HA RT M.A N N'S
THEORY
OF
ICHRONIC DISEASES
AND THEIR
HOM(EOPATHIC       TREATMENT.
THIRD GERMAN EDITION.
REVISED AND CONSIDERABLY ENLARGED BY THE AUTHOR.
TRANSLATED, WITH ADDITIONS,
AND ADAPTED TO THE USE OF THE AMERICAN PROFESSION,
BY
CHARLES J. HEMPEL, M.D.


VOLUME IV.
NEW-YORK:
WILLIAM RADDE, 322 BROADWAY.
PHILADELPHIA:-C. L. RADEMACHER, 239 ARCH-ST.
BOSTON:-OTIS CLAPP, 12 SCHOOL-ST.
ST. LOUIS:-FRANKSEN & WESSELHOEFT.
1 849.



**L


ENTERED
According to Act of Congress, in the year 1849, by
WILLIAM RADDB,
In the Clerk's Office of the District Court of the United States
for the Southern District of New-York.


S. LUDWIG AND CO., PRINTEI1, r. T.



THE


TRANSLATOR'S PREFACE.
THIS volume completes Hartmann's work on the treatment
of Acute and Chronic Diseases. I commend it to the careful
attention of all those who are anxious to possess a systematic
expose of the homoeopathic treatment of acute and chronic diseases. It is the only complete work of its kind in existence,
and will be found a most acceptable guide of practice, not only
to beginners, but also to older practitioners.
I ought to state, here, that Hartmann generally prefers the
attenuations from the 30th downward, especially in the treatment of syphilis and chblorosis, where, he contends, large doses
of low attenuations are absolutely necessary to a prompt,
safe and thorough cure.
In this, I believe, all wise observers agree. On the other
hand, the so-called high potencies are, in certain cases, valuable
in practice, Hartmann's opinions to the contrary, notwithstanding. Of course, if we wish to see effects from the high potencies, we must in the first place be sIre to select the proper, that
is, the specific remedy. I have seen effects from the high po



TRANSLATOR'S PRBIACE.


tencies, a denial of which would infallibly and necessarily lead
to the rejection of all evidence of any action of our medicines
whatsoever. Hartmann contends, and I fully agree with him
in this, that the successful treatment of syphilis and chlorosis
requires large doses of the specific remedial agent. To this I
would add, that another numerous class of diseases requires,
in a large number of cases, the exhibition of large doses of
the specific medicine, viz: hysteria, neuralgia (with a few
exceptions), the numerous ailments arising from nervous irritation, and intermittent diseases, especially fever and ague. The
specific remedy for neuralgia, nervous irritation, and hysteria,
is Aconite, as will be demonstrated in the Organon to which
allusion has been made in former volumes; the principal
specifics for fever and ague in our country are: Cinchona
and Arsenic, the former of which has sometimes to be given
in five drop doses, at repeated intervals, to effect a permanent
and reliable cure.
CHARLES J. HEMPEL.


NIW-YORK, 1849.



SEVENTEENTH CLASS.


~ 178. Apoplexia cerebralis, Apoplexia sanguinea,
encephalorragia.
BY apoplexy, we understand a more or less sudden,
entire or partial loss of consciousness, accompanied
with loss of sensation and motion; the latter (sensation and motion) are sometimes still existing, but very
feebly; the vital functions, circulation and respiration,
continue, sometimes a little slower and more laboured;
at others even with more vigour. In almost all cases apoplexy is preceded by precursory symptoms, which are,
properly speaking, symptoms of general plethora, such
as: dulness and heaviness of the head, derangement
of the sensual functions, obscuration of sight as if
through gauze, buzzing in the ears, hardness of hearing, indisposition to perform mental labour, great desire
to sleep, the sleep being unrefreshing and disturbed by
dreams; injected state of the eyes, increased redness
and temperature of the scalp, throbbing of the carotids and temporal arteries, cold hands and feet, the
extremities go to sleep, they feel numb, as if the patient were walking on velvet; the cerebral nerves feel
irritated, with hard aching pain through the brain.
The abdominal organs are frequently very torpid, the
pulse is slow, full and intermittent, the patient has frequent nightmare, etc.
In sudden and total sanguineous apoplexy the brain
feels as if torn, the cerebral functions cease suddenly,
the patient falls down without consciousness or sensation, totally or partially paralyzed; stool and urine
pass off involuntarily, the patient is comatose, breathing stertorous, slow, pulse hard, full and slow, the eyelids hang down as if paralyzed, the mouth is drawn to
VOL. IV.-1



2


APOPLEXIA CEREBRALIS, ETC.


the side not paralyzed, the eyes are staring and protruded, the pupils insensible and frequently dilated;
speech is difficult or entirely lost, etc. In many cases
the patient vomits, the face looks livid and turgescent.
If the cerebral functions cease totally or partially, in
consequence of the pressure of the extravasated blood
upon the brain, the symptoms of nervous apoplexy or
paralysis of the brain make their appearance, resembling very closely those of a violent concussion of the
brain; the patients, totally paralyzed, look pale as
death, they seem to be in a deep swoon, their pulse is
feeble and irregular, vomiting and nausea are present.
In some cases, after this condition has existed for a couple of hours, the pulse becomes fuller, the face looks
red, and all the other symptoms of hyperoemia make
their appearance, precisely as after concussion of the
brain.
In other cases the patients complain of a sudden violent headache, become pale and vomit; sometimes
they are able to walk a few steps, the seated pain in
the head and the vomiting continuing all the time; the
face looks pale as after death, the pulse is soft, the patient is conscious but stupified; little by little the redness of the face and the stupor increase, the patient
answers slowly and with difficulty; coma finally sets
in, from which the patient cannot be roused. These
cases are probably induced by the bursting of a cerebral vessel, and the gradual extravasation of blood in
the brain.
In most cases partial paralysis remains; sometimes
one side remains paralyzed (hemiplegia), in other cases an extremity, or the patient may remain paralyzed
crosswise; in some cases one half of the face, or the
tongue and larynx, remain paralyzed, without loss of
consciousness.
Serous apoplexy is said to be characterized by paleness and bloatedness of the face, cachectic appearance, leucophlegmasia, gradual setting in of complete
or partial paralysis, vomiting, fits of nausea; it is occasioned by debilitating causes, metastasis, suppression



APOPLEXIA CEREBRALIS, ETC.


3


of the secretions, cerebral diseases, terminating in serous effusions. Post mortem examinations have, however, shown that an extravasation of blood had taken
place in supposed serous apoplexy, and a simple effusion of serum in apoplexy which was characterized by
all thie symptoms of an extravasation of blood, showing that, in practice, it is of scarcely any use to distinguish serous and sanguineous apoplexy. (Canstatt).
Gastric, bilious or abdominal apoplexy, is induced
by constitutional predisposition, excesses, chagrin,
over-eating, constipation; it is characterized by a coated tongue, eructations, disposition to vomit, bilious
vomiting, yellow tinge of the eyes and shrivelling of
the skin; the precordial region is distended, sensitive,
the patient sometimes grasps at these parts.
~ 179. Causes. Apoplexy is more frequent among
old than young people, and likewise among males than
females; in many families it is hereditary. A constitutional predisposition for sanguineous apoplexy is indicated by a stout and short body, a disproportionately
large head, a short and big neck, with the head set upon
broad shoulders, corpulence, dark-red, livid countenance, distention of the frontal and temporal veins.
This predisposition is increased by a plethoric constitution, piles, rich living, sedentary habits; it exists
most frequently among literary men, and persons given
to idleness and luxurious living.
External causes. Traumatic, dry and cold weather,
excessive heat, stroke of the sun, sudden transition
from cold to warm, and vice versa; apoplexy is very
apt to take place at the time of the spring equinox, or
in consequence of the abuse of spirituous drinks, or of
narcotic substances, scurvy, etc. It is occasioned by
metastasis, sudden suppression of humorrhage, sweat
on the feet, closing of ulcers, etc. It is likewise occasioned by tight cravats, which prevent the proper reflux of the blood from the brain, by tumours of the neck,
goitre, angina, impeded circulation of the blood in the
lungs, occasioning a repletion of the cerebral vessels;
by asthma, whooping-cough, emphysema of the lungs,



4            APOPLEXIA CEREBRALIS, ETC.
or by organic affections of the heart and the large vessels, hypertrophy of the left heart, contraction of the
aorta; or by disorganizations of the cerebral vessels.
Prognosis: Apoplexy is the more dangerous the
more frequently the attacks occur; the danger is particularly great in the case of old people with an apoplectic habit. Apoplexy is more especially dangerous
when the respiratory and circulatory apparatus is paralyzed, when the breathing becomes laboured, stertorous, slow, superficial, irregular; when the cheeks puff
up and then collapse again at every expiration in consequence of a paralysis of the muscles of the cheeks
and lips; when the pulse becomes slow, small, intermitting, and deglutition difficult; when the sphincters
become relaxed and urine and faeces are passed involuntarily. Bad symptoms are: coldness of the extremities, clammy sweat on the upper parts of the body,
continued or even increased paralysis; mechanical
grasping of the patient, without consciousness, at one
and the same spot of the head.
The homweopathic treatment of apoplexy is much
more favourable than the allaeopathic; even in cases
which seemed almost hopeless, I have succeeded in
effecting a cure. We know, from experience, that
sanguineous and nervous apoplexy is much more easily cured than the nervous and serous varieties, which
frequently leave important secondary diseases.
~ 180. In treating apoplexy, the exciting causes
should, if possible, be removed, as the first step: tight
dresses, for instance, should be taken off before any
other treatment can be thought of. The patient is carried to a cool place, and everything that has a tendency
to vitiate the air is removed from his presence. Head
and trunk are raised. If the attack is owing to poison, this has, in the first place, to be antidoted, after
which the other medicines required by the symptoms
are administered. Strong coffee by the mouth and
anus is the best antidote for opium, accompanied with
friction. If the irritability of the muscular fibre should
have been destroyed, if the body should already be icy



APOPL.MXA VE1IE1BRAIIS, ETc.


time the swelling had reached the pit of the stomach.
The animal functions remained pretty regular, until
one evening, at supper, the arms suddenly sank, the
head inclined forward. the mouth was drawn to one
side, and speech became extinct. The patient was sitting in her bed, with the head bent forward, the breathing was short, rattling, skin cold, pulse small, feeble,
scarcely perceptible; the secretions were suppressed;
she seemed to be very little conscious or sensible, for,
on being spoken to, she remained perfectly silent, and
listless; all the functions of irritability, sensibility and
reproduction seemed to be quite low. She did not desire anything, nor did she refuse anything, but she was
unable to swallow; if some liquid was poured into
her mouth it flowed out again at the corners. I gave
her a few pellets of Belladonna, 30. This seems to be
the principal remedy, shortly after an attack characterized by speechlessness, loss of motion and sensation,
diminution of the sensual functions, stupor, paralysis,
convulsive movements of single muscles, or extremities,
dysphagia, flow of saliva from the mouth. On the following morning she was able to swallow some liquid,
and she continued to improve until the fourth day.
All the symptoms decreased except the cedema, and
the general paralysis. On the fourth day a violent orgasm of the circulation supervened, with a full, quick
pulse, and a general restlessness. I gave a few doses
of Aconite, which quieted the circulation, but left shortness of breathing and rattling, aggravated by motion.
Chamomilla was given without success, but Arsenic
seemed to relieve her very much. The patient had
now been sick a fortnight. She was able to raise her
head, and to utter a few sounds, without articulating.
The breast seemed to be fiee; the patient was able to
take some more substantial food, stool and sleep were
regular; she passed, however, less urine than before,
and the cedema and paralysis of the lower extremities
and right arm seemed to have increased, rather than
otherwise, The swelling yielded to Helleborus niger,
followed in six days by Fcrrum, and then, in four days,



APOPLEXIA CEREBRALIS, ETC.


7


China. For the remaining paralysis I first gave Stannum, and a fortnight afterwards, Causticum, highest
potency. A fortnight after taking this medicine, the
patient was able to walk across the room by means of
a cane, and to articulate a few words. She remained
the same for about four or five weeks. Stannum was
now given. This seemed to strengthen her lower extremities, and to enable her to utter a few coherent
words. Baryta carbonica, 30, two pellets, did more good
than any of the above-mentioned remedies. The improvement was particularly visible in her speech.
Baryta seems to be the principal remedy in paralysis
of old people, particularly when remaining after an
apoplectic fit.
Other remedies for apoplexy are: Ipecacuanha in
frequent, small doses, particularly when the patient
moans a good deal, and the breathing is very short
and deep. It is an excellent remedy for sanguineous
apoplexy, but may likewise be of service in gastric
and serous apoplexy. In the two latter kinds, Nux
vom. and Digitalis are principal remedies. Carbo veg.
has been found very useful in sanguineous apoplexy.
Aconite is a remedy for every variety of apoplexy,
particularly, however, when plethora and an excited
dirculation are striking phenomena, or when the nervous system is very much irritated.
A few doses of Coffea may be given when the patient is very sensitive, and, after return of consciousness, complains a good deal of intolerable pain.
The principal remedies for nervous apoplexy are:
Belladonna, Arnica, Cofea. Hyoscyamus, Stramonium,
lodium, etc.; for sanguineous apoplexy: Aconite, Ipec.,
Nux vom., Bellad., Mercur., Lauroc., Opium, etc.; for
gastric apoplexy: Nux v., Bryon., Ignat., Ipec., Ant. cr.,
Tart. emet., Pals., etc.; for serous apoplexy: Arn., Ipec.,
Merc., Opium, etc.
Belladonna is useful in almost every form of apoplexy, except, perhaps, the gastric variety. It antidotes the apoplectic effects of Merc., Opium, Valerian,
Sec. corn., and other substances. It deserves attention



8


APOPLEXIA CEREBRALIS, ETC.


when congestion of the chest and head is present. It
is indicated by redness and congestion of the conjunetiva, by glistening eyes, dilated pupils, muscaý volitantes, diplopia, restlessness and tremour of the extremities, indisposition to move, lethargy, excessive ncrvousness and sensibility, sopor, stertorous breathing,
jumping out of bed from anxiety, tendency to start,
fearful, peevish, whining mood, insensibility, loss of
consciousness, illusions of the senses and fancy, dutness of the head, vertigo, heaviness of the head, aching
pain in the forehead as if the head would burst open,
drawing, tearing and heat in the head, etc.
The symptoms of Aconite have been so frequently
mentioned in this work, that it seems superfluous lt
reiterate them here.
Cojfea is suitable for apoplexy of nervous.individuals, caused by violent emotions. In sanguineous apoplexy it acts as a palliative, and requires to be succeeded very shortly by some other remedy of a more lasting effect. Its principal sphere is the nervous variety,
in individuals affected with the following symptoms,
in their healthy state: great nervousness, sad and whining mood, sleeplessness from excessive bodily and
mental excitement, frequent flushes of heat in the face,
dizziness and heaviness of the head, anxious restlessness in the whole body, tightness of the head with pain
as if bruised, sensitiveness of hearing.
Opium corresponds to the symptoms which characterize the apoplexy of drunkards. It is a valuable
medicine in apoplexy, for this reason: that the reactive power of the organism frequently sinks to such an
extent, that the proper remedy cannot act upon the disease, on account of this apparent extinction of irritability. A single dose of Opium is frequently sufficient
to restore the reactive power of the organism. It is
indicated by the following symptoms: stupor, coma,
with stertorous breathing and depressed lower jaw, the
patient is roused with difficulty; on waking, he looks
about senseless, and is unable to answer a single
question; red, bloated face, moaning, constant mo



APOPLEXIA CEREBRALIS, ETC.


9


tion of the lips as if to talk; full, slow pulse, with oppressed, anxious breathing, and frequent breaking out
of copious sweat, which is cold in the face; on trying
to raise the head, it falls back again immediately; the
temporal arteries throb visibly. All these are symptoms of sanguineous apoplexy, and it would seem as
though Opium must be indicated by them. This is,
however, not the case: for the same symptoms make
their appearance, if the cerebral irritation and the pressure on the brain last a sufficient length of time; in
this way the physician is frequently led into error.
Laurocerasus is useful in apoplexy when the patient
falls down suddenly without any precursory symptoms.
It is a species of intoxication, as is sometimes observed after taking large doses of prussic acid..If a cure
be possible in such a case, a few doses of Laurocerasus
are frequently sufficient to restore the vital action.
The improvement is indicated by a deep sleep, with
stertorous breathing. The medicine has to be continued until the patient seems to slumber quietly. On
waking from this slumber, the patient is sometimes not
quite conscious of himself.
Hyoscyamus. The patient falls down suddenly, with
a violent shriek, convulsive motions, followed by stertorous breathing. This attack is frequently characterized by precursory symptoms: languor and lassitude all over, transitory loss of consciousness, frequent
disposition to sleep, which, if the patient should yield
to it, ends in a continuous deep sleep, from which the
patient frequently starts as if in affright; during this
sleep the pulse becomes remarkably small and feeble,
and the whole body is covered with a profuse and cool
sweat. The patient complains of frequent attacks of
violent vertigo, as if he would fall down, illusions of
sight, concussive jerks in the brain; the patient's features are distorted; his face looks livid, and he has a
sad and peevish mood.
Stramonium corresponds rather to the precursory
stage, and to the after symptoms, which I do not deem
it necessary to describe in this place.
1#



10


APOPLEXIA CEREBRALIS, ETC.


Arnica is useful in apoplexy from mechanical injuries. It is now employed by even the most celebrated
alloeopathic surgeons for injuries of the head, without
any one acknowledging his indebtedness to Hahnemann for this valuable medicine. Arnica corresponds
principally to serous and sanguineous apoplexy, even
if not of a traumatic nature. Persons with a sanguine
temperament, red face, plethoric, and liable to flushes
of heat, are more particularly benefited by Arnica.
The principal remedy for gastric apoplexy is Ipecacuanha, particularly when the stomach had been overloaded with pork and fat pastry, and the patient had
indulged in nightly revelry. Precursory symptoms
are: restless sleep, disturbed by frequent starting, irritable mood, ineffectual urging to vomit, and other gastric symptoms. After Ipecac., Pulsatilla, Nux vom., Ignat., and the antimonial preparations are frequently indicated. The various forms of apoplexy being related
to each other, Ipec. may therefore be employed in any
of them.
Merc. sol. corresponds to every form of apoplexy.
The excessive use of coffee and wine produces, besides
many ailments which yield to Nux v., Arsen., etc. a
variety of symptoms, very much resembling those of
apoplexy; particularly congestions of the head, characterized by a distensive pain in the head, as if the
head would be pressed open, or as if it would burst,
accompanied with orgasmus, sanguinis, and throbbing,
a condition which is frequently observed in plethoric
persons; constant uneasiness and heaviness of the
limbs, languor and lassitude, even from the least exertion; turgor of the vessels of the eye, with sudden and
frequently recurring paroxysms of loss of sight, or
blackness of sight with vertigo, obliging one to lie
down; buzzing in the ears. Belladonna may be given before Mercury.
Plumbum acet. or metallicum seems to be an excellent remedy in apoplexy. I would recommend, however, to give first a dose of Opium, Bellad., Hyoscyamus, or some other remedy, before administering Plum



PARALYSIS.


be caused by real debility, or by some other external
cause suppressing the nervous action, such as: fulness
of the vessels, extravasation, foreign bodies, tumours,
dislocation, ligatures; spasmodic affections may likewise lead to paralysis. Paralysis may alternate with
spasms, or be accompanied with spasms and pain. It
may proceed both from the peripheral and the central
nervous system.
What apoplexy is to the brain, paralysis is to
single branches of the nervous system. In paralysis
the cerebral functions remain, in themselves, undisturbed. It is easy to diagnose paralysis of an external organ. Paralysis of internal organs is inferred from the
complete inability of the organ to perform its functions.
Paralysis cannot take place suddenly, except during
the incipient stage of apoplexy. Paralysis which sets
in gradually, is preceded by precursory symptoms, such
as: spasms, convulsions, pains in the affected parts;
frequent precursory symptoms are: creeping and tingling sensation, formication, going to sleep of the part,
numbness, weakness and coldness, or sensation as if
drops of cold water were flowing through the diseased
part.
The setting-in of paralysis is characterized by a complete loss of motion and sensation (complete paralysis); or one only of the nervous functions, most frequently motion, is lost, (incomplete paralysis, paresis).
Paralysis of one side of the body is called hemiplegia.
In paraplegia the upper or lower, most frequently the
lower extremities, are paralyzed. In transverse or
cross-paralysis, one upper, and the opposite lower extremity, are paralyzed. Beside the above-mentioned
precursory symptoms, which continue during the attack, we may mention a slow, feeble, small, soft pulse,
discoloration of the affected part, diminution of animal
heat, want of nutrition, gradual emaciation, tabes, or
cedema.
Universal paralysis frequently sets in in apoplexy,
and many other diseases, shortly before death. Partial paralysis derives its particular name from the or



PARALYSIS.


13


gan which is the seat of the disease. Hemiplegia, for
instance, is characterized by a sunken countenance on
the side affected, by stuttering speech, deafness and
blindness on one side, oppression and heaviness in the
chest on the affected side, constant rattling.
Paraplegia of the lower extremities is frequently accompanied with involuntary stool and discharges of
urine, less frequently with the contrary condition.
Blepharoplegia, or paralysis of the eyelids, is either
a paralysis of the upper eyelid (blepharoptosis), in
which case the upper eyelid hangs down over the eye,
and the patient is unable to raise it without assistance;
or else the eye remains uncovered all the time, (lagophthalmus, oculus leporinus); the consequences of
this'par alysis are constant lachrymation, photophobia, frequent ophthalmia, occasioned by dust getting
into the eyes.
Glossoplegia (paralysis of the tongue) is frequently
a symptom and consequence of apoplexy, characterized by stuttering, inarticulate sounds, difficulty of moving the tongue, inability to chew, involuntary flow
from the mouth of the saliva, and of the liquid which
is introduced into the mouth.
Dysphagia paralytica (paralysis of the pharynx)
frequently accompanies the former paralysis. The
patient is unable to swallow, principally liquids; in
attempting it, he is frequently exposed to the danger of
suffocation.
Enuresis paralytica, and paralysis ani, have been
mentioned under paraplegia.
~ 182. Post-mortem examinations do not reveal any
great changes in the structure of the nerves; they very rarely appear decayed, dissolved or desiccated; in
the neighbourhood of the nerves, various disorganizations, such as swollen and indurated glands, steatomata, indurations, scirrhus, etc., are frequently discovered.
Etiology. What has been said of the predisposition
for apoplexy, that is likewise applicable to paralysis.
Exciting causes are: strong emotions and passions,
continuous violent pains, convulsions, nervous fevers,



14


PARALYSIS.


poisoning by narcotic substances, lightning, disorganizations and injuries of the brain, spine and spinal marrow, dislocations, curvatures, ruptures and caries of the
vertebral column, contusion, tearing and compression
of single nerves by a ligature, or by some other mechanical cause, such as hard bodies situated in the
neighbourhood of the nerve, suppression of exanthems,
arthritis, rheuma, hysteria, pregnancy, gastric causes,
worms.
Prognosis. This depends upon the exciting cause,
and the facility of removing it. It is very unfavourable when the disease is caused by organic diseases of
the brain and nerves; more favourable; on the contrary, when succeeding typhus or dysentery. It likewise
depends upon the importance of the paralyzed organ;
upon the duration of the malady; upon the constitution and age of the patient; upon the intensity and
extent of the disease.
~ 183. The remedies which have been proposed for
apoplexy, are likewise useful in the treatment of paralysis. I shall therefore omit repeating them here in
detail, and shall confine myself to those remedies
which were not mentioned in the chapter on apoplexy.
The success of the treatment depends a good deal
upon the exciting cause, which the homoeopathic physician should therefore endeavour to find out, particularly in recent cases, where the disease was caused,
for instance, by the abuse of narcotic substances. For
as long as they remain in the stomach or intestinal canal, they ought, in the first place, to be removed by
vomiting, or an artificial evacuation. This end is
most speedily and safely attained by large quantities of
coffee, taken by the mouth and anus: the fauces may,
at the same time, be tickled with a feather. Coffee
antidotes a great many narcotic substances. If some
of the effects of the narcotic poison should still remain,
Camphor should be given as the next best antidote, the
doses to be repeated at short intervals. I propose Camphor in case no more specific antidote should be indicated.



PARALYSIS.


15


A paralysis which is occasioned by the inhalation of
mercurial vapours* and is accompanied with tremour of
the paralyzed part, is best met by Stramonium, which
requires to be repeated very frequently during the
treatment. Next to Stramonium we have Hep. sulph.,
Sulph., Nitr. ac., Argent., Cicut., China and Staphys.
These remedies are generally sufficient to effect a cure.
Other remedies may, however, be necessary.
Paralysis occasioned by the inhalation of the vapours of Arsenic, has likewise to be first treated with
the antidotes of that poison. This kind of paralysis is
accompanied with occasional paroxysms resembling
fever and ague, which occur principally at night, and
are very often accompanied with general prostration.
The first remedy for that paralysis is China, to be repeated at suitable intervals. Next to China we have
Veratrum, which is even preferable when the frequent
paroxysms of debility and the general and sudden
prostrations are exceedingly troublesome. China and
Verat. are likewise suitable when the above symptoms are not present. In this case Ipecac. may perhaps deserve a preference; Ferrum, Nux v., Sambuc.,
Graphit. and Hepar. are likewise useful remedies.
If paralysis should have been occasioned by any
other causes than the above named, the physician will
have to prescribe in accordance with the symptoms.
I.will offer a few more observations about several remedies.
Rhus tox. It is well known that this remedy is one
of our most valuable medicines for paralysis; but it
is perhaps less well known that Rhus is the best remedy for paralysis caused by nervous fevers and
typhus.
Stannum is the principal remedy for paralysis of
one side, particularly the left, if the patient complain
of a heavy weight in the arm and side of the chest,
and suffer with night-sweats. This remedy may have
to be succeeded by others, if the paralysis should not
entirely disappear under its influence; afterwards it
* As occurs frequently among looking-glass makers.



16


PARALYSIS.


may occasionally be resorted to again during the
treatment.
Causticum, when the affected part trembles on rising from one's seat, the trembling ceasing again on
sitting down.
Cicuta is likewise indicated by those symptoms,
particularly when the lower extremities are periodically attacked with paroxysms of crampy pains, leaving a trembling behind.
Oleander is recommended for painless paralysis.
In paralysis arising from suppressed discharges of
blood, the action of* the proper remedies should be
supported by foot-baths of salt and ashes, tepid sitzbaths, warm oat-meal, or flaxseed-poultices to the
soles of the feet.
Paralysis occasioned by the suppression of habitual
sweat on the feet by exposing them to humidity, is
best met by Rhus t., Colch., Mercur., Zinc.; Nux v.,
Dulc., Bryon., are the best remedies for paralysis
arising from a general cold. Paralysis arising from
external injuries yields to Arnica, Calendula, Cicut.,
Con., Plat.
~ 184. In this paragraph I will endeavour to describe the symptoms of various particular forms of
paralysis which have yielded to specific remedies.
Rhus t. has been successfully administered for paralysis of the lower extremities characterized by a sensation of numbness and insensibility. This remedy
is likewise indicated by cramp and a sensation as if
single tendons were shortened, symptoms which evidently depend upon a diminution of' the nervous action; likewise by a sensation as if bruised and sprained, on one side; by a distressing uneasiness wandering about in single limbs during rest, and relieved
only on increased motion. This distress leaves a kind
of lameness in the part, increasing with that distress,
and distinctly pointing to ultimate paralysis. The
principal symptoms of Rhus are: lameness in all the
extremities and joints, with stiffness, worse on rising



PARALYSIS.


after having been seated a long time; paralysis of
one side or of the lower extremities, with dragging,
slow, difficult walking. Rhus t. is therefore an excellent remedy for hemiplegia and paraplegia, for enuresis paralytica, and paralysis of the rectum, provided
the other symptoms correspond, and, in such a case,
likewise for blepharoplegia and dysphagia paralytica.
I have cured, with Cocculus, several cases of paralysis of the lower extremities, proceeding from the
small of the back, and arising from cold. Some of
the patients complained of great itching of the skin
at night, with small red pimples on the skin in the
day-tinie; most of the patients had cedomatous feet
and an irritable nervous system. Cocculus corresponds likewise to hemiplegia, particularly of the left
side, with a sensation of coldness in the affected part;
and to paralysis of the right upper and lower extremity, with numbness as if gone to sleep; also to dysphagia paralytica, provided the symptoms correspond.
Causticum has been rejected by a number of homeopathic physicians, who declare it a useless agent.
I have used it successfully in partial paralysis occasioned by a cold current of air, and in hemiplegia
from suppressed itch or some other cutaneous eruption, with numbness, deadness, and coldness of the
affected part, especially the head and foot. It is a
valuable remedy for paralysis remaining after apoplexy and characterized by weakness of the arms and
a dragging, vacillating gait, sometimes accompanied
with frequent rush of blood to the head and anxiety,
also vertigo, dulness, and tightness of the head. I
have used Causticum with success in paralysis of one
side of the face from cold, extending from the forehead to the chin. I have never been able to cure paralysis of the tongue with stuttering, hissing, indistinct speech, with Causticum alone, but had always
to resort to Stramonium, Dulcam., and Acid. mur. It
renders good service in enuresis paralytica.
Oleander. All I can say about this agent is, that it



18


PARALYSIS.


has removed several cases of painless paralysis of the
upper and lower extremities, with coldness of the
former. The paralytic attack was preceded for a
long time by frequent attacks of violent vertigo.
Secale cornulum. It is well known that paroxysms
of cramps, when frequently recurring in the same
limb, leave lameness and even complete paralysis.
Secale corresponds to this condition. If the lower extremities are attacked, stool and urine are frequently
passed involuntarily, and the paralyzed limbs emaciate rapidly.
Cuprum is useful for paralysis remaining after an.attack of Asiatic cholera, nervous or typhus-fever, or
apoplexy, particularly when the following symptoms
are present: sensation as if the blood were rushing to
the chest, accompanied, when lasting a long time,
with violent palpitation of the heart, and with a slow,
feeble, and small pulse: the eyelids close frequently
and twitch; on opening the lids, the eyeballs seem to
wander, as is observed soon after the removal of apoplexy; the faculty to open the eyes returns after the
return of consciousness.
Plumbum corresponds to paralysis remaining after
apoplexy, and very particularly to paralysis characterized by loss of sensation, and great and sudden
emaciation of the paralyzed part; also to paralysis
of the arms, with pain, dryness and death-like paleness of the skin, which is constantly cold; also to hemiplegia and to periodical paroxysms of paralysis.
Zincum. I have employed it empirically in paralysis of single parts, hemiplegia, paralysis of the lower
limbs, feet, upper eyelids.
Stannum. This remedy is valuable only in cases of
paralysis complicated with psora. I have used it successfully in paralysis of the left arm and foot caused
by fright. It is useful only in paralysis of single extremities.
Kali carbonicum is useful when the paralysis came
on gradually and was caused by taking cold without
the patient knowing it, particularly when the pa



PARALYSIS.


tient's skin inclines to perspiration, though he complains of dryness. I used this remedy in the case of
a patient who had complained for a long time previous of frequent paroxysms of vertigo in the open air,
accompanied with a tottering gait as if intoxicated,
which, afterwards, lasted much longer than the attack
of vertigo, and finally terminated in complete paralysis
of the lower limbs; two or three years after, the upper limbs became likewise paralyzed. In this case I
employed Kali, but without success, nor was the patient cured by other remedies.*
Natrum muriaticum corresponds to paralysis caused
by sexual debauchery and onanism, and proceeding
from the cauda equina; also to paralysis caused by
violent passion, anger or chagrin. This agent is valuable for nocturnal pains which, though depending
upon some apparently insignificant cutaneous irritation, arrest the free use of the affected part leading
to momentary paralysis and even hemiplegia, which
becomes permanent after several paroxysms, and occasions involuntary discharges of stool and urine.
The symptoms of Natrum pointing to paralysis, are:
sensation as if the extremities would go to sleep;
stiffness and cracking in the joints; shortening of
tendons; indolence, indisposition to work; languor;
incipient amaurosis; lameness of the small of the
back, with tightness and sensation as if bruised;
lameness and heaviness of the extremities, with numbness and deadness.
Sulphur corresponds to paralysis of the lower extremities, and to paralysis arising from suppressed
eruptions. Sometimes we are unable to ascertain the
cause of paralysis; in this case we may commence
the treatment with Sulphur, which frequently reproduces old pains that the patient had forgot, and will
prove of essential service to the practitioner in the
* Did Dr. Hartmann make use of Aconite, not one or two doses, but
systematically for weeks?  Iow  strange it is that Aconite, which is the
sovereign remedy for almost every species of paralysis, should be so little
used by physicians!-Hempel.



20


PARALYSIS.


selection of adequate remedies. It may be occasionally repeated during the treatment for the purpose of
restoring the susceptibility of the organism to other
agents.
Strontian is said to have been successfully used in
paralysis of the lower limbs and right side.
Argilla has been found useful in paralysis of the
arm and hand.
Anacardium has rendered some service in paralysis
of the lower limbs remaining after apoplexy.
Baryta carbonica is one of the most valuable remedies for paralysis after apoplexy, and particularly for
paralysis of old people, preceded for a long time by a
feeling of instability in the whole body, sudden giving
way of the knees and pain in the lumbar-vertebrae.
Glossoplegia can scarcely ever be cured without Baryta, which is considered a panacea for old people.
Dulcamara, alternated with Sulphur, is an excellent
remedy for paralysis arising from a cold. or from
dampness, and from suppressed itch and terpes. It
cures paralysis of the arm with icy coldness, as if occasioned by apoplexy; paralysis of the upper and
lower extremities, tongue, urinary bladder.
Colchicum autumnale corresponds to paralysis from
exposure to wet, or from sudden suppression of the
perspiration on the skin, or of habitual foot-sweat.
The Colchicum-symptoms pointing to paralysis, are:
drawing-jerking, stitching-tearing pains in single muscles and in the periosteum, with lameness or paralysis; painful lameness of the knee-joints, with sudden
prostration, &c.
All the remedies recommended for apoplexy, may
likewise prove useful in paralysis, beside the following: Phosphorus, Verat., Staphys., Silic., Sep., Carb.
veg., August., Arsen.
Guaco proved useful in two cases of paralysis of
the lower extremities from cold.
For incontinence of urine we may use: Magnes.
aust., Bellad., Acon., Dulc., Lauroc., Canth., Stann,,



NEURALGIC AFFECTIONS.


21


Lycop., Magnes. carb., Natrum      mur.;*-for paralysis
of the feet: Sulph., Nux vom., Zinc., Cocculus, Therm.
Tepliz;-for paralysis of the eyelids: Stramon., Chamom., Spigel., Verat., Bellad., Sepia, Zinc.;-for paralysis of diseased parts: Plumb., Colch., Natr. mur.;
-for paralysis of the tongue: Stramon., Dulcam.,
Opium, Acid. mur., Baryt. carb.
EIGHTEENTH CLASS.
~ 185. Neuralgic affections.
They are affections of the sensitive sphere. The
old physicians called them spasmodic affections. Their
physiological character is made up of the following
facts:
1. They are seated in the peripheral system of
nerves; we have cerebral, spinal and ganglionic neuralgiae. 2. Every neuralgia consists of a series of paroxysms of different durations, separated by irregular
intervals of ease. 3. The pain varies: it is tearing,
stitching, burning, etc. In neuralgias of the central
nerves the pain is directed from within, outwards; in
those of the ganglionic nerves it runs from the periphery towards the centre. 4. The volume of the affected
organ decreases. 5. The temperature of the organ
decreases. 6. Discoloration takes place, the affected
part becomes paler. The urine becomes paler, losing
its characteristic   pigment.     Another characteristic
phenomenon is the spastic pulse; the artery becomes
* Also Sulphur. I used it in the case of a boy, who had to urinate
every half hour during the day, and wetted his bed every night; he had
to sleep on a hard board and in a sitting posture; on urinating, the
urethra swelled up to a bag of the size of a walnut, blue-coloured; before the bag appeared, the urine seemed to be arrested in its course by
a valve. which caused great pain. The patient had been treated allceopathically for months, getting worse all the time. After the first dose of
Sulphur Ist., the patient ceased to wet his bed; the whole cure was completed by means of eight doses of Sulphur. The patient has been perfectly
well for more than a year past.-Hempel.



22


NEURALGIC AFFECTIONS.


thinner, and contracted, in proportion as the volume
of the affected part decreases; the current of blood is
much smaller, it rushes along with much less force,
though not always with less rapidity.
Etiology: Prosopalgia is more frequent among people of a certain age, than previous to pubescence: abdominal spasms appear at every age, but of different
forms. Females are more liable to neuralgia than
males. One attack predisposes for other similar attacks, and other forms of neuralgia.
The principal causes of neuralgia are: change of
temperature, sudden transition from warmth to cold,
causing a rheumatic or inflammatory affection, which,
though apparently not neuralgic, yet shows a remarkable tendency to periodicity; irritation of the nerve
by some mechanical cause, a foreign body, ball, splinter, exostosis, etc.; calcined metals, lead, copper, etc.
The violence of the attack seems to depend in some
measure upon the time of day, or the period of the year,
when it takes place.
Prognosis. Neuralgic affections are not always very dangerous, though they require a proper appreciation on the part of the practitioner. If an important
vital organ should be affected, the prognosis is much
less dangerous than in the opposite case: acute neuralgia are more dangerous, though also more curable,
than chronic; the most dangerous neuralgias are those
that depend upon internaOirritating causes, which cannot be removed; those that depend upon atmospheric
causes, are much more easily cured; neuralgiae complicated with other pathological states, are not so
easily cured; recent neuralgiae are much more easily
cured than neuralgia of long duration, where symptoms of paralysis have already supervened; the more
violent and frequent the paroxysms, the more unfavourable the prognosis (Schcenlein).
Before describing the treatment of neuralgic affections, it may be proper to speak more in detail of the
causes which occasion the attack, and of the diet to be
pursued during the treatment. Neuralgima are very



NEURALGIC AFFECTIONS.


23


frequently incidental to particular seasons, appear at
a time when epidemic fevers generally prevail, and
therefore require to be guarded against in the same
manner as the fevers, such as: avoiding to take cold,
to be wet through, to lie on the cold floor, or to expose
the bare body, or single parts only, to the cold night
air; or to drink much cold, bad or marshy water, or to
eat sour fruit containing a good deal of water. Simple, easily digested food, is the best nourishment.
Some attacks yield to dietetic measures. Neuralgiae, depending upon a mechanical cause, demand surgical aid, though Arnica, Calendula, Conium, Platina,
Dulcam., Ruta, etc., may likewise be employed. If
caused by a cold, or by getting wet through, etc., the
attack is sometimes arrested in its incipiency by the
use of Dulcamara, Colchicum, Rhus t., Chamom., Colocynt., Ignat., etc. If caused by some gastric derangement, the proper remedies will be found in the paragraph on gastroataxia; likewise, the remedies for
fright, (especially Sec. corn., Strain.,) chagrin, fear, indignation. If the attack should have occurred frequently, and should come on again by simply touching
the diseased part, the following remedies will remove it,
and if properly and carefully administered, will frequently cure the whole disease: China, Stramn., Arsen.,
Coccul, Bellad., etc. If the affection is easily excited by
touching an ulcer on the finger, Cocculus is the best remedy to remove the pain. If '_iused by swallowing a liquid, Hyoscyamus, Bellad., Stramon., Canthar, are the
best remedies; if caused by noise, or tepid water, Angustura should be resorted to; if caused by moving or using
the diseased part, try Cocculus; and if the glare of
the light have excited the attack, give Bellad. or Stramonium. Camphora antidotes the neuralgic effects of
the grains of Cocculus, and Stramonium those of the
vapours of Mercury. Neuralgie, caused by worms, require Ignat., Marum. verum, Mercur., Valeriana, Hyoscyam., Cicuta, etc.



PROSOPALGIA.


