ceived notion," may fancy that they are dealing with facts when they are only using metaphors; for such are these phrases, "Nature's efforts," "failing to accomplish for herself," &c.-convenient enough as phrases, if we are not misled by them. Now, in this case, the practitioner who recognizes the cause of the illness and removes it, may if you please be acting "in accordance with Nature," but the plain fact is, that he knows his work and does it. As the tooth is growing upwards and the gum is not absorbed fast enough, injurious pressure is the consequence, which the surgeon's lancet removes. This unavailing "effort of Nature" is in more correct language an imperfect process of Nature, remediable by art. So with strangulated hernia, instead of saying that the surgeon "assists Nature to overcome the obstacle," it would surely be at once more correct and more simple to say that he removes it. "To act in accordance with the laws of Nature" comes then to this, that we should know the construction and action of the organism which we wish to rectify, that we should recognize the impediments, and remove them as delicately and tenderly as possible. If an engine is out of order, and the overseer goes about rashly twisting a screw here, drawing a bolt there, putting on the steam, taking it off again, in a hap-hazard fashion, we see at once that he is an ignorant bungler; but if he ascertains some particular part to be clogged or rusted, and clears away the obstacle, he acts, if you so please to term it, in accordance with the laws of the machinery. But there is no difference of system here. It is the difference between action founded upon knowledge, and action founded upon ignorance,-between rational therapeutics and blind empiricism. The word Nature is the parent of many logomachies. Often it is a collective term, representative of all things around us, and of all their qualities and actions. It is also often used to express the causes of things being and doing as they are and do. When the mind fails to discover an efficient cause of an event, which is then an ultimate fact, we say it is the nature of the thing to be so-Nature has so ordered it; or, if we ascend to the First Cause of Nature, we say that it was the will of God that it should be so. But there is a strong instinct in the mind to interpose a power or intelligent agent in the production of events. Hence originated those hypotheses of quoc, Archæus, anima regens, vital principle, &c., now vanished into the world of shadows. If this tendency is yielded to, philosophical investigation is continually liable to the risk of being cut short. The process of digestion may seem to be sufficiently explained by providing a vis concoctrix, and the complex congeries of actions in walking by à vis ambulatria. If phrases of this kind are used only as provisional terms, pending the results of further inquiry, or for the mere purpose of classification, they may be very convenient; but, employed as expressions of causation, they cannot fail to do harm. Dr. Combe, as we have seen, speaks of Nature as making efforts to do this, that, and the other; but I do not think he would say that, in teething, the epileptic paroxysms, the frightful laryngismus stridulus, and the slighter troubles of strangury and colic, are efforts of Nature. Yet they are not artificial they are the morbid products of irritation in the cerebro-spinal axis, proceeding from the extremities of the trifacial nerve in the jaws. In strangulated hernia those terrible tormina, which add so much to the patient's sufferings, are the violent contractions of the tube, excited by its contents, which have been unduly retained in consequence of the mechanical impediment, and which become unusual stimulants to the muscular fibres, just as in the case of the bladder when some sudden stricture has occurred at the neck or in the urethra. Were there no obstacle, these "efforts," as Dr. Combe terms them, would be effectual in propagating the contents, but, as it is, they are preju dicial, and need to be quieted. But how came this obstacle? A fold of intestine slipped into the inguinal canal, the internal ring having been too patent, and some of the contents became gaseous and so distended the gut that In order to determine, concerning any disease, what influence our remedies actually exert upon it, we must first ascertain what will be its course and termination if suffered to go through its usual series of changes without the interference of art. This is a point in the history of diseases to which reference should always be had in deciding upon the principles, or calculating the efficacy of the treatment to be employed. This is particularly desirable in those diseases which, like that now under consideration, have but recently become the subjects of medical observation and inquiry. I have witnessed a considerable number of cases of delirium tremens, in which the patient, after the establishment of the paroxysm, has been left to contend