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that in an essay professing to deal candidly and manfully with a question of so much importance for considering only the extent to which homœopathy exists throughout the world it is of much importance the unchallenged records of some public hospital, such as that attached to the Hotel Dieu of Paris, where Dr. Tessier treated* his patients homoeopathically, or the hospital in Vienna, where Dr. Dietl treated + so many of his on the expectant plan, should have been selected for a grave and earnest discussion of the subject. These, and such as these, are the sources from which alone materials sufficiently abundant, and entirely free from the interferences which are liable to disturb and deteriorate those which are collected in private practice can be derived; and it is on materials acquired from such sources that physicians of the homœopathic school have almost exclusively founded their public assertion of the superiority of their practice over the allopathic. But the essayist, for certain very obvious, if not very creditable, reasons of his own, has preferred selecting for his animadversions an insignificant number of cases which I have adverted to as having occurred in my private practice, His words are:
"Dr. Henderson has taken occasion to inform us in one place, obviously, though not statedly, for purposes of numerical comparison, that he had treated homoeopathically throughout 16 cases of pneumonia with one death. To this statement, considered merely as a statement, I do not object; but if we are intended to draw the inference from it, that the homoeopathic mortality of pneumonia in Dr. Henderson's hands has been 1 in 16, then I must observe that such an inference, however naturally resulting from the facts stated, would be grossly incorrect. For in a detailed record of eleven cases of pneumonia homoeopathically treated, published in the Homoeopathic Journal for 1850, Dr. Henderson incidentally notices two very severe and complicated cases, in one of which he himself, in the other the friends of the patient, became dissatisfied with the results of the homoeopathic treatment, and both of which cases ended fatally, after passing into the hands of another physician. Such events are known to be common in the practice of most homœopathists; the alarm of a really severe disease being generally all that is required to send men away from infinitesimals in quest of active remedies. Indeed, I suppose that few instances of really severe and fatal disease are ever treated 'homoeopathically throughout' in private practice, at least among those able to have a choice of physicians. But it is evidently a most erroneous calculation which would pass over these palpable failures of the homeopathic treatment, simply because they were transferred, possibly when beyond hope, into other hands. Had the two cases alluded to (and we have no security that there were not others) remained under Dr. Henderson's treatment and died (as they most probably would in any hands,) the mortality of his cases would at once have been altered from 1 in 16 to 1 in 6; which, considering the character of the cases reported, would have been a very high average indeed." (Page 123.)
My first observations upon this passage is, that my allusion to the 16 cases of pneumonia in question was obviously not for the purposes of numerical comparison. Writing, some five or six years ago, * He has since been promoted to the Hôpital Beaujon.
+ He has recently been appointed professor in the university of Cracow.
regarding the success of the homoeopathic treatment under Fleischmann and other hospital physicians, at a time when it was almost universally believed, in the allopathic world, that acute inflammations required vigorous blood-letting, &c. for their cure, I took occasion to add, in a note, some of my own reasons for believing that the accounts of the homoeopathic success were trustworthy, those reasons having been that I had treated 16 cases of pneumonia homoeopathically throughout (that is without bleedings, &c.) with only one death; 10 of croup without a death; "besides a few cases of pericarditis, pleurisy, peritonitis, and many of dysentery, &c., &c.”
In the next place, I remark that the account of the "two severe and complicated cases, &c.," is not fairly given, that particulars are suppressed, which, if stated in the essay, would have prevented those cases from appearing to its readers to warrant much of what they are employed to prove or to suggest. It is not mentioned that the "severe" case of pneumonia, as the essayist would have it appear, placed by the friends in other hands, was under my care for only one day, and during that time, was a case only of lumbago, while it was not till the poor old lady had been three days without relief under the other physician, that her case turned out to be pneumonia. She died, certainly, seven days afterwards, but on no honest principle, that I ever heard of, can her death be put down to a system which never treated her for the disease of which she died, and had no opportunity of doing so. All these particulars are noticed in my reference to the case, but are most successfully suppressed in the essay. The homœopathic physician may be just as fairly charged with the death of every man who happens to die ten days after he last shook hands, or took snuff, with him, as with such a severe and complicated case" as the above. Why, it may be asked, was the case noticed by me at all, in a record of cases of pneumonia. The answer is, that two other cases occurred to me about the same time, in which lumbago had happened a few days before inflammation of the lungs had commenced, and that the severe and complicated" case appeared to me worth mentioning in connexion with that part of their history. Both of these cases having had the good fortune to have sensible friends, had also the advantage of being "treated homoeopathically throughout," and the consequent happiness of being cured, although they most certainly were very much more severe and complicated cases" than that which had the orthodox benefit of "active remedies," and incurred their too frequent penalty. From which double success, in more unfavourable circumstances as to age and complications in both, and to long previous bad health in one, I very reasonably inferred, that, but for the "friends," the third case, like the others, might have been still alive.
