruction of the bowel by the large tumor masses, before attention is called to it. In children chronic ascites with fever is good evidence of tubercular peritonitis. If with tuberculosis of other organs there are irregular colicky pains and abdominal tenderness, tubercular peritonitis should be strongly suspected. If there are irregula: tumors in various parts (f the abdomen with tar.cierness, emaciation and fever with or with out ascites, tubercular peritonitis can be diagnosed. In women one of the most common errors of diagnosis is to mistake a circumscribed ascitic accumulation for an ovarian cyst.

The treatment is hygienic, medical and surgical. Taken in the very early stages, from 25 to 50 per cent. of cures result from hygienic and medical treatment alone; consisting of rest in bed, fresh air, anti-tubercular remedies, intestinal anti-septics and sterilized foods. In case the patients condition does not improve satisfactorily or has already advanced beyond the primary stage, the abdomen should be opened, -- being careful not to penetrate the viscera which may be glued to the parietal wall. The fluid should be evacuated. and to avoid a recurrence of the disease the focus of invasiou. as the appendix or the fallopian tubes, should be removed whenever it can be done without injuring the diseased peritoneum. No attempt at breaking up adhesions should be made as the peritoneum is friable, and rents thus made are difficult to close and fistulae are liable to follow. Drainage is unnecessary and only invites infection. The after treatment consists of the ordinary hygienic and internal antitubercular treatment.

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