with it, without the administration of any remedy whose tendency was to cut it short, or in any decided way to modify its symptoms. The active treatment has been confined to the period of indisposition preceding the paroxysm; and after its accession articles of a negative character alone were administered, with the exception sometimes of purgatives. The result has uniformly been, that the disease has gone through that regular course, which has been already described in the former part of this paper, and has terminated in the manner there described, at a period seldom less than sixty or more than seventy-two hours from the commencement of the paroxysm. The termination in these cases has also been almost uniformly favorable, except where there has been a combination of the delirium with some acute disease in itself dangerous, or where it has appeared in connexion with some fatal chronic malady. This course has been pursued, I do not mean to say without any deviation, but without any deviation which I believe to have essentially affected the result, in about fifty cases of the several classes which have been described; and although several deaths have taken place among them, none are recorded, except among cases, which I have arranged, whether justly or not, in the third and fourth classes.* It may be stated, in confirmation of the opinion now expressed concerning the natural tendency of the paroxysm to terminate in a spontaneous and salutary sleep at the end of a certain period, that, even in the reports of cases which have been submitted to the public as evidences of the efficacy of various modes of practice, sleep has not actually taken place sooner than it would have done in the natural course of the disease, if the history which has now been given of it be founded on correct observation. In the cases which I have formerly treated with opium, and which have at last terminated well, a salutary sleep has not actually taken place till toward the close of the third day, let the quantity of opium be what it would. I have indeed seen sleep induced by opium at an earlier period, but it was premature; it passed into a state of coma, and the patient died. I am satisfied, therefore, that in cases of delirium tremens, the patient, so far as the paroxysm alone is concerned, should be left to the resources of his own system, particularly that no attempt should be made to force sleep by any of the remedies which are usually supposed to have that tendency; more particularly that this should not be attempted by the use of opium. I do not undertake to say that it can be never right to administer opium for the removal of the paroxysm itself, but I believe it can be rarely necessary, and I have not yet seen a case in which I think that it was. Dr. Ware classes his cases as follows: 1. As the disease occurs as an immediate consequence of a particular excess or excesses in persons not otherwise disposed to disease. 2. As the result of habitual intemperance, without any particular or extraordinary excess. 3. As the disease occurs in connexion with other regularly-formed diseases or as the consequence of injuries, and still having the natural tendency to end in sleep. 4. An irregular form, of a recurrent or less permanent type, not ending in sleep, coming on in the course of other diseases.-ED. V. REMARKS ON THE DISEASES OF VIENNA, AND ON THE COMPARATIVE EFFECTS OF THE HOMEOPATHIC, HEROIC, AND EXPECTANT OR SIMPLE METHODS OF TREATMENT. BY GEORGE W. BALFOUR, M.D. (In a Letter to John Forbes, M.D., F.R.S.) Corstorphine, March 13, 1847. MY DEAR SIR,-You will oblige me by giving a place in your Journal to the few following observations, which I intend as partly explanatory of some statements in my Report (Br. and For. Med. Rev, No. XLIV), and partly as a reply to objections that have been made to some of these statements by your own correspondents and by others. My animadversions on the Homœopathic treatment would be much more effective if I could vouch for the accuracy of a statement recently made to me-which I myself believe, but cannot positively assert to be true-viz., that in the Wiesen district hospital of Vienna, a physician has been treating all his patients with aqua colorata only, and, on being accused of doing so, and therefore threatened with dismissal, has retained his situation by producing his books and showing better therapeutic statistics than his colleagues! Peritonitis.-The startling results obtained by Fleischmann in peritonitis, caused me to make it the subject of strict inquiry, and I found that its idiopathic and too fatal form, so frequent here, was unknown, or at least very rare in Vienna. There it occurs as a subacute, tubercular inflammation usually of circumscribed extent. Such cases I have seen recover under the use of extract. graminis, and, although no cases occurred during my visits to the Homœopathic Hospital, I have no doubt that the infinitesimals would be equally efficacious. The disease is truly peritonitis, but of so peculiar character that there cannot be a more flagrant instance of the deceptive nature of the statistics of names, than to compare it with ours. Gout. This disease, or, as it is called, "die gichtische Dyscrasie," as evidenced by symptoms of portal congestion, is exceedingly common, and exercises its modifying influence on many diseases. Its recognition in relation to those of the eye, forms, indeed, one of the peculiarities of the Vienna Oculistic School. The prevalent use of fermented liquors, wine, and beer, and greasy sauces, are looked upon as its causes. It is at best a hypothetical erratic gout, and comparison with ours leads but to misconception. Bronchitis. This is a comparatively rare disease in Vienna, and, compared with the frequency of pneumonia, it is most strikingly so. I could name some other peculiarities of the Vienna class of diseases; no less striking, and still less easily explicable. Thus, during the ten years preceding 1845, we have in Fleischmann's tables, as published in the Austrian Journal of Homoeopathy, 4 inflammations of the aorta, all cured; 2 of inflammation of the spinal cord, cured; 3 of ulceration of the stomach, discharged unimproved, and 2 cured; 4 cases of white swelling of the knee-joint, cured. Intermittent fever. Of the 30 patients who had intermittent fever and were treated by Fleischmann, the average number of attacks was 47; while under Skoda's treatment, the average number could not be more than 3, and was most probably under this. The number of his patients was, I believe, at least as great as Fleischmann's-if not greater; his cases were as severe; the patients were afflicted with the same epidemic, during the same season, inhabited the same town,-many of them the same quarter-and belonged to a similar rank in life. They were treated in undoubtedly less advantageous circumstances with respect to food and lodging—yet all were cured. In no one case was the number of attacks more than 4: and in none did the fever recur while they continued under observation: they were therefore cured speedily, safely, and effectually. If it be true that none but homœopathic remedies are capable of effecting this, then Skoda's remedies must have been homeopathic-but they were not so, were not infinitesimal. Were homoeopathy true, it would be very extraordinary that a physician practising empirically like Skoda, should have so simply and effectually cut short the disease, while a scientific homoeopathist of experience, with his carefully and scientifically selected array of China, Quinin, Ipecacuanha, Nux vomica, Arsenic, and Aconite, was unable to do so. It is still more singular that, although it is evident from the results of Skoda's practice that Quinin was indicated in the greater number of cases of this epidemic, it fared no better with those of the homoeopathic patients who got this remedy infinitesimally than with the others. In corroboration of the obvious inference from these facts, we might quote the confessions of the homoeopathists themselves, or of those who have been reconverted to allopathy. Thus, Kopp states that this disease can neither be certainly, quickly, nor pleasantly cured by the infinitesimals. Nay, he quotes avowed homoeopaths, Gross, Rummel, (Egidi, and Hauptmann, to the same effect. It must be admitted, however, that while acknowledging this, and in certain cases flying to allopathic doses of quinine, these gentlemen look upon their non-success as merely an imperfection of the youth of their system, and hope yet to discover the true, i. e. homœopathic, specific for ague. Gross expressly states that ordinary homeopathic remedies only cured ague excep tionally, and that antipsoric remedies alone fulfilled his expectations. But, as Kopp says, this is too bad to submit the poor patients to a method of treatment which allows of the renewal of the dose only after 4 or 6 weeks.* Kopp also tells us as the result of his own experience (s. 184), that even where the remedy (China) was homoeopathically indicated, and given in infinitesimal (Hahnemann'scher) doses, it had no influence over the appearance or diminu tion of the intermitting fever; while, on the contrary, when given in substance in sufficient dose (as sulphate of quinine, 2 grs.), it speedily cut the fever short. I think there can be, therefore, but one opinion as to which method of treatment for this disease is the preferable. But what are we to think of a system whose very foundation-stone is so unstable? For, as is well known, it was the action of cinchona that first led Hahnemann to think of his new theory. Dysentery. In my Report under the head of dysentery, one case will be found in which the amelioration of the symptoms was curiously coincident with the administration of the Homoeopathic remedies. I say coincident, because in the first case, which greatly resembled it, the same remedy was of no avail; and we also know that however medical men have been accustomed to regard the disease as demanding the most active treatment, more especially in warm climates, we know that many cases of dysentery may, nay do, recover without it. I may refer for an illustration of this fact to the case of a patient, a physician, as narrated by himself. Away from all friends and without medicine, he was seized with dysentery while voyaging on the Nile in an open boat; after a partial recovery he relapsed, and using nothing but hot fomentations finally recovered, after about a week's illness, and this during continued exposure. He adds, "during a precisely similar attack in India, I got 216 grs. calomel, was bled at the arm, had 50 leeches applied, and used mercurial frictions; in spite of this heroic treatment I recovered, but in such a state as to require 6-8 week's furlough to recruit."+ Again, Dr. Smith ‡ mentions the case of a Frenchman who cured himself of Denkwürdigkeiten in der ärztlichen praxis, s. 290. + Cumming's Notes of a Wanderer in Search of Health, p. 277. a dysentery after 13 relapses, by semistarvation; and of a medical man who trusted to this alone for the cure of his patients, and found it undoubtedly successful in many cases, though in others it was too reducing. There can, therefore, be no doubt that dysentery may recover without any active treatment whatever. Skoda's treatment consists in giving injections of tincture of opium or sulphate of zinc, and, if these fail, of corrosive sublimate, which he looks upon as the ne plus ultra. In corroboration of the occasional usefulness of these stimulating injections, Dr. Smith (loc. cit.) mentions the case of a boy who, instead of a little rum and water as a drink, got a whole syringeful of pure pale rum per anum. The boy became intoxicated, fell asleep, and awoke quite recovered from a dysentery of some months' standing. In Skoda's hands these injections prove very successful. Pneumonia. In the cases of pneumonia observed by me in the Homœopathic Hospital, there were one or two coincident cures; in most, however, the symptoms were either aggravated or run their course, or merged in others, apparently uninfluenced by the remedies. I question not the homœopathic correctness of the selection of the remedies, for most of the cases were treated with Phosphor., and Fleischmann has said, that any pneumonia incurable by Phosphor., is as yet incurable homoeopathically, and other homoeopaths have corroborated this. Who am I, therefore-heretic, as I avow myself-that I should gainsay this deliberate opinion of the initiated, founded on the experience of years? In regard to the aggravations, I acquit the remedies of all blame in their production, just as I deny them all merit in the ameliorations and eventual cure. Surely it is much more natural and consonant with reason to believe that these and all the other cures hitherto of the homoeopathists are natural cures-effects of the too-much neglected vis medicatrix. And I will even go so far as to doubt whether Fleischmann himself will not here agree with me; for I have heard him say that, out of 1000 cases treated, he did not believe that above 200 were cured; the rest got well. And where is the proof that even these 200 did not also get well? Were not even the most remarkable cures merely coincidences? Every quack medicine, however ridiculous or inert, either in an allopathic or homoeopathic point of view, has also, as everybody knows, its numerous extraordinary cures, or coincidences. It would be remarkable if homoeopathy had none. Even under Skoda's treatment such occur; yet, according to our ideas, his treatment is equivalent to nothing; according to the homoeopathists, it must be worse than nothing. And yet, as we have seen, the patients recovered perfectly, aye, and speedily,—the average duration of treatment in acute cases being under a fortnight, about 9 to 10 days. A few cases of a chronic character remained in the state of hepatization for weeks, but these had been generally some time ill previous to admission. The most remarkable fact with respect to the pneumonic patients treated without active interference is, that however much they may suffer for a time, on the disease breaking, the recovery is extremely rapid, insomuch that the general health seems almost as strong in a day or two as it was before the attack: there is no tedious convalescence. This remark applies both to those treated by Skoda, and by the homoeopathists. The completeness of the recovery was ascertained in one by dissection. The patient, a woman, died a week or two after dismissal from a heart complaint under which she had long laboured. Both of her lungs were found perfectly healthy, and permeable by air in every direction, although one had been completely hepatized. Skoda does not, however, always trust to Nature. When the dyspnoea is very great at the commencement of pneumonia, or pleurisy, he bleeds, but never after hepatization or effusion has taken place; as he believes that abstraction of blood lessens the chance of a speedy and complete absorption of |