I have no desire to be very hard upon "friends of the patient." They no doubt act according to the best of their judgment and knowledge and when patients happen to have friends with a scanty provision of either, that is their misfortune, and there can be no help for it. But I do think it very paltry conduct in a physician to chuckle over the preference which his sect may occasionally receive from persons of whose competency to judge and to decide regarding the merits of the one practice or the other he knows absolutely nothing. In exhibitions of this kind, it is not the philosopher, the man of science, the truth-seeker whom we see, but the small and commoner man,-the fee-seeker, the partisan, the every-day practitioner. Besides, the
round assertion in the essay about the "alarm of a really severe disease being generally, &c.," is actually not true, as the very record of cases on which the commentary is made, abundantly testifies,for of the whole thirteen patients noticed in that paper, only one was withdrawn by "friends," and at a time when her illness was the least severe and alarming of the whole number. And why? Her husband was an old valetudinary allopathic doctor, who, in conformity with the instinct of that kind of being, went, naturally enough, in "quest of active remedies," and he got them,- (having had "a choice of physicians,") and that, too, very long before the patient was "beyond hope," that is to say, if the "quest" did not of itself, as Dietl's statistics induce me to believe it did, place her in that unhappy predicament. To end this dissention about friends and their doings, I must say, since a subject so utterly worthless has been introduced in a way intended to tell against homoeopathy, that I have reason to believe, or rather to know, that the custom among "friends" and patients, is the very reverse of what is stated in the essay, a large proportion of homoeopathic practice, consisting of acute and chronic cases, in which allopathy had failed,- -a circumstance which I confess never appeared to me to be any reason for exultation, but when I knew it to result from superior intelligence in those who made the change.
Of the other severe and complicated case, in regard to which it is said that I myself became dissatisfied with the homoeopathic treatment, the fact is, that treatment was not tried, and is not said in my account of the case to have been so. Neither Dr. Alison nor I could make out what the case really was, (as is fully stated by me in the paper referred to,) and in such company, I may be pardoned for expressing my conviction that, if we could not make it out, few others were likely to do so. And yet the fatal termination of a case which was never understood during life, and was not treated as a case of pneumonia, on either homoeopathic or allopathic principles, is complacently numbered, though in a hypothetical sort of way, among homoeopathic results! I leave this subject, with the remark that those two cases, thus easily divested of every shadow of a claim to a place in the statistics of the homoeopathic treatment of pneumonia, supply the only objections which Dr. Gairdner has made to the elaborate details on pneumonia, given in my "Homœopathy fairly Represented," although they are not statedly advanced as objections to those details, probably because, had they been so, it would not have been easy to evade the consideration of the much more important and wholly unobjectionable hospital statistics of the disease, with which my small contribution is mixed up.
Dr. Henderson's full and satisfactory explanation needs no comments on our part. We therefore pass on to the consideration of what is said by Dr. Gairdner in reference to homœopathic statistics.
The whole of what Dr. Gairdner says of the statistics of homeopathic hospitals is comprised in the following quotations which, although in immediate sequence, we divide, as they refer: 1, to the general mortality of hospitals, and, 2, to the mortality in special diseases.
