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ingly painful malady, and thus far has only been amenable to treatment during its early stage, when it requires very intelligent observation for its detection.

Two forms of the disease are recognized-first, a central type, and, secondly, a peripheral one. The symptoms of the central variety depend upon changes in the coats of the arteries of the brain and spinal cord, while those of the peripheral form arise in consequence of sclerosis of the arteries of the extremities, usually those of the legs, the anterior tibial, and the peroneal being the most frequently involved.

The essential symptom of intermittent claudication is painful periodic lameness, coming on while taking exercise, accompanied by pricking sensation, aching in the limbs, stiffness in the muscles involved, and a climax of such intense pain as to require immediate cessation of all exercise. Relief quickly follows rest. After a time the patient is fairly comfortable,—in fact, he is free from pain, except on prolonged exercise; thus he can walk about the house or office or he can use his arms in moderation without bringing on the pain, but if he attempts to extend his walks to several blocks in distance or to increase his arm exercise to any great degree, the severe agony quickly returns and he is compelled to desist. If the case is one of cerebral type, the reflexes are exaggerated; and if the medulla is involved, there are local or general flushings or sweatings, showing vasomotor disturbance. In the peripheral type the sclerosis of the walls of the arteries can readily be felt.

Flat-foot is a common complication, and when present should receive careful attention.

There is only one disease which resembles intermittent claudication, which is Thompson's syndrome, but the differentiation is readily made, as the etiology and pathology have no resemblance.. The writer's experience with this disease has been limited to one classical case, although he has observed several atypical The patient is a man a little past sixty years of age. He has always been active in business and temperate in habits. His heredity is good, and is entirely free from any history of arterial disease.

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The first evidence of the onset of the muscle block was displayed by a sense of great weariness after his day's work was done, which generally included very considerable walking. Later

this tired feeling came several times during the day, and gradually he noticed that it was accompanied more and more by a feeling as if his legs went to sleep.

After several months of such symptoms, with a tendency to grow more severe as time went on, one day the pain compelled him to stop in the street and sit on the curbstone until it was better. That night he complained of coldness of the legs and cramps in the calves.

Gradually such paroxysms of pain came more frequently, and the distance he was able to walk without pain lessened until he discovered that a quarter of a mile was his limit of comfort. Finally, any distance caused almost unendurable agony.

For several months he was confined to the house, and during five or six weeks of this time he was greatly harassed by such complicating symptoms as sleeplessness, coldness of the extremities in spite of constant artificial heat, and an attack of cardiac asthma, which seemed to threaten the patient's life.

His sufferings were nearly intolerable, and the outlook continued gloomy. Under various carefully prescribed remedies his condition slowly improved, and he became able to resume his regular employment. One evening he retired to his room to prepare himself for dinner, but the time passed and he failed to appear, when a member of his family went to his room to discover the cause of his delay; he was found on the floor unconscious from a left-sided cerebral hemorrhage. He partially regained consciousness, but died that night.

Now that the condition is recognized as a disease with diagnostic symptoms, it may soon be possible to treat its earliest manifestations with success and save years of suffering to its unfortunate victims.

ARGENTUM NITRICUM.

By J. S. HUNT, M. D., Santa Monica, Cal.

Argentum nitricum is described by Allen as an irritant poison causing inflammation and ulceration of the throat and stomach and mucous membranes generally.

It attacks and destroys the red corpuscles of the blood, causing general malnutrition, especially ecchymosis.

It increases the flow of bile and causes degenerative changes in the liver and albuminuria.

It depresses the temperature.

It produces violent tetanic convulsions followed by paralysis. Provings of argentum show that the drug expends its energy particularly upon the gastroenteric system, the urinary and sexual organs, the skin, the spine, and upon the mental functions. Its action upon the throat is inflammatory in appearance, the uvula and fauces are dark red; there is thick tenacious mucus, and a feeling as of a splinter in the throat when swallowing. Hoarseness with dry cough and suffocative breathing and sighing respiration.

It is a remedy par excellence in chronic throat troubles of singers and public speakers.

Eyes-Bloodshot, extreme photophobia, agglutination of lids, profuse mucopurulent discharge and perhaps blindness.

The remedy is especially indicated in the purulent ophthalmia of new-born children.

Stomach-Nausea and vomiting, painful swelling or feeling of fulness in pit of the stomach, stinging or burning ulcerative pain. Craving for sweets is a keynote symptom.