CEREBRAL NEURALGIE.
~ 186. Prosopalgia, dolor faciei Fothergilli, neuralgia facialis.
The disease occurs in paroxysms, at irregular intervals; the attack is sometimes preceded by oppressive
anxiety, itching or feeling of coldness in the part to be
attacked, formication and trembling of the eyelids,
tension in the palate and nose, numbness of the tongue,
etc. At first the pain is inconsiderable, like a mere
prick, or a common toothache, but gradually it becomes more violent and piercing; the pain is lancinating or tearing, dragging or pressing, beating,boring,
frequently accompanied with a sensation as if the face
would be cut or sawed to- pieces. The pains either
follow the course of the different branches of one side
of the trigeminus (more frequently on the right than
left side of the face), or exclusively one or the other
branch of the nerve. If the pain be seated in the supraorbital branch, it generally commences at the foramen supraorbitale, shooting to the eyebrows, forehead,
eyelids, and frequently, deep into the orbits; if the infraorbital branch should be the seat of the affection,
the pain spreads over the cheek, upper lip, lower eyelid, radiating to the teeth, palate, and tongue. A neuralgia of the inframaxillary branch extends to the lips,
alveolar processes, teeth, to the soft parts under the
chin, and the side of the tongue. Frequently the pain
seems to follow the ramifications of the pes anserinus,
spreading even to the temporal region; least frequently the pain is seated in the lingual branch, and most
frequently in the superior maxillary and frontal nerves.
Reflex phenomena, in the motor nerves, are scarcely
ever wanting; for instance: the muscles of the affected side of the face twitch involuntarily, the eyebrows
are knit, and the eyelids close spasmodically, the corner of the mouth is drawn towards the ear, and the
spasm extends even to the respiratory muscles; the
contractions exhibit the forms of oscillating movements,



PROSOPALGIA.


or of clonic spasms, or they are tonic, and of the nature
of trismus; the jaws are locked, as in tetanus, during
the attack. The vasomotoric nervous fibres are likewise affected; this is to be inferred from the redness,
puffiness, and sometimes from the paleness and blueness of the affected side of the face, during the paroxysms; sometimes the cheek becomes cedematous and
collapses again afterwards; the arteries of the affected side pulsate more strongly, and the veins swell. If
the ophthalmic branch be the seat of the affection, the
conjunctiva becomes red, and a profuse lachrymation
takes place during the paroxysm; in neuralgia of the
maxillary branches, a more copious secretion of saliva
takes place.
The attack ends either gradually or suddenly; the
more violent the attack, the shorter its duration, sometimes only a few minutes, rarely longer than a quarter
of an hour. The intervals between the paroxysms may
last for hours, days, weeks, months, and even longer;
during these intervals the pains generally cease entirely; but if the affection should have lasted for years,
indications of pain are always present. At first the
paroxysms are rare, but become more and more frequent the longer they last. Paroxysms occur very seldom at night, hence sleep remains generally undisturbed.
The affected nerves are sometimes so sensitive that
the paroxysm is excited by the least emotion, contact,
pressure, exposure to cold air, motion of the facial
muscles by talking, chewing, yawning, sneezing, or
even by merely thinking of the attack. Amusement
sometimes keeps the paroxysm off for a time (Cann.
statt).
Etiology: Prosopalgia is hereditary the same as
any other species of neurosis. This affection is most
frequent among females of the age of 40; it occurs
rarely among younger persons, and never among
children.*) Constitutional nervous irritation predis* This is a mistake. I have treated a girl of 10 years for prosopalgia; the
paroxysms occurred at night, and were truly dreadful.-Hempel.
VOL. IV.-2



26


PROSOPALGIA.


poses for neuralgia; this kind of irritation is met with
among unmarried persons, or married persons without
children, or it may be the consequence of chlorosis,
hysteria, hypochondria, loss of animal fluids, frequent
emotions, chagrin, grief, care, etc.
Local hurtful influences are: wounds, contusions,
splinters, foreign bodies, abuse of washes and other
substances for beautifying the face, ulcers and disorganizations, affections of the teeth and abdominal
organs, metastasis, suppressed chronic eruptions, itch,
herpes, suppression of habitual discharges of blood,
arthritis, carcinomatous dyscrasia, psoric or syphilitic
dyscrasia, etc.
The disease is not very dangerous, but the cure is
generally very slow. It depends upon the age of the
patient and upon the duration of the disease, upon
the manner in which it originated; rheumatic and
intermittent prosopalgia is more easily cured than
gastric, and this more easily than impetiginous, arthritic and cachectic prosopalgia; prosopalgia occasioned
by organic alterations of the nerves, brain, bones, is
exceedingly doubtful; likewise when the attacks succeed each other very rapidly. The prognosis depends
likewise upon the circumstances of the patient: tran.
quillity of mind, absence of care, a confident, quiet
mood; intellectual amusements facilitate the cure very
much.
~ 187. Treatment. The homoeopathic treatment of
prosopalgia, in order to be successful, has to be based
upon an accurate knowledge of the physiological
nature of the disease, and, if this knowledge cannot
be obtained, then the treatment must be instituted in
accordance with the symptoms.
For inflammatory prosopalgia (of the fifth nerve)
Aconite is the best remedy; the pain is continuously
throbbing and stitching, not only in the nerve, but
also in the surrounding muscular parts, with swelling,
alternate heat and chilliness, etc. Rheumatic prosopalgia with swelling, always requires Aconite; the
pain is intolerable, burning, tingling-stitching, ap



PROSOPALGIA.


27


pearing in paroxysms, accompanied with great nervousness, as if occasioned by some internal ulcer.
The medicine has to be repeated.
Belladonna is indicated in inflammatory and nervous prosopalgia by paroxysms of long duration, commencing with a troublesome itching and titillation in
the affected part, which changes to a violent lancinating pain, or to an aching, crampy, tearing, drawing pain in the malar and nasal bones; the pain is
always seated on one side; frequently the pain follows the course of the infra-orbital nerve, when it
changes to an intolerable violent cutting pain; it is
frequently accompanied with an increased secretion
of tears and saliva. Belladonna is likewise useful for
stitching and tensive pains, accompanied with a
spasmodic closing of the jaws and painful stiffness of
the neck.
One of the most valuable remedies for stitching
pains with pressure, or for fine-beating pains in the right
malar bone and right side of the nose, is China, particularly when the pain is aggravated by contact, or
when the pain is excited by touching the diseased
part and then increases to a frightful degree. The
nervous and rheumatic neuralgic pains, the stitching
pains in the malar bone which disappear by pressure,
the tearing with pressure and the cutting burning in
the upper jaw, belong to the curative sphere of China.
Veratrum is closely related to China; the pain is
drawing and tensive, spreading over the right half of
the face as if the parts would be compressed or
pressed into, recurring in paroxysms; the patient is
slightly delirious, and the part swells after the cessation of the paroxysm.
Arsenic did me good service when the pain, only on
one side, was seated around the eyes, more below
than above, sometimes extending over the temporal
region; the pain was burning or drawing-stitching,
as from a multitude of red-hot needles; the whole face
assumed an expression approaching to the hippocratic
countenance, disappearing with the attack. Arsenic



28


PROSOPALGIA.


A
is likewise useful for intermittent prosopalgia, characterized by a violent stitching pain deep in the right
eye, aggravated by motion; also for prosopalgia commencing with a tearing-darting pain in the teeth
which rouses the patient from sleep before midnight,
extending to the right temple and right side of the
face and driving the patient to despair; the pain
abates in a few hours and sometimes only towards
morning.
I have used Capsicum when the patient was unable
to state whether the pain was seated in the bones,
muscles, or nerves, or in all these parts together; the
pains were excited by contact, they were fine pains
penetrating the nerves, or a tearing-burning stitching
in the right malar bone; the pains were particularly
acute on going to sleep, and were aggravated by
contact.
I have frequently cured prosopalgia with verbascum,
1st att., when all other remedies failed. The pain is
an intensely painful aching, sometimes interrupted by
a violent stitching.
Digitalis purpurea is indicated by a crampy, or
laming-drawing pain in the malar bone, preceded by a
corrosive itching of the cheek; the crampy pain is
characteristic..Mlezereumn is indicated by a crampy, stupifying
pressure in the malar bone, spreading over 1he neighbouring parts and frequently terminating in tearing.
The attacks are almost always accompanied by
chilliness and shuddering.
Staphysagria was found useful in a case of 15
years' standing; flashing stitches darted through the
affected side of the face, leaving behind a dull aching
pain. The nightly sleep became quite good. It is
absolutely necessary to repeat the dose, and to alternate with some other remedy.
Aurum is suitable for a syphilitic dyscrasia; the
senses are morbidly sensitive; the patient dreads the
pain, and excites it by merely thinking of it. The pain



PROSOPALGIA.


29


is tearing and stitching, in the soft parts'and the malar
bones; it is sometimes accompanied with tension.
Spigelia is a valuable remedy for intermittent and
nervous prosopalgia, and for prosopalgia seated deep
in the orbits, imparting to the eyeball a sensation as
if it were too large; this sensation is especially felt
during a motion of the eyeball and the facial muscles,
and is accompanied with an intensely painful pressure
and a digging-stitching in the ball. The prosopalgia,
properly so-called, is characterized by pressure and
burning, particularly in the malar bones; the pain
does not bear the least motion or contact, is always
felt on one side only, and is accompanied with anguish
about the heart and great uneasiness.
Stannum is indicated by aching-drawing pains in
the malar bone and along the orbital margin of the
right eye; they commence very slight, increase and
decrease again gradually, disappear during walking,
but re-appear again during rest if the paroxysm should
not yet have run its natural course.  An achinggnawing or cutting pain on the left side is almost
always accompanied with swelling of the cheek.
Hepar sulphuris is useful for a drawing-tearing
pain extending from the cheeks to the ears and
temples, aggravated by contact, caused by former
severe affections, in cachectic individuals.
Colocynth removes prosopalgia caused by internal
mortification and chagrin; the pain is tear:ng and tensive, or burning and stitching, in the left side of the
face, with swelling, redness and heat of the cheek.*
Conium is valuable for a flashing-tearing pain in
the right half of the face, recurring every two to five
minutes; or for a stitching pain in the right cheek,
in front of the ear, sometimes accompanied with tearing. These pains are sometimes preceded by a corrosive itching on the part to be attacked.
Kali carbonicun corresponds to a drawing-tearing,
the drawing being sometimes accompanied with pres*See the valuable clinical remarks in Hempel's Jahr.



30


PROSOPALGIA.


sure in the cheek; the tearing, almost always seated
in the left malar bone, generally appears at night, is
accompanied with swelling of the cheek, sleeplessness,
and extorts tears from the patient.
Thuja is suitable for females at the critical age,
and corresponds to crampy pains in the right cheek
during rest; darting and stitching pains in the malar
muscles, only while walking in the open air; boring
pain in left malar bone diminished by contact, or
digging and jerking pains; gnawing and boring pain
in the left upper jaw, or tearing pain striking in the
direction of the eye; all these pains leave behind
them a stiffness in the muscles of deglutition and a
pain in the articulation of the jaws.
Beside the above-mentioned remedies, we may
mention Arnica, Ferrum, Nux v. Bryon., Ruta, Phosphor., Sepia, Lycop., Ledum, Clematis, Baryt. carb.,
Calc., and above all, Sulphur and Causticum.
~ 188. I take the liberty of here offering a few
remarks on
CANCER OF THE FACE, LIPS, CHEEKS, NOSE AND TONGUE.
Generally it is the lower lip that is attacked, whence
the disease spreads; but it may likewise first break
out in any other of the above-mentioned parts, and
thence extends farther. It develops itself out of a
scurfy or ulcerated spot, which gradually spreads and
gives rise to fungous excrescences, etc.; or a portion
of ihe lip becomes hard and swollen, assuming an illshapen form, which enlarges, pains violently, and
breaks. The cancer gradually involves the skin of
the chin, the mucous membrane of the month, the
gums and submaxillary glands, destroying the whole lip
and the bones. Ulcers of the lips frequently become
malignant without being cancerous, especially syphilitic ulcers.
Cancer of the tongue generally commences with a
hard, circumscribed swelling on one or the other side



PROSOPALGIA.


31


of the tongue; lancinating pains are experienced; the
swelling breaks, spreading rapidly.  Ulcers in th3
spongy tissue of the tongue frequently become obstinate,
or are rendered obstinate by being constantly moistened with saliva, or irritated by pointed and decayed
teeth.-The papillae frequently become hypertrophied,
forming spongy excrescences.-Syphilitic ulcers of
the tongue frequently degenerate to cancerous ulcers.
Every cancer, including cancer of the tongue, depends upon a peculiar, specific disposition of the organism, which may be hereditary.  Cancer may be
caused by a blow or contusion; by treating an ulcer,
an induration or excrescence of the face, lips or nose
with irritating substances externally; by scrofula and
syphilis; suppression of habitual secretions, etc.
Prognosis: This is not very favourable, although
many cases are said to have been cured. The more
extensive the cancer and the more enfeebled the constitution, the more unfavourable the prognosis; this is
likewise the case when the cancer re-appears again
after an operation. The knife should never be resorted to in the treatment of cancer; an operation is not
only useless, but inflicts unnecessary tortures upon the
patient, and, generally speaking, hastens his end.
~ 189. For cancers of the face, the first remedy is
Arsenic; not Fowler's solution, but the pure Arsenic.
The pathogenetic effects of Arsenic which point to cancer, are: Burning swelling in the nose, with pain to
contact; tumour in the nose; ulceration of the nostrils,
high up, with discharge of fetid ichor;-ulcers in the
whole face; wart-shaped ulcer on the cheek; dry,
cracked lips, brown streak in the lips, as if burnt;
bleeding of the lower lip; ulcerated eruption around
the lips; cancer-like eruption on the lower lip, with
thick crust, hard, pad-shaped edges, with burning pain,
particularly when the parts become cold, and with a
lardaceous bottom; spreading ulcer on the lip, painful in the evening, when in bed, with tearing and
smarting in the day-time during motion, which is
worst when touching the ulcer and in the open air,



32


PROSOPALGIA,


disturbing the night's rest;-corrosion of the edge of
the tongue, in front, with smarting; the tongue is
blackish, cracked.-Arsenic may sometimes require
some other medicine with it, but it is undoubtedly the
most valuable agent when the cancerous dyscrasia
has tainted the organism; it is the sovereign remedy
for cancer of the nose, tongue and alveolwa.
Clematis being a remedy for the effects from abuse
of mercury, such as indurations, even when of a
schirrous nature, it will be found useful for syphilitico-mercurial ulcers on the lips when becoming carcinomatous; it may likewise prove useful in alveolar
cancer when characterized by a drawing-jerking and
burning-stitching in the edges of the ulcer on touching
the affec ed part; these sensations spread over the
whole side of the face as far as the eye and ear.
Aurum met. is preferable to clematis when the cancer of the lip, nose or alveolke, grows out of a syphilitic or syphilitico-mercurial soil; the scrofulous
diathesis is not excluded from  the sphere of this
agent. Aurum may likewise prove useful for cancer
generally. It is preferable to many other remedies
when not only the soft parts, but also the bones,
are affected. In this case Aurum muriaticum is preferable to the metallic gold; for the muriatic acid
is not without its use in the treatment of cancer of
the face, especially of the tongue, where I have employed it in alternation with Arsenic, guided by these
symptoms: the tongue feels heavy and elongated,
so that he is unable to move it, with great dryness
in the mouth and fauces; painful blister on the
tongue, with burning; deep ulcer on the tongue, with
black bottom and inverted edges.-Mcrcurius may be
of service if the bones have already become affected;
likewise Nitric acid, particularly when the ulcers bleed
profusely, with stinging and burning; even Asa. may
be serviceable when the edges of the ulcer are hard,
bluish, and sensitive to contact.
Conium has been employed with success in carcinomatous affections arising from contusion or shocks;



" 34


PROSOPALGIA.


Sepia may be given in cancer of the nose, when
the patient complains of a violent burning pain
in the large. scurfs; beneath the scurfs, which
keep spreading and thickening all the time, a corrosive ichor is constantly oozing out, essentially
favouring the spreading of the cancer. The general
organism soon suffers sympathetically; we may infer this from the paroxysms of feverish heat and
chilliness which recur several times during the day.
The disposition of the patient is likewise to be considered; Sepia is indicated by sad fancies, apprehensions about one's health, fearfulness inducing a hurried pulse and hurried breathing, as if the breath
would give out.
Antimonium crudum may be considered of value
in cancer of the face. I used it successfully, until a
cure was completed, for a horny excrescence under
the lower lip; the horn fell off every eighth day, after
which it grew again; after falling off, the surface
of the stump, which kept increasing, looked raw like
raw flesh; the fleshy papillae looked like the papillwe
on the tongue; a viscid humour oozed out of every
single papilla. If the scurf to which the thickening
of the humour gave rise, remained for more than eight
days, the humour then oozed out between the scurf
and the horn which now developed itself in breadth.
The horn was painless, except when knocked against,
in which case it bled. I gave one dose of the third
trituration every day, and covered it moreover with
a little plaster of antimonial butter.
A similar horny excrescence was cured by means
of Ranunculus bulb. The excrescence was seated
on the forehead, somewhat painful; the patient complained frequently of a burning itching in the excrescence; the scurf formed more rapidly than in the
former. After falling off, the stump resembled a deepeating ulcer with sharp edges. I used Ant. crud. for
several weeks without success.  Ranunc., 6th att.,
morning and evening, and applying the first externally, effected a cure in a few weeks.



NOMA, CANCER AQUATICUS.


35


Acidum nitri has been employed by me not only
in carcinomatous ulcers arising from a syphiliticomercurial origin, but also in strawberry-shaped or
other fleshy growths in "the face, spreading rapidly.
The remedy was used internally high, and externally low. Not in every case had the excrescence
a syphilitic origin.
~ 190. Noma, cancer aquaticus.
This morbid process in the mucous membrane of
the mouth is similar to the pustula maligna on the
skin. Symptoms of constitutional illness are not at
first perceived; a whitish, reddish and frequently
blackish pustule or blister shoots suddenly up in the
mouth, forming a scurf; the surrounding cellular
tissue is swollen, hard, though painless, not red nor
very white either; cheeks, lips and eyelids are generally cedematous; the skin is pale, livid, feels like
wax, shines like grease; the parotid and cervical
glands soon become affected. The blister soon breaks,
discharging a blackish ichor and assuming a livid
colour; the parts around, to a considerable extent,
change very rapidly to a gray, ash-coloured, or black
papescent scurf, or to a putrid discoloured papescent
mass, in which the mucous membrane and other soft
parts are contained in a state of dissolution. The destruction generally commences in the middle of the
cheek or at the corners of the mouth, attacks not only
the soft parts, but also the bones and teeth, and extends
even to the orbits and forehead, neck and chest. The
ulcer is irregular, shaggy, insensible, and discharges
a thin, bloody ichor with a cadaverous odour; the edges
of the ulcer are hard, indented, black as coal, surrounded by a dark shining redness; the parts which
slough off do not bleed. In from three to eight days
the cheeks, lips and eyelids may become transformed
to a soft, putrid mass.-Afterwards fever and symptoms of constitutional suffering set in; the breathing
becomes oppressed, the pulse small and frequent, colliquative diarrhcaa sets in, etc.-;If we succeed in ar



36


NOMA, CANCER AQUATICU.


resting the destruction, the gangrenous parts are separate from the sound parts by a border of an intense,
vivid redness, the odour disappears, laudable pus is
secreted instead of the ichor, and healthy granulations
shoot up from the ulcerated surface.
Noma affects almost exclusively children from the
second to the tenth year, rarely full-grown people, and
infants at the breast very rarely. The patients are
generally unhealthy, scrofulous, delicate children
with blond hair, brought up on bad food, in bad air,
in foundling or almshouses, orphan asylums, etc. Sometimes the disease sets in as a sequel to measles, scarlatina, smallpox, whooping-cough, dysentery, typhoid
or intermittent fevers. The disease is not epidemic,
and is very rare.
Generally speaking, the disease terminates fatally.
I have never treated a case of this disease, and what
I offer about the treatment is therefore purely theoretical.
I recommend Secale cornutum as the specific for th!s
disease. Its destructive action seems to be similar
to that of noma. We know from post-mortem examinations that it produces gangrene of the stomach,
lungs and other viscera; that the heart and lungs are
generally pale, flabby and deprived of blood. Gross
recommended Anthracin in case Secale should have
proved fruitless. Others recommend Corrosive sublimate, and some again Helleborus niger, though the
eruption which this substance produces in the mouth,
seems to be aphthous rather than any thing else.
Iodium has the following symptoms: Ulcer on the
left cheek with hard tubercle, and swelling of the surrounding glands; vesicles in the mouth with increased
secretion of fetid saliva and swelling of the gums,
small elevations on the inner side of the right cheek,
with inflammation of the surrounding parts; putrid
smell from the mouth; sudden emaciation down to a
skeleton, with hectic fever.-This remedy acts slowly,
but the slowness may be overcome by repeating the
dcse the more frequently; I would likewise state that,



HEMICRANIA, CLAVUS, MEGRIM.


in such diseases, I never use the high or highest potencies. Kali hydriodicum may likewise be mentioned
along with Iodium. Acid. mur., Tart. emet., Carbo veg.,
Chlore, Kreasot., have likewise been proposed.
After this short deviation, I return again to the
treatment of neuralgic affections.
~. 191. Hemicrania, Clavus, ilMegrim.
The attacks are periodical. The patients complain
of a boring pain at a circumscribed spot near the sagittal suture in the outer parts of the head; or the
pain occupies one side of the head, the forehead,
supra-orbital and temporal region, extends into the
orbits, and is sometimes relieved by pressing the head
together; whereas, at other times, the affected part is
extremely sensitive to the least pressure. When the
paroxysm is at its height, the patient feels sick at the
stomach, vomits up water and mucus, after which the
patient feels somewhat relieved. The attack is sometimes excited quite suddenly, by chagrin, fright, sudden joy, a cold, indigestion, etc. During the attack
the patients are extremely sensitive to light, noise,
change of temperature, even to the smell of food;
they endeavour to keep mind and body as quiet as
possible. The paroxysm generally commences with
sun-rise, on waking, and ceases at night; sometimes,
however, it lasts longer. Next day the patient is well
again, after a refreshing sleep. The left side of the
head is more frequently attacked than the right.
The attacks generally occur periodically, either at
regular or irregular intervals. Among females, the
menses are sometimes retarded by the pain. The attack is frequently preceded by vertigo, cheerful and
loquacious mood, or sadness, nausea, loss of appetite,
sour eructations, vomiting, etc. It is more or less
mild or violent; generally it increases gradually, commencing with a slight pressure or a sensation of coldness in the part to be attacked, and then changing to
a throbbing, boring pain, or to a stitching, burning,
tearing pain, etc.



38


HEMICRANIA, CLAVUS, MEGRIM.


The characteristic symptoms of hemicrania are:
the characteristic neuralgic character of the pain, its
periodical recurrence, the absence of any derangement of the cerebral functions between the paroxysms,
the absence of all febrile symptoms during the attack;
these may, however, set in after years of suffering,
and then the patient is never entirely free from pain,
particularly in the region of the sagittal suture; sleeplessness supervenes, and the affected spot is swollen
externally and sensitive to the least pressure.
Causes: Persons with irritable nerves, hysteric, hypochondriac, chlorotic individuals, females who have
become enfeebled by hard labours and haemorrhages,
individuals leading a sedentary life, literary people,
etc., are most liable to the disease. It is occasioned
by bad digestion, obstructions in the portal system,
arthritis, mercurial dyscrasia, etc., by menstrual suppressions, excessive intellectual labour, excitement of
the fancy.
~. 192. Treatment. Coffee should be avoided very
particularly, otherwise a cure is impossible. The
disease is sometimes caused by coffee, particularly
when the patient complains of a violent drawing-aching pain in one side of the head, with a sensation as
if a nail were driven into the parietal bone; the
aversion which patients experience against coffee
during the attack, likewise shows that coffee is food
for such a megrim. The brain sometimes feels as if
torn or smashed to pieces. For this headache, Nux
vom. is the first remedy, which may be given in repeated doses; or Ignatia, Pulsalilla or Chamomilla may
be required after the first dose of Nux, and this medicine may then be repeated afterwards. Nux v. is
likewise indicated when the stitching-aching pain in
one side of the head commences early in the morning,
increases gradually, and finally becomes so violent
that the patient is almost frantic. This attack is
rarely accompanied with congestion of blood to the
brain; generally the face is pale, and the features distorted. Nux v. is one of the principal remedies.



HEMICRANIA, CLAVUS, MEGRIM.


89


Dr. Tietzer furnishes the following indications for.Nux in megrim: " It is more suitable to men, when
the disease proceeds from the ganglionic system, and
the hemicrania is sympathetic, particularly among
hbeemorrhoidal subjects who complain of pain in the
small of the back, pressure on the rectum, difficult
stool and gastric ailments; or to persons with a choleric temperament, to drunkards, and literary persons
leading a sedentary life.-The pain is most frequently
drawing-aching; there is frequently a sensation as if
a nail were driven into one side of the head; on
one side the brain feels as if dashed to pieces.-Among
females, the menses occur prematurely and are too
profuse.-The pain sets generally in early in the morning, or after a meal, or on exerting the mind."
" Ignatia. It is suitable to sensitive, hysteric individuals with a sanguine nervous temperament, and
soft, insinuating manners, with a disposition to reverie, silent grief, fright, mortification and clonic
spasms after some emotion.-The pain is chiefly pressing, sometimes stitching, from within outwards, in the
forehead and root of the nose." The pressing pain is
predominant; when there is a sensation as though a
nail were bored into the brain, the pressing is felt
from without inwards; a peevish mood likewise indicates Ignatia.
Chamomilla is indicated by drawing-beating pains
in the right half of the head, recurring in paroxysms
and excited by emotions; by a quarrelsome and vexed
mood, hypochondriac, whims, etc.
Pulsatilla is suitable to chlorotic, hysteric persons,
with a phlegmatic, good-natured and roguish disposition; it suits a scrofulous diathesis and abilioso-gastric
state. It corresponds to stitching-tearing pains, worse
in the evening and most violent at night; to a sad,
whining mood.
Belladonna should be used when the pain extends
to the orbit and nasal bones; the pain is pressing, undulating, as if the brain would be dashed to pieces or
as if it were shaking to and fro. (Platina might like



40


HEMICRANIA, CLAVUS, MEGRIM.


wise be tried for an undulating pain.) Belladonna is
particularly indicated when the pain is aggravated by
the least motion of the body, and especially of the
eyes, by exposure of the eyes to the light, by noise,
by people walking about in the sick-room, and generally by every least concussion; the arteries pulsate
audibly.-Belladonna is likewise suitable for the arthritic hemicrania, with shooting, deeply penetrating,
intense pains, sometimes commencing at one spot as
with a breath, changing to a long, extremely painful
stitch, which pierces the whole hemisphere of the brain,
and deprives the patient of consciousness. This attack
yields to one or two doses of Belladonna in 36 hours,
and frequently remains suppressed for a long time,
though Sepia seems more adapted to a cure, inasmuch
as stitching and pricking pains are among the pathogenetic effects of that medicine. Sepia is particularly
indicated by stitching pains in one of the frontal or
occipital protuberances; the stitches are like flashes
from without inwards, and reverberate deep in the
brain for a long time; the more frequently they recur,
the more the patients complain of heat in the head,
which gradually becomes more and more troublesome
and is accompanied with great tightness of the head,
and painfulness of the head to contact. In arthritic
hemicrania it is frequently observed that the scalp is
very painful to contact, with a sensation of tightness.
In some cases I have removed this last symptom with
Acid. nitr., or Zincum or Petroleum, being guided by the
accompanying symptoms in the selection of the remedy.
Though Sepia and Belladonna are necessary to effect
a radical cure, yet Aconite is absolutely required for
the following symptoms: a tearing-drawing and
jerking-stitching pain in the head, with fulness and
weight in the forehead, throbbing in the temples,
bloated and red countenance, the headache gradually
increasing to such an extent, that the patient almost
becomes frantic; the patient moans aloud, complains
of great anguish, with shortness of breathing and palpitation of the heart, etc. I give the patient Aconite



HEMICRANIA, CLAVUS, MEGRIM,


41


to smell of every 5 or 10 minutes; in a short while
the patient goes to sleep, and feels relieved.
Coffea corresponds to a pressing pain on one side of
the head, as from a nail being driven into the brain,
or as if the brain were smashed to pieces; the pain is
generally excited by mental exertions, and occurs even
in persons who had never used coffee. In some cases
Nux v. and Bryon. are required after Coffca. The
symptoms for Bryonia are: Pressing pain in the left
frontal eminence from within outwards, as if the part
would burst open, aggravated by moving the eyes,
accompanied by tearing with pressure in the affected
hemisphere of the brain, likewise with dizziness and
heaviness in the same, sleeplessness, and a vexed, irritable mood.
Colocynthis corresponds to a pressing or drawingcrampy hemicrania when aggravated by lying on the
back or by stooping, accompanied with nausea and
vomiting, appearing every afternoon or evening, extorting cries and tears, and inducing an increasing
shortness of breathing. It is easily excited by emotion,
indignation and mortification.
This kind of hemicrania is frequently cured by
China. I have used it principally for a pressure with
tearing, or for a tearing with pressure at some spot of
the head, with great mental excitement, restlessness,
excessive activity of the fancy; the pain is aggravated
by movement in the open air, or by pressure.
Hemicrania, and headache generally, are frequently
accompanied with vomiting and nausea. Ipecacuanha
is suitable for many of such cases, likewise Pulsatilla,
particularly when the pain is boring, stitching, contractive, or as if the head were screwed in.
Hemicrania is seldom cured with one remedy only.
Among those that require to be mentioned is Vcratrum
album, when the pain is throbbing with pressure, with
sensation as if the brain were bruised, rush of blood
to the head, pains in the stomach, obstinate constipation, etc.
Arsenic corresponds to a throbbing-stupifying pain



42


HEMICRANIA, CLAVUS, MEGRIM.


in the forehead, particularly over the root of the nose,
or over the lett eye, the pain almost always leaving
a weakness of the head with qualmishness and weakness in the pit of the stomach. The arsenic-hemicrania is characterized by symptoms like the following: it occurs regularly after dinner, decreases by
applying cold water to the head, and increases again
on removing it; it is most violent in the evening and
at night, is relieved by walking about, by external
warmth and compression of the head; it is sometimes
accompanied by excessive prostration, etc.
Arnica is suitable for paroxysms of stitching pain in
the forehead and temple, with heat in the face and
thirst, nausea and qualmishness in the pit of the stomach, particularly on stooping. Arnica is suitable
for arthritic hemicrania, likewise Guajacum. The
pressing pain, which frequently changes to a stitching,
occurs most frequently in the right frontal eminence,
or on the vertex, and ascending from the nape of the
neck, shortly after rising in the morning. Guajacum
is also indicated by a drawing-tearing pain from the
left parietal bone to the frontal protuberance; it is
generally accompanied with a sensation as if the
scalp were swollen, and as if a throbbing were felt
in it.
The principal indications for Hyoscyamus are: stupifying pressure, changing to stitches or tearing and
shifting about.
Cicuta corresponds to a pressing heaviness, or a
stitching-compressive pain, generally in the right side
of the head, from the nose and eye to the occiput. It
occurs most frequently among hysteric individuals,
with a sad and anxious temper.
Ruta removes a stupifying pressure in the right half
of the forehead, and above the root of the nose, with
nausea, decreased by motion.
Manganum aceticum is indicated when the pains
occur at night, are aggravated by stooping; sometimes they occur during a walk in the open air, and
are relieved in the room, or they get worse or better



HEMICRANIA, CLAVUS, MEGRIM.


with a change in the weather. The principal symptom is a tearing-stitching pain in the left side of the
head; the pressing pain from the occiput across the
vertex to the forehead is less frequent.
Capsicum annuum is an excellent remedy for arthritic headache and hemicrania, particularly when
the pain is throbbing or stitching with pressure, aggravated by moving the eyes and head, and by inclining the latter forward; in hysteric megrim. it
deserves a preference over many other remedies.
Thuja renders good service in old hemicrania; in
hemicrania arising from former sycosis, which, after
being apparently cured, leaves behind it rheumatic
affections of other organs, which disappear again with
the setting-in of the hemicrania. Thuja is characteristically indicated by a pressing-aching pain in one side
of the head, as if a nail were driven in, in the right
hemisphere of the brain; the pain generally becomes
worse in bed, during rest and in warmth, and is relieved by motion, coldness and sweat.
Spigelia, Sabina, Aurum, Rhus tox., deserve to be
ranked next to Thuja.
Nitri acidum: Indicated by oppressive heaviness
which passes into a drawing-stitching and dartingcutting pain, with tightness of the head and nausea;
the drawing-stitching pain, generally in the left side,
in the occiput and parietal bone, is the most painful
symptom; it obliges one to lie down, and prevents
sleep; the darting cutting strikes from before backwards. This kind of hemicrania occurs in scrofulous,
hysteric, syphilitic subjects, and is accompanied with
vascular excitement; it is excited by little exercise,
a walk in the open air, by a slight cold, etc.
Tinctura acris sine kali. Hahnemann has mixed up
the symptoms of this agent with those of Causticum.
I have used the former remedy when the patients
complained of the brain feeling as if torn or smashed
to pieces on one side, which was aggravated by shaking the head. The pains became worse towards



44        NEURALGIE OF THE SPINAL NERVES.


evening and in the open air; the aching pains are
excited by a current of air, and set in with chilliness.
Conium has been given for drawing-tearing-stitching pains; for a sensation as if a large foreign body
were lodged in the right hemisphere of the brain,
which can be dislodged by external friction. It is
suitable for old people and females, and for hypochondriac, hysteric, scrofulous and syphilitic individuals.
Culcaiea carbonica is suitable for scrofulous subjects, and is principally indicated by a stupefyingaching pain on one side, with empty eructations, excited by reading and writing; by an oppressive sensation of fulness, with heat in the head, and aggravation on raising and moving the head; by a pressure
from within, relieved by counter-pressure; by an
aching-drawing, tearing, stitching pain.
Petroleum, Lycop., Zinc., Phosphor., Silic., Kali
carb., should not be forgotten. The latter remedy
relieves headaches caused by riding in a carriage.
NEURALGIiE OF THE SPINAL NERVES.
~ 193. Neuralgia of the spinal marrow, spinal irritation, rhachialgia, notulgi.a.
Spinal irritation is a disease of the spinal marrow
which scarcely ever leaves a trace of material alteration of that organ in the dead body. The principal
symptom is: pain in the back, accompanied with
pain, disagreeable sensation and convulsive paroxysms
in the internal body, or in the organ which is in relation with the affected portion of the spinal marrow.
The pain extends through the whole or part of the
spine. The pain in the marrow is sometimes more
deep-seated than the origin of the nerves of the
secondarily affected organ. When the upper cervical
portion (especially the 2d and 3d) is affected, the
patients complain of pain in the head, forehead, face,
illusions of the senses, hemeralopia, vertigo, araurosis, buzzing in the ears, deafness, delirium, stiffness



NEURALGIE OF THE SPINAL NERVES.


45


of the neck or altered inclination of the head. A pain
in the lower cervical portion is accompanied with:
pain in the region of the clavicles, shoulders, breasts,
sternum, arms and fingers, spasm of the fauces or
larynx, singultus; spasmodic movements or paralysis,
sensation of oppression or palpitation of the heart. If
the upper dorsal portion be affected, we have: constriction of the thorax, orthopncea, spasmodic cough, palpitation of the heart, fainting fits, moaning; pains in the
hypochondria, below the false ribs. If the lower dorsal
portion be affected, the patient complains of pain in the
stomach, cardialgia, pain in the pit of the stomach, derangement of the digestive functions, vomiting, eructations; sometimes pains in urinating, with frequent urging to urinate. An affection of the lumbar portion is indicated by sensitiveness of the abdominal integuments,
colic, pains and impeded motion of the lower limbs;
ischuria, drawing in the testicles.-The most important
symptoms sometimes run a more or less regular
course.-The irritation is most frequently seated in
the region of the 7th to the 9th, and of the first to
the second dorsal vertebra.
Causes: The disease is more frequent among
women than men, and principally among hysteric and
hypochondriac individuals; it is caused by menstrual
irregularities, confinement, digestive derangement,
affections of the dental nerves, foreign bodies which
irritate the spinal marrow. The blood, when infected
with the miasma of typhus and intermittent fever,
appears to cause a secondary spinal irritation, which
many consider as the essence of the disease. In this
case the irritation is principally seated in the first
and the adjoining dorsal vertebrae. (Canstatt).
~ 194. I shall not attempt to construct a complete
special therape'a upon the subject of spinal irritation.
Many of the diseases arising from spinal irritation,
have already been treated in former chapters, such
as: intermittent diseases, ar. hritis, rheumatism, paralysis, prosopalgia, etc.; many others will be mentioned
hereafter. I will add a few general indications, which,



46       NEURALGIAE OF THE SPINAL NERVES.


though of little practical value in themselves, may
serve to suggest a useful remedy in particular cases.
Pain of the cervical vertebrae.-For pressure in
the same: Guajacum; tension and pressure: Bismuthum; cracking in the same on shaking the head:
Stannum; cracking or crackling, on moving the head,
also stiffness in the same: Magnes. arct.; pain as if
sprained: Cinnabaris; soreness of the lower cervical
vertebrae: Coniul.-Intermittent stitches in the clavicles: Sabina; tearing in the clavicular region:
Lycop.; muscular jactitation around the clavicles:
Asa.-Pressure on the shoulders: Kali karb.; tearing
pain with pressure in the shoulders, striking down
the arm very rapidly, particularly at night, relieved
by pressure, excited by motion: Belladonna; tearing
stitching in both shoulders: Asa; tearing in the
shoulders, with stiffness of the lower limbs and difficulty of moving them: Thermce Tepl.; tearing in
the shoulders with pressure from without inwards:
Laurocerasus; rumbling and gurgling in the shoulders
and scapulae, with chilliness over the whole body:
Taraxacum; rheumatic tearing in the shoulders:
Rhodod.; tearing between the shoulders, aggravated
by cold, relieved by warmth: Rhus tox.; stitching
with burning and pain as if bruised between the
shoulders: Magnes. mur.; stitching pain in the
shoulder on raising and moving the arm: Ledum;
drawing, tension and tearing from the shoulders across
the nape of the neck through the whole arm: Manganum; dull stitching pain betw vcn the shoulders
from above downwards: Mezereum; sore feeling between the shoulders, with stitching tightness when
walking: Colocynth; tearing, throbbing, ulcerative
pain from the shoulder to the fingers, also pain as if
sprained with cracking: Thuja; tearing apd burning
in the shoulder with lameness of the arm, particularly
during the cold season, during rest and in the warm
bed: Rhus tox.-Pain at the lower end of the sternum
as from a shock or sore: Cicuta; stitches in that
region: Angustura; stitching with pressure in the



48      NEURALGTIE OF THE ABDOMINAL NERVES.
NEURALGICE OF THE ABDOMINAL NERVES.
S195. Neuralgia coeliaca.
Formerly this disease was confounded with colic
and cardialgia, until Autenrieth succeeded in establishing the correct diagnosis of each of those affections.
The paroxysms are preceded by a precursory stage
lasting from a few minutes to several hours, during
which the patients are very uneasy and apprehensive
of the coming attack, which sets in in the following
manner: The patient feels a violent pain in the pit
of the stomach, below the ensiform process; the pain
is burning, tearing, stitching, aching, as if a hot coal
were lodged there; or as if the part were violently
torn asunder; the pain is frequently so piercing that
it sets robust persons frantic, and causes feeble individuals to faint. After the pain has lasted for a while
at this spot, say from five minutes to half an hour, it
leaves there and shoots under the sternum towards the
neck like a flame, or it divides into two currents,
which, following the course of the sympathetic nerve,
ascend towards the neck on both sides of the vertebral column; or else the pain suddenly branches off
in every direction, particularly towards the hypochondria, following the course of the plexus lienalis
and hepaticus. Towards the end of the paroxysm the
patient is troubled with eructations or accumulation
of water in the mouth; after the paroxysm the patient
complains of great emptiness in the abdomen and
languor and lassitude in the whole body; the tongue
is clean and the appetite and digestion are good. It
is very rare that several paroxysms take place in one
day; but if they continue long, scarcely a day passes
without a paroxysm. The paroxysms are most violent
in spring and fall; much less so in summer and
winter; they are most frequent at night and in the
morning.
Etiology: The disease is much more frequent
among men than women, in the proportion of 3 to 1.



50


COLICA, ETC.


after the paroxysm the patient complained of empty
eructations and a feeling of emptiness in the abdomen;
languor of the whole body, and sensation as if he had
been lying on wood the whole night.
Veratrum may be tried in the place of Nux if this
should fail, and Phosphorus in the place of Arsenic.
Cicuta virosa suits nervous, irritable females; the
pain in the pit of the stomach is burning-stitchingthrobbing, accompanied with loud singultus.
Bryonia, Conium and Sulphur deserve to be named,
the two latter especially when the disease is supposed
to have arisen from the suppression of some cutaneous eruption. Other remedies will be found mentioned in the chapter on cardialgia.*
~. 197. Colica, enteralgia, enterodynia, colic.
Colic is characterized by pressing, constrictive, cutting, pinching, tearing, wandering or seated pains,
principally in the umbilical region, or along the course
of the colon; they abate or cease, and recur again,
alternately; the abdomen is not distended, hot or sensitive to pressure. The duration of the attack varies.
The pains may become so violent that the patient
writhes like a worm, tosses about the bed in anguish
and despair, rolls about the floor; the abdomen is so
sensitive to the touch that one might be led to suppose a violent inflammation must have developed itself. By increasing the pressure, the pain issometimes diminished, which is not the case when inflammation is present. After the attack, the sensitiveness of the abdomen ceases.-The colic may be accompanied with pain in the stomach, bladder, uterus,
calves.-During the paroxysms the abdominal muscles
and integuments are spasmodically drawn to the spinal column. The contraction of the bowels frequently leads to obstinate constipation; the reflex action on
the stomach causes vomiting, and upon the biliary
*  If physicians will try  the tincture of Aconite for this disease, they
will soon find out what is the true specific for it. In most cases card algia
is a simple state of venous congestion which yields to Aconite, and the application of warm flannel to the stomach.-Hempel.



FLATULENT COLIC.


ducts icterus. The sympathetic suffering of the
nerves of the diaphragm and of the nervi vagi explains the oppression, anguish, the moaning and irregular breathing, the singultus, etc.-The pulse is
contracted, small, the extremities are cold, face pale,
the features exhibit an expression of pain; after the
attack, the urine is watery, pale-yellow; fainting fits
and convulsions sometimes set in.
Etiology: Colic may be excited by every unusual
irritation of the intestinal mucous membrane: indigestion, a cold drink while the body is hot, crude vegetables, unripe fruit, excessive use of ripe fruit, improper use of emetics and cathartics, acrid and metallic substances, poisons, foreign bodies, retained or
indurated faeces, worms, excessive or morbid secretion
of bile, flatulence, mechanical dragging of the intestine by hernia or other alterations of place, etc.
According to the origin, we distinguish rheumatic,
bilious, gastric, stercoral, verminous, metastatic, arthritic, hremorrhoidal, menstrual, flatulent, hysteric,
hypochondriac colic.
The prognosis is not unfavourable.
~ 198. Flatulent colic.
Flatulent colic depends upon an accumulation of
air induced by flatulent and fermenting food, etc., during a weak state of the bowels, or it may be caused
by a cold, disturbing emotions, such as: anger and
chagrin, inducing a spastic state of the bowels, which
prevents the discharge of the accumulating gas. The
pain is distensive, stitching, drawing, cutting, and is
somewhat relieved by pressure on the abdomen.
Frequently the pain wanders about, with rumbling,
following the course of the intestines, particularly the
colon, and affecting even the stomach and chest. The
abdomen is irregularly distended in some places,
without hardness, or great sensitiveness; here and
there a hard elastic swelling starts up yielding a tympanitic sound. The pain is relieved by the discharge
and shifting of the flatulence. The same relief is
procured by eructations, and rubbing the abdomen.



FLATULENT COLIC.


Sometimes the flatulence wanders only as far as the
region of the left hip, where it causes a horrible pain,
and then leaves again with a noise. Violent colic is
sometimes accompanied with ischuria, spasmodic erection of the penis, and coldness of the extremities; the
pulse is generally small, intermittent; costiveness,
anguish in the precordial region, straining, etc., are
likewise present. This kind of colic frequently befals
infants that are brought up without the breast, hypochondriac, hysteric persons, and individuals leading a
sedentary life. The colic is generally of short duration, disappears after the emission of flatulence, but
is apt to re-appear, and, finally, to become habitual.
~. 199. Nux vom. is one of the first remedies for
this disease. It causes difficulty of digestion, distention of the epigastric region, pressure and fulness in
the stomach, particularly after dinner, disposition to
flatulence, and even a real flatulent colic. It removes
colic which is deep-seated in the abdomen, and is accompanied by a sensation as if a cutting or sticking
instrument were operating upon the bladder, the neck
of the bladder, the commencement of the urethra, the
perinaum, the rectum and anus, as if cutting flatulence would press out everywhere; the pains become
intolerable by stepping about, so that the patient is
obliged to walk bent double, whereas they disappear
rapidly during rest, when sitting or lying. This colic
is frequently accompanied with the most violent headache, and pains in the small of the back.
Cocculus is indicated by a constrictive pain in the
abdomen, with qualmishness, and pressing towards the
sexual parts; by discharge of flatulence without relief,
constantly followed by other flatulence which becomes
incarcerated here and there, and causes a pressing,
tearing, and burning pain; sometimes the flatulence
distends the whole abdomen, affects the stomach,
causing a crampy and griping-tearing pain in the
same, and creates a feeling of anguish, with pressure
in the subcostal region; these symptoms abate or disappear by eructations. The attack generally sets in
after midnight.



FLATULENT COLIC.


53


Chamomilla removes the following symptoms, which
are sometimes caused by a cold: sensation as if the
flatulence would press through in various places; distention in the praecordial region and hypochondria;
indescribable anguish, restlessness, clammy sweat. A
violent attack is sometimes accompanied with an
urging to stool and rumbling, which disappears again
after the discharge of some slimy water. This kind
of colic frequently occurs among infants, and readily
yields to Chamomilla.
Belladonna removes a flatulent colic, which is relieved by bending forward and by pressure; the transverse colon protrudes like a pad. This colic is frequently accompanied by a pinching and pulling from
above downwards in the affected parts, which increases in proportion as the patient endeavours to remain up; in this case he feels as if the bowels were
loose and had settled lower down. The colic is sometimes accompanied by discharges of pus, which seem
to point to the presence of an ulcer in the bowels; in
such a case Mercurius may be given after Belladonna.
Mercury is very frequently indicated after Belladonna
in abdominal affections.
Belladonna is likewise useful in those kinds of colicodynia flatulenta, which bring on fainting fits, cold
sweats, or a violent congestion of blood to the head,
with redness of the face and swelling of the veins;
the pains are so violent that the patients behave like
frantic madmen.
Belladonna likewise removes the grasping and griping as if with nails, under the umbilicus, particularly
when accompanied with pain in the back and small
of the back.
Flatulent colic deep in the abdomen, with sensation
as if the lower bowels were constricted, incarceration
of flatulence, with pressing and tensive pains, a tight
and anxious feeling under the short ribs, is most speedily relieved by China.
Hysteric persons are frequently roused from sleep
at night by an attack of flatulent colic, characterized



54


FLATULENT COLIC.


by stitches in the sides and towards the chest; the
pain is relieved by emission of flatulence, but the
emission being incomplete, the pain lasts a long while.
This kind of colic is most certainly relieved by Ignatia amara. The colic is sometimes accompanied by
an aching pain at a small spot of the head, peculiar
to hysteric females; this pain is a sensation as if a
blunt body were driven into the brain.
Pulsatilla is more suitable for women than men,
and is especially indicated when the headache arises
from nervousness rather than from hysteria; also,
when the aching colicky pains recur periodically in
the evening or after midnight, and when the flatulence
which is incarcerated in the epigastric region, and
causes pinching and gurgling, passes off with a violent
cutting colicky pain, and frequently even with nausea
and vomiting.
Zincum seems to help when the flatulent pains,
which afterwards increased to real aching colicky
pains, get worse from drinking a glass of wine, or appear towards evening, during rest; the pains are
generally accompanied with constipation, with loud
rumbling, fermenting sensation, and retraction of the
abdomen; hot, humid winds are frequently passed
without relief.
Veratrum is suitable to flatulent colic preceded by
anguish, despair as if beside one's-self, particularly
when the flatulence shifts about and finally attacks
the whole abdomen; the emission of flatulence is so
much more difficult, the longer it remains incarcerated; the abdomen is distended and hard.
Phosphorus relieves flatulent colic which is deepseated in the distended abdomen, aggravated in a recumbent posture, and accompanied with loud, painful
rumbling.
Hyoscyamus is useful for pressing flatulent colic, in
the evening when in bed, with distention of the abdomen, and pain on touching it; also for flatulent colic
which sets in after rising in the morning, and is accompanied with meteoristic distention of the abdo



COLICA GASTRICA.


of diet, worms, etc. The colicky pain is more or less
violent, accompanied with a sensation of tightness,
heaviness, repletion; pains in the back extending to
the loins, thighs, knees; deranged stool. The abdomen is not hot, the pulse somewhat irritated, but
neither hard nor tight; fever may, however, supervene.
The pain is relieved by the discharge of the foreign
substances.
Bilious colic is induced by the presence of acrid bile
which is secreted, to excess, into the stomach and intestinal canal; the colic is generally felt in the epigastrium; it is generally accompanied with vomiting
of greenish matter, from which we may infer the
presence of bile in the stomach. This kind of colic is
sporadic, caused by violent anger or chagrin; it is
endemic in hot countries, where bilious fever and hepatitis are common diseases; it is frequently epidemic,
even in our climate, in hot summers, with cool nights;
then it prevails in company with bilious fevers and
bilious dysentery, or other bilious diseases, is frequently combined with these diseases, and is caused
by a cold, indigestion, carousing in the evening, or
night-air. Bilious colic does not always set in suddenly; sometimes it is preceded by bilious phenomena,
such as loss of appetite, hitter taste, yellowish-slimy
coating on the tongue, tightness in the praecordia. The
colicky pains are generally violent, acute, cutting, contractive, frequently emanating from the right side.where
they are most violent; accompanied with great internal heat, thirst, restlessness. The patient is relieved
by discharges of bile from the stomach or rectum.
Violent attacks easily lead to hepatitis or enteritis, or
leave, at any rate, a great sensitiveness of the intestinal canal, predisposing the patient to new attacks.
~. 202. If we can ascertain the cause of the colic,
we should endeavour to remove it, or to select our remedy accordingly. Chamomilla, for instance, should
be given when the attack was brought on by violent
passion or chagrin. It is indicated by a painful distention and tightness in the subcostal region, particu



COL1CA GASTRICA.


57


larly in the right hypochondrium, whence colicky
pains spread to the umbilicus, causing a pressure and
griping in the stomach, which lead to nausea and
bilious vomiting, and leave the tongue coated with
yellowish slime, and a bitter, bilious taste in the
mouth.
Nux vom. is preferable to Chamom., if the attack
took place after a copious meal, or some time elapsed
before medical aid was required; it suits patients with
a robust, plethoric constitution, or persons accustomed
to rich living.
Ignatia corresponds to colic from silent grief, and
Pulsatilla should be given when Chamomilla relieves
but does not stop the recurrence of an attack. See
the chapter on Gastroataria, vol. I.
Ipec., Bryon., Verat., Arsen., Dulc., Sulph., are likewise indicated for bilious colic.
Hahnemann cured a case of colicodynia with large
doses of Veratrum (see Hufeland's Journal, vol. III.,
No. 3, year 1797.) Four or five hours after eating
fruit, particularly pears, the patient experienced a
certain movement about the umbilicus;* suddenly he
felt, at the same spot, a pinching as if with pincers,
accompanied with excruciating pains; this continued
for half a minute or a whole minute, and disappeared
suddenly after some rumbling extending down to the
groin or coecum. If the attack was very bad, the
pinching and rumbling occurred more frequently until
they remained altogether.  This sensation was accompanied with a feeling of constriction from above
downwards, so that no flatulence could be discharged
either above or below. The anguish and pain increased from hour to hour, the abdomen became
swollen and painful to the touch. The anguish, which
resembled a fever, was attended with a frequent urging to vomit, the chest became oppressed, the breath* The patient had complained of a dull, disagreeable sensation
in the left hypochondrium for a year past, after having had an attack of colic.
3V



COLICA SATURNINA, ETC.


59


tended with flatulence.-Colic from indurated fceces,
to which old people, hypochondriacs, pregnant females
and individuals with old herniae, are subject. The
lumps of faeces may be displaced and felt with
the hands, etc. The remedies are the same as those
that have been indicated in the last paragraphs, and
in the first volume.
~. 203. Colica saturnina, pictorum, rhachialgia metallica.
This kind of colic arises from the introduction of
metallic oxyds, especially lead, in various forms and
ways, into the human body. This may take place by
mixing it up with food and drink, wine for instance, or
by administering it as a medicine in the form of an
acetate, or by inhaling metallic vapours, as is the case
among miners, potters, painters, type-founders, or by
using badly glazed leaden vessels. This colic is characterized by an excessive retraction of the abdominal
muscles towards the spine, sympathetic vomiting,
strangury, slow and hard pulse, obstinate constipation,
and dryness of the faces.
The colicky pains are at first dull, intermitting; as
the disease increases, they become twisting, constrictive, boring; they become concentrated in the pit
of the stomach and umbilical region, when they
radiate to the chest, back, hips, arms and feet; at last
the intermissions disappear, the pain becomes continuous, and is frequently so violent that the patients
toss about, moan, writhe in agony; the pain is
sometimes relieved by compressing the abdomen.
The abdominal muscles are frequently contracted to
such an extent that the vertebrae can be felt through
them. The alvine evacuations cease; sometimes a
scanty discharge of hard lumps like sheep-dung does
not take place till a week or a fortnight after the
commencement of the attack.
Reflex-symptoms are: loss of appetite, nausea,
retching, vomiting of a dark-green matter, or like
verdigris; strangury or isehury; retraction and co



UOLICA RATV2RN!1NA, ETC.


traction of the sphincter ani; the testicles are drawn
spasmodically to the abdominal ring; the breathing is
anxious and even asthmatic, particularly during the
attack, the voice is hollow and dull; sometimes singultus is present.
The following symptoms are likewise frequently
observed in the course of an attack: tearing pains in
the limbs, sometimes alternating with the colic, particularly at night; these pains, if lasting, increase to
weakness, tremor and paralysis; the extensor muscles
are paralyzed, the flexor muscles remain active; this
is strikingly noticed in the muscles of the hands,
which are then bent inwards towards the forearm;
the pain in the limbs frequently continues with the
paralysis., Other nervous symptoms are: epileptic
spasms, delirium, amaurosis, apoplexy.-The patients
emaciate rapidly, the skin becomes dry, cracked, yellowish.
The attacks generally last from eight days to a
fortnight. They are readily cured by homceopathic
means, but the cause remaining, relapses are very
frequent. In this case the constipation becomes habitual, the patients retain a pale complexion, they become thin, feeble, paralytic and dropsical.-Termination in enteritis and ileus is not very frequent.*
~ 204. The specific remedy for lead-colic is Opium.
It removes the attack by opening the bowels. None
of the allceopathic adjuncts, such as alum, cathartics,
oleosis, hyoscyamus, etc., are required with Opium.
Platina is recommended by some as a superior remedy for lead-colic.
After the removal of the attack, various symptoms
sometimes remain, such as the paralysis. The constipation, spasms in the chest, amaurotic weakness,
can be met by Stramonium; Belltdonna deserves a
preference if the amaurosis and deafness should be
very great, and may be followed by Byoscyamus. In
* For a beautiful description of the lead cachexia, see Hempel's
Jahr.



COLICA RERUGINALIS, COPPER-COLIC.


some cases slight electric shocks will be found useful.
Alumina is likewise a good remedy for many afterdiseases.
~. 205. Colica ceruginalis, copper-colic.
This colic attacks workers in copper, coppersmiths,
etc., or persons who eat food prepared in badly tinned
copper vessels. It differs from lead-colic in many respects.
The abdomen is distended, hard, painful to contact;
the spasms, which are sometimes accompanied with
cutting and tearing in the bowels, are very violent,
and attack even the extremities, accompanied with
piercing shrieks; anxiety and pressure in the pit of
the stomach, spasmodic constriction of the chest,
white-coated tongue, with red tip and edges; difficult
speech, diarrhoea, sometimes resulting in the discharge
of a thin, green, or bloody mucus, with tenesmus; the,
urinary secretions are frequently totally suppressed;
sympathetic vomiting as consensual symptom.
~ 206. Treatment. This must be antidotal. Belladonna is the best remedy when the above-named
symptoms occur: erethism, distention, hardness and
sensitiveness of the abdomen, spasmodic tenesmus,
colicky griping, particularly in the umbilical region,
the above-described stools, stuttering speech, etc.
After Belladonna, we may give Mercurius, when
the erethic symptoms are subdued, and purely gastric
symptoms exist in the lower part of the intestinal
canal, the stomach being quiet.
Ipec. and Verat. may likewise be indicated by the
symptoms.
Nux vom. is related to Mercurius, and is to be preferred when the reflex-action towards the stomach
continues.
China, Hep. sulp., Cocc., Calc. c., may likewise be
mentioned as useful remedies for the after-effects,
after the colic is subdued.



62 COLICA SANGUINEA, PLETHORICA, HAEMORRHOIDALIS.
~ 207. Colica sanguinea, plethorica, hamorrhoidalis.
This colic is excited by congestion of the abdominal
organs, hmemorrhoidal or menstrual suppression. The
symptoms are various, and are apt to recur periodically, especially when the moon is on the increase.
Fever is piresent only when the colic is very violent.
The colic, which is apt to assume an inflammatory
character, is extremely violent, continuous, seated,
stitching, cutting, oppressive, increasing by contact;
if the spasmodic character prevails, the pains are paroxysmal like labour-pains, and the abdomen is at
times distended and sensitive, at others spasmodically contracted; a sensation of coldness in the
abdomen is experienced when a paralytic state is
present. These colicky pains are accompaned with
drawing, tensive, stitching pains in the small of the
back, back and loins, which suddenly shoot through
the pelvis or extend to the thighs; all sorts of congestions and spasms, such as: spasms of the bladder,
stomach, and uterus, pressing on the rectum, distress
in the chest, headache, buzzing in the ears, vertigo,
fainting fits, palpitation of the heart, anxiety, etc.
These symptoms frequently continue for months until
the blood is discharged; the symptoms decrease with
every new paroxysm, they are most violent when the
first discharge of blood takes place. Ift' this should
not take place, the symptoms increase to the utmost
violence.
~ 208. Nux vorn. is an excellent remedy for this
disease. In haemorrhoidal colic the bladder is more
or less affected, which makes the pain very distressing. The external sexual parts and the region of the
bladder are spasmodically drawn inwards, the abdomen becomes more and more sensitive, denoting an
inflammatory state; there is a constant urging to
urinate, without ability; great anguish and restlessness, leading to a sinking of the vital forces, parti



COLIC DEPENDING UPON LOCAL CAUSES.


63


cularly among old people, unless speedily relieved.
These symptoms are frequently relieved by a few
small doses of Nux.
If the prostration should increase from minute to
minute, Arsenic must be substituted for Nux, provided
help is not too late.
If the colic should have lasted until an inflammatory state is developed, Aconite is required, which will
remove the whole trouble.*
Belladonna corresponds to a constrictive, spasmodic
sensation deep in the abdomen, with a hot, burning
sensation, and a pressing sensation close above the
pubic bones and the sacral region, becoming intolerable by motion, and inducing a sensation of extreme
weakness, sensitiveness, loss of consciousness, even
fainting.
Sulphur is suitable for a colic which sets in slowly,
from day to day, particularly when the spasmodic colicky pains are accompanied with a sensation as
though the inside of the abdomen were all raw, and
the least touch causes great pain. The spasmodic
contractions extend to the chest, pelvis, sexual organs,
frequently alternate with cutting and stitching, and
are at the same time accompanied with violent pains
in the small of the back, which sometimes extend
along the back as far as between the shoulders, in
the shape of drawing and tensive-aching pains.
Useful remedies are: Capsicum, Ferrum, Thuja,
Puls., Ignat., Colocynth., Carb. veg., Phosphor., and
others.
~ 209. Colic depending upon local causes.
Under this head belong those kinds of colic which
attack old people, or are caused by sedentary habits,
dry food, tight lacing, accumulation of faeces. This
accumulation generally takes place in the colon or
* Aconite should be given from the commencement. Hartmann commits the same mistake as most other physicians, to suppose that spasms
and inflammation are two different conditions. See my Organon.-H5&mpel.



COLICA HERNFOSA.


accompany the incarceration. If the swelling becomes rose-coloured or livid, gangrene is imminent;
gangrene has actually set in if the swelling retreats
with a noise under the pressure of the finger; the denuded intestine is black, relaxed, or hard and liver-coloured. Incarceration may take place with every form
of hernia, even internal hernia, particularly at tie
abdominal ring, and with intestinal hernia. It frequently exists even if no external trace of hernia is
visible.
We may class here the involution of the intestines
termed volvulus, intussusceptio. This is a very
dangerous and acute affection. It is characterized
by a continuous, violent vomiting, with obstinate constipation, no flatulence even being passed. The patient complains of violent, boring pains in the distended region, and a sensation as if the bowels were frequently tumbling amongst each other. The pain is frequently concentrated about the umbilicus, it is a sensation as if a string were tied round the umbilicus, or
a violent tension. The pain finally spreads over the
whole abdomen, with meteorism and excessive sensitiveness. There is painful rumbling above the incarceration, eructations, singultus, thirst, anguish, sudden
prostration, quick and contracted pulse, sometimes
urinary difficulties. Fever sets in on the supervention
of enteritis.
~ 211. A specific remedy for this affection is Nux
vin., which should be given in a small dose, and, of
course, before gangrene sets in. It is not advisable to
try the taxis previous to the exhibition of Nux, because it increases the constriction of the muscular
fibres of the intestinal canal and abdominal ring, rendering the trouble more obstinate. The medicine has
to be repeated frequently, unless an improvement sets
in in the first half hour. The symptoms indicating
Nux, have been described before.
For ileus, Nux may likewise be tried. Belladonna
is useful for spasm from volvulus, intussusception and



66


PROCTALGIA AND TENESMUS.


incarceration, even when faecal vomiting is about setting in. It is preferable to Nux and Opium when the
abdomen is meteoristically distended, with anguish
and restlessness, spasmodic and griping pains in the
abdomen and region of the bladder, and constant involuntary discharge of urine. Plumbum should not
be forgotten for these symptoms.
~ 212. Proctalgia and tenesmus.
These affections are, generally speaking, symptoms
of some more general disorder, but they are sometimes so acute that the patient fancies he has no other
disease, and wishes to be freed from the local distress.
The distress must be very painful, if we consider
the multitude of nerves which are ramified over the
mucous membrane of the rectum. Neuralgic or other
painful affections of the mucous membrane covering
the sphincter ani, such as: fissures, even hemorrhoidal tumours, are sometimes accompanied with a spasmodic contraction of the muscle, which, at first, consists of short paroxysms of painful constriction, but, if
recurring frequently, may increase to a permanent
contraction, and constitute a painful affection that
"may exercise a very pernicious influence on the general health of the patient.
Tenesmus-a constrictive pain at the anus, with
sensation of urging to stool-may be excited by acrid
facal matter (in various forms of diarrhcea, dysentery,
blennorrhcea of the rectum) by an irritation produced
by ascarides, by a reflex-action from the bladder or
uterus; it may be present in catarrh of the bladder,
vesical calculi, etc. Violent tenesmus may occasion
prolapsus of the rectum.
~ 213. The treatment of these complaints is principally symptomatic. Among the following medicines
the beginner will find perhaps some that not only correspond to the particular distress, but the general state
of the patient.



68    GASTRALGIA, GASTRODYNIA, CARDIALGIA, ETC.
Prolapsus of the rectum, occasioned by these neuralgic affections, may be treated with Arsen., Sulph.,
Mercur., Sep., Dulcam., Colch., Ruta, Magnet., Ignat.
and Magnes. mur.
~. 214. Gastralgia, gastrodynia, cardialgia, colica
ventriculi.
This disease depends upon an increased irritation
of the nerves of the stomach, inducing an abnormal
contraction of the muscular fibres of that organ.
General diagnostic symptoms of cardialgia are: (a)
Neuralgic phenomena. The region below the xiphoid
cartilage, the epigastrium, and partly even the hypochondria, are the seat of the pains of various character
and intensity, the paroxysms alternating with intermissions. Generally the pains are violently constrictive, twisting, turning, cutting, tearing, boring, gnawing,
beating, etc.; at times dull, as if a band were strung
round the body; at times so violent, that the patients
bend double. The extent of the pain varies; frequently it occupies the epigastrium or only a small
portion of the same, or it extends to the back, breast
and scapula. Pressure from without frequently relieves the pain; this is the reason why the patient
presses the region of the stomach against hard bodies;
at other times the patient is afraid of slight contact,
whereas hard pressure is always easily borne. The
attacks generally last from a quarter of an hour to a
full hour; sometimes a whole day; the paroxysm is the
shorter the more acute it is. As the disease progresses, the paroxysms increase in intensity and frequency;
sometimes they are caused by eating light food, by
fatigue, emotions, a change of weather; the intermissions gradually become so short that the patient feels
a pain all the time. The exacerbations generally take
place in the afternoon, less at night; sometimes at
certain hours of the day, and even when the stomach
is empty, before breakfast.
(b) Sympathetic symptoms:By sympathy the patient
frequently experiences a pain in the spine in the region


I



GASTRALGIA, GASTRODYNIA, CARDIALGIA, ETC.


of the last dorsal vertebre, extending as far as the
scapulae. The motor nerves are frequently affected
sympathetically: we have distressing vomiting, not
always of food, eructations, yawning, spasmodic contraction of the abdominal muscles, diaphragm, the pit
of the stomach sometimes is drawn in to the vertebral
column, singultus, obstinate constipation, feeling of
anguish, palpitation of the heart, constriction of the
fauces, aphony, urging to urinate. The stomach is
sometimes distended by flatulence; towards the end of
the paroxysm the patient is relieved by the vomiting of
grass-green bile, or of an acrid-sour, sometimes slimy
secretion from the mucous membrane of the stomach.
This vomiting frequently terminates the paroxysm.
The pulse is contracted and small, the skin cold.
Sweat breaks out as the pains abate, the pulse rises.
Violent cardialgia may lead to sympathetic fainting,
tremor, delirium, general debility, convulsions and tetanus. Cardialgia is generally without fever; appetite frequently undisturbed, the patient frequently desires salt, sour, spiced, bitter food. (Canstatt.)
VARIETIES OF CARDIALGIA:
Pyrosis, soda, ardor ventriculi, which not only occurs in the higher degrees of cardialgia, but sometimes
indicates that it is about setting in. This is a burning
sensation from the stomach to the mouth along the
whole of the esophagus; it is frequently accompanied
with accumulation of water in the mouth, which has
at times an acrid, at times a sour, corrosive taste, is
frequently accompanied with nausea and discharged
with vomiting. The spasm is sometimes diminished
by the secretion of such a watery fluid.
A second variety is flatulent cardialgia. The gas
which is accumulated in the stomach may not only occasion the attack, but be produced by the reflex-action
instituted by cardialgia. The cardialgia is then accompanied with flatulence, meteorism of the epigastrium and hypochondria, tympanitic percussion sound



70    GASTRALGIA, GASTRODYNIA, CARDIALGIA, ETC.
of the swelling, difficult breathing, great anguish,
small pulse, rising of air, emission of flatulence with
relief. The flatulence may be caused by indulging
in flatulent, fermenting food, fruit, cider, grapes, etc.
A third variety is, according to Canstatt, neuralgia
coeliaca, of which mention has been made above.
~ 215. Many authors designate by the term gastrodynia a rather aching, continuous pain (Hufeland),
by the term cardialgia a constrictive pain in the stomach causing anxiety; by pyrosis is understood a
lighter degree, or rather a mere symptom of the disease. This division has no practical value. It is
more useful to distinguish an idiopathic and symptomatic cardialgia; by the former we mean a primary
affection of the stomach, and by the latter we understand an affection depending upon other pathological
states, such as: indurations of the liver, affections of
the spleen, kidneys, etc.
A predisposition for this disease is frequently hereditary. It is more frequent among women than men,
and is principally met among individuals with irritable
nerves, weakly, hysteric, chlorotic subjects, and individuals disposed to spasms, particularly at the menstrual
period, at the critical age, by weak digestion, abuse
of cathartics, improper use of the hydropathic treatment, abuse of coffee and tea. The reason why the
excessive use of coffee predisposes women to this disease more than men, is this, that women are more
confined to their houses and have i!-, the same oppoi'tunities that men have to dispel the pernicious effects
of coffee by active business, and exercise in the open
air. Literary men who lead a sedentary life and use
much coffee, are, for the same reason, likewise subject
to that disease. It occurs most frequently between the
ages of 20 and 50, rarely before the age of pubescence.
Exciting causes: Emotions, a cold, suppression of
foot-sweat and habitual discharges of blood, and particularly suppression of cutaneous eruptions. Taking
cold on the stomach while the body is heated, is one
of the principal causes of cardialgia, particularly



72    GXSTRALGIA, GASTRODYNIA, CARDIALGIA, ETC.
accumulation of water in the mouth, gulping up of
a sour, bitter fluid, with or without heart-burn, vomiting of mucus or of the ingesta, empty retching, palpitation of the heart with anxiety, sour, putrid taste in
the mouth, constipation, flatulent distention of the abdomen, hemicrania or aching pain in the forehead.
Nux is likewise indicated when the attack sets in at
the time of the catamenia, in females who menstruate profusely.
The more delicate the patient, the smaller the dose;
and vice versa, the more robust the patient, the larger
the dose. I have never given lower than the third
attenuation, and never hesitate to repeat the dose.
Chamomilla is suitable for persons with irritable
nerves and easily excited by anger. It is indicated by
a hard pain in the pit of the stomach as from a stone,
also under the left short ribs. This pain is always
attended with shortness of breath and anxiety, is worse
at night, so that the patient has to toss about his bed
in agony; it is frequently accompanied with a throbbing pain on the vertex which the patient supposes
can be relieved by getting up from bed. He feels
relieved during rest, and by bending double. The pain
is generally relieved by coffee, whereas it is aggravated when Nux is to be given. Chamomilla will
therefore be found useful for cardialgia induced by
abuse of coffee, for which Nux alone would not be
sufficient. Cardialgia caused by abuse of chamomiletea, can be relieved by Ignatia, Pulsat. and Cofea
cruda, the latter medicine when the pains seem to be
intolerable and the patient is very nervous. Cardialgia caused by the abuse of both chamomile tea and
coffee, yields to Nux, though Ignat. or Pulsat. may
sometimes be required in conjunction with Nux.
The dose of Chamomilla is from the first to the sixth
att., and to be repeated.
Belladonna may be tried in cases for which Chamomilla seemed to be indicated, but had no effect. Belladonna can scarcely ever be given at the commencement of an attack; it is suitable for females with irri



GAbTRALGIA, GASTRODYNIA, CARDIALGIA, ETO.


73


table nerves, and is particularly indicated by the following symptoms. Gnawing pressure, spasmodic tensive pain in the pit and region of the stomach, obliging
the patient to bend backwards for relief or to arrest
the breath; the violent pain induces loss of consciousness or even fainting, or it recurs during dinner. Hyosciamus and viola odorata deserve consideration when
these symptoms occur, particularly in cardialgia hysterica. Bellad. is somewhat more indicated by slow
stool, sleeplessness, increased thirst, with aggravation
of the pain afterwards.
Cocculus: I never gave it at the commencement of
a paroxysm, but always after Nux when this medicine
relieved the attack, but did not prevent its recurrence.
Cocculus acts well when constipation or costiveness
is present, never when there is diarrhoea. It suits
persons with taciturn, peevish dispositions, and is characteristically indicated when the attack is accompanied by a pressing constrictive pain over the whole
abdomen relieved by emission of flatulence, or by
nausea and accumulation of water in the mouth;
heartburn is never present.
Ipecacuanha is indicated by nausea, retching, vomiting of quantities of mucus attended with dull stitches
in the pit of the stomach and great distress in that
organ.
Pulsatilla suits individuals with quiet, sensitive,
kindly dispositions, and is indicated by stitching pains
in the stomach aggravated by making a wrong step
and attended with nausea; also by liquid stools, vomiting during the attack, absence of thirst except when
the pains are very violent; violent tension and crampy
pain in the pit and region of the stomach; throbbing
and sensation of anxiety in these parts, or griping
and pinching which is relieved by eating. Pulsatilla
is likewise indicated by the opposite symptom, when
the pains are aggravated by eating and change to a
pressure and pinching, or are excited by the use of
pastry and fat meat.
Ignatia is sometimes useful after or alternately with
VOL. Iv.-4



74    GASTRALGIA, GASTRODYNIA, CARDIALGIA, ETC,
Pulsatilla. It is more suitable, however, when there
is less vomiting and costiveness rather than diarrhoea.
The stitching sensation is a characteristic indication
for Ignatia, though it is not counter-indicated by a
sensation of pressure in the region of the pyloric orifice, aggravated or excited by eating. It is an excellent remedy when the disease was brought on by
starvation, care, grief.
These three last-named medicines relieve cardialgia
caused by the abuse of chamomile-tea, or by anger,
particularly when Chamomilla is found insufficient.
In this case Colocynthis is likewise useful, particularly,
however, when the attack was caused by indignation,
or inward mortification on account of insulting treatment; the distress is a hard pressure as from a stone,
particularly after eating, with sensation of hunger,
and pain in the pit of the stomach when touching it;
frequently attended with vomiting of the ingesta,
without previous nausea, small, diarrhoeic greenishyellow stools and colicky pains.
Hyoscyamus. The attack occurs at any time during
the day; it does not depend upon eating or drinking;
it is a vague distress in the pit of the stomach, which
is painful to the touch; it frequently sets in during
the night, with violent sweat, and occurs every time
the patient takes cold by placing the hands in cold
water.
Bismuth. Mild form of cardialgia, pressure shortly
after a meal, with nausea as if the patient would
vomit. I use the second to fourth alt.
Platina. Especially suitable to females when the
attack occurs at the time of the profusely flowing
menses. It is a pressure in the pit of the stomach
after a meal, with sensi;iveness to contact and constrictive sensation; these symptoms are generally
attended with qualmishness, succeeded by great
'anguor.
China. The cardialgia is occasioned by debility
induced by great loss of animal fluids. It is useful
for flatulent cardialgia and pyrosis caused by abuse



GASTRALGIA, GASTRODYNIA. CARDIALGIA, ETC.


75


of cathartics and emetics, by bloodletting, haemorrhage,"xcessive loss of the seminal fluid, galactirrhoea,
exhausting sweats; these causes induce debility, bad
digestion, a bilious, acrid or sour state of the intestinal
canal, with soreness in the stomach, bloatedness and
pressure after every meal, etc., so that the patient
feels much better during rest and without food than
with it. China corresponds particularly to the continuous violent attacks of cardialgia attended with
repletion, oppression and anxiety, aching pain, heartburn, accumulation of water in the mouth,.and empty
retching.
Staphysagria: Painful pressure with tension and
crampy feeling in the pit of the stomach, taking away
the breath when increasing, relieved by bending forward; it is sometimes accompanied with a digging
pain.
Stannum. This remedy cured cardialgia which
would not yield to any of the above-mentioned remedies; I used repeated doses of the sixth trituration.
The pain was a griping and kneading pain, extending
to the umbilical region; the region of the stomach
was very sensitive to the touch; tension, pressure,
shortness of breath, anxiety and nausea were present.
Stannum  acted particularly well, when a chronic
diarrhoea, frequent and bitter eructations, a sensation
of fulness and distention, with hunger, were resent.
Argentum nitricum chrystallisatum is an excellent
remedy for violent cardialgia. I have only used it for
females with irregular menses, generally too early
and too profuse, with debilitated bodies and very
irritable nerves; the violent spasmodic pains in the
stomach, obliging the patients to bend double, had no
regular intermissions; they appeared at any period of
the day, early, afternoon, evening or night, always
attended with violent retching and discharge of an
acrid, sour yellow-greenish tenacious mucus, bitter as
bile. This group of symptoms was removed very
speedily.
Cases which required a longer use of Argent. nitr,



76    GASTRALGIA, GASTRODYNIA, CARDIALGIA, ETC.
were likewise more or less depending upon irregular
menses, but likewise upon more or less flowing piles,
particularly among females that had borne children;
the pain was a burning, heat, uneasiness in the pit of
the stomach, contractive rising from the pit of the
stomach to the throat, nausea, eructations, loss of appetite, whereas the appetite remained unchanged in
the former variety. Stool was generally regular, but
irregular stool was no counter-indication to Argentum
nitr.
I used the first to third tritur., decimal scale.
The lighter attacks yielded to five or six doses, three
a day, in water; the latter variety required a longer
use of the medicine.
Bryonia is useful in the lighter cases of cardialgia
characterized by pressure in the pit of the stomach
during or after a meal, and by a sensation of swelling
in the pit and region of the stomach. This pressure
sometimes increases to a contractive pinching or cutting, and is relieved or even removed by pressure on
the stomach, which brings on frequent eructations.
In describing the symptoms which indicate the particular remedies for cardialgia, I have confined myself
to those that are characteristic of the primary disease,
leaving out the secondary symptoms as being too
various to admit of a minute description. But if the
disease be really cardialgia, one of the above-mentioned remedies will most probably be found indicated
by the secondary or sympathetic symptoms. for which
I refer the reader to the Materia Medica Pura. Bryonia, for instance, is indicated when the symptoms of
cardialgia are accompanied by a pressing, aching
pain in the temples or in the forehead or even in the
occiput, as if the skull would be pressed asunder;
this pain can be relieved by external counter-pressure;
also by costiveness, or by aggravation of the pains
during motion and amelioration during rest.
Allrnopathic physicians frequently reproach the homceopaths with not being able to cure disorganizations of single organs. These reproaches are un



SCIRRHUIS.


77


founded, for such disorganizations can be and have
been cured, provided the general debility of the particular organ and the general organism  had not
become excessive. For the homceopathic agent,
haNi4g a specific curative relation to the affected
organ, must necessarily reduce and finally remove
the disorganization in proportion as the pain is diminished. I am confident that the many cases of gastromalacia and cancer of the stomach which occur nowa-days, would not have developed themselves, if the
primitive affection, a simple cardialgia perhaps, had
been met from the commencement by appropriate
specific remedies instead of the round-about destructive allaeopathic drugs. But even where homoeopathy is unable to cure, it is almost always able to
procure relief.
~. 217. Scirrhus et carcinoma ventriculi; gastrostenosis cardiaca et pylorica. Induration and cancer
of the stomach.
Precursory symptoms of cancer of the stomach:
They frequently exist for years; the digestion is exceedingly difficult, the nourishment which the patient
takes troubles him during the whole period of the
digestion; he complains of a dull pain, heaviness,
tension in the epigastrium, flatulence; sometimes of
heartburn, desire to vomit, vomiting of water; generally early in the morning before breakfast a watery,
slimy, thready fluid rises into the mouth, sometimes in
considerable quantity, after which the remainder of
the day is passed in tolerable ease. At last vomiting
takes place one, two or several hours after a meal,
which, however, can be avoided, provided the patient
takes such food as agrees with him; the vomiting returns, however, after the least excess, though this
likewise takes place when the degeneration of the
stomach is pretty far advanced.
Symptoms of fully developed scirrhus of the stomach:
Hardness and swelling in the epigastrium, in the right
hypochondrium, or at some place which corresponds



78


SCIRRHUS.


to the situation of the disorganized stomach; this disorganization can be felt, sometimes even seen; it is
circumscribed, and its extent varies. The swelling
has various forms, is at times movable, at others immovable, and interwoven with the neighbouring
parts. Gradually the vomiting becomes habitual, it
takes place two, three or four hours after a meal, or
at last even before breakfast; the latter vomiting is
characteristic of cancer of the stomach, the substance
which is thrown up being blackish, chocolate-coloured,
or like soot or the sediment of coffee, or even pure
blood.
The difficulty of digestion now reaches the highest
pitch. The patient at last dreads taking the least
nourishment, because it induces vomiting preceded by
dreadful distress, anguish even unto fainting, and
agonizing pains in the stomach. A constant distress
frequently deprives the patient of all rest. Obstinate
constipation; appetite feeble or quite extinct; great
thirst; scanty secretion of urine; skin dry, like parchment.-The patient is reduced to a mere skeleton;
dropsical symptoms set in; an expression of pain is
visible in the sunken, emaciated countenance; the
eyes are dull and sunken; the formerly livid complexion changes to a dingy-yellow, yellow-green (carcinomatous habit).  The changes in the vascular
system frequently are not perceived until shortly before death, the pulse becomes feeble, small and irregular. The patient feels sad and desponding.
These symptoms may vary more or less, as in all
other diseases: the swelling, for instance, is not perceptible when the schirrous degeneration is seated in
the cavity of the stomach, or in the lesser curvature
of that organ. The vomiting varies likewise in regard
to time, quality and quantity of the substance which
is thrown up; the same remark applies to the stool,
digestive derangement and the pain. (Canstatt.)
~ 218. Cancer of the stomach generally runs a
course of several years, and terminates fatally, unless



SCIRRHUS.


and tearing pain alternating with the above-mentioned burning and corrosive pain, aggravation of the
pain after a meal and after midnight attended with
extreme prostration, vomiting of food and mucus,
which is frequently so distressing that it induces
fainting. Mezereum and Plumbum are likewise indicated by this group of symptoms.
Mezereum is indicated by a burning-corrosive pain
in the stomach, and as if the internal surface of the
stomach were sore; sensation as if the food remained
for a long time undigested in the stomach, and occasioned a pressure; bloody vomiting frequently takes
place, and the patient is very sad. These symptoms
may likewise characterize a chronic gastritis.
Plumbum is an admirable medicine for cancer of
the stomach. It has: vomiting without relief, obstinate constipation; the substance which is vomited
up is like verdigris, blackish, bilious, bitter, and the
paroxysms of burning constrictive pains in the stomach are excessively violent, and attended with praecordial anguish, anxious and cold sweat.
Latterly Verat., Carb. anim., Con., and Lycopod.
have beep employed for cancer of the stomach. The
last-named is particularly useful, especially in induration of the stomach. Carbo animalis is likewise useful in this disease, as well as in very obstinate cardialgia characterized by griping in the stomach, and
flatulent distention of the abdomen. Veratrum is indicated by occasional turns of blackish vomiting, as
of black bile and blood.
In two cases occasioned by a violent kick on the
region of the stomach, I have seen good effects from
Conium.
Phosphorus, from 6 to 8 doses, cures a species of induration or constriction of the cardiac orifice, with
twisting, constrictive pains in the region of the stomach, and vomiting of a clear, sourish fluid towards
evening and sometimes at night, sour eructations with
regurgitation of the ingesta.



SCIRRHUS.