The homoeopathic hospitals have in fact, by a somewhat strict comparison with those of ordinary physic, been shown to be systemati
cally filled with those trivial and easily curable cases, which all considerable and well-filled hospitals are compelled, by the pressure of severe and fatal disease, to exclude. Thus, in the vienna homopathic hospital, consumption and organic disease of the heart, liver and kidney, find place in exceedingly small proportions; while colic, diarrhoea, headache, sore-throat, chicken-pox, affections of the skin of an acute and curable kind, and similar diseases of other organs, swell the lists to a degree unknown in any considerable hospital established for purely charitable purposes. To give but one or two instances-out of about 6,500 cases, the accumulation of several years, the homoeopathic hospital at Vienna had 300 of sore-throat; while the general hospital of Vienna, admitting not less than 21,400 cases in a single year, had, in this enormous number, only 216 cases of inflammation connected with the mouth, gums, teeth, palate, or tonsils, or about one-third less than the cases of sore-throat alone, in the homœopathic institution. Again, in the homoeopathic hospital, there were 110 cases of chicken-pox, while in the edinburgh infirmary, there were only two, out of a nearly equal aggregate of cases on the other hand, for 276 cases of consumption in Edinburgh, there were only 98 so called in the vienna homoeopathic hospital; for 159 cases of diseased hoart, 15; for 82 cases of diseased kidney, none; for 103 of paralysis, 5; for 33 of disease of the liver, 1; for 17 of diabetes, none; for 14 of neuralgia, none; for 18 of internal aneurism, 1; and so on. Yet, with this very remarkable selection of cases, the mortality was actually higher by one-third than that of the average of english provincial hospitals; and was, in fact, shown to be only exceeded by those hospitals in this country and abroad, which, from their situation and other causes, receive an enormous proportion of severe and incurable cases. (Edin. Essays, page 124.)
We regret that we cannot at present follow Dr. Gairdner in all the statements adverted to in the course of his essay. We cannot do so, because we are not able just now to procure the article in the Medical Times for April 3, 1852, to which he alludes. We are, therefore, compelled to examine only the statements now before us. It is a fortunate circumstance for us, having so little time at our disposal for the calculation of per-centages and other necessary calculations, that we have still in our possession some articles written in 1852 in refutation of Dr. Routh's "Fallacies of Homœopathy" and of statements advanced by him in a letter written to the editor of the Halifax Guardian (Nov. 20, 1852) and the tables upon which several of our statements were based. The whole of these articles appeared in the Homeopathic Times in the course of 1852 and in the beginning of 1853-possibly they may not have been read by Dr. Gairdner; if not, we recommend them to his notice before he writes again on homoeopathic statistics. We therefore are prepared to go tolerably deeply into the matter, and to show that the smaller mortality in homoeopathic hospitals is not due to the admission of trivial cases or to the selection of the cases admitted.
In the first place, we regret to state that Dr. Gairdner's arguments and statements are only a second edition of Dr. Routh's-consequently, he will not be offended, we hope, if we reply to some of his declarations by arguments and facts written for the information of his predecessor on the allopathic side.
We shall examine Dr. Gairdner's statements one by one and answer them categorically-without leaving out a single one.
1.-The cases of Sore-throat.-We cannot say what proportion of cases of sore-throat usually present themselves at the doors of a hospital chiefly destined to the treatment of acute disease. In the years 1835 to 1854,—a period of 19 years, there were admitted into Dr. Fleischmann's hospital 920 cases of angina faucium; cases, no doubt, of severe quinsy as well as of slighter sore-throat. Of these only one died-the death was the result of gangrene. At the same time there were 17,294 admissions for all cases. Thus, the proportion of sore-throats to other cases was only about one-twentieth or 5 per cent. A proportion which we should not expect to cause a reduction from 10 per cent. at the general hospital of Vienna (Routh) to 6 per cent. at the homeopathic.
2.-The cases of Chicken-pox.-Dr. Gairdner speaks of the cases of chicken-pox as if it were certain that they were that disease. In truth, in the tables published in the British Journal of Homœopathy, we find the word varicella, but we doubt its being correctly entered. We think it ought to be varioloides, or modified smallpox. Now, if we examine the tables of the homœopathic hospital for the nineteen years ending January, 1854, we find 169 cases of varicella aud 194 of variola or small-pox -precisely the proportion in which we should expect to meet with the modified und unmodified forms of smallpox in a tolerably well-vaccinated country. But granted that the proportion is too large-to what degree is the general mortality affected?-169 cases of varicella or varioloides against 17,294 cases of all diseases; in other words, nine-tenths of one in every 100 admissions! This is surely a trivial matter, for if we take the allopathic mortality at 10 per cent., we find that this 9/10 of a case only diminishes the general mortality by 9/100 of a unit per cent.
3.-The cases of Consumption.-Here we have a statement upon which we can prove the fallacy of Dr. Gaird