Indicated in gastritis and gastric ulcer and in gastric derangements resulting from over-indulgence in sweets or in alcoholic. beverages.

Judging from the apparent popularity of the flowing bowl and the bon-bon box, it would appear that few remedies in the materia medica are more frequently indicated, and this in truth is the keynote of my paper.

Argentum nitricum has proved such a power for good in my hands and its action has been, in a great many cases, so unmistakably effective that I feel like urging its broader use, or at least a more frequent consideration of its symptomatology.

Referring to its action upon the intestinal tract, we find that it produces flatulence, distention and pain, with frequent evacuations of green mucus or perhaps bloody stools looking like chopped spinach. Hence we find it frequently indicated in diarrhoea or dysentery with the above characteristic symptoms; and here, too, it will not fail to give satisfaction both to the patient and physician.

It is an excellent remedy in diarrhoea resulting from mental

emotion.

The most prominent symptom to be kept in mind is the grassgreen stool.

Upon the genito-urinary organs the action of the drug is no less marked, causing nephritis, cystitis, urethritis, inflammation of the pelvic organs and sexual irregularities.

There is frequent and painful urination, with the striking symptom often present as of a splinter in the urethra, the same characteristic mentioned above in relation to the throat.

Incontinence of urine; sometimes bloody.

The remedy is indicated in the early stage of gonorrhoea with profuse purulent discharge and intense cutting pains.

The most noticeable effect of a toxic dose of argentum on the skin is the pronounced discoloration, usually of a bluish gray. At times a pustular eruption will result, with intense itching or pain. The skin upon the lower limbs may be brown, tense, and hard.

The remedial effect of argentum, internally administered, in skin diseases is very limited, owing to the fact that there are but few skin lesions in which it is homoeopathically indicated.

Its action upon the heart and chest is to cause palpitation and irregular action of the heart and a feeling as if a heavy bar lay across the chest. Indicated in angina pectoris, with intense pain and dyspnoea.

Upon the back and lower limbs its action is marked. Pain in lumbar region with heavy paralytic feeling extending down both legs. Difficult to arise, but feels better standing. Chorea-like motions, cramps, inability to walk with eyes closed, and a feeling of great fatigue are the most prominent symptoms. Hence its indication in many forms of nervous troubles, such as hysteria, chorea, convulsions, locomotor ataxia, paraplegia, and especially in the paralysis of the lower limbs.

Argentum also causes marked mental changes-confusion of thought, weakened memory, faltering speech, stupid or anxious expression, tremulous weakness, extreme depression, insomnia, and horrible dreams. It is a valuable remedy in melancholia, especially if resulting from excessive mental application or worry and if any of the gastric or abdominal symptoms of the drug are present, good results may be confidently expected.

The uses of silver nitrate locally are well known and need no mention here.

I will say in conclusion that I prescribe the remedy very frequently and have learned to rely upon it with the greatest confidence, the largest experience and best results being in the treatment of gastric and intestinal disturbances, both acute and chronic.

LEUCOCYTES AND LEUCOCYTOSIS.*

By H. J. WRIGHT, M. D., San Francisco, Cal.

Almost all histologists and hæmatologists classify under four heads the leucocytes occurring in the peripheral blood in the healthy state: (1) the polymorphonuclear or polynuclear neutrophiles; (2) the large mononuclear or large lymphocytes; (3) the small lymphocytes, and (4) the eosinophiles. Under normal conditions these various forms of colorless blood corpuscles are present in about the following percentages:

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Mast-cells and transition forms are also included by many authors, but very little importance has as yet been attached to their presence, probably because of the very small number of them making their demonstration difficult. Pathologically there is but one additional form of leucocyte, the myelocyte.

For many years leucocytosis was considered and described as a mild form of leukemia, but by the advancing strides in laboratory technique of a few years back and even to the present day, it has been proved that they are two quite different phenomena, different not in the number of cells, but in the kind of cells present. in increased number. In this paper we will deal with definitions of various phenomena affecting the leucocytes, which are not infrequently misinterpreted, and with the physiologic changes met with under the study of the varieties of leucocytes. It is the rule that physicians and surgeons accept as a leucocytosis any and all counts in which the leucocytes (all varieties included) are increased beyond 7,500 cubic millimeter without taking into con

*Read before the San Francisco County Homœopathic Society.

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