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THE
IHOMEOPATHIIIC VADE MECUM
OF MODERN
MEDICINE AND SURGERY.



FROM REVIEWS OF THE "VADE MECUM."
" Homcoopathy is now acknowledged in quarters where it was once ignored, and
many who, like the author of this compendium, graduated under allopathic auspices,
have since recognised the superiority of this philosophic school of medicine. We
must confess to having studied this ' Vade Mecum' with deep interest. It is written
in a scholarly and lucid style, and great pains have evidently been bestowed upon its
preparation. From preface to index it wears the aspect of a text-book suited alike
to the professional student, the clergyman of a parish, and the head of a family.
Encouraged by the success which has attended previous efforts in the same field,
DR. RUDDOCK now essays the bolder enterprize of endeavouring to furnish a consecutive, and, we may add, complete view of modern medicine and surgery. The
several functions of the body are familiarly explained, and ' the ills that flesh is heir
to' are carefully enumerated. Diagnosis is, however, wisely supplemented by
medical instruction how to proceed in the absence of a duly qualified practitioner,
or in cases of emergency. Indeed, one could scarcely desire a more convenient book
of reference for the library table or travelling chest. For missionaries we should
think it will be found especially useful, since they are ofttimes lefc entirely without
the resources so available in our dear native land. The work is printed in clear
type, on good paper, and affords unusual facilities for reference."--Church Standard.
"It is exceedingly comprehensive. The descriptions of diseases seem to be
drawn with much care, and are the result of a large amount of experience and
observation; such careful descriptions of the manifestations of various diseases as
will enable the reader, professional or otherwise, to identify with certainty those
which come under his own observation. We commend the book as a most valuable
and useful one."-The Halifax Courier.
" The student and the visitor of the sick will find in the work before us a vast
fund of useful information-information conveyed in a clear and practical style, by
one entitled to speak with authority on the subject. We commend the work to all
homceopathists, and to others interested in the subjects of which it treats."Morning Advertiser.
" That there are among the popular guides to hommeopathic practice some which
are as perfect as, under the condition of non-technicality, they can be, is acknowledged; and it is no slight recommendation to Dr. Ruddock's Fade illecum, to say
that, in its order, arrangement, and details, it is equal to the best."-The Tomozopathic Review, July, 1864.
"The present volume is, throughout, a thoroughly practical work. 'The chapters
on the nature and treatment of diseases are the result of many years' close observation and practical application in the two largest hospitals of London-St. Bartholomew's and Guy's-in dispensary practice with other homceopathic medical
men, in thd consulting room, and at the bedside.' The gentleman who can use
such languqge as this with truth, is not to be shoved aside as an empiric. The
work is very comprehensive; in all respects answering to its title. It is calculated
to do much good."--British Standard.
"The volume is carefully compiled, and evidences the experience which the
author has had in the London hospitals."--The Reader.



THE
HOMI(EOPATHIC VADE MECUM
OF MODERN


MEDICINE AND


SURGERY.


FOR THE USE OF
JUNIOR PRACTITIONERS, STUDENTS, CLERGYMEN,
MISSIONARIES, HEADS OF FAMILIES, ETC.
BY
E. HARRIS RUDDOCK, M.D.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL
COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND
EDINBURGH, ETC. PHYSICIAN TO THE READING AND
BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of " The Stepping Stone to Homcopathy and Health," " Te Lady's
Manual of Homropathic Treatment," etc. Editor of
"The Hoomeopathic World."
SECOND EDITION, MUCH IMPROVED AND ENLARGED.
LONDON:
JARROLD AND SONS, 12, PATERNOSTER ROW.
And all Homoopathic Chemists and Booksellers.
1867.



*?/smaLvq 1999.S UjOPUOV      'OSY Puv P2O.u4jf liq pOMUt4J



PREFACE.


The publication of five editions of "The Stepping-Stone
to Homoeopathy and Health," comprising forty thousand
copies, has materially facilitated the preparation of "The
Vade Mecum; "      while an extensive correspondence with
many of the readers of the former work has led to a more
intimate acquaintance with the requirements of persons
consulting a domestic book.
The work, however, is designed, not for domestic use
alone, but for junior practitioners also.  The author may
therefore be permitted to remark, that the chapters on the
nature and treatment of disease are the result of many
years' close observation and practical application in the two
largest hospitals of London (St. Bartholomew's and Guy's),
in dispensary   practice, in  the consulting-room, at the
bedside, and in conference with other homoeopathic physicians. He therefore presents the work to such, and to all
who desire to find the most certain and speedy means of
relieving suffering, and of prolonging life, with confidence;
and predicts the happiest results whenever the directions of
the Manual are faithfully carried out.
Objections have been made to domestic medical works,
both on the ground of their danger, and as likely to inter* From Vadle, go, and mecum, with me, a Latin phrase applied to a book
which a person carries with him for its constant usefulness.



vi


PREFACE.


fere with the legitimate pursuits of the profession. Neither
objection is of any force. It is well known that in nearly
every  family  domestic drugs are employed-castor oil,
Epsom   salts, rhubarb, sulpkur, magnesia, antibilious pills,
and even preparations of mercury and opium. We are not
responsible, therefore, as originators of domestic treatment;
but finding drugs everywhere in use, we have sought to
reform the practice by substituting remedies and suggesting
measures, whose virtue is that they are not only more
harmless, but very much more efficacious than those too
frequently adopted. Departures from health, at first simple
and uncomplicated, frequently occur, the nature of which
then is so plain, and the treatment so obvious, that with the
guidance of a work like the present, a safe course may be
taken.   Hence it is that we have made most prominent
diseases of common occurrence-cold, fever, dyspepsia, etc.,
at the early stages of which appropriately selected remedies
may be administered with good hope of success, but which,
neglected, might lay the foundation of most intractable and
fatal maladies.
At the same time, it is proper to add, that in all serious
cases, or when the treatment suggested is insufficient quickly
to bring about the necessary improvement, professional
advice, if possible, should be procured. The vast resources
which a professional homoeopath has at command, of which
the present volume represents but an inconsiderable fraction,
should encourage hope in most difficult and complex cases.
The learning of the medical schools is as essential for the
general homoeopathic practitioner as for the allopathic, and



PREFACE.


vii


cases are of frequent occurrence in which it is impossible to
act judiciously without an acquaintance with anatomy, physiology, pathology, surgery, etc. A most obvious advantage,
xendering professional treatment when accessible, always
preferable, is the one just referred to, namely, the amplitude
of the resources at the command of a medical man, including
hundreds of remedies, in various forms and attenuations.
Successful treatment depends not alone on the choice of the
right remedy, but also on its adaptation in form and strength
to the age, sex, habits, temperament, or idiosyncrasies of
the patient. In this respect, the writer is neither an exclusively high or low dilutionist, ranging his remedies from
high attenuations to the strong tincture or trituration, but
more frequently preferring the lower forms, as often better
adapted to impress the affected tissues, and with little of that
risk of aggravating existing symptoms which have been held
forth with such exaggerated prominence.
The writer has freely quoted from the works of many of
the highest authorities, both in the new and old school of
medicine; such quotations are duly acknowledged, although
he may have used the illustrations and arguments of writers
or lecturers which he has unintentionally omitted to note,
and which, as the materials for the work have been in course
of preparation for many years, he cannot now supply.
The diseases peculiar -to the female sex are not specially
considered in this work, for several reasons. 1. The author
has already issued a manual on the subject, which has
reached a second edition, and been extensively circulated.
2. The subject is one of such amplitude and importance as



viii


PREFACE.


to demand a separate treatise. 3. It is, further, most undesirablo to enter into many details, which are necessary to be
intelligent and useful, in a work intended for general readers.
This consideration alone seems to justify its isolation in a
separate form.   At the same time, the subject is by no
means overlooked in the present work.       Much valuable
information may be gathered from the "Materia Medica,"
where, grouped under appropriate sections, it will be readily
available.
In conclusion, the author trusts that the contribution he
here makes to the knowledge of the laws of health, that
element in life which is so essential to its happiness and
usefulness, may serve as a faithful guide to its preservation
to the expiration of the ' threescore years and ten, or fourscore years" span of human life; not merely by avoiding
those multiform causes which often immediately destroy it,
but by raising that health to such a high state of perfection
in which, with the blood coursing cheerily through its
vessels, firm muscles, well-strung nerves, exuberant spirits,
and a mind clear as the light, existence is truly enjoyable,
and the duties of life are performed with such vigour and
zest, as to invest with a charm what would be, with less
exalted health, irksome and disagreeable,-the point of view
from which he anticipates the greatest amount of good from
his publication.
E. HARRIS RUDDOCK.
12, Victoria Square, Reading,
December, 1866.



PREFACE TO THE SECOND EDITION.


In this edition every page has been carefully revised,
many entirely new sections have been introduced, while
extensive additions have been made throughout the work, all
of which have a practical bearing.
There are yet, however, many points which we have not
been able to include in this edition, the chief of which are
the following:1. A short description of various remedies found valuable
in practice, and occasionally prescribed in the body of the
work, but not included in the list, pages 46-7.
2. A chapter on Toxicology.
3. A clinical index.
4. A longer list of medical and surgical diseases.
As time and opportunity permit we shall arrange the
materials for these additions, so as to be prepared to publish
them when occasion demands.



HINTS TO THE READER.


The author earnestly requests attention to the following
points:I. Persons desirous of being able to exercise the best
measures for preventing and removing suffering, should read
this manual through, from   the first page to the last, as
many important practical points are scattered through the
various sections, but which, to economise space, are not
repeated, and so may be lost to those who only read detached
portions. Even after reading it through, an occasional halfhour spent in studying the manual will facilitate its consultation in cases of urgency. The novice in Homoeopathy should
first read "The Stepping-Stone to Homceopathy and Health,"
especially the introductory chapters.
II.  When the work is consulted for the treatment of any
particular affection, the whole section devoted to it should be
studied-the symptoms, causes, medicines, and accessory
means-before deciding on any course of treatment. One
portion of a section often throws light upon another, and
hesitation in the choice between two or more remedies may
often be removed by considering the causes or symptoms of
the disease under treatment. As a rule, as far as practicable,



HINTS TO THE READER.


xi


the medicines are prescribed in the order in which they are
most likely to be required, or in the order of their importance; this, however, must never be taken for granted, but
the remedy or remedies administered strictly according to
the present symptoms of the patient.
III. Occasionally, remedies are prescribed without describing the symptoms, or but very imperfectly, by which
their use is indicated.   Under such    circumstances, and
whenever in doubt in choosing the remedy, the reader is,referred to the MATERIA BMEDICA, which forms a very important chapter in the volume.     An attentive study of this
portion of the work will give a broad and tolerably exact
knowledge of many valuable remedial agents, and a measure
of skill in using them.
IV. The utility of the work may be greatly increased by
having it interleaved* for recording the results of cases
treated, and general observations. Whoever faithfully carries out this hint will accumulate a valuable store of information, the retrospect of which will be interesting and
encouraging in the highest degree.
V. Facility of reference may be secured by acquaintance
with the arrangements of the Manual; it is divided into
parts, chapters, and sections, and the headings on the top
of the pages indicate the general and particular disease under
consideration.  Medical terms are occasionally used, but
they are either explained 'in the text, or in the list of Hard
Words which follow the Materia Medica. The index at the


"* Interleaved copies may be procured from the publishers.



Xii               HINTS TO THE READER.
end of the volume is very copious, and every point of importance may be found by it.
VI. Lastly, the author desires to make this a thoroughly
useful Manual; he will therefore be glad to receive suggestions and notes of the experiences of persons using it. Any
points likely to be of value, in preparing another edition, of
a directly practical character, sent to the author, will be
thankfully received, and will aid in making it what he
desires it to be, a reliable guide to good health.



CONTENTS.
PART I.
INTRODUCTORY.
CHAPTER I.
PAGE
OBSERVATIONS PERTAINING TO HEALTH (Hygiene)..   9
Diet - Brown Bread - Cooking -Water - Air -Light- ExerciseClothing-Bathing-The Wet Pack-Influence of Professions and
Occupations on Health.
CHAPTER II.
SIGNS AND SYMPTOMS OF DISEASE.....   88
The Pulse-The Tongue-Breathing-Pain-The Skin-The Urine.
CHAPTER III.
THE MEDICINES, ETC........ 45
Tinctures-Pilules-Globules-Triturations-List of Principal Medicines-Matrix Tinctures, for External Use-Directions for Taking
the Medicines-The Dose-Alternation of Medicines-Drugs, etc.
PART II.
MEDICAL AND SURGICAL DISEASES, AND THEIR
HOM(EOPATHIC TREATMENT.
CHAPTER I.
FEVERS.......... 52
Simple Fever-Inflammatory Fever-Typhoid Fever-Typhus Fever
-Intermittent Fever, Ague-Hectic Fever-Hay Fever, Hay
Asthma.



xiv       '


'CONTENTS.


CHAPTER II.
PAGE
THE ERUPTIVE FEVERS.......  96
Measles - Scarlet Fever, Scarlatina - Small-pox - Vaccination -
Chicken-pox-Erysipelas.
CHAPTER III.
DISEASES OF THE ORGANS OF BREATHING.... 122
Cold in the Head-Influenza-Hoarseness, Loss of Voice-Clergyman's
Sore Throat-Cough-Hooping-cough-Bronchitis-Chronic Bron-.chitis-Asthma-Asthma of Children-Inflammation of the Pleura
-False Pleurisy-Inflammation of the Lungs-Croup-Diphtheria
-Consumption-Domestic Accessories in various Inflammatory,
Debilitating Diseases.
CHAPTER IV.
DISEASES OF THE ORGANS OF DIGESTION.... 193
Digestion, Why we Eat-Indigestion-Loss of Appetite-Voracious or
Depraved Appetite-Biliousness-Spasms or Pain in the Stomach
-Heartburn-Waterbrash-Nightmare-Vomiting-Sea Sickness -
Flatulence-Constipation, Confined Bowels-Colic-Painters' Colic,
'Lead Colic-Diarrhcea, Looseness of the Bowels, Purging-Dysentery, Bloody-Flux-Asiatic Cholera-Worms.
CHAPTER V.
AFFECTIONS OF THE LIVER....... 253
Inflammation of the Liver-Chronic Inflammation of the Liver, Liver
Complaint-Jaundice, The Yellows.
CHAPTER VI.
DISEASES OF THE ANUS....... 260
Piles-Protrusion of the Lower Bowel-Fistula in Ano-Itching of
the Anus.
CHAPTER VII.
DISEASES OF THE URINARY ORGANS.... 272
Inflammation of the Kidneys-Inflammation of the Bladder-Difficulty
in passing Urine-Incontinence of Urine-Wetting the Bed-Retention and Suppression of Urine-Inflammation of the Urethra.



PART I.


INTRODUCTORY.
CHAPTER I.
OBSERVATIONS PERTAINING TO HEALTH (Hygiene).
1.-Diet.
HOM(EOPATHY is not a mere system of dietetics. Extended
observation proves that the curative action of medicines,
chosen according to the homoeopathic law, is but little
affected by ordinary food or beverages; hence beyond the
prohibition of certain articles which stimulate the system
too much, clog it in its operations, or impose on weak or
diseased organs a task to which they are unequal, homoeopathic physicians interfere but little with their patients'
diet.
The food of the invalid, however, must be regulated
according to the nature, stage, and progress of the malady;
therefore, the diet appropriate in acute and chronic diseases
will be found prescribed in the following pages.
Respecting the diet of healthy persons, the following
suggestions, with occasional modifications, will, in general,
be found suitable. The plan is chiefly from Dr. Williams'
" Principles of Medicine."
Breakfast at eight, a.m., of bread or dry toast, with a
moderate quantity. of fresh butter. A new-laid egg, boiled
three minutes; or a little mutton, beef, home-fed boiled
bacon, cold chicken, or game, may be added for those who
make much bodily exertion.    A breakfast-cupful of cocoa,
deprived of its excess of oil, such as is sold by most
B



10


OBSERVATIONS ON HEALTH.


homoeopathic chemists, or black tea, with milk, may be
substituted; but the latter is less nutritious.
Dinner at one, p.m. Wholesome fresh meat and vegetables, carefully proportioned, plainly cooked, served hot,
and properly masticated. These should be varied from day
to day, with occasional additions, in moderate quantities,
of fruit or farinaceous puddings; and fish occasionally substituted for animal food. Highly-seasoned dishes, pickles,
salt and dried meats, rich and heavy pastry, and cheese,
should be excluded from tables aiming at wholesomeness.
Persons who are accustomed to take much exercise, and are
weakly, may take a small quantity of malt liquor, never
exceeding half a pint: bitter ale is the lightest, and porter
or stout is, perhaps, the more sustaining. But, in by far
the majority of cases, fermented liquors had better be avoided
altogether for dinner, and a few sips of filtered water substituted. Too much cold water lowers the temperature of
the stomach, and so interrupts digestion. The habit of taking
wine after dinner is one of luxury, not of health; and all
that can be said of it, from a hygienic point of view, is
the less the better.  An occasional slight dessert of wholesome fruit is not objectionable.
Tea or supper may be taken at six, p.m., and include
one or two cups of black tea, bread or dry toast with butter,
fruit, or marmalade, as may be found most digestible or
agreeable. If it is the last meal in the day, and the person
is not plethoric, and takes a great amount of physical
exercise, the meal may include a little light meat, chicken,
or white fish.
A different arrangement is necessary for those who dine
late-say at five or six, p.m.-as then a luncheon should be
taken at about one, p.m., which may consist of a small basin
of good shin-of-beef soup, with vermicelli, rice, or toasted
bread in it. But if meat have been taken at breakfast, a



DIET.


11


biscuit, or bread and butter, or a small sandwich may suffice;
wine and malt liquors are better avoided at this time. At
five or six, dinner may be taken, and include the dishes
already mentioned. The custom of taking tea, or a simple
warm liquid meal three or four hours after dinner, is a very
salutary one, as the warm liquid assists the separation and
absorption of the chyle from the chyme, which is effected at
this period. But the introduction of solid food, especially
large quantities of buttered-toast or rich cake, would
seriously interfere with this process. Two moderate cups of
black tea, with a little milk and sugar, form a useful and
agreeable beverage, and serve to remove all acrid materials
left undissolved by digestion, and which, if not carried off,
might disturb that rest for which the appropriate hour now
approaches.
When convenient, the dinner hour may be advantageously
deferred until five or six, p.m., so that sufficient time may
be devoted to it, and that rest taken after it which the
principal meal requires, but which it is often impossible to
give to it in the middle of the day. The chapter on " Indigestion" contains almost everything necessary further to
be remarked on the subject of diet, and to that the reader
is referred.
2.-Brown Bread.
The importance of bread, aptly termed the " staff of life,"
the common food of all classes, and its abundance being
properly regarded as one of our greatest national blessings,
seem to justify a brief inquiry into the kind most conducive
to health. Wheat contains the following principles, which
slightly vary in different samples:Water...   11 per cent  Gum...   4 per cent.
Gluten..     13           Oil..      2,
Starch...   60,,      Bran (the thin exterSugar               8.          nal husk).    2



12


OBSERVATIONS ON HEALTH.


It is important to remark that these elements are not
uniformly distributed throughout a kernel of wheat.  Immediately beneath the thin external covering is a layer of
darkish coloured matter, most rich in gluten, and in which
the chief of the oil in the wheat exists in minute drops
enclosed in its cells. In the ordinary course of grinding
and dressing, a large portion of this is removed from the
superfine flour, as it is not so readily reduced to a fine
powder, and hence is rejected with the middlings and bran.
Beneath this dark layer is the heart of the kernel, which is
very white and chiefly composed of starch, and from it the
best looking and finest flour is made. This portion is not
absolutely destitute of gluten, nor is the dark portion free
from starch; but they exist in excess in the parts indicated.
The mineral ingredients of a kernel of wheat are also
unequally distributed. They are chiefly, phosphoric acid,
potash, soda, magnesia, oxide of iron, sulphuric acid, salt,
and silica; and in superfine flour they exist in the proportion of a little over 1 per cent.; in the next quality between
3 and 4 per cent.; still coarser flour, about 5 per cent.; and
bran 7 per cent. Thus it will be seen that fine flour contains
but a small portion of those mineral ingredients which are
found in wheat before grinding, a large portion being cast
off with the bran.
But the mineral constituents of the vegetables we consume
are as indispensable to the human organization as any
other; experiments upon the inferior animals prove that
their withdrawal from vegetable food is prejudicial, and that
animals so fed perish from starvation. Mineral ingredients
form the nourishment for important parts of the animal
economy, and, dissolved in the blood, are taken up at
points where they are necessary to sustain local parts.
Thus phosphates of lime are required by the bones, phosphates
of magnesia and potash   by the muscles, soda by the



BROWN BREAD.


13


cartilages, phosphorus by the brain; silica by the hairs and
nails; and iron by the red globules of the blood, and black
colouring matter within the eye.
The dark portion which chiefly contains the gluten; the
most nutritious constituent of the wheat kernel, is almost
entirely separated in the process of dressing; while the central
is almost wholly starch, and of much less value to the body.
In thus rejecting the dark portion which immediately underlies
the bran, and is almost entirely removed with it, and used
for the food of our cattle, we lose the most nutritious as well
as the sweetest portion of the grain.
In the preparation of wheat for the purpose of food, it
should be borne in mind that its value depends not upon
the quantity of starch it contains, but upon the amount of
gluten, and any process which diminishes this element is
most objectionable.
The mere bran, without its underlying strata, may be
partially removed without much detriment, for though
useful in obstinate constipation, it is irritating to the
mucous membrane of the alimentary canal of some persons.
In such cases the coarse portions of bran may be removed,
but not to the extent of divesting it entirely of the bran and
the darker portion referred to, and thus to sacrifice its
nourishing properties for mere fineness or whiteness of
bread.
3.-Cooking.
Much depends, as to the digestibility and nourishing
properties of animal food, on the mode in which it is prepared
for the table. The following passage from Professor Johnstone's work contains at once the whole theory of the art
of cooking meat, and we give it entire, as such knowledge
cannot be too widely diffused:" In cooking animal food, plain boiling, roasting, and



14


OBSERVATIONS ON HEALTH.


baking, are in most general favour in our islands. During
these operations, fresh beef and mutton, when moderately
fat, lose on an average aboutIn boiling.  In baking.  In roasting.
4 lbs. of beef lose...  1 lb.  1 lb. 3 oz.  1 lb. 5 oz.
4 lbs. of mutton lose  14 oz.  1 lb. 4 oz.  1 lb. 6 oz.
The greater loss in baking and roasting arises chiefly from
the greater quantity of water which is evaporated, and of fat
which is melted out during these two methods of cooking.
Two circumstances, however, to which it has not hitherto
been necessary to advert, have much influence upon the successful result of these and some other modes of cooking.
" If we put moist flesh-meat into a press and squeeze it, a
red liquid will flow out. This is water coloured by blood,
and holding various saline and other substances in solution.
Or if, after being cut very thin, or chopped very fine, the
flesh be put into a limited quantity of clean water, the juices
of the meat will be gradually extracted, and by subsequent
pressure will be more completely removed from it than when
pressure is applied to it in the natural state, and without any
such mincing and steeping. The removal of these juices
leaves the beef or mutton nearly tasteless. When the juice
of the meat, extracted in either way, is heated nearly to
boiling, it thickens or becomes muddy, and flakes of whitish
matter separate, which resemble boiled white of egg. They
are, in fact, white of egg or albumen; and they show that
the juice of flesh contains a certain quantity of this substance,
in the same liquid and soluble state in which it exists in the
unboiled egg. Now, the presence of this albumen in the
juice of butchers' meat is of much importance in connection
with the skilful preparation of it for the table.
" The first effect of the application of a quick heat to a
piece of fresh meat is to cause the fibres to contract, to
squeeze out a little of the juice, and, to a certain extent, to



COOKING.


15


close up the pores so as to prevent the escape of the remainder.
The second is to coagulate the albumen, and thus effectually
and completely to plug up the pores, and to retain within the
meat the whole of the juice. Thereafter, the cooking goes on
through the agency of the natural moisture of the flesh.
Converted into vapour by the heat, a kind of steaming takes
place, so that whether in the oven, on the spit, or in the
midst of boiling water, the meat is in reality, cooked by its
own steam.
" A well-cooked piece of meat should be full of its own
juice or natural gravy. In roasting, therefore, it should be
exposed to a quick fire, that the external surface may be
made to contract at once, and the albumen to coagulate,
before the juice has had time to escape from within. And so
in boiling. When a piece of beef or mutton is plunged into
boiling water, the outer part contracts, the albumen which is
near the surface coagulates, and the internal juice is prevented
either from escaping into the water by which it is surrounded,
or from being diluted and weakened by the admission of
water among it. When cut up, therefore, the meat yields
much gravy, and is rich in flavour. Hence a beaf-steak or
mutton-chop is done quickly, and over a quick fire, that the
natural juices may be retained.
" On the other hand, if the meat be exposed to a slow fire,
its pores remain open, the juice continues to flow from within
as it is dried from the surface, and the flesh pines and becomes dry, hard, and unsavoury. Or if it be put into cold or
tepid water, which is afterwards gradually brought to a boil,
much of the albumen is abstracted before it coagulates, the
natural juices for the most part flow out, and the meat is
served in a nearly tasteless state. Hence to prepare good
boiled meat, it should be put at once into water already
brought to a boil. But to make beef-tea, mutton-broth, or
other meat soups, the flesh should be put into cold water,



16


OBSERVATIONS ON HEALTH.


and this afterwards very slowly warmed, and finally boiled.
The advantage derived from simmering, a term not unfrequent
in cookery books, depends very much upon the effects of slow
boiling as above explained."
It is a cause of regret to find how very extensively the
principles expressed in the above quotation are disregarded.
Even in well-informed circles, there exists lamentable
ignorance or extreme carelessness as to the proper method
of cooking animal food so as to utilize its most valuable
constituents.
4.-Water.
There is no drink in the world so wholesome, or, to the
unperverted taste, so agreeable, as pure water. It is the
natural drink of man, is highly favourable to digestion, and
may always be taken in moderation when thirst is present.
It enters into the composition of the tissues of the body,
forms a necessary part of its structure, and performs such
important purposes in the animal economy as to be absolutely
indispensable for life and health. Water enters largely into
combination with our food, and articles that we take as food
can only afford nourishment by being dissolved in it. It also
acts as a vehicle to convey the more dense and less fluid
substances from the stomach to their destination in the body.
It gives fluidity to the blood, holding in suspension, or solution, the red globules, fibrine, albumen, and all the various
substances which enter into the different structures; for the
whole body is formed from the blood. Not only the soft
parts of the body, but even the very bones, or the materials
of which they are composed, have at one time flowed in the
current of the blood, suspended or held in solution in water.
To prove how essential water is for the development and
maintenance of the animal body, we may here state that a
calculation has been made which shows that a human body,



WATER.


17


weighing 154 lbs., contains 111 lbs of water. Such a fact
suggests the necessity of obtaining water pure, and of
taking it unpolluted by animal and mineral ingredients.
When practicable, water for domestic purposes should be
filtered.
Water may be obtained tolerably pure in rain or snow
collected in suitable vessels in the open country, away from
crowded dwellings and manufactories, where processes are
constantly going on which tend to deteriorate the water.
Spring, river, sea, surface, well, and mineral water, all contain
various substances dissolved in them, which render them,
without distillation or filtration, unsuitable for drinking, or
even to be used in the preparation of articles of diet. The
purest water is obtained from deep wells, bored through the
earth and clay down to the chalk (Artesian Wells). Even for
cooking purposes and bathing, the purest water that can be
obtained is the best.
It is a fallacy to suppose that surface well-water is purer
Sthan that obtained from deep wells because it is more sparkling and often cooler and clearer. The sparkling of these
waters is due to the presence of carbonic acid gas, that acid
being derived from the decomposition of animal and vegetable
substances.
" The situation of these wells, especially in London, explains the origin of these impure matters. The water that
supplies the surface-wells of London is derived from the rain
which falls upon the surface of the land, and which percolates
through the gravel, and accumulates upon the clay. Now
this gravel contains all the soakage of London filth; through
it run all the drains and sewers of London, and its whole
surface is riddled with innumerable cesspools. Here is the
source of the organic matter of surface well-waters, and also
the cause of their coolness, their sparkling, and their popularity. In most small towns there is a public pump, and,



18


OBSERVATIONS ON HEALTH.


when this is near the churchyard, it is said to be always
popular. The character of the water is no doubt owing to
the same causes as that of London surface wells, the remains
of humanity in the churchyard supply the nitrates and carbonic acid of the water.
From this kind of impurity the water of deep wells in
London, and of wells cut into rocks which bring their water
from a distance from towns, are entirely free.   They frequently contain inorganic salts in abundance, but they do
not contain organic matters; hence, for drinking purposes,
they are very preferable to the waters of surface-wells. A
great number of these wells exist in London. There is one
attached to almost every brewery in London; and other manufacturers, who need pure water for their operations, sink
these wells."-Lancaster.
Not one of the least important objects contemplated
in  the publication  of this work is the removal of a
foolish prejudice, which unhappily exists in the minds of
many, to pure water, an element which God has provided
for His creatures with the most lavish abundance; and of
promoting, both for internal and external purposes, in health
and sickness, a more regular use of this invaluable boon and
blessing. Pure water has justly been regarded as an emblem
of innocence, truth, and beauty. In a community in which
this element shall be used as the chief beverage, and more
abundantly for purposes of purification, we may hope to find
in the morals of the people reflections of virtue of which
water is so vivid a type. And, in a sense which more immediately bears on the subject of this manual, suffering will be
more easily controlled by our remedies, and the development
of those latent tendencies to disease most effectually prevented, which the habits and fashions of the present age
seem to favour.



AIR.


19


5.-Air.
A proper supply of pure, fresh air is essential for the preservation of life and health.  Although life may not be
destroyed suddenly by breathing an impure atmosphere, still
the vital energies are slowly but surely impaired thereby;
and this is especially the case with growing children, and
persons suffering from disease.
AIR SPOILED BY BREATHING.-It will be sufficient for
our present purpose briefly to state, that in the process of
breathing the air loses its oxygen, the life-giving principle,
and receives in exchange carbonic acid gas, a gas not only
incapable of supporting life, but actually destructive of it.
Such is the change effected by a solitary act of breathing;
and if this process goes on in an ill-ventilated room where
several human beings are gathered together, the carbonic
acid gas accumulates, usurps the place of the oxygen
consumed, and so renders the air less and less fit for
the purposes of the renewal of life. Carbonic acid gas
cannot support combustion; hence a lighted candle partially
or completely surrounded by it, burns slowly or goes out; so
is it with human beings, when more or less completely
enveloped in an atmosphere charged with this gas; all the
functions of the body are tardily and imperfectly performed;
the muscular tissues are enfeebled, the breathing becomes
oppressed, the head aches, and in extreme cases, life is extinguished amidst sufferings of the most distressing nature.
AIRY SLEEPING RooMS.-The fact that carbonic acid
gas is inimical to health and life, shows the importance
of making provision for its uninterrupted removat from our
houses and places of assembly, and above all, from our
sitting rooms and sleeping rooms, in which we pass so
large a portion of our lives.  Airy, well-ventilated sleeping
apartments should be ranked with the most important re



20


OBSERVATIONS ON HEALTH.


quirements of life, both in health and disease. Bed-rooms,
in which about one-third of human existence is passed,
are generally too small, crowded, and badly ventilated.
Often the doors, windows, and even chimneys are closed,
and every aperture carefully guarded so as to exclude
fresh air. The consequence is, that, long before morning
dawns, the atmosphere of the whole apartment becomes
highly noxious from the consumption of its oxygen, the
formation of carbonic acid, and the exhalations from the
lungs and the relaxed skin. Under such circumstances, the
sleep is heavy and unrefreshing, partaking more of the character of insensibility. Were there due provision for the
uninterrupted admission of fresh air, and the free escape
of impure air, the sleep would be lighter, shorter, and
more invigorating. In nearly every instance, the door of the
bed-room may be left open, and the upper part of the
window let down a few inches-a greater or less extent
according to the state of the weather-with perfect safety.
A current of air may be prevented from playing on the face
of the occupant, by placing the bed in a proper situation, or
by suspending a single curtain from the ceiling. We may be
permitted to add, we always sleep with a portion of the top
sash of the window down, except in very wet, windy, or
foggy weather; even then the door of communication with
the adjoining room or landing remains open. During foggy
weather, the apertures directly communicating with the
external air may be closed.
The importance of the subject is very correctly and strikingly put by a medical writer of the last century. " If any
person," he remarks, "will take the trouble to stand in the
sun, and look at his own shadow on a white plastered wall,
he will easily perceive that his whole body is a smoking
mass of corruption, with a vapour exhaling from every part
of it. This vapour is subtle, acrid, and offensive to the



AIR.


21


smell; if retained in the body it becomes morbid; but if
re-absorbed, highly deleterious. If a number of persons,
therefore, are long confined in any close place not properly
ventilated, so as to inspire and swallow with their spittle the
vapours of each other, they must soon feel its bad effects."
Unpleasant as it is to dwell on such a subject, it is yet true
that the exhalations from the human lungs and skin, if
retained and undiluted with a continuous supply of oxygen,
are the most repulsive with which we can come in contact.
We shun the approach of the dirty and the diseased; we
hide from view matters which are offensive to the sight and
the smell; we carefully eschew impurities in our food and
drink, and even refuse the glass that has been raised to the
lips of a friend. At the same time, "we resort to places of
assembly, and draw into our mouths air loaded with effluvia
from the lungs and skin and clothing of every individual in
the promiscuous crowd: exhalations, offensive to a certain
extent, from the most healthy individuals, but which, rising
from a living mass of skin and lung in a state of disease,
and prevented by the walls and ceiling from escaping, are,
when thus concentrated, in the highest degree deleterious
and loathsome" (Bernan).
CAUTIONS AS TO BADLY VENTILATED CHURCHES, ETC.-The
great practical inference is, that the only means of preventing people from poisoning themselves and others is
to ensure their being constantly surrounded by fresh air;
otherwise, low fevers may result, and such acute diseases as
scarlatina, measles, small-pox, etc., may be excited in epidemic forms, marked by a class of symptoms described in
medical terms as "typhoid " or malignant. The air of an
apartment containing several human beings, if unchanged,
not only becomes charged with carbonic acid gas, but also,
as before stated, impregnated with animal particles which
fly off from the skin and lungs, so minute as scarcely to be



22


OBSERVATIONS ON HEALTH.


detected by the microscope, but capable of decomposition;
and, taken by the breath into the lungs, may be absorbed
and develop the worst forms of scrofula and consumption.
But if these particles are given off from bodies affected with,
or recovering from, small-pox, scarlet fever, hooping-cough,
typhus, etc., they will exert a most injurious influence upon
the health, and probably generate in other bodies diseases like
those from which they emanated. It is most important to
bear in mind that the assembly in an ill-ventilated church,
court of law, school-room, theatre, ball-room, or evening
party, may include in its number some as yet unsafe convalescents from these or kindred diseases. The only security
we can suggest is, as far as possible to avoid all places of
public resort or private gatherings in which the most ample
provision is not made for the admission of fresh air, and for
the uninterrupted escape of air spoiled by carbonic acid gas
or animal exhalations.*
6.-Light.
The importance of sunlight for physical development and
preservation is not, it is believed, duly appreciated. Women
and children, as well as men, in order to be healthy and well
developed, should spend a portion of each day where the solar
rays can reach them directly. Just as sprouts of potatoes in
dark cellars seek the light and are colourless till they come
under its influence, and as vegetation goes on but imperfectly
in places where sunlight does not freely enter, so the cheeks
of children and adults who live almost entirely in dark kitchens, dingy alleys, and badly-lighted workshops, are pale,
and their bodies feeble. Houses are only fit to be occupied
at night that have been purified and dried by the solar rays
during the day.


*See "Ventilation in Cold Weather," in "The Homoeopathic World,"
January, 1866.



LIGHT.


23


It has been pointed out by Dr. Ellis that women and
children in the huts and even log cabins of America, which
contain only one or two rooms, remain healthy and strong;
but that, after the settler has built a house, and furnished it
with blinds and curtains, the women and children become
pale-faced, bloodless, nervous, and sickly; the daughters
begin to die from consumption, and the wives from the
same or some disease peculiar to women. At the same time,
the adult males, who live chiefly out of doors, continue
healthy.
The value of sunlight, with its accompanying influences,
for animal development, may be illustrated by such facts as
the following:-In decaying organic solutions, animalcules
do not appear if light is excluded, but are readily organized
when it is admitted. The tadpole, kept in the dark, does
not pass on to development as a frog, but lives and dies
a tadpole, and is incapable of propagating his species. In
the deep and narrow valleys among the Alps, where the
direct rays of the sun are but little felt, cretinism, or a state
of idiocy, more or less complete, commonly accompanied by
an enormous goitre, prevails, and is often      hereditary.
Rickets, or deformities, crookedness, and enlargement of
the bones, are very common among children who are kept in
dark alleys, cellars, factories, and mines.
During the prevalence of certain epidemic diseases, the
inhabitants who occupy houses on the side of the street
upon which the sun shines directly, are less subject to the
prevailing disease than those who live on the shaded side.
In all cities visited by the cholera, the greatest number
of deaths took place in narrow streets, and on the sides
of those having a northern exposure, where the salutary
beams of the sun were excluded. It is said that the number
of patients cured in the hospitals of St. Petersburg was four
times greater in apartments well lighted than in confined,



24


OBSERVATIONS ON HEALTH.


and dark rooms. This discovery led to a complete reform in
lighting the hospitals of Russia, and with the best results.
Except in severe inflammatory diseases of the eyes or
brain, the very common practice of darkening the sick room
is a highly prejudicial one.   The restorative influence of
daylight is thus excluded, and also the grateful and natural
succession of light and darkness, the two always making up
the same period of twenty-four hours, which favours sleep
at the appropriate time, and divests the period of sickness
of the monotony and weariness of perpetual night.
7.-Exercise.
Exercise strengthens and invigorates every function of the
body, and is essential to health and long life. No one in
health should neglect to walk a moderate distance every day
in the open air, if possible in the country, where the invigorating and balmy air of nature can be freely inhaled. Walking
is the healthiest as well as the most natural mode of exercise.
Other things being equal, this will ensure the proper action
of every important function. The walk for health should be
diversified, and if possible include ascents and descents, and
varying scenery; and be alternated, when circumstances
admit of it, with riding on horseback, active gardening,
or similar pursuits, and with gymnastics and games of
various kinds. Athletic sports and manly exercises should
form a part of the education of youth, nor should they be
neglected in after life, especially by persons of sedentary
pursuits. Many aches and pains would rapidly vanish if
the circulation were quickened by a judicious and regular
use of the muscles. These modes of exercise, practised
moderately and regularly, and varied from day to day, are
much more advantageous than the exciting, immoderate,
and irregular exertions which characterize the ball-room,
the hunting-field, and even the cricket-ground or the rowing



EXERCISE.


25


match. These exercises are sometimes pursued so violently
as to be followed by severe and permanent injury to the
constitution. In the case of very feeble and infirm people,
carriage exercise, if it may be so called, and frictions, by
means of towels and bath gloves, over the surface of the
body and extremities, are the best substitutes for active
exertion.
The best periods for exercise are, when the system is not
depressed by fasting or fatigue, or oppressed by the process
of digestion. The robust may take exercise before breakfast;
but delicate persons, who often become faint from exercise
at this time, and languid during the early part of the day,
had better defer it till from one to three hours after breakfast. An evening walk in fine weather is also advantageous.
Exercise prevents disease by giving vigour and energy to
the body and its various organs and members, and thus
enables them to ward off or overcome the influence.of the
causes which tend to impair their integrity. It cures many
diseases by equalising the circulation and the distribution
of iervous energy, thus invigorating and strengthening
weak organs, and removing local torpor and congestion.
8.-Clothing.
The adoption of artificial clothing by man may be stated
to serve three purposes, the regulation of temperature; protection from friction, insects, and dirt; and ornament.
In this climate clothing is chiefly employed for warmth,
which purpose is secured by moderating or restraining the
escape of caloric from the body. Articles of clothing have
no power in themselves of generating heat, and are designated as warm or cool just in proportion as they restrain
or favour the escape of caloric. Thus a lady's muff and a
marble floor are ordinarily of the same temperature; but
the sensation produced by each is widely different, because
C



26


OBSERVATIONS ON HEALTH.


the animal heat is retained by the muff, and rapidly carried
off by the marble.    Hence for clothing we select those
substances which conduct heat least, such as the wool of
sheep, and the silk produced by silk worms, which are
superior, as non-conductors, to cotton or linen.    In this
country we have recourse chiefly to the former in winter,
and to the latter in summer, cotton and linen garments
being coolest, the linen being cooler than the cotton.
There are several practical errors on the subject of clothing,
committed perhaps by a majority of persons, to which we
may briefly direct attention. "The first and most obvious
of these," says Dr. Baikie, "is wearing too much clothing
indoors or in bed, thereby both exhausting the natural
powers of the skin and exposing its action to a sudden
check on going out into the cold air. This forms one of the
principal objections to the almost universal use of flannel,
worn next the skin, and kept on even during the night, as
is the practice with many people. The skin is thus unnaturally excited, and in course of time loses its natural action;
or, on the other hand, becomes so sensitive, as to have its
action checked on the slightest exposure.     I venture to
propose my own plan of clothing as suitable to elderly
people and those of delicate constitutions in general.
" 1. In summer as well as winter, I wear a cotton garment
next the skin, thin in summer, stouter in winter; over this
a very light silk shirt for summer, and a thicker one in
winter. I also wear a narrow strip of flannel, lined with
cotton, round the abdomen in summer, replacing it by a
thicker one, made so as to double over the front of the
belly in winter; my ordinary shirt is always of cotton.
"2. In the beginning of autumn I add a light-coloured
flannel shirt over my ordinary one, leaving the front open, or
wrapping it across according to circumstances. When the
*winter fairly sets in, I replace this by a stout flannel shirt;



CLOTHING.


27


but in both cases, I take this off on dressing for dinner, so
as to have the full benefit of it while exposed to cold in the
open air; this I think of great importance; and I never
use anything else than a light cotton shirt to sleep in, and
strongly object to the common practice of sleeping in
flannel."
The colour of clothing is not unimportant, light being
preferable for the following and other reasons:-(1.) White
reflects the rays of heat which the black absorbs; at the
same time it impedes the transmission of heat from the
body.   Light-coloured clothes are therefore best both for
winter and summer, retaining the heat in the former, and
keeping it off in the latter. (2.) Particles which emanate
from diseased bodies, unhealthy accumulations, or miasmatic
districts are much more readily absorbed by dark than by
light clothing. Therefore those who are exposed to contagious influences, or the sick room, or in unhealthy neighbourhoods, should wear light clothing. Dark clothes favour the
transmission of contagious disease, from house to house,
much more readily than light ones.
Another point deserving attention is, that of frequent
changing and cleansing of clothes. The practice of adopting
dark-coloured instead of light-coloured garments has frequently its origin in economy, dark clothes tolerating an
amount of dirt inadmissible in light ones.    It should be
recollected that dark garments contract dirt after being worn
a little time as much as light, and if not changed and
cleansed may favour the production or spread of disease.
Another evil of far greater moment, is the adoption by
ladies of extended skirts, a fashion, not merely inconvenient,
but one of risk, exposing them to the danger of the most
horrible of deaths. The returns of the Registrar-General
reveal the appalling fact, that eight persons are burned to
death every day in England and Wales, a large proportion



28


OBSERVATIONS ON HEALTH.


resulting from the uncontrollable dimensions of the extended
skirt.  In addition to the lives thus immediately sacrificed,
a far greater number survive, after enduring sufferings of
the most acute description, and often crippled for life.  Is
it not, therefore, a question deserving serious consideration,
whether the fashion of wearing extended dresses is not
one unsuited to a country where fires, gas, and candles are
in general requisition?
In connection with this subject it may be well to advert
to the inconvenience of heavy thick clothing, the tissues
of which are close and firm.  Materials for clothing should
be chosen the textures of which are loose and porous, and
contain air in their interstices, air being a. bad conductor.
"The advantage of having numerous light instead of
fewer heavy coverings to the skin are these-the stratum of
air interposed between each layer of covering being a nonconductor, they are relatively much warmer than a much
greater thickness in fewer pieces; 2ndly, they can be more
easily laid aside to suit changing temperature; 3rdly, being
lighter, they are less apt to overheat the wearer, and thus
lesson the chance of a consequent chill."*
Other points may be briefly referred to. Summer clothes
should not be put on too soon, or winter ones too late.
Thin-soled boots and shoes are destructive to health.    So
are stays.  The body is strong enough to support itself;
while stays often bring on diseases of the lungs and other
important organs. The muscles of the body were intended
to sustain it erect, but when stays are applied, they soon
become indispensable, by superseding the action of the
muscles; and, in accordance with a well-known law of the
Q In China, one of the most changeable climates in the world, the variation
in one day being frequently 35 or 40 degrees, this is the mode adopted
by the natives to protect themselves: a working man will often appear in the
morning with 15 or 20 light jackets on, one over the other, which he gradually
strips off, as the day gets warm, resuming them again towards night.



BATHING.                     29
muscular system, when they cease to be used they cease to
"grow, and become insufficient for the discharge -of their
natural functions. Not only so, stays are directly injurious;
and it is a well ascertained fact, that cases of organic
disease have arisen from, or at least were aggravated by,
their use.
Finally, it may be stated that the clothing of children,
whose feeble frames are less able to resist or endure cold
than those of adults, is generally insufficient. When a baby
is divested of its long clothes, it is in danger of being
insufficiently clad, the danger increasing when it can run
alone, and is more exposed to atmospheric influences. It
cannot be too strongly impressed upon those who have the
charge of children that the practice of leaving those parts
exposed, which when grown up we find it necessary to clothe
warmly, especially the lower limbs and abdomen, is a
frequent cause of retarded growth, inflammation, mesenteric
disease, consumption, etc.
9.-Bathing.
The cold bath, often recommended in this work, when
practised in a reasonable manner, is a most valuable aid to
health. As a general rule, once a day, certainly not less
frequently than every second morning, every person in
health should bathe or sponge the whole body with cold
water, immediately following it by friction and exercise, to
promote the reaction. This tends to health, just as opening
the window lets fresh air into a room. Merely washing the
hands, face, and neck, is by no means sufficient; the entire
surface of the body requires the application of water, not only
for the purpose of cleanliness, but as a means of invigorating
the capillary circulation, and so fortifying the system as to
enable it to resist atmospheric vicissitudes. The secret of
attaining these ends consists in employing the cold in such



30


OBSERVATIONS ON HEALTH.


a manner and degree, and in the body being in such a state
before and after the application, as that the reaction or
glow shall be most perfect. The cold sponge-bath may be
adopted with safety by almost any one, the shock not being
too great, and good friction rapidly causing agreeableý
warmth. The best time for a cold bath is on rising from
bed, before the body has become chilled. Cold bathing should
not, therefore, be practised when the body is cold or cooling,
or when it is exhausted by exertion or fatigue, or is naturally
too weak, or when the skin feels chilly, until this feeling
has been removed by friction or exercise. A bath should
not be taken too soon after a meal, for then the circulation
should be undisturbed, as the stomach requires all its power
to digest the food; nor should the time spent in the bath
be too long; that may vary, according to circumstances,
from about one to four minutes.
TEMPERATURE.-The water of the bath should not bp colder
than 59~, ranging from this to 64~, according to the season,
and according to the temperature of the room. The temperature of the bath-room should be 640 or 650; if lower than
this the water should be a little warmer, and if the room is
cold, then the water should be 680, and the bathing process
performed as quickly as possible. The temperature of the
bath-room is a point of considerable importance, and it can
only be accurately measured by a thermometer; one of these
useful instruments should therefore be kept in every bathroom.
SPONGE.-A large sponge, of good quality, is a very useful
adjunct to a bath-room, as by its use'a much larger quantity
of oxygen can be introduced into the skin than can be effected
by any other means, and thus one of the prime conditions of
bathing is secured.
If the important conditions stated above are disregarded,
the immediate depressing effects of the bath will be con



BATHING.


31


tinned; there will be no glow of reaction, and subsequent
ehilliness and dulness will ensue. An occasional addition of
sea-salt to the water, as recommended in the next paragraph,
communicates a stimulating property favourable to reaction.
A similar effect is likely to result from the force or shock
with which the water is applied, and probably a shower-bath
is the most efficient, as it most excites those forcible and
deep inspirations which are the most efficient cause of the
reaction which follows.  The reaction is further promoted
by vigorous friction over the entire surface with coarse
large towels, which operate both by stimulating the cutaneous
vessels, and also by muscular exertion, which promotes the
more energetic action of the heart. A brisk walk after the
bath also tends to promote reaction.
ADDITION OF SEA-SALT TO THE BATH.-" If the back or
hips are weak, and also occasionally in good health, the addition of a solution of sea-salt to the water in the bath will add
greatly to its tonic properties. Sea-salt is the residuum of
evaporated sea-water; and if it be added in such quantity to
a bath that the mineral ingredient is equal to that contained
in salt water, it will be far more efficacious than a simple
fresh-water bath, as it combines the advantages of temperature with the stimulating action of the water upon the
skin, imparted by the saline matter which it holds in solution. Sea-salt can now be very generally obtained, and at a
cheap rate; and thus persons residing at a distance from the
coast may enjoy, to a certain extent, the advantage and
luxury of a sea-bath. In the absence of sea-salt, a handful of bay-salt, or of common salt, may be added to the
water." *
Such a bath, taken regularly in the morning, is conducive
to health in two ways:-It inures the body to a degree of
cold greater than it is likely to be exposed to during the rest
* The Lady's Manual of Homceopathic Treatment.



OBSERVATIONS ON HEALTH.


of the day, and so proves most serviceable in protecting it
from atmospheric influences; and it tends to remove irregularities in the circulation, and, by exciting the healthy action
of the skin, may aid that organ in removing disease.
It is not everyone, however, who can with safety practise bathing in the manner just now pointed out. Cold
bathing would be very hazardous, not only to patients who
are extremely weak, or who have any organic disease, especially of the heart or lungs, but there may be some
idiosyncrasy or condition of the constitution peculiar to the
individual which would render such a course the very reverse
of beneficial. Patients who have any ground for doubt on
the subject should consult their medical attendant. Caution
is more particularly necessary in infancy and old age. The
adaptation of the cold bath to individual cases may often be
determined by the following criterion:-If, after a bath, the
patient remains chilly, languid, and dejected, or suffers
headache, it had better be discontinued; but if the sense of
cold rapidly passes off, and a glow of warmth and animation
of spirits succeed and continue for some time, the cold bath
is almost sure to be productive of good.
The warm bath, to the feeble and exhausted frame, is often
very beneficial, and a great luxury. The temperature may
be varied according to the sensations of the patient, but as a
rule should be that of the temperature of the blood-960 to
980; if higher than 980, the bath may be followed by a
profuse perspiration, which weakens the system. Warm
bathing, however, including the hot air or Turkish bath,
except as a remedial agent, and prescribed by a medical man,
is generally prejudicial.
For suggestions on various forms of baths, and their
admissibility to persons in disease, consult subsequent portions of this volume; especially under " Consumption," and
"( Cold in the Head."



THE WET PACK.


330


10.-The Wet Pack.
As we have often prescribed the wet pack in the following
pages, we here offer a brief description of the process. A little
practice will enable any one to carry out the directions with
ease. Whenever indicated, we can assure our readers, from extensive practice, they need not hesitate to adopt it, as the wet
pack is both salutary and comforting. Spread a macintosh
sheet or stout blanket or quilt on a mattress, and over it,
leaving a margin at the head, spread a thick linen sheet,
wrung out of cold water. The wringing is best effected by
two persons, one taking hold of either end, the sheet being
doubled, and twisting as long as any water can be got out.
In fevers, the colder the water is the better; for very delicate
persons with feeble reaction, water at 68' may be used: The
patient is to be extended on his back naked on the wet sheet,
so that the upper edge covers the back of the neck, but the
lower one is to project beyond the feet; holding up the arms,
one side of the sheet is to be thrown over the body and
tucked in; the arms are now placed by the sides, and the
other part of the wet sheet is thrown over all, and tucked
rather tightly in, turning in the projecting ends under the
feet. The macintosh or blanket is then to be brought over
all the sheet, and well tucked in round the neck, at the
sides, and over the feet, so as completely to exclude the
air. A stout quilt or extra blanket is to be put over all.
In a short time the patient will become warm; the sensation is most agreeable, especially in fevers.     He may
remain in the pack three quarters of an hour to an hour,
then be put into a shallow bath of water at 64~, well
washed, dried, and put to bed. It may be repeated once,
twice, or thrice a day, according to circumstances and the
violence of the attack. Perspiration may be encouraged
by giving sips of cold water. If the head becomes con



34


OBSERVATIONS ON HEALTH.


gested, or the face flushed while in the pack, a cold compress should be applied over the forehead. The wet pack
is invaluable in the early stages of all fevers; and in scarlatina, measles, and small-pox, it assists in bringing out
the eruption.
11.-The Influence of Professions and Occupations
on Health.
Whatever may be the particular employment of an individual, it can rarely be divested of certain effects, more or
less prejudicial to his general health. Occupations which
permit of the free use of pure air and moderate muscular
exercise, with exemption from want or anxiety, are those
most conducive to a healthy, long life.  Statistical tables
afford evidence of the greater longevity of some pursuits as
compared with others. The following table from Tarbell's
" Sources of Health," published at Berlin in 1834, is on too
limited a scale for general application, but is undoubtedly a
close approximation to the truth.
Of 100 Clergymen   42 attained the age of 70 years and upwards., Farmers      40,,, Commercial Men 35,,, Military Men  33,, Lawyers       29,,,,, Artists       28,,Teachers      27,, Physicians    24, 
The first half in the above list, with the exception of the
clergymen, are necessarily much exposed to the air, and take
physical exercise; but the other half, with the exception of
the physicians, are chiefly confined in-doors, engaged in
sedentary occupations. The difference between the longevity
of the clergyman and the physician may no doubt be accounted for by the fact, that the literary pursuits of the



INFLUENCE OF OCCUPATIONS ON HEALTI.


35


former are not of so multifarious and unremitting a character
as to prevent sufficient out-door exercise being taken; the
nature of his studies may be regarded as favourable to a long
life, by inspiring influences conducive to cheerfulness, hope,
and serenity. The physician, on the other hand, is exposed
to influences most adverse to health; he has frequently to
encounter the poison of infectious disease, and is often unable to observe those rules and precautions which it is his
duty to enforce in the practice of others; his responsibility
often involves extreme mental anxiety; and his almost
incessant occupation of both mind and body, no doubt
account for his comparatively short life. There are, however, instances of medical men attaining an advanced age.
Harvey reached the age of 81; Hoffmann, 83; Hahnemann,
88; Heberden, 93; and Hippocrates, 109. The last individual was much engaged in travelling, and passed much
more of his time in the country than in crowded cities.
WHY EMPLOYMENTS ARE UNHEALTHY.-The circumstances
which operate in rendering occupations unhealthy, are chiefly
the following: deficiency of daylight and pure air; a bad
position of the body during employment; and the inhalation
of mechanical or poisonous substances.
Abundance of sunlight is of great importance in workshops and offices, particularly where young people are
employed. As already pointed out, patients make better
and more rapid recoveries in well-lighted hospitals; and
very serious cases are generally placed in the sunny side of
such buildings. If, therefore, persons are more likely to
regain health in such apartments, we may fairly conclude
that the health of a person will be better preserved, if employed in a large well-lighted workshop or office. Windows
should be frequently cleaned, and the walls and ceilings
whitewashed at least twice a year.
The sedentary occupations, such as are followed by book



36


OBSERVATIONS ON HEALTH.


keepers, milliners, tailors, shoemakers, and many others,
are often most unfavourable to health, as the sitting posture
is generally combined with an inclination to lean forwards,
so as to compress the chest and stomach. To a limited
extent, the hurtful consequences of such postures may be
avoided by occasionally changing to a standing position
when at work, and by taking out-door exercise during the
hours of relaxation. Plenty of healthful recreation in the
open air is the best corrective of the injurious consequences
of sedentary employments.
Occupations, however, are only injurious accidentally, a
certain amount of work being advantageous for man, both
in regard to his body and his mind. Industry alone can
preserve anything like a healthful contentment of the
spirits, or dispel melancholy from the mind; or remove
those dissatisfied and restless cravings which prey upon the
unemployed. Industry, moreover, is ordinarily followed by
rewards such as are esteemed most desirable even by the
mere worldling; and when wealth accumulates or honour
flows in upon a man, through God's blessing on his honest
industry, it is immeasurably more precious to him than
if ancestors had bequeathed it. True, there are districts
of the earth where but little demand is made on the labours of the husbandman, the mountains and the valleys
yielding almost spontaneously their rich produce. But the
people of districts whose soil possesses the greatest fertilityItaly and Spain-are often sunk to the lowest condition in
those mental, social, and moral qualities, which constitute
the chief glory of a nation. Released from the necessity of
industry, the body becomes enfeebled, the mind weak and
vacillating, the sensuous passions preponderate over the
intellectual powers; and man, in such circumstances, presents the humiliating spectacle of a mere stagnant humanity,
excited into action only by the lowest instincts of his nature.



INFLUENCE OF OCCUPATIONS ON HEALTH.


37


Having regard to the material frame of man, the point
that comes especially within our province, we commend
industrious employment, which, when followed under the
conditions already indicated, are conducive to health and
long life. The body was formed for active duties, and the
performance of these is indispensable alike for perfect physical development, for health, and happiness. The muscles,
the tendons, the ligaments, and even the bones, require
exercise, and become deteriorated in structure, and feeble from
indolence. Hence the vertebrae (backbone) of a carpenter,
or of any one who has followed a similar occupation, are
larger and also much heavier in proportion to size, than those
of a shoemaker or tailor. It is stated of a person who, in
consequence of a trifling lameness, took up the occupation
of begging, and sat almost wholly during the rest of his life,
using the limb as little as possible, that the thigh-bone of
this limb was found to be considerably less in circumference,
and shorter than the other. From more than one point of
view, then, it appears that the real good of life does not
consist in being exempt from the necessity of daily toil, and
that happiness is more equally distributed than would seem
on a cursory glance on the surface of society. Providence,
who has made industrious employment the heritage of man,
confers at least daily bread, contentment, and physical wellbeing, as the reward of industry; while He would seem to
have ordained that the carriage, the luxurious dwelling, and
the rich and varied edibles, shall tend in a measure to deteriorate the health and blight the happiness of those possessing them. The man who has nothing to do is ever restless,
and craving for a good not yet enjoyed; his pleasures lose
their character as such by becoming the business of his life,
and satiety produces disgust. In brief, the industrious man,
if his labours are not too exhausting, or carried on in an
unhealthy atmosphere, but relieved by daily out-door exer



S38


SIGNS AND SYMPTOMS OF DISEASE.


cise and relaxation, will pass a happier life, and live longer
than the indolent man; and though some occupations or
professions may not be directly promotive of health, industry
is man's best estate.
CHAPTER II.
SIGNS AND SYMPTOMS OF DISEASE.
To recognise fully the various evidences of an unhealthy
action of the system, a long course of study, including both
healthy and morbid anatomy, is necessary. If the several
points referred to in this chapter are carefully examined,
with the different cases which come under our notice, they
will aid us in arriving at a tolerably accurate idea of the
nature and severity of the disease we have to treat. The
following are several of the more common and well-known
diagnostic signs.
1.-The Pulse.
The pulse is produced by the blood forced into the aorta,
and thence into the various arteries of the body, by each
contraction of the left ventricle of the heart; its character
will consequently be modified by the condition of the heart,
the blood-vessels, and of the blood itself.
In feeling the pulse, great gentleness should be observed,
and it should be done as easily as possible, so as not to
excite the action of the heart, which would defeat the object
in view. The pulse may be examined in any part where an
artery is so close to the surface that its throb can be plainly
felt; but in general the most convenient locality is at the
wrist.  While examining the pulse, there must be no
pressure exerted upon the artery in any part of its course by
tight sleeves, ligatures, etc. The examiner should place



THE PULSE.


39


three fingers just above the root of the thumb and the joint
of the wrist, with his thumb on the opposite side, so as to
be able to regulate the pressure at will. Its frequency may
thus be measured by the seconds' hand of a watch; but its
peculiar characteristics, as indicative of various phases of
disease, can only be appreciated by the educated hand of the
medical man. By this method we can detect its rythm,
its fulness, or softness; whether by compression it may be
rendered almost imperceptible; whether it is strong and
bounding, forcing the fingers almost from the arm; or hard,
or small and wiry, like the vibrations of a string; or intermittent, striking a few beats, and then apparently stopping
for one or two beats; or whether the pulsations flow into
each other, small and almost imperceptible.
HEALTHY PULSE.-The healthy pulse may be described as
uniform, equal, moderately full, and swelling slowly under the
fingers; it is smaller and quicker in women and children,
In old age, the pulse becomes hard, owing to the increased
firmness or structural change in the arterial coats. The
average number of beats of the healthy pulse in the minute,
at different ages, is as follows:-At birth, 140; during
infancy, 120 to 130; in childhood, 100; in youth, 90; in
adult age, 75; in old age, 65 to 70; decrepitude, 75 to 80.
The healthy pulse is influenced, however, by the following
and other conditions, which should be considered in estimating the character of the pulse as a diagnostic sign. It
is faster in the female than in the male, the former exceeding
the latter by from six to fourteet beats; but this difference
only occurs after about the eighth year. It is quickened by
exertion or excitement; it is more frequent in the morning.
and after taking food; it beats faster standing than sitting,
and sitting than lying; but it is diminished by cold, sleep,
fatigue, want of food, and by certain drugs, especially
Digitalis.



40


SIGNS AND SYMPTOMS OF DISEASE.


PULSE IN DISEASE.-In estimating the differences of the
pulse as signs of disease, allowances must be made for those
sudden irregularities which are often observable under transient excitement or temporary depression.
The rapid pulse, especially if strong, full, and hard, indicates inflammation or fever; if small and very rapid, it
points to a state of great debility, such as is often present in
the last stage of typhoid fever.
Thejerking pulse is marked by a quick and rather forcible
beat, followed by a sudden, abrupt cessation, as if the
direction of the wave of blood had been reversed, and is
indicative of structural disease of the valves of the heart.
The intermittent pulse is that in which a pulsation is
occasionally omitted, and is frequently owing to some obstruction in the circulation in the heart or lungs, or inflammation or softening of the brain, apoplexy, etc. In minor
degrees, indigestion with flatulence may produce it.
The fidl pulse occurs in general plethora, or in the early
stages of acute disease; while the weak pulse denotes impoverished blood, and an enfeebled condition of the system.
When the pulse resists compression, it is said to be hard,
firm, or resistant; if it is small as well as hard, it is said to
be miry.
2.-The Tongue.
This organ affords important indications:-Dryness points
to diminished secretion, and is common in acute and febrile
diseases; moisture is generally a favourable sign, particularly
when it succeeds a dry or furred condition. A red tongue,
that is, preternaturally red, is common in the course of
the eruptive fevers; but in gastric and bilious fevers, and in
bad cases of indigestion, the redness is often limited to the
edges and tip. When the tongue is livid or purple, there
is defective oxygenation of the blood. The furred tongue,



BREATHING.


41


is the most marked, and is common in inflammation and
irritation of the mucous membranes, in diseases of the brain,
in all varieties of fever, and in almost all acute and dangerous maladies.    It should be added, some persons have
usually a coated   tongue on rising, without any      other
symptom   of disease.   A  uniformly white-coated   tongue
is not very unfavourable; a yellow coat is indicative of
disordered action of the liver; a brown or black, of a low
state of the vital powers, and contamination of the blood.
The gradual cleaning of the tongue, first from the tip and
edges, shows a tendency to health; when the fur separates
in patches, leaving a red glossy surface it is less favourable;
when the crust is rapidly removed, leaving a raw or darkcoloured appearance, the prognosis must be unfavourable.
3.-Breathing.
Healthy inspiration is performed with great ease, by a
nearly equal elevation of the ribs and enlargement of the
chest; expiration is the natural return of the chest to its
proportions during rest.
Dyspncea, or difficult breathing, may result from spasm
of the air passages, as in asthma; the presence of tumours,
or false membranes, as in diphtheria and croup; or great
swelling of the tonsils, or inflammation of the glottis; all of
which obstruct the entrance of air to the lungs, and so
occasion dyspnoea.   Disease of the nerves which preside
over the respiratory movements, or in that part of the
nervous centres from which they proceed, may also produce
serious difficulty of breathing. Ii pleurisy, fracture of the
ribs, apoplexy, and cases of great exhaustion, when an
insufficient supply of blood is sent to the great nervous
centre, the brain, the respiratory movements are deranged,
and otherwise greatly or even fatally obstructed.
The odour of the breath is also characteristic, and may be
D



42


SIGNS AND SYMPTOMS OF DISEASE.


most disagreeable, as the result of want of attention to
cleanliness of the mouth and teeth, indigestion, putrid sore
throat, etc. During the eruptive fevers, and in typhoid and
pestilential fevers, it is both offensive and infectious.
4.-Pain.
This is often a most important indication of the nature and
seat of disease, pointing to an interruption of the harmony
of the bodily organs; the severity and persistency of the
pain being in proportion to the disorganizing violence of this
interruption.  When attended with a throbbing sensation,
consequent upon the heart's action, it is called pulsating
pain; when with a feeling of tightness, tensive; when with
heat, burning. Inflammatory pain is continuous, grows
gradually worse, and is aggravated by touch or pressure.
Nervous pain may be recognised by its disposition to follow
a certain  course, without being rigidly limited  to  one
particular part; by its being subject to perfect intermissions; and by the suddenness with which it comes and
goes.  Spasmodic pain is mitigated by pressure, by frictions, and by applications of heat; it comes on suddenly
with greater or less severity, terminating abruptly. Sometimes pain occurs, not in the part diseased, but in a
distant one. Inflanmmation of the liver generally first shows
itself by pain in the right shoulder; inflammation of the
hip-joint, by pain in the knee; stone in the bladder, by
pain at the end of the penis; disease of the heart, by pain
down the left arm, etc.
5.-The Skin.
In health the skin imparts to the touch the sensation of
an agreeable temperature, with just sufficient moisture to
preserve its softness; it is also elastic, smooth, and neither
too tense nor loose. A harsh, dry, burning heat of the skin
is indicative of fever, and must ever be regarded as unfa



THE SKIN.


43


vourable, especially in inflammatory conditions of internal
organs. If this condition be followed by perspiration, and
at the same time by an improvement in the general symptoms of the patient, it is a favourable indication.   Great
relief is usually experienced on the supervention of the
sweating stage in ague, rheumatism, and inflammatory
fevers. On the other hand, complications may be feared
if perspiration ensue without any amelioration of other
symptoms.
Partial or local perspirations indicate a deranged condition
of the nervous system, or an affection of the organs contained
beneath the perspiring surface. If perspirations occur after
trifling exertion, they point to excessive weakness. Night
sweats, of frequent occurrence, not only show debility, but
when preceded by chills and fever, indicate a hectic and
consumptive state of the constitution.
The colour of the skin is also diagnostic. A bluish tint of
the skin indicates structural disease of the heart. A yellow
colour points to biliary affections. A rich blush of the
cheeks, especially if it be circumscribed, and the surrounding
parts pale, indicates an irritable condition of the nervous
system, or a tuberculous cachexia.
6.-The Urine.
The urinary organs are the kidneys and bladder, with their
appendages. The kidneys secrete the urine from the blood,
and by this process the blood is relieved of many impurities,
which if retained would give rise to disease in the whole
system. The secretion of the kidneys reaches the bladder
through little channels (ureters), and when the bladder is
filled, the urine is discharged, through the urinary canal
(urethra).
Healthy urine is of a brightish yellow or straw colour, a
tint darker in the morning than in the afternoon, yielding a



44


SIGNS AND SYMPTOMS OF DISEASE.


slight ammoniacal smell, devoid of unpleasant odour, and
precipitating no deposit on standing, or only the merest
trace of mucus, or of urates from a low temperature. In
advanced age the urine becomes darker and slightly offensive; it is darker in persons who lead a very active life;
different varieties of food also produce a marked effect both
on the colour and odour of urine. The stream of urine
should be round and large, and it should be passed about
five or six times in twenty-four hours without any pain or
straining.
The average specific gravity of healthy urine is 1,020,
being in excess of water, which is the standard (1,000).
In disease, the urine presents many varieties, and furnishes valuable indications to the pathologist. Thus, it may
be of a dark yellow or saffron colour, as in jaundice, or derangement of the liver; it may be red or high-coloured, and
scanty, with quickened pulse, as in fever; it may be bloody
or slimy, as in the affections of the kidneys or bladder; it
may be watery (pale) and copious, as in nervous and hysterical ailments; it may be heavy, muddy, or of a purple
colour, showing an unfavourable condition of the system;
or it may be dark or black, indicating putridity. The urine
may be passed too copiously or scantily, with pain, with
effort, or it may be retained with- difficulty. There may be
a frequent or uncontrollable desire to micturate, with burning or scalding pain; or the pain may be only experienced
in passing the last few drops.
When urine has to be examined, a little should be taken
from the whole quantity that has been passed during twenty-four hours, as it varies greatly in its properties at different periods of the day.
The specific gravity of urine in Bright's disease, is 1,015
to 1,004; diabetic urine, 1,025 to 1,040.



HOMCEOPATHIC DOMESTIC MEDICINES.


45


CHAPTER III.
THE MEDICINES, ETC.
The following short description of the different forms of
Homceopathic medicine used in the practice, is given for the
sake of the uninitiated. The-preparations are of four kinds,
viz., Tinctures, Pilules, Globules, and Triturations.
TINCTUREs.-These contain the more active principles of
the vegetable medicines, in a greater or less concentrated
form, and are generally supposed to be quicker and more
decided in their action, in acute diseases, than either pilules
or globules. It is therefore advisable for those who reside
at a distance from medical aid, to be furnished with such a
selection of the tinctures as are adapted to sudden and
acute diseases, in addition to a complete case of the pilules
or globules. The selection recommended by the author,
may be found page 47.
PILULES.-These are made of a porous, non-medicinal
substance, and afterwards carefully saturated with the
tinctures. They are very tangible; do not evaporate like
tinctures, and retain their virtue for many years if unexposed.
They are probably the best form of medicine for domestic use.
GLOBULES.-In size, globules may be compared to poppy
seeds: they are, therefore, very portable, and, on this
account, are recommended to the missionary, emigrant, etc.
They are prepared in the same manner as the pilules, but
being so small, are less appreciable to the touch.
TRITURATIONS.-These are in the form of powder, containing a portion of the original drug, triturated with a given
quantity of sugar of milk, and are necessary to the administration of the lower attenuations of insoluble medicines,
such as Calcarea, Carbo Vegetabilis, Hepar Sulpiuris, Mercurius, Sepia, Silicea, etc.



46


HOM(EOPATHIC DOMESTIC MEDICINES.


LIST
OF THE
PRINCIPAL MEDICINES PRESCRIBED IN THIS
MANUAL,
With their Latin and English Names, their Abbreviations, and the
Potency recommended for general domestic use.0


Latin.
1. Aconitum Napellus
2. Antimonium Crudum
3. Antimonium Tartaricum
4. Arnica Montana
5. Arsenicum Album
6. Aurum Metallicum
7. Belladonna
8. Bryonia Alba
9. Calcarea Carbonica
10. Cannabis Sativa
11. Cantharis
12. Carbo Vegetabilis
13. Chamomilla Vulgaris
14. China
15. Cina
16. Cocculus Indicus
17. Coffea
18. Colocynthis
19. Cuprum Metallicum
20. Digitalis
21. Drosera Rotundifolia
22. Dulcamara
23. Ferrum Metallicum
24. Graphites
25. Helleborus Niger
26. Hepar Sulphuris
27. Hyoscyamus Niger
28. Ignatia Amara
29. Iodium
30. Ipecacuanha


English.
Monk's Hood
Crude Antimony
Tartar Emetic
Leopard's Bane
White Arsenic
Metallic Gold
Deadly Nightshade
White Bryony
Carbonate of Lime
Hemp
Spanish-fly
Vegetable Charcoal
Wild Chamomile
Peruvian Bark
Worm-seed
Indian Berries
Coffee
Bitter Cucumber
Metallic Copper
Foxglove
Round-leaved Sundew
Bitter Sweet
Metallic Iron
Black Lead
Black Hellebore
Sulphuret of Lime
Black Henbane
St. Ignatius' Bean
Iodine
Ipecacuanha


Abbrev.
Acon.
Ant. Cr.
Ant. Tart.
Arm.
Ars.
Aur.
Bell.
Bry.
Calc. C.
Cann. S.
Canth.
Carbo V.
Cham.
Chin.
Cin.
Cocc.
Coff.
Coloc.
Cup.
Dig.
Dros.
Dulc.
Ferr.
Graph.
Hell.
Hep. S.
Hyos.
Ign.
lod.
Iiec.


Dil.
3
6
6
3
3
6
3
3
6
1
3
6
3
I
3
3
3
3
6
3
3
3
3
6
3
6
3
3
3
3


* For information respecting the properties and uses of the medicines in this list,
their antidotes, etc., consult the Materia Medica at the end of the volume.



LIST OF THE MEDICINES.


47


Latin.
31. Lycopodium Clavatum
32. Mercurius Corrosivus
33. Mercurius Vivus
34. Nitri Acidum
35. Nut Vomica
36. Opium
37. Phosphorus
38. Phosphori Acidum
39,,Platinum
40. Plumbum Metallicum
41. Pulsatilla
42. Rhus Toxicodendron
43. fepia Stces
44. Silicea
45. Spigelia
46. Spongia Tosta
47. Staphysagria
48. Stramonium
49. Sulphur
50. Veratrum Album


English.
Wolf's Foot
Bichloride of Mercury
Quicksilver
Nitric Acid
Strychnos Nux Vomica
White Poppy
Phosphorus
Phosphoric Acid
Platina
Metallic Lead
Pasque Flower
Poison Oak
Inky juice of Cuttlefish
Silex
Indian Pink
Roasted Sponge
Stavesacre
Thorn Apple
Sublimed Sulphur
White Hellebore


Abbrev.
Lye.
Mere. C.
Mere. V.
Vit. Ac.
Nzux V.
Op.
Phos.
Phos. Ac.
Plat.
Plumb.
Puls.
Rhus.
Sep.
Sil.
Spig.
Spong.
Staph.
Stram.
Sulph.
Verat.


Dil.
3
3
6
3
3
3
3
3
6  '
6
3
3
6
6
3
3
3
3
3
3


Also the strong Tincture of CAMPHOR, which must be kept by itself, or the
pilules; the latter may be kept, well corked, with the tinctures for external
use.
In addition to the fifty remedies in the above list, a few
others, at present less frequently employed, are occasionally
prescribed. A brief description of the uses of such addenda
may be found immediately following the Materia Medica, at
the end of the volume.
Besides the Medicines in Pilules or Globules, the following
twelve tinctures for internal use, in acute cases, should be
added, namely:-Nos. 1, 5, 7, 8, 13, 14, 30, 35, 37, 41,
42, and 50.
MATRIX TINCTURES, FOR EXTERNAL USE.


AcoNITUM NAPELLUS
ARNICA MONTANA


b 1 CALENDULA OFFICINALIS (
0    RHUS TOXICODENDRON


These are recommended to be kept, with the tinctures for internal use,
Arnica plaster, strapping plaster, scissors, oiled silk, etc., in a compartment
beneath, and separate from the medicines in the body of the chest.



48


HOM0EOPATHIC DOMESTIC MEDICINES.


DIRECTIONS FOR TAKING THE MEDICINES-Tinctures should
be dropped into the bottom of a glass, and water, in the
proportion of one tablespoonful to a drop, poured upon the
medicine. It is desirable to drop the tinctures accurately;
and to this end the bottle should be held in an oblique
manner, with the lip resting against the cork; the bottle
should then be carefully tilted (as shown in the accompanying
drawing), when the tincture will drop from the lower edge of
the cork. A little practice will enable a person to drop one
or any number of drops with great exactness. The vessel in
which the mixture is made should be scrupulously clean,
covered over, and the spoon not left in the medicine.* If it
has to be kept several days, a new bottle and cork may be
used.
Pilules or Globules may be taken dry on the tongue; but
it is always better, if convenient, to dissolve them in pure
soft water.
The Triturations should be placed dry on the tongue, and
gradually swallowed, the mouth having first been rinsed with
water.
* Glazed spoons, and graduated fine earthenware medicine cups, with covers,
numbered 1 and 2, specially made for this purpose, and sold by Homceopathic
chemists, are the most suitable. These vessels are recommended, as they protect the medicines from light and dust, and distinguish them from other
liquids. Mixtures prepared in glasses or other domestic vessels are often
thrown away in mistake, sometimes causing great inconvenience.



THE DOSE.


49


The most appropriate times for taking the medicines, as a
rule, are, on rising in the morning, at bed-time, and if oftener
prescribed, about an hour before, or two or three hours after,
a meal. Under no circumstances should a patient be aroused
from sleep to take medicine.
THE DOSE.-In determining the quantity and strength of
doses, several circumstances must be taken into consideration, such as age, sex, habits, the nature of disease, etc. As
a general rule, without reference to individual idiosyncrasies,
the following may be stated as the proper dose in domestic
practice:FOR AN ADULT, one drop of the tincture, one or two
pilules, four globules, or one grain of the trituration.
FOR A CHILD, about one half the quantity.
FOR AN INFANT, one third.
One drop, or a pilule, is easily divided into two doses by
mixing it with two spoonsful of water, and giving one
spoonful for a dose.
RIEPETITION OF DOSES.-The repetition of the dose must
be determined by the character of the malady from which
the patient is suffering, the urgency and danger of the
symptoms, and the effects produced by the medicines. In
violent and dangerous diseases, such as cholera, croup,
diphtheria, pleuritis, convulsions, etc., the remedies may be
repeated every ten, fifteen, or twenty minutes; in less urgent
cases, every two, three, or four hours. In chronic maladies,
every six, twelve, or twenty-four hours. When improvement
takes place, the medicines should be administered less
frequently, and gradually relinquished.
ALTERNATION OF MEDICINES.-To avoid the confusion
resulting from mixing different remedies in one prescription,
and to ascertain the pure action of each separate drug,
homoeopaths never mix several medicines together in one
potion; but in acute diseases, when the symptoms of the



50


IHOM(EOPATHIC DOMESTIC MEDICINE.


malady are not covered by a single remedy, and a second
one is indicated, the two may be given in alternation; that
is, one medicine may be followed by another at certain
intervals of time, and in a regular order of succession.
The alternation of drugs is sometimes necessary in acute
diseases; in croup, for example, Acon. and Hepar., or lod.
and Brom.; in pneumonia, Acon. and Bry.; in typhus, Bry.
and Rhus, etc. The different stages of such diseases can
rarely be accurately defined, one stage merging into another,
requiring the alternate use of remedies, so as to form a kind
of natural transition in the regular progress of the disease.
In chronic diseases, the alternation of medicines is seldom
necessary.
DRUGs.-While on the subject of medicines, we would
strongly dissuade from the practice of taking pills, herb
teas, senna, salts, castor oil, etc. Aperient drugs especially,
which are advertised and sold so freely as "patent" medicines, should be avoided, as they inflict an incalculable
amount of injury, by     over-stimulation, weakening "the
digestive organs, producing indigestion, costiveness, piles,
and a gradual decline of the general health and strength;
until at length, the patient falls a victim to some acute
disease, or dies from a chronic affection of the parts on
which the chief force of the drugs was expended.
MEDICINE CHEST.-A case or chest to suit this manual,
should contain the medicines mentioned in the following
list, should be constructed expressly, and used for no other
purposes; it should also be protected from light and heat,
and kept apart from substances which emit a strong odour.
Immediately after using a phial it should be corked again,
and the corks and phials never changed from one medicine
to another.
CORKS.-If a cork decays, breaks, or is otherwise damaged,
a new one should be at once substituted. Except for strong



MEDICINE CHEST.                  51
acids, good sound corks are preferable to glass stoppers, as
they more effectually prevent evaporation, preserve the
virtue of the medicine, and are easily replaced when broken.
Missionaries, emigrants, etc., should take an extra supply.
If the above directions are observed, the medicines may
be kept unimpaired for years.



PART     II.


MEDICAL AND SURGICAL DISEASES AND THEIR
HOM(EOPATHIC TREATMENT.
CHAPTER I.
FEVERS.
FEVER (from Ferves, to burn,) has been thus defined:After a preliminary stage of languor, weakness, loss of
appetite, and some degree, of shivering or chilliness, there
succeeds preternatural heat of body, increased waste of
tissue, quickened pulse, muscular debility, and general
functional disturbance.  This morbid state accompanies
many diseases as one of their phenomena-symptomatic
fever; but under certain circumstances we meet with idiopathic or essential fevers, which are quite independent of any
local inflammation. In this chapter, we shall consider the
following varieties:-1. Simple Fever; 2. Inflammatory
Fever; 3. Typhoid Fever; 4. Typhus; 5. Intermittent
Fever; 6. Hectic Fever; 7. Hay Fever.
1.-Simple Fever (Febricula).
This is the mildest form in which fever occurs; and, as
it usually disappears in from eight to thirty-six hours, it is
called an ephemeral disease. This condition, however, may



INFLAMMATORY FEVER.


53


be the precursor of very serious disorders, and requires
prompt attention.
SYMPTOMS.-It usually commences in the afternoon or
evening by slight shiverings, lassitude and weariness,
succeeded by heat, thirst, general uneasiness, quickened
pulse, headache, and disturbed sleep. It generally terminates in gentle perspiration.
CAUsEs.-Excessive exertion, exposure to sudden changes
of temperature or a hot sun, derangement of the digestive
organs, or mental excitement.
TREATMENT.-Aconitum.-When the skin is hot and dry,
and whether or not the symptoms can be traced to any
particular cause. A dose every two hours, until the skin
becomes moist, and the pulse less frequent.  Should the
attack be one of simple fever merely, this remedy will be
rapidly effectual: if it be the precursor of eruptive diseases
or of some severe disorder, it is still the best remedy at this
stage, and will materially modify its violence.
Aconitum has been appropriately termed the Homoeopathic
lancet; for in febrile attacks, whether slight or serious, it is
the first remedy to be administered.
AccEssoRY MEASUREs.-The patient should be kept cool
and quiet, no stimulating food or drink taken, and all causes
likely to occasion mental or bodily excitement carefully
avoided.
2.-Inflammatory Fever.
This is a more severe form of fever than the one just
noticed, continues much longer, and may be regarded as a
modification of one of the two varieties next described.
SYMPTOMS.-Inflammatory fever is preceded by rigors, or
alternate chills and flushes, followed by burning heat and
dryness of the skin; hard, full, quick pulse; dryness of the
tongue, mouth, and lips; white coating, or bright redness,



54


FEVERS.


of the tongue; great thirst; highly-coloured and scanty
urine; and constipation. To these may be added-pains in
the loins, headache, loss of appetite, hurried breathing,
delirium, etc. These symptoms usually continue for a few
days, with an aggravation of them     at night.   Profuse
perspiration, bleeding of the nose, or diarrhoea, eventually
follow, and the fever gradually declines, leaving the patient
weak, but otherwise well.
DANGERs.-This disease may degenerate into typhoid or
other severe and fatal forms of fever, or it may attack some
vital organ. If the treatment is relinquished too early, or
proper care is not exercised during recovery, relapses are
apt to occur, and prove troublesome and even dangerous.
CAUSES.-Suppressed perspiration, exposure to damp or
cold, dwelling in damp houses, sudden changes of temperature, wearing damp linen, poor or insufficient diet; injuries;
circumstances which cause shock to the nervous system, or
debility.
TREATMENT.-Aconitum is found to be the principal remedy
for all such symptoms as those above indicated; and it will
most effectually calm the arterial excitement. A dose every
two or three hours, or, in urgent cases, every half-hour or
hour. A profuse perspiration following the administration
of Aconitum may be taken as an indication of its beneficial
action, and should be then discontinued.
Belladonna will be required, if, after repeated doses of
Aconitum, there should be violent head-ache, redness and
congestion of the face; a wild and fiery appearance of the
eyes; throbbing and distension of the blood-vessels in the
temples: wakefulness, or furious nocturnal delirium, and
other well-marked cerebral symptoms. It may be frequently
advantageously alternated with Aconitum. A dose every one
to four hours.
Bryonia.-When, in addition to the ordinary symptoms



INFLAMMATORY FEVERS.


55


of inflammatory fever, there is a heavy, stupifying headache,
aggravated by movement, and a sensation as if the head
would burst; when the disease appears to be concentrated
in the chest, with cough, oppressed and laboured breathing,
stitching pains in the sile, aggravated by movement and
breathing; or when there. is a bilious complication, with
oppression at the pit of the stomach, yellow-coated tongue,
nausea, constipation, shooting pains in the limbs, brown or
bright yellow urine, and extreme irritability.
Antimonium  Crud.-When gastric irritation is present,
nausea, inclination to vomit, eructations, flatulence, etc.,
this will be found an excellent remedy.
Opium.-Great stupor; slow, stertorous breathing; a hard,
full, slow or oppressed pulse; low delirium; deafness, or
blindness.
Arsenicum.-Great debility, prostration, and rapid sinking,
with very small, thready pulse; burning thirst; diarrhcea,
with dark offensive discharges; cold perspirations, the
symptoms being aggravated at night.
Rhux Tox.-Extreme weakness and prostration; low
muttering delirium; picking at the bed-clothes; offensive,
putrid, or bloody diarrhoea; dry, cracked tongue; great
thirst, and scanty urine.
ADDITIONAL MEDICINES SOMETIMES REQUIRED.--Jfer., China,
Canth., Nux Vom., Puls., Nit. Acid., Verat., or Sulph.
ACCESSORY MEASURES.-The patient should be placed in a
spacious, well-ventilated room, and protected from  everything that is likely to cause excitement or prevent sleep,
such as too much noise, company, heat, or too many or
thick bed-coverings. In the preliminary stage, the use of
the hot foot-bath, as recommended in the section on " Cold
in the Head," or the Wet Pach described page 33, will often
immediately restore the equilibrium of the system; or at
least, greatly facilitate the cure.  The linen should be



56


FEVERS.


changed often, and all matters discharged from the body at
once removed. The patient should be also sponged over at
suitable intervals with tepid or cold water, as may be most
agreeable.  The application of water in this manner will
prove a valuable adjunct to the medicinal treatment prescribed, and will accelerate those favourable changes which
are now hoped for. As the fever rises, the patient loses all
appetite for food, nature thus indicating that none is now
required. As a beverage, water is the principal, and should
be given in small draughts, frequently repeated. In acute
fever, cold water is like the "Balm of Gilead."  The patient
may also take Gum-water,* sweetened with a little sugar,
or barley water,* both of which are somewhat nutritive,
often very grateful, and less stimulating than other forms of
nourishment.    Ripe grapes, roasted apples, etc., may also
be allowed in moderation; and, after the urgent symptoms
have abated, first arrowroot, then chicken broth, with a few
crumbs of stale bread; as the appetite returns, beef-tea;
and, finally, such articles of food and drink may be allowed,
as will partially appease the appetite; for if the still weak
and often irritable stomach is overloaded, a dangerous relapse
may occur.
The treatment here recommended must of course be
modified as circumstances require, our aim being to suggest
such general directions as are often appropriate in inflammatory diseases.
If the fever occurs in debilitated persons, is protracted
or attended with great and rapid prostration, beef-tea, or
the essence of beef,* brandy and water, or brandy and egg
mixture, should be early administered in small quantities,
at regular and frequent intervals. For full directions, see
"Hints on Nursing Fever Patients," in the next section.


"* For directions to prepare, refer to Index.



TYPHOID FEVER.


57


3.-Typhoid Fever (Febris Typhoides).
COMMON CONTINUED FEVER is divided into four forms,
as follows:-(1) Typhoid Fever, sometimes described as
Enteric, Intestinal, or    Gastric  Fever, Typhia,    etc.;
(2) Typhus Fever, often called Brain, Hospital, Camp, or
Ship Fever; (3) Relapsing Fever, a variety of rare occurrence, followed by a prolonged convalescence, in which
the pulse is remarkably low; and (4) Febricula, a simple
variety of fever, not due to any specific poison, or a modification of one of the other varieties. This form has been
previously described.
The first-named form, typhoid or enteric fever, we have
considered with more than usual detail, having watched and
treated a very large number of cases during a severe epidemic
of this disease in 1864, a year remarkable as one of the
driest upon record, only 15-7 inches of rain having fallen.
DEFINITION.-TYPHOID FEVER is a continued fever, lasting
about twenty-three days, often longer, with an eruption on
the chest, abdomen, or back', and attended with great feebleness, abdominal pains or tenderness, and diarrhoea, which
increases with the disease, the discharges being copious,
liquid, of a light-ochre colour, putrid, and often containing
altered blood.
Although having many symptoms in common with typhus,
it is an essentially different fever, and there are several considerations which render it important to be able early to
identify the variety we may be called upon to treat. Thus,
the causes of these fevers are different, and suggest sanitary
regulations of an opposite nature; typhoid is less contagious
than typhus; the tendency to a fatal issue varying, the
treatment must be regulated accordingly; and, further, if
not early recognised, patients may persist in their usual



58


FEVERS.


occupations at a time when rest in bed would conserve the
strength and moderate the progress of the disease. To
render the recognition of these fevers easy, we subjoin the
following table, page 59.
SYMPTOMS.-These may be arranged into the accession and
the three weekly periods.
Unless the poison is very concentrated, there is a period
of incubation, varying from ten to fourteen days, after which
the disease sets in slowly and insidiously. The patient becomes languid and indisposed to exertion; is chilly and
unwilling to leave the fire; the back aches, and the legs
tremble; the appetite fails, and there are even nausea and
sickness; the tongue is white, the breath offensive, and
often the throat is sore; the bowels are deranged, sometimes
confined, but oftener relaxed; the pulse is quickened
and   the  sleep  disturbed.  These symptoms      gradually
increase, until at length the patient has a violent rigor,
succeeded by heightened temperature, severe headache, and
such muscular debility that he takes to his bed. This is the
accession. The course of the fever is now set in, and may
be divided into three weekly periods (Watson) from the
accession.
IST WEEK.-The prominent symptoms are, vascular excitement and nervous oppression, including a bounding pulse
(90), great heat of skin, thirst, and obscured mental faculties; the patient cannot give a coherent account of himself,
complains of little except his head, and is usually delirious
at night. The abdomen enlarges, is resonant on percussion,
and there is tenderness or even pain on firm pressure,
especially in the right iliac fossa, near the termination of the
small intestine; a peculiar gurgling sensation is imparted to
the fingers when pressing there from the mixing of the
gastric fluids.



TYPHOID FEVER.


59


TABLE OF THE CHIEF DIFFERENCES BETWEEN TYPHOID AND
TYPHUS FEVER.


TYPHOID.
1. Typhoid arises from bad drainage, foul drinking-water, as from a
drain leaking into a well, decomposing
animal matter, etc., combined with
high temperature, deficient rainfall,
certain electrical conditions, or an insufficient supply of ozone.
2. Seldom   attacks persons after
forty, and is most common in youth,
including childhood.
3. Is more common among the
rich than the poor.
4. Commences slowly and insidiously, the premonitory stage lasting a
week or more.
5. The eruption of the skin consists of ROSE-COLOURED spots, something like measles, appears upon the
chest, abdomen, and back, comes in
successive crops, and fades under
pressure.
6. Diarrhoea, with light, ochrecoloured, watery stools, is very common, with congestion of the mucous
membrane of the intestine, sometimes
hamorrhage, or even ulceration.
7. The expression is bright, the
hectic blush is limited to the cheeks,
and the pupils are dilated.
8. Continues at least three weeks,
and often five or six, or even more.
9. Relapses, marked by a return
of all the former symptoms, frequently
occur, especially in certain epidemics.
10. The tendency to death is by
Asthenia (exhaustion).


TYPHUS.
1. Typhus arises from overcrowding,
with defective ventilation, and spreads
by contagion.
2. Occurs at any age, but most
frequently in middle life.
3. Is rare among the wealthy
classes, excepting doctors, students,
and visiting clergymen.
4. Comes on quickly.
5. The eruption is of a MULBERRY
COLOUR, comes out only once (between
the fourth and seventh days), lasts until the termination of the disease, and
does not disappear under pressure.
6.. The brain is chiefly affected, and
the bowels are but little so.
7. There is a dusky blush on the
face, neck, and shoulders, injected
eyes, and contracted pupils.
8. Runs its course in     about a
fortnight.
9. Relapses are of rare occurrence.
10. The tendency to death is by
Coma (morbid drowsiness).



60


FEVERS.


2ND WEEK.-Debility and emaciation become very marked,
the muscles wasting as well as the fat; the urine becomes
scanty and heavy, being loaded with urea from wasting of
the nitrogenized tissues. At this time, from the seventh to
the fourteenth day, the characteristic eruption generally
begins to show itself, chiefly on the sternum and epigastrium,
in the form of rose-coloured dots. These papulae or pimples
are few in number, round but slightly elevated, and insensibly fade into the natural hue of the surrounding skin.
The quantity of the rash bears no proportion to the severity
of the disease.   "This successive daily eruption of a few
small, very slightly-elevated, rose-coloured spots, disappearing on pressure, each spot continuing visible for three or four
days only, is peculiar to and absolutely diagnostic of typhoid
fever" (Aitken). Although, however, the rose-coloured rash
is never met with in any other disease, yet we have treated
cases of true typhoid without being able to detect a solitary
spot. Occasionally, also, sudamina appear, which are very
minute vesicles, looking like drops of sweat, chiefly on the.
neck, chest, or abdomen. During the second week there is
almost always diarrkwa, which generally increases towards
the end of the week, and consists of semi-fluid, pale-yellow,
frothy motions, of which there may be five, six, or even
more in twenty-four hours.     The specific characters of the
evacuations in enteric fever are the following:-fluidity;
pale-ochre or drab-colour; sickly, putrid odour; absence of
bile; and ajloculent debris of disintegrated agminated glands
of the ileum. The floculent debris may be discovered by
washing the discharges. In reference to the colour of the
stools, it is worth notice that often before a patient takes to
his bed, or looseness of the bowels sets in, the faeces are
of a light-ochre colour, and furnish the most marked early
sign of enteric fever.



TYPHOID FEVER.


61


3RD WEEK.-The debility and emaciation become extreme;
the patient lies extended on his back, sinking towards the
foot of the bed without making an effort to change or preserve his position. There is a bright and pinkish flush of
the cheeks, which strongly contrasts with the surrounding
pale skin; sordes occur on the mucous membrane of the
mouth and lips; the tongue is dry and brown, or red and
glazed, and often rough and stiff, like old leather; the urine
is frequently retained from inaction of the bladder; the
fteces pass without control, the tendons start from irregular,
feeble contractions of the muscles; the patient picks vacantly
at the bedclothes, in an attempt to pull black spots, like flies
on the wing (muscce volitantes), which appear before the eyes,
or attempts to grasp at or catch in the air; becomes deaf,
and no longer knows his friends, and on recovery will have
no remembrance of anything that has at this time ocuurred.
TEMPERATURE.-The information afforded by the application of the thermometer to the body in the diagnosis of
enteric fever is very important. In all the acute specific
fevers the temperature is abnormally raised, but in typhoid
the elevation is gradual, while in most others it is abrupt.
During the first three or four days, except a light-ochre
colour of the faeces, we have no symptoms to indicate the
invasion of so serious a disease except a gradual elevation of
the temperature; but if, on the fourth or fifth day, the
maximum    temperature attained    during  the twenty-four
hours be not 1050, the disease is most probably not typhoid
fever. And, further, if on the first or second day the
maximum temperature reaches 104~, the disease is some
other acute fever, as the temperature only gradually attains
such a degree in typhoid fever. At the commencement the
diagnosis is difficult, inasmuch as the characteristic rash
does not usually appear before the sixth, sometimes not till
the twelfth, day of the disease; and, indeed, in children,



62


FEVERS.


cannot sometimes be observed at any stage of the disease.
Temperature is also an important element in the prognosis.
Thus we have great variations in the temperature in typhoid
fever, being low in the morning, and attains its maximum
degree in the evening. The greater these fluctuations at the
end of the second week, the more favourable is the attack,
and the shorter. will be its duration. If the temperature
falls considerably in the morning, even though the evening
rise is considerable, the prognosis is favourable. On the
other hand, should the temperature during the second week
remain continuously high, we may predicate a severe and
prolonged attack. Again, the first probable indication in
cases of persistent elevation of the temperature, is a decline
in the morning temperature. When such a decline occurs,
especially if it be repeated on subsequent days, even though
the maximum temperature reached in the evening remain
the same, we may be certain that the fever has begun to
abate. It is true, a sudden fall in the temperature may be
consequent on diarrhcea or hemorrhage-probably the latter
if it occurs very suddenly; but, usually, other symptoms
would indicate such an occurrence.
DANGERS.--(1) iemorrhage.-This may occur from the
ulcerated patches in the ileum, during the separation of the
gland sloughs, and may be either capillary or from the
opening of a large vessel. The discharge of blood may be
so great as to be immediately fatal by syncope, or it may be
remotely fatal, by exhausting the patient so that he has no
power to bear up against the fever in its subsequent course.
Sometimes without any escape of blood from the orifice of
the bowel, the patient becomes suddenly blanched and dies
of syncope. In such a case, a post mortem examination finds
the intestines distended with red, clotted blood. (2) Exhaustion from profuse and persistent diarrhea, in cases in
which the catarrhal affection of the mucous membrane has



TYPHOID FEVER.


63


been very severe and obstinate.   The evacuations weaken
the patient rapidly, and hasten     the fatal termination.
(3) Perforation.-The ulceration may extend till the coats of
the bowel are perforated and cause fatal peritonitis; but this
is not so likely to happen till an advanced stage of the
disease-about the fourth or fifth week-or just as convalescence seemed to be setting in. The symptoms of this
occurrence are, a sudden pain and tenderness in the abdomen,
with swelling, altered expression of the features, more or
less nausea and vomiting, and death in one or two days.
(4) Congestion.-The lungs may become congested, giving rise
to bronchitis, pleurisy with effusion, pneumonia, or latent
tubercle may be called into fatal activity; in short, there is
a tendency, from the poisoned state of the blood, to congestion in the three great visceral cavities of the body-the
head, the chest, and the abdomen. No disease presents, in
the mode of its accession, in the course, gravity, and termination of the symptoms, so many varieties, complications,
and accidents as typhoid fever, so that it has been considered almost as an epitome of the whole practice of medicine.
MORTALITY.-The reports of the Registrar-General show
that in this country alone about 20,000 persons die annually
of typhoid fever, and that probably 150,000 persons are laid
prostrate by it. It proved fatal to the Prince Consort on the
14th of December, 1861, twenty-one days from the commencement of the attack. Several members of the royal
family of Portugal also came to their untimely end by it;
and Count Cavour, but the death of the latter was accelerated
by venesection.
CAUSE.-According to Drs. Budd, Aitken, and others, the
poison of typhoid fever does not originate in decomposing
sewage, and is only transmitted by it, the specific poison
being contained and transmitted by the discharges from the
bowels of the person infected with the fever. The contagious



64


FEVERS.


matter may convey the fever, in two principal ways:-(1) By
percolating the soil into the wells which furnish drinking
water; (2) By infecting the air through defective sewers or
water-closets. In opposition to this hypothesis, Dr. IMurchinson makes the following objections:-" (1) There are
many facts which show that enteric fever often arises from
bad drainage, independent of any transmission from the sick.
The danger ensues when the drain becomes choked up, when
the sewage stagnates and ferments, and when the transmission of a poison from any distant locality is impeded, if
not completely arrested. (2) There are numerous instances
of enteric fever appearing in houses having no communication
by drain with any other dwelling. (3) There is no evidence
that the stools of enteric fever are of such a virulent nature
as has been stated. The attendants on the sick are rarely
attacked. (4) The fact that the prevalence of the disease is
influenced by temperature is opposed to the idea that it
depends on a specific poison derived from the sick; but is
readily accounted for on the supposition that the poison is
generated by fermentation or decomposition."
We conclude, therefore, that refuse animal and vegetable
matters, if permitted to accumulate and decompose in seasons
of drought generate a poison, which if not washed away or
diluted by sufficient rain, rises into the air, or becomes difutsed
in the water; and which, when introduced into the body by
these media, may produce enteric fever (HARLEY). Hence we
find it most prevalent in Autumn, and at the commencement
of winter, after a long season of heat and drought. THE
BEST PROPHYLAXIS, THEREFORE, ARE, AN ABUNDANT SUPPLY OF
PURE WATER; SUFFICIENTLY INCLINED AND WELL-CONSTRUCTED
SEWERS, WITH IMPERMEABLE WALLS; A WELL-DRAINED SOIL,
AND REGULARLY FLUSHING THE DRAINS DURING DRY WEATHER
COPIOUSLY WITH WATER. IF THESE MEASURES ARE EFFICIENTLY
CARRIED OUT, TYPHOID OR ENTERIC FEVER MAY BE EXPECTED
ENTIRELY TO DISAPPEAR.



TYPHOID FEVER.


65


TREATMENT.-A medical man should conduct the treatment; for just as no two human faces are precisely alike, so
no two cases of typhoid or typhus fever ever present, from the
commencement to the close, exactly the same symptoms.
The following classification of symptoms will, it is hoped,
aid the selection of the remedy.
Inflammatory symptoms.-Acon. and Bry.
Great prostration.-Ars., Mur. Acid, Vbrat., or Rhus.
If the lungs are most involved.-Phos. or Bry.
If the brain.-Bell., Hyos., Camph., Opi., Agaricus Mus.,
Stram., or Rhus.
If the bowels.-Bry., Ipec., Ars., Mere., Nux Vom., or
Puls.
Typhoid with putridity.-Carbo Veg., Ars., Rhus., and
Verat.
Hemorrhage from the bowels.-Cup. Sulph., Nit. Acid, or
Ipec.
Nervous debility following fever.-China, Fer. Sulph., or
Ign.
The symptoms indicating some of these medicines are
described under "Inflammatory Fever," page 53-4. We
shall only add the following distinctive features.
Aconitum.-A dose every two or three hours when inflammatory symptoms predominate.
Bryonia.-Bitter taste, brown-coated, rough tongue, nausea,
confined bowels, stupifying headache, cough, with stitches in
the chest, and irritability.  During the inflammatory stage,
Bry. and Acon. in alternation; in low forms of the disease,
Bry. and Rhus.
Belladonna.-Redness of the face; bright, shining eyes,
and dilated pupils; distension of the veins, and throbbing
of the arteries of the head; startings during sleep, or continued wakefulness.
Hyoscyamus. -Constant and furious delirium; sudden



66


FEVERS.


starts and outcries; twitching; great nervous excitability.
This remedy has similar indications to Belladonna, and often
succeeds when that fails.
Arsenicum. - Extreme prostration; insatiable burning
thirst; diarrhcea; feeble, intermittent, almost imperceptible
pulse. If to these symptoms are added foetid evacuations,
cold perspirations, rattling respiration, Carbo V. should be
administered in alternation; a dose every three or four
hours. Arsenicum is a remedy of priceless value in enteric
fever, and it should be administered somewhat early, as it
tends to prevent extreme prostration.
Baptisia Tinctoria.-This remedy is useful in all stages of
typhoid fever. In large doses, long continued, it is said to
effect changes in the blood similar to those in typhia, and a
condition of the fluids of the body generally resembling that
which occurs in low fevers.
Hydrochloric Acid (A) in two-drop doses, every three
hours, has, in my hands, been highly successful in the treatment of typhoid fever, particularly when the pulse has been
very slow and weak, the tongue morbidly clean, with great
nervous depression, and when the patient has complained of
a constant sour taste in the mouth; but, in proportion as
the tongue has been coated dry or brown, and the pulse has
been accelerated, so have I found the efficacy of hydrochloric
acid weakened (DR. SIMMONS).
ilmuriatic Acid.-Constant stupor, the patient sinks down
in the bed, moans during sleep, and mutters when awake;
there is a paralytic condition of the tongue, and dryness of
the mouth and throat. These symptoms will be best met by
giving ilfur. Acid in alternation with Opium, a dose every
three or four hours.
Mercurius.-Copious debilitating perspirations; diarrhoetic
evacuations, greenish or yellowish; thickly-coated tongue;
tenderness at the pit of the stomach.



TYPHOID FEVER-HINTS ON NURSING.


67


Carbo Veg.-Offensive smells from the patient; putrid,
involuntary evacuations; deep-red urine; pinched and sunken
countenance; burning in the abdomen and at the pit of the
stomach; cold extremities; rapidly sinking powers, and
scarcely perceptible pulse.
Nitric Acid.-He-morrhage from the bowels, or discharges
of a greenish, slimy mucus, with extreme tenderness of the
abdomen; scalding urine; sore mouth; foetid perspiration;
and tendency to collapse. A dose every four hours.
China.-When the tongue becomes clean and moist, the
pulse soft, and all feverish excitement has disappeared, this
remedy may be administered with the best effects.
ACCESSORY MEASURES.-The points that require special
attention in the management of fever patients are referred
to in the following "' hints."
HINTS ON NURSING FEVER PATIENTS.-The unremitting
attention of an experienced, trained nurse is a part of the
treatment quite as essential as the administration of medicine. To aid to some extent in the performance of this duty,
the following general suggestions are offered. The medical
attendant alone can furnish directions adapted to special
cases. Under such circumstances it is the nurse's duty
faithfully to carry out his directions, and to report to him at
each visit the symptoms and progress of the patient, and
the effects of the treatment.
1st.  The Sick Room.-The following points should be
studied: (1) It should be airy. If practicable, the patient
should be placed in a spacious, well-ventilated apartment,
which allows an uninterrupted admission of fresh, and the
free escape of tainted, air. Fresh air can only be ensured
by an open window or door, or both. It is generally desirable to have a blazing fire kept burning night and day, both
in summer and winter, as this assists the efficient ventilation
of the room; but the patient's head should be protected from



68


FEVERS.


its direct effects. The poison of the disease being thus
diluted with atmospheric air loses its power and so becomes
inoperative. The room should be divested of all superfluous
furniture-carpets, bed-hangings, etc.  (2) It should be
darkened; not by excluding all light and air, by closed
shutters, or closely-drawn bed-curtain, but by letting down
the window-blinds and securing a subdued light, and by
protecting the patient's face from any glare, as from gas or
candles. (3) The sick room should be quiet. Silk dresses
and creaky.boots should not be worn; the crackling noise
made by anyone reading a newspaper is often most distressing
to invalids; the tones of the voice should be gentle and
subdued, but whispering avoided; all unnecessary conversation must be forbidden, and noise shut out. (4) The
temperature of the room should be regulated by a t/hermometer,
and maintained at an even temperature, not exceeding 55~
Fahr. The sensations of the nurse cannot be depended
upon as a sufficient guide; but the thermometer, suspended
out of a current of air and the direct influence of the fire,
will indicate the proper temperature at which the room
should be kept.
2nd. Rest.-The patient should be disturbed as little as
possible, and enjoy the most complete rest during the whole
course of the disease. The importance of this is proved by
post-mortem examinations, which often show vigorous attempts on the part of neighbouring structures to limit, by
union and adhesion, the results of perforation, obviously
indicating, in practice, the necessity of absolute rest
throughout the disease (AITKEN). Any efforts made when
the ulcers in the ileum were cicatrizing would affect the
system unfavourably, and re-excite that morbid action which
might end in perforation of the bowel.
3rd.  Cleanliness.-The personal and bed linen should be
frequently changed, and all matters discharged from the



TYPHOID FEVER-HINTS ON NURSING.


69


body immediately removed. The mouth should be frequently
wiped out with a soft wet towel, to remove the sordes which
gather there in severe forms of fever. The patient's body
should be sponged over as completely as possible at suitable
intervals with tepid or cold water, as may be most agreeable to
the feelings, and quickly dried with a soft towel.  Sponging
the whole surface of the body with cold or tepid water should
never be omitted in fever, as it reduces the excessive heat,
soothes the uneasy sensations, and is indispensable in maintaining that cleanliness which is so desirable in the sick
room. Cold water thus applied acts as a tonic, giving vigour
and tone to the relaxed capillaries, in which the morbid
action probably chiefly goes on. Frequent washing with
soap and water also tends to prevent the occurrence of bed
sores, by keeping the skin in a healthy condition.
4th. Hydropathic Applications.-In       addition  to  the
sponging and washing just recommended, I have found
the abdominal wet compress of great utility; it tends to
diminish excessive diarrhoea, checks the spread of ulceration
of the ileum, and obviates perforation. The compress is
made of three or four thicknesses of coarse linen, sufficient
to cover the whole abdomen, including the liver and spleen,
and extend down to the pubes. This is to be wrung out of
cold or tepid water, covered with oiled-silk or India-rubber
cloth, to retain the warmth and prevent too rapid evaporation; it may be simply laid on the abdomen, or if the
patient is restless it should be secured by three broad tapes
round the hips and waist. The compress should fit as
closely as possible, and displacement be avoided; otherwise
air penetrates between it and the skin, and cold, instead of
a moist heat, is produced. As long as the compress continues moist and warm it need not be disturbed; but as
soon as it becomes dry it should be re-wetted. Should lung



70


FEVERS.


complications arise, the compress should be applied to the
chest as well as the abdomen.
During the early course of the fever, the Wet Pack,
described page 33, is an invaluable application, and tends,
as the author has found, to give a mild character to the
disease.
5th. Beverages.-In mild cases, and at the commencement of all fevers, pure water, toast-and-water, gum-water,
sweetened with a little sugar,* barley-water, lemonade, or
soda-water is nearly all that is necessary. Cold water is an
agent of supreme importance, and acts favourably by lowering
the excessive temperature, and proves a valuable adjunct to
the medicinal treatment prescribed, by accelerating those
favourable changes which are anxiously hoped for.
6th. Diet and Stimulants.-In a disease which lasts three
weeks, often five or six, in which the waste of tissue is great,
and in which common food cannot be taken, it is a point of
high importance to supply the patient with nourishment
appropriate to his condition; otherwise he will sink before
the disease has completed its course. The following are the
chief points to be attended to in the diet of fever patients.
All the aliments given should combine both food and
drink in a fluid or semi-fluid form, until recovery has fully
set in. The digestive functions being more or less completely suspended, the nourishment given must be only
such as requires the simplest processes for its assimilation.
Examples of this form of nutriment are the following:milk; thin arrowroot with milk, wine-whey, prepared     by
adding one pint of good sherry to two pints of boiling milk,
and straining after coagulation; blancmange of isinglass or
ground rice; yolk-of-egg, beaten up with a little brandy,
wine, tea, cocoa, or milk; beef-tea and animal broths; and


* For direction to prepare, see the Index.



TYPHOID FEVER-HINTS ON NURSING.


71


alcoholic drinks.* The list might easily be extended, and no
good nurse will overlook the importance of variety in the
nourishment and delicacies for the sick room.       Milk is an
important article in the treatment of fever patients.   " Milk
or buttermilk is with me," says Dr. Gairdner, " the staple
food in typhus; and I will even say that I know of no
other food that can be depended on. Yet I see, and always
see with a new surprise, descriptions of the treatment and
dietetics of fever in which not a word is said about milk,
and a great deal about beef-tea, wine, brandy, and all
manner of things supposed to be more strengthening, or
stimulating than milk diet. Now, I suppose I have not
treated a single case of fever of any kind for the last fifteen
years without milk, and I always proceed on the understanding that milk in fever is the one thing needful as diet,
always to be given, and given liberally, whether specially
ordered or not." If, however, fever is attended by symptoms
of decided prostration, feeble pulse, a confused and dusky
countenance, or hectic, beef-tea or the essence-of-beef should
be added to the milk diet and given early. The beef-tea or
the broths may be thickened with well-cooked rice or
vermicelli, isinglass, or crumbs of bread. The egg-mixture
is of great utility; the yolk should be well beaten with a
table-spoonful of brandy or wine and as much water, or in
a little milk or cocoa, and two or three taken daily.   If the
prostration is very great notwithstanding the use of the
* "The writer has no intention to side in the controversy concerning the
food character of alcohol. He accepts the evidence that much ingested alcohol
is got rid of by the excretory organs, or is retained for some time in the tissues
after the manner of many medicines. But with food in its widest sense, as
what keeps up the vital functions, the physician will have little hesitation in
classing alcohol, who has observed the common case of an habitual tippler
maintaining for years a fair standard of bodily health upon a quantity of
other nutriment wholly insufficient by itself to maintain such health. And to
such a case a fever patient offers some resemblance. He, too, may not be able
to take enough of other food to maintain him, but alcoholic drinks will help
him not to starve. And thus the writer judges them to have a food-value
apart from their medicinal action" (BUCHANAN).



72


FEVERS.


nourishment already suggested, wine or brandy, diluted,
may be added. A little good wine with an equal quantity
of water may be given every hour or every two hours.
Efervescent wines must be avoided.    Dr. Harley advises,
six to eight ounces of wine or four ounces of brandy every
twenty-four hours when the pulse is of moderate force and
under 120. When the pulse ranges between 120 and 130,
and is small, double these quantities. If the patient enjoys
these stimulants, and desires their continuance, they may
be regarded as signs of their utility.  The effects of the
wine or brandy should, however, be carefully watched by the
medical attendant, and only given in proportion to the
demands of the system, the bulk and force of the pulse
being the main guides. As a rule, stimulants, except in
small quantities, are not required by children, or persons
who can take a sufficient quantity of other kinds of nourishment, or early in the disease. On the other hand, aged
persons, and cases of great prostration, or in which the
extremities are cold and the general surface livid, almost
invariably require alcoholic stimulants. Under any circumstances, if stimulants aggravate existing symptoms, their
employment should be modified or altogether discontinued.
Fever patients are often unable to relish or swallow
nourishment in consequence of the dry and shrivelled state
of the tongue, and it often becomes necessary to put a little
lemon juice and water into the mouth before offering food;
in a minute or two the mucous membrane becomes soft
and nourishment may be swallowed       and  enjoyed.   No
food  to be kept in the sick room.-Miss Nightingale's
suggestion on this point is so important, but, we regret
to observe, so often disregarded, that we venture to repeat
it here.   It is this-do not keep the food, drink, or
delicacies intended for the patient, in the sick room or
within his sight. The air of the apartment is liable to



TYPHOID FEVER-HINTS ON NURSING.


73


deteriorate them, and the sight of them, always before his
eyes, to excite disgust. Rather take him up at the fitting
time, and by way of surprise, two or three teaspoonsful of
jelly, or as many fresh grapes as he may consume at once,
or one or two segments of an orange. Or, if it is appropriate
to his condition, a small cup of beef-tea, covered, with one
or two narrow slips of toasted bread, just from the fire;
this is much preferable to the attempting to swallow even
a less quantity from a basinfil that has been kept for many
hours within the reach of the patient's hand and eye.
Lastly, nourishment should be given with strict regularity;
in extreme and long continued cases of prostration, every
hour or half-hour, both day and night.      Frequently the
functions of digestion and assimilation are so greatly impaired, that the largest quantity of nourishment must be
given to sustain the patient till the disease has passed
through its stages. Dr. Graves was so strongly impressed
with the importance of nourishment in fevers, as to have
said that he desired no other epitaph than that he fed fevers.
7th.  Watching Patients. -Fever patients should be attended and watched by day and by night. Their urgent
and incessant wants require this, and their safety demands
it. Instances have occurred of patients, in the delirium
which so frequently attends this disease, getting out of bed,
and even out of the window, during the absence of the
nurse, and losing their lives from injuries thus sustained.
8th. Moderation   in  convalescence.-Relapses are very
liable to occur from indulging the appetite too freely during
convalescence; and, therefore, toast and black tea, jellies,
light bread-puddings, white fish, mutton broth, a small
quantity of tender chicken, broiled mutton, etc., with a
little stale bread and boiled rice instead of potatoes, may
only be allowed in great moderation; but never to the
capacity of the appetite, till the tongue is quite clean and
F



74


FEVERS.


moist, and the pulse and skin have become natural.  If
stimulants have been given they should be gradually withdrawn as the quantity of nutritious food is increased. Even
when convalescence has somewhat advanced, moderation
should still be exercised, as the appetite is often excessively
craving.
9th.  Unnecessary approaches.-These should be guarded
against by persons in health, especially by the young, in
whom susceptibility to disease is greatest. Another precaution is, not to visit the sick chamber after long fasting.
The great protective influence, however, is fresh air; this
neutralizes fever poison, and should be uninterruptedly
passing through the patient's apartment. With open door
and windows, and by avoiding the patient's breath, and the
exhalations from his person, till they become well diluted
with pure air, fever cases of the very worst kind may be
visited fearless of danger. In the particular case of typhoid
fever, the following additional precautions have been suggested by Dr. Aitken, with the view of checking the spread
of this disease:(1.) All discharges from fever patients should be received
on their issue from the body into vessels containing a concentrated solution of chloride of zinc.
(2.) All tainted bed or body linen should, immediately on
its removal, be placed in water, strongly impregnated with
the same agent.
(3.) The water-closet should be flooded several times a
day with a strong solution of chloride of zinc; and some
chloride of lime should be also placed there, to serve as a
source of chlorine in the gaseous form.
(4.) So long as fever lasts, the water-closets should be
used exclusively as receptacles for the discharges from the
sick.



TYPHOID FEVER-HINTS ON NURSING.


75


10th.  Change of air.-The salutary influence of change
of climate and scene to persons who have suffered from a
serious attack of fever can scarcely be overestimated, and if
the place or climate has been chosen with intelligence and
judgment, the happiest results may be anticipated. If the
change of air includes agreeable society, and excludes all
business anxieties, it is a remedy of the very highest importance for bracing up the system, and restoring the patient
to his usual health and strength. Often any painful symptoms remaining are at once arrested; the current of the
thoughts is turned into new and healthy channels; and in
the luxuriance of nature, in the grand scenery of mountainous
districts, or inhaling the tonic air of the sea coast, the eyes
beam forth with new life, the forces of the circulation are
raised and equalized, the mind is unencumbered, and all
the functions of the body are pleasantly and healthily performed. After recovery from a serious attack of fever, the
whole man becomes changed, and there seems to be a
renewal of youth. Nothing gives such a beneficial direction
to this change, or renders it so perfect as a temporary
removal to a suitable climate and locality. We fully endorse
Dr. Aitken's statement,-No man can be considered asfit for
work, for three or four months after an attack of severe typhoid
fever.
11th.  General Preventive Measures.-To prevent bad
forms of fever, the cholera, and other acute and dangerous
diseases, the following suggestions should be carried out:abstinence from alcoholic drinks; temperance in eating and
drinking; healthy and cheerful amusements, especially in
the open air; industrious occupations, short of exhausting
labour; fear should be dismissed from the mind as a base
passion, beneath the dignity of man; the light of the sun and
fresh air should be freely admitted into every room of the
house; all stagnant water around or under the house should



76


FEVERS.


be drained off; filth-animal and vegetable matters-not
allowed to accumulate and decompose about sinks or drains;
personal cleanliness should receive due attention, and a
sponge, shower, or plunge bath be taken daily; and, lastly,
a small bottle of the strong tincture of  Camphor (the
Homoeopathic preparation), should always be accessible, so
that when unavoidably exposed to infectious and dangerous
influences, a drop may be taken before the poison has
extended to the blood. As general preventive means, these
hints are of the highest importance, and may be carried out
in the confident hope of exemption from the threatened
evil.  The words of Heberden embody a law of nature,
the recognition of which is a matter of the highest importance:-1"THE SEEDS OF VARIOUS KINDS OF DISEASE, LIKE
THOSE OF VEGETABLES, WILL ONLY. SPRING UP AND THRIVE
WHEN THEY FALL UPON A SOIL CONVENIENT FOR THEIR
GROWTH.
4.-Typhus Fever (Febris Typhus).
DEFLNITION.-Typhus is an acute specific form of fever,
highly contagious and infectious, continuing from fourteen
to twenty-one days, attended with a lethargic or confused
condition of the intellect, and of an eruption on the skin of
a measly or mulberry rash, and is the accompaniment of
privation, overcrowding, and defective ventilation.
SMrPTOMS.-The precursory stage varies, but is usually
short, so that the patient yields to the disease within the
first three days, giving up his employment and taking to
his bed; in this respect strongly contrasting with the
protracted invasive stage of typhoid. Sensations of uneasiness, soreness, or fatigue, loss of appetite, headache, and
disturbed sleep, are 'the early symptoms. The patient is
often seized by a rigor, but less marked and severe than
in small-pox or internal inflammations, usually succeeded



TYPHUS FEVER.


77


by dry heat of skin, thirst, quick pulse, white, dry, often
tremulous tongue, scanty and highly-coloured urine, sometimes vomiting, heavy look or stupor, prostration, and
muscular pains; towards evening there is irritability or
restlessness, and if sleep occurs, it is disturbed by dreams,
or frequent sudden starts, and is in consequence unrefreshing.
The general appearance of a typhus patient is very marked
and affords to the practised eye a ready means of diagnosis.
In an average attack the patient lies prostrate on his
back with a most weary and dull expression of face, his
eyes heavy and with some dusky flush spread uniformly
over his cheeks. In the advanced stage of a severe attack
he lies with his eyes shut or half-shut, moaning and too
prostrate to answer questions, to protrude his tongue, or to
move himself in bed; or the mouth is clenched, the tongue
and hands tremble, and the muscles are twitching and half
rigid. The dryness of the mouth, the sordes on the teeth
and lips, the hot dry skin, and the deafness, are other
symptoms which strike an observer so immediately as to
deserve to be included in the physiognomy of the disease."*
During the first week the patient complains much of
headache, noises in the ears, and, subsequently, deafness.
The conjunctivae are injected, the pupils contracted, painfully
sensitive to light, and therefore often closed. He becomes
irritable, and his answers short and fretful. After the lapse
of a period usually between the fourth and eighth days, the
mind passes from a state of excitement to one of delirium.
This symptom is usually more severe and appears earlier
when the disease attacks persons in the upper classes of
society, in consequence, no doubt, of the greater activity of
their brains. It is at first one of confusion of ideas as to
time, place, persons, and even personal identity, with vague
* "A System of Medicine." Vol. I.



78


FEVERS.


rambling talk, of which occasionally he seems conscious,
and from which he can be roused. Afterwards the delirium
may become active and maniacal, or low and muttering.
The patient often fancies that he is two or three persons,
and the subject of a series of miseries and violence; confined
in a dungeon, pursued by enemies from whom he vainly flies,
or with whom he struggles, and he attempts to spring from
bed to reach the door or window to fly from his tormentors.
Sometimes the delirium passess into a heavy stupor, with
tremulousness of the tongue and hands, and twitching of
the muscles (subsultus tendinum); but in favourable cases
it gradually subsides in two or three days, the powers of the
mind begin again to dawn, the countenance assumes a more
tranquil aspect, sleep becomes natural, and at length
convalescence is fully established.
Diarrhoea is not of infrequent occurrence, but sometimes
the bowels are confined; the evacuations are natural or dark,
and contrast strongly with the yellow-ochre colour of the
stools in enteric fever; finally the evacuations may be
involuntary.
THE PULSE.-In typhus the pulse is rarely less than 100,
sometimes 120, or 130, or even 140 in the minute. In the
last case, however, in adults, it is indicative of great danger.
As a rule the pulse pursues a gradually increasing rate of
frequency up to the 9th or 12th day, and afterwards undergoes a correspondingly regular decline.  Cases so marked
almost invariably get well. On the other hand, departures
from this gradual rise and fall in the pulse, especially if
considerable, mark the existence of complications or dangerous symptoms.     In fatal cases of typhus the pulse
becomes more and more rapid, and also weaker and smaller
up to the very hour of death. The first glimpse of dawning
convalescence is afforded by watching the pulse; the
temperature, as measured by the thermometer, is a valuable



TYPHUS FEVER.


79


but less available sign; and whenever the pulse is fairly on
the decline, especially if it gets stronger and fuller, we may
confidently conclude that the patient will recover.  The
crisis of typhus is often indicated by no other symptom
than the gradual decline of the pulse, after having gradually
reached its maximum degree of rapidity. There may be no
marked perspiration, no critical diarrhea, no striking alteration in the urine, or startling phenomena of any kind;
the only trace of crisis, being the gradual decline of the
fever as indicated by the fall in the pulse and the thermometer.
DISTINCTIVE CHARACTERS.-The typAus rash appears between the fourth and seventh days, and consists of irregular,
slightly elevated spots, of a mulberry hue, disappear on
pressure, and may be single and few, or numerous and large;
in the latter case two or more spots coalesce. They are
usually first seen on the abdomen, and afterwards on the
chest and extremities; and the number and depth of colour
of the spots are in proportion to the severity of the disease.
From the first to the third day after the appearance of the
rash, no fresh spots appear; and each spot, although it
undergoes certain changes, continues visible till the whole
rash disappears, and the disease terminates. In fatal cases,
the typhus spots remain after death.
The odour of the poison of typhus is very characteristic,
and it is described as offensive, pungent, and ammoniacal.
Nurses, familiar with the disease, are thus alone able to
recognise it, and estimate the amount of danger by the
badness of the smell.
Prominence of Nervous Symptoms.-It is from the constancy and prominence of these symptoms that the name
of typhus was first employed, and it is almost certain
that it is through the nervous system that the poison of
the disease chiefly operates. Hence extreme restlessness,



80


FEVERS.


ringing noises in the ears, and low delirium or stupor, are
invariably present to a greater or less extent. In fatal cases,
about the ninth or tenth day, delirium merges into profound
coma, or the condition described as coma-vigil may come on.
In this latter condition, the patient lies on his back with his
eyes wide open, and certainly awake, but indifferent or
insensible to everything transpiring around him. His mouth
is partially open, his face expressionless, and he is incapable
of being roused. At length the breathing becomes nearly
imperceptible, the pulse rapid and feeble, or it cannot be
felt, and the transition from life to death occurs without any
gleam of returning consciousness, and can only be recognised
by the eyes losing their little lustre, and the chest no longer
performing its slow and feeble movements:
UNFAVOURABLE INDICATIONs.-Early, furious, and persistent delirium,with complete sleeplessness; coma-vigil; convulsions; involuntary twitchings of the muscles of the face and
arms; abundant and dark rash, nearly unaffected by pressure; great duskiness of the countenance, or lividity of the
surface; involuntary, uncontrollable diarrhoea; suppression
of urine, or albuminuria; a brown, hard, tremulous tongue;
a temperature gradually rising to 1070 Fahr., or higher; a
great sudden elevation of temperature in the third week;
a small, weak, irregular or imperceptible pulse, stationary at
above 1200; bed sores, or inflammatory or erysipelatous
swellings; a strong presentiment of death on the part of
the patient, etc.
CAUSES.- Overcrowding, with   defective ventilation, and
destitution, and thus is the scourge of the poor inhabitants
of our large towns.  Overcrowding includes the several conditions of overcrowding of rooms by too many occupants;
overcrowding of dwelling-houses upon too circumscribed
area, preventing the proper ventilation of streets and houses;
want of personal and domestic cleanliness. A spacious



TYPHUS FEVER.


81


dwelling, with free ventilation, robs the disease of its power,
and arrests its spread to others. Privation, as famine through
failure of crops, commercial distress, strikes, hardships in
war, etc; this predisposes to typhus by deteriorating the
constitution. Before the days of Howard, typhus was never
absent from our prisons and hospitals; it was the scourge of
the armies of the first Napoleon, and it decimated those of
the Allies in the Crimea, the disease varying among the
troops exactly in proportion to the degree of privation and
overcrowding. In 1818, and again in 1847, the failure of
the potato crop in Ireland gave rise to'an epidemic of this
fever, so that it is estimated that an eighth part of the entire
population was attacked. There is undoubted evidence that
the poison of typhus may be generated de novo, and that the
circumstances under which this occurs are those above stated,
namely, overcrowding, defective ventilation, and destitution.
There seems ground for believing that the poison is chiefly
transmitted by the exhalations from the lungs and skin; the
material poison (materies morbi) being inhaled or swallowed,
and so finds ready admission to the blood, upon which it
exerts its morbid influence. The effects of bad ventilation in
the development of typhus is well expressed in the following
words: "If any person will take the trouble to stand in the
sun, and look at his own shadow on a white plastered wall, he
will easily perceive that his whole body is a smoking mass
of corruption, with a vapour exhaling from every part of it.
This vapour is subtle, acrid, and offensive to the smell; if
retained in the body it becomes morbid; but if re-absorbed,
highly deleterious. If a number of persons, therefore, are
long confined in any close place not properly ventilated, so
as to inspire and swallow with their spittle the vapours of
each other, they must soon feel its bad effects. Bad provisions and gloomy thoughts will add to their misery, and
soon breed the seminium of a pestilential fever, dangerous



82


FEVERS.


not only to themselves, but also to every person who visits
them or even communicates with them at second hand.
Hence it is so frequently bred in gaols, hospitals, ships,
camps, and beseiged towns. A seminium once produced is
easily spread by contagion."
TREATMENT.-It is a question whether typhus can ever
be cut short, or the definite course of the disease altered
by the administration of remedies; some contend that it
may be broken up in the first stage, especially by the
combination of Hydropathic appliances with the use of
Homceopathic remedies; others believe that the disease
must have its course. However, we have ample experience
to prove that in the great majority of cases the violence of
the symptoms can be held in check, the patient's comfort
greatly promoted, and convalescence hastened, by judicious
treatment.
The remedies appropriate for the ordinary run of cases
are the following:-Acon., Ars., Bell., Bry., Hlyos., Opi.,
Rhus, China.
Remedies for special symptoms are prescribed in the
following table:
1. Inflammatory Symptoms.-Acon. and Bell.
2. Cerebral Symptoms.-Hyos., Bell., Rhus.
3. Typhus with extreme Prostration.-Ars., Carbo Veg.,
Phos. Ac.
4. With Pulmonary complications.-Bry. Phos.
5. With Gastric derangements.-Ipec., Nux Vom., Puls.,
or Bry.
6. With Stupor.-Opi., Rhus.
7. With Sleeplessness.-Coffaa, Bell.
8. With Putridity.-Carbo. Veg., Ars., Verat.
As we have described the treatment of typhoid with
considerable detail, and as many of the symptoms common



TYPHUS FEVER.


83


to that fever are present in typhus, we shall only offer the
following characteristic symptoms:Belladonna.-Inflammatory typhus chiefly with brain
symptoms; fever commencing with rigors in the evening or
at night; redness of the face; dilated pupils, with wild,
unsteady expression.
Hyoscyamus.-In the delirium  of typhus, with sudden
startings as in afright, this remedy should never be overlooked; it often acts like a charm after Bell. has effected
but little improvement.
Opium.--Stertorous breathing; low moaning noise; muttering delirium, or delirium after a short sleep; dusky flush
of the countenance; picking at the bed-clothes; coma vigil;
involuntary discharges of faeces and urine.
Rhus Tox.--In the lonw forms of typhus, with great
debility, almost amounting to paralytic weakness of the
limbs; small and quick, or weak and slow, pulse; anxious
and depressed mood; oppression of the chest.
Arsenicum.-Rapid prostration of strength; sunken countenance and eyes; red, brown or blackish, dry, cracked, and
trembling tongue; insatiable, burning thirst; sensation as
of hot water coursing through the veins; rapid, small,
irritable pulse.
AccEssoRY MEAsURES.-The points of greatest importance
may be briefly summed up as under: (1.) The patient
should be placed in a large, or at least in a well-ventilated,
room, so as to secure a continuous and amply supply of
fresh air. Cases occurring in close, crowded rooms in which
this prime hygienic condition cannot be secured, should
be removed to a properly consructed hospital. (2.) Frequent changes of personal and bed linen, changes of
posture to avoid congestion and bed-sores; if bed-sores
form notwithstanding, the patient should be placed on a
water-bed; also the wet pack is a valuable measure,



84


FEVERS.


especially early in the disease, and when the skin is dry
and hot. (3.) Food or beverages should be given in small
quantities at regular and frequent intervals, including water,
milk-and-water, tea, broth, beef-tea, and, if prostration,
feeble and irregular 'circulation, or complications, indicate
their use, wine or brandy. In some cases in which patients
obstinately refuse all food, or are unable to swallow, life
is often saved by nutritious or stimulating enematae.
(4.) Quiet, or in noisy streets stuffing the ears with cotton
wool; cleanliness, sponging the whole surface of the body
and careful drying at least once a day, and intelligent and
unremitting watching.
The hints on nursing fever patients in the previous section
should be studied.
PROPHYLACTICS.-As disinfectants, fresh air, efficient ventilation, and cleanliness are of paramount importance; as
additional means for avoiding contagion but by no means as
substitutes, whitewashing with quick lime, repapering infected rooms, washing the wood-work with soap and water,
cleansing the linen in water to which chloride of lime has been
added, and the use of this substance or of carbolic acid in the
water employed in sponging the patient. Without cleanliness
and fresh air, vinegar, camphor, and other so-called preventives, are useless, and only disguise noxious vapours. Persons
in attendance on the sick should especially avoid the odour
from the breath and the exhalations which arise on turning
down the bed-clothes. Nurses should not be overworked,
deprived of repose in bed, or of daily out-door exercise. If
there is any ground to fear an attack of typhus, Bry. and
MRus. are the best preventives.



INTERMITTENT FEVER.              85
5.-Intermittent Fever (Febris Internitten)s)-Ague.
DEFINITION.-The disease known as ague, consists of
severe paroxysms of fever, characterized by a cold, a hot,, and a sweating stage, between which there is a period of
comparative health, in which the patient is able to follow his
usual occupation.
Two centuries ago, when the soil around London was
neither cultivated nor drained, and when during portions of
every year, the marshes of Lincolnshire, Cambridgeshire,
and adjoining counties sent forth their emanations of malaria,
ague was a very fatal disease in this country. James I.
succumbed to its power in London, March, 1625. When
told by his attendants that " an ague in spring is physic for
a king," James replied that " the proverb only held good
to a you.ng king." In 1658, Oliver Cromwell died from it
at Somerset House.
Geographical facts, collected by medical writers from
Hippocrates downwards, show that every country is unhealthy
in proportion to the quantity of marshy or undrained alluvial
soil it contains, the inhabitants of such districts dying often
in the ratio of 1 in 20 instead of 1 in 38-the average
mortality in healthy districts. The connexion of a given
class of disease-represented by remittent and intermittent
fever-with marshy districts is now distinctly established
and generally recognised (AITKEN).
The disappearance of ague has always been in direct
relation to the drainage and cultivation of the soil, not only
in England, but in every portion of the globe. If the
cultivating hand of man is withdrawn from a district, and
the former conditions reappear, malaria again becomes rife.
SYMIPTrIMs.-These may set in suddenly, or they may
appear gradually, until a regular paroxysm  occurs. An
ague fit has three stares-the cold, the hot, and the



86


FEVERS.


perspiring.  The first stage comes on with a feeling of
debility, lassitude, weariness, chilliness, and rigors; then
follow sensations as of cold water trickling down the spine
and a shivering of the whole body: the teeth chatter, the
nails turn blue, and the whole frame trembles, often with
such violence as to shake the bed on which the patient may
be lying. The face becomes pale, the features and skin
contracted, and the papille of the skin are rendered so
prominent as to give it the appearance aptly described as
goose skin, such as may at any time be produced by exposure
to cold. These symptoms are accompanied by an anxious
expression of countenance, the eyes are dull and sunken,
the pulse frequent and small, the breathing hurried and
oppressed, the tongue white, and the urine scanty and frequently passed. After a period, varying from half an hour
to three or four hours, the second or hot stage comes on
with flushings, until the entire body becomes hot, with
extreme thirst, full bounding pulse, throbbing headache,
and restlessness, the urine being still scanty, but highcoloured. At length, after two, three, and even six or twelve
hours, the tkird or perspiring stage succeeds, and the patient
feels much relieved. Thirst diminishes, the pulse declines
in frequency, and the appetite returns; at the same time
there is a red deposit of urates in the urine. The perspiration first breaks out on the forehead and chest, and gradually
extends over the entire surface of the body; sometimes it is
only slight, but at other times it is very copious, saturating
the patient's linen and bed-clothes. A paroxysm usually
lasts about six hours, allowing two hours for each stage.
The period between the paroxysms, as already explained, is
called the intermission; but by an interval is meant the whole
period or cycle between the beginning of one paroxysm, and
the beginning of the next.



INTERMITTENT FEVER.


87


TYPES.-There are three chief types of ague; lst.-The
Quotidian, has a paroxysm daily, coming on generally in the
morning, from about 7 to 9 o'clock, has an interval of
twenty-four hours, and is most common in the spring.
2nd.-The Tertian, has a paroxysm every other day, coming
on from 10 to 12 o'clock at noon, has an interval of fortyeight hours, and is most frequent in the spring and autumn.
3rd.-The Quartan, which has a paroxysm every third day,
coming on from 2 to 4 p.m., has an interval of seventy-two
hours, and is most common in the autumn. The hours of the
day during which the paroxysms occur are, however, by no
means uniform. The tertian is perhaps the most frequent,
and has the most marked hot stage; but the quartan is the
most obstinate. There is still another type in which, though
there is an attack every day, those only resemble each other
which occur on alternate days.
PATHOLOGY.-It is probable that in the cold stage, the
blood leaves the surface and the capillaries, and accumulates
about the right side of the heart, the large veins and great
venous organs of the interior, such as the liver, spleen, and
the bases of the lungs. In the hot stage, the heart reacts
and throws out the blood again to the surface, but beyond
the conditions of health, so that it is rendered preternaturally
dry and hot, with all the symptoms of inflammatory fever;
in the sweating stage the secretions are re-established, and
the proper balance between the large and small blood vessels
is restored.
LAws.-Although at present ignorant of the physical or
chemical nature of this aerial poison, we know that malaria
obeys the following laws, which, being of great practical use,
are worth remembering. 1st-It spreads in the course of
prevailing winds. It has always been observed that when
the wind blows across malarious tracts of land, the disease
prevails on the opposite side to that from which the current



88


FEVERS.


proceeds; at the same time the inhabitants of the ventilated
district escape.  2nd-Its progress is arrested by water,
especially by rivers and large running streams. Thus persons
on board ship, or on the side of water opposite to a marsh,
are unaffected by it, although a favourable wind transmits
the poison a far greater distance by land. Water probably
absorbs malaria; and it is a common opinion in India that
water so charged produces periodic fevers in those who
drink it. In like manner, thick rows of trees intercept the
progress of the poison. 3rd-Malaria does not rise above the
lonw level. It seems to be of greater specific gravity than
atmospheric air, its power diminishing as we rise from the
surface of the earth. Persons occupying the upper stories
of a house in an infected locality suffer to a far less extent
than those living on a ground floor. 4th-It is' most dangerous at night. It has been often observed that sailors who
go on shore in the daytime, when off a malarious coast, do
so with no bad results; but that those who remain on the
shore during the night are almost invariably seized with
fever.
EFFECTS.-From the recurrence of internal congestions in
each cold stage, the function of the liver, bowels, and sometimes the kidneys, is disordered; the patient becomes sallow,
his limbs waste, but his abdomen is distended, and his bowels
are constipated. The spleen is especially liable to be enlarged,
sometimes to a great extent, when it can be felt externally,
attaining a weight of many pounds. An enlarged spleen is
popularly called ague cake. " The heat-generating power of
all victims to malaria is impaired; hence they suffer from
atmospheric changes, of which healthy men take no note"
(ilMaclean). Another result is extreme liability to repeated
attacks; for the disease often leaves the body so enfeebled,
that ague may be reproduced by agencies which, under other
circumstances, would produce no ill effects.



INTERMITTENT FEVER-AGUE.


89


CAUSES.-This disease is called an endemic, because it is
peculiar to a particular locality or country.  The exciting
cause of ague is an exhalation of invisible particles from the
surface of the ground, known by the term malaria or marsh
miasma. Malaria is thought to be the product of vegetable
decomposition in soils, and is inhaled by the lungs during
breathing, and thence absorbed into the system. The emanation takes place from marshy lands which have been
flooded with water and dried under the influence of the sun's
heat, and is most rife in the spring, and when the rains fall
upon the decaying leaves of autumn. It is not due, as was
formerly supposed, to putrefaction of animal matter. All
that seems to be essential to the production of malaria, is
the continued action of the sun on moisture stagnant upon
or near the surface of the ground. A certain amount of
moisture is necessary; for a very dry season which desiccates
a marsh stops the malaria; while the deposit of the evening
dew always favours its production. Excess of moisture, on
the other hand, checks its development, so that a very wet
season, as well as a very dry one, may render a marsh less
unhealthy. But extreme heat does not diminish malaria on
the banks of rivers, because portions of these are never dry.
The shores of the Black Sea and the Mediterranean are
always malarious at the commencement of hot weather, as
in the absence of a tide there is none of that frequent salt
washing and drainage which purifies other European shores
(Williams).
The predisposing causes are fatigue, exhaustion, insufficient
or improper diet, intemperance, exposure to night air, and
previous attacks of ague.
TREATMENT.-This is divided into the Palliative and the
Curative. The Palliative is adopted during the paroxysms to
mitigate the immediate symptoms, and consists chiefly in
imparting warmth during the cold stage, removing the
G



90


FEVERS.


patient's coverings and giving cooling drinks during the
hot; and supplying him with warm and dry linen when the
perspiring stage has passed by.
The Curative is adopted during the intermission, and is of
the greatest importance. The following are the chief remedies in our short list:-ARSEN., CHIN., Carb. Veg., Bry.,
Verat., Nux V., Puls., Fer., etc.
The object of treatment is not, therefore, directly to arrest
the paroxysms, but to bring about such a healthy condition
of the system that the disease may gradually decline, until
it disappears altogether. It is often observed that persons
who have been drugged with large doses of bark and quinine
look sickly and debilitated, and that ague returns again
upon trifling exposures. It may be necessary to persevere
for several weeks with the appropriate remedy, and not to
change it too frequently, or at all, if the paroxysms become
less severe, and occur at later periods of the day.
Arsenicum.-This is indicated when the stages are not
clearly marked, as in the simultaneous occurrence of shivering with heat, or shivering alternating with heat, or internal
shivering with external heat; burning heat; insatiable thirst;
great debility; tenderness of the liver and spleen; nausea;
violent pains in the stomach; great anxiety; tendency to
dropsical afections; also when Cinchona has been used in
excess. A dose every four hours between the paroxysms if
they occur daily, or once in six hours if they occur every
second or third day. In brow-ague and hemi-crania, occurring in marshy districts, Arsenicum is very efficacious.
China.-A prominent remedy in well-defined cases of ague
in which all three stages are distinctly marked, and take place
in their regular order, and especially when the fits occur in
marshy districts; also where there exist previous to the
attack nausea, thirst, headache, palpitation, anxiety, sneezing,
etc. The symptoms are: yellowish complexion, drowsiness



INTERMITTENT FEVER-AGUE.


9I


after a meal, soreness or swelling of the liver or spleen;
watery, slimy, or bilious diarrhoea; sensation of chilliness
or shuddering after drinking, etc. A dose every four or six
hours, one being administered an hour before a paroxysm is
expected to occur. Should Quinine have been administered
in excessive quantities, Carbo Veg. or Ars. should be substituted for China.
Ipecacuanha.-Nausea, vomiting, and other gastric symptoms, worse in the evening; external heat aggravates the
shiverings, slight thirst during the shiverings, with extreme
thirst during the heat; also in paroxysms in which the
sweating stage is indistinctly marked.
Nux Vomica.-This remedy is more particularly indicated
when the paroxysms occur in the afternoon or evening, and
where there are aching pains in the forehead, giddiness,
nausea, bitter taste, constipation, a kind of paralytic weakness of the limbs, etc. It is well indicated in persons who
take strong drinks, of sedentary habits, or whose occupations
are mental rather than bodily.
Bryonia.-Paroxysms preceded or accompanied by cough,
difficult breathing, pain in the chest or side, thickly-coated
tongue, headache or vertigo, constipation or diarrhcea, etc.;
also when coldness is more marked than heat.
Mfercurius.-Profuse and fcetid perspirations, staining the
linen yellow.
When gastric or bilious derangements are prominent
symptoms, or when dietetic errors have occasioned an attack,
one of the following remedies may be administered: Ant.
Crud., Verat., Puls., Ign., or Bell.
When the object is to destroy the predisposition to a
recurrence of the-ague, and to eliminate from the system
those morbid products upon which such tendency depends,
Carbo Veg., Lyc., or Sulph.,- should be administered for a
considerable period, once or twice daily. The choice of the



92


FEVERS.


appropriate remedy is a point of great importance, and after
such a selection has been made the remedy should be steadily
persevered with.
A much larger list of remedies is often prescribed, but the
author has treated most unpromising cases with complete
success, by means of a small selection.
Treatment of Enlarged Spleen.-Should this organ continue undiminished in size, we have a powerful remedy in
the ointment of the biniodide of Mercury, applied over the
gland. The experience of many practitioners in India having
demonstrated the extraordinary efficacy of this remedy in
cases of goitre, it has of late years been successfully used in
some parts of India as a remedy in solid enlargements of
the spleen.  It has been very successful at the R. V. Hospital, Netley; in some cases, where the spleen has extended
down into the pelvis, it has, after several applications, been
reduced almost to its normal limits. It has acted just as
energetically on enlarged malarial livers. This mode of
treatment is worthy of extensive trial, because in not a
single example has it induced any unpleasant constitutional
action (Maclean).
ACCESSORY MEANS.--One of the first and most essential
points is, if possible, the removal of the patient to a more
healthy locality. Removal from an aguish district to a dry
bracing situation, is often immediately attended by a very
marked improvement in the health. As patients frequently
appear quite well between the paroxysms, particular caution
is necessary against exposure; they should not venture into
a damp or chilly atmosphere, remembering that the poisonous
miasma is most powerful at NIGHT and near the SURFACE OF
THE GROUND; hence they should not remain out of doors in
the evening, or go out too early in the morning, at least not
without first taking breakfast. They should also select the
loftiest part of the house to sleep in. The light and heat of



94


FEVERS.


soles of the feet, and extreme restlessness. Towards morning, however, there is a remission, and the patient falls
asleep, and, when he wakes, is bathed in perspiration. The
pulse is small and weak, and greatly accelerated, reaching
120 beats in the minute, or more; "' the beat being performed
with a jerk, as if the result of irritation upon a weakened
heart." The pulse is quickened by any exertion, by excitement, or even by food; the bowels are relaxed with diarrhoea,
especially in advanced stages of the disease, the diarrhcea
aggravating the s-weating, and consequent exhaustion; the
tongue is furred white or brown in the centre, but unnaturally red around the tip and edges; the urine deposits
the red brick-dust or pink sediment, consisting of the urates
of soda and ammonia; the skin is clammy except during
the inflammatory stage, when it is burning hot; the complexion is clear, the eyes are bright and sparkling, and there
is most marked emaciation, especially as death approaches.
The mind usually remains bright, often vigorous, and hopeful, except towards the end, when slight delirium sometimes
occurs.
CAUSES. -Long-continued disease, especially when attended with profuse suppuration. It is one of the fearful
accompaniments, and frequently a most characteristic symptom of Consumption. When our diagnosis of that disease
wants confirmation, the appearance of hectic often furnishes
the melancholy but decisive proof. The cause in this and
other instances is an habitual drain upon the system beyond
the amount of nourishment supplied or appropriated, so
that the excessive waste is not counterbalanced by any
adequate reparative process. Sometimes hectic is unconnected with any suppurative process, it being the result of a
wasting of the bodily substance, as in too prolonged nursing,
excessive sexual indulgences, etc.
TREATMENT.-The only cure for hectic fever is the removal
of the original cause on which it depends; but when that is



HAY-FEVER-HAY-ASTHMA.


95


impossible, the treatment must be directed towards moderating the symptoms as they occur, and supporting the system
by the most concentrated nutriment, and tonics. The medicines most likely to be of service are, Ch/iina, Ars., Phos. Ac.,
Hepar Sulph., Calc., Carbo Veg., Sulph., Nux Vom., etc.
ACCESSORY MEANS.-Generous diet, wine, change of air
and scene, and pleasant associations. Any cause likely to
favour hectic, such as too prolonged nursing, in which
a drain upon the system is established beyond its means,
and which depress the mind and enfeeble the body, must be
strictly avoided.
7.-Hay-Fever-Hay-Asthma (Catarrhus astivus).
This is a singular species of summer catarrh to which only
few persons are liable.
SYMPTOMs.-They are those of an ordinary severe cold, to
which those of asthma are superadded. The patient complains of sneezing; profuse discharge from    the nose;
irritation of the eyes, nose, and air-passages; tightness of
the chest, and dyspnoea, sometimes with, and sometimes
without, mucous expectoration; pricking sensations in the
throat; harassing cough, etc. Exposure to the powder of
Ipecacuanha gives rise to similar symptoms in many persons.
CAUSES.-An emanation from certain grasses in May or
June, during the haymaking season. It only occurs at this
period, and persons susceptible of its influence escape by
removal from the neighbourhood of hay-fields or hay-stacks.
TREATMENT.-Ipec., Ars., Euphrasia, Puls., and Mere.,
are remedies which the writer has used with good results.
The choice of the remedy must depend upon the accompanying symptoms.
ACCESSORY MEANS.-Removal to the sea-coast, or to any
part where grass does not grow, or hay is not stored, offers
the surest protection. The cold shower bath, the Turkish
bath, and the use of a respirator, are also recommended.



96


ERUPTIVE FEVERS.


CHAPTER       II.
THE ERUPTIVE FEVERS (Exanthemata).
THE Exanthemata or eruptive fevers may be regarded as
continued fevers, having an eruption superadded.         They
have the following common characters:-they arise from a
specific contagious poison, between the reception of which
and the occurrence of the symptoms, a variable time elapses;
ran a definite course; are accompanied by a specific inflammation of the skin, called the eruption, which passes through
a regular series of changes; affect some part of the mucous
membrane as well as the skin; and, as a general rule, only
attack an individual once during life.
The true Exanthemata, including all these characteristics,
are, the small-pox, measles, and scarlet-fever; but there are
other less perfect forms, as chicken-pox, nettle-rash, and
rose-rash; even continued fever itself is classed with them.
These diseases are called by the Registrar-General, Zymotic
diseases, a term implying their origin in a poison which acts
like a ferment in the blood, and are regarded by sanitary
reformers as preventible diseases. They have all a latent
period intervening between the reception of the contagion
and the accession of the fever, during which time the patient
is to all appearance in good health.
The following table, from Dr. Tanner, shows the latent
period or period of incubation, and the accession and disappearance of the eruption in the three great eruptive fevers.
isease.     Period of    Eruption appears.  Eruption fades.
Disease.    Incubation.
Scarlet Fever  4 to 6 days.  On 2nd day of fever.  On 5th day of fever.
Measles....  10 to 14 days.  On 4th day of fever.  On 7th day of fever.
Scabs form on 9th or
~   10th day of fever,
Small-pox..   12 days.   On 3rd day of fever.  ad a off about
and fall off about14th.



MEASLES.


97


1.-Measles (Rubeola, Morbilli).
FORMERLY this disease was confounded with scarlatina;
but there are well-marked differences which are pointed out
a little further on. Measles, presenting symptoms varying
according to constitutional or atmospheric peculiarities, is
generally unattended with danger, unless improperly treated.
Children are usually the subjects of its attack; but when
adults succumb under its influence, it is a severe or even
dangerous disease. Like scarlatina and small-pox, it is
highly contagious, often epidemic, and generally attacks the
same patient only once.
MODES OF PROPAGATION.-No susceptible person       can
remain in the same room or house with an infected person
without risk of taking the disease; and it is almost impossible to isolate the disease in large establishments or schools.
It is propagated by forites.  This is proved by the fact
that children's clothes, sent home in boxes from schools
where the disease has raged, communicate the disease; and
also by the same circumstance resulting when susceptible
children have lain in the sane beds, or in the same room,
shortly after it has been occupied by patients suffering from
the disease (Aitken). The danger of the spread of contagion
from measles, scarlatina, etc., only ceases when desquamation
(scaling) of the cuticle (scarf skin) is complete.
SYMPTOMS.-Measles passes through its courses by stages;
there is its period of incubation, lasting from ten to fourteen
days; its precursory fever; its eruptive stage; and its
decline. The introductory fever is ushered in with lassitude
and shivering, which are soon succeeded by heat of the skin,
quickened pulse, loss of appetite, thirst, etc.  But the
peculiarity of the early symptoms is, their resemblance to
those of a common cold, such as sneezing; red, swollen, and
watery eyes; discharge fiom   the nose; a hoarse, harsh



98


ERUPTIVE FEVERS.


cough; fever; and sometimes, diarrhoea and        vomiting.
These symptoms usually increase in intensity till about the
fourth day, the eruption appears, first on the face, then on
the neck and breast, and soon after on the whole body.
It is in the form of minute pimples, which multiply and
coalesce into blotches of a more or less crescentic form,
slightly raised above the surrounding skin, so as to be felt,
particularly on the face, which is a good deal swollen. The
eruption is two or three days in coming out, and remains at
least three days; the fever then abates, and the eruption
declines, becoming browner as it fades, and the cuticle is
afterwards thrown off in a fine bran-like scurf. As the rash
declines, diarrhoea sometimes occurs; this, unless very
troublesome, should not be interfered with, as it is often
beneficial.
Table shewing the chief differences between Mfeasles and
Scarlet Fever.


MEASLES.
1:  The rash is of a pinkish-red or
raspberry-colour.
2. The eruption is somewhat rough
so as to be felt by passing the hand over
the skin, and is in groups or in rounded
or irregular-shaped masses.
3.  Catarrhal symptoms are prominent-watery discharge from the eyes
and nose, sneezing, harsh cough, etc.
4. The cuticle is thrown off in
minute portions like scales of fine bran.
5. The most common sequclce are
diseases of the lungs, eyes, cars, and
skin.


SCARLET FEVER.
1. The eruption is of a brightscarlet-colour.
2. The rash usually presents no
inequalities to sight or touch, and is so
minute and closely crowded as to give
the skin a uniform red appearance.
3. Great heat of skin, sore throat,
and sometimes delirium, are the chief
symptoms.
4. Desquamation of the cuticle
is in large patches, especially from the
hands and feet.
5. The most frequent sequel is
anasarca, especially after mild cases.


TREATMENT.-In mild form of measles, Acon., Puls., and
Sulph.   Severe and complicated cases, Acon., Bell., Bry.,
Carbo Veg., Tpec., Mfere., Arsen., Phos., Puls., and Sulph.



MEASLES.


Aconitum.-If fever symptoms are well marked at the?
outset, or during the progress of the disease, this remedy
should be administered every two or three hours as long as
it may be necessary to diminish the fever.  Even after
other remedies have been administered, Acon. may have to
be repeated, to control inflammatory action.
Pulsatilla.-Almost a specific in this disease, and may
be given when the fever has been subdued by Aconitum;
sometimes it may be advantageously given in alternation
with it, if both catarrhal and fever symptoms are present;
but if the first indications of measles are chiefly those of
a common cold, it may be given alone.   This remedy is
especially valuable for the following symptoms:-Cough,
worse towards evening, or during the night, with rattling
of mucus in the air passages, or much expectoration of
thick, yellowish or whitish mucus, sometimes followed by
vomiting, or partial suffocation; thick, greenish or yellowish
defuction from the nose; bleeding at the nose; derangement
of the stomach. A dose every three or four hours.
Ipecacuanha.-Nausea, vomiting, gastric derangement.
Ammon. Carb.-This remedy is useful in cases in which
the eruption is slow in making its appearance, and may be
given in repeated doses to assist it.
Belladonna.-Sore throat, with pain and difficult swallowing; dry spasmodic cough; inflammation of the eyes;
restlessness, and tendency to delirium.  A few doses, at
intervals of two or three hours.
Bryonia.--Imperfectly developed or suppressed eruption;
stitching pains in the chest, difficult breathing, cough, etc.
A dose every two or three hours.   In addition to this
remedy, a sudden recession of the eruption might necessitate
a warm bath.
Mercurius.-Glandular swellings in the neck, ulcers in the
mouth and throat, bilious diarrhoea, dysenteric stools, etc.



100


ERUPTIVE FEVERS.


Phosphorus.-Pale colour of the eruption, or imperfectly
or irregularly developed; dry, hollow cough; pain in the
chest; nervous or typhoid symptoms.
Under the last condition, Arsen., Carbo Veg., Rhus Tox.,
Phos. Ac., and Sulph. may also be considered.
Sulphur.-This remedy is required after the eruption has
completed its natural course, and the other medicines are
discontinued. A dose every night and morning, for three
or four days; afterwards every morning for a like period
will generally be sufficient. For dose, etc., see page 49.
DISEASES FOLLOWING MEASLES (Sequelce).-Measles is often
succeeded by diseases which are more difficult to treat, and
more dangerous than the complaint itself; but, except in
scrofulous or tuberculous children, they are generally the
result of irrational treatment; under homoeopathic management patients usually recover rapidly and perfectly. The
diseases of most frequent occurrence after an attack of
measles, are inflammatory affections of the eyelids; purulent
discharge from  the ear; swelling of the glands, chronic
cough or hoarseness; pneumonia; bronchitis; consumption;
cutaneous eruptions; and various other weaknesses.
These diseases are referred to in other parts of this
manual, and may be found by the index, and nearly all
of them require professional treatment. As a general rule,
the following remedies may be consulted:-Bell., Calc. C.,
Carbo. V., Mere., Phos., Puls., or Sulphur.      The lastnamed remedy, if used when the disease is declining, will
often prevent the occurrence of the complaints enumerated
above.
ACCESSORY MEASURES.- Cold water, gum-water: no stimulants should be given. As the fever abates, milk diet,
gradually returning to a more nourishing kind of food. In.this, as in the other eruptive fevers, the wet pack, described
page 33, is of essential service. The patient should be



MEASLES.


101


-kept in bed, and the room sufficiently darkened to protect
the sore eyes, but the proper and constant circulation of pure
air must by no means be interrupted. The temperature of
the patient's room should be about 60~ Fahr., and it should not
be liable to rapid changes. Except during the very height
of summer, a fire should be kept burning in the room.
Tepid sponging, followed by careful drying, is necessary
several times a day, also a frequent change of linen. After
the disease has subsided, the patient should be warmly clad
and taken into the open air frequently, when the weather is
fine. He must not, however, go out of doors too soon, or
be in any way exposed to cold. Prevention of exposure to
cold and wet is of great importance during convalescence,
in consequence of the excessive susceptibility to inflammatory affections of the chest.
PREVENTIVE TREATMENT.-This is of little consequence,
as the danger of measles under homoeopathic treatment is
so trifling that parents need concern themselves but little
about it. It may, however, be often prevented or modified
by giving children who have not had the disease a dose of
Pulsatilla every morning, and one of Aconitum every evening,
for a week or ten days, during its prevalence in the neighbourhood.  Puls. has undoubtedly great influence over
measles, being in this disease just what Bell. is to scarlatina.
2.-Scarlet Fever-Scarlatina.
Like measles, this is an infectious and contagious, but
much more to be dreaded disease, chiefly affecting children,
and rarely occurring more than once in the same person.
The second, third, fourth, and fifth years of life are those in
which it is most prevalent; after the tenth year its frequency rapidly declines. The opinion that the disease does
not attack children under two years of age is very erroneous,
as the following statistics prove. In 1862, the deaths from



102


ERUPTIVE FEVERS.


this disease in England were 14,834; out of this number
9,569 were children under five years of age, and of these
903 were infants, under twelve months old. Infancy therefore offers no exemption to severe attacks of scarlatina.
The increasing prevalence of scarlatina during the present
century leads us to assign to it that pre-eminent rank among
the causes of the mortality of childhood which was formerly
occupied by small-pox; indeed it is probable that as smallpox has declined since the introduction of vaccination,
scarlatina has proportionately increased, so that the mortality
from it greatly exceeds that from measles and small-pox
combined. In the year 1863, the mortality for this disease
in London alone was 4,982, a year remarkable for the
wide-spread character and fatality of this epidemic. Nor
were its ravages restricted to London, for scarcely a town,or district of England escaped.
SYMPTOMS.-Scarlatina commences with the ordinary precursors of fever-cold chills, succeeded by hot skin, shiverings, nausea, and sometimes vomiting, frequent pulse, thirst,
and sore throat. In about 48 hours after the occurrence of
these symptoms, a rash is perceptible, first on the neck and
breast, and is gradually extended over the great joints,
limbs, and trunk, till the whole body is covered with it.
The eruption is of a bright-scarlet colour, and consists of
innumerable red points or spots, which have been compared
to a boiled lobster-shell in appearance. These spots either
run together, and diffuse themselves uniformly over the skin,
or else appear in large irregular patches in different parts of
the body. At the same time, the appearance of the tongue,
as afterwards described, is very characteristic of the disease.
A diffused redness, sometimes of a dark claret colour, covers
the mouth, fauces, etc., which disappears as the febrile
symptoms and rash subside. On about the fifth day, the
eforescence generally begins to decline and gradually goes



SCARLET FEVER.


103


off by desquamation of the cuticle, in the form of scurf,
from the face and trunk; but from the hands and feet large
flakes are separated, so that sometimes the scarf-skin comes
away entire, like a glove or slipper. On about the eighth or
ninth day the eruption has entirely disappeared, leaving the
patient in a weak condition.
It is not always, however, that the disease pursues this
uniform course. Sometimes the eruption is livid and partial,
and is attended with prostration so extreme that the patient
sinks in a few hours under its virulence.    In puerperal
women, it is a most malignant disease, and nearly always
fatal; during pregnancy it almost invariably leads to abortion
and death.
VARIETIES.-There are three forms of this disease, viz.:
1. Scarlatina simplex, in which the skin only appears to be
affected; this form may be expected to terminate quite
favourably under proper treatment. 2. Scarlatina anginosa,
in which both skin and throat are involved, and is the variety
commonly known as "scarlet fever;" this has many points
of danger, and in several ways may jeopardise the patient's
life. 3. Scarlatina maligna, in which extreme depression
of the vital strength and great cerebral disturbance are
superadded to the affection of the throat and skin, the fever
soon assuming a malignant or typhoid character. The tongue
is brown; there is low delirium; the throat is dark, livid,
or even sloughy; the eruption comes out imperfectly or
irregularly, is darker than just described, or alternately
appears and disappears. In many cases, this form of the
disease terminates fatally on the third or fourth day, and is
always one of such extreme danger that none but patients
of very vigorous constitutions, and when skilful treatment is
commenced early, survive it.
DISTINCTIVE FEATURES OF SCARLATINA.-(1.) The scarlet
rask, already described.-(2.) The high temperature of the



104


ERUPTIVE FEVERS.


skin and blood.   The thermometer placed in the arm-pit
(axilla) rises to 1050 Fahr., sometimes to 1060; 98~ being
the normal standard.-(3.) The papillae of the tongue are
red and prominent, and may be first seen projecting through
a white fur, or, as this fur clears away, on a red ground, and
has been termed " the strawberry tongue."-(4.) The sore
throat. The throat is congested and swollen round the soft
palate and tonsils, and the mucous membrane of the mouth
and nostrils are generally affected.
SCARLATINA   AND   MEASLES.-For the chief -differences
between these diseases, see the table in the section on Measles.
CAUSE AND MODES OF PROPAGATION.-The poison of scarlet
fever is of a subtle nature, the earliest source of which is
distinctly traceable to Arabia; and the disease has now spread
over the whole world (Aitken). It has been found to spread
more extensively, and with greater fatality, among the poor
than among the rich. It may be transmitted by fomitesclothes, bedding, carpets, etc.; this is proved by the fact that
medical men have often carried the disease to their own
families. The poison may be destroyed by a temperature of
2050 Fahr., or by disinfection and ventilation. The infecting
power probably commences as soon as the primary fever has
set in, and continues till desquamation of the cuticle is complete, and attains its maximum degree at the commencement
of desquamation.
TREATMENT.-It should be laid down as a maxim that in
Scarlatina, medical advice ought always to be had recourse
to; for the worst cases we meet with (as those in which
mortification of the nose, cheek, or limbs, sometimes takes
place) are those in which the disease has, from its apparently
mild character, been left to itself (Aitken).
Belladonna.-Immediately Scarlatina is suspected, and
especially when the rash appears, the swallowing becomes
difficult, the throat and eyes become inflamed, and there is



SCARLET FEVER.                  105
sleeplessness and nervous excitement, attended with starts
and jerks, administer Belladonna, every two or three hours,
according to the severity of the symptoms, and as long as
the eruption is bright-red.  This medicine exerts a direct
power over scarlet fever, and the disease, in its less malignant form, will frequently yield to its action, without the
aid of other medicines.
Aconitum.-If the febrile symptoms are very severe, indicating a tendency to inflammatory action in any particular
part, a few doses of this medicine may precede Bell., or be
alternated with it.
Afercurius.-If the throat is much inflamed, swollen, or
ulcerated; when there is an acrid discharge from the nostrils,
profuse secretion of saliva, or ulcers in the mouth, this
medicine should be employed, and will often most suitably
follow the administration of Belladonna.
Arsenicum.-If the disease is attended with great prostration of strength, rapid emaciation, cold clammy sweats,
frequent and weak pulse, nightly paroxysms of fever, with
burning heat, and threatening dropsical afections, this remedy
is especially indicated, and should be administered every
three or four hours.
Cofcea.-Extreme restlessness, irritability, and a whining
disposition, particularly at night.
Calcarea.-Scarlatina, complicated with scrofula, and in
patients previously troubled with cutaneous eruptions, and
more especially if they have been suppressed.    A  dose
occasionally during the progress of the disease, and continued
night and morning for a week or two after it has declined.
Sulphur.-Under similar circumstances to Calcarea; it is
valuable as a preventive of the secondary diseases so
frequently succeeding scarlet fever.
MALIGNANT SCARLATINA.--In this form of the disease,
with inflamed glands, dark-coloured ulcers, extreme debility,
H



106


ERUPTIVE FEVERS.


cold extremities, hippocratic countenance, and other marks
of a typhoid condition, one or more of the following medicines
may be had recourse to:-Arsen., lMfur. Ac., Carbo V., Nitric
Ac., or Veratrum.    For the symptoms indicating these
remedies, see under their respective names in the chapter on
Typhoid Fever.
PREVENTIVE TREATMENT.-When Scarlatina prevails in a
family or neighbourhood, the administration of a dose of
Belladonna, night and morning, to children who have not
had the disease, will often entirely ward off an attack; should
the disease occur, notwithstanding this treatment, it will,
undoubtedly, greatly modify its severity.
ACCESSORY MEANS.-As an invariable rule, the patient
should remain in bed; the room should be well ventilated,
at the same time that the patient is protected from direct
currents of air. He must not go out too early, as secondary
symptoms are of frequent occurrence from neglect of this
precaution.  His beverage may consist of cold water, gumwater, barley-water, weak lemonade, etc., in small quantities,
as frequently as desired.   The diet should be simple,baked apple, toast, gruel, etc., gradually returning, as the
disease declines, to food of a more substantial kind.  The
fever being of short duration, wine or brandy may generally
be dispensed with, except in malignant cases, in which two
or three ounces of wine, diluted with two-thirds water, may
be given in twenty-four hours; or the wine may be mixed
with arrowroot, sago, jellies, etc.  The patient should be
frequently sponged over with tepid water, and dried as
rapidly as possible, to obviate too long exposure. Other
measures are often necessary; poultices, frequently renewed,
or spongio-piline, squeezed out from hot water, if the glands
are swollen; the inhalation of the steam of hot water, as
recommended in the chapter on Quinsy, as long as the throat
is sore and painful; injections of tepid water, if the bowels
are costive.



SCARLET FEVER.                 107
SECONDARY DISEASES (Sequela).-If there are no complications or sequelae, scarlatina may be expected to terminate
favourably within a week from the setting in of the disease;
but in weakly or scrofulous children the disease is liable to
be followed by troublesome or even dangerous maladies,
especially if the treatment and nursing have not been skilful and careful.  The most frequent sequelae, with the
remedies most likely to do good, are the following:Glandular swellings, or discharges from the ears, deafness,
require Merc., Calc., or Phos.
Pain in the ear, Puls., Bell.
Croupy cough, Hepar Sulph.
Infaimmatory affections of the eyes, Bell., Acon., Sulph.
Anasarca (dropsy), Hell. Apis., Arsen., Digitalis, Terebinth.,
Sulph.
The last affection is the most common sequel of scarlet
fever, and it has been observed to result more frequently
from a mild than from a severe form of the disease. This is
probably owing to the disease not having expended all its
force, so that some of the poison remains in the system; or
it may be due to the neglect of proper caution, during the
period of recovery; or, again, to the patient having been in
a debilitated condition previously to the attack of fever. The
symptoms of this disease are, puffiness of the eyelids and
face, followed by general swelling of the whole body; frequent desire to pass urine, which is scanty, and of a smoky
colour, and if tested by heat and nitric acid, is found to
deposit albumen.
Affections of the kidney or dropsy are infrequent after
homoeopathic treatment. During convalescence, warm clothing, including flannel, is necessary, and subsequently, a
change of air, if possible to the sea-side.



108


ERUPTIVE FEVERS.


3.-Small-pox (Variola).
This, the most marked of the eruptive fevers, is a disease
of a highly contagious nature; but less common in this
country, and far less disastrous and fatal in its results, than
formerly. We may fairly consider the disease as presenting
two varieties: Variola Discreta, and Variola Confluens. In
the former, the pustules are comparatively few, and they
remain distinct and separate from each other, and may be
easily counted. It is the simplest form of the disease, and,
except during the first dentition, is rarely fatal. In the
latter, the pustules are numerous, and their outline becomes
irregular or they run into each other, and form large continuous suppurating surfaces, and it is attended with the
greatest danger to life. This division of small-pox is of
great importance, as the severity of the disease bears a direct
proportion to the amount of the eruption, and danger in the
confluent form arises chiefly from the large quantity of
pustulation. In determining between these two varieties,
we judge from the eruption on the face; for if the pustules
are confluent there, whether they are so or not on other
parts, we class it with the confluent kind. " The danger is
always rendered greater, cceteris paribus, when the eruption
is very full about the head, face, and neck" (Mason).   There
is also a variety in which the pustules partially coalesce,
termed Variola Semi-conffuens.
SYMPTOMs.-In its course, small-pox runs through four
stages:-The latent or incubative period, which lasts twelve
days from   the reception of the poison; the primary or
initiatoryfever continues about forty-eight hours; the stage
of maturation, of about nine days' duration; and of secondary
fever and decline of the eruption, the period of which varies
according to the severity of the disease.
The first stage commences like most other fevers. There



SMALL-POX.


109


are chilliness, heat, headache, sometimes delirium; a thicklyfurred white tongue, a deep flush upon the face, a hard and
frequent pulse, a feeling of bruised pain all over the body,
but especially in the back and loins; more or less pain or
tenderness at the pit of the stomach, and sometimes vomiting.
When the pain in the loins and vomiting are very severe and
continuous, they may be regarded as the precursors of a
severe form of the disease. On the third or fourth day, the
eruption, often so minute as to escape observation, appears
in the form of red spots, or small hard pimples, which feel
like shot in the skin. It appears first on the face, neck, and
wrists, then on the body, and finally on the lower extremities.
If examined, the eruption may be seen upon the palate, and
is often formed on the membrane lining the larynx, trachea,
and bronchi, giving rise to sore throat, cough, a viscid
secretion, and hoarseness. The pimples gradually increase
in size until about the eighth day from the commencement
of the fever, when the contents, at first watery and transparent, then white and opaque, have become yellowish
matter, the pimples having ripened into pustules.       The
pustules are depressed in the centre, and surrounded for a
short distance by a rose-red areola. During the time the
pustules are filling up, there is swelling of the eyelids and
face, sometimes to such a degree as to obliterate the features.
A peculiar, disagreeable odour now begins to emanate from
the patient, which is so characteristic, that the disease at
this stage might be known by this alone. On the first
appearance of the eruption, the fever subsides; but when it
is at its height, a fresh attack sets in, which, to distinguish
it from the precursory fever, is called the secondary fever.
In Variola confluens, the secondary fever is often very intense,
and is the most dangerous period of the disease, owing to
the return of the fever when the system had been already
greatly exhausted. Severe and even fatal results may arise



110


ERUPTIVE FEVERS.


from exhaustive suppuration, erysipelatous inflammation,
suffocative breathing, and, the most dreaded of all symptoms, a putrescent state of the blood. In about eight days
from the first appearance of the eruption, the pustules
break, and discharge their contents; scales then form, which
dry up, and, in a healthy state of constitution, fall off in the
course of four or five days. When this takes place, purplish
red stains are left behind, which very slowly fade away, or
indelible, depressed scars remain, which are calledpits. In
the latter case, the person so marked is said to be " pitted
with the small-pox."
DIAGNOSIS.-An early recognition of this disease, both on
account of the patient himself, and for the protection of
others, is. of great importance. Severe pain, evidently not
muscular, in the small of the back, is the most characteristic
symptom. It has been mistaken for measles; but the eruption is more perceptible to the touch, and gives the sensation
of shot under the skin. From    the insidious invasion of
Continuedfever, it is easily recognised by the abruptness and
severity of its attack.
DANGERS.-The greatest danger arises from the secondary
fever, in the confluent form of the disease, about the ninth
to the twelfth day, when the pustules are ripening; for then
the fever is likely to return, the vital strength having already
been much exhausted. In a confluent case, fatal chest
symptoms may arise, or there may be ulceration, opacity,
and loss of sight. An inflamed condition of the skin between
the pustules, instead of the rose-red areola, is a bad sign.
Infancy and advanced age are unfavourable periods; beyond
sixty years of age, Mr. Marson states, hardly any who take
it escape dying. Violent and uncontrollable delirium is
often an attendant on the confluent variety, and if it occurs
early, in persons who have lived freely or irregularly, is
an unfavourable symptom.   "Draymen, barmen, potmen,



SMALL-POX.


111


tailors, and the women on the town, are very unfavourable
subjects to be attacked with small-pox, owing to their habits
of indulging freely, and almost daily, in strong drinks"
(Marson). Irritability, the patient vexing himself about
trifles, sleeplessness, and a plethoric habit, are unfavourable.
On the other hand, a quiet, contented, and hopeful state of
mind, must be regarded as favourable to recovery.
CAUSE.-Contagion.     It is supposed never to occur except
from contagion; for large portions of the world have remained for centuries entirely free from it, until it was
imported; and then it spread so rapidly, and often so fatally,
as almost to depopulate whole countries.   " There are some
grounds for believing, however, that small-pox, in common
with some other diseases, originated in the lower animals,
and extended from them to the human species by infection
or contagion" (Aitken).   " There is no contagion so strong
and sure as that of small-pox; none that operates at so
great a distance" (Watson). The period during which the
poison is most powerful, is probably when it is most perceived by the sense of smell.
The circumstances which determine the more severe forms
of this malady, are small, dark, and badly-ventilated dwellings, poor or scanty food, insufficient clothing, want of
cleanliness, intoxicating beverages, and other similar adverse
influences.
It is worthy of remark, as Dr. Letheby states in his
quarterly report on the sanitary condition of London, as to
the recent (August, 1863) outbreak of small-pox and increase of scarlatina, that " these sudden outbursts of zymotic
disease show that the force of these maladies is not exhausted
by sanitary measures, but only kept in check; and that,
when occasion serves, as in this instance, by neglect of
proper precautions, the force manifests itself in all its
original vigour."



112


ERUPTIVE FEVERS.


TREATMENT.-1. Primary fever, Acon., Ant. Tart., Bell.,
Bry., Veratrum Viride.
2. Eruptive stage, Ant. Crud., Ant. Tart.
3. Suppurative stage, Merc., Ant. Tart., Sulph.
4. Desquamation, cleanliness and tepid sponging.
5. Confluent and malignant cases, Ars., Carbo Veg., Strain.,
Opi., Camph., etc.
6. To prevent Pitting, smearing the parts with bacon fat,
and protection from air and light.
Aconitum.-This remedy is indicated, during the precursory
fever, by shivering, heat, dryness of the skin, rapid pulse,
swimming and pain in the head, nausea and vomiting, and
pain in the back and loins; it may also be used during any
course of the disease, whenever febrile symptoms are prominent. As soon as perspiration sets in this remedy should be
discontinued.
Antimonium Tart.-Useful during the eruptive stage, and
should be given as soon as this makes its appearance; it is
also indicated in the febrile stage, if nausea and vomiting,
or convulsions precede the eruption. The spasmodic retching, nausea, and hoarse cough, sometimes very distressing,
may often be relieved by this medicine. Ant. Tart. is
specific to small-pox, in consequence of its power of producing in large doses, in healthy persons, an eruption so
closely resembling it as to have been mistaken for it.*
Veratrum Viride.-As soon as the disease is recognised,
Dr. Wilkinson recommends the administration of this
remedy, to control the fever, and redness and swelling of
the parts.   He also prescribes it as a lotion.     See the
MlIateria Medica, article Veratrum Viride.
Belladonna.-Delirium, severe headache, ophthalmia. Bell.
* A striking illustration of the disease-producing effects of Ant. Tart. is
recorded by Dr. Baikie in " The Homreopathic World" for March, 1866,
pages 73-4.



SMALL-POX.                   113
has a direct action upon the brain; it also tends to retain
the eruption upon the skin. A dose every second hour, till
the symptoms are mitigated. It is frequently indicated
after, or in alternation with, Aconitum.
Bryonia.-Pain in the loins, tenderness at the pit of the
stomach, confined bowels, rheumatic pains, and cough. A
sudden disappearance of the eruption, whether from cold or
any unknown cause, requires this remedy in alternation with
Aconitum.
Mercurius.--Ulcerated throat, salivation, and diarrhoea
with bloody stools. It is also of great utility during the
process of suppuration, and should be given as soon as the
spots become opaque.
Rhus Tox.-When the eruptive stage is accompanied with
marked prostration, and severe pain in the loins and back.
Sulphur.-During the formation of the pustules, and when
there is furious itching of the parts; also when the disease
is on the decline. It should be continued till complete
recovery takes place.
Cortcea. Great restlessness and inability to sleep. A few
doses only will be required.
Camphor.-If the eruption suddenly disappear from the
skin, or suddenly assume a malignant type, with symptoms
of paralysis of the brain, coldness of the skin, and difficulty
of breathing; two or three drops in a little water, every ten
or fifteen minutes, for two or three times, or until the skin
becomes warm, and the eruption reappears.
Opium.-If, during the progress of the disease, drowsiness,
stupor, stertorous breathing supervene, this remedy should
be administered.
Carbo Veg.-Malignant small-pox, with a putrid tendency,
or other symptoms of a low typhoid variety.
Nit. Acid or Arsenicum may be administered under similar
circumstances, and when Carbo Veg. fails.



114


ERUPTIVE FEVERS.


ACCESSORY MEANS.-The patient should be kept cool; the
sheets and linen be frequently changed, and ample provision
made both for the uninterrupted admission of fresh air, and
the free escape of tainted air. A small, ill-ventilated room,
overheating, and giving hot cordials, interfere much with the
tendency to recovery. During the course of the disease,
especially when the skin becomes hot, painful, or irritable,
the whole surface may be sponged with warm water, and
well dried with a soft towel. This generally affords great
relief. In the early stage of the disease, great advantage
may also be derived from the wet pack (see page 33), followed
by a sponge bath. If ulceration on the back or nates is
threatened, the patient should be placed on a water-bed.
When the pustules have burst, powdered starch, or any other
dry powder, should be freely applied, to absorb the matter.
Cleanliness and frequent tepid washings are especially
necessary during the last stage of the disease. An occasional warm bath towards the end of the treatment is also
very advantageous. To prevent pitting, when the eruption is
out, the patient's room should be kept as dark as is consistent with its thorough ventilation; as soon as the pustules
have discharged, and begun to dry, they should be frequently
smeared over with best olive oil, cold cream, or a mixture of
one-third of glycerine to two-thirds of water, to prevent
permanent scars. Dr. Baikie states, in a letter to the author,
when the eruption is thoroughly out, the heat and irritation
may be materially alleviated by smearing the whole surface
of the body with fresh-cured bacon. A piece is to be boiled
with the skin on, and then cut horizontally, so as to leave
about a quarter of an inch of fat adhering to the skin; this
is to be scored across, and used to anoint the eruption, and
may be repeated twice or thrice daily. It completely prevents pitting. Children's hands should be muffled to prevent
scratching, which might lead to ulceration.



VACCINATION.


115


DIET.-Tea and dry toast, bread and milk, sop, gruel, etc.;
grapes, roasted apples, strawberries, and wholesome ripe
fruits generally. For drink, cold water is generally preferred; in addition, milk and water, raspberry vinegar and
water, currant jelly and water, apple water, lemonade, and
barley-water.
4.-Vaccination- (from VACCA, a Cow).
DEFINITION.-Vaccination is the process by which a specific
disease-vaccinia or the cow-pox-is artificially introduced
into the human system for the purpose of protecting it
against small-pox.
The process of vaccination      most fully recognises the
homoeopathic principle, as it is preventive of small-pox
entirely on account of the homoeopathic relationship it bears
to that disease. Dr. Jenner named the diseasq variolw
vaccine, and believed that small-pox and cow-pox were in
reality identical.  Its tendency is not only to prevent a fatal
termination, and render the disease mild in its course, should
it occur, but to keep off the disease altogether. The resident
surgeon of the Small-pox and Vaccination Hospital at Highgate states, that in the course of his large experience, he found
that when small-pox attacked persons who had not been
vaccinated it killed 36 per cent. of them-that is, one in
every three died; but that when vaccination had been performed, the death-rate of those attacked by the disease fell
to one infifteen.  He also found that the protective power of
vaccination was in proportion to the way in which it had been
done; thus one permanent cicatrix (scar) after the operation
gives a mortality from the disease of nearly eight in the
hundred; two scars of rather more than 4 per cent.; three
* It is stated that in Sweden, forty years before vaccination, out of every
million persons, 2,050 died annually; after vaccination, 158 only. In Berlin,
before vaccination, 3,422; after, 176.



116


ERUPTIVE FEVERS.


scars less than 2 per cent.; and if four scars, not one in a
hundred die when they catch the disease.* This is a most
important practical point to remember: if only one indifferent cicatrix remains after the operation, such persons,
taking small-pox in after life, die at the rate of 12 in the
100; but if four or more cicatrices remain, only one in 200
will die of small-pox.  Further, Mr. Marson states, of 370
persons treated in the Small-pox and Vaccination Hospital,
London, who believed themselves vaccinated, but who had
no cicatrix to show, and trusted to such vaccination for their
protection, they died of small-pox at the rate of 231 per
cent.  Persons, therefore, having no cicatrix remaining, are
in a very unsafe condition.
In performing vaccination, the following are the chief points
to be observed:-1. The vaccine lymph] used should be taken
from a child free from scrofula, syphilis, or any constitutional
taint; skin diseases, swollen glands, inflamed or sore eyes,
are decided objections, and if disregarded might result in
the transmission of disease to previously healthy children.
2. The vaccinator should employ a clean lancet; pyemia,
syphilis, and other kinds of blood-contamination, no doubt
often follow from the use of a foul lancet. 3. Pure lymph
should be taken on the eighth day, unmixed vith blood or any
other secretion. Attention to the above hints will afford
ample security against any of the so-called evils of vaccination.  4. The matter should be inserted in four places in
each arm, it having been found that the protective power of
vaccination is in proportion to the number of the resulting
cicatrices, that being the most efficient which leaves the
most and the best cicatrices. 5. When arm-to-arm vaccination cannot be practised, the lymph should be preserved
in hermetically sealed capillary tubes. 6. Vaccination should


* See the Lancet, August 15th, 1863.



VACCINATION.


117


be performed between the third and the sixth months, or
earlier if an epidemic of small-pox prevails in the neighbourhood. The third month is perhaps the best, before
dentition has commenced.      7. Treatment is scarcely ever
necessary, as the condition thus set up, described as smallpox in miniature, is very simple.   Should, however, there be
much inflammatory redness and swelling, a few        doses of
Aconitum   or Belladonna will relieve the patient; while
occasionally a poultice is necessary. As the pock is declining, a few doses of Sulphur are usually recommended.
8. Re-vaccination should take place at the age of puberty;
the great changes which occur in the system at this period
of life rendering its repetition generally necessary. Persons
at this period, especially if they are about to change their
place of abode, should be examined, and if they have only
one cicatrix, or that is imperfect, or if there is no cicatrix at
all, they should be re-vaccinated. " For just upon thirty
years we have re-vaccinated all the nurses and servants who
had not had small-pox, on their coming to live at the
Small-pox Hospital, and not one of them has contracted
small-pox during their stay there" (Marson).
From the above observations it will be inferred that we
think highly of the protection afforded by efficient vaccination.   Evils indeed may have arisen from its careless performance; but they only tend to prove that this operation,
like every other on the human body, should be performed
with care and skill. We fully endorse the following remarks:
" It is thus clearly demonstrated how vaccination has thrown the cegis of
protection over the world; and how ample, how great, and how efficient
that protection may be. It has been shown to diminish mortality
generally, and the mortality from small-pox in particular, both in civil
and military life, at home and abroad, and just in proportion as it is
efficiently performed. It has been shown to diminish the epidemic
influence; it has been shown to preserve the good looks of the people; it



118


ERUPTIVE FEVERS.


has been shown that it tends to render small-pox a mild disease compared
with the same disease in the unprotected; it confers an almost absolute
security against death from small-pox; and, lastly, it has been shown to
exercise a protecting influence over the health of the community
generally" (Aitlcen).
5.-Chicken-pox (Varicella).
This is a pustular eruption, similar in its appearance to
small-pox, for which it is at first often mistaken. It generally requires little medical assistance, but merely attention
to diet, as in inflammatory fever. It differs from small-pox
in the slighter degree of fever which attends it, in the
pustules becoming filled with a watery fluid about the second
or third day, which is never converted into yellow matter, as
in small-pox, and in its rapid course. Generally, on the
third or fourth day, the pustules dry up, forming crusts or
scabs, leaving no permanent scars.
TREATMENT.-If the fever is considerable, give Aconitum
every four or six hours.     When there is much headache,
flushing of the face, sore throat, or if the brain is affected,
administer two or three doses of Belladonna. Rhus Tox.
will generally be found one of the best remedies in this
disease, and under its action will soon disappear. Pulsatilla.
-This remedy may be selected if there is derangement of
the digestive organs.
ACCESSORY MEANs.-Too early exposure to cold, and errors
in diet, must be guarded against; the latter caution is more
especially necessary if the digestive organs are at all impaired.
5.-Erysipelas (S. Anthony's Fire-Rose).
When this disease arises from constitutional causes, it is
called idiopathic erysipelas, and generally affects the head
and neck; when it follows a wound or external injury, it is
called traumatic erysipelas, and may occur on any part of
the body which is wounded.



ERYSIPELAS.


119


SYMPTOMS.-Simple or cutaneous erysipelas is known by a
spreading redness of the skin, of an inflammatory character,
with considerable puffy swelling, tenderness, burning, and a
painful sensation of tingling and tension. The colour of the
skin varies from a faint-red to a dark-red or purplish colour,
becoming white under pressure, but assuming its former
colour on the removal of the pressure. An attack is usually
ushered in with shivering, languor, headache, nausea, bilious
vomiting, and the ordinary symptoms of inflammatory fever,
accompanied or followed by inflammation of the part affected.
PHLEGMONOUS ERYSIPELAS is marked by a deeper redness,
or it may be redness of a dusky or purple hue, which is
scarcely, if at all, removed by pressure; the swelling is
greater, and the swollen part is hard and tense; the pain
is burning and throbbing, and it occurs generally about the
extremities.
DANGERS.--Erysipelas may prove fatal in the following
ways:-(1) By exhaustion. The constitutional symptoms
resemble those of typhoid fever, and the degree of bloodpoisoning is great, although the local disease may be limited
in extent. (2) By obstruction to the air-passages. The inflammation may lead to infiltration of the submucous tissues
about the windpipe, the opening into which may be closed,
and the patient die suddenly of apncea. The symptoms
indicating this condition are impaired respiration, slight
lividity of the lips or finger nails, altered tone of voice, or
cough, etc. (3) By coma from effusion within the cranium.
This may arise from extension of the inflammation to the
membranes of the brain, or to effusion.
CAUSES.-Debility and loss of resisting power, from disease; the habitual use of stimulants; exposure to cold; impaired digestive organs; wounds; badly-ventilated and overcrowded apartments; certain conditions of the atmosphere,
and a morbid state of the blood. The tendency of this



120


ERUPTIVE FEVERS.


disease to attack different parts simultaneously or by metastasis-that is, leaving one part and flying to anotherfurnishes evidence of its origin in a vitiated condition of
the blood. The chief exciting cause of erysipelas is undoubtedly a recent wound, and the predisposing cause is
inattention to those hygienic conditions that should surround
a patient, combined no doubt with the existence of a personal or family proclivity to the disease. Erysipelas may
be considered as one of the penalties inflicted by Nature on
those who neglect those prime requisites of health-cleanliness, temperance, wholesome food, and pure air.
PROGNOSIS.--The simple or cutaneous variety is attended
with much less danger than the phlegmonous. The traumatic form is more dangerous than the idiopathic. It is
also more serious when it occurs in an epidemic or endemic
form. Mere extent of inflammation is not of so much importance as a high degree of blood-poisoning, combined with
a rapid and weak pulse, a dry brown tongue, low muttering
delirium, and great prostration. When the disease attacks
the head, unless it is controlled by skilful treatment, the
membranes of the brain are in danger of being implicated. The disease in any of its forms is most serious at
either of the extremes of life. Lastly, the habits and health
of the patient, prior to the attack, greatly influence the
result.
TREATMENT. -1. Febrile stage, Acon., Veratrum Viride.
2. Nonz-vesicular, Bell.
3. Vesicular, Rhus Tox.
4. Phlegmonous, Ars., Carbo Veg., Nit. Ac., Secale.
5. Wandering, Puls., Graph.
6. During convalescence, China, and afterwards Sulph.
Aconitum.-General fever, much local inflammation and
tenderness. A dose, several times repeated, at intervals of
two or three hours. Aeon. is mostly required before the



ERYSIPELAS.


121


rash appears, but may be given, if indicated, at any stage of
the disease. Hempel recommends the concentrated tincture
of the root of Acon. as one of the best remedies for either
smooth or vesicular erysipelas.
Belladonna.-Violent pressing headache, the brain seeming
to be involved; thirst; bright-red skin; constipation; brownred and thick urine; and when the eruption is without vesicles.
This medicine may often be advantageously alternated with
Acon. in the early stages of the disease.
Rkus Tox.- Vesicular (having little bladders) erysipelas,
whether on the face or any part of the body, with considerable swelling, shining redness of the part, and great restlessness.
Bryonia.-Erysipelas in the neighbourhood of joints, with
aggravation of the pain when the parts are moved or touched.
Pulsatilla.-Erysipelas traceable to fat, indigestible food.
Arsenicum.--This remedy is indicated when the erysipelatous inflammation assumes a gangrenous character, and also
when there is great general prostration.
Mere., Cuprum Met., Hepar Sulph., Graph., Canth., and
Sueph. are also remedies required under peculiar conditions;
the one last-named is especially useful when the disease has
become chronic.
LOCAL MEASURES.-In the local management of erysipelas,
the natural functions of the skin are to be promoted, and
currents of air, or exposure of the skin to great variations
of temperature, guarded against. In mild forms of the
disease, no external applications are required, except when
fluid exudes, which may be absorbed by dusting powdered
starch freely over the surface.   But when inflammatory
swellings are tense and painful, warm fomentations may be
first applied, and afterwards the parts sprinkled over with flour
or fine starch, or painted with collodion, if the inflammation
is of limited extent, or any other suitable substance, to keep
I



122


ERUPTIVE FEVERS.


out the air. If there is much cedema, moderate pressure
should be maintained by the application of well-adjusted
bandages. If matter forms, incisions are generally necessary
to afford openings for its discharge; poultices are then to be
applied, and afterwards bandages, to prevent the lodgement
of matter.
Dr. Wilkinson recommends lotions of Veratruim Viride;
he remarks, " The triumph of Veratrum Viride, locally
applied to pure erysipelas, is as complete as the art of
medicine can desire. Diversity of cases of course require
corresponding diversity of treatment; yet, from no slight
experience, I can declare that Veratrum Viride is a cardinal
remedy for erysipelas."  See the Materia Medica.
DIET.-Pure water, gum-water, or barley-water, with
lemon-juice, to allay the thirst. If the attack is severe and
protracted, good beef-tea, and port wine or brandy should be
given, at regular intervals, as required. Subsequently, a
change of air, regular habits, and nourishing diet, essential
in the after-treatment of all acute diseases, are necessary
after a severe attack of erysipelas.
CHAPTER VI.
DISEASES OF THE ORGANS OF BREATHING.
1.-Cold in the Head (Catarrh, Coryza).
THIS is a very common complaint, and often the precursor
of many serious and fatal diseases. It consists of inflammation of the mucous membrane of some portions of the
air-passages. If it affects the mucous membrane of the
nose, it is called coryza. If the frontal sinuses (the veins
of the thick membrane covering the brain), gravedo. If the
trachea (windpipe) and bronchial tubes, bronchitis.



COLD IN THE HEAD.


123


SYMPTOMS.-Catarrh usually commences with lassitude,
slight shiverings, a feeling of weight in the head, sneezing,
watery eyes, and obstruction of one or both nostrils, with a
discharge of thin, colourless fluid. These symptoms are
often soon followed by a dry cough, hoarseness, sore throat,
dryness, tenderness and swelling of the nostrils, pains and
soreness of the limbs, general weakness, more or less fever,
loss of appetite, a quick pulse, thirst, etc. Under a vigorous
condition of the constitution, or as the result of judicious
treatment, in two or three days the symptoms just described
gradually subside. In neglected cases, the complaint may
assume the form of Bronchitis, Pneumonia, Quinsy, Rheumatism, Erysipelas, Toothache, Neuralgia, Inflammatory
fever, or even Consumption.
CAUSES.-Exposure to draughts of cold air, wet boots or
clothing generally, deficient warmth, or insufficient clothing,
when the body is cooling after having been heated. It is under
the condition described in italics that cold is most prejudicial,
namely, not when the body is hot, but when it is cooling.
Exposure to cold is chiefly dangerous when the body has
been heated or exhausted by exercise. Under such a condition, the frame is not able to react, and hence the application
of cold increases the depression. Partial exposure to a cold
atmosphere, as in a close carriage with the windows open, is
more injurious than a general exposure, as in travelling outside a coach; probably because the balance of the circulation
is less disturbed, and the lungs are better supplied with
oxygen. Wet feet or wet clothes do not ordinarily result in
a cold so long as the individual continues in active exercise,
and changes,his clothes for warm, dry ones, avoiding all
further exposure, immediately on ceasing from active exercise. But if a person has been exerting himself, perspires,
and then gets his feet wet, or is otherwise chilled, and does
not continue his exercise, he will be very likely to takeoa



124     DISEASES OF THE ORGANS OF BREATHING.


cold, and to exhibit some of its internal morbid effects.
The general recognition of these principles is a matter of
great importance in the prevention of diseases, especially
those which affect the respiratory organs. It will not, therefore, be inappropriate at the commencement of the chapter
which treats of those diseases briefly to consider how external
application of cold acts in exciting internal disease.
It is probable, as Dr. Williams states, that external cold
excites internal disease, by deranging the circulation and
condition of the blood, particularly in the capillaries. Cold
checks the secretion (perspiration) of the external surface;
it constricts and obstructs the vessels of the skin, and thus
throws more blood inwardly, so that internal congestions are
produced. These internal congestions impair the functions
of the affected organs, and in other ways lay the foundation
of disease. This effect of cold takes place more readily and
to a greater extent in proportion to the weakness or sluggishness of the capillary circulation. If this be naturally weak,
or weak and relaxed from  previous excitement, or during
fatigue or sleep, there is a liability to take cold. Hence
persons are more liable to cold after having been in a hot
room, after making exertion, or when asleep.  On the other
hland, the injurious effects of cold are diminished or prevented
by a vigorous state of the capillary circulation, whether that
vigour be natural, or artificially excited.
On this view we can understand how chilling influences,
such as those resulting from  draughts of cold air, damp
clothes, or standing on cold stones, acting long on the same
part constrict its vessels, check its secretion and nutrition,
derange the balance of the circulation, and, by determining
a corresponding amount of congestion inwardly, fix it in
some part predisposed to disease.  Hence the results of cold
differ widely in different persons. Exposure to cold or wet
may excite a sore throat, a cold in the head or chest, an



COLD IN THE HEAD.


125


inflammation of the lungs, a rheumatism of the limbs, or
any other disease to which the individual may be constitutionally predisposed.
It is also probable, as the same writer observes, that the
derangement of circulation and of secretion and nutrition
produces a corresponding change in the condition of the
blood itself; and this change serves to explain why the
morbific influence of cold often cannot be removed until
some critical discharge takes place, as by perspiration or,urine. It is probably by interrupting or modifying the
processes of nutrition and disintegration of textures that
cold operates in causing rheumatic pains in parts exposed to
its influence. Thus the decaying material which, under
ordinary warmth, assumes the form of urea, may, by the
retarding influences of cold, be changed only into lithic or
lactic acid, and immediately exert that irritating influence
on the part which causes the rheumatic pain resulting
directly from cold.
TREATMENT. - The principal remedies are Aconitum, Arsenicum, Mercurius, and Pulsatilla.
Aconitum.-This is a remedy of great power, and undoubtedly surpasses every other in efficacy at the beginning
of a cold, or in the precursory stages of all diseases resulting from a cold. If appropriately and early administered it
will generally remove all the morbid symptoms consequent
on cold, restore health, and so obviate the necessity for any
other medicine; a dose every second or third hour. If the
cold has resulted in any of the diseases so often following it,
Aconitum may be alternated with, or substituted by, one of
the annexed, or some other remedy, according to the directions given in other parts of this manual.
Arsenicum.-An abundant discharge from the nostrils of
thin, hot mucus, which excoriates the parts over which it
flows; burning sensations in the nostrils; flow of tears from
the eyes; lassitude and prostration.



126     DISEASES OF THE ORGANS OF BREATHING.


Pulsatilla.-Loss of appetite; impairment of the senses
of taste and smell; thick fcetid discharge from the nose;
heaviness and confusion in the head; aggravation of the
symptoms in the evening or in a warm room; sharp pains
in the ears and sides of the head, which often change from
one place to another.
Mercurius.-Constant sneezing, with soreness of the nose;
thick discharge of mucus, profuse perspiration; alternate
heat and shivering, sore throat; aggravation of the symptoms toward evening.    This remedy is often useful in
alternation with Nux Vomica.
Dilcamara.-Cold traceable to getting wet, or to the
chilling or checking of perspiration upon the skin. This,
medicine, like the former, should be had recourse to on the
appearance of the earliest symptoms of catarrh, following
exposure to wet; it is also recommended when from such
exposure it is feared a cold may result.
Antinonium   lart.-The air-passages are loaded with
phlegm, rendering breathing difficult.
Bryonia and Ipecacuanla may be administered in alternation, should difficulty of breathing be a very marked and
persistent symptom; these may be followed by Arsenicum,
if only slight relief is obtained after two or three doses of
each have been given.
Camphor.-This remedy is only suited to the chill or cold
stage, when its prompt administration, in two-drop doses,
every half-hour, repeated several times, will often terminate
the disease in the-first stage. It should be chosen in preference to Aconitum during the chill stage, and especially when
the patient has still to be exposed to changes of temperature.
DIET.-As for inflammatory fever, if there is much feverishness; if no fever attend the cold, the usual homoeopathic
diet. As a rule, light food, and a very sparing use of meat
should be adopted at the commencement of the attack.



COLD IN THE HEAD.


127


Beer, wine, and spirits are inadmissible, but cold water may
be freely taken, especially if thirst is present.
"ACCESSORY MEANS.-THE HOT FOOT-BATH.-This form of
bath is of easy application, and if the following suggestions
are faithfully and early carried out, will often arrest colds
and fevers in their incipient stages.
Immediately before retiring -to bed, the feet should be put
in moderately hot water, the water rising nearly to the
knees; the patient should be undressed, but well covered
with one or two blankets, which should also cover the footbath, so that the steam may have access to the body
generally; the temperature of the water should be maintained, and increased by fresh additions of hot water, for ten,
fifteen, or twenty minutes, or even longer, according to the
strength of the patient, and until perspiration breaks out on
the face. The patient should then get into bed, be well
covered with clothes, and free perspiration encouraged by
drinking cold water. On rising in the morning he should
take a cold plunge, or shower bath, or quickly sponge over
the whole surface of the body, and afterwards use vigorous
friction with a coarse towel.
Other aids in arresting colds may be mentioned. Breathing
almost entirely through the nose is recommended as a means
of expediting the cure.    The most essential measure to
ensure a rapid recovery is to avoid all exposure to atmospheric vicissitudes, until the attack has passed away. This
can scarcely be accomplished except by lying in bed, or
remaining in a room of unvarying temperature, for two or
three days; in all serious cases this course should be
adopted.
To FORTIFY THE BODY AGAINST COLD.-Persons extremely
sensitive to cold should consult a homoeopathic physician,
who will be able to prescribe both hygienic and medicinal
measures suitable to individual cases. The two following



128      DISEASES OF THE ORGANS OF BREATHING.
measures are, however, strongly recommended for general
adoption.   lst.-Free, daily exposure to the open air,
Familiarity with the atmosphere has a wonderful influence
in diminishing the sensibility of the skin, and enabling
the body to resist the invasion of cold. What a striking
contrast, in this respect, is presented by farmers, shepherds,
coachmen, sailors, and others who live much in the open air,
as compared with tailors, shopmen, lawyers, women, and
others whose occupations are pursued within doors! The
sensibility of the former is blunted by habitual exposure,
while the latter are liable to danger from every vicissitude of
the weather. It may be added, the pure air breathed by the
out-door labourer, together with his active life, leads to a
most vigorous condition of health, if his labours are not too
exhausting or too prolonged, which contrasts most favourably
with the condition of one occupied within-doors. 2nd.T1e morning cold bath.    Cold sponging over the entire
surface of the body, the plunge-bath, or the shower-bath, is
the most certain method we can suggest of protecting the
body against injury from exposure to changes of temperature.
The cold bath, regularly taken in the morning, inures the
surface of the body to a degree of cold greater than it will
probably encounter during the remainder of the day, and at
the same time it promotes the most vigorous capillary circulation, so essential to the harmonious and healthy working
of the system. For hints on the use of the bath, see the
first chapter of this manual, pages 29-32.
2.-Influenza (Catarrhus Epidemicus).
This is an epidemic catarrh, and is so called from the
Italian word, which means " influence," because it arises from
some specific but unknown agent in the air. It is supposed
to travel from east to west, spreads most rapidly and extensively, and rarely remains more than from four to six weeks



INFLUENZA.


129


in one district. It is most severe in low and insalubrious
localities, and at the early part of the visitation. In aged
persons, and in others whose lungs have been previously
diseased, it is a tedious and sometimes fatal complaint. " In
the last epidemic (1847) it has been calculated that in
London at least 250,000 persons suffered; in Paris between
one-fourth and one-half of the population; and in Geneva
not less than one-third" (Peacock).
SYMPTOMS.-The symptoms differ from those of common
cold chiefly in their sudden appearance and rapid extension
among a population, their entire disconnection with either a
low or a sudden variation of temperature, the great febrile
disturbance which prevails, marked general prostration and
nervous depression which accompany and follow the disease,
and in their protracted duration. There exist chilliness or
coldness down the spine, anxiety, feverishness, frontal headache, pains in the limbs and back, severe paroxysms of
cough, nausea, loss of appetite, vitiated taste, aching pain
and suffusion of the eyes, great sneezing, thin acrid discharge
from the nostrils, and extreme prostration of muscular
strength.  In short, all the symptoms which characterize
gravedo, coryza, and bronchitis, respectively, are usually
present in influenza.
TREATMENT.- Camphor, given as directed for " cold in the
head;"   afterwards, as may be necessary, Arsen., Mierc.e
Puls., Nux Vom., Bry., Ipec. For indications, see " Cold
in the Head."
Arsenicum is always a prominent remedy.
DIET AND REGIMEN.-Farinaceous food, and if there is
great prostration, beef-tea, with repose in bed or on a couch.
In many cases, confinement in bed is quite necessary for
the safety of the patient, and always hastens recovery.
The room    should   be warm, well ventilated, aid      the
patient placed so as to avoid draughts or chills. If there



130      DISEASES OF THE ORGANS OF BREATHING,


is much fever present, with loss of appetite, toast-and-water
or barley-water, will be suitable. If the cough is very severe,
the air of the room should be kept moist by conducting the
steam from a boiling kettle into it by means of a tube, or by
putting boiling water into flat shallow vessels. When the
fever abates, a more generous diet should be allowed. If
prostration is the predominant symptom, stimulants, such
as wine or brandy, and the essence of beef should be resorted
to. After a severe attack, change of air, with walking, or
horse exercise, is very desirable. During an epidemic of
Influenza, night air is invariably injurious.
3.-Hoarseness (Raucitas)-Loss of Voice (Aphonia).
These terms indicate degrees of the same affection, and is
rather a symptom of some other disease, than a disease per
se. It is generally the result of an acute or sub-acute inflammatory condition of the mucous membrane lining the larynx
and the windpipe, and is a frequent accompaniment of a
common cold; also of several other diseases.
SYMPTOMs.-The voice is hoarse and husky, and at times
almost or entirely inaudible; there is tickling, dryness, or
irritation, and perhaps soreness, in the throat, with a dry
short cough.
TREATMENT.-Recenlt Iioarsenesss, Acon., Bell., Dros.,
Merc., Phos., Puls., Spong.
Chronic Hoarseness, Hepar Sulph., Carbo. Veg., Caust.,
Iod., Calc., Sulph.
When hoarseness is an accompaniment of a cold, the cold
should first be treated in accordance with instructions contained in the article on that subject. If, however, the
hoarseness continue when the other symptoms of cold have
disappeared, or if it recur alone, the case should be carefully,
and if practicable, professionally examined, and remedies



HOARSENESS.


131


administered. A few of these, with their indications, are
annexed.
Belladonna.--Hoarseness, or complete loss of voice; spasmodic constriction and soreness of the throat, and difficulty
of breathing.
Dulcamara. -Hoarseness from exposure to wet.
Mercurius.-Hoarseness from a cold, with a thick and profuse discharge from the throat, tickling, burning, swelling,
and tendency to ulcerate; also shivering, cough, and a disposition to perspire, with aggravation of the symptoms in
the evening, in the cool air, or by speaking and eating.
Drosera.-Hoarseness, with a tickling sensation in the
larynx, as from a feather, accompanied with a barking cough,
a deep, hollow voice, oppression of the chest, and wheezing
breathing.
Pulsatilla.-Loss of voice, with catarrh, impaired smell
and taste, loose cough, and much thick, yellow, and offensive
discharge from the nose.
Hepar Sulphur.-Chronic hoarseness; also when the voice
is weak and the breathing wheezing. It is particularly indicated for hoarseness after the subsidence of acute inflammation of the larynx; also in persons who have taken large
doses of Mercury.
Carbo Veg.-Like the last, this is a valuable remedy in
chronic, obstinate hoarseness, and in old standing diseases of
the windpipe and air-passages of catarrhal origin; hoarseness
worse in damp cold weather, in the evening and after talking;
and for patients who have been drugged with Mercury.
Phosphorus.--An invaluable remedy in the chronic form
of this affection, when there are dryness and soreness, or
tickling of the larynx and chest, and is to be administered
in preference to those last mentioned, when there is a tendency to tubercular disease, or even for patients in whose
family consumption has been rife.



132      DISEASES OF THE ORGANS OF BREATHING.
Sulphur may be selected when other medicines afford only
partial relief; when the symptoms are aggravated by damp
and cold weather; also as an intercurrent remedy.
ADMINISTRATION.-A dose every three or four hours in the
acute form  of the disease;  twice or thrice daily in the
chronic. In the latter case, a remedy should be continued
for ten or fourteen days, and, if necessary, after waiting a
few days and taking an intercurrent remedy, resumed.
ACCESSORY MEANs.-See the next section.
4.-Clergyman's Sore Throat (Dysphonia Clericorum).
In its incipient state, this affection consists of irritation of
the lining membrane of the fauces; afterwards of congestion,
inflammation, or relaxation of that membrane, enlargement
of the tonsils, elongation of the uvula; in its advanced
stage, of morbid deposit and ulceration of the mucous
follicles.
SYMPTOMS.-The patient first complains of an uneasy sensation in the upper part of the throat; with a frequent disposition to swallow, as if something existed there which that
act could remove. If proper treatment be not adopted, the
voice soon undergoes a change; it becomes feeble and hoarse,
and sometimes, especially towards the evening, there is
complete loss of voice. The patient complains of pain in
the larynx, and makes frequent efforts to clear the throat of
phlegm by coughing and spitting. On looking into the
throat, the parts will be found to have an unhealthy appearance, being raw and granular, and the mucous follicles will
be seen filled with a yellowish substance; a viscid mucopurulent secretion may be seen adhering to the palate and
adjacent parts.
CAUSES.-This condition is probably most often induced
by the thoughtless or necessary exercise of the organ of the
voice when in an inflamed state. An extension of the affec



CLERGYMAN'S SORE THROAT.


133


tion is almost certain to result from preaching or reading
during an attack of sore throat or hoarseness, as the muscles
of the larynx lose their nutrition through extension of the
morbid materials from  the inflamed mucous membrane.
The Clergyman's Sore Throat may also result from     an
immoderate ori irregular exercise of the voice, or it may
follow inflammatory disease of the bronchial tubes or lungs,
by much exercise of- the voice before recovery has taken
place.
TREATMENT.- Skilful treatment, if adopted early, is
generally quite successful.
Remedies for the incipient and acute stages.-Acon., Bell.,
Dros., Phos., and Spong.
-For the chronic form.-Hepar S., Caust., Bar C., Aurum.,
Calc., Carbo V., Sulph.
For symptoms, see Hoarseness, and the Materia Miedica.
ACCESSORY AND PREVENTIVE MEANS.-1st. PERFECT REST.
-The first and most important is to exercise a sore and
inflamed organ as little as possible. The treatment of an
inflamed larnyx, like that of an inflamed joint, should
include a state of almost complete rest.
2nd.-THE WET COMPRESS. This is an excellent hydropathic application in various affections of the throat, and
may be used preventively or remedially, in the following
manner:-Wring a piece of linen or flannel out of cold
water, and wrap it in two or three thicknesses round the
throat; cover the compress with oiled-silk or gutta-percha
tissue, and place over this two or three thicknesses of
flannel to maintain the warmth, and keep the compress in
apposition.  If oiled-silk is not procurable, one or two
thicknesses of flannel over the compress may be substituted;
but flannel is far less effective than the oiled-silk, the object
of which is to exclude the air and prevent evaporation of the
fluid. When this is applied, the patient should retire to



134     DISEASES OF THE ORGANS OF BREATHING.


bed, and he will generally have the satisfaction of finding
his throat-difficulty much relieved by the morning.     In
more obstinate cases, the compress should be re-wetted
during the night and also worn in the day-time, re-wetting
it as often as necessary. When the compress is discontinued,
the throat and chest should be bathed in cold water, followed
by vigorous friction with a coarse towel. However often
repeated, the wet compress never relaxes the throat.
3rd. CULTIVATION OF THE BEARD.-The beard in the
vicinity of the throat should be permitted to grow, as it
affords an excellent protection to the delicate organs of the
voice, especially in the case of clergymen, public singers,
and others subjected to their undue or irregular exercise.
After exercising the vocal organs, as in a public address, the
skin about the throat becomes relaxed, and on entering the
open air the unbroken force of the atmosphere breaks upon
these parts, often inducing acute or chronic affections of the
throat and bronchial tubes, while the natural respiratorthe fine-flowing beard-which our Maker intended to be one
of the distinguishing features of the male sex, unshorn,
would in many cases effectually protect these important
parts. The hair on the human male face, planted there by
the goodness and wisdom of our Creator, has its uses, and
we may add, its beauties. Let the young man, therefore,
never become a slave to the false and pernicious fashion
which compels him to shave off his beard, when this natural
appendage is found contributory to the health, if not to the
improved personal appearance, of those who wear it. See
also under Chronic Bronchitis.
4th. THE WEEKLY HOLIDAY.-Sunday, the day of rest
for the man of business and the day-labourer, is to the
earnest and conscientious clergyman a day of great mental
and physical expenditure, rendering a thorough holiday on
the Monday indispensable to healthy and vigorous life. It



4


COUGH.                     135
should be a rule therefore with every clergyman to make
Monday a day of cessation from work, and of out-door
recreation.
If these measures were faithfully and perseveringly carried
out, the affection known as Clergyman's Sore Throat, would
soon become obsolete.
5.-Cough (Tussis).
Like hoarseness, cough is but a symptom of some more
general disease, such as cold, asthma, bronchitis, or consumption. It may indeed be regarded as a conservative act,
being an effort of nature to rid itself of a diseased condition,
or to throw off morbid products.
To attain this end two things are essential; namely, a
certain quantity of atmospheric air beyond the offending
material, and a sufficient degree of muscular power to expel
it. Hence in croup, or diphtheria, or in the case of a patient
on the verge of suffocation from the lodgment of food or
other foreign matter in the upper part of the windpipe, the
surgical operation of making an artificial opening in the
windpipe, below the foreign body, often enables the patient
instantly to eject the suffocative body. In aged and feeble
persons, suffering from  chronic bronchitis with copious
secretion from the mucous surface, the muscular power is at
last so expended that the phlegm cannot be coughed.up,
and suffocation ensues.
The accumulation of mucus in the air-passages is, however,
by no means the only cause which prompts to the'act of
coughing. Simple irritation, congestion, an elongated uvula,
irritating vapours, pressure upon the respiratory organs, and
sometimes even sympathy with other parts; any of these
may be sufficient to excite cough.
From this point of view may be inferred the incorrectness
of speaking of " curing a cough;" certainly it is not the



136     DISEASES OF THE ORGANS OF BREATHING.


cough we desire to cure, but the disease itself for which the
cough has been set up.
Cough is often a symptom of some of the most fatal
diseases of our climate, and should, therefore, never be
disregarded. There are many varieties of cough, but our
prescriptions are intended only for common and uncomplicated cases.
TREATMENT.-It may be stated with great confidence that
homoeopathic medicines are capable of removing every
variety of cough not resulting from organic changes, or
destruction of the parts implicated. But, to accomplish this
result, care, and often a considerable amount of pathological
knowledge are necessary.
The following is a selection from the most useful remedies
in continued cough; that is, cough remaining after the other
acute symptoms of disease have subsided:-Aeon., Ant. C.,
Ant. T., Ars., BELL., BRY., CHAM., Caust., CaTro V., Calc.,
Dule., DRos., Hepar S., HYos., Ign., IPEC., Lye., Ilerc.,
Nux., Puls., PHos., Rhus, Sep., Silic., SPONG., Sulph., Ver.
In addition to the following symptoms, see also under Bronchitis, Asthma, Croup, Pleurisy, Consumption, etc.
Aconitum.-Cough of an inflammatory character, especially
in patients of a nervous temperament. There exist shiverings, heat and restlessness, thirst, scanty and high-coloured
urine, constipation, and the cough is short, hard, and dry.
Belladonna.--Spasmodic, short, dry, and convulsive cough,
worse at night, in bed; also for a cough occurring at any time
which is sudden and irrepressible, and excited by a sensation
of tickling in the throat and chest, and accompanied by
flushed face, sore throat, or headache. Bell. is generally
indicated in the dry, spasmodic cough of children and women,
and of stout persons.
I/Ioscyamus.-The indications for this remedy are very
similar to those just pointed out, and it should be had



COUGH.


137


recourse to if Belladonna has only imperfectly succeeded.
It is especially adapted to nocturnal, spasmodic cough; constant cough on lying down, which passes off on rising;
sensation of constriction or burning in the larynx; cough
resembling hooping-cough.
Kali Bichron.-This is a valuable remedy when there exist
headache, biliary symptoms, constipation, and when the
cough strains the stomach.
Ipecacuanha.-Irritating, nervous, and spasmodic cough,
attended or followed by vomiting. The chest is oppressed by
the accumulation of mucus in the air-vessels, rendering
breathing difficult, and producing a smothering sensation.
It is effective in hooping-cough, spasmodic asthma, and when
the expectoration is bloody.
Pkosphorus.-Dry cough, excited by tickling in the throat,
with shooting in the larynx, hoarseness, loss of voice, and
pains and soreness, in the chest; the expectoration viscid,
rusty-coloured, bloody or purulent, with a salt, sweet or
sour taste. As it is especially indicated in the coughs of
consumptive persons, cases requiring Phos. should be undei
the care of a homoeopathic physician.
Hepar Sulphur.-Irritating cough, with hoarseness and
smarting in the throat, excited or aggravated by exposure to
atmospheric changes.
Chamomilla.-Cough of children during teething and when
attended by fretfulness and wheezing breathing; also in
cough from suppressed perspiration.
Spongia.-Dry cough, with a burning or choking sensation in the throat; throat-cough, with hoarseness or feeble,
husky voice; croupy cough, after the use of Acon.
Carbo Vegetabilis.-Cough on taking the least cold; obstinate hoarseness, and loss of voice.
Bryonia.-A hard, dry, catarrhal or imflammatory cough
(after Acon.), with stabbing or catching pains in the sides and
K



138     DISEASES OF THE ORGANS OF BREATHING.


chest; headache, as if the head would burst during the cough;
cough becoming worse by motion, when passing from warm
to cold, or from cold to warm. Loose cough, with white or
yellow expectoration, sometimes streaked with blood.
Silicia.-Chronic cough in persons who expectorate transparent mucus or pus, and are troubled with an unhealthy
condition of the skin, ulcers, etc.
Nux Vomica.-Principally indicated when the cough is
due to indigestion, and when occurring in persons of sedentary
habits, or in individuals addicted to intoxicating drinkls,
strong coffee, and stimulating food.
Sulphur.-Obstinate dry cough, with tightness in the
chest, and retching; or loose cough, with expectoration of
whitish or yellowish mucus during the day, and dry cough at
night, attended with headache and pain in the loins and
hips, with spitting of blood. Sulphur is also useful as an
intercurrent remedy; that is, when the remedy indicated
ceases to benefit, Sulph. should be substituted for a few days,
after which the former remedy may be resumed.
Dose and Administration.-See page 49.
DIET AND ACCESSORY MEANS.-It is a rule of the first
importance in the treatment of cough, as in most chronic
diseases, that the food should be such as has been uniformly
found to agree with the patient.  Narcotics, stimulants,
spices, strong acids, and all relaxing medicines and drinks
should be avoided, as inimical to recovery. Good bread, not
less than one day old; beef, mutton (especially the lean
parts), and poultry, may be taken in moderate quantities.
Puddings of rice, arroworot, sago, tapioca, etc.; mealy potatoes
and other vegetables; ripe and wholesome fruits, etc.; the
food may be taken warm or cold, but not too hot.
Gum-water,* barley-water, and other mucilaginous drinks,


* For directions to prepare, refer to Index.



COUGH.


139


or if preferred, simple cold water in small quantities,. at
frequent intervals, are highly useful in cough.
A light and airy room, with a good chimney draft, and
well ventilated, should be selected. The morning air is
generally the best; night, damp, or confined air, and crowded
assemblies, are to be avoided.
If, after these directions are strictly carried out, and one
or more of the foregoing remedies administered, the cough
is not suppressed in a reasonable time, or at least sensibly
diminished in its severity, the case should be regarded as
too serious and of too complicated a nature any longer to
be treated merely by the aid of books, and should at once
be placed under the care of a homoeopathic physician.
PREVENTIVE MEASURES.-The whole body should be bathed
or sponged every day, or at least every second day, with
water of such a temperature as is found most agreeable or
beneficial. The bathing should be performed rapidly, and
the skin quickly dried with a large towel, after which it
should be warmly clad. Clothing should be adapted to the
varying conditions of the atmosphere. See article, Clothing,
page 25-9. Another preventive, also referred to under " Cold
in the Head," is to allow no day to pass without enjoying
the pure open air of the country, as far beyond the boundaries
of a town or city as possible.   Familiarity with a free
atmosphere will be a security against excessive sensibility to
variations of the weather, which is a most prolific exciting
cause of cough, as also of general disease.
6.-Hooping-Cough (Pertussis).
DEFINITION.-This is paroxysmal cough of an epidemic
and contagious nature, consisting of a series of short, spasmodic, forcible expirations, followed by a deep, prolonged
inspiration, attended with a peculiar sonorous sound called



140      DISEASES OF THE ORGANS OF BREATHING.
the " hoop," " whoop," or " kink," the paroxysms terminating in expectoration or vomiting.
It chiefly affects infancy and childhood, and in delicate
or scrofulous constitutions is a distressing malady.
SYMPTOMS.-Hooping-cough is generally preceded by a
common cold and cough and by febrile symptoms. After
the catarrhal stage has existed from seven to ten days, the
cough becomes louder and more prolonged, until it assumes
the characteristic convulsive character. The paroxysms are
extremely severe, by which the lungs are emptied of air to
the last degree, and then a long sonorous inspiration, taken
to refill them, constitutes the hoop. The ropy kind of
expectoration which follows the cough enables us to distinguish the affection from common cough even before the
hoop has been heard. Each paroxysm consists in a number
of sudden, violent and short expiratory efforts or coughs,
which expel so large an amount of air from the lungs that
the patient appears on the point of suffocation; these forcible
efforts are followed by a deep-drawn inspiration, in which a
rush of air through the partially-closed glottis, gives rise to
the distinctive crowing or hooping noise. This hooping is
the signal of the patient's safety, for when suffocation does
take place, it is before the crowing inspiration has been
made.   During the paroxysms, the face becomes deeply
red or black, and swells; the eyes protrude, and are suffused
with tears; and the expression    and appearance of the
sufferer are such as apparently indicate imminent suffocation.
The paroxysm terminates by the expectoration or vomiting
of a considerable quantity of glairy, ropy mucus, almost
immediately after which the child returns to his amusements, and appears quite well. The attacks recur three or
four times a day, or every three or four hours, or oftener;
sometimes blood escapes from the nose, mouth, and even
from the ears, during the fits.



HOOPING-COUGH.


141


PATHOLOGY.-There is probably at first a peculiar inflammation of the mucous membrane of the bronchi, and as a
consequence of this the absorbent glands at the root of the
lungs enlarge and then irritate the branches of the pneumogastric nerve which are situated there.
CAUSE.-An unknown materies morbi acting in the body
and transmitted by the air. It spreads by infection, and.
one attack generally protects the system from its recurrence.
COMPLICATIONS.-Hooping-cough may be complicated with
smallpox, measles, bronchitis, pneumonia, pericarditis, etc.
It is therefore desirable that the chest should be examined
occasionally during the disease by percussion and auscultation,
especially in obstinate cases, so that any complications may
be early met by appropriate measures.
TREATMENT.-The ordinary course of hooping-cough-six
weeks to three months, or much longer-may be greatly
abridged, and its intensity moderated, by judiciously selected
homceopathic medicines. As it begins in a common cold,
the medicines most appropriate to its early treatment are
stated under "Cough" and "Cold in the Head;" the
prompt use of which will often prevent the development of
the disease. In the treatment of this complaint, the general history and symptoms of the' patient must be fully
considered.
Aconitum.-Dry, hard, or wheezing cough, with fever, dry
heat of the skin, scanty, high-coloured urine, and burning
pains or tickling in the windpipe, most severe at night.
Two or three doses, at intervals of about two hours, will
often suffice.
Ipecacuanka.-Convulsive, violent cough, which threatens
suffocation, the face becoming blue and turgid; vomiting of
mucus; sneezing; watery or bloody discharges from the eyes
and nose. Useful in the early stage, especially after Acon.
A dose every two or three hours.



142      DISEASES OF THE ORGANS OF BREATHING.
Drosera.-This remedy is indicated in the hooping stage,
when the cough is loud and hoarse; the paroxysms recur
frequently, and are excessively violent, with very marked,
hooping sound, sometimes with hbemorrhage from the mouth
and nose; there may be no fever, or it may be intense, with
perspiration, vomiting of food, water, or slimy mucus.
Drosera is generally efficient in epidemic hooping-cough,
except in scrofulous children, who require professional treatment.
Veratrum.-Hooping-cough with extreme weakness, fever,
thirst, cold perspirations, blue face, protruding eyes, anxious
expression of the countenance, involuntary escape of urine
during the cough, and vomiting; also when there are pains
in the chest, abdomen, and groin; the patient avoiding
exercise.
Arsenicum may follow or be alternated with the last-named
medicine, when exhaustion and debility are very marked
symptoms.
Cuprum.-Violent forms of hooping-cough, when the body
becomes rigid, the cough suffocating, and the breath nearly
suspended during the paroxysms, which occur frequently,
and are followed by vomiting and great prostration. After
the cessation of the fit, the patient is but slowly restored to
vitality; and during the intervals there is a rattling noise,
as if the bronchi were filled with mucus.
Belladonna.-Sudden, violent cough, worse at night, with
sore throat, and determination of blood to the head. In the
usual course of hooping-cough, it may advantageously follow
Aconitum.
Opium.-Stupor, irregular breathing, constipation; also in
cases in which a remedy, apparently indicated, does not produce the desired results. After a few doses, the former
remedy may be selected.
Bryonia and Phosphorus, in alternation, every three or



HOOPING-COUGH.


143


four hours, when the hooping-cough is complicated with
diseases of the chest, fever, and pain.
Cina.-Hooping-cough with worm symptoms, paleness of
the face, picking at the nose, itching at the anus, irregular
appetite, a dark semicircle under the eyes, etc. (See the
chapter on " Worms.") Cina is often useful in alternation
with Bell.
Sulphur.-Hooping-cough on the decline, which may be
recognised by a change in the phlegm, which then loses its
tenacious character and becomes opaque. This remedy may
be given thrice daily for a few days, and afterwards continued
for a week, morning and night.
Additional R2emedies.-Hyos.., Lob. Inf., Spong., Phos.,
Ant. Tart.
DIET AND REGIMEN.-The diet should be light and easy of
digestion; all kinds of stimulants avoided, and care taken
that the stomach be not overloaded. Indigestible food, or
food in too large a quantity, is almost certain to excite a
paroxysm. If fever be present, the use of animal food should
be restricted. The drink should be toast-and-water, barleywater, gum-water, or linseed-tea. These kinds of drink,
varied to meet the patient's taste, will be found grateful and
soothing.
During fine, warm weather, the patient should remain in
the open air as much as possible; but damp and cold, and
exposure to draughts should be strictly avoided. In obstinate cases, and in convalescence, change of air, if only for
a short distance, proves very beneficial. If possible, mountain or sea air, or pure country air should be chosen, as it
acts favourably by removing irritation of the nervous system,
and completing the restoration to health. If change of air
be not practicable, the shower bath should be used.
It is necessary to treat children with great consideration
during the complaint, and to overlook many of their dere



144       DISEASES OF THE ORGANS OF BREATHING.
lictions; as violent emotions of the mind, or fits of anger
add to the severity and frequency of the paroxysms. Infants
must be constantly watched, taken up as soon as a fit comes
on, and placed in a favourable posture.
7.-Bronchitis.
DEFINITION.-Bronchitis is inflammation of the mucous
membrane of the air-passages, and is a diffused disease,
extending more or less through both lungs, with hoarseness,
cough, heat and soreness of the chest, the mucous secretion
being at first arrested, but afterwards increased in quantity;
it differs from  cold or catarrh only in the severity and
persistency of the symptoms, and most often occurs in old
persons, although it sometimes affects children, when it is
called sjfocative catarrk.
SYMPTOMS.-At first there is fever, with headache, lassitude, and anxiety; a feeling of tightness or constriction
about the chest; oppressed, hurried, anxious, laboured
breathing, with wheezing, severe cough, and expectoration,
at first dry, then viscid and frothy, and sometimes streaked
with blood, and subsequently it becomes thick, yellowish,
and purulent. The pulse is frequent and often weak; the
urine scanty and high-coloured; the tongue foul; there is
throbbing pain in the forehead, and aching pain in the eyes,
aggravated on coughing, with other symptoms of fever.
If the disease terminates fatally, the skin becomes covered
with cold perspiration; the cheeks and lips pale and livid;
the extremities cold; there is rattling and a sense of suffocation in the throat; the breathing being nearly suspended
by the morbid secretion which chokes up the bronchial tubes
and their ramifications, which the patient has no longer
power to cough up, and at length extreme prostration and
complete insensibility end in death. In favourable cases,
however, the disease begins to decline between the fourth



BRONCHITIS.


145


and eighth day, when the breathing becomes easier, and the
expectoration thicker, less frothy and stringy; and the complaint soon entirely disappears, or assumes the chronic form.
MORBID ANATOMY.-On examination of the body after
death, we find the trachea, the bronchi, and their divisions
and subdivisions, completely blocked up by a frothy, adhesive mucus, resembling that which had been expectorated
during life.
CAusEs.-Similar to those of common cold:-exposure to,
cold draughts of air, to keen and cutting winds, sudden
changes of temperature, scanty clothing, or undue exposure
of the throat and neck after public speaking and singing.
Bronchitis often follows cold in the head.
TREATMENT. Aconitum.-Short hard cough from a tickling sensation in the windpipe and chest, troublesome at
night and preventing rest and sleep, with rapid and full
pulse, hot skin, frontal headache, palpitation of the heart,
dizziness, constipation, and other febrile symptoms. This
remedy is generally required about every third hour at the
commencement of an attack, and often during its progress
if febrile symptoms recur. Its utility is generally indicated
by the cough becoming loose, the breathing easier, and the
skin moist, when the remedy may be given less frequently,
or discontinued.
Antimonium Tart.-Severe paroxysms of loose cough,
with suffocative, wheezing respiration, palpitation of the
heart, pain in the loins and back, headache, thirst, etc.
A dose every third or fourth hour.
Bryonia.-A dry hard cough with a stitching pain in the
chest, aggravated by movement, headache as if it would burst
during coughing; violent morning cough, with copious
expectoration of thick or yellow mucus, sometimes streaked
with blood; cough with retching or vomiting; cough with
oppressed painful breathing. In advanced stages of Bron



146     DISEASES OF THE ORGANS OF BREATHING.


chitis, this remedy will often be found valuable in alternation with Phosphorus. Bryonia is also useful in the acute
attacks of children with suffocative cough, rapid, difficult,
or sighing breathing, great agitation and anxiety.
Spongia.-Dry, spasmodic cough, without expectoration,
or only a little frothy mucus; oppressed breathing, or
inability to breathe unless the head is thrown backwards;
hoarseness, or husky feeble voice; heat and burning in the
chest, and tearing pain in the region of the throat.
Hepar Sulphur.-A wheezing sound of the voice; oppressed breathing; irritation in the throat, with violent
spasmodic cough.  It is especially serviceable in chronic
cases.
Mercurius.-The indications for this remedy are, in addition to the ordinary symptoms of bronchitis, abundant loose,
sometimes fcetid, perspirations; offensive breath; acrid
discharge from the air-passages, or increased flow of saliva.
Arsenicum.-Cough, with difficult expectoration of tenacious or saltish mucus stained with blood; sensation of
burning heat in the chest; a suffocative sensation on going
up-stairs or on lying down; anxious, painful, laboured
breathing; or when the lungs no longer permit the free
entrance of oxygen into the air-tubes, and thus are incapable of expelling the morbid secretions. Ars. is well
indicated in aged or feeble persons.
ADDITIONAL REMEDIES.-Ammon. Curb., Dros., Ipec., Samb.,
Phos., Stannum, Rhus., and Sulph.
In making our selection from  these medicines regard
should not only be had to the actual symptoms present,
but to the temperament, hereditary predisposition, and the
remote cause of the malady. For example, if, in any given
case, the indications actually present point equally to Hepar
Sulph., and Rihus., but the attack was found to be connected
with a repelled eruption, our choice would evidently rest



BRONCHITIS.


147


upon the former medicine; while if the disease was found
to be dependent upon an arthritic habit, Rhus would be the
appropriate remedy (Marcy). The principle embodied in
these remarks applies with equal force to the treatment of
any other disease.
DIET.-In bronchitis the diet should be light and liquid,
including gum-water, barley-water, gruel, jelly, beef-tea,
etc. Throughout the disease the air of the patient's apartment should be maintained at a temperature of about 65
to 700 Fahr., and it should be kept moist by the evaporation of hot water from shallow dishes near the bed, as
directed in the section on Quinsey.   Congestion of the
lungs may be relieved by covering the chest with large hot
linseed-meal poultices. If there is great prostration, nutritious liquid diet and stimulants are necessary; if they
cannot be taken by the mouth, they should be administered
in the form of enemata.
PREVENTIVE.-Susceptible patients may sometimes ward
off an attack by wearing a good respirator whenever exposed
to night air, or during inclement weather; or in the case of
males, the cultivation of the beard. See the next section.
8.-Chronic Bronchitis (Catarrhus Senilis).
This somewhat different form of bronchitis is very common
in advanced life. The milder forms are indicated only by
habitual cough, shortness of breath, and copious expectoration. Many cases of winter cough in old people are
examples of bronchial inflammation of a low, protracted
character. It is often insidious in its approach, although it
sometimes succeeds to acute bronchitis, when that disease
has been neglected or has not been properly treated.
TREATMENT.-The following are valuable remedies and
may be selected according to the cause of the disease and



148     DISEASES OF THE ORGANS OF BREATHING.


the symptoms present:-Bry., Ars., Lob., Phos., Hepar
Sulph., lod., Ipec., Hyos., Lyc., Silic., Stan., Sulph. For
details see " Bronchitis," and the 1" Materia Medica."
PREVENTIVE MEANs.-The first and most important is
cold bathing in the morning, that particular form of bath
being adopted which is found most useful or convenient.
(See Bathing, pages 29-32). Another preventive is the
Beard, which protects the respiratory passages against the
effects of sudden changes of temperature. We may regard
the beard as a kind of natural respirator, the shaving off of
which is a frequent cause of acute and chronic bronchitis.
Can we doubt the wisdom and beneficence of the Creator in
giving this ornament to the male sex, who is so frequently
exposed to atmospheric vicissitudes, and withholding it from
the female, who, as the keeper at homne, requires no such
appendage?   Hair is an imperfect conductor of both heat
cold, and placed round the entrance to the lungs, acts like
a blanket, which is used for warmth in cold weather, or to
prevent the dissolving of ice in hot weather. In many
instances, the beard would protect lawyers, clergymen, and
other public speakers, as also singers from the injurious
effects of sudden variations of the atmosphere, from which
professional men often suffer. It has been observed that
the Jews, and other people who wear the beard, rarely suffer
from bronchitis or analogous disorders; and so may be considered as examples of the utility of the beard.
9.-Asthma (Dyspncea).
DEFINITION.-Asthma is a spasmodic disease, characterized
by paroxysms of difficult breathing, with great wheezing,
and a dreadful feeling of constriction across the chest; each
paroxysm terminates by the expectoration of a more or less
abundant quantity of mucus. The air-tubes of the lungs



ASTHMA.


149


are encircled by minute bands of muscular structure, which
like other muscular fibres are liable to be affected' with
spasms, as is proved by the phenomena presented in this
disease.  These spasms constrict the air-tubes, and the
difficulty of breathing and the wheezing respiration are
caused by the air being forced through these contracted
channels. The spasmodic character of this disease is further
proved by the fact that post-mortem examinations of the
lungs of some asthmatic patients have been made without
presenting scarcely any traces of disease, either in the lungs
or heart, except that the air-cells are dilated, and the entire
lungs are puffy and anaemic. The attacks are often periodic
and sudden, and are attended with distressing anxiety.
SYMPTOMS.-A fit of asthma generally occurs in the night,
particularly from midnight to early morning, the patient
waking suddenly with a sense of suffocation, springing up
in bed, and assuming various postures, or even rushing to
the opened window, where he remains leaning forward on
his arms, employing the assisting muscles of inspiration,
and wheezing loudly, from great obstruction to the entrance
and exit of air into and out of the lungs, labours for breath
like one struggling for life. The countenance bears evidence
of great distress, the eyes protrude, the skin is cold and
clammy, the pulse small and feeble, the perspiration stands
in large drops on his forehead, or runs down on the face, and
he often looks imploringly, sometimes impatiently, at his
medical attendant for relief from his misery. At length,
after an uncertain time, one to three hours, or longer, there
comes a remission; cough ensues, and with it expectoration
of mucus, and soon the paroxysm   ceases, permitting the
sufferer to fall into the long-desired slumber.
The patient probably retired somewhat ill or uncomfortable
on the previous evening, and woke at one or two o'clock
with a feeling of constriction and inability to expand the



150       DISEASES OF THE ORGANS OF BREATHING.
lungs freely. An attack is unattended with fever, and is
generally preceded by disturbance of the digestive organs.
PHYSICAL SIGNS.-On percussion during a fit the chest is
resonant, showing that the lungs are distended with air; but
on applying the stethoscope little or no respiratory sound
is heard, as if the air were imprisoned or in a state of stagnation in the air-cells; and it is probable there is a spasmodic contraction of the muscular fibres at the base of the
trachea which stops the respiratory murmur.
DIAGNOSIS.-The physