tastatic gout. When there are decided febrile symptoms present, it should be alternated with Aconite or Gelseminum.

Cannabis-indica is also a remedy of great value in cases of this kind.

5. ARTHROPATHIE.-INFLAMMATIONS OF THE JOINTS.

ARTHROPATHIE.-WHITE SWELLINGS.

The Diseases of the Joints are divided into two grand divisions: A. DISEASES OF THE SOFT PARTS.

External.

Internal

Capsular

White swellings of Bell; and diseases referred by Brodie to the ligaments.

Hydarthrus.

B. Cartilaginous, superficial, bony and

deep-seated or parenchymatous bony arthropathie.

All of these forms of arthropathie may be, either rheumatic, scrofulous, tuberculous, syphilitic, scorbutic, cancerous, &c.; or simply inflammatory.

1. Extra Capsular Arthropathie.-Stiffness, pain, irregular swelling, without effusion into the joint. This is generally a slight disease requiring some treatment corresponding with other phlegmonous, erysi pelatous affections, or mere engorgement of the subcutaneous tissue, perhaps the bursæ mucosa. If purulent collections are discovered we have to use the bistoury.

2. Pure Capsular Arthropathie.-Caused by sprains, external violence or rheumatic affections accompanied with pain on certain movements, aud sometimes increased by pressure. These causes produce a swelling of the extracapsular layers, which leads to internal effusion. It is a more serious lesion than the preceding; and it often proceeds forward to more serious disease yet to be described. It requires the most careful but efficient medication. Allopathic treatment involves "resolvent ointments, large blisters, compression and mercury."

3. Specific or Blenorrhous Arthropathie.-This comes on suddenly; it is soon characterized by an abundant effusion; with little pain in the first stage, it acquires all the characters of an acute arthritis in the second. The common treatment is rather evacuant and revulsive than antiphlogistic; blisters, mercurial frictions, compression, evacuants, embrocations. They are never successful.

4. Fungous Arthropathie.-This is sometimes a primary, though oftener a consecutive disease; always mild, little painful. It is announced by an elastic, thickened enlargement, sometimes rolling under the finger, like a foreign body; occasionally, without effusion, the joint. may acquire an enormous volume, without absolute hindrance to loco

motion. It is generally serious from its obstinacy, sometimes resisting every thing. It never yields to bloodletting. The surgeons rely chiefly on blisters, resolvent ointments, cauteries, moxas, setons, escharotics, compression and debilitating doses of calomel. Brodie speaks of this case as one of "morbid change of structure," which he thinks to arise from "morbid action in the synovial membrane, which loses its natural organization (like the fungus articuli of the German writers,) becoming converted into a thick pulpy substance of a light brown or reddish color, intersected by numerous white lines. The disease seems to be peculiar to the synovial membranes having some affinities with tubercle, scirrhus, and fungus hæmatodes, in all of which the natural character is destroyed and a new one added. This change is most common in the knee-joint, where it is usually attributed to cold or sprains. In some cases we find what are called loose cartilages.

5. Pure Synovial Arthropathie.—Hydarthrus.-This is a dropsy of the joint from inflammation of the synovial membrane, and subsequent effusion. It is essentially characterized "by a serous effusion without pain, or sensible thickening of the articular envelops, slightly hindering the movements of the joints. Here the surgeon has generally resorted to purgatives, mercurials, Colchicum or diuretics, associated with large blisters and resolvent frictions," and generally with very little success. All of these forms of disease have the common character of swelling and superficial pain from the beginning; and they never last long without changing the form of the part. The synovial membrane is proved to extend over the cartilages of the incrustation and the interarticular fat, as the conjunctiva covers the cornea; and it has a strong functional and anatomical resemblance to the serous membranes. It seems that the disease seldom or never originates in the ligaments, but almost always in the synovial membranes, which are quite as often diseased as any part of the body. Cruvelhier says (Dict. De. Med.) the disease consists in nineteen out of twenty cases, of a chronic inflammation, commencing in this membrane, even when other tissues become involved.