81


~ 220. Continuatioir of the homoeopathic treatment
of cardialgia.
Since the discovery of the antipsorics, we cure a
great many cases of cardialgia that could not be
cured before. Carbo animalis and veget. fiequently
complete a cure when Nux vom. had but a temporary
effect. Carbo veg. is indicated by a burning sensation
in the stomach, (hence it may be of use in the treatment of the above-mentioned disorganizations of the
stomach), by a continuous, painful pressure in the
region of the stomach with anxiety, aggravated by
contact; by a contractive, spasmodic sensation in the
stomach obliging the patient to bend double, arresting
the breathing, and worse when lying down, attended
with a kind of heartburn, nausea, loathing even when
merely thinking of food, constipation. Carbo animalis
is indicated when the patient, after a slight meal,
complains of fulness, malaise, feeling of coldness in
the stomach, the latter symptom being relieved by
laying the hand on the stomach, after which the other
symptoms get likewise better. I have always employed Nitrum with success when the patient complained of a burning pain in the stomach with violent
stitches; after the paroxysm was over, the patient
complained of a sensation as if ice were in the stomach,
the pit of the stomah -being at the same time sensitive to the touch. Carbo anim. cures a state of
debility of the stomach where every thing the patient
eats, distresses him.
Calcarea carbonica: Indicated by cutting, compressive, or spasmodic, or pinching-choking pains, attended
with a sensation of anxiety. It is likewise excellent
for weak digestion, together with Graphites.
Graphites is likewise suitable for a wrenching and,
griping in the stomach, disappearing after a meal,
and generally attended with nausea, and accumul ttion of water in the mouth.
Nitric acid is suitable for cardialgia accompanied
with diarrhea, or when the patients had been syphilitic and had been treated with Mercury. Principal
4,



GASTROMALACIA.


symptom: spasmodic wrenching in the stomach and
pit of the stomach, which ascends into the chest and
oppresses the breathing.
Castoreum: bitter-sour regurgitations with loathing,
after a meal; sickness at the stomach, with ptyalism,
tightness and weight in the stomach, with contractive
pain under the sternum and ulcerative pain in the pit
of the stomach, flatulent distent ion, of the abdomen,
urgings to stool are generally present; the stool is
hard.
Baryta carb. suits scrofulous subjects. It is indicated by the following symptoms: the patient is easily
satiated, great fulness after a slight meal, pressure
and weight in the stomach, with externally perceptible
hardness close under the stomach. It may be used
for disorganizations of that organ.
Sepia suits delicate, nervous females with fine skin
and liable to get angry, or who have deranged their
nervous system by onanism. Symptoms: oppression
and weight, with cramp in the stomach; sour eructations, indifference to life, frequent turns of nausea,
ineffectual urging to stool, or hard stool.
Lobelia inflata may be tried for a pressing- constrictive sensation in the stomach and pit of the stomach
after a meal. particularly aft  supper, extending to
the back and inter-scapular re6ion, and attended with
bilious vomiting, oppression and anguish in the chest
and pain in the small of the back.
Natrum carb. and muriatum. The latter for a contractive cramp in the stomach, commencing after
dinner and continuing until evening, attended with
feeling of coldness in the back and stomach.
Alumina is useful when the cardialgia is attended
with constipation.
~ 221. Gastromalacia; malanis ventriculi, gastrobrosis (Alibert), perforatio ventriculi spontanea (Gerard);
softening of the stomach.
Though no neuralgic disease, yet I mention this
disease here, in order not to separate it from the affec



CASTROMALACIA.


tions of the stomach generally. A greater or lesser
softening of the membranes of the stomach always
precedes the formation of ulcers and the suppurative
process such as take place in the stomach in tuberculous and carcinomatous formations. This is another reason why I should be excused for treating of
this affection in this place.
The disease is principally observed among children
of from a few weeks to two years old. Omitting the
anatomical characteristics, I at once proceed to describe the
Symptoms. The disease scarcely ever appears
under the same form. At times it is like cholera, at
times like a gastritis of full-grown persons, at others
again like a hydrocephalatous fever, or like a slow
nervous typhus. Sometimes the disease breaks out
suddenly without any precursory symptoms, with
violent fever, the children are restless, scream a good
deal, the pulse is quick and their thirst can scarcely
be quenched; the abdomen is distended, the region ot
the stomach is hot to the touch, painful to pressure
which may be inferred from the fact hat- the children
draw the lower limbs up to the abdomen; repeated
and frequently conti ual vomiting of a greenish-slimy,
sour-smelling fluid~ companied with frequent discharges of watery,-  en, acrid, sour-smelling stools;
breathing oppressed, dry cough; breath and skin are
cool; extremely rapid collapse of the features, and
emaciation; the screams gradually change to mere
moaning; stupor sets in, convulsions and death.-If
the affection should be less acute, it has the following
symptoms: The children lose their appetite, they are
peevish, low-spirited, suffer frequently with eructations, aphthae, obstinate diarrhoea, vomiting; their
sleep is restless and they look pale and suffering.
When the fever appears, the diarrhea and fever become more obstinate and frequent, the discharges
consisting of a watery mucus, with putrid odor, and
sometimes mixed up with. gray-green filaments and
flocks; the abdomen becoines distended, the head



GASTROMALACIA.


and (exremities become cold, whilst the remainder o
the body is hot, and the abdomen even burning-hot tc,
the touch; rapid emaciation, particularly about thc
neck. The head-symptoms are very striking, the
children are in a constant sopor, half stupified, bui
can easily be roused (agrypnocoma).
Etiology: infantile age, dentition, atmospheric
causes, late-summer and spring when gastric diseases
and intermittent fevers prevail, swallowing corrosive
saliva as is secreted in stomacace, angina gangranosa
or aphthe. According to Rokitansky, the disease is
frequently traceable to a disease of the brain, particularly hypertrophy of the brain or hydrocephalus.
Prognosis: More favourable than would at first
sight appear; only the physician must not be scared
by the idea of gastromalacia, and boldly prescribe his
remedies in accordance with the symptoms.
~ 222.  Treatment. Many symptoms characterizing the precursory stage of this disease, and being
very frequently underrated by physicians, are so much
like a gastric disease, that the remedies indicated for
gastric affections may be used here (see vol. I.). A
few remedies which seem to have a more specific relation to the disease, will, however, be mentioned.
If the disease should commeng  with a diarrhoea, as
is frequently the case, and if s should threaten to
become habitual, a few drops of Calc. acet. daily, will
be found eminently useful, being at the same time an
excellent remedy for troublesome dentition and scrophulosis; Calc. carb. does not seem to have the same
penetrating effect in this disease. Acidum phosphoricum is preferable to Calc. acet., when the diarrhoea
has become habitual and the central organ of the
abdominal system of nerves seems to be more deeply
invaded.
If the first symptoms should point to a febris hydrocephalica, the ineffectual exhibition of Belladonna,
Acon., Br-yon., will soon reveal the mistake.
If the disease should resemble choler. suitnale remedies have to be administered.



86


SPASMUS VES1CCA.


trembling, nervous paroxysms, cold sweat, small, contracted pulse, vomiting.
Etiology. The disease may attack either sex, and
every age; it is most frequent among middle-aged
persons. Nervous, hypochondriac, hysteric individuals are subject to the disease. Erciting causes:
emotions, anger, chagrin, mental efforts, irritation of
the uropoitic or genital system by cantharides, diuretics, new wine, beer, excessive embraces, sitting on a
damp, cold floor, etc.
~ 224. Treatment. If possible, the exciting cause
should be removed or counteracted. If the spasm be
caused by cantharides or by the linseed-emulsions which
are so frequently used in gonorrhcea, Camphor is the
proper remedy. I always use this medicine when the
pain is so great that the patient is unable to explain
himself.
Cantharides may be given when the spasm is attended with enuresis spastica. Of course, the disease
must not have been caused by that agent. The patient wanders from one place to another, complaining
of cutting, and a contractive pressing pain along the
ureters toward the lower part of the bladder; sometimes there is a fleeting-tearing pain in the neck of
the bladder, all of which painfit sensations the patient
endeavours to moderate by compressing the-glans;
sometimes, after the urine ceases to be discharged in
drops, a full stream of urine flows out with relief or
even an entire abatement of the spasm; the urine
was, in such cases, scarcely ever found by me of a
purely spastic nature; generally turbid, or with a
white-slimy sediment, particularly at night.
Sassaparilla is, according to my experience, useful
only when the spasm depends upon the presence of
urinary calculi; the patient complains of a painful
pressing burning, and a quantity of pale urine is discharged.
Pulsatilla suits females rather than men: the disease occurs after the use of sulphur-water, or from



NEUROSES.


87


taking cold by exposing the feet: the pain is intense,
continuous, the urine is discharged in drops.
Colchicum and Dulcamara are likewise useful when
the spasm is caused by a cold. I am unable to indicate the particular symptoms.
I will also mention Lycopod., Acid. phosphor., Sepia
and Terebinthina.*
NINETEENTH CLASS.
~ 225. Neuroses.
Their physiological character according to Schoenlein: 1. The morbid process always takes place in the
peripheral nerves. 2. Every neurosis consists of a
series of irregular paroxysms, without regular intermissions; the moon has a great influence on these
affections, the paroxysms of many forms of neurosis
are more violent at certain quarters of the moon. 3.
The irritation in the peripheral system of nerves is
continued, during the paroxysms, to the central organ,
particularly the spinal marrow and brain, though the
continuation is sometimes perceived only at the extremities of the affected nerve; it is distinctly perceptible in an attack of peripheral epilepsy, at first
slight spasms, afterwards convulsions, finally the
brain is affected and loss of conciousness takes place.
The sensation indicating the continuation, varies; for
instance, sensation of a passing wind, of formication, of
an electric stroke, of a flame, etc.; in an hysteric attack,
the patient feels as though a ball were rolling up
from the uterus with a constrictive sensation; in
other cases the distress is felt only at the commencement and end of the time, in the uterus and in the
head (clavus hystericus). The central portions of the
* And Aconite, the grand antispasmodic of homreopathy? Why
omit Aconite?--Hempel.



NEUROSES.


nervous system being not always invaded, this leads
to a classification of neurosis in higher and lower
forms; to the former belongs epilepsy, to the latter
tussis convulsiva. 4. The single paroxysms are characterized by spasms and convulsions. 5. During the
attack the normal function of the irritated nerve is
either altered or suppressed, in hysteria for instance,
where the smell of burnt feathers, of Assa fcetida, etc.
appears agreeable, that of a rose, on the contrary,
disagreeable.
No decisive anatomical change is observed either
in the peripheral or central portions of the nervous
system; I therefore omit making any particular mention of those changes.
Etiology: Age; abdominal epilepsy, for instance,
attacks youth, and is not observed among old people;
asthma affects generally people of a certain age,
hysteria takes place at the age of pubescence, etc.Sex.-External causes: Emotions, gout, irritants such
as splinters, contusions, sore fingers, worms. Nervous
diseases may likewise be transmitted by the eye or
ear; epilepsy, for instance, is frequently communicated by seeing an epileptic attack, or by hearing
epilepsy or mania spoken of with warmth. A material contagium exists only in whooping-cough, if
anywhere.
Prognosis: Some forms of neurosis, such as hysteria,
are not dangerous; eclampsia is very dangerous. If
the attack depend upon a material cause which can be
removed, the prognosis is more favourable; or if the
attack should have been caused by a momentary
noxious influence, the prognosis is likewise more
favourable; the prognosis depends likewise upon the
manner in which the disease develops itself, and upon
the importance of the irritated portion of the nervous
system, upon the frequency and violence of the
paroxysms, upon the supervention of other dangerous
symptoms and the termination in some other disease.
Treatment: We will speak of the treatment of each
species of neurosis in particular.



NEUROMES OF THE NERVES.


89


~. 226. Neuroses of the nerves of the thorax.
TUSSIS CONVULSIVA, PERTUSSIS, WHOOPING-COUGH.
Every epidemic disease is, properly speaking, acute;
we call it chronic when it divests itself of the febrile
symptoms, runs a long course, calls up ailments which
had so far remained latent in the organism and unites
itself with them; whooping-cough belongs to this
class of diseases.
In whooping-cough we distinguish three stages:
the precursory or catarrhal stage, the convulsive or
nervous, and the critical or secretive stage.
First stage. It commences with catarrhal symptoms.
sometimes catarrhal-gastric; these symptoms frequently
resemble the precursory symptoms of an exanthematic
fever. The patients complain of tickling in the trachea,
particularly under the sternum, occasioning a dry, peculiarly hollow cough with a metallic sound, characterized even at this stage by more or less periodical
paroxysms. It is frequently accompanied with angina,
slight inflammation of the organs-of deglutition, hoarseness, sneezing, lachrymation, sensitiveness of the
eyes to light, chilliness, languor; the child is peevish,
restless, feverish; the fever is erethic, comes on towards
evening, with coated tongue, hurried pulse, hot and
dry skin; towards morning the patient perspires, the
urine exhibits a sediment, and the symptoms intermit,
sometimes completely. If the fever should increase
to a synocha, the chest frequently exhibits inflammatory symptoms to be diagnosed by percussion and
auscultation and by the blood-streaked expectoration.
This stage having lasted from 3 to 21 days, it gradually
passes over into the
Second stage. This stage is characterized by the
paroxysmal cough, which one need but hear once to
recognise it again immediately. Previous lo a paroxysm the patient generally becomes restless, and endeavours to support himself by holding on to something, impelled by anguish, dull pain, pressure under



90


NEUROSES OF THE NERVES.


the sternum in the region where the diaphragm is inserted, in the pit of the stomach; children breathe
more rapidly, anxiously, irregularly, weep, or start up
from sleep, seat themselves suddenly in an erect posture, stooping forward. The cough consists of short,
irregular, violent expirations in rapid succession, interrupted by short or long, imperfect attempts at inspiration, accompanied with a peculiar whizzing sound
resembling the bray of an ass; during this time the
glottis is spasmodically closed, which may be easily
inferred from the fact that, on applying the ear to the
chest, no respiratory murmur is heard, but a sonorous
whizzing which is formed in the half-closed glottis
and extends down to the bi'urcation of the trachea;
shortly before and after the paroxysm the respiration
is frequently puerile. During these phenomena all
the muscles of the respiratory organs are spasmodically convulsed, the face becomes purple-red or blue,
swollen, the eyes become red and seem to start from
their sockets, the veins of the neck swell up; blood is
frequently discharged from the nose, mouth, ears and
bronchi, and ecchymosed blood is seen in the conjunctiva; face and neck are covered with a cold sweat,
the pulse is suppressed. In from three to ten minutes
the paroxysm generally terminates with vomiting, a
quantity of colourless, viscid mucus being discharged
together with'the contents of the stomach. After a
violent paroxysm, the patient sometimes falls asleep
from exhaustion. Generally, however, he feels well
again immediately after the cessation of the paroxysm,
wants to eat, or returns to his play; physical changes
in the respiratory organs are seldom seen, except
sometimes a puerile respiration with rhonchus. The
paroxysms are not regular; they amount from 3 or 4
to 40 or 50 within the 24 hours. They gradually decrease in number and intensity. This second stage
lasts from 4 to 8 weeks.
In the third stage the paroxysms decrease more and
more, the convulsive phenomena disappear, the respiration ceases to be whizzing, the cough becomes



NEUROSES OF THE NERVES.


91


moist, and the patients, at the termination of the short
paroxysms, discharge a viscid, thick, greenish sputa.
with noise in Ihe bronchi, and affording great relief.Relapses may occur in this stage, which scarcely ever
lasts more than from 3 to 4 weeks.
Whooping-cough is liable to complications with
other diseases, particularly with bronchitis and pneumonia, also with congestion of the brain and cerebral
membranes, gastric and intestinal irritations with
remittent fever, pleuritis, pericarditis, croup, angina.
Etiology: Whooping-cough occurs most frequently
before the seventh year, less frequently between the
7th and 14th, and least frequently among adults; it is
sometimes epidemic, but may occur in every season;
it is rather contagious than miasmatic; it likewise
occurs sporadically.
Prognosis: Not unfavourable; whooping-cough is
a slow and distressing, but not dangerous complaint.
The prognosis depends upon age, constitution, complications, duration of the convulsive stage, etc.
~ 227.  Treatment: It is quite easy when the
patients are perfectly free from all scrofulous taint.
Scrofulous children require to be treated with the
antipsorics. Drosera is ineffectual in the case of scrofulous patients. In epidemic whooping-cough 1 have
found Drosera sufficient in most cases. Different remedies, however, may be required by different forms
of whooping-cough. The great point is to notice the
characteristic symptoms of the cough and to prescribe a remedy in accordance with the symptoms.
This accounts for the fact that epidemic whoopingcough has been successfully treated with different
remedies by different practitioners.
The catarrhal stage may require one of the remedies mentioned vol. i. ~~ 29, etc. and ~~ 194, etc.
The patient should be kept in the room, in the same
temperature; he should be protected from changes of
weather, cold, etc., and should use slimy drinks,
gruel, slippery elm, etc. If the catarrhal stage should
have been induced by a cold, and the cough shoul.



92


NEUROSES OF THE NERVES.


be moist and loose, with slight hoarseness, Dulcamara will be found useful. Pulsatilla likewise corresponds to these symptoms, particularly when vomiting is apt to set in, in which case Ipecacuanha
should not be left out of consideration.
Aconite should be given when febrile motions are
present and the dry cough is excited by a burningstinging pain in the larynx increased by coughing
(the child grasps at that spot with the hand). The
remaining cough may then be treated with alternate doses of China and Belladonna, which may
even be followed by Ledum. By this treatment the
cough is not always stopped, but rendered loose and
mild.
In many cases the catarrhal stage is removed by
Chamomilla, particularly when the constant irritation in the region of the larynx, inducing a dry
cough, is accompanied by a crampy sensation, or
when the cough is excited by a titillation under the
sternum in the upper part of the chest; Chamomilla
is not counter-indicated by a burning sensation in
the larynx and a painful soreness at the spot where
a little phlegm is detached after a long paroxysm
of distressing cough. The dry, spasmodic cough is
sometimes accompanied with retching and vomiting
impeding the breathing; the patient's face turns
blue, and he is tortured with anguish; Nux vom.
relieves the vomiting, and generally requires Pulsatilla after it. If the cough should remain dry and
spasmodic, without the wheezing, Ignat., Ipec., Hyosciam., Bellad., Conium, are excellent remedies.
In the second stage, Drosera is a specific remedy,
particularly in epidemic whooping-cough. SymptomsRapid succession of single turns of cough during a
paroxysm, causing danger of suffocation; titillation
in the larynx which rouses the child from sleep particularly after midnight, and causes a rapid succession of paroxysms; discharge of blood from mouth
and nose; the cough is easily excited by laughing,
singing, weeping, and emotions.



NEUROSES OF THE NERVE..


93


Cina is likewise an excellent remedy in the second stage, particularly when the cough is complicated with gastric symptoms and the child had been
troubled with phlegm in the stomach and intestinal
canal, weak digestion, anorexia, worms, etc. some
time before the outbreak of the disease; it is likewise suitable to scrofulous children, or when the
paroxysm is caused by a sudden spasmodic contraction of the larynx, accompanied with a general
rigidity of the whole body, loss of consciousness and
staring look.
Belladonna will seldom be found useful in the convulsive stage, when the periodical intermissions of
the inspirations during the paroxysms are present.
Belladonna is counter-indicated by the phenomena
characterizing the second stage; it is otherwise indicated by a dry cough accompanied with a spasmodic contraction of the larynx, and preceded by
weeping and a disagreable sensation in the- region
of the stomach. Belladonna and Cina, in alternate
doses, are said to be very useful in this cough.
Cuprum acet. is eminently useful when the patient
is suffocated during the paroxysm, and when he vomits ar.d is slowly restored to vitality after the cessation o0' the paroxysm; even between the paroxysms
the reSpiration is accompanied with a rattling noise
in the bronchi, as if they were filled with mucus.
I have since used this remedy even in the commencement of the disease, and have found it more useful
than Drosera, the wheezing and whooping being removed in a few days.   The remaining catarrhal
cough yields to repeated doses of Ipecacuanha. This
agent is frequently sufficient to remove whoopingcough, provided it is repeated every 2 or 3 hours; it
is indicated when the turns of cough succeed each
other so rapidly that the respiration is cut off and
every inspiration seems to excite a new paroxysm;
retching is generally present.
Cortex ulmi is said to be a very useful remedy.
Conium suits nightly attacks of whooping-cough;



94      ASTHMA, MALUM CADUCUM PULMONUM.
the patients have a scrofulous and chlorotic constitution, the cough is exceedingly violent, suffocative,
attended with flushes of redness in the face and bloody
expectoration.
Lactuca virosa is said to remove the anguish with
which many children are troubled previous to an attack, and to be useful for violent paroxysms of dry,
spasmodic cough.
Ambra has been found useful when the cough is
accompanied with eructations and hoarseness. Also
Hyoscyam., Arsen., and Laurocer. Arnica is suitable
when the paroxysms set in with weeping.
It has been proposed to give a dose of Aconile every
day. This proceeding is well worthy of a careful
trial.
If chronic ailments should have been roused by the
whooping-cough, the antipsorics are then indispensable, particularly Tinct. sulph. and Sepia. I have
frequently given Sepia at once, at the commencement
of the second stage, when the spasmodic cough set
in at night, so suddenly that the patients came near
being suffocated and the chest was constricted, with
shrieks and retching.
Whooping-cough is sometimes complicated with
dentition and worm-fever; I have even seen a oemplication of whooping-cough and intermittent fever, for
which I gave Silicea, this being the specific for the
then prevailing fever. The whooping-cough disappeared with the fever. I tried afterwards to prescribe
Silicea for whooping-cough without the fever, but
found myself obliged to recur to the usual remedies.
~ 228. Asthma, malum caducum pulmonum, dyspncea, orthopncea.
The general character of asthma is: Periodical
spasm of the respiratory organ, paroxysmal difficulty
of breathing, accompanied with a sensation of constriction of the chest and violent exertions of all the
auxiliary organs of respiration.
The paroxysms generally take place in the evening,



ASTHMA, MALUM CADUCUM PULMONUM.


95


or between sunset until 2 o'clock at night. Generally
the patients start from sleep with a sudden feeling of
suffocation; a feeling of stricture across the chest, or
as of a tight belt or a, heavy weight on the chest,
stops their breath and obliges them to raise themselves
suddenly in order not to suffocate; the patients have
not air enough in the closed room, and the windows
have to be opened. The breathing, particularly the
inspirations, is carried on with great difficulty, and
the wheezing, metallic-sounding, rough, rattling inspirations are even heard at a distance. The thorax is
not raised as in its natural condition; it heaves upwards and downwards, or is even quite immovable,
whilst the cervical, intercostal, dorsal and abdominal
muscles, and the diaphragm, work violently, and the
patient, in his anxiety, is endeavouring to support
himself in any way he can by holding on to any thing
in his neighbourhood; the shoulders are raised like a
pair of wings, and the praecordial region is drawn inwards along the region where the diaphragm is inserted. The patients are unable to speak, swallow,
cough; all these movements increase the spasm.
The features express anguish, fear, fright; the
wings of the nose are widely distended, the face is
blue-red, the eyes protruded from their sockets, the
vessels of the conjunctiva are very much congested,
the jugular veins are swollen. The extremities are
cold, forehead and neck are covered with sweat as
from anxiety. The beats of the heart and the pulse frequently remain natural; frequently however, particularly when the heart is organically diseased, its beats
intermit, the pulse becomes small; irregular, violent
paroxysms may cause vomiting, convulsive movements of various parts of the body, even epilepsy.
During the paroxysm we hear in various parts of the
chest, by means of the stethoscope, a wheezing,
rattling, rumbling, and generally a very feeble and
sometimes even a puerile respiratory murmur; the
percussion sound is rarely altered. Relief commences
when the patient begins to cough up with ease a



96       ASTHMA, MALUM CADUCUM PULMONUM.
tenacious mucus; the breathing becomes freer, and
the anxiety disappears; sometimes sweat breaks out
and the bowels are moved, or the patient is refreshed
by a sound sleep.
The paroxysms last from a few minutes to several
days, with remissions in the day-time and exacerbations in the evening. During the remissions the
breathing is oppressed, but the anxiety is less. The
paroxysms occur very irregularly, sometimes every
week, month, in the fall or spring, and at other times
they intermit several years.
~ 229. Anatomical changes: We know of no organic
alteration of the thoracic organs, heart, large vessels,
pleura, lungs, mediastinum, that has not been met in
the bodies of asthmatic subjects; disorganizations in
the brain, spinal marrow, pneumogastric and phrenic
nerves, larynx and abdominal organs. On the other
hand, there are many subjects in whom no anatomical
alteration whatsoever has been discovered. This
shows that those alterations are not necessarily the
cause of the asthma, inasmuch as they frequently
exist without asthma, and asthma frequently occurs
without them. Various anatomical alterations, such
as: hypersmia of the bronchial mucous membrane,
emphysema of the lungs, dilatation and hypertrophy
of the heart, dropsy of the chest, etc. are very often
products of the frequently repeated asthmatic paroxysms. (Canstatt).
Diagnosis and etiology: The disease can be confounded with angina pectoris, with asthma induced
by affections of the larynx, or with night-mare. In
angina pectoris the patient experiences a piercing,
crushing pain in the region of the heart, under the
sternum, extending to the left arm and shoulder; the
pain obliges the patient to stand still, but the breathing remains tolerably free; the patient's anxiety is
not caused by want of air, but by an indescribable
agony as of death; the paroxysms frequently occur
in the day-time and during motion; the expectoration
which affords relief in asthma, is likewise wanting.



ASTHMA, MALUM CADUCUM PULMONUM.


97


In asthma caused by an affection of the larynx, this
local disease is easily recognised between the paroxysms; the spasm, by the patient's own statement,
commences at the larynx, the patients look as if strangulated, they are unable to speak a word, and they
press the air with a strong wheezing croupy sound
through the half-closed rima glottidis.-Asthma is
easily distinguished from nightmare: for, although it
occurs likewise at night only, yet it is a state of halfwaking, during which the patient remains in a recumbent posture, all unpleasant sensations disappearing
as soon as the patient wakes; during the attack the
patient feels as if his chest were oppressed by a load;
but this does not prevent a paroxysm of real asthma.
Asthma is sometimes hereditary; men are more
liable to the disease than women; asthma generally
affects persons somewhat advanced in age; among
young people we meet the asthma Millari, and the
asthma thymicum ofKopp. We distinguish asthma
plethoricum, organicum, cardiacum, metastaticum,
arthriticum, podagricum, impetiginosum, urinosum
(from anuria of old people), humidum, etc. These
names are of use only in so far as they point to the more
or less specific medicine in every case.
Prognosis: It is favourable for a single paroxysm,
but unfavourable for the disease itself, since it generally lasts during the patient's life-time. It is generally favourable when the exciting cause can be removed; it is unfavourable when an organic disease is
the cause of the paroxysms. In old people the prognosis
is much less favourable than in young subjects, inasmuch as the former generally labour under some organic disease. Hereditary asthma is generally incurable. Death is imminent when the patient becomes
weaker and weaker, when hydrothorax, paralysis of
the upper extremities, hectic fever with irregular, intermitting pulse, swelling of the extremities, continual
palpitation of the heart, set in.
~ 230. Treatment: This is facilitated a good deal
by a knowledge of the cause of the disease. The reVotL. IV.--5



ASTHMA, MALUM CADUCUM PULMONUM.


dreams, such as attack persons who suffer with irregular beating of the heart, abdominal pulsations,
hypertrophy of the liver and spleen. It suits melancholy and hypochondriac subjects with atrabilious
temperament; it is likewise adapted to those kinds of
asthma where the patients complain of the clothes
being too tight, and chest and abdomen being oppressed by them; nevertheless, putting off one's clothes
makes the asthma worse instead of better. Asthma,
when depending upon cardialgia, is so frequently relieved by Nux for this reason, that Nux removes so
many kinds of cardialgia.
Arsenicum is a specific for asthma when it depends
upon a dilatation of the heart, hypertrophy, emphysema or aedema of the lungs, hydrothorax, chronic
bronchitis, hypereemia of the bronchial mucous membrane, tuberculosis (scrophulosis), abuse of China or
lodium. Ars. is more particularly indicated by the
following symptoms: frequent cough during motion
as if caused by the vapour of Sulphur, particularly at
night, attended with constriction in the trachea and
suffocative fits; or even without cough this suffocative oppression of the chest and arrest of breathing
set in in full-grown persons, a real spasmodic asthma,
accompanied with anguish and restlessness, as if the
whole chest would be constricted; the patient cannot
speak a word without making the asthma worse,
which sets in particularly in the evening.
The asthma caused by copper and -arenious vapours, is relieved by several remedies, the paroxysm
itself by Ipecac., then Nux voom., Hep. sulph. and
sometimes Merc. sol. The proper antidotes should
be administered between the paroxysms, to eradicate
the constitutional ailments which had been occasioned by those poisons.
If an asthmatic spasm be caused by the vapour of
Sulphur, Pulsatilla is the best remedy to stop it; it is
likewise the best remedy for asthma caused by the
abuse of sulphur-water. I have frequently been led
to give Pulsatilla by the good-natured, mild counte



100


ASTHMA, MALUM CADUCUM PULMONtUM.


nance of the patient, that seemed to invite pity, a
reflex of the patient's character in his healthy days;
it is likewise useful when the asthma depends upon
hypertrophy of the pulmonary mucous membranes;
this condition is recognised by the fact, that after the
abatement of the paroxysm, the patient is relieved
by raising large quantities of disorganized mucus, after the discharge of which a physical examination reveals in many places the bronchial respiration,
as in partial emphysema of the lungs; this kind of
asthma might be termed asthma humidum. Pulsat.
is likewise useful in the asthma senile and urinosum
of old people, where the audible vesicular breathing
points distinctly to oedema of the lungs and scattered
interstitial tubercles. It is highly recommended in
the asthma menstruale and cardiacum of chlorotic
and hysteric subjects.
In the above-mentioned varieties of asthma, Stannum
ranks with Pulsatilla when the constrictive oppression of the chest sets in in the evening, causes an extreme anguish, and obliges the patient to loosen his
clothes; recovery does not always take place by raising large quantities of mucus at once, but by mucus
being coughed up gradually.
Colchicum may be tried in asthma cardiacum with
dilatation of the heart occasioned by acute rheuma.tism; also when the heart is hypertrophied and the
paroxysm is raised to the highest pitch by the least
change in the weather, with icy-cold extremities, excessive restlessness, anguish, and sudden prostration
of strength. Colchic. is likewise useful in asthma attended with cedema of the lower extremities (this
being a characteristic symptom of affection of the
heart, according to Kreyssig), or with constant urging
on the bladder, like spasm of the bladder, and painful
discharge of a small quantity of urine.
I have used Ammon. carbon. in a few cases of
asthma, with repeated palpitation of the heart, considerable cedema of the feet, and an asthmatic state
every evening which continued until midnight and



ASTHMA, MALUM CADUCUM PULMONUM.


101


was relieved by the admission of open air. The
symptoms were relieved, except the palpitation.Ainmon. carb. is known as an excellent remedy in
hydrothorax.
Belladonna is excellent in asthma plethoricum, cardiacum, metastaticum, hmmorrhoidale, laryngeum,
not only for the paroxysm, but for the disease itself.
I do not consider it necessary to describe the symptoms more particularly.
I have found Ambra, second or third trit., an useful
remedy in asthma siccum and senile, particularly
when the oppression was principally felt in the left
chest, extending from the heart to the back and between the shoulders, attended with palpitation, anguish, arrest of breathing; it likewise proved useful
in asthmatic ailments of scrofulous subjects.
Cannabis is suitable when the patient can only
breathe in a sitting posture with the neck stretched
forward, attended with wheezing in the trachea; the
abdominal muscles have to be put violently on the
stretch during every inspiration; the patient is exceedingly restless and tortured by anguish. These
symptoms always occurred before midnight, in bed.
The patient was suffering with organic disease of the
heart (hypertrophy) and hydrothorax thence arising.
The effect of Cannabis was very striking.
Tartarus emeticus: The suffocative distress depends
upon constriction of the air-passages; it increases
gradually from evening till morning, and then decreases again as gradually; during the paroxysm the
anguish is sometimes increased by sudden violent beats
of the heart as if the heart would start out of its place.
In the present case, though there was occasional palpitation between the paroxysms, yet no organic disease
could be discovered, showing that Tart. emet. suits
asthma with or without organic affections of the heart.
Plethoric asthma is perhaps the more immediate
sphere of action for that agent.
Moschus is suitable to hysteric or hypochondriac
subjects, when the attack was developed by the body



102     ASTHMA, MALUM CADUCUM PULMONUM.


getting cold. The paroxysm commences with difficulty of breathing, increases to constriction of the
chest, and finally becomes a suffocative spasm of the
lungs which drives the patient to despair; there is
no cough, perhaps a slight irritation at the commencement.
Oleum animale. The asthma is occasioned periodically by a flatulent distention of the whole abdomen.
particularly of the subcostal regions, or it is caused by
a spasmodic contraction of the larynx. Kali carb.
may be tried under similar circumstances, and particularly in the dynamic asthma, or when the lungs are
partially destroyed.
Nitri acidum is an excellent remedy to eradicate
the asthmatic disposition. It is particularly useful
to delicate constitutions, persons with sensitive nerves
and irritable temperaments, particularly when the organism had been weakened by mercurial treatment,
or by syphilitic, scrofulous or herpetic diseases. The
patient complains of fluent coryza, roughness of the
throat, husky voice; as the coryza diminishes, the
chest feels oppressed; if the coryza disappear entirely,
the oppression increases to complete loss of breath,
attended with palpitation of the heart and anxiety on
ascending an eminence; or the patient complains of
constant dyspncea, he is scarcely able to breathe,
worse on leaning backward; sometimes the dyspnoea
is attended with anxiety, particularly when walking
fast; when reaching the most violent degree, the disease increases to a spasmodic oppression of the chest,
with rush of blood to the heart, languor, anguish,
which is excited by the least emotion.
Lobelia inflata. This remedy seems to be principally adapted to asthma depending upon degeneration
of the bronchial mucous membrane occasioned by
chronic inflammation of the air-passages. The characteristic symptoms for Lobelia are: Dyspncma, also
with oppressed, hurried respiration, frequent desire to
take a deep breath, oppressive asthma, sometimes
after the least exertion and after exposure to the least



ASTHMA, MALUM CADUCUM PULMONUM.


103


draught of air, and after eating heavy food; periodical
spasmodic asthma of full-grown persons.
Lactuca virosa relieves spasmodic asthma occasioned by organic diseases of the heart, hydrothorax:
great tightness of the chest, which rouses one from
sleep at night and obliges one to sit up suddenly as if
in anguish, with heaviness on the chest which increases
to stricture.
Digitalis. This medicine is useful in asthma complicated with thoracic disorganizations. It is supposed
that Digitalis is indicated by a disturbed action of the
heart and slow pulse; but I have always employed it
with success when the disturbed action of the heart
manifested itself equally in the pulse. The increased
action of the heart depended upon incipient disorganization of that organ and its vessels? and the
asthma caused by that disorganization'-as characterized by the following symptoms: Roughness in the
trachea which had existed for some time previous, accompanied with a short, hacking cough, and gradually leading to laboured breathing which increases to a
spasmodic constriction of the larynx and chest, with
suffocative anguish which is particularly troublesome
early in the morning, on waking, and obliges one to
sit up. Digitalis is therefore an excellent remedy for
asthma cardiacum, organicum, metastaticum, hydrothoracicum.
Sulphur is a most universal remedy for asthma.
There is scarcely a case of asthma where Sulphur is
not used. It suits almost every constitution and temperament, and antidotes the bad effects of a number
of metallic poisons. Sulphur is particularly useful
for the following conditions: Rough and deep voice
when the weather is cold and damp; accumulation
of mucus in the throat and chest, exciting a cough
which causes a spasmodic contraction of the chest;
difficulty of breathing, more when sitting than when
walking; he is unable to take deep breath, because
the chest then feels contracted, the breathing is sibilant; excessive dyspnoaa after a walk, continuing



4STHMA MILLARI.


105


3) Camp/tor is likewise a palliative, but only in
certain cases. I use it in asthma humidunm with velry
irritable nerves, and particularly when the larynx and
bronchial tubes are so filled with mucus that the patient is almost suffocated, which is easily inferred by
the movement of the patient's hands and by ihe spasmodic contortion of the facial muscles.
4) Tabacum, first or second att., or the slnoke of
tobacco if the patients are not used to it; it relieves
the anguish in asthma organicum, cardiacum, when
depending upon stenosis of the left heart.
Other palliative remedies are: Ipec., Puls.. Ignat.,
Nux vom., Ambr., Colch., Digit., Arsen., Tart. stib.
~. 232. Asthma Millari, Asthma laryngeum, spasm
of the glottis.
The two latter names belong more properly to the
asthma thymicum of Kopp; I have classed both varieties under the same head, because the treatment is
the same.
The pathognomonic symptom of asthma laryngeum
is a sudden and violent interruption of breathing for a
few minutes, after which the children resume their
respiration with a crowing noise.
The lowest degree of spasm of the glottis is frequently observed in children with a vehement temperament, when they get out of breath in consequence of
a violent fit of anger or violent cries. If the disease
be more violent, the spasm sets in suddenly, generally
on waking from sleep, or, after fright, anger, in consequence of crying, laughing, a cold, or a drop of liquid getting into the larynx while drinking, or without
any perceptible cause; the spasm commences with a
whizzing, exceedingly fine, almost crowing inspiration, which is several times repeated with great
force until the breathing stops entirely; the children
gasp for air with the most violent exertions, they turn
pale and blue, the eyes protrude from their sockets,
cold swecat appears on the forehead, and the pulse bei   V



ASTHMA MILLARI.


107


quently for days, the paroxysms may set in in all:their
violence from the very commencement, the symptoms
do not increase as in croup, there are no catarrhal
symptoms either previous to the disease nor during the
intermissions, the children are quite well between the
paroxysms, there is no hoarseness, the disease lasts
much longer than croup, etc. The disease is easily
distinguished from whooping-cough; the similarity
extends only to the wheezing breathing; the violent
cough which terminates in retching and vomiting and
is always present in whooping-cough, never exists in
asthma millari; the paroxysms of whooping-cough occur at night as well as in the day-time, and a catarrhal
stage is always present, quantities of tenacious mucus are likewise thrown up; all these symptoms are
wanting in asthma millari. Cyanosis always depends
upon congenital organic defects of the circulatory apparatus, which can be diagnosed by means of the
stethoscope through the continual irregularities of the
beats of the heart; the symptoms of suffocation show
themselves even a few days after birth, whereas the
asthma sets in in the first period of dentition, or even
afterwards; cyanosis is attended with a peculiar
rattling or wheezing, accompanied with violent cough.
Etiology: The disease generally occurs between
the 6th and 18th month, seldom later; boys are more
liable to it than girls; it is sometimes hereditary, and
it happens that all the children of a family are visited
by it. Such children are generally of a delicatt coti-..stitution, pale, lymphatic, scrofulous, the scrofulous
habit manifesting itself by eruptions on thwaead atfd
face, otorrhaea, glandular swellings. Many physicians consider this asthma as a disease inherent to the.
period of development; more frequently, however,
the disease is excited by catarrh, bronchitis, crotip,
whooping-cough, measles, hydrocephalous fevers, cold,
particularly in the cold, damp season.
Prognosis: It depends upon the age and constitution of the patient; the older and more robust the
patient, the less dangerous the disease; the prognosis



ASTHMA MILLARI.


is likewise depending upon the causes and complications of the disease, and upon its duration and
course; the convulsive stage and the termination in
hydrocephalus are very dangerous. (Canstatt).
~. 234. Treatment: One of the principal remedies
for the spasm which is the characteristic pathognomonic symptom in asthma millari, is Sambucus. The
indications are the following: The patient wakes
from his slumber with his eyes and mouth half open,
and has to sit up suddenly on account of want of
breath; the inspirations are short and sibilant, with
occasional suffocative fits, during which he throws his
hands about, face and hands are swollen and bluish,
with dry heat all over, without thirst, and irregular,
small, intermittent pulse; the patient cries when the
paroxysm is setting in; there is no cough, and the
paroxysm generally sets in about midnight.
Arsenicum. The paroxysm is preceded for several
days by slight catarrhal symptoms; the little one goes
to sleep quietly, and the spasm develops itself gradually and visibly; the breathing becomes shorter,
sibilant, until the spasm sets in in all its violence with
a loud whizzing cry and sudden suffocation as if the
patient would die.
Menyanthes trifoliata ranks with Sambucus, except
that the spasm is lighter, though it comes on. suddenly and the breathing is exceedingly laboured.
Moschus is useful for sudden constriction of the
larynx, with desire to take a deep breath.
Veratrum. Suffocative constriction of the larynx,
with imperceptible breathing, contracted pupils, or
protruded eyes; laboured breathing between the
paroxysms.
The following remedies may be given for paroxysms
of nocturnal anguish: Ignat., Ipec., Bellad., Puls., Lauroces., Nux v., Aconit., Angust., Stramon., Calcar., Lycop., Phosph r.



112      ANGINA PECTORIS, NEURALGIA, ETC.,
ever, I first give the spirits of Campih. in drop-doses,
every 5 or 10 minutes, and afterwards Baryt. carb.
~ 238. Angina pectoris, neuralgia of the heart.
Pathognomonic symptoms of angina pectoris: Horrid
pain in the region of the heart, under the sternum,
setting in suddenly, paroxysmally, extending over the
chest, neck, arms, diaphragm, accompanied with a
sensation of fainting and internal annihilation; the
patient has to stand still and hold fast to some fixed
object.
Course of the disease: The paroxysm frequently sets
in without any precursory symptoms, which is characteristic of the disease; low-spiritedness, indescribable restlessness, stretching of the extremities, cloudiness of sight, are sometimes felt previous to the
paroxysm.
The neuralgic pain is characterized by a feeling of
approaching syncope, anguish as of death; the pain
itself varies, pressing, constriction or distention of the
heart, as if it would break; or sensation as if the
heart remained standing still; or the pain is cutting
as if the chest would be cut to pieces. The pain is
relieved by quiet and by pressing the chest against
something hard. The breathing is apparently arrested, the patient thinks he will suffocate, is speechless.
Palpitation is not always present; the beats of the
heart are rather fluttering, irregular; the pulse is
generally small, feeble, somewhat accelerated, frequently irregular; sometimes, however, it is hard, full,
unaltered, even slower than usual, symptoms which
point to organic disease of the heart. During the
paroxysm the face and extremities are cold, covered
with cold sweat; the features are spasmodically distorted, and the senses vanish; generally, however,
the patients retain their consciousness during the
paroxysm.
At the commencement of the disease the paroxysm
lasts only a few minutes, afterwards it lasts a little
longer, but is then less violent the spasm abates



ANGINA PECTORIS, NEURALGIA, ETC.


bladder take place; sometimes erysipelas breaks out
on the feet, relieving the chest. The disease has
likewise been known to alternate with other nervous
diseases, gastralgia, ischias, headache, etc., or to terminate in organic disease of the heart, cachexia,
dropsy. Generally. however, the patient dies during
a paroxysm, previous to these disorganizations setting  in.
Prognosis: It is generally unfavourable, particularly when the cases are old, or complicated with disorganizations, when the paroxysms are violent, and
follow each other rapidly in consequence of trivial
causes, and when the intermissions are not entirely
free from pain. The prognosis is less unfavourable
when the disease depends upon gout, hysteria, spinal
irritation, when the paroxysms are rare and not too
vehement, and the patient is young in years. (Canstatt.)
~ 240. Treatment: During the paroxysm the patient
should be relieved of every pressure, even that of his
clothes, and he should keep perfectly quiet, in an
erect posture; a recumbent posture is intolerable. It
is of great use to bathe the hands and feet in warm
water, to rub the skin with woollen cloths, to apply
warm cataplasms and animal magnetism. Cold affusions, applications of cold water to the chest, may
likewise prove useful; experience will have to decide
on this point.
Arsenicum is a specific remedy for this disease,
provided the structural disorganizations of the heart
or larger vessels are not too considerable. It is indicated when the patient is unable to breathe except
with his chest bent forward, and then only very imperceptibly; when the least motion causes a loss of
breath; when an oppressive stitching in the region
of the heart is attended with fainting and anguish;
when even getting into bed causes a loss of breath,
and the patient requires a long time to recover himself; when the attack is renewed by merely turning
round in bed. Arsenic is certainly a truly excellent



NEUROSES OF THE GENITAL SYSTEM.


115


remedy when the disease is purely dynamic; though
it can only palliate the pain when extensive disorganizations are present, in which case the least cause
may provoke a new paroxysm.
Digitalis is indicated when the action of the heart
is more vigorous than the pulse; or when the disease
sets in suddenly, and drawing-tensive spasmodic pains
in the left chest and sternum, towards the nape of the
neck and upper arm, and an indescribable deathly
anguish are present.
Sambucus may likewise prove useful in angina pectoris (see Asthma millari).
Angustura may be tried in the lighter cases, when
the chest is in constant motion, and this is aggravated
by the least exercise, going up stairs, etc., attended
with anxiety and palpitation of the heart, cutting
shocks in the sternum and back, or painful shocks in
the region of the heart.
Lactuca virosa deserves consideration. when a
crampy stitching in the left chest, extending to the
left scapula, and an indescribable tightness of the
whole chest, are experienced.
Veratrum album: periodical attacks of contractive
crampy pain in the left chest, or cutting pain with
excessive agony, arresting the breathing, and extending even to the shoulder.
Asafeatida and Sepia are likewise to be considered.
I have frequently arrested or moderated an attack
by repeated doses of Aconite. Ipecac. may be tried,
when the patient frequently experiences an urging to
vomit during the paroxysm.
Bellad., China, Spongia, lodium, Mercur., etc., are
suitable intercurrent remedies.
~ 241. Neuroses of the genital system.
HYSTERIA, ASTHMA UTERI, SUFFOCATIO UTERINA, PASSIO
HYSTERICA.
In describing the treatment of this disease, or rather
of this multitude of diseases, I shall follow the arrangement of Schoenlein and Canstatt.



116


NEUROSIS OF THE GENITAL SYSTEM.


Hysteria is the name for a vast number of female
diseases. It occurs in the most varied forms, which
makes the treatment of hysteria rather difficult. A
sudden change of the phenomena of disease is characteristic of hysteria. Vehement symptoms frequently set in without any apparent cause, and then disappear again as suddenly, or change to some other
form of disease, or give place to perfect health and
cheerful spirits.
The psychical phenomena are very characteristic.
Hysteric females are capricious, their emotions and
feelings are very changeable; from deep grief they
sometimes pass over to the liveliest mood; they
always consider themselves very sick and want to
be pitied; they affect to be very sick, in various ways,
sometimes only to excite interest; their eyes are
humid, languishing, half closed; the nerves are very
sensitive, idiosyncrasies are more strikingly developed.
Symptoms of hysteria: General malaise, sadness or
excessive cheerfulness, loquacity, restlessness, anguish,
slight convulsions and pains in all the limbs, moaning
and yawning, urging to urinate, discharge of watery
urine; sensation as if a ball were rising with a rumbling noise from the left side of the abdomen to the
epigastrium, where it causes a retching and vomiting,
or it rises in the throat and causes a constriction in
that part. This is followed by convulsions: the
patients strike their breasts with their fists, and are
tossed up in the air, in consequence of which they
have to be watched with great care, lest they should
hurt themselves. In this condition they generally remain conscious; they scream, howl, laugh, sob spasmodically. During the remission the patients are
exhausted, delirious, soporous, or they are in ecstasy,
or in a state of somnambulism; soon, however, the
convulsions return and the same scenes recur sometimes every three or four minutes. Such a paroxysm
may last for several days, after which it frequently terminates in asphyxia, coma, rising of air, or in weeping,
sobbing, laughing, increased secretion of mucus from



LOCAL F'ORMS or HYST'tERA.


117


the genital organs, or increased discharge of watery
urine. At first the pulse is small, contracted, the face
pale, the extremities cold; afterwards the patients
feel exhausted, the pulse gradually becomes fuller,
and the temperature of the skin returns.
This is the usual character of hysteric convulsions;
in a higher degree the convulsions increase to St.
Vitus' dance, tetanus, catalepsy, even epilepsy with
loss of consciousness. Sometimes the paroxysm sets
in without any known cause; sometimes they are excited by emotions, cold, dietetic transgressions. Sometimes they are inconsiderable, and recur every week
or month; as the patients grow older, the paroxysms
become more frequent and more intense; the patients,
however, always look well, and remain fleshy.
~ 142. Local forms of hysteria.
1) Hysteric headache (encephalopathia hysterica,
hysteria cephalica): hemicrania, clavus, sensation of
coldness at the occiput, sopor and coma, symptoms of
threatening phrenitis, delirium, obstinate sleeplessness. It is characteristic of these ailments, to cease
suddenly, and to alternate rapidly with other ailments;
pale face, watery urine, small pulse, etc., are likewise
characteristic.
2) Hysteric states of the mind: To these belong the
frequent repetition of certain syllables, words, sentences, tunes; nymphomania.
3) Hysteria spinalis, myelopathia hysterica. This
spinal irritation is generally sympathetic. The pain
is generally a drawing through the whole of the vertebral column, accompanied with pains in the extremities, formication, contraction of the muscles, cramps
in the calves, paralytic states, neuralgic affections of
the thoracic and intercostal nerves, joints. This pain
is rarely seated, generally fleeting, and erratic.
4) Hysteria uterina, neurosis uterina, spasmus hysteralgicus. The patients complain of pain, tightness in
the hypogastric and pubic regions, frequently attended
with drawing pains in the loins and small of the hack,



118


LOCAL FORMS OF HYSTERIA.


following the course of the round and broad ligaments of the womb; they feel as if the uterus were
forcibly drawn up from the small to the large pelvis.
At times these pains are colicky, at others they are
attended with a sensation as if a ball were ascending.
The sexual instinct is sometimes violently excited.
The menses are generally disturbed: at times they
are scanty, at others profuse, they are always irregular, and come on by fits and starts; they are accompanied with leucorrhoea. The paroxysms are most
violent at the time of the menses, first periodically;
if the menses have become irregular, the paroxysms
occur at irregular periods.
5) Hysteria vesicalis, nephro et cystopathia hysterica. The patients are attacked with violent, contractive, and frequently burning pains in the lumbar
region, along the course of the ureters, through the
whole pelvis, in the region of the bladder, without
sensitiveness to hard external pressure, which distinguishes the disease from nephritis and cystitis; violent
desire to urinate, no urine being passed, or but very
little and with violent pains (ischuria and stranguria
hysterica); the urine is clear, sometimes like water.
6) Hysteria intestinalis, colica hysterica. The spasm
generally commences in the region of the coecum or
of the sygmoid flexure, with a sensation as if a ball
were lodged in these parts which is constantly increasing in size. The pain is like a violent colic,
burning, tearing, as if the bowel were torn to pieces
with knives. The patient screams when one merely
attempts to touch her, whereas she bears hard pressure, provided her attention is directed to something
else in the meanwhile.    Borborygmi, tympanitis,
sometimes enormous distention of the transverse
colon, with anxiety, shortness of breath, vomiting, etc.
No trace of fever.
7) Hysteria gastrica, gastropathia hysterica, cardialgia hysterica, pyrosis hysterica. The patients complain of a constrictive, or burning, or spasmodic pain
in the stomach, with oppression, nausea, vomiting;



LOCAL FORMS OF HYSTERIA.


dread of contact, and yet they bear the hardest
pressure. The patients bear very little medicine.
8) Hysteria pulmonalis, asthma hystericum. Hysteric
females sometimes suffer with violent oppression of
breathing, suffocative anguish, stitching pains in the
chest, yet they are able to take deep inspirations.
Sometimes cough is present, at others there is not any:
it is dry, barking, sometimes like whooping-cough.
In many cases the patients breathe only with the abdominal muscles, in other cases the breathing is panting, anxious, or the patients breathe only while sittirg up in bed. Percussion and auscultation do not
reveal any changes in the lungs, no fever.
9) Hysteria laryngea, laryngopathia( hysterica. The
patients complain of a loud, dry, almost barking cough,
in paroxysms, occasioned by emotions and nervous excitement, sometimes attended with spasm of the rima
glottis, and croupy respiration.  Another form  is
hoarseness and aphonia. It comes on suddenly, lasts
for months and years, and then disappears again suddenly; sometimes, after a violent mental excitement,
the patient talks with her usual voice, whereas a few
moments previous she was only able to speak in a very
low tone. Hysteric females sometimes utter sounds
like those of certain animals, dogs, etc., paroxysmally.
10) Hysteria cardiaca et vascularis, cardio- et angiopathia hysterica. Hysteric patients complain very
frequently of palpitation of the heart and anxiety in
the region of the heart; the former is sometimes visible;
sometimes it occurs periodically, and becomes so violent that one would think the heart would burst out
of the chest. The pulse is frequently irregular, slow
and then again quick.
11) Globus hystericus, pharyngopathia hysterica.
Sensation of constriction in the throat, as if a ball
had lodged in it, sometimes relieved by eructations.
Sometimes a spasm occurs when the patients attempt
to drink. (Hydrophobia hysterica.)
There are other local forms of hysteria, which it is
unnecessary to mention.



LOCAL FORMS OF HYSTERIA.


paroxysms of syncope, excessive dyspncea, loss of the
senses and of consciousness, foam at the mouth during
the paroxysm; these symptoms precede the termination
of the disease in epilepsy. Hysteric paroxysms during
pregnancy are dangerous, inasmuch as they easily
cause miscarriage; and likewise during confinement,
because, by a process of metastasis, they may lead to
mania puerperarum, exhaustion, etc.
~ 244. Before describing the treatment of hysteria,
I will transcribe the excellent advice of Schcenlein to
the practitioner: " The treatment of hysteria is a very
difficult task for the physician, not only because the
diagnosis is difficult, and the disease runs along course,
but because there are spiritual obstacles. The physician's patience is sometimes tried to the utmost: for,
though persuaded that the disease is of very little consequence, yet he is constantly obliged to listen to the
patient's lamentations, and to hear the same complaint repeated for the hundredth time, without getting
impatient; for if he should excite the least suspicion
in the patient's mind that he underrates her sufferings,
her confidence is irretrievably lost. If a physician
wants to treat hysteric females, he must show them
the greatest sympathy, must patiently listen to their
complaints, must not appear vexed or indifferent, unless he cares to be dismissed."
There are few remedies in the homoeopathic Mat.
Med. which have not been employed in the treatment
of hysteria. Almost every organ and system has been
visited by this disease, every function has been disturbed by it. And yet, the phenomena of hysteria are
so evanescent that it seems impossible to indicate positive remedies for them. Nevertheless, guided by
the nervous symptoms and the physical distresses of
the patient, I will try to point out some of the principal remedies to the beginning practitioner.
For the hysteric paroxysm mentioned in ~ 241, one
of the principal remedies is Nux moschata, which is
particularly adapted to hysteric spasms and paroxysms
of debility. Tt is indicated by a changeable disposition,
VOL. Tv.-6



LOCAL FORMS OF HYSTERIA.


123


about one's own-deserved fate, great anguish about
the heart, dread of men, etc.
Pulsatilla ranks with Aurum, except that Aurum
suits every constitution and temperament, whereas
Pulsat. is principally adapted to females, and can
scarcely ever be exhibited in the hypochondria of male
subjects.  Schcenlein recommends Pulsatilla in hysteria uterina as one of the most powerful remedies,
particularly when the menses are scanty and attended with nervous paroxysms. He proposes very
small doses, forgets, however, to state that he owes
this piece of wisdom to Hahnemann and homceopathy.
Moschus is an excellent remedy in hysteria, when
the following symptoms exist: Hysteric patients frequently complain of a feeling of pain in the whole
body without being able to indicate the precise spot;
the pains are felt more intensely, when inquired
into; they shed tears while complaining of a general
languor, with a feeling of malaise which increases
to fainting; various kinds of spasms, to which hysteric females are subject, are relieved by Moschus,
such as: sudden rush of blood to the head, with
staring eyes and spasm in the mouth, followed by
rapid, confused talking, after which cadaverous paleness with profuse sweat over the whole head; or:
sudden paroxysm characterized by staring eyes with
paleness of the face, heaviness of the head, pressure
in the nape of the neck, coldness of the body, nausea,
afterwards obscuration of sight, contraction of the
pupils, loss of equilibrium, rigidity and extension of
the right hand and fingers; sudden vanishing of
sight from a slight pressure on the vertex, with great
anxiety, palpitation of the heart and stupifying
headache, or pain as if from a nail driven into the
skull; oppression across the stomach and pit of the
stomach, with anxiety; violent excitement of the
sexual organs with intolerable titillation; suffocative
constriction in the larynx, etc.
Conium suits unmarried females, particularly when
the symptoms seem to proceed from the sexual sys



LOCAL FORMS OF HYSTERIA.


125


to their condition, and that it is owing to this power
of divination, of which the patients are not conscious,
that they will swallow a quantity of salt, quantities
of the chemically prepared vinegar (containing sulphuric acid), chalk, lime, etc.  The same remark
probably applies to the so-called idiosyncrasies, which
impels them to desire Asafcetida as well as Moschus.
May this appear hypothetic or otherwise, it is a fact
that these strange desires and idiosyncrasies sometimes reveal the means by the employment of which
the disease can be cured. I have frequently prescribed Natrumn mur. with great success, when the
particular taste of the patient for salt was the principal curative indication. Of course, Natrum mur.
possesses among its pathogenetic symptoms far more
certain and valuable therapeutic indications than the
uncertain idiosyncracies of the patients; the principal
of these indications are: frequent recurrence of the
paroxysms in the day-time; speedy disappearance of
the hysteric symptoms after sweat sets in; cadaverous
paleness of the face and general debility during the
paroxysm; drawing sensation from the left shoulder
to the head, with pressing in the temples as if the
head would burst, pain in the brain as if sore and
bruised, constant nausea as if proceeding from the
stomach, desire to lie down, and chilliness with heat
in the face. Other indications are: general debility
and frequent paroxysms of fainting; frequent sensation
in various parts of the body as if they had gone to
sleep; vivid, fanciful dreams during a light sleep;
somnambulistic rising and walking in the room; sadness, grief, whining and melancholy mood, irresoluteness, great absence of mind; sudden disappearance
of the headache with nausea; clavus in the left side
of the head;,and lastly the menses, which delay and
decrease more and more.
Calcar. carb. is a good remedy for hysteria, particularly when the sexual system is unusually excited
and the hysteric spasms show a tendency to assume
the epileptic form.



LOCAL FORMS OF HYSTERIA.


Asafartida corresponds to the following symptoms:
pressure in the oesophagus, contraction of the throat,
sometimes occasioned by a sensation as if a body
were rising in the throat, which obliges the patient to
swallow frequently; this pressure generally proceeds
from the stomach, ascending along the cesophagus and
producing the sensation as if a foreign body were
rising in the throat, attended with nausea and a feeling of fulness in the pit of the stomach, compressive
sensation in the abdomen.
Sepia is suitable to feeble females with a fine, delicate skin. Sepia corresponds to the following paroxysm: sensation as of an icy-cold hand between the
shoulder-blades, followed by coldness over the whole
body, suffocative spasm in the chest for several minutes, followed by clonic convulsions of the right
limb, and twitching of the right limb and arm, when
the limb is held; lastly, tremor of the lower extremities; the nightly sleep is disturbed by frequent attacks of anxiety, sudden fainting with profuse sweats
and undisturbed consciousness, without, however,
being able to speak or stir. Sepia is more suitable to
sad than cheerful dispositions. For further symptoms,
I refer the reader to the Mat. Med.
Magnesia muriatica corresponds to the following
symptoms: liability to take cold, frequent attacks of
a bruising pain throughout the whole body, sick feeling, fainting fits at table, with anxiety, nausea, pale
face, photopsia (green and red colours.) trembling of
the whole body, relieved by eructations; uterine
spasms, pain in the small of the back, leucorrhoea;
these last-named symptoms become more violent as
the menses diminish, they appear periodically, and
the spasms finally extend down the thighs and upwards, involving the whole abdomen, causing a painful hardness of that part.
NiUri acid'in: Drawing sensation in the back, every
day once or twice, changing to a griping in the sides,
whence it passes along under the ribs to the pit of the
stomach, where the patient experiences a twisting



TREATMENT OF LOCAL HYSTERIA.


wise be used during confinement, though Bellad. and
China may likewise be indicated, particularly when
a thin, fetid ichor is secreted instead of the regular
lochia. Veratrum is indicated when the lochia are
suppressed or very scanty during the nymphomania,
attended with delirium. If the lochia should be suppressed, and the secretion of milk in the breasts decrease, attended with a painful sensitiveness of the
external and internal sexual parts, Zincum is the best
remedy; this is likewise the case when the disease
had been occasioned by onanism, and when the menses, after having been suppressed for a certain length
of time, reappeared suddenly with alternate paleness
and redness of the face, and violent cutting and
pressing in the abdomen and small of the back.
If nymphomania should arise from some of the
many abdominal ailments to which hysteric females
are subject, Gratiola might perhaps prove efficacious.
For nymphomania caused by sexual excesses, onanism, or by an unsatisfied sexual desire, China,
Conium, Anacardium, Staphysagria, or perhaps Aurum,
Thuja, Mercur., Ignat., Nux vom., Hyoscyam., etc.,
may prove useful.
~ 247. 3) Hysteria spinalis. This is generally, as
I remarked in ~ 242, a drawing pain along the
spinal column, upwards or downwards; but it may
change to some other pain, or be a different pain from
the commencement. For hysteria spinalis I recommend Belld., Dulcam., Digit., Capsic., Thuja, Mercur., Sulphur, Carbo veg.-If the pain should be accompanied with spasmodic contractions of the muscles,
cramps in the calves, Ipec., Cuprum and Secale should
be considered. If the pain should be attended with
paralytic conditions, neuralgic affections of the thoracic and intercostal nerves, nerves of the articulations, Dulc., Rhus t., Plumb., Stann., Squilla, etc., or
Puls., Ignat., Ars., Moschus, Caust., Cicut., deserve to
be mentioned.
~ 248. 4) Uterine hysteria. To the remedies mentioned in ~ 244 I will add the following:
6*



TREATMENT OF LOCAL HYSTERIA.


profuse menses, hysteric states of the mind, and globus hystericus.
Magnes. mur., Conium and Ignat. should not be
forgot in uterine hysteria.*
~ 249. 5) Hysteria vesicalis. The statements of
the patient are not always sufficient to enable us to
distinguish between an inflammatory and spasmodic
affection of the kidneys and bladder. In such a case,
all we can do is, to take a careful record of the symptoms of the disease, and to select a remedy in accordance with those symptoms.
The remedies which the patient had better try first,
are: Cantharides, Mercur., Hepar s., Bellad., China,
Mezereum, Colocynth., etc.-Zincum is excellent for
burning pains, though it may likewise be tried for
pressing-stitching, and  lancinating  sore pains.Stitching pains in the renal and lumbar regions are
cured by Zincum, Lycop., Canthar., Dulcam., Acid.
sulph.
For hysteric ischuria and stranguria: Canthar.,
Arnica, Digit., Pulsat., Nux vom., Camphor., Colch.,
Sassap., etc., are the best remedies. (See ~ 177 and 223.)
~ 250. Hysteria intestinalis. The same treatment
should be pursued here, which has been recommended
for neuralgia of the abdominal nerves. (See ~ 196
and subseq.). The same remark applies to
7) Hysteria gastrica (see ~ 216); and to
8) Hysteria pulmonalis; (see ~ 230.) To this class
belong the frequent nocturnal paroxysms of asthma
preceding hysteric fainting fits, though these fainting
spells may likewise be occasioned by a violent boring
pain at a small spot of the head, as from a nail being
driven in, or by a periodical pain in the stomach and
bowels. For such paroxysms Ignatia is an excellent
remedy. Other paroxysms of nightly anguish, particularly in delicate subjects, with whining disposi* Magnes. mur. is a specific for spasms of the ligaments of the womb.
-Hempel.



ECLAMPSIA, ACUTE EPILEPSY.


tions and want of animal heat, yield to Pulsat. or
Veratrum, according to the symptoms.*
9) Hysteria laryngea. I refer the reader to catarrhal fever, catarrh, laryngitis, tracheitis, bronchitis, phthisis laryngea, etc., where the treatment of
cough, hoarseness, aphonia, is minutely described.For a lisping, low voice, and for the frequent and
sudden giving out of the voice, I recommend Phosphor.,.Platin., Ignat., Angust., Spong., Pulsat., Antim. crud.
~ 251. 10) Hysteria cardiaca and vascularis. Hysteric females frequently complain of palpitation of the
heart and anxiety in the region of the heart, sometimes accompanied with great nervousness and debility. Aconite is generally the best remedy for this
condition.
If the palpitation of the heart be accompanied with
an oppressive pain in the stomach, extreme nervousness, languor, coated tongue, anorexia, etc., China or
Pulsat. will have to be given.
The palpitation is frequently accompanied with
fainting, vanishing of the senses, general insensibility;
these symptoms, which are very evanescent, are relieved by smelling of Nux mosch., Moschus or Aconite.
These phenomena generally constitute symptoms of a
general hysteric illness, which is very frequently removed by Nux vom., to be repeated several times
during the treatment. It is an admirable remedy for
the hysteria of a so-called virago.
11) Globus hystericus. I refer the reader to ~ 244
for the remedies.
~ 252. Eclampsia, acute epilepsy.
A. ECLAMPSIA INFANTUM.
The disease is divided into the precursory stage, the
paroxysms, and the intervals.


* Also to Ipecacuanha. Hempel.



ECLAMPSIA, ACUTE EPILEPSY


133


Precursory symptoms are either wanting, or precede the disease for a shorter or longer time. They
are: bad humour, whining mood, sudden starting as if
in affright, starting during sleep, sleeplessness, screams
without sufficient cause, frequent and rapid change of
complexion, sudden relinquishing of the breasts; or
the following group of symptoms will be observed:
heat and redness of the gums during dentition, fever
with eruptions, vomiting, stool looking like stirred
eggs, acidity of the stomach.-By the term "internal
spasms" we mean a distortion of the eyeballs, which
the children roll upwards so that only the whites can
be seen; the facial muscles are trembling, and the
children seem to smile during sleep; the breathing
is anxious and irregular; after a violent interruption
of breathing, the children suddenly take a long and
deep inspiration; their limbs twitch during sleep,
they clench their thumbs and toes, and bend the feet
towards the retracted abdomen. We frequently perceive a peculiar livid colour around the mouth and
eyes; the nose and features become pointed.
Paroxysm: An attack of eclampsia is very similar
to one of epilepsy; distortion of the features, staring,
rolling and distortion of the eyes; throwing the head
backwards, convulsive jerking of the chest and abdomen; panting breathing; hoarse cries, or moaning, rigidity and alternate shocks of the extremities.
The face swells, becomes dark-blue, purple-red, gradually the whole body assumes the same colour, and
the jugular and frontal veins swell; hands and feet
frequently remain cold, though the temperature of
the skin is elevated.  Such a paroxysm should be
termed: eclampsia cum hyperaemia, in contradistinction
from eclampsia cum anamia, with pale, sunken face
and cold skin; the conjunctiva and cornea are deprived of blood, without lustre. In the former variety
the spasms are rather tonic, tetanic; in the latter,
clonic. The convulsions proceed from the face, or
the abdomen, or chest.
Intervals: The paroxysms generally last a few se



134


ECLAMPSIA, ACUTE EPILEPSY.


conds or minutes, sometimes a little longer; they are
followed by languor or comatose stupefaction. The
interval is sometimes very short, during which the
symptoms of cerebral congestion continue, such as:
hot face, injected eyes, restlessness or constant sopor,
fever, etc. The more frequent the paroxysms, the
more violent. In many cases the very first paroxysm
terminates fatally.
~ 253. Etiology: Convulsions occur most frequently among infants, and among children of from 3 to 4
years. In many cases the disease is hereditary,
and the disposition to such diseases is said to be known
by the large skull, retarded closing of the fontanelles,
white and delicate skin, feeble muscles, glossy eyes,
rapidity of motion, frequent starting, particularly
during sleep, frequent internal spasms, rapid development of the mental faculties.  Other causes are:
Emotions, fright, spasms of the mothers and nurses,
mechanical pressure of the head during confinement;
abuse of spirits and narcotics, mental efforts.
Also: Gastric irritation, hence the disease is apt to
occur during the period of weaning; over-feeding,
sour pap, etc.
Convulsions which occur during the first stage of
febrile 'diseases, are no more dangerous than the
chilly stage in full-grown individuals. If convulsions
set in at the close of the period of dentition, Sydenham considers them as indications that the smallpox
is going to break out, but that, on the other hand, the
eruption will run a favourable course.
Prognosis: Very unfavourable, particularly among
infants, and when the disease is hereditary; convulsions caused by poisoned milk, either of the mother or
nurse, are almost always fatal. Convulsions from
worms or gastric irritation, are less dangerous; the
least dangerous are those which occur in the first
stage of febrile or exanthematous diseases. There is
great danger when the disease occurs without premonitory symptoms, when the paroxysms take place
in rapid succession, are very violent, and do not even



ECLAMPSIA, ACUTE EPILEPSY.


137


was caused by sudden fright. It corresponds to
eclampsia cum hypercemia.
Stramonium is suitable for lock-jaw, complete rigidity of the whole body, or rigidity of the extremities
alternating with convulsive shocks; the patient lies in
a deep sleep with stertorous breathing, and a quantity of urine is emitted; these symptoms are generally
accompanied with great heat over the whole body,
the patient drinks a good deal, the tongue is very dry,
the features are distorted as if from pain, the face is
red and as if bloated, the tongue seems paralyzed, deglutition is difficult.  Stramn. is principally indicated
in eclampsia cum hypercemia.
Cicuta virosa should be used when the child, having
been playful and well a moment before, suddenly becomes rigid and immovable; in a few minutes a state
of languor sets in, during which the child becomes
prostrate. This paroxysm recurs frequently and lasts
a little longer each time. Cicuta is likewise useful
in frequently recurring paroxysms of eclampsia.
During these paroxysms the extremities, head and
trunk are moved and distorted in a strange manner,
the face is swelled and bluish, foam is at the mouth,
and, after the cessation of the convulsions, the child
looks like insensible and dead.
Stannum: the convulsions come on whenever the
child cuts a new tooth, increasing in violence each
time; the child suffers of spasms more or less generally, and looks feeble and miserable.
Cuprum metallicum: excellent in the most violent
convulsions from dentition, the whole head is bloated,
and the face red and swelled, the child utters crowing
screams; the attack is preceded by loathing and
nausea, and a lethargic state, or a quantity of phlegm
is forced up; when consciousness returns, the child
writhes, screams, the abdomen is distended, with involuntary discharge of thin stool, occasional convulsive movements and distortion of the limbs; these
symptoms are succeeded by new paroxysms, during
which the child is without consciousness.



ECLAMPSIA OF PARTURIENT WOMEN.


A principal remedy for such convulsions is Zincum.
We give it for the lighter paroxysms, characterized
by screams, shrieking during sleep without the child
knowing any thing about it; but, if it should wake
up, its features express fright, it looks about with
great anxiety, as if waking from frightful dreams;
the child's body is very hot on putting it to bed in the
evening; in the day-time there had been a good deal
of muscular twitching, more on the right than the
left side; for several days previous the child had been
irritable, peevish, whining, eating with a ravenous
appetite, swallowing hurriedly, the abdomen distended
as if from flatulence, with involuntary discharge of
urine.
~ 255. B. ECLAMPSIA OF PARTURIENT WOMEN.
This disease depends upon a congestive state, in
contradistinction from hysteric spasms, and spasms
caused by exhaustion or loss of blood.
The precursory symptoms generally point to congestion of the brain, characterized by intolerable pain
in the forehead which sets in suddenly in the most
violent degree; vertigo, heat in the head; hallucinations, scintillations, ringing in the ears, diminution
of sight even unto blindness, difficulty of speech, feeling of lameness in the extremities. The patient is
out of her usual mood, melancholy, she treats those
around her with indifference, her eyes are staring,
with dilated pupils. The patient complains of a disagreeable sensation and pain in the praecordial region,
nausea, vomiting, pressure and pain in the hypogastrium, sensitiveness of this region to external contact; the pulse is irregular, or hard and full; in
parturient females the eclampsia is sometimes preceded by a violent chill. In some cases these precursory symptoms precede the paroxysm for days, in
others for a few hours or minutes only; they may remain away altogether; the shorter the precursory
stage, the more dangerous the paroxysm.



CHOREA ST. VITI, SCELOTYRBE, ETC.


143


nates from one side to another; in some cases a series
of muscles are attacked one after the other. The
patients never complain of fatigue, even if the motion
of the limbs should have been ever so constant. The
spasms generally cease during sleep, although, in bad
cases, the sleep is sometimes disturbed. After a meal,
the muscular jactitation is worse. If the disease last
a long time, the face becomes pale, the pulse is
hurried towards evening, the patient becomes thin.
Wichmann terms this chorea Anglorum. Schcenlein
terms this and the following form hysteria muscularis.
Symptoms of chorea St. Viti major. It is paroxysmal, like epilepsy and eclampsia, from which it
cannot always be easily distinguished. The paroxysms are a mingling of clonic and tonic, epileptiform,
tetanic and opisthotonic spasms, or a combination of
the strangest motions; the patients dance, crawl on
all fours; they act as if they would fly, swim, they are
tossed off the floor, make the wildest leaps, turn summersets, laugh in an extravagant manner, imitate
the sounds of animals. Even the most violent paroxysms do not cause any fatigue. The patients are
disposed to hide themselves in corners or behind
other objects. Intermissions of several days occur at
times. The paroxysms take place both at night and
in the day-time. Symptoms of mental derangement
are: excitement of the fancy, delirium, craziness,
somnambulism, ectasy. After the paroxysm, the patients are generally ignorant of what had taken place.
This species of St. Vitus' dance sometimes disappears
quite suddenly, and the patients are cured.
Mania saltatoria. " This mania showed itself in
its most extensive and striking form in 1374 and 1418,
immediately after the terrors of the black plague, in
Aix-la-Chapelle, in the Netherlands, Metz, Strasburg,
etc. The so-called St. John-dancers (whose numbers
were swelled by impostors and mendicants), men and
women, danced for hours in succession, with wreaths
on their heads, and the abdomen tightly bandaged,
jumping about in the wildest bacchanalian style,



144


CHOREA ST. VITI, SCELOTYRBE, ETC.


foaming and screaming, until they fell down exhausted. Then they complained of great oppression,
and moaned as if they would die, until the abdomen
was still more tightly bandaged, after which they
felt better. The bandaging took place on account
of the meteorism which set in after the paroxysm.
Sometimes the meteorism was relieved by kicking
on the abdomen, or striking it with fists. During the
paroxysm the dancers had all sorts of visions. When
the disease was at its height, the paroxysms commenced with epileptiform convulsions, the patients
fell down without consciousness, with foam at the
mouth, stertorous breathing, after which they jumped
up and commenced their dance with frightful distortions. In a paroxysm of religious mania they sang
during the dance, calling upon St. John for strength, in
whose chapels the mania was appeased, and at whose
festival it afterwards broke out again."
It is said that a species of mania saltatoria occurred
in 1808 in the states of Tennessee and Kentucky
among a sect of religious fanatics. The mania which
Boerhaave observed in the Leyden orphan-hospital,
the Bohnhorster St. Vitus' dance described by Albers
in Hufeland's journal, 1813, April No., p. 3, etc. etc.,
belongs under this head.
Tarantism. The poison of the tarantula, when inserted under the skin, frequently causes a considerable
and intensely painful swelling spreading over the
neighbouring parts. In a few hours melancholy, anguish, oppression of the chest, vertigo, general tremor
set in; the patients become convulsed and delirious;
the pulse becomes frequent and irregular; loathing
and vomiting supervene. Unless help is speedily secured, the patients, in a few days, fall into a state of
imbecility and melancholy. The heat of the summer,
and the sight of another patient similarly afflicted,
excite paroxysms of rage. Music exercises a peculiar
charm over the patient; it excites a desire to dance,
which he gratifies until he feels tired and overcome,



CIIOREA ST. VITI1 SCELOTYRBp, ETC.


volition and the subsequent anxiety which the patient
expresses in his movements, point to Ignatia. Ignatia
is, however, likewise a good remedy for the second
variety of chorea, which has often been cured by Ignat.
when caused by fright. I may here observe that epilepsy is probably very frequently mistaken for chorea,
and that a pretended cure of epilepsy was probably
one of chorea. This, however, is of very little consequence, as it is much better to know how to cure than
to know the disease without knowing how to cure it.
Asa fcEtida is of very little use in chorea, exceDt
perhaps where an irritation of the abdominal nerv..
by gastric crudities, worms or other causes, may have
led to chorea. There is sometimes abdominal pulsation
present, with twitching of single muscles, or convulsive motions of the same. The patients change their
minds constantly, are restless, and become easily confused.
Belladonna is particularly indicated when the
twitching is observed in the flexor-muscles, and the
paroxysms are preceded by a creeping and a feeling
of numbness in the muscles. The moral symptoms
frequently point to Belladonna.
Cuprum acet. or metallicum corresponds to twitching
of the muscles, sudden piercing cries, spasmodic distortions and motions of the extremities even when
occurring at night, during sleep, mostly commencing
at the fingers and toes and gradually changing to
convulsions as the body becomes involved, attended
with distortion of the mouth, alternate opening, closing
and distortion of the eyes. Another species of chorea,
for which Cuprum is indicated, is the following: Redness of the face, spasmodic distortion of the face, eyes
and body, at times risus sardonius, at others violent
weeping, anxiety, ludicrous gesticulations and desire
to hide one's-self. These symptoms are either attended
with melancholy and dread of society, or with an
ecstatic mood. Gross has reported a case of chorea
occasioned by fright, and characterized by involuntary
motions of the right arm and lower limb, gradually



CHOREA ST VITI, SCELOTYRBM, ETO.


147


involving the other extremities, so that no part of the
body could be kept still while waking, all parts being
engaged in strange motions, and even speech being
sometimes wanting. Afterwards Gross recommended
Calcar. instead of Cuprum. Bethmann cured the following case with Cuprum: the attack came on in consequence of seeing a child in convulsions; there was a
stitching and burning in the left arm, followed by
violent convulsions of the arm, anxiety and weeping;
the paroxysms returned 8 or 10 times within 24 hours,
the fingers being seized first, afterwards the lower
limbs, attended with heat in the face, sweat, thirst,
neck drawn to the right side, frightful distortion of the
eyes. face and body, afterwards some ludicrous exhibitions, hiding under the table; accompanied with irritable mood, at times mild and sensitive, at others
contrary.
Agaricus muscarius is indicated by the following
symptoms: slight twitchings here and there; slight
distortion of the uper extremities; convulsive condition of the muscles of the head and neck, constantly;
extreme mobility of the lower limbs, and the body
generally. This medicine is particularly useful in
mania saltatoria and tarantism.
Secale cornutum. In some cases I employed this
medicine in conjunction with animal magnetism, and
always with a good success; the magnetism was particularly useful when whole bundles of muscles were
attacked at once, and even internal organs were involved. The paroxysm, for which I prescribed Secale,
always commenced with oscillations of single muscles
of the face, increasing to convulsive twitchings which
produced distortions of either a frightful or ludicrous
character. The spasm then suddenly shifted to an arm
or foot, or to both arms or feet, causing a dancing,
leaping or gesticulating motion of those parts. Or
the spasm attacked the muscles of the chest and the
diaphragm, causing loss of breath. The spasm was
worst when affecting the abdominal muscles, in which
case it was always painful.



CHOREA ST. VITI, SCELOTYRBE, ETC.


149


the patient lies quiet, with his eyes closed. During
the intervals the movements of the patient are likewise
very hasty, he seems exceedingly busy, talkative,
shows a disposition to laugh at every thing; and, it
the disease should last a certain time, it terminates in
idiocy, imbecility.
Crocus. With this remedy I cured one case of the
following kind: the patient had complained of a
twitching in the muscles for some time previous,
which got worse at times and increased to spasmodic
contractions of single bundles of muscular fibres; the
patient suffered with bleeding of the nose, and felt the
better the more profuse it was; the bleeding was
preceded by a visible throbbing of the temporal arteries and a prostration of the child; the blood was
black and tenacious.  Aconite, Arnica, China, etc.,
were of no avail; on the contrary, the symptoms
seemed to get worse; a few doses of Crocus stopped
the disease. I was guided in the selection of Crocus
by the cerebral congestion.
China corresponds to chorea caused by onanism, or
loss of animal fluids by other causes; the patients are
nervous, very sensitive to external impressions, etc.
Causticum is recommended by some physicians; I
have never used it.
Rhus tox.: Twitchings in the extremities and
muscles, unsteadiness of the extremities, vacillation
of the extremities when attempting to stand or walk;
it is particularly indicated for chorea occurring after
a cold bath and repelled measles.
Pulsatilla, for the symptoms of which I refer the
reader to the Mat. Med.
lodium is probably suitable when the disease was
partially caused by a morbid state of the abdominal
nerves, when the stomach, liver, pancreas and abdominal glands are morbidly irritated, and the cerebral
functions are sympathetically involved. These pathological states lead to uneasiness in the limbs with
nervousness, and tremor from  the region of the
stomach to the periphery; trembling of the ex



150


RAPHANIA, MORBUS CEREALIS, ETC.


tremities, hands, fingers and eyelids; a vacillating,
unsteady gait; inability to move the hand to the
mouth in a straight line, pain on moving the body,
hurried, small, wiry pulse; during rest the trembling
parts can easily be held still; the spasms are violent
in the back and feet, with convulsive twitchings of
the feet and arms, occasional subsultus tendinum,
sadness and lowness of spirits, particularly at the
period of digestion.
Sulphur might perhaps be tried when the sudden
suppression of an acute or chronic eruption seems to
have caused the disease.
Chorea-patients are peculiarly charmed by music;
chorea-paroxysms characterized by dancing motions,
might perhaps be cured by music.*
~ 261. Raphania, morbus cerealis, convulsio cerealis,
ergotism.
Raphania is a disease which is principally causel
by  eating   spurred  rye.    There are    two   distinct
varieties of the    disease, the convulsive and the
gangrenous variety, the former being probably caused
by Lolium temulentum, the latter by Secale cornutum.
The disease occurs epidemically at a period of famine,
* Aconite is a very useful agent in the treatment of chorea.
Very lately I cured two interesting cases of chorea with Aconite.
One was a case of three years' standing, the patient a girl of
7 years; it had come on after an inflammation of the lungs
treated allceopathically. The left arm was the seat of the disease; the patient had no control over the motion of this arm;
there was a constant twitching and jerking of the arm. The
cure was effected in 3 weeks.  The second case was that of a
girl of 6 years.  For several months past the parents had observed a good deal of twitching and jerking in the left lower
extremity of the child, which increased gradually so that the
child was unable to stand or walk; she could not sit still one
minute; the upper extremities were similarly affected; she had
to be fed; the mouth was constantly drawn to one side, with
constant twitching of the corners; the head was drawn close to
the left shoulder. The cure was effected in five weeks, with
the tincture of Aconite.  Hempel.



RAPHANIA, MORBIIS CEREALIS, ETO.  151
after a bad harvest, and is caused by the use of bad
food generally, and spoiled grain in particular.
Symptoms of convulsive raphania.  Precursory
symptoms: Symptoms of languor and tiredness in
the extremities, frightful dreams, restlessness, formication, stitching, cramps in the lower extremities,
headache, stupefaction, vertigo, melancholy mood;
constrictive sensation in the epigastrium, disposition
to vomit, vomiting of a dark, or black-brown, imperfectly mixed bile.
These symptoms belong to so many diseases, that it
would be impossible to select the proper remedy by
those symptoms unless we knew from other cases before us that they were the precursory stage of the disease. In such a case the right remedy, if given at
the commencement, will cut the disease short at once,
without allowing it time to develop itself. Let us
describe the disease more in detail.
The precursory stage lasts from 7 to 21 days, after
which the disease assumes its true form. The pains
in the extremities become more violent, and extend
over the whole body. The patient complains of an
intolerable burning in the feet, knees and hands
tremble, and the upper and lower extremities are attacked by convulsive motions, particularly the flexor
muscles, so that it frequently takes a good deal of
force to straighten the limbs; the heels are forcibly
drawn to the buttocks, the hands towards the shoulders. The very painful spasms are at first clonic:
sometimes the clouic spasms are mingled with tonic
spasms, opisthotonos, trismus, strabismus; a bloody
foam appears at the mouth, as in epilepsy, the eyes
are staring, or they are rolled about in a wild manner,
the breathing is laboured, etc.  Sometimes the
patients retain their consciousness during these paroxysms, though, in some cases, there is headache, vertigo, furious delirium, screams, mania, melanc'..y,
difficulty of speech, stupor or coma, deafness, ringing
in the ears, optical illusions. Sometimes a cold sweat
breaks out on the forehead or the whole body, the



RAPHANIA, MORBUS CEREALIS, ETC.


urine is discharged involuntarily, the face has a jaundiced or livid appearance.
The paroxysms frequently last for hours, recur
several times in the day, but sometimes intermit fbr
several days. During the intervals the pulse remains
natural, the appetite is good, frequently the patients
have a sort of canine hunger; in other cases, gastric
symptoms set in, such as cardialgia, nausea, violent
thirst, heartburn, bilious vomiting, colic, diarrhoea,
evacuations of a fcetid, liquid, yellowish matter; the
skin is icy-cold, internally the patients complain of a
burning heat.
When the disease terminates favourably, the convulsions abate; the disease lasts from 4 to 12 weeks.
Sometimes phlyctaene, filled with an acrid serum,
form on the skin. For some time after, the patients
continue to complain of trembling of the hands,
weakness of the eyes, stiffness of the muscles and
joints, lameness, etc. The disease terminates fa.tally
when the tetanic spasms continue, or when paralysis
or apoplexy sets in.
~ 262. Symptoms of raphania gangrenosa (necrosis utilagine(t). The precursory stage is almost the
same as in the former variety: general malaise, tiredness, restless sleep with dreams, anguish; wandering
pains in the back and lower limbs, spasmodic contractions of these parts, frequent attacks of violent
pain and spasms, flushes of heat; pulse and appetite
are generally unchanged; the abdomen is sometimes
distended and painful; the urine clear and copious.
Gradually the convulsed limbs begin to feel numb,
arid the limbs that afterwards become gangrenous, are
exceedingly painful; hurried, contracted, feeble pulse,
sweat on face and head. The patient complains of a
feeling of icy-coldness in the hands and feet, nothing
can get them warm. Erysipelas is sometimes seen on
the extremities.
All at once the pains in the extremities disappear,
the icy-coldness increases, and sensation and motion
disappear; mostly dry gangrene sets in, though in



RAPHANIA, MORBUS CEREALIS, ETC.


153


some cases humid. In the former case, the limb becomes livid, the skin is withered, wrinkled, turns
yellow; finally, the limb becomes black, dry, hard as
horn. In the latter case, (humid gangrene,) the extremity swells, phlyctaen  filled with a yellowish,
bloody serum, form on the skin, the muscles become
soft, and the gangrenous parts spread a most fetid odor
of putrefaction. The pulse becomes more and more
feeble, the languor reaches the highest degree, symptoms of a torpid putrid fever set in, the features become sunken, fainting fits, delirium, coma, exhausting
diarrhaea set in, and death takes place with the symptoms of gangrene more or less extended. Recovery
is, however, possible, before gangrene sets in; and
even after gangrene has set in, the gangrened limb
may be separated from the healthy trunk by suppuration. In dry gangrene, the dead parts fall off
without bleeding; in humid gangrene, the falling off
is frequently accompanied with haemorrhage. In many
cases the sick limbs remain mutilated, atrophied, paralyzed. The gangrene sometimes extends to the
toes, hands, feet, as far as the knee; in other cases
the whole limb is lost. If the suppuration should
be very profuse, the patient may die of hectic fever,
un!ess the suppurative process should be stopped in
time. (Canstatt).
~ 263. Etiology: Raphania is an endemic disease,
and occurs at periods when men have to be satisfied
with spoiled flour, in consequence of war, famine, bad
harvest or weather. The corn itself is either disorganized or it is mingled with poisonous plants, such
as: Lolium temulentum, Raphanus raphanistrum, Nigella sativa, Agrostemma githago, etc. Disorganizations of the corn take place by means of fungous
formations shooting up on the grains, which may be
termed Sclerotium clavus, Uredo caries, Rubigo. The
corn may likewise get spoiled by moisture, fermentation, insects, and, in this way, its use may become
hurtful.
There is no doubt that other causes concur in the
7*



RAPHANIA, MORBUS CEREALTS, ETC.


155


Subsequent observations have showr. tC.LI tue abovementioned remedies are more suitable for the secondary diseases, particularly Belladonna for a peculiar
kind of stupidity and nervous debility.
Solanum nigrum is recommended by Hahnemann as
the most certain remedy for raphania.  -.L,. XI.,
No. 1, p. 92, Dr. Gross reports several cases of
raphania which he treated with Solanum nigrum; I
extract the following from his report.
"In the latter part of the summer of 1830 I was
requested to send some medicine to a farmer who had
been afflicted for some time past with epileptic
spasms and rage. I was told by the messenger that
a younger brother of the patient was afflicted with a
painful creeping in the extremities with curvature of
the hands; but as this disease was very common in
his district, and was considered incurable, I was not to
prescribe anything for it. Nevertheless I gave the messenger medicine for this second patient, four pellets of
Solanum nigrum of the 30th att. I gave it on Hahnemann's recommendation contained in his " Lesser
Writings," published by Dr. E. Stapf, vol. I., 1829.
p. 162. The epileptic patient was to take a dose of
Hyoscyamus, for it did not occur to me that he was
suffering from the same cause as his brother. In a
few days the father of my patients reported to me
that his younger son was quite well, and that the
other son had ceased raving, but was without consciousness, and that his limbs were spasmodically distorted; two other children had been attacked as the
second son, and I was requested to cure them likewise.
I found out that the elder son was likewise attacked
with raphania, for which I now gave him Solanum.
Some time after I was told that all these patients had
got well, and I was requested to treat a number of
other patients similarly afflicted, some of whom had
gone into the last stage of the disease, convulsions and
rage. I cured them all with Solanum nigrum. Afterwards I was called to two patients in my neighbourhood, one of whom I had an opportunity to examine.



HYDROPHOBIA, RABIES CANINA.


159


At last rage breaks out, and tetanic or epileptic
convulsions take place; periodically the patient is attacked with furibond delirium, during which his muscular strength increases to an enormous extent, and
he can scarcely be controlled; at the same time he
spits about, bites, endeavours to escape from his attendants, tears clothes and beds, howls, barks like a
dog, and endeavours to destroy himself; his bloodshot
eyes roll wildly in their so,-lk.ets and fright is d,~;c (d
in the features of the patient. He is frequently attacked with epileptic convulsions or tetanus. The
attacks last a quarter or half an hour. During the
intervals the patient is entirely exhausted; he is generally conscious of himself, warns his attendants of
the danger to which his rage might expose them, and
prays them  to terminate his frightful sufferings.
Sometimes vomiting takes place, and men are attacked with priapism and seminal emissions, and women
with furor uterinus. The pulse is up to 130 to 150
beats, small, irregular. As the disease increases, the
paroxysms become more frequent and violent, until
death ensues after 24 hours, two or three, and less frequently five to eight days, generally by exhaustion
(apoplexia nervosa); towards the end the patient sometimes becomes quiet, is even able to drink, and dies
quite composedly in a state of sopor, or in a violent
paroxysm of convulsions, suffocated. Modifications
occur in this disease as in any other, but the symptoms
are the same, except more or less intense: for instance,
in some cases the patient is able to swallow, in others
he is able to swallow coffee, beer or solids, but no
water; or the hydrophobic symptoms only occur during the paroxysms; or the patient is able to swallow
water, provided he does not see it and his nose is kept
closed. There are cases where the disease did not
*break out, but the cerebral affection was confined to
anguish and sensitiveness; this is probably the case
when the patient, after being bitten by a dog, is tormented by the fear that he will be attacked by the disease; this might be termed an imaginary hydrophobia.



HYDROPHOBIA, RABIES CANINA.


~ 267. Anatomical changes: The bodies of hydrophobic subjects generally decay very rapidly; the
blood is dark, fluid, and is rapidly imbibed by the
tissues; the veins are engorged. Air is frequently
found in the larger vessels, and emphysema develops
itself rapidly. The whole surface of the body is
blue-red, the epidermis very dry, all the muscles are
dark-red, and, like the tendons, they are rigid and
tight.
Causes: This disease develops itself spontaneously among the canine and feline races. Spontaneous rage has been observed among every species
of those races, wolves, foxes, jackals and cats. The
virus can be transferred to men and to all sorts of
warm-blooded animals, horses, cattle, sheep, swine,
goats; but animals that live on vegetables do not
seem to reproduce the virus. The same remark applies to man, and all the observations which have been
gathered on that subject, go to show that the bite of a
man is not dangerous.
The primary cause of this disease is not known. It
is supposed that it can be excited by excessive heat or
cold, unsatisfied sexual instinct, decayed food, deprivation of fresh meat, want of water in very hot
weather.
The rage of dogs is either raving or silent. Formerly it was supposed that a mad dog dreaded the water,
that he had foam at the mouth, that he took his tail
between his hind-feet, and went straight on in his
course. All this is either false or only partially true.
We now know that dogs, even in the last stage of the
disease, do not always dread the water; on the contrary, real hydrophobia only attacks man. Foaming
at the mouth and slavering occur only among dogs
attacked with silent rage, etc.
Other and more important symptoms of hydrophobia
among dogs are: Alteration in their conduct, restlessness, constant roving about, escape from their masters,
loss of appetite, devouring of things which are not
natural food for them, such as wood, straw, dirt, etc.;



HYDROPHOBIA, RABIES CANINA.


constipation, vomiting, a peculiar rough, hoarse,
howling bark, disposition to attack and bite people,
hasty snapping at inanimate objects. altered, lean,
shaggy, sleepy appearance, redness of the conjunctiva,
photophobia; in dogs attacked with silent rage, the
lower jaw is moreover depressed as if paralyzed;
they blaver, the tip of the tongue is protruded between the teeth, and finally the hind-legs are paralyzed. Dogs attacked with rage. die after six or
eight days, and sometimes even before that time, in
an apoplectic fit.
The following anatomical alterations have been
discovered in the bodies of mad animals: dark, tarry
blood; inflammation of the pharynx, tonsils, epiglottis, larynx and mucous membrane of the stomach;
pieces of undigested food in the stomach. Sometimes
the duodenum and jejunum were found inflamed; the
trachea and bronchi were filled with a tenacious,
bloody foam, congestion of the brain and spinal
marrow.
The hydrophobic virus is transmitted by the saliva
or blaver being applied to a sore or a part covered
with a very delicate epidermis. Contact is necessary
to establish the infection. The flesh, spleen, or the
substance of the nerves, do not contain any virus. It
has no poisonous effect when received into the stomach. A peculiar predisposition on the part of the
poisoned subject is likewise necessary to create hydrophobia. Not every bite of a mad animal is contagious,
if the necessary susceptibility be wanting. Hunter
relates that four men and twelve dogs were bitten by
a mad animal: all the dogs died, but the men remained uninjured. In another case, twenty individuals
were bitten by the same dog, but one only was
poisoned. It is probable that the virus loses of its intensity, when several animals or men are bitten in
succession, and that those only who were bitten first,
are poisoned. Age, sex or constitution do not modify
the action of the virus.
The hydrophobic virus retains its infectious power



HYDROPHOBIA, RABIES CANINA.


patient had already been treated with the plaster of
Cantharides or had been salivated, the homceopathic
remedies have to be chosen with reference to the results of that trealment. It should be observed, that
under homoeopathic treatment, the patients experience
no pain from the treatment; whereas the allkeopathic
treatme nt inflicts upon them untold tortures.
The principal remedies for hydrophobia are: Belladonna, HIyoscyamus, Struamonium, Cantharides.
Belladonna is principally indicated by the following symptoms: ineffectual attempts at sleep, anxious
breathing, frequent desire to drink, though the patient rejects every drink which is offered; burning
sensation in the throat with great dryness, red. bloated face and glistening eyes; excessive thirst with suffocative constriction of the throat on attempting to
swallow liquids; (this constrictive sensation in the
throat does not exist continually, but only at the
commencement of every new attempt to swallow a
liquid;) inability to swallow; fear alternating with a
desire to snap and spit at those present, or to escape
from the attendants; constant restlessness of the whole
body, and jactitation of single muscles, particularly
the muscles of the face.
Though Belladonna is not counter-indicated by convulsions of the extremities, yet Hyoscyamus is preferable when the convulsions are more permanent, when
the spasmodic constriction of the throat is less violent,
and there is not so much a desire to snap and spit at
the attendants as to injure them in some other
way. Hyoscyamus is particularly adapted to the following symptoms:
The patient complains of great dryness and burning
heat in the throat, with stinging in the throat, and
a suffocative constriction of the throat when swallowing; he has a dread of drinks because he is unable to swallow them, and, if he does succeed in
swallowing a liquid, he is attacked soon after with
spitting and with convulsions that deprive him of his
senses. He is constantly delirious, even when there



HYDROPHOBIA, RABIES CANINA.


is no paroxysm, or he is taciturn and exceedingly
fearl'ul, or he has paroxysms of rage during which he
endeavours to injure others, and is so strong that he
can scareely be controlled; frequently excessive anguish alternates with startings as if in affright, trembling and convulsions; he shows a peculiar fear of
being bit by animals; at times the upper and lower
extremities are only slightly convulsed, at others the
extremities are spasmodically curved and the body is
tossed off the bed; during such attacks the patient is
often drenched with sweat.  His face is red and
bloated. There is some sleep, but it is disturbed by
starting, and by anxious visions and dreams. In this
respect Hyoscyamus is distinguished from Belladonna,
which has inetfectual attempts to go to sleep.
Stramonium is indicated by the following symptoms:
Restlessness, violent convulsions (of a rather tonic
nature), during which the patient becomes so frantic
that he has to be tied; he has no sleep, and tosses
about his bed, uttering hoarse screams; he is delirious, without memory or consciousness; his pupils
are very much dilated; violent desire to bite, and to
tear every thing with his teeth; excessive dryness of
the inner mouth and fauces; the sight of a candle, of
a mirror or of water, throws him into frightful convulsions with irresistible aversion to water, constriction
and convulsions of the pharynx, blaver at the mouth
and frequent spitting; loquacious mania with gesticulations. dancing, singing, laughing.
Drs. Hartlaub and Trinks recommend Cantharides
as a preventive of hydrophobia. I have no experience
on this point. In my judgment, Cantharides should be
recommended for the following symptoms: alternate
paroxysms of rage and convulsions, the convulsions
can be excited by touching the larynx, which is painful, in the region of the thyroid cartilage, by making
pressure on the abdomen, and by the sight of water;
the eyes look fiery and flushing, and roll about in
their sockets in the wildest manrner; the patient is
scarcely able to swallow, especially liquids, on ac



HYDROPHOBTA, RABIES CANINA.     165
count of a burning and dryness of the mouth and
pharynx. There is an excessive desire for sexual intercourse, with constant painful erections or constant
itching and burning in the internal sexual parts. The
oppression of breathing and anguish are less striking
than in cases for which Bellad. and Hyoscyam. are indicated; the convulsions, however, are sometimes
frightful. In general, Cantharides seems to be more
indicated when the inflammatory symptoms are more
prominent, and when the impeded deglutition does
not proceed from a spasmodic constriction of the
fauces, but the spasm proceeds from the inflammation
of those parts or from the pains caused by the swallowing.
~ 210. Symptomatic hydrophobia is much less dangerous than the real disease: it is not contagious, and is
not always attended with violent symptoms; the
frightful anguish is likewise wanting, nor is there any
blavering. It is not caused by virus; frequently by
fright or anger, or it is a symptom of some inflammatory, nervous or hysteric disease, or attending a very
acute eruption, or some other spasmodic or malignant
disease. Fear and imagination, after an innocent
bite, may, in very sensitive persons, cause the disease.
The alloeopathic preventive treatment with large
doses of Belladonna, Cantharides and Mlercurius, may
likewise lead to a medicinal hydrophobia, which
ignorant physicians might mistake for symptomatic
hydrophobia.
To cure this disease, it is of the utmost importance
to find out its cause. If it was caused by the continued
use of large doses of Belladonna, large quantities of
black coffee should be administered by the mouth and
rectum, to be followed by one, two, three or four doses
of Hyoscyamus. Repeated doses of Camphor may likewise be required, particularly if the disease was occasioned by the abuse of Cantharides. If there should
be symptoms of poisoning by Mercury, Camphor,
Opium, Belladonna, electricity, or some other of the



MORBUS SACER, ETO.


above-mentioned remedies will have to be given, in
accordance with the prominent symptoms.
If, however, the symptoms should point to the
existence of a more general and more deep-seated
disease than symptomatic hydrophobia, in this case
the physician will have to select one of the remedies
mentioned in the preceding paragraphs; and this will
be so much easier, as the hydrophobic symptoms constitute the more prominent symptoms of his patient's
illness.
~ 271. Morbus sacer, "morbus caducus, epilepsy.
Epilepsy consists of paroxysms of sudden and complete interruptions of consciousness and of the sensual
functions, accompanied with convulsions.  Every
single paroxysm  is a development of successive
symptoms distinguished by stages. This development
by stages is not regular in every case; in many cases
one or the other stage is wanting.
First stage: A well-known precursory symptom is
the so-called aura epileptica, though it is much less
frequent than is commonly believed. It is a peculiar
nervous action perceived by the patient, which emanates from the peripheral nerves and seems to extend
itself to the brain, where it terminates in loss of consciousness; or it may terminate in this way at the
praecordia. At times this aura epileptica manifests
itself by cloudiness of sight, scintillations, ringing in
the ears, illusions of smell or of the other senses; at
other times its manifestations are a sensation of
warmth, chilliness, titillation, prickling, formication,
sensation of a cool breath or cool current of air; at
other times again the aura is perceived as a spasmodic contraction, tremor, convulsive motion or sudden
paralysis of some portion of the motor system, tongue,
muscles of the extremities, palpitation of the heart,
etc. Every part of the body may be the starting-point
of this aura.
There are other precursory symptoms of less importance: Symptoms of congestion of the brain, vertigo,



MORTUS MACER, ETC,


167


headache, gastric derangement, morbid states of the
mind, heart, respiratory and sexual organs, etc. Vomiting is very frequent.
Convulsive stage. In the greatest number of cases
this stage sets in with a roar; the patient falls down
without consciousness, after which all sorts of convulsions set in; distortion of the eyes, mouth, features,
the forehead is drawn into wrinkles, the eyelids are
alternately opened and closed, the muscles of the
jaws are spasmodically affected; the tongue is convulsively protruded and drawn back, and in this way
is frequently injured, whichl is to be inferred from the
foam at the mouth; grating of the teeth, they are even
broken by the violence of the convulsive friction; the
head is spasmodically turned, inclined or bent backwards; the breathing is irregular, laboured, moaning;
the face is livid and bloated; the frontal and jugular
veins are swollen; the eyes are protruded from their
sockets; the hands and fingers are spasmodically contracted; the thumb is clenched, (this is, according to
Hufeland, the only muscle which remains in a state
of tetanic rigidity, whilst all the other muscles are
convulsively agitated; the clenching of the thumb is
no constant symptom); the patients throw themselves
about, and it is very difficult to protect them from injury; the trunk is curved and thrown about. Among
men we sometimes observe priapism, emission of
semen, drawing-up of the testes to the inguinal ring;
involuntary emission of urine, involuntary stool; hiccough, sudden distention of the abdomen; eructations,
vomiting. As soon as the convulsions set in, there is
an entire loss of consciousness; this is the pathognomonic symptom of epilepsy, and where this symptom
is wanting, the disease is not epilepsy; on the contrary, if this symptom should be present and the convulsions should be ever so slight, the disease is epilepsy.
It is important to know, that without loss of consciousness there is no epilepsy. The disease is frequently simulated with great success. If the patients



MORIEUB ACER, ETC.


select a place where they can drop down safely, this
is a sure sign of deception; for, in true epilepsy, consciousness is gone as soon as the convulsions set in.
The same remark applies to the perceptive faculties:
in true epilepsy, all the sensual functions cease, sight
and hearing are suppressed, the skin is insensible to
the most violent impressions, even cutting and burning.
An impostor is not apt to bear such treatment. This
stage lasts from a few minutes to half an hour.
Third stage (stadium soporosum or apoplecticum),
stage of collapse, of muscular relaxation. The spasms
abate, the breathing is easier, somewhat stertorous;
the pulse is more regular, and the patient falls into a
sort of comatose sleep, resembling that of an apoplectic
person; on waking from this sleep, which has an uncertain duration, the patient knows nothing of what
has happened, he feels languid, tired, sad, the head is
confused and dull, he frequently complains of headache. Sometimes it takes several days before every
trace of the attack has disappeared. The dulness
and the forgetfulness sometimes continue for some
time. It even happens that partial paralysis, strabismus, distortion of the eyes, delirium, or a somnambulistic, ecstatic, maniacal state remains after an epileptic attack.
In some cases the paroxysms set in typically, at
certain periods and on certain days, sometimes every
night (epilepsia nocturna); more frequently, however,
the paroxysms occur at irregular periods, every week,
month, or even once or twice a year.
~ 272. Etiology: Causes: The disease is hereditary; in this case it frequently happens.that the disease first makes its appearance at the age of pubescence and then lasts until the patient's death. Congenital epilepsy may arise from the mother having
had a fright during pregnancy.-The disease is most
frequent and varied between the 6th and 11th year,
after which the disposition decreases, increases again
at the age of pubescence, and gradually disappears
during manhood, but returns again in old age. Ac



MORBUS SACER, ETC.


169


cording to Schobnlein, a particular formation of the
skull, an extraordinary thickness of the bones of the
skull, are predisposing causes of this disease. Nervous irritation, scrofulous and rickety diathesis, predispose to epilepsy. Celibacy seems to favour the development of epilepsy.
External causes of epilepsy are: violent emotions,
fright, fear, anger, excessive mental labour, sexual
excesses, onanism; sight of an individual in an epileptic paroxysm; worms, tenia, metastasis by suppressed itch, herpes; arthritic formations; local, mechanical irritants, such as: splinters, exostosis, occult
caries, suppressed hamorrhage, particularly suppressed
bleeding of the nose, etc.
Prognosis. It is difficult to cure this disease. It
is not fatal, but exposes the patient to great danger on
account of the falling; it is troublesome, frightful,
dangerous, were it only on account of the mere possibility of infection, and finally induces mental debility
and even imbecility.
~ 273. Treatment: This disease is generally incurable, even under hommopathic treatment. It may
be said that two thirds of all cases of epilepsy remain
uncured. It is likewise probable that not all cases of
epilepsy which are reported cured, were true epilepsy.
The treatment should commence, if possible, with
removing the cause. Mechanical irritants have sometimes to be removed with the knife. Suppressed
menses have to be restored. The apparent cause,
however, is sometimes removed, and yet the disease
will continue. As regards treatment, I refer the reader
to the chapters on eclampsia, hysteria, and St. Vitus'
dance, where a number of remedies have been
mentioned that will likewise be found useful in the
treatment of epilepsy.
According to v. Benninghausen, Calc. carb. and
Causticum are two of the best remedies for epilepsy.
He pretends to have cured a number of patients with
them. Calcarea has the following two symptoms
pointing to an epileptic paroxysm: While performing
VOL. IV.---



MORBUS SACER, ETC.


171


little use. Opium will be found preferable; at any
rate, Ignatia would be better than Calcarea.
For a particular description of the epilepsy which
is curable by Plumbum, I refer the reader to the
article Plumbum in "Hempel's Jahr."*  It will there
be seen that the Plumbum-epilepsy generally proceeds
from the splanchnic nerves, thence extending over the
sentient and motor nerves, and finally affecting the
brain and the sensual organs. The Plumbum-epilepsy
is generally characterized by precursory symptoms;
after a paroxysm, paralytic symptoms frequently remain behind, or total or partial loss of consciousness for some time; a characteristic symptom is protrusion of the tongue, which is enormously swollen
and is bitten by the patient.
Causticum may be an excellent remedy in convulsive and spasmodic attacks, but I cannot recommend it in epilepsy. It has only one trifling symptom
pointing to epilepsy: " Sudden falling down without
consciousness, during a walk in the open air, and
rising again as suddenly." With all the other symptoms the characteristic loss of consciousness and perception is wanting.
Petroleum is said to have been useful in one case,
but I cannot say any thing in its favour.
Cicuta virosa, which I have recommended for
eclampsia, is likewise excellent in epilepsy. Beside
the general and sometimes frightful convulsions,jactitation of the limbs, spasmodic contortions of the extremities, tossing of the body off the floor or bed, it
has among its symptoms true epileptic paroxysms recurring at shorter or longer intervals, and characterized by strange motions of the head and trunk, lockjaw, foam at the mouth, bloated, bluish face, or else
cadaverous paleness of the face, protrusion of the
eyes, vomiting, feeble, scarcely perceptible pulse,
complete loss of consciousness, and scarcely perceptible
or completely interrupted breathing; previous to the


* Published by W, Radde, 322 Broadway.



172


MORBUS SACER, ETC.


paroxysm, the patient complains of a strange feeling
in the head, great sensitiveness of the eyes to the
light, he is delirious while walking about; with slow
pulse; generally, however, the paroxysm  sets in
without precursory symptoms, and commences with a
sudden fall; after the paroxysm the breathing is free,
but the patient remains lying in a state of unconsciousness, insensibility, lethargy.
Lachesis is said to be one of the best remedies
for epilepsy, next to Bell., Caust., Cicut., Hepar.
sulph., Calc. and Silicea; I am sorry to say, however,
that I am entirely unwilling to take the responsibility of recommending it.
Repar s. is recommended for epilepsy, but I think
it can only be employed against certain incidental
symptoms, and even these are better removed by Aurum, Calc. carb., Nitri ac., Sulphur, etc. Hepar suits
scrofulous and psoric constitutions, affections of the
reproductive system occasioning epilepsy, mercurial
cachexia, secondary syphilis, tuberculosis, excessive
irritation of the olfactory nerves, illusions of smell.
Agaricus muscarius has: epileptic paroxysms with
great muscular exertions; but they are so vaguely
expressed that we cannot avail ourselves of such indications.
Alumina has been proposed, but without reason, in
my judgment.
Camphor is, in many cases, an excellent palliative;
it shortens the paroxysms, and, in this way, contributes
to the cure of the disease. The paroxysms for which
Camphor is indicated, are generally accompanied
with rattling, redness and bloatedness of the face, jactitation of the limbs, and even twitching of the tongue,
eyes and facial muscles, with hot, viscid sweat on the
forehead and head, and complete loss of consciousness;
the attack commences with a horrid cry, sudden falling
pf the patient, with foam at the mouth; after the
paroxysm the patient lies in a state of sopor, with
slow, laboured breathing; on waking, he finds it difficult to recover hinmself.



MORBUS SACER, ETC.


173


Stannum acts on the whole animal and vegetative
sphere, and on single nervous trunks and plexuses,
particularly on the genital organs of both sexes,
where the epileptic malady frequently has its origin.
The symptoms which indicate Stannum, are: Epileptic
paroxysms, particularly in the evening, with clenching
of the thumbs, or bending the head backwards, pale
face, twitching of the hands and eyes, loss of consciousness. Stannum is particularly adapted to epilepsy of children, though it likewise cures epilepsy in
any other age.
Silicca is suitable to scrofulous and rickety patients,
and for epileptic paroxysms proceeding from the cerebro-spinal system of nerves. It is indicated by the
following symptoms: Loss of consciousness after a
sensation of great coldness in the left side of the body,
frequent slumbering and starting as if in affright; the
patient talks unintelligibly, does not know any body,
becomes so feeble that he is unable to turn to the other
side; afterwards violent convulsions with staring
look, distortion of the eyes, twitching of the lips, utterance of inarticulate sounds, stretching and turning
of the head sideways, distortion of the extremities, afterwards a horrid roar, lachrymation, foam at the
mouth; lastly, warm  sweat over the body, easy
breathing, slumber, and, in a few hours, return of
consciousness and speech. Silicea likewise relieves
nocturnal epileptic paroxysms, particularly when
taking place at new moon: the body is stretched out,
and afterwards tossed off the floor; these paroxysms
take place without the usual cry.
Nux vom. may be tried in epilepsy characterized by
the following symptoms: Ascension of heat to the
heart, thence to the throat, with nausea and oppressive anguish, trembling; lastly, the heat goes to the
head; crampy sensation, without much pain, in the
muscles of the extremities, back, ý.- pulm, etc., succeeded by speedily passing convulsions which recur in
paroxysms and are easily excited by contact; convulsive paroxysms with disfigured countenance and ri



174


MORBUS SACER, ETC.


gidity of the muscles; closing of the jaws, extension
of the trunk, the pulse being little altered, but hearing
and tact being extremely sensitive; tetanic convulsions are excited by the least contact or noise; extremely painful muscular contractions which continue
from 3 to 4 minutes and are interrupted by a violent
spasm, with the body drawn considerably backwards,
feeble beating of the heart,small and scarcely perceptible pulse; tension in the temples and nape of the
neck, shortly involving all the muscles of the trunk
and extremities; this tension or rigidity is not continuous, but comes in momentary paroxysms, increasing
suddenly; these spasmodic contractions are frequently preceded by a violent chill and shuddering, and
succeeded by formication and painful sensations along
the nerves in the extremities, which the patients compare to electric sparks passing through the parts;
after the chill, the spasms set in with greater violence
than before, so much the more, the more violent were the
precursory symptoms; every three or six minutes the
patient has an attack of frightful spasms through the
whole body, a real tetanic spasm, with opisthotonos,
retraction of the pectoral muscles, loss of consciousness, rigidity of the extremities, excessive hardness
of the muscles, contortion of the eyes, cherry-red
face, etc. For further indications, I refer the reader
to Hempel's Jahr.*
Beside the above mentioned remedies, the following
medicines may be considered: Secalo corn., Solanum
nigr., Magnes. carb., Sulphur, Lycopod., etc.
~ 274. Schcenlein mentions several other kinds of
epilepsy, in accordance with the part where the
paroxysm commences. I will mention them cursorily,
and name a few remedies which I have found useful
in the treatment of those varieties.
First:
Epi/epsia abdominalis, ganglionic epilepsy.  At
first it is imperfectly developed, and runs through a


* Published by Radde, 322 Broadway, N. Y.



176


EPILEPSIA UTERINA.


to ~~ 28, 41, 44, 53, 108 of vol. i., and to the preceding paragraphs. I recommend particularly Ignat.,
Chamom., Cina, Bellad., Nux vom., Merc., Stannum,
Cupr., Magnes. carb., Calcar., etc.
~ 275. Epilepsia uterina.
Schaenlein distinguishes chlorotic and plethoric
uterine epilepsy. Both varieties have two periods.
In the first period the patients experience a constrictive sensation proceeding from the uterus and
rapidly ascending, as globus hystericus, across the
chest to the brain, causing blackness of sight, scintillations, which obliges the patients to sit down lest
they should fall. In the second period, complete
epileptic paroxysms with loss of consciousness, and
convulsions, set in. In the chlorotic variety the face
remains pale, chlorolic; there is no symptom of vascular excitement. This excitement takes place in
the plethoric variety; even several days previous to a
paroxysm the patients complain of increased warmth
in the head, which is hot to the feel, of redness of
the face, and headache; during the paroxysm the
eyes are congested and protruded, the breathing is
hurried, there is a bloody foam at the mouth, and
even blood-spitting.  In both varieties the menses
are disturbed. The chlorotic epilepsy principally
takes I lace with feeble, nervous, chlorotic individuals
at the age of pubescence; the plethoric variety, on
the contrary, during the period of womanhood. The
disease is principally excited by violent emotions,
such as anger, during the menstrual period, arresting
or suppressing the menses; likewise by hysteria,
disorganizations or retroversion of the uterus.
Prognosis: Not unfavourable; plethoric epilepsy
is sometimes more easily cured than the chlorotic
variety.
Treatment: For the treatment I refer the reader
to the paragraphs on menstrual irregularities. If the
disease should be occasioned by retroversion of the
uterus, this organ should first be restored to its na



178


EPILEPSIA THORACICA.


should be given up entirely; the sexual intercourse
should be practised moderately. For the excessive irritability of the sexual organs, I recommend: China,
Acid. phosphor., Strphys., Calc. carb., Sulphur, Sepia,
Natrum mur.-The ill effects of extreme abstinence
are best met with Conium, Phosphorus, Nux vom.,
Sepia, etc.-For excessive seminal emissions, I recommend: Sulphur, Sepia, Conium, Phosphorus, Caust.,
Bovista.-For the drawing pains with spasmodic
drawing up of the testes: Thuja, Rhodod., Pulsat.,
Zinc., Nux v., Terebinth., Clematis, Nitri ac., Coccul.
The second period of testicular epilepsy requires
the same remedies as all other epileptic paroxysms.
~ 277. Epilepsia thoracica.
This disease is occasioned by an irritation of the
pneumo-gastric nerve. Schcenlein furnishes the following description of this disease:
"First period: Towards evening, the patients, who
are frequently roused from sleep by it, are attacked
with a sensation of great tightness, oppression of the
chest, so that their breathing becomes laboured and
panting, without, however, any stitching pain being
felt. This constrictive sensation commences at the
ensiform process, thence extending over the chest, frequently with a sensation as if a current of air (a
breath of air) were ascending. The attack lasts from
a quarter to half an hour, and even longer, and either
terminates with spasmodic cough, where but little
phlegm is raised, or with luminous vibrations before
the eyes, and vertigo. This period sometimes lasts
several months, or even years. In the latter case,
the paroxysms are much more frequent and violent
durin winter than during the summer-season.
Second period: The patients are roused from their
sleep, they utter peculiar sounds, like those of beasts,
sometimes screams, and are attacked with convulsions, which are frequently so violent that the patients
are thrown out of bed. Towards morning they feel
very much exhausted, and, if injured by the fall, won



EPILEPSIA THORACICA.


179


der how those injuries came to take place, as they
have no recollection of any thing that took place
during the night. At first, the paroxysms occur only
at night; afterwards, if the disease should continue,
the paroxysms likewise take place in the day-time,
but even then the nocturnal paroxysms are always
more frequent and violent than those which occur in
the day-time."
Etiology: The disease occurs principally among
young men; the most frequent cause is: suppressed
itch, but this is not the only cause, as is supposed by
Autenrieth; it can likewise be occasioned by exposure
to wet, and by taking cold while sweating profusely.
Prognosis: Not unfavourable.
Treatment: An excellent remedy is Aurum metal.,
for great tightness of the chest, with a crampy contractive sensation in the chest at night, and a constant sensation of taking a deep breath, which is frequently accompanied with violent palpitation of the
heart.
Next to Aurum we have Arsenic for nocturnal suffocative oppression and dyspnoea, with considerable
palpitation of the heart.-Colchicum deserves consideration if the disease occur by exposure to wet while
sweating profusely.
Sulphur is one of the principal remedies for epilepsia thoracica from suppressed itch. It is indicated
by the following symptoms: Arrest of breathing, frequently, during sleep; the patient has to be roused
from sleep, lest he should suffocate; sudden dyspnoea,
at night, in bed, while turning to the left side, going
off on rising; after falling asleep. at night, her breath
was gone, she was going to suffocate, started up with
a loud cry, and was unable to recover her breath;
violent palpitation of the heart towards morning, followed by a light sweat; suffocative paroxysm, at
night, during sleep, without great pain; great weakness of the chest, particularly troublesome at night
when getting into bed, so that he is unable to remain long in one position.



EPILEPSIA PERIPHERICA.


Sepia ranks with Sulphur, in the first period of the
disease, and is particularly indicated by the following
symptoms: Considerable oppression of the chest, in
the evening, rendering the breathing very difficult,
and obliging her to sit up in bed; luminous vibrations
before her eyes.--He wakes in the night, with oppression and tightness; he had to breathe heavily and
deeply for an hour; afterwards cough with raising of
tenacious mucus.-These symptoms correspond to the
first period, when the aura is confined to the chest and
ends in cough with expectoration of mucus, or when
the head is involved, with luminous vibrations before
the eyes. S pia is likewise one of the remedies, according to Hahnemann, which is best adapted to the
ailments arising from suppressed itch.
Sulphur and Sepia may likewise be used to advantagte when a cutaneous eruption had been suppressed
a long time previous, and the present disease had
developed itself afterwards by some accidental cause,
such as a cold, exposure to wet, violent emotions, etc.
In the second period, the same treatment should
be pursued which has been indicated for epilepsy
generally, except that particular reference should be
had to the remedies which relate to nocturnal paroxysms, such as: Calcarea, Kal. carb., Cuprum, Sec.
corn., Arsenic, Ipec., Moschus, Lycop., etc.
~ 278. Epilepsia peripherica.
It is probable thlat the exciting cause of this epilepsy
is seated in one of the peripheral nerves of the extremities, if this nerve have been wounded or injured in
some way or other; if the patient, previous to the paroxysm, experience pain, or some other disagreeable
sensation at the place where this nerve is located; if
the aura commence at this nerve, and, in its development towards the brain, follow the branches which
belong to the nerve; or if, by tying up the nerve, the
development of the aura can be interrupted. Sometimes it is a cicatrix or a hardness deep under the
skin, which leads to the suspicion that the epilepsy



CYAN TS.


181


arises from one of the peripheral nerves. The irritation of one of the peripheral nerves has to be permanent, if it is to cause peripheral epilepsy: for instance, a buckshot, ball, piece of wood, must press
upon a nerve constantly; or the irritation must arise
from morbid products which have been formed in the
organism, such as: exost, ses, arthritic concretions;
or lastly, metastatic formations, such as: suppressed
itch.
Prognosis: Always favourable if the cause can be
removed, and the disease is not too far advanced.
Treatment: The same as that of the other varieties.
I omit the other varieties of epilepsy, such as: epilepsia protopathica, arising from fright, anger, etc.,
epilepsia spinalis, proceeding from the spinal marrow,
etc., because the treatment is entirely the same as
that of  y other variety.
TWENTIETH CLASS.
~ 279. Cyanosis.
At first this term was used for a particular disease
of the heart; but, inasmuch as other diseases, chlorosis for instance, exhibit similar phenomena, especially as regards the composition of the blood, I shall
consider cyanotic and chlorotic diseases under the
same head, as belonging to the same family.
The blood of all cyanotic patients is excessively
fluid, coagulates with great difficulty, and never forms
a perfect crassamentum; there is always a disproportionate quantity of serum; the blood is seldom red,
generally dark-coloured, with a violet or blue tinge;
not only the mass of the blood itself, but also its component parts, crassamentum and serum, are specifically lighter than in a healthy state; there is less
fibrine and albumen, and more aqueous matter. Respiration and digestion are likewise altered; the former is accelerated, short, painful, though percussion
and auscultation do not reveal any changes in the



CYANOSIS CARDIACA, ETC.


183


not without the interference of art, and even then
only very slowly, without critical changes, generally
by a gradual diminution of the symptoms. In summer,
patients recover more speedily than in winter.-2) In
partial recovery. There remain derangements of the
ganglionic system, hysteria, hypochondria, melancholy,
dyspepsia.-3) Death, by sudden exhaustion in consequence of a momentary want of good arterial blood;
the patients faint suddenly and die;-or by exhaustion
in consequence of colliquative haemorrhage;-or by
the supervention of dropsy and phthisis.-The prognosis
may be inferred from our previous remarks.
~ 281. Treatment. It is of great importance to
regulate the diet of cyanotic patients. They should
use nourishing, but not stimulating food, substances
containing nitrogen rather than carbonic acid or hydrogen; fresh meat, saccharine vegetables, turnips,
etc.; they should drink fresh water, or, if the case
allow, water mixed with a little egg and sugar, or
even water holding a little iron in solution. Heating
or stimulating things, such as quantities of wine,
brandy, acrid spices, etc., are hurtful. The air should
be warm, dry, containing a good deal of oxygen, for
humid or cold air does not agree with the patients;
it is therefore of importance that they should take
frequent changes of air, and, if their means permit,
frequent journeys from a cold to a warm climate.
Bathing is very useful.
~ 282. Cyanosis cardiaca, morbus coeruleus, bluedisease.
Phenomena: Even in infancy the patients have a
peculiar blue tinge of the skin. They are more or
less slender, without ft., have feeble muscles, blue
lips, frequently a blue nose, and the upper limbs
are of an unusual length.  The last phalanges of
the fingers are strikingly mal-formed, swollen, bulbous, furnished with claw-shaped nails. The patients
look as if they had been eating whortle-berries.
This livid colour is especially seen in the face, on



184


CYANOSIS CARDIACA, ETC.


the lips, in the buccal cavity, on the upper and
lower limbs, and particularly on the fingers and
their terminal phalanges; it increases with the temperature of the body, on exerting the muscles or
lungs. The muscles of the patients are thin, flabby; the patients get tired on making the least effort, they are indolent, and dread exercise.  The
skin feels cold. All the normal secretions, of the
skin, intestines, uterus, etc., are limited, but there is
a great disposition to haemorrhage. Young" persons
are subject to heumorrhages from  the nose and
mouth; afterwards, haemorrhages from the lungs set
in; haemorrhages from the bowels and urinary organs are not unfrequent.  A manual examination
of the chest frequently reveals a considerable purring as of cats. The pulse is very seldom normal,
generally small, feeble, irregular or intermitting,
from 80 to 120.
~ 283. Eliology: Malformations of the heart: The
perforation of the septum between the auricles and
ventricles, is, generally speaking, a congenital defect; the left and right ventricles are not separated,
and the venous and arterial blood must necessarily
constitute one mass. The violence of the disease
depends upon the size of the perforation and the
quantity of the venous blood entering the left ventricle. The phenomena of the disease are less intense when it results from the non-closing of the
foramen ovale, than when it originates in the aorta
having a double root. Frequently the symptoms of
cyanosis manifest themselves only in after life, in
consequence of violent exertions, after whoopingcough, a fall, and similar events, which cause the
latent disease to break out. The disease is particularly apt to manifest itself at the period of dentition, at the age of pubescence, during febrile diseases, exanthemata, a catarrh, etc.
The disease, whether it run a long or short course,
always terminates fatally. Most patients die a few
day& after their birth, at the period of dentition or



CYANOSIS CARDIACA, ETC.


185


at the age of pubescence; or else death supervenes
during an affection of the chest, or during measles,
small-pox, scarlatina, dysentery, etc.
Anatomical changes: In a multitude of cases the
foramen ovale, or the ductus arier. Botall., or both together, are open, without any morbid symptoms having
been observed as the necessary consequence of this
defect; but if other defects should supervene, the phenomena of the disease generally make their appearance. Such defects are principally: origin of the
aorta from the right and left ventricle, opening in the
septum ventricul., either straight, or oblique, or canalshaped, generally close to the origin of the large
arteries, in which case the foramen ovale is generally
open; origin of the aorta from the right, and of the
pulmonary artery from the left ventricle; origin of the
pulmonary artery from both ventricles; heart with
one ventricle and atrium; one or the other of those
defects is very frequently accompanied with contraction or even obliteration of the pulmonary artery,
alterations of the valves; in such cases the heart is
almost always enlarged.  Among the anatomical
changes likewise belongs the cyanotic habit, the phenomena of which have been described, ~ 282.
~ 284. Treatment: The disease depending upon an
organic malformation of the heart, the treatment can
only be palliative, and is limited to the periods which
have been pointed out in the preceding paragraph.
If we succeed in carrying the patient through those
periods, we enjoy the satisfaction of prolonging his
life for a few years.
Every thing which might excite the heart or lungs,
or might impede the circulation, should be most carefully avoided. The patient complaining all the time
of feeling cold, he should dress himself warmly, use
warm baths, etc.; colds and exposure to wet are exceedingly hurtful. The action of the heart should be
favoured by passive exercise, such as riding in a
carriage, or on horseback, swinging, etc. The constipation of which such patients frequently complain,



CYANOSIS CARDIACA, ETC.


and which, on account of the straining, might develop and increase the phenomena of cyanosis, should
be removed by Nux vom., Bryon., Bellad., Opium. etc.
The patients should observe the greatest possible tranquillity of body and mind, their diet should be light
and nourishing, the stomach should never be overloaded, all heating food and drinks should be avoided.
Asthmatic paroxysms and fainting fits are treated
as usual. It is useful to rub the chest with warm
flannel, to use affusions of the chest with water or
vinegar, warm hand and foot-baths, to keep very
quiet, and to sit erect. Suffocative paroxysms are
most speedily relieved by Ipecac., Opium, and when
the face turns blue and the patient coughs with great
exertion, by Crocus and Moschus; Ferrum, particularly, when the paroxysm is accompanied with an almost
imperceptible movement of the thorax, and considerable dilatation of the nostrils; and lastly, by Camphor,
Sambucus, etc. The fainting fits, to which cyanotic
patients are subject, require principally Aconite, Moschus, Crocus, Veratrum, Nux vom., etc.
I have always found that bleeding of the nose is a
most dangerous symptom in this malady. Several
days before the bleeding took place, the livid color
around the nose, lips, in the buccal cavity and on the
fingers, was strikingly marked; the patients were indolent, low-spirited, suffered with catarrh, and slept
very restlessly at night. Opium, Laurocerasus, Acid.
hydroc., and whatever other remedies seemed to be
indicated, were employed without success. Crocus,
China, Bryon., Bell., Phosphor., Carbo veg., nothing
was of any avail; the patient went into a state of
collapse, death seemed to be at hand, when Arnica,
five drops in one ounce of water, a tea-spoonful every
five minutes, and a few drops being introduced into
the nose by means of a sponge, arrested the haemorrhage; the Arnica was continued for a few days, and
then I gave a little China, to raise the strength of the
patient.
Digitalis might perhaps be adapted to the state



CYANOSIS PULMONALIS.


