pieces like bran. The genital organs were always quite flaccid; the lad had never had emissions or practised masturbation; there was no discoverable affection of the spine. The boy's father had cavernous phthisis, and in the patient himself the chest had the build peculiar to consumptive subjects. He was ordered meat and beef-tea three times a-day, and very little vegetable food. Having been consulted in 1831 by a person who said he had been cured of diabetes by drinking the waters at Carlsbad by Hufeland's directions-relata refero—and having, by the way, great faith in soda springs, I made him drink one or two glasses of the water of the castle-spring here (Dresden) for three weeks but without the slightest effect. Then he got Hydrosulphate of Ammonia with the same result. Acid. nitr. and mur., Carbo.-veg., Coloc., Chinin. sulph., Argent. nit., Kreosote, Zinc.-met., and Arsen. were equally ineffectual. Aphthae formed in the mouth and throat; then violent vomiting came on; then sudden sopor, and the patient sank under the symptoms of paralysis of the lungs. The sectio cadaveris revealed hyperaemia of both kidneys, on squeezing the full-gorged papillæ of the calyces there oozed out a fluid resembling milk and pus in colour and consistence; the pelvis and ureters were much dilated; the liver healthy; the spleen rather shrunk, pale, and anaemic; the intestines and mesenteric glands natural.

Summary. All observations up to this time have only had the effect of settling the constant nature of the phenomena of diabetes mellitus; the greater or less saccharine quality of the urine and its immense quantity, greatly surpassing that of the ingesta. My weekly analysis shewed the amount of sugar to augment as the disease gained head. The other phenomena observed are secondary and necessary consequences of the wasting that is going on in the body; science affords us no information as to the causes, nature and development of this still mysterious complaint, but only offers hypotheses and conjectures insufficient to base a plan of treatment on, or to yield indications for the choice of a remedy. The relation existing between this disease and tuberculosis is easily discerned. In the first of my two cases phthisis proceeded pari passu with the diabetes; in the second, the system was hereditarily predisposed to consumption. The specific remedy must be one which, besides causing increased renal secretion, can determine the kidneys to discharge

sugar, which is easily detected by adding muriate of tin to the urine; but as we do not yet know any medicine which answers these two conditions, we do not possess any specific remedy for diabetes. We may anticipate, from the constant character of the pathognomonic signs, that the medicine, when found, which can give rise to saccharine urine, will cure it in every case, because all diseases with constant, invariable symptoms are always curable by one medicine. Lastly, diabetes mellitus is to be regarded as a specific local disease of the kidneys, in which, through a functional disturbance of these organs, the sugar naturally contained in all healthy blood is eliminated in increased quantity along with the other constituents of the urine.

CONTRIBUTIONS FROM PRACTICE.

BY DR. GENTZKE, of Bützow.*

I HAVE for years withheld contributions of this nature, both because fewer noteworthy cases have occurred in my practice than heretofore, and still more because the experience of the last few years has brought me, as I doubt not it has many another, to look with the utmost distrust on accounts of cures. Hence I feel very cautious and even reluctant to swell the number of such histories.

As to the cases here presented, I have to remark that they contain nothing extraordinary, either from extreme rapidity of the removal of the complaint, or its rare occurrence or difficulty of treatment. I only claim to have, to the best of my knowledge, recorded cases in which I could be sure that the favorable result was owing to the employment of the medicines, and to have used every precaution against all the fallacies which so easily beset the practitioner.

Phthisis pituitosa.

This complaint is not an uncommon one in other countries, but is extremely common in this low-lying vale of Warnow and in the close neighbourhood of the Baltic, so that I have treated

*From the Hom Vierteljahrsch., Vol. ii.

a great number of cases during a series of years. On the other hand this disease has been the cause of many mistakes, and I may state as a fact that by far the greater number of instances in which patients are supposed to have been cured of developed phthisis have arisen from its being confounded with this complaint, which hence acquires on this account additional interest. That this is really the case any one may convince himself by subjecting the great number of recorded cases of cure of phthisis in our homœopathic literature to critical examination. There can be no doubt as to the modern method of research by percussion and auscultation of the thorax having powerfully contributed to fix on a firm basis the diagnosis of diseases of the lungs; and while it cannot be matter of reproach to the elder practitioners that they, wanting this important assistance, committed the errors they did, those deserve to receive a public rebuke who in the present day, after we have for so long a time been in possession of this means of diagnosis, pronounce from the professorial chair a case of blennorrhoea from the lungs to be pulmonary consumption. Several such instances, however, have come to my own knowledge.