B. 6. Cartilaginous Arthropathia.-This consists in an ulceration of the articular cartilages and of the synovial membranes investing them. There is a mechanical affection embracing ulceration and contusion of the cartilages and ulceration of the synovial membrane; or from the pressure of the cartilaginous surfaces on one another: it may be compared to a crushing, wasting, or excoriation of the organic plates. It comes on suddenly, and is announced by a crackling and by acute pain that ceases entirely while the limb is still, and recurs on certain movements. It is sometimes complicated by extending to the bones. A cure is commonly effected by absolute repose, or after the disappearance of the cartilaginous rugosities.

7. Superficial Arthropathie of the Bones.-This is generally over

looked, as its cause is internal. It is announced by a dull pain where the joint is at rest, and acute intolerable pain is excited by the smallest motion. The effusion, swelling, &c., are secondary. The surgeons usually begin its treatment by bleeding, cups, leeches, mercurial purgatives. All of these measures, however, fail to give relief, and they resort to embrocations, blisters, or compression; then to moxas, the cautery, and, especially, absolute rest. They generally resort at last to amputation, or the inflammation terminates in anchylosis.

8. Deep-seated Artropathia of the Bones.- Scrofulous Disease of the Joints.-When it involves the epiphyses and not the shafts of the bone it is regarded as having its origin in the cancellous structure of the bone and has a malignant character. There is a dull deep pain during motion as well as when at rest; worst at night; there is no heat or swelling at first. It may last for months or years without effusion; sometimes it invades the cartilages of the incrustation, producing an excessively painful affection. It often embraces the head of the bone, where it gives rise to symptoms of mild acute inflammation, and finally assumes the character of exostosis with inflammation or ostitis. It is always tedious, often requiring amputation, and never ending happily until the elimination of the necrosed or altered tissue. It requires internal remedies. The common treatment consists of blisters, cauteries, moxa, but avoiding compression and other topical applications. Pain, the primary symptom of disease of the hard parts may exist for weeks or months without swelling. (M. Velpeau, Memoir sur les Tumeurs Blanches. Exposition nouvelle de ces Maladies, par Gustave Jeanselm, Paris.) TREATMENT.-The appropriate remedies in these cases are, Sulphur, Silicea, Calcarea-carb., Iodine, Rhus-tox., Arsenicum, China, Phosphorus, Acid-phos.

In order to prove effective these medicines must be given in the high attenuations, and be repeated at long intervals, in strict accordance with the directions of Hahnemann.

An expert selection of the remedies, high potencies, very rare repetitions of the doses, and patience, have often enabled homoeopathic physicians to perform cures which have amazed the surgeons of the old school. In these cases such a regime should be enjoined as shall promote the general health and rigor of the system.

Compression is a resource of great power. Apply a roller bandage so as to fill up all external inequalities; begin the application below the joint and extend a few inches above it. Blisters, ointments, &c., can be used at the same time. We may make permanent compression by pasting each surface of the bandage by starch or paste, and applying pieces of paste-board, as is often done in dressing fractures of the extremities. The patient may now rise and walk; and it is almost impossible for the joint to swell again.

ORDER IV.-DYSTHETICA.-CACHEXIA.-ABNORMAL CONDITIONS OF THE CIRCULATION DEPENDENT ON DETERIORATIONS OF THE BLOOD.

MICROSCOPICAL EXAMINATION OF THE BLOOD.-The red globules in man are small round discs, of which the central part of each appears shadowed or transparent, according as it is approximated to or removed from the focus of the lens. The central part seems to be the thinnest of the globule, which is depressed on both sides; and when placed on the field of the microscope, it presents the appearance of an elongated 8. The edge forms a thick ridge all around, more colored than the central part. The size of the blood globules varies in different animals. The elephant has the largest globules, among the mammalia, and the ruminantia the smallest. (Mandl. Anatomy and Physiology.)

The blood globules are suspended in a colorless fluid called plasma 1 quor sanguinis, or serum. In frogs it can be separated from the globules by filtering, though human blood can not be filtered.

White Globules. These are small colorless finely granulated corpuscles, soluble in water, and strong refractors of light. Some are round and include two or three granules; these are true lymphatic globules, arising at least in part from lymph mixed with blood. The other white globules are also generally round, though sometimes oblong, or irregular, with edges slightly serrated. They are the product of the coagulation of the fibrin. (Mandl.)

State of the Blood in the Vessels.-Many authors have believed that the blood possessed some mysterious powers of vitality. According to the observations of Kolk, Treviranus, and others, the globules of blood possess a rotatory motion during life, independently of the motion arising from the impulse of the heart; and this motion continues till coagulution takes place. Schulz of Berlin has shown that the blood globules have a power "by which they move on by themselves, surrounded by envelops of coloring matter, and keeping at a distance from each other." Copland imputes this force to the influence exerted by the ganglial nerves on the interior of the vessels on which they are distributed. (See Vol. I. p. 843.) To this force of mutual repulsion we attribute the fluidity of the blood; but there is another force by which the blood globules are attracted by the tissues when brought in contact with them in passing through the minutest vessels. This latter force, first examined by Schultz, "may be compared to a vortex, whence globules constantly pass from the arterial or terminal capillaries, and are lost in the different tissues. So that although the vital endowment of the blood is manifested by its fluidity

VOL IL-12.

in the vessels, it assumes an opposite manifestation in the capillaries, where this fluid is brought within the sphere of the vitality of the dif ferent structures; each one attracting from it those constituents of which itself is formed, and which are always present in healthy blood" "Thus we see organization commencing in the chyle, advancing further in the blood, and reaching its acme in the vital attraction of the constituents of the tissues from the blood circulating in the capillaries which supply them. At this part of the circle, where the arterial capillaries, with the fluid circulating through them, become, as it were, confounded with the tissues in which they are distributed, there appears to be not only a constant attraction of particles by the tissues from the blood, but also an equal extrication of other particles from them into the blood received by the radicles of the veins." (Schultz.) Coagulation of the Blood. In the process of coagulation the red globules of the blood are principally concerned; "it being chiefly the result of the loss of the vital motion which these globules possess in the vessels, and of the attraction existing between the coloring envelops and central bodies. As the vital attraction which keeps the red substance fixed around the whitish corpuscles, ceases soon after the removal of the blood from the veins, these bodies can then obey the force which tends to unite them, and they then form a net-work, in whose meshes the liberated red particles are entangled, and thus produce the phenomena of coagulation. If the coagulum be exposed to a stream of water, the colored matter is washed away, while the aggregates formed by the colorless corpuscles remain in the form of filaments in which may be recognized an analogous structure to muscular fibre, and constitute the fibrine of the blood.

The phenomenon of the coagulation of the blood, is due to the evaporation of its ammonia, on exposure to the air. The blood is retained. in a liquid state in the blood-vessels by the pressure of ammonia; and just in proportion to the loss or diminution of this substance, will it retain or lose its fluidity.

This may be readily demonstrated by draining blood from the arm into an exhausted receiver. Thus excluded from the oxygen of the air, it remains fluid; but if we expose it and collect the products of evaporation, it coagulates, and ammonia is found as one of the products of evaporation. This coagulated blood may be again redissolved, by incorporating ammonia with it at the proper temperature.

A knowledge of this fact may prove useful in many maladies which are accompanied with more or less decomposition of the blood, as diphtheria, typhus, malignant scarlatina, yellow fever, &c.

PLASMA.-Constituents of Plasma.-Water, fibrin, albumen, colorless corpuscles, votatile matter, fatty compounds, and salts.

Plasma passes through all the capillary vessels, permeating all or