187


preceding the bleeding, but it should then be employed
at once, before any thing else is given to the patient.
~ 285. Cyanosis pulmonalis.
According to Schienlein, this form of cyanosis is as
frequent as the former.
Phenomena: The patients complain of a sensation
of oppressive weight on the chest; the breathing is
short, hurried, somewhat panting; the thorax does not
expand during the breathing, but this is effected
rather by means of the abdominal muscles and the
diaphragm.  If the disease is uncomplicated, percussion yields a dull sound, which, if the disease is not
spread all over, is frequently limited to one side of the
chest or to one spot only. At this spot the respiratory
murmur is either entirely wanting, or is at least indistinct. Instead of the bellows-sound we hear mucous rattle, not a cough, or bronchial rattle; if the
disease be per'ectly developed, these sounds can be
heard without the stethoscope. The patients raise a
glassy mucus, or a purulent mucus mixed with black
blood. The livid colour is most marked in the face,
particularly on the cheeks, lips, and in the buccal cavity; suffocative fits and violent exertions increase the
livid appearance. The extremities are cold, the skin
is dry, the bowels are constipated; the urine is scanty,
dark-coloured, brown-red; the pulse is quiet; the patient is very much debilitated, gets tired after the least
exertion, or an exertion is followed by suffocative fits
or shortness of breathing.
~ 286. Etiology: Pulmonary cyanosis is always
a secondary disease, and generally arises from a
chronic inflammation of the lungs. Beside the abovenamed organic defects of the heart, there are other
diseases, which, inducing the same mechanism of
venous engorgement, realize the phenomena of cyanosis; such diseases are: diseases of the heart; alterations of the lungs, such as emphysema of the
lungs, hepatization, effusion into the pleura; cholera.
Pathologists distinguish even a cyanosis encephalica,



188


CHLOROSIS, ETC.


arising from some disease of the brain, hydrocephalus;
a cyanosis gastro-intestinalis; a cyanosis uterina or
dismenorrhoica; but these varieties are mere symptoms, not general diseases.
Prognosis: The disease is of a chronic nature, and
always terminates fatally; in the summer the symptoms are much less intense than in winter, when the
cutaneous secretions are much less active, and this
diminished activity induces striking aggravations.
The patients almost always die from suffocation; the
breathing becomes shorter, interrupted, rattling; the
extremities are cold, but the head feels hot all the
time. Death is near, if stupefaction, irregular breathing, and particularly organic defects of the heart
(viz. dilatation of the right ventricle) sets in.
~ 287. Treatment: The patient should be kept as
quiet as possible, use passive exercise, and not exert
his lungs; the patient should eat vegetables rather
than meat, he should avoid spirits, drink fiesh water,
or perhaps a little light malt-beer. The skin and
abdominal organs should be taken care of; remedies
have to be chosen in accordance with the principal
symptoms. Dropsical symptoms have to be treated
as dropsies generally. Sanguineous congestions have
likewise to be met with the usual remedies.
~ 288. Chlorosis, morbus virgineus, icterus albus,
febris amatoria.
Phenomena: The patients have a peculiar chlorotic
appearance; the skin has a strikingly pale colour, not
of a dazzling white, as after hmamorrhage, but with a
tinge of yellow and green; the blood seems to have
retreated from the skin; the skin is rather flacci i, the
lower eyelid is sacculated, and has a dingy blue appearance. The skin is cold to the feel, the patients
are very sensitive to a low temperature, are all the
time chilly, and want to be in a warm temperature.
The same paleness is seen on the mucous membranes
of the tongue, which is frequently covered with a
thick, tenacious mucus. The muscles are very weak;



CHLOROSIS, ETC.


189


the patients get easily tired, even after a slight exertion; they are indolent, and want to enjoy rest; the
respiration is oppressed, the patients complain of difficulty of breathing, not dyspncea but apncea, for, if requested, they are able to expand the thorax. Palpitation of the heart and arterial murmur are two characteristic symptoms of chlorosis, which continue even
when all the other symptoms have disappeared. The
pulse, when the disease is perfectly developed, is from
120 to 140, small, feeble, wiry, empty, easily compressible; the cutaneous veins are pale, rose-coloured,
as if filled with coloured water, but are never distended. Diminished appetite, slimy taste in the mouth,
oppression, eructations, flatulence after every meal,
even after light food; constipation for three or four
days, which is rarely interrupted by diarrhea; in
which case the food is passed half digested.-If the
patient be a female (which is generally the case), and
the disease have made its appearance before the age
of pubescence, the menses do not make their appearance at the proper time. If, however, the menses had
already appeared before the disease set in, they then
become irregular as regards time, duration, and nature; sometimes some light-coloured blood is discharged every six or eight weeks, at other times there
is no blood, but merely a little mucus.
Chlorotic phenomena  are sometimes observed
among men; the genital organs remain undeveloped,
both physically and dynamically; no hair grows, the
testicles remain small, there is no erection, no secretion of semen; the voice remains thin and feeble, like
that of a child.
The above-mentioned phenomena are accompanied
with striking derangements in the abdominal system
of nerves; the phenomena indicating either a simple
hysteric affection, or a highly developed ganglionic disease, spasms, somnambulism, burning in the
stomach, frequently sour vomiting and desire for
things which are not eatable, pica chlorotica.
The aedema, to which chlorotic patients are liable,



CHIOROSIS, ETC.


stant dry heat of the body without thirst, anxious
dreams, and feeling of heaviness in the limbs; whining
mood, restlessness, anxious care about every thing,
stitching in the region of the liver, which sometimes
continues several days and weakens the body very
much; the menses are entirely suppressed.
Phosphorus is indicated when the menses are not
entirely suppressed, but appear irregularly; the
patient complains of nausea, sour vomiting, oppression of breathing, vertigo, and great sexual excitement.
Natrum nmuriaticum may be given when there are
frequent ineffectual indications of the appearance of
the menses, accompanied with great sadness, oppression and anxiety, fainting spells, coldness of the pelvis
and internal heat, heat in the face, weight in the abdomen, tearing toothache, frequent burning and cutting in the groins.
Sulphur is one of the principal remedies for chlorosis.
On perusing the provings of Sulphur, it will be found
that a number of chlorotic conditions are represented.
by the symptoms of Sulphur. But these symptoms
very seldom point to any particular form of chlorosis;
the symptoms of Sulphur indicate chlorosis generally,
and this is the reason why it is difficult to determine
the particular form of chlorosis to which Sulphur corresponds. Sulphur can be given alternately with
Pulsatilla.
Sepia is likewise generally indicated for chlorosis
the same as Sulphur, except that Sepia has various
morbid conditions in the sexual organs; for instance,
the patients complain frequently of a painful pressing
in the inner pelvis from above downwards, sometimes
accompanied with discharge of mucus; sometimes of
a jerking, darting in the vagina from below upwards,
or of a stitch in the vagina with occasional discharge
of single drops of blood. If no blood be discharged,
the patient complains at particular periods of aching
pain in the abdomen, swelling of the pudendum, burning in the pudendum, or even discharge of mucus.
Belladonna and Platina should be carefully compared
VOL. TV.-9



194


HYPOCHONDRIA, ETC.


with Sepia. These three remedies shiould first be
thought of when the disease originated in onanism.
Nitri acidum, Lycopod., and Graphit., deserve consideration. As regards Psorin, I cannot recommend it.
Ferrum is the grandest remedy for inveterate cases
of chlorosis, and it should be continued until every
vestige of arterial murmur has disappeared. But it
must be given in massive doses; small doses are of no
avail. Even iron-mineral springs have to be resorted
to, and in some few cases we may have to give iron
in large allaeopathic doses.
TWENTY-FIRST CLASS.
DISEASES OF AN INTERMEDIATE ORDER, MENTAL AND
PHYSICAL.
~ 291. Hypochondria, Hypochondriasis, morbus eruditorum.
For the better understanding of this Protean disease, we will bring its groups under the following
heads:
a) Mental phenomena;
b) Symptoms of the digestive apparatus; and
c) Symptoms of the nervous system.
A) Mental phenomena. Ill humour, particularly
during the period of digestion, lowness of spirits,
sadness, despondency, constant dwelling upon his ailments, which the patient considers of great importance, exaggerated description of his sufferings, delight in reading  medical writings, inexhaustible
readiness in discovering similar sufferings to his own
condition; selfish desire that others should sympathize
with his sufferings, uncommon mental irritability,
melancholy, distrust, taciturnity, despair of the future,



HYPOCHONDRIA, ETC.


195


dread of death; no aversion to life, in spite of all his
sufferings; lastly, inability to perform any kind of
work, even to live, from distrust in his own strength,
from fear lest he should injure himself. Sometimes
his spleen alternates with cheerfulness. The changes
in the moon seem to affect the patient a good deal;
his condition is most painful when the moon is on the
increase. Sometimes these symptoms constitute the
whole of the disease, or the disease remains at this
point for a long time.
B) Symptoms of the digestive apparatus. Though
the patients look well, and have a good and even
regular appetite, they are constantly complaining of
bad digestion. After and frequently during the meal,
they experience a tension and pressure in the abdomen; sometimes the abdomen is really distended,
there is a constant formation of flatulence which is
said to be the cause of the most varied sufferings.
Sometimes there is a perceptible swelling under the
short ribs and in the epigastrium; flatulence becomes
incarcerated, causing anxiety, palpitation of the heart,
rising of heat, and distress; sometimes there is loathing, heartburn, sour eructations, even vomiting of a
tenacious, sour mucus. The distress occasioned by the
flatulence sometimes increases to general nervous
paroxysms, vertigo, fainting, coldness of the extremities, etc. Relief is afforded by the passage of the
flatulence upwards and downwards. In spite of all
these sufferings, the appetite of the patient remains
undisturbed, and his looks and digestive powers unaltered.  Only when organic alterations develop
themselves, the patient assumes a cachectic appearance and becomes thin. The patient is generally
costive, though the costiveness, which is sometimes
very obstinate, at times alternates with diarrhoea;
a good evacuation relieves the patients, hence their
constant desire for cathartics.
C) Symptoms of nervous derangement, particularly
of the ganglionic system. This series is still more
varied than the previous ones; there is scarcely a



HYPOCHONDRIA, ETC.


part or function of the body which remains undisturbed. We observe the following local symptoms: sensation of coldness and heat, formication, itching of
various parts, asthma, cough, palpitation of the heart,
throbbing in various parts of the body, particularly in
the abdomen, hemicrania, vertigo, cramp in the neck,
buzzing in the ears, muscae volitantes, amblyopia, neuralgia, spasm of the bladder, frequent urging to urinate, congestions, increased secretion of saliva, lachrymation, copious sweats, trembling of the limbs, convulsive motions, paralytic paroxysms, etc. Hypochondriacs are so sensitive to external impressions, that the
least change in the temperature or pressure of the
atmosphere, or the slightest dietetic transgressions,
affects them beyond measure, yea, that the least exertion is unpleasant to them. They suffer with headache, are sleepless, troubled by heavy dreams, start
up from their sleep; sleep does not refresh them, and
in the morning they generally feel worse than the previous evening.  The urine of hypochondriacs is
generally watery and clear, and they void it in large
quantities; frequently, however, the urine is thick,
cloudy, with a sediment, and causes fears in the minds
of the patients they might be attacked with gravel and
stone.
These symptoms are variously modified; but the
rapid change of the phenomena, the opposition between the subjective complaints of the patient, and the
objective condition of the organ which the patient
points out as the seat of the disease, and, yet, where
no disease can be discovered; the idiosyncratic sensitiveness of the nervous system to the most innocent
and most indifferent impressions; the monomaniacal
attention with which the patient contemplates all his
sufferings, and interprets all the phenomena of his being as phenomena of disease; and finally, the anxiety
and depression of spirits under which the patient is
constantly labouring; all this is, like a red thread,
winding itself through all the various forms and manifestations of his illness. marking its principal features.
(Canstatt).



HYPOCHONDRIA, ETC.         197
~ 292. It is very difficult to comprehend hypochondria, and it is of importance not to neglect anything by
means of which a correct diagnosis can be obtained.
It is very wrong to trifle with such patients, or to console them with the unmeaning and trite phrase that
their sufferings are all nervous, (meaning imaginary.)
It is a great feat for a physician to examine a hypochondriac patient in such a manner that the patient
will seem to be satisfied. A hypochondriac patient is
distrustful; he has read a good many medical books,
and he thinks that he is fully able to comprehend the
character, not perhaps of diseases generally, but at
least of his own sufferings. It frequently requires
great tact to answer the perplexing questions of the
patient to his satisfaction, and without his confidence
being shaken. If this confidence should have been
gained, and the physician should really comprehend
the character of his patient's illness, then there is
scarcely a doubt that the physician will accomplish a
cure, even if it should proceed slowly.
Hypochondria can be distinguished from melancholia
by the following facts: melancholy arises from mental, hypochondria from corporeal causes; a hypochondriac is in full possession of his reason; he talks rationally about every thing, even about his health, except, as regards this latter, in extravagant terms; he
is conscious of his condition, and wants only to be
pitied by every body. A patient affected with melancholia, complains of spiritual sufferings, not of corporeal ailments; he is astonished to hear that he should
be considered sick; at last he becomes indifferent, and
does not even care for what he used to love; he cares
only for his illusion, to which he sacrifices everything,
even his life; hence great disposition to suicide. This
is in direct contradiction to the disposition of the
hypochondriac patient, who delights in life, clings to it,
and attaches himself to his friends and relatives.
Causes: Only the male sex are attacked with hypochondria, and very seldom before manhood; it frequently lasts during the whole life of the patient. In



198


HYPOCHONDRIA, ETC.


hypochondriac patients the abdominal veins are generally strongly developed, which has probably given rise
to the notion that the disease depends upon increased
venosity. Hypochondriacs generally have a spongy,
flabby constitution.  The disease is frequently inherited.
A sedentary mode of life is highly favourable to it;
this is the reason why literary men are subject to the
disease; they are deprived of exercise, and their mental faculties are moreover strained in one direction.
Mariners, arithmeticians, copyists, weavers, shoemakers, tailors, are freqhently attacked with hypochondria. But by nothing is the nervous system more
irritated and weakened than by grief, care, watching,
home-sickness, disappointed love, ambition, hazardous
speculations disturbing the mind; persons who are
exposed to the operation of such causes, frequently
become hypochondriac. The sudden passage from a
stirring and active mode of life to idleness and absence
of all business, has a similar effect in many cases.
Farther causes are: Loathing of enjoyment from
satiety, diarrhoea, dysentery, colic, fever and ague;
extreme abstinence in sexual matter,:from principle.
Also, constant overloading of the stinach with indigestible, flatulent, sour, greasy food, or heavy dishes
made of flour; or, on the other hand, fasting; or a
quantity of warm drink: tea, coffee, etc.
Prognosis: Not unfavourable; the disease does not
endanger life, but the multitudinous forms in which it
is constantly harassing the patient, tries the patient,
his physician and attendants to the utmost. It is very
difficult to conduct the treatment of hypochondria systematically, for this reason, that the patient is constantly complaining of some new trouble, and wants
to consult another physician. The more wavering the
patient, the more unfavourable the prognosis. Unless
the patient has full confidence in his physician, is determined to submit to all his dietetic regulations, and
is in possession of the requisite means of accommodating himself to the arrangements proposed by his me



HYPOCHONDRIA, ETC.


dical adviser, it will be very difficult for him to derive
any benefit from treatment. The more recent the
disease, the less it had been treated with violent
means, the less the danger of material alterations, the
more favourable is the prognosis. Hypochondriacs
who indulge sexual excesses or onanism, are incurable. I advise a young physician, however, to be
careful not to express himself too unfavourably about
his patient's prospects; he might be deceived by the
extravagant statements of the sick man, and might
afterwards have to blush at holding out such discouraging prospects. Bad symptoms are: yellow, cachectic complexion, constant sleeplessness, emaciation,
cedema of the feet.
~ 293. Treatment. Without proper exercise, amusement, and a strict diet, it cannot be expected that the
hypochondriac should ever recover his health. The
literary man must give up his sedentary life, and resort
to spade and pickaxe; the gourmand should confine
himself to a simple and nourishing diet, and the sensualist has to renounce his excesses and mortify his flesh
with an unflinching determination. Care should, if
possible, be avoided, and, if the circumstances of the
patient permit, he will derive vast benefit from travelling.
As regards exercise, it should be observed that excessive exercise is not advisable. The best time for
taking exercise is in the morning and evening, never
immediately after a meal; the best kinds of exercise
are walking, gymnastic exercise, swimming, hunting,
sawing wood, etc.
It is extremely difficult to restore the mental health
of the patient; but we must attempt to afford adequate
amusement to the patient, suitable to his talents, disposition and social position.
If it should be necessary to resort to remedies, we
have in the first placeNux vomica, which is suitable to literary men;
particularly with a vehement temper, and a nervous,
venous, bilious constitution; sedentary life, want of



200


HYPOCHONDRIA, ETC.


fresh air, constant mental efforts, and the use of stimulants, develop the disease among that class of individuals. Digestive derangements, derangements of
the portal and biliary system, constipation, etc., must
necessarily take place, and it is at this stage of the
disease that Nux is specifically indicated. Nux likewise corresponds to hypochondria caused by rich and
excessive living. In general, Nux is the best remedy
for hypochondria arising from a morbid condition of
the abdominal nerves; after dinner, the patients generally experience a feeling of malaise and languor.
Staphysagria is an excellent remedy for hypochondria arising from abuse of the sexual instinct, or from
chagrin with indignation, or from care and grief.
Staphys. is characteristically indicated by a fitful
mood, or change of the morbid phenomena, except the
flatulence which remains all the time; also by indifference with indisposition to talk.
Phosphorus is supposed, by Hahnemann, to be contraindicated by want of sexual desire, and debility of
the sexual organs. I do not think that this observation is correct, and I give Phosphorus particularly for
hypochondria arising from onanism.
It is well, if the nervous system should be very much
excited, to give a few doses of Nux vom., and afterwards a few doses of China before administering the
Phosphorus. Phosphorus is likewise suitable to hypochondriacs with a thin, slender constitution. Such hypochondriacs are fond of walking about; all their senses are very much excited, and they are so irritable,
particularly after dinner when they experience a pressure at the stomach, nausea, and heat in the face, that
their company becomes exceedingly unpleasant.
Conium corresponds to hypochondria arising from
extreme abstinence in sexual matters. Even on their
walks they are sad and melancholy; they become
more and more listless, indifferent, indolent, and finally the disease becomes so inveterate that the patient
becomes averse to life, and thinksof killing himself.
This last symptom indicates, perhaps, Aurum me



HYPOCHONDRIA, ETC.


201


tal. more characteristically than any 6ther remedy.
This symptom is always accompanied with great oppression and anguish, particularly in the region of the
heart, and with constant.congestion of the chest. The
Aurum-hypochondria is moreover characterized by a
bruised pain in the brain, which becomes excessively
violent by thinking, reading, talking, writing, and
leads to an extreme confusion of ideas. For the gastric symptoms, I refer the reader to the Mat. Med.
Gratiola may be tried, when the patient complains
of his stomach, hypochondria and abdomen; his stool
is hard and insufficient; there is pinching and cutting
in the umbilical region, malaise with repletion and
pressure in the stomach, and a good deal of eructations. Although stool relieves the patient, yet he
keeps constantly thinking of his condition.
Stannum. The patient feels better when walking,
worse during rest, and yet he is all the time complaining of bodily and mental weakness; he feels on that
account sad and low-spirited, cries, and, if with all
this there should be a stupefying pain in the brain as
if the skull were screwed in, illusions of hearing, pains
in the stomach, with irregular appetite, feeling of emptiness in the abdomen, constipation, exhausting nightsweats, etc., then the patient feels extremely unhappy,
and is a source of great discomfort to his attendants.
Zincum. Crampy pains prevail; the patient complains particularly after dinner, during rest; he is very
sensitive to the open air. His sleep is restless, disturbed with fancies which worry him even in his
waking state, inducing a hypochondriac mood and
frequent thoughts of death. These are, of course,
favoured by his nervousness, a constant pressure under
the short ribs, particularly on the right side, frequent
empty eructations which afford no relief, pressure in
the middle of the spinal marrow, a frequent, constrictive sensation in the pit of the stomach, witli anxiety,
incarceration of flatulence in the abdomen, frequAit
ineffectual urgings to stool, a peculiar distress about
the head, etc.
9*



202


VENEREAL DISEASE, SYPHILIS.


Natrum caibon. is particularly indicated when the
slightest dietetic transgression causes a great digestive
debility, ill humour, etc. The patient is at times restless, anxious; at times he dreads men and company, is
fearful and even listless as though he did not care
about living; he complains all the time of an aching
pain in the head, bad taste, with tolerable appetite,
qualmishness, with tension in the hypochondria, drawing cutting in the stomach, and   oppression of
breathing.
Sulphur is a great remedy in this disease, even if it
should not always be indicated by the symptoms; it
sometimes is required to restore the susceptibility of
the organism to the action of the proper remedies.
Beside the above-mentioned remedies, Verair., Asa.,
Pulsat., Bellad., Plumb., Magnes. mur., Valeriana,
Arnica, Moschus, Mezer., etc., should not be forgotten.
TWENTY-SECOND CLASS.
~ 294. Venereal disease, Syphilis.
The doubts which I have expressed relative to Hahnemann's theory of psoric diseases, are likewise to be
applied to his doctrines about syphilis and sycosis. It
is perfectly evident that his experience in the treatment of these diseases has been very scanty; and I
shall therefbre take the liberty, in describing the treatment of syphilis, to substitute my own and other physicians' experience for Hahnemann's mode of treatment.
~ 295. Name and origin of the disease.
Syphilis has had different names, derived either from
th$ prominent symptoms, or from the nation among
whom it was supposed to have originated, or from the
saint whose aid was invoked for the deliverance from



204


CHARACTER OF SYPHILIS.


had been introduced by the army of king Charles VIII.
of France.
~ 296. Character of syphilis.
Syphilis is a dyscrasia of the reproductive system,
manifesting itself in the shape of ulcers, excrescences,
blennorrhaea, and cutaneous eruptions; after having
been developed in the individual by means of a peculiar, fixed contagium, it reproduces the same virus, by
means of which it can be transmitted to other individuals. The disease is distinguished by the fact that it
is either attended with decrease of the vegetative life,
destruction of the fibre y ulceration, or with the contrary phenomena, hy   Vophy of the tissue, excrescences and blennorr    his opposition is observed in
no other disease, ex   erhaps, scrofula.
~ 297. Contag    character of syphilis.
The syphiliti ltagium is transmitted either1st. Direct    coit, paederastia, a kiss, (provided
primary syp    c ulcers have broken out around the
mouth); by    contact of sore parts with the syphilitic virus; o
2d. Indirectly by the contact of substances that are
infected with the syphilitic virus; tobacco-pipes,
cigars, drinking vessels, spoons, wind-instruments,
tooth-brushes, syringes, bathing-tubs, privies, etc.The virus can even be transmitted by a healthy woman who had an embrace with a syphilitic individual
without being infected herself; the virus may have
remained in the vagina, and, in this way, may be communicated to another man.
The period between the infection and the breaking
out of the disease, is very uncertain: the shortest period is from twenty-four to forty-eight hours, the
longest seven weeks; generally, however, the first
syphilitic symptoms appear between the fourth and
eighth day. The development of the syphilitic disease
seems to depend a good deal upon external causes,
violent physical or moral stimulating influences, in



GENERAL TREATMENT OF SYPHILIS.


205


creased temperature of the body by dancing, warm
baths, etc. It depends likewise upon the greater or
lesser susceptibility of the patient to morbid influences.
Prognosis. Generally speaking, favourable, provided
the patient is otherwise well, the secondary symptoms
are of a recent origin and not much developed, no
osseous disorganizations have taken place, the patient
lives soberly, has not been poisoned with mercury, follows the instructions of his physician, and no other
dyscrasia has been roused in his organism, combining
itself with the syphilitic virus. Relapses cannot always be avoided. Disfiguring cicatrices, deformities,
disorganizations, bony swellings, very often remain.
In scrofulous individuals the syphilitic virus is extremely inveterate.
~ 298. General treatment of syphilis.
This refers exclusively to the diet. We know that
the speedy cure of syphilis requires the observance of
the following rules:
1st. An equal temperature, from eighteen to twenty
degrees R., and a pure air. In warm climates the
disease runs a much milder course than in northern
countries, and, in these, the disease is more easily
cured in the summer than in winter. This is probably owing to the fact, that the cutaneous action is
much more prompt and regular in the summer than in
the winter.
2d. Starvation; the less the patient eats, the less
he feeds the disease. Feeble patients, however, may
be allowed a more nourishing diet. The following
articles of diet should be particularly avoided: acids,
such as vinegar and lemon-juice; spirits, such as wine,
brandy, etc.; a little light beer may be used; light
vegetable food and mucilaginous substances are
allowable, likewise meal and flour; meat should be
strictly forbidden, and spices likewise, such as coffee,
tea, pepper, saffron, cinnamon, vanilla, cloves, caroway; scents, perfumes, artificial tooth-powder should
be avoided. Moderate smoking is admissible.



MODIFICATIONS OF GONORRH(EA.


207


Gradually the pains diminish, the erections become
less frequent and painful, the swelling of the glans and
tip of the urethra disappears, the discharge becomes
thicker, jelly-like, diminishes, and finally disappears
altogether.
~ 300. Modifications of gonorrhcea.
Gonorrhoea is not always as mild as I have described
it in the previous paragraph; it frequently passes beyond a mere erythematous inflammation of the mucous
membrane, increasing to a synochal phlegmonous inflammation, much more intense than the former, running a more rapid course, and penetrating more deeply into the tissues adjoining the mucous membrane.
This more intense degree depends upon the constitution of the patient, upon the character of the infection,
or upon the treatment which, when too stimulating,
sometimes transforms a mere erythematous inflammation to a synochal, etc. This latter inflammation
sometimes involves the prostate and even the bladder,
being attended with acute pains. The glans is brightred, swollen, the urethra is very painful to pressure in
its whole length, and feels hard in some places. The
discharge is sometimes streaked with blood; sometimes even pure blood is discharged from the urethra
during an erection. Micturition is difficult, very painful, the desire to urinate intolerable; sometimes there
is complete ischuria, spasm of the bladder and tenesmus, constipation, chord6e, orchitis, consensual buboes, synochal fever. The inflammation is sometimes
so intense that there is no secretion at all, in which
case the Germans term it " dry gonorrhcea."
A second variety is the so-called torpid gonorrhcea;
the patient feels otherwise well, and there is only a
discharge from the urethra.
Another variety is the so-called erysipelatous gonorrhcea, with erysipelatous inflammation of the prepuce, codematous, shining, pale-red swelling of the
prepuce and orifice of the urethra, and discharge of a
rather watery mucus, with erysipelatous fever.



MODIFICATIONS OF GONORRHOEA.


Chordee is generally present in the synochal variety;
this is a curvature of the penis downwards during the
painful erections, and is caused by an effusion of plastic lymph into the interstices of the spongy body of the
urethra, to which the inflammation of the mucous
membrane had extended; this effusion prevents the
free passage of the blood into the cells of the corpus
cavernosum during an erection.
If the prepuce is very long, phymosis is apt to set in,
that is. the prepuce bec6omes inflamed or oedematous,
and can no longer be drawn back over the glans. By
paraphymosis we understand a constriction of the
penis by the swollen prepuce being drawn back behind the glans, and not allowing of being brought forward again over the glans; it takes place when the
prepuce is very tight, and has been violently drawn
back behind the glans, for instance, in consequence of
erection, embrace, etc.; the prepuce forms pad-shaped
swollen folds behind the corona glandis, which sometimes swells up enormously, and may even become
gangrenous unless the stricture is relieved very soon.
~ 301. Terminations of gonorrhaea.
The usual termination is in dispersion, with gradual
abatement of all the troublesome symptoms and transformation of the purulent into a rather serous discharge. Some pains pass off sooner, others later.
Secondary gonorrhcea frequently remains, trying
most severely the patience of both physician and patient. All the morbid symptoms have disappeared, except a chronic irritation of the urethra which remains
and manifests itself by a constant discharge of mucus,
and very frequently by pain in the urethra. Irritable
individuals get worse by exercise or stimulants; torpid
individuals are less affected by such causes.
Long-lasting secondary gonorrhcea may likewise
lead to strictures and ulcers, though I have never witnessed such results under homoeopathic treatment; I
have seen, however, difficulty of urinating and emission of the urine drop by drop under that treatment.
It is a remarkable fact, that gonorrhcea will rouse



HOMCEOPATHIC TREATMENT OF GONORRHCEA.


209.


many ailments which had previously remained latent
in the organism. Even perfectly healthy individuals
frequently complain of distresses which make their appearance after the gonorrhoea and even during the disease, and first announce themselves by the fact that
the discharge will not pass off under several weeks, or
turns into secondary gonorrhoea. In a very few
cases, the remedies which Hahnemann has proposed
for this disease effect a cure; but in by far the greater
number of cases, the Hahnemannean mode of treatment would allow the disease to run its course unchecked.
~ 302. Homceopathic treatment of gonorrhcea.
This disease is exceedingly troublesome both to the
patient and physician. The former would be willing to
bear the pain if it were not for the discharge; and the
latter is perplexed by the uniformity of the symptoms.
The different forms of gonorrhcea are only distinguished by the intensity of the symptoms, and perhaps only
the synochal variety points more distinctly to one or
the other remedy. I have not always been able to
prevent the disease running into a secondary form; I
have even no hesitation in saying that, when I hit the
right remedy, it was more by accident than anything
else.
Hahnemann proposes to cure sycosic gonorrhea
with a few pellets of Thuja 30, allowing them to act
for thirty or forty days, to be followed with a few
pellets of Nitric acid 30, which are to act as long.
For common gonorrhea he prescribes a drop of the
recent tincture of Petroselinum, provided there is frequent urging to urinate, or a drop of an alcoholic solution of Balsamus Copaive, provided the excessive
inflammation of the urethra, or the psora which had
been roused by a violent allmcopathic treatment, does
not require the use of the antipsorics.
As I said above, the treatment proposed by Hahnemann is entirely insufficient.  Petroselinum and the
tincture of Copaivce cure but very few cases of



210    HOMQEOPATHIC TREATMENT OF GONORRHQEA.
gonorrhoea. Thuja alone is scarcely ever sufficient
to cure sycosis; Nitric acid has to be given afterwards, or even Cinnabaris, or some other mercurial
preparation. Some cases of syphilis do not yield to
Mercury, but require Hepar sulph., Acid. nitr., Aurum,
Rhus tox., or some other remedy. Some patients are
sufficiently impressed with a dose of Mercurius 12,
others require repeated doses of the first trituration.
Some gonorrhoeas require a variety of remedies.
In gonorrhcea which at once sets in with great intensity, I give from the commencement a dose of
Thuja; this facilitates the treatment, though I confess, I am entirely unable to distinguish between
sycosic gonorrhoea and one of an ordinary kind. If
figwarts are present, the gonorrhea always disappears with the general disease. There are syphilitic
gonorrhoeas capable of producing a chancre; these
gonorrhoeas yield to Mercury. This agent is indicated when the urging to urinate is not relieved,
but rather increased, by Petroselinum, and when an
intolerable burning is experienced in the forepart of
the urethra during micturition, particularly during the
passage of the last drops of urine, the glans being
at the same time swollen and hot; the discharge has
a greenish tinge. The remedy has to be repeated
frequently. Mercury is particularly suitable when the
gonorrhoea is attended with phymosis, paraphymosis
and balannorrhaea. Mlercury is perfectly suitable at
the commencement of a synochal gonorrhcea, or when
an erethic gonorrhoea is about to assume a synochal
character. If syphilitic ulcers are present, Mercury
should be given as a matter of course.
In several cases where the patients presented themselves at once, as soon as they perceived any untoward symptoms, a cure was effected immediately by
a small portion of a drop of Copaivce bals.; but there
was no urging to urinate. But, if the patient drank
coffee, took much exercise, used stimulants, etc., the
effect of the Copaiva was destroyed immediately, and
no subsequent dose was able to repair the mischief.



HOMOEOPATHIC TREATMENT OF GONORRHEA.  211
Petroselinum helps only in very mild cases which
would, probably, have got well in the end without any
medicine.
Cannabis, three doses a day of the mother-tincture,
is the best remedy in the erethic stage of gonorrhcea.
I continue it, until the pain has entirely gone; the discharge of mucus frequently decreases at the same
time. If this, however, should not be the case between five or six days, I then frequently resort to
Cantharides, 3 att., ten drops in one ounce and a
half of water. This will effect a cure in many cases,
but in many other cases it will not, and then the
choice is difficult, for secondary gonorrhcea now
makes its appearance.
Torpid gonorrhoea requires to be treated as the
other forms of gonorrhcea. In synochal gonorrhcea,
with painful erections, violent burning and tenesmus
of the bladder, we have to give repeated doses of
Aconite, in alternation with Cantharides, after which
the gonorrhcea assumes the ordinary mild form, for
which Cannabis or some other remedy should then be
given.
In dry gonorrhoea, with inflammation of the neck of
the bladder and of the bladder itself, Aconite, Pulsat.,
Thuja, Cannabis and Canthar., are the principal remedies. In chordee we give Cannabis, Merc., and
Canthar., or. when there is much inflammation, Aconite, which can sometimes be followed by Sulphur.
Sulphur is an excellent remedy in torpid gonorrhoea,
even when the glans is red and swollen; it frequently
proves efficient in secondary gonorrhoea, and in the
gonorrhoea of children, produced by worms or some
other unknown cause. For symptomatic buboes, Mercur., is the principal remedy; sometimes, however,
Hepar sulph.; they disappear, however, of themselves
as soon as the urethritis is removed.
Mercurius should likewise be administered for the
painful swelling of the lymphatic vessels along the
penis and the prepuce; Calomel, however, acts better
than Mere. sol., and, if Calomel should not produce an



212    HOMEOPATHIC TREATMENT OF GONORRHCEA.
improvement between sixteen or eighteen hours, Merc.
prcecip. ruber should be given. In secondary gonorrhcea, Sulphur, Lycop., Conium, Hepar s., Nair. mur.,
Agnus cast., Acid. nitr., Sepia and some other remedies are the best. Latterly I have cured many
cases of secondary gonorrhoea with one drop of Cantharides, morning and evening; many other cases remained uncured. On one occasion Hahnemann complained to me of the secretions of mucus which continued to take place between the prepuce and glans
in cases of condylomata, though the excrescenses
had been cured; " in these cases," said he, " limewater, a solution of the acetate of lead, or some other
external application, may be used without injury to
the general health." Why should not this remark
apply to secondary gonorrhcea? I have tried an injection of the acetate of Zinc, from ten to fifteen
grains in five ounces of water, three times a day, in
very difficult and inveterate cases, with great success.
When the secondary gonorrhea was not too old, an
injection of red wine and water was found sufficient.
To moderate the nocturnal erections, the patient
should not only take Cantharides, but he should eat
little or nothing at supper; he should sleep on mattresses, cover himself moderately, and urinate as often
as he wakes. If Cantharides be not sufficient, Cannabis will be found to answer the purpose, particularly if the phlegmonous symptoms had been removed.
Blood is frequently discharged from the urethra in
synochal gonorrhcea; the patient feels rather better
after it than otherwise; only when the discharge is considerable, cold applications may be made to the penis
and perinaeum, or cold injections into the urethra,
or compression of the urethra may be resorted to.
Dysuria and ischuria are treated as usual.
The phymosis disappears with the inflammation;
it does not require any particular treatment; the
parts should be kept very clean, and tepid water



INFLAMMATION OF THE GLANS AND PREPUCE.  213
should be frequently injected between the prepuce
and glans.
Paraphymosis, on the contrary, has to be removed
immediately, lest gangrene of the glans should supervene. The glans has to be compressed with the
fingers, and the prepuce should, at the same time
be drawn back over the glans; this is frequently
very difficult, and takes from one half to one hour;
the operation is frequently facilitated by previously
bathing the parts in warm water.
Pulsat., Ferrum, Capsicum, Mezereum, Ledum, Nitr.
acid. and Sabina seem to be related to the symptoms
of this disease, but I have never derived any benefit
from these remedies. Nor have I from Tussilago
Petasites, recommended by Dr. Rosenberg, or from
Bignonia radic. minor, proposed by Dr. Wahle.
~ 303. Inflammation of the glans and prepuce.
These inflammations most frequently set in as a sequel of syphilitic diseases. Sometimes, however, they
occur without any infection having taken place, in
consequence of sexual excesses, contusions, irritating
vegetable poisons; even the whole penis appears inflamed, with violent burning pains through the whole
penis, and attended with painful stitches, shootig
from the back to the fore part of the urethra. These
inflammations terminate in gangrene more easily
than any other, particularly when they have an
erysipelatous character, as is sometimes the case in
gonorrhcea.
If this inflammation should have been caused by
abuse of Cantharides, the antidote is a solution of
Camphor.
Paraphymosis may arise from too tight an embrace,
with swelling and burning pain of the glans and
swelling up of the prepuce in the shape of a blister;
in this case, the taxis, which has been described in the
preceding paragraph, should be attempted, and Aconite and Arnica, or, if these remedies be not sufficient,
Rhus tox. should be given. But if the whole penis



OPIITHALMIA GONORRHOICA.


217


If orchitis should have set in, the patient must
keep a horizontal position, and wear a suspensorium.
~ 307. Ophthalmia gonorrhoica.
This disease is produced by a metastatic transfer
of the gonorrhoic miasm to the eye, not by the introduction of the secretion into the eye. This may
induce conjunctivitis, which, however, can easily be
removed by washing the eye with tepid water or a
decoction of althea.
Symptoms: The gonorrhaea disappears suddenly.
Soon after, the patients experience a burntig sensation in the eye, with visibly increasing dark redness of the eyelids and conjunctiva, which swells and
becomes raised round the cornea like a wall. Soon
after, the cornea becomes involved, turbid, congested
interstitially distended, and assumes a granular appearance; a quantity of yellow or yellowish-green
mucus is secreted, which resembles a good deal the
secretion from the urethra. In many cases the cornea
becomes softened, the humours of the eye flow out, and
the eye becomes atrophied. In lighter cases, when
the cornea is only partially destroyed, staphyloma
takes place. In such cases, help must be afforded immediately, for the destruction of the eye is sometimes
completed in twenty-four hours.
~ 308. Treatmet: If the inflammation should develop itself slowly, it may be proper to give first a
few doses of Aconite; but the more specific remedy
should not be neglected., If the inflammation and
swelling should continue in spite of the Aconite, if
there should be an increase of secretion with burning
pains in the eyes, Mercurius is probably the first remedy. Next to Mercurius we have Nitri acidum, or
Hepar sulph., unless Thuja, Cannabis, Belladonna,
Aurum, Euphrasia, Sulphur, should be required by
the symptoms.


VOL. IV.-10



218


RHEUMATISMUS GONORRHOICUS.


~. 309. Rheumatismus gonorrhloicus.
This is a peculiar rheumatic na ection, especially of
the knee and tarsal-joints. The symptonis are the
following: The disease sets in ehith(lr during or after
the gonorrhcea; it commences with p ain and swellilng
of the joints, and is generally connlinlcd to the kne-e and
tarsal joints, though other joints may likewise be involved. It is seldom the case that two joints are
attacked at the same time. The symptoms are most
violent when the gonorrhoea is on the decrease, or
after -it had been suppressed by Cubebs or Copaiva.
The joints are generally somewhat swollen and painful, particularly in the evening, in bed. There is
scarcely ever any external redness, nor is there any
pain on pressure. The pulse is hurried; loss of appetite, derangement of the stomach. Relief is sometimes afforded by a sudden eruption of pustules,
papule or spots, which remain a few days and then
dry up and scale off. The articular affection sometimes sets in after a few days, or after weeks, and
even months, and either runs an acute or chronic
course.
Causes: Opinions differ in this respect.  Some
authors think the disease is occasioned by a cold, by
living in damp dwellings, by an imprudent suppression
of the gonorrhea, metastasis to the joints, reflex-action
of the irritated urethra to one or the other portion of
the spinal marrow; others consider the disease as
something accidental, existing independently of the
gonorrhoeal disease; others again consider the disease
as produced by the action of Copaiva.
~ 310. Treatment: In the first volume of this work
the reader will find a number of remedies indicated
for rheumatism and arthritis, of which a physician
may likevise avail himself in this disease, provided
the symptoms correspond. One of the principal remedies is the Balsam of copaiva, of which I dissolve one
drop in 99 drops of alcohol by means of long shaking,
and give the patient a drop three times every day in
water. I used the medicine when the gonorrhea and



CHANCRES.


219


the articular affection was attended with the breaking out of pustules over the whole body; these indications are sufficient, for the disease yielded in a few
days.
If, after the cure of the gonorrhoea, when the urethra
was only left closed by a little mucus, the rheumatism
was caused by a cold or exposure to wet, while the
body was heated, I employed Colchicum 3 with great
success; the pains in the joints are most violent from
e vening until day-break.
Some alleopathic writers (A Cooper, Curi~s) recommend small doses of Terebinthina for this disease.
I have never used it, though it may be a good remedy.
Thuja is perhaps preferable whether the disease
sets in during or after the gonorrhoea. The Thujapains are worse in the warmth, especially in bed, and
its curative virtues in sycosic gonorrhoeas, and in
rheumatic and arthritic affections, especially of the
knee and tarsal joints, are well known.
Sabina. Both the upper and lower limbs may be
affected; small itching pimples which form scurfs
after scratching, frequently appear on the affected
joints, and the patient feels more comfortable in a cool
room than in a warm.
Mlanganum aceticum is useful for rheumatic pains,
particularly when digging and shooting pains in the
cross-wise affected joints torment the patient, particularly at night, attended with little itching blotches
which cause a burning after being scratched.
Phosphorus and Hep. sulph. are useful in the chronic
variety. I refer the reader to the Mat. Med. for the
symptoms.
~ 311. Chancres.
There are many varieties of chancre, though all are
of syphilitic origin; they secrete a humour which is capable of transmitting the disease to other persons.
BaumBs asserts that primary chancre has not a single
positive pathognomonic symptom.



220


CHANCRES.


The different varieties of chancre may be classed
under the following heads, if we take their essential
characters for guides:
1) Simple chancre, including the raised ulcer;
2) Indurated or Hunterian chancre;
3) Phagedenic chancre, including the so-called diphtheritic, gangrenous and serpiginous varieties.
a) Simple chancre. This is most frequent. It is
seated on the body of the penis, on the inner and outer
surface of the prepuce, and on the scrotum; it is of the
size of from a small pea to that of a shilling-piece.
The simple chancre develops itself in this fashion:
first a vesicle or pustule which shortly covers itself
with a scurf, which, after falling off, leaves an excavated, oval or circular ulcer, with a lardaceous, dingyyellow or brown bottom, and sharp edges which are,
however, neither very much inflamed, nor callous or
raised; the surrounding parts are of a brown-reddish
colour. Neither the bottom nor the edges of the ulcer
are hard.
In eight or ten days, the edges and sometimes even
the base of the ulcer become raised, exhibiting a sort
of spongy growth, and being sometimes considerably
raised over the healthy parts (ulcus elevatum); in spite
of this elevation there is no hardness as in the Hunterian chancre; the pus is of a serous character.
There is little pain, or else it lasts but a short time;
it is more painful when seated behind the glans or on
the inner surface of the prepuce, than when seated on
the glans itself. It may be complicated with bubo
and phymosis; in the latter case it is not easy to diagnose a chancre on the internal surface of the prepuce,
as it is impossible to feel any hardness through the
prepuce.  Unfavourable circumstances may trans.
form a benign chancre to a phagedenic, or gangrenous
ulcer.
b) Indurated or Hunterian chancre. This is either
a primary chancre or it develops itself out of a simple
chancre in consequence of bad treatment.   This
chancre is most frequently seen on the frenulum,



CHANORES.


if corroded, without granulations, sometimes bleeding
very readily; the edges are irregularly indented,
frequently cedematous, surrounded by dark redness.
A phagedenic chancre is generally very painful;
the patient complains of a violent burning as from
hot coal, of violent stitches and gnawing, and the
pains spread to the adjoining parts. There are likewise cases where the pain is very slight, in spite of
the spreading destruction. The general organism is
sometimes considerably disturbed, pulse 120 to 130,
tongue brown and dry, face disfigured; the patient
loses his strength, and typhoid symptoms seem to be
approaching.
This kind of chancre involves the glans, prepuce,
penis, labia, vagina, perineum, buttocks, and keeps
spreading, until all these parts are destroyed. The
ulcer seldom cicatrizes before the end of the second
month, even in the most favourable case, whether
the destruction run a rapid or slow course; in many
cases the disease lasts from four to eight months and
upwards; the ulcer keeping spreading from one part
to another, alternately healing and breaking again.
A chancre which heals on one side while it keeps
spreading on the other, has been termed serpiginous;
it gets worse under the treatment of Mercury. Buboes rarely exist with a phagedenic chancre; but if
they did exist before this chancre broke out, they
too become phagedenic.
~ 312. Every chancre may be complicated with
phymosis, or, though less frequently, with paraphymosis. Phymosis makes it frequently impossible to
diagnose ulcers seated on the inner surface of the
prepuce, until they have spread a good deal, or gangrenous destruction of the glans and urethra, or perforation of the urethra, has taken place.
Females are less liable to chancres than males,
probably owing to the greater elasticity of the female
organs, which protects their mucous membrane from
infection. The chancres of females are generally more
benign than those of males; the classification is the
same.



CHIANCRES.


223


Primary chancres may be moreover seated at the
anus, on the lips. tongue, female breast; exhibiting, of
course, different forms, according as the tissue of the
parts where the chancres are seated; for instance,
ulcers on the glans are, generally speaking. round, excavated, indurated; when seate'd on soft skin or in loose
subcutaneous cellular tissue, the bottom of the ulcer
is more elevated, the edges are raised above the adjacent tissues, the base is hard and circumscribed. On
the body of the penis the chancre is broad and superficial; on the thighs and calves it has a rounded-off
shape, etc.
Diagnosis: The exciting cause must tell us whether
an ulcer is syphilitic or not; besides, the following
characteristic symptoms aid us in determining the
syphilitic character of an ulcer: rounded-off shape,
sharp edges, lardaceous, whitish bottom, hardness,
disposition to spread, swelling of the inguinal glands,
etc.
IIerpcs prceputialis is distinguished from chancre
by its base, which is not indurated as in chancre. On
a red spot of the size of a dime, groups of little vesi.
cles, from six to ten, start up, which break and then
change to small crusts; the ulcers which thus arise,
disappear in a few days. Psoriasis of the prepuce is
easily distinguished from chancre by its scaly appearance.
Prognosis: Favourable, provided the patient obeys
strictly the instructions of his physician, and does not
indulge the least excess. A simple chancre most
generally gets well without anysecondary symptoms.
A phagedenic chancre is very difficult to cure, particularly if the patient be infected with dyscrasia, with
an impoverished constitution, and living in unfavour.
able circumstances.  The longer the chancre had
lasted, the more easily do symptoms of secondary
syphilis break out. An indurated chancre is almost
always followed by symptoms of secondary syphilis.
They rarely set in after the serpiginous or gangrenous
variety. (Canstatt.)



224


CHANCRES.


S313. Treatment. According to the doctrines of the
homoeopathic school, a chancre is not a local symptom,
but the visible representative of an internal syphilitic
disease. A chancre does not make its appearance till
the syphilitic miasm has penetrated the whole organism, which, by means of its inherent vital or reactive
energies, checks the destructive effects of the poison
by compelling it to locate its sphere of action on
the external skin within definite limits.
The specific remedy for syphilis is Mercury, not
only Mercurius solubilis, but all the other mercurial
preparations combined with other chemical substances.
These will sometimes effect a cure where 3Mere. sol.
leaves us in the lurch. Also in secondary syphilis, and
in the diseases which sometimes set in as consecutive
diseases of syphilis, Mlercurius is the principal remedy, although we sometimes have to resort to other
remedies on account of the psora and the mercurial
symptoms with which we find the syphilitic disease
combined.
As regards the action of Mercury, I am entirely of
the opinion of Dr. Trinks, that, " in consequence of the
slow action of Mercury upon the animal organism,
Mercury is very little adapted to diseases that might
soon terminate fatally, but only to diseases that run a
slow course, and allow the Mercurius sufficient time to
develop its action. This is the reason why one dose
of Mercury will seldom be found sufficient, and why
repeated doses of this medicine are required to overcome the inherent slowness of its action, especially in
diseases which are deeply seated in the vegetative
system."
The specific remedy for a primary chancre is MJrrcurius sol. The cure is effected more or less rapidly
according as the patient is more or less sensitive to the
action of medicine generally, or according as he had
been treated with large doses of Mercury for previous
syphilitic diseases. The best dose is one grain of the
first or third trit.. morning and night. If no improvement should take place within the first eight days, a



226


CHANCRES.


fauces, even while the primary ulcer is still existing.
It seldom gets well under forty to fifty days. Avoid
all improper hurry. I give a dose of the above-mentioned remedies morning and night, and discontinue
them as soon as the consecutive symptoms make their
appearance. Then I give Hep. sulph. first or second
trit., and if this should not be sufficient, Nitri acid.
This treatment is generally sufficient, and nothing remains except the local chancre, or even this symptom
may have disappeared, and nothing may have been
left except a remnant of the tuberculous disorganization. For this I give the Iodide of mercury, second or
third trit., at first at short, and then at longer intervals, continuing it until the indurations have entirely
disappeared. I have tried Calomel for the consecutive symptoms, but with no good effect, for ptyalism
set in even after the smallest doses; it is perfectly
suitable, however, when ptyalism accompanies the
above-mentioned consecutive symptoms.  In cases
where the velum palatinum is sore and ulcerated, with
painful burning, Acid. phosph. is preferable to Nitri
acidum.
~ 315. Continuation of the treatment of chancre.
The phagedenic chancre, this most destructive form of
the disease, demands a most energetic treatment. I
formerly believed, with other physicians of our school,
that this chancre derived its destructive properties
from its complication with scrofula or herpes; but experience has taught me better. Prescribing upon this
supposition, I have allowed the fauces to be destroyed
by ulcers, the nasal bones to become involved, the
syphilitic ulcers to spread over the whole body, to
enlarge and to discharge a cadaverous ichor with a
cadaverous smell. The patients scarcely looked any
more like human beings, suffering dreadful pains, with
swelled bones or the bones destroyed by ulcers. No
remedies will do for this kind of chancre except Mlercury, but it must be given in proper doses; the organism must be saturated with Mercury to overcome the
dire enemy. Be not afraid of aggravations; away



228


SYPHILITIC BUBOES.


~ 316. Syphilitic buboes.
They are commonly found among the superficial,
seldom among the more deep-seated inguinal glands.
They generally appear the second week after the
breaking out of the chancre, are sometimes preceded
by a chill, and set in with a slight pain in the inguinal fold, extending down the thigh and impeding the
use of the lower limbs. Shortly after, a gland begins
to swell, which is at first movable under the skin,
having a globular or flat-oval shape, and being painful to pressure. Sometimes the lymphatic vessels extending from the chancre to the gland, are inflamed.
Little by little the gland enlarges, becomes immovable, and the skin which covers it becomes red, cherry-brown. The swelling is either dispersed or else
the gland suppurates under hommcopathic treatment.
The bubo requires the same treatment as the
chancre. It disappears with or before the chancre;
but, if the chancre should get well first, another mercurial preparation would have to be chosen for the
bubo; or, if the patient should have been drugged
with Mercury, some suitable antidote, or some antiscrofulous medicine, if scrofula should complicate the
syphilitic disease. I do not deem it necessary to repeat the various remedies which might be required for
these different contingencies.
~ 317. Sqyphilitic excrescences, condylomata, Hlah emann's sycosis.
According to Hahnemann, sycosis is a disease caused by a particular virus, not syphilitic, and generally,
but not always, accompanied by a discharge from the
urethra. It is probable, however, that sycosis is a
syphilitic disease, though not curable by Mercury.
The phenomena which characterize this disease
we will designate by the term "syphilitic excrescences."
These are the vegetations of the skin and mucous
membranes known as venereal w arts, figw! arts, cond -
lomata, mucous tubercles, etc., which are nolhing but
hypertrophies of the subcutaneous or submucous cel



SYPHILITIC EXCRESCENCES, ETC.


229


lular tissue. If covered with a thick epidermis, they
are dry, horny, and are called venereal warts; if
covered with a thin pellicle, or none at all, they are
soft, moist, secrete a peculiar, acrid fluid, and then
belong to the class of moist condylomata or mucous
tubercles.
Condylomata are either flat, with a broad basis, or
pediculated, conical.  This depends upon locality,
warmth, greater or lesser degree of humidity, friction.
The flat condylomata consist in a soft, superficial,
almost circular elevation of the cutis, smooth on the
surface; they are the more frequent, and are generally
found between the buttocks, around the anus, on the
perineum, thighs, scrotum, on the skin of the penis,
especially where it covers the scrotum, and on the outer
surface of the labia.
The acuminated, pediculated condylomata are
small, sometimes from one to two lines long, threadshaped, forming groups shaped like the crest of a
cock or a strawberry; they spread very rapidly and
sometimes cover a large surface; they are less frequent, but more obstinate; they are generally found
on the inner side of the prepuce, on the clitoris, at the
entrance of the vagina, on the nymphae, even higher
up.
There are pin-shaped condylomata, seated on the
border of the glans, and on both surfaces of the lesser
labia.
The more delicate, vascular and nervous the tissue
of the condylomata, the more obstinate their course.
They secrete a peculiar, fetid, acrid matter, which
gives rise to new condylomata on the adjacent parts.
They are generally very little painful, sometimes,
however, a good deal; on open parts of the skin they
look much paler than on those parts which are not
exposed to the light and air.
~ 318. Treatment of syphilitic excrescences.
According to Hahnemann, the best mode of treating
sycosis is the following:-A few pellets of Thuja 30,



SYPHILITIC EXCRESCENCES, ETC.


to be allowed to act for thirty or forty days, and to be
followed by a few pellets of Nitric acid. 9, to be allowed to act equally as long. In bad cases, the excrescences may be touched once a day with the
essence of Thuja.
It is true that Thuja and Nitric acid. are the best remedies for sycosis, but not in such small doses as have
been prescribed by Hahnemann; much less should
the so-called high potencies be relied upon; these are
positively useless in the treatment of syphilitic diseases.
Physicians still differ in their opinions about the use
of one or the other of these two remedies in sycosis.
According to my observations, Thuja is suitable for
condylomata attended with gonorrhma, for such as
develop themselves out of chancres (not quite certain)
and for flat condylomata with a broad basis; the two
latter varieties require the external application of
Thuja. According to Attomyr, on the contrary, Thuja
corresponds to condylomata which are not humid at
first, but become so afterwards, and, in shape, resemble the cauliflower.
Acid. nitri. seems to be the specific for pediculated
and pin-shaped coudylomata.  The larger, readily
bleeding condylomata, which, by their rapid growth,
are apt to induce phymosis, should at the same time
be touched with a solution of Argent. nitric. There
is a kind of condyloma which develops itself out of a
boil-shaped ulcer on the prepuce; the ulcer has a
dark blue, greasy bottom, and covers itself with a
crust under which an ichor is secreted which causes
the ulcer to spread more and more. After the falling
off of the scurf, we perceive enormous abnormal granulations which at once reveal the true character of
the excrescence. In two cases, the whole disease disappeared in a few days after the use of Acid. nitr.
Six or eight weeks after, I saw the patients again,
and other fresh-looking condylomata had started up
behind the glans. I could not tell whether these were
a new development of the old disease, or the result of



SECONDARY SYPHILITIC DISEASES, ETC.


231


a recent infection. They were pediculated, and yielded to Sabina 1, very readily.
Sabina is an excellent remedy for condylomata; I
generally give it when Thuja and Nitri. acid. are ineffectual; it seems to rank with Nitr. acid.
Cinnabaris is suitable for condylomata which develop themselves out of chancres, particularly when
pediculated and readily bleeding. I have used Euphrasia for stinging or burning pains in the figwarts.
Acid. phosph., Staphys., Lycop., seem to have some
relation to figwarts, but I am unable to say where
these remedies should be used.
~ 319. Secondary Syphilitic diseases. Syphilides.
Generally speaking, condylomata and cutaneous excrescences. They sometimes appear even during the
existence of the primary chancre, sometimes, however,
not till months and years have elapsed.
The principal forms of these secondary syphilitic
diseases are, scales, tubercles, macule, pustules,
vesicles.
a. Maculce. Roseola syphilitica.
These are irregular, circular, measle-shaped, copper-coloured spots, momentarily disappearing under
the pressure of the finger; they frequently spread over
a large portion of the body, disappear at one place and
reappear again at another; they generally appear
on the neck, head, face, and fall off in bran-shaped
scales; they are generally attended with primary
syphilitic symptoms, and sometimes disappear without
treatment.
b. Papulce. Blotcles, Lichen syphiliticus, venereal
itch.
These are copper-coloured spots, from the surface of
which start up papula without itching, of a gray,
brown, or brown-violet colour, small and conical, or
large and spherical; at times they appear in groups
like lichen, at others they are scattered. This eruption generally appears on the upper extremities, the
back, shoulders, forehead, scalp, and abdomen. The



232     SECONDARY SYPHILITIC DISEASES, ETC.


blotches scale off after a time; the papule,'-on the
contrary, leave a yellow, brown-violet spot on the skin,
which disappears after a while. The tip sometimes
suppurates; or obstinate scales and scurfs form on the
papulm; or they increase to the size of tubercles.
This excrescence is likewise frequently accompanied
with primary syphilitic diseases, and is sometimes difficult to cure.
c. Scales, Lepra et psoriasis syphilitica.
Of these we have the following varieties:
a. Psoriasis syphilitica guttata, (see ~ 30, vol. II.)
These are small, circular, lentil-sized, copper-coloured spots, somewhat raised on the skin, gradually
covering themselves with small, (lingy-white, or
grayish scales surrounded by a white border; after
the scales fall off, the skin is still a little raised and
dark-red.
3. Psoriasis syphil'tica difusa. Larger, round, or
irregular, yellowish, pale-red or copper-coloured spots,
covering themselves with scales; in the centre of the
spots a little ulceration sometimes forms, covered with
a black crust; the scaly part frequently appears
fissured. The former variety is almost always seated
on the scalp, the latter on the trunk, extremities,
scrotum, anus, scalp. On moist parts, a clear serum
is discharged from these spots, after which superficial
ulceration or condylomata take place.
v. Psoriasis syph. plantaris et palmaria. Shining,
hard, dingy-gray or blackish scales, sea'ed on small,
round, as it were horny spo.s, with a pale-red or ind.stinctly-coloured bottom.
J. Lepra. nigricans. Rare. Circular spots of different sizes, of a dingy or blackish colour, pitted in the
centre. After the falling off of the little scurfs, a
slightly swollen spot remains, which looks like the
scurf, and retains its colour for some time.
E. Psoriasis syph. frequently invades the finger and
toe-nails, and causes them to fall off, (onychia syphilitica,) the nail is not reproduced with a regular
shape.



234    * SECONDARY SYPHILITIC AFFECTIONS, ETC.
painful, ulcerated fissures which frequently arise from
pustules, with hard edges and a grayish bottom, principally seated between the fingers and toes and at the
anus. Partial falling of of the hair is very frequent;
alopecia much less so.
~ 320. Treatment of secondary syphilis. Mercury is
the principal medicine for these secondary syphilitic
eruptions, and for the syphilis, of which they are mere
symptoms. Alleopathic physicians use lodium and
Sassaparilla for these eruptions, which homoeopathic
physicians only use for syphilis complicated with mercurial symptoms. The principal mercurial preparations which are of service in the treatment of these
secondary syphilitic diseases, are: Merc. prcecip.
rub., Mere. corr., Cinnaburis, Merc. nitros., though
the other preparations may likewise be useful. Beside these preparations, we have: Thuja, Nitri acid.,
Hepar sulp., Clematis, Staphys., Phosphor. acid., Mezereum, etc. (See cutaneous eruptions at the commencement of this second volume.)
~ 321. Secondary syphilitic afections of the mucous
membranes.
There. are likewise syphilitic spots, pustules, tubercles upon the mucous membranes as upon the skin,
except that they cannot be distinguished as clearly on
account of the mucous membrane not being provided with a firm epidermis. These affections are best
divided into two groups, pustulous and exanthematous
or condylomatous.
The pustulous form is principally seen on the mucous membrane of the tonsils and the posterior portion of the fauces; sometimes it is likewise seen in the
inner nose and larynx, at the rectum, rarely somewhere else. It frequently co-exists with pustulous
eruptions on the skin. The ulcers on the mucous
membrane are excavated, with a white bottom, sharp
edges, red border; they frequently cause frightful



240    SECONDARY SYPHILITIC AFFECTIONS, ETC.
~ 326. Syphilis neonatorum s. congenita.
The infection of the fetus or infant takes place in
the following manner:
1. Father or mother, or both parents, are afflicted
with primary or secondary syphilitic symptoms at the
time when they are engaged in the act of propagation, thus communicating the disease to the germ;
such a fetus seldom arrives at a full period, but generally dies in the fifth or sixth month in the uterus, producing miscarriage.
2. Only the mother is syphilitic, infecting the fetus
during pregnancy.
3. The mother is affected with primary syphilitic
symptoms of the genital organs, discharge, chancre,
condylomata, infecting the child while passing through
the vagina. In such a case, the syphilitic symptoms
make their appearance a few days or weeks after
birth.
4. If nurses or mothers are affected with primary
-yphilitic rhagades, ulcers of the nipples, similar
ulcerations will break out on the lips or in the mouth
of the infant, and vice versa.
Phenomena of secondary syphilis of new-born infants.
If the child is born with syphilis, the skin generally has
a light-brownish or dingy-straw-coloured appearance,
the epidermis is easily detached, as on parts in a state
of decay, or else it is raised in blisters; the muscles
are soft, flabby, the children are exceedingly small,
impoverished, they look old; their voice has a piping
sound, the nose is stopped, the corners of the mouth
are putrid.
If the disease break out after birth, this generally
takes place two months after the birth of the infant.
Wallace furnishes the following description of it:
" In the first weeks, the disease looks like measles.
On the face, the eruption is frequently confluent, and
the scales are so thick that the eruption looks like
psoriasis.  On the nates, the eruption is likewise
strongly marked, and speedily terminates in ulceration
when the children have an impoverished constitution.



SECONDARY SYPHILITIC AFFECTIONS, ETC.


241


If the disease should break out still later after birth,
condylomata make their appearance on the sexual
organs, rhagades in the corners of the mouth, superficial suppuration of the mucous membrane of the lips,
mouth, ulcers in the throat, and the voice is almost
always altered, with difficulty of breathing through
the nose. The older the child, the more frequent the
condylomata, rhagades in the corners of the mouth,
ulcers in the fauces and on the mucous membrane
of the mouth." Sometimes there is otorrhea, iritis,
periostitis. Hufeland thinks that congenital syphilis
frequently appears in the shape of scrofula.
Prognosis. Not very favourable; the disease is
curable, but weakly children die of it very often.
~ 327. Treatment of congenital syphilis. If the parturient female should be syphilitic, the vagina and
vulva should be greased, the child should be disengaged as soon as possible, and, after birth, should be
washed very carefully, especially the eyes, inner
mouth, and the different orifices of the body and the
folds in the skin; it is likewise necessary to examine
the child every day in order to meet by proper treatment whatever syphilitic symptoms may make their
appearance.
If the child should still be at the breast, it is best to
give the medicine to the mother or nurse.
If the medicine be given to the child, a high preparation of M'erc. sol. is sufficient; if the mother, on the
contrary, take the medicine, a lower preparation
should be given.
It frequently happens that a homoeopathic physician is called upon to treat children that have already
been under allceopathic treatment. In this case, the
physician must examne with great care what course
had been pursued by the allceopathic physician; for
it is more than probable that the large doses of mercury with which the little patient had been dosed, have
produced mercurial symptoms. It is the fashion of
allceopathic physicians to give large doses of MerVOL. Iv.-11.



242    SECONDARY SYPHILITIC AFFECTIONS, ETC.
cury even when there is no positive proof of syphilis,
and the homceopathic physician is afterwards called
upon to relieve the little patient of the horrid disease
which the destructive action of syphilis and Mercury
had occasioned.
If the disease had been getting worse under the
action of Mercury, this would be a sure sign, that
mercurial symptoms had developed themselves. The
prognosis is rather doubtful.
If the little sufferer should be attacked with stomacace, or angina mercurialis; if the soft and hard
parts should even be partially destroyed; Aurum 3
would be the most efficient remedy to stop the further destructive effects of Mercury. Aurum should
be followed by Hepar. sulp. 2d or 3d. If the mercurial disease have been caused by Calomel, a dose of
Merc. sol. Hahn. or of Mercurius vivus, or, still better,
of Merc. sublim. corros., may occasionally be given.
If the stomacace should be accompanied with dysphagia, or with an immobility of the jaws, swollen,
retreating, spongy gums, ptyalism, etc., Belladonna,
Dulcam., and Acid nitri. should be resorted to.
For caries of the nasal bones, give Aurum. For
caries of other bones, swelling of single parts of cartilage, thickening of the periosteum, especially when
these symptoms had been made worse by Mercury,
give Asafoetida.  It is therefore eminently useful
in scrofula mismanaged by Mercury. Mezereum and
Acidum phosphor, rank with Asa. If time permits, a
dose of China may be given before the above-mentioned remedies are used.
For suppurating lymphatic swellings or for other
suppurating ulcers, Pulsat., Acid. phosph., Silicea or
Carbo veg. will be found very useful.
Cicuta virosa is likewise very useful in painful
glandular indurations and other pains produced by
Mercury.
China should always be given first when the following symptoms are present: great sensitiveness for external irritating causes, spasms, tremour, and other



SDCONDARY SYPHILITIC AFFECTIONS, ETC.


243


nervous symptoms, restlessness, want of appetite and
sleep, loathing, cold extremities, pointed nose, livid face,
hectic fever, with great prostration and thirst, small,
hard, quick pulse. After China may be given Ferrum.
Perhaps a few doses of Spiritus nitri dulcis will be
found very useful at first. For the profuse and obstinate sweats or night-sweats, Phosphoric acid will,
next to China, be found very useful.
For all the above-mentioned mercurial symptoms,
Dulcam., Acid nitri., Sarsapar., are excellent remedies,
and deserve honourable mention even as intercurrent
remedies.
For syphilis congenita without mercurial complications, the well-known mercurial preparations are the
specific remedies, except that the dose has to be
adapted to the age and constitution of the patient.
All the various remedies which have been named in
these chapters on syphilis, correspond both to syphilitic and mercurial affections.


THE END.






GENERAL INDEX
OF THE FOUR VOLUMES.
(The small figure immediately after the iname of the disease, indicates the volume.)
PAGz
Abdomen, dropsy -of,  3......  196
Achor larvata,  3.......   28
Achores,  3........   23
Acne,  3.1..                   37
-  punctata,  3.......   38
-  indurata,  3.....   39
-  rosacea,  3.1..               39
-  simplex,  3...  37
Anasarca,  3..                     199
Angina,  2.......   95
-  maligna, gangrenosa, putrida, diphterica,  2... 100
-  membranacea, polyposa, 2... 108
-  mercurialis,  2.....  101
-  cesophagea,  2....  103
-  parotidea,  2......  112
-  pectoris,  2.  4.....  104, 112
-  pharyngea,  2.....  102
Animi deliquium,  3... 203
Ankyloglossum,  3.... 221
Anus, burning pain at,  4...  67
-  itching of,  4...   67
Aphthw,  2..  4                     36
Apoplexia cerebralis, or sanguinea,  4..   1
Apoplexy, from mechanical injuries,  4... 10
-  gastric,  4.  *......    7
-  nervous,  4...  597
-  serous,  4...    7
Apparent death,  3..             203, 206
-  by congelation,  3...  212
Arthritis,  2..  0                  87
Ascites,  3..                       196



-GENERAL INDEX OF THE FOUR VOLUMES.  247
PAGE
Catarrh, suffocative,  4.....   110
Cephale~toma,  3.......  221
Cephalitis,  2..                           170
Ceratitis,  2......   202
Chancre,  4.......   219
Chest, drospy  of,  3.....190
Chilblains,  2......   41
China-cachexia,  1......   269
Chlorosis,  4,.                            188
Choanorrhagia,  3...   127
Cholera, Asiatic,  1.....   187
-  febrile conditions resembling,  1... 182
Chorea  St. Viti,  4....   -.   142
Choreomania, 4...   142
Cingulum,  2....   40
Clavus,  4......   37
Colic, bilious,  4....   56
-  copper,  4....   61
-  depending upon local causes, 4....   63
-  flatulent,  4.....   51
-  gastric,  4....   55
-  MUCOUS, 4....   58
Colica,  4.....   50
-  Eeruginalis,  4....   61
-  herniosa,  4.....   64
sanguinea, plethorica or h~amorrhoidalis,  4.  0  62
-saturnina or pictonum,  4.           %   59
- ventriculi,  4.                     a   68
Colic-worm, 4.                           a    58
Constipation of new-born infants,  3.  &~.  223
Colicodynia,  4.                         %    57
Colliquations,  3......   10
Comnplications of scarlet fever with other diseases,  2... 23
Condylomata,  4...    6    0            228
Congestion of the abdomen, 3...   121
-  of the chest, 3.  -.  120
-  of the head,  3....    -  118
-  of the  uterus,  3.  -.         -   123
Conjunctivitis syphil.,  4.  -..           239
Consumption,  3.  -.         -.         78
-  aphthae in, 3.   -..   95
-  bedsores in, 3..                       95



GENERAL INDEX OF THE FOUR VOLUMES.   249


Enteritis,  2....
-   mucosa infantum,    2..
Enterodynia,   4....
Enuresis paralytica,  4.
Ephidrosis,  3.
Epididymitis gonorrhoica,  4..
Epilepsy,  4..
Epilepsia abdominalis,  4.
-   acute,   4....
-   peripherica,  4.
-   saltatoria,  4..
-   testicularis,  4.
-   thoracica,  4.
-   uterina,  4....
Epistaxis,  3..
Ergotism,   4..
Eruptions,   2.
-   crustacea,   2.
-   maculosa,   2.
-   papulosa,   2.
-   pustulosa,  2...  '.
-   ulcerosa,  2...
Erysipelas,   2....
Excrescences, syphilitic,  4..
Fainting,  3..
Favus,    3..
Febrile conditions resembling cholera,
Febris lactea,  2....
-   putrida,    1..
-   amatoria,    4...
Fevers, general remarks on    1.
-   critical diarrhcea in,  1.
-     -     phenomena in,    1.
-     -     ptyalism in,   1.
-   dysenteric,   1...
-   and ague,     1...
-   hemorrhages, critical in,  1.
-   intermittent,   1.
-   of dentition,   1..
-   classification of,  1.
-   prognosis in,   1.
-   general remote causes of,  1.
-   catarrhal,    I.   *'


PAGE
137
140..  50
13
S.  111
S.  216
166
174
132
180
142
S.  177
178
176
127
150
S.   1
S1
S ~   1
S.   1
S.   1
1
38
228
203.  23
182
163
252
188
84
93..  86
94
202
258
90
258.
114
97
99
94
123



250.GENERAL INDEX OF THE FOUR VOLUMES.


Fevers, pituitous or mucous,  1.
-   synochal or simple inflammatory,  1.
-   bilious,  1.
-   worm,    1...
-   hospital, or jail,  1.
-   simple rheumatic,  1.
-   diet and temperature in,  1.
-   putrid,  1..
-   suburral,  1..
-   terminations of,  1.
-   critical vomiting in,  1.
-   catarrhal, of children,  1.
-   gastric,  1...
-   mucous,   1..
-   yellow,  1...
-   exanthematic,  2....
-   puerperal,  2....
Fluor-albus,  3....
Fothergilli, dolor faciei,  4.
Galactorrhaea,  3..
Gastritis,  2...
-   toxica,  2...
-   traumatica,  2..
Gastrobrosis,  4...
Gastralgia,  4...
Gastrostenosis cardiaca et pylorica,  4.
Gastrodynia,  4...
Gastromalacia,  4.
Glossitis,  2...
Glossoplegia,  4..
Gonorrhoea, acute,  4....
-   modifications of,  4.
-   prmputialis,  4....
-   secondary,  4....
Gout,   2....
Grippe,   1....
Gutta rosacea,  3..
Hamatemesis,   3..
HMmaturia,   3..
Hamoptoi,    3..
Hamoptysis,   3..
Hamorrhage from the lungs,  3.
-   from the urethra,  3..


PAGE
151
108
151
172
254
140
102
254
154
101
93
133
S 151 and 154
165
255
S.      1
153
113
24
113
130
136
136
82
68
77
68
82
94
13
206
207
214. 216
87
136
39
134
139
130
130
130
143



252      GENERAL INDEX OF THE FOUR VOLUMES.
PAGE
Inflammation of bones,  2.....    115
-     of the bladder,  2....    145
-     -   -  bowels,   2.....    137
-     -   - cornea,    2...          202
-     -   -  diaphragm,   2....           64
-     -   -  ear,   2......    187
-   -   -   eye,   2.....   190
-     -   -  fauces,  2.....    95
-     -   - glands and prepuce,  4...    213
-     -   - heart,   2.....    62
-     -   -  iris,  2.....    203
-     -   -  kidneys,   2.....    142
-     -   - labia and vulva,  2....    153
-     -   -  liver,  2.....          119
-     -   -  lungs,.  2......    46
-   -   - lymphatic glands and vessels,  2...   117
-     -   - mamm,       2.....    166
-     -   -  meningeal membranes,   2...    170
-     -   - nose,    2......    114
-     -   -  ovary,   2.....    150
-     -   - psoas-muscle,   2....     86
-     -   - spinal marrow,   2....    185
-     -   - spleen,   2.....    130
-   -   -  stomach,    2.                             130
-     -   -  testicles,  2.....    168
-     -   - tongue,    2.....     94
-     -   -  uterus,  2.....    147
Inflammations in general,  2.....     42
-     with fever,  2.,....     44
Influenza,  1.......    135
Intertrigo,  2......     34
Iritis,  2........    203
-   syphil.,  4.......    239
Irritation, spinal,  4......     44
Ischias,  2.......     92
Itch,   3....     *     *..     11
-   venereal,  4....,,..    237
Jail-fever,  1......    254
Jaundice,   2.......   125
Labia, emphysema of,  3.....    201
Laryngitis,  2......          104
-   exsudatoria,  2....                109
Lentescent typhus,   1...                256



GENERAL INDEX OF THE FOUR VOLUMES.  253
PAGE
Lepra syphilitica,  4...               232
-  nigricans,  4.....           232
Leucorrhcea,  3......   113
Lichen, simplex,  3.....           40
-  syphiliticus,  4.....  231
Lienitis,  2.....   130
Lienteria,  3.                             108...  o
Lipothymia,  3.1.                         203
Lumbago rheumatica,  2....   77
Lungs, dropsy of,  3.1.                    194
-  cedema of,  3...  194
Maculae, syphilitic,  4......  231
Malum caducnm pulmonum,  4....   94
Mammae, scirrhus and cancer of,  3.... 178
Mastitis,  2.....   166
Measles,  2.....           16
Megrim,  4...   37
Meibomian glands, inflammation of,  2...-199
Melena,  3..        0                 134
Menses, morbid phenomena occurring during,  3...166
- retarded appearance of the firtu.    157
- scanty,  3......  165
-  suppression of,  3.....  159
Meningitis,  2...            170
-  spinosa,  2.......  185
Metritis,  2......   147
Metrorrhagia,  3......   160
Miliaria,  2.....   32
purpurea,  2...   27
Milk-fever,  2...   163
1Miscarriage,  3...  164
Mixtus cruentus,  3...   139
Morbilli,  2.....   16
Morbus caducus,  4.                        166
- cerealis,  4.                     0   150
caeruleus,  4....  183
- eruditorum,  4...  194
- gesticulatorius,  4...  142
-maculosus hmmorrhagicus Werlhofli  3..   154
niger Hippocrat.,  3.....  134
- sacer,  4.....  166
-- virgineus,  4..                 0  188
Myelitis,  2..                           185



254       GENERAL     INDEX   OF THE FOUR       VOLUMES.
PAGE
Nasitie,   2.....             114
Nephritis,  -2....                       142
Nettlerash,    2......     15
Neuralgia,    4......     21
-    eceliaca,  4.....     48
-   facialis,    4.....     24
-    of the heart,   4.....    112
-    of the spinal marrow,   4....     44
Neuroses,     4......     87
Nightmare      4......    109
Noma,      4.......     35
Notalgia,    4.....              44
Odontalgia, rheumatic,     2.....     79
(Esophagitis,    2......    103
Onychia syphilita,    4.....    232
Oophoritis,   2......    150
Ophorites,    2......    150
Ophthalmia,     2......    189
-    arthritic,  2....    194
-    catarrhal,   2.....    191
-   erysipelatous,   2.....     190
-    gonorrhoica,   4.....    217
-    neonatorum,     2.....   201
-    rheumatic,    2.....     193
-    scrofulous,   2.....    197
Ophthalmitis,    2......    189
Orchitis,    2......    168
-    gonorrhoica,    4.....    216
Orthopnaoa,    4......     94
Ostitis,   2......     115
Otitis externa and interna,   2....    187
Ovaries, dropsy of,    3.....    201
Padatrophia,     3......     96
Papule, syphilitic,    4.....    231
Paraplegia,    4......     13
Paralysis,    4......     11
Paraphrenitis,    2......     64
Parotitis,   2.....    112
Passio hysterica,    4.....    115
Perforati9 ventriculi spontanea,  4...          82
Pericarditis,   2......     62
Pericarditis infagtum,   2,....     62
Pericardium, dropsy of,    3....,    195



GENERAL INDEX OF THE FOUR VOLUMES.


255


Peripneumonia,   2.
Perniones,   2.
Pertussis,  4.
Petechie,   2.
Pharyngitis,   2.
Phlegmasia alba dolens,  2.
Phrenesia,   2.
Phrenitis,  2.
Phthisis,   3.
-   florida,  3.
-   hepatica,   3.
-   laryngeal and tracheal   3.
-   meseraica,   3.
-   pulmonary,    3.
Piles,   3.
Pleuritis,  2.
Pleurisy,   2.
Pneumonia,    2.
Pneumonitis,   2.
Pneumo-typhus,    1.
Porrigo larvalis,  3.
Pressing pains in the internal sexual parts,
Proctalgia,  4.
Prosopalgia,  4..
Psoitis,  2.
Psoriasis,  3.
-  syphilitica,  4.
-  -  diffusa,  4..
-   -    guttata,   4.
-  -  plantaris et palmaria  4.
Ptyalism,    3.
Purple-rash,   2.
Purpura rubra,  2.
Pustules, syphilitic,  4.
Putrefaction of the uterus,  2.
Rabies canina,   4.
Raphania,    4.
Rectum, prolapsus of,  4.
Rhachialgia,   4.
-   metallica,   4.
Rhachitis,   3.
Rhagades syphil.,   4.
Rheumatalgia,    2.


3.


PAGE
46
41
89
35
95 and 102
157
174
170
78
87
101
79
96
83
145
60
60
46
46
222
28
201
66
24
86
S  41
232
232
232
232.    109
27
S  27
233
156
157
S  150
68
44
59
61
233.
66



256    GENERAL INDEX OF THE FOUR VOLUMES.


Rheumatic affections,  2.
Rheumatism, acute,   2.
-   gonorrhceic,  4.
-   of the extremities,  2.
-   -   - head,    2.
-   -   - heart,    2.
-   -   - thorax,    2.
-   paralytic  2.
Rhypia,   3.
-   syphilita,  4.


PAGE...    66...    66...   218
68
79
70
76
84
46
233


Rickets,    3...
Roseola syphilitica,  4.....
Rubeole,     2.....
Salivation,   3......
Scabies capitis,  3..
-   vesicularis or lymphatica,  3..
Scaldhead,    3.....
Scales syphilitic,  4....
Scarlatina,   2...
-   and scarlatina complicated with purplerash, means of
preventing,   2....
-   complications of, with other diseases,  2.
-   miliaris Hahnemanni,     2....
-   secondary diseases succeeding,   2.
Scarlet-fever,   2...
Scelotyrbe,   4...
Scirrhus of the stomach,  4...        *
Screams of infants, without any perceptible cause,  3.
Scrophulosis,   3....
Secondary diseases succeeding scarlatina,  2.
Sideratio,   3.....
Skin, dropsy of the,   3...
Smallpox.    2.....
-   spurious,     2..
Softening of the stomach,   4....
Soreness,    2..     ".
-   of the nipples,   2..
Spasm of the bladder,    4..
-   of the glottis,   4..
Spina bifida,   3...
-   nodosa,    3..
Spinitis,   2....
Splenitis,   2.....


61
231
31
109
23
11
23
232
20
26
23
27
24
20
142
77
223
51
24
213
199
4
"13
82
34
166
85
105
61
61
185
130



GENERAL INDEX OF THE FOUR VOLUMES.


257


PAGE
Stomacace,     2......     99
Stomatitis mercurialis,  2.....    101
Strangury, of infants,  3.....    224
Strophulus confertus,  3.....     35
St. Vitus' dance,   4.....    142
Stymatosis,    3.....             143
Suffocatio uterina,  4.....    115
Sycosis capillicii,  3.....     49
Sycosis Hahnemanni,     4....    228
-   menti,    3......     49
Syncope,    3......    203
Syphilis,   4.....             202
-   neonatorum,     4.....    240
-      -     secondary,    4....    231
-      -        -  of eye, 4....    234
-       -       -   - muc. membrane,      4...    234
-      -        -  - osseous, and fibrous syst.  4..    234
Sweating disease,   3.....    111
Swelling of the breasts, of infants, soon after birth,  3..  222
Swellings, partial, of new-born infants, in consequence of heavy
labour,  3......    221
Swoon,     3.......    203
Tarantism,    4......    144
Tenesmus,     4......     66
Testicles, swelling of,  4.....    216
Thrush,     2......     36
Tinea capitis,   3......     23
Tongue, tied,   3......    221
Tracheitis,   2......    104 -Tubercles arising from cold drink,   3...       70
-   arthritic,   3.....     72
-   exanthematic,    3....     71
-   hereditary,    3.....     72
- -impetiginous,    3.....     71
-in the brain,     3....              75
S   -   -  liver,   3.....     77
-   -   -  spinal marrow,    3....     76
-   menstrual and puerperal     3....     69
- pulmonary,     3.....     66
Tuberculosis,   3....                51 and 64
Tumor, bloody, of infants,....    221
Tussis convulsiva,   4....    89
Typhus,     1......   220
VOL. IV.--12



258   GENERAL INDEX-ý OF THE FOUR VOLUMES.
PAGE
Typhus abdominalis,  1.....  222
- bellicus,  1..... 254
-- cerebralis,  1.....         221
- contagiosus  1...            254
- icteroles,  1..                255
- lentus,  1..                  256
p-  I J ~~l tialis,  1....  25
- pneumonalis,  1.... 222
- putridus,  1..... 252
Ulcera pedis,  3.1.                  33
Umbilicus, protrusion of,  3. -... 224
Urethrorrhagia,  3.  -.             143
Urina sanguinea,  3..139
Urine, bloody,  3.1.                 139
Urticaria  2....    -   15
Uterus, cancer of,  3....       169
- dropsy  of,  3.....  200
-- meleorism of,  3.1.            201
- prolapsus  of,  3....  201
- putrefaction of,  2.....  156
- scirrhus of,  3.1.               169
Vagina, prolapsus of.  3.1.          200
-  sore pains in,  3...  201
Varicella,  2....   13
Variola,  '2.                         4
Varioha vacchims, tutorie,  2.... 11
Varioloid,  2.  0                     14
Vomiting  of blood,  3.....  134
Vomuitus cruentus,  3.....  134
Worm-fever,  1......  172
Whites,  3.1.                        113
Whooping-cough,  4..       -    -   89
Zona,  2.  -..    -   40
Zoster,  2..-                       40






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