The prevalent confusion between the two complaints has contributed to the common idea that phthisis is much less serious when the individual attacked has reached thirty or even forty years of age; for it is well known that phthisis tuberculosa falls especially upon the period of youth and development, whereas blennorrhoea of the bronchial mucous membrane generally befalls persons of mature age.

Among the remedies which I have found useful in this affection, China and Arsenicum occupy the foremost place. In many instances where the complaint had reached that stage in which it threatened to pass into catarrhus suffocativus, where the patient sat up in bed panting for breath, with but momentary intervals of relief after having succeeded in coughing up a quantity of mucus, I have seen these two medicines remove all the dangerous symptoms even at the most unfavourable season of the year, and the condition of the sufferers rendered very tolerable. Indeed the striking effect of these remedies in the affection in question led me to adopt a practice which I have

since made a custom of, that of giving them in alternation. I certainly cannot entirely justify it, as experience thereby becomes less pure and distinct, but I must put forward as my excuse the excellent results that attend it.

A vast majority of the persons I have treated for this affection have been in advanced life and had laboured under it for years, so that it had in a measure become part of themselves. I never cured any such radically, but am well pleased when I can effect a considerable assuagement of their malady, and carry them safely forward into the good summer season, which usually sets limits to the intensity of the complaint. But I have frequently cured it occurring in younger persons or in elderly ones possessed of healthy constitutions, and where there was no complication of disorders. Whereas I never have succeeded in effecting a cure in any case of developed phthisis pulmonalis. The following two cases are, I think, worth communicating.

Marie L., aged 22, daughter of a miller near Rostock, of leucophlegmatic habit of body, had in her youth evidenced her scrofulous taint by affections of various organs, especially the eyes, and a speck on the cornea remained to mark the occurrence of scrofulous ophthalmia. She was not menstruated till 17 complete, but thenceforth regularly though scantily, usually with crampy pain in the hypogastrium, till the present complaint began. In her 19th year, in the autumn of 1844, she had influenza severely, which left behind it as a permanent ailment a cough attended with moderate expectoration; her general health was little affected. The following year, having undergone great fatigue in washing, and caught a severe cold in stormy weather, she laid the foundations for serious disease, and from that time coughed much with profuse expectoration, while her strength declined and her flesh wasted, notwithstanding all that could be done by her two allopathic attendants during a couple of years. Latterly the complaint, so far from giving way, increased to such a degree that Dr. T., the physician last consulted, pronounced her case one of incurable pulmonary consumption, and advised a purely expectant treatment, as medicine could do no more for her. In February 1847 her father sent for me to see her, when I was visiting a landed proprietor in the neighbourhood, and I then drew

up the following account of her actual state. The patient, who is rather above the common height, has got very thin and stoops much; face pale, eyes dull, sunken and dark-circled; she is extremely weak and weary all the day, and sleeps ill and coughs constantly at night. She complains of great tightness of the chest, especially in the region of the manubrium sterni, and most felt in walking; continual cough, with expectoration of a quantity of phlegm, which is usually colourless and albuminous, except in the morning, when it is rough and yellowish, and floats on water, and this phlegm, unlike that at other times, it only got up after painful and powerful efforts of coughing with retching, and sometimes actual vomiting. On examining the chest I find there is but slight acceleration of the breathing so long as the patient keeps still, and she can draw a pretty full breath, with uniform expansion of her rather capacious chest. Percussion gives a clear, sonorous result everywhere except over the lower part of the sternum, where it is rather dull. On auscultation I can perceive the normal respiratory murmur; there are bronchial râles here and there, whistling and rattling, and particularly loud near the bifurcation of the trachea. Appetite has fallen off; thirst felt periodically; has a slimy taste in her mouth. In addition to these symptoms the patient mentions being sometimes shivery, and that she perspires usually in the morning, after coughing. Pulse small, soft and rather accelerated, 90 to 96 per minute. She has not been unwell for eighteen months, and both her feet are oedematous, especially at night.

The appearance of the patient, together with the above-named physical signs, led me to regard the diagnosis of the former medical attendants as mistaken when they pronounced the disease phthisis pulmonalis, and I was convinced it was bronchial blennorrhoea, and therefore gave a rather favorable prognosis, which the parents heard with incredulity. The diagnostic marks, which in greater or less degree are present in every case of advanced phthisis, were wanting, such as tuberculous matter in the sputa, dull sound on percussion over a limited space, especially under one clavicle, cavernous râles, and pectoriloquy along with hectic fever and colliquative sweats;nothing of all this was to be observed.

I commenced the treatment on Feb. 10th with Dulcamara 6, of which the patient got a dose every evening. In a fortnight I heard that the dyspnoea had somewhat diminished, the appetite somewhat increased, but that all the other symptoms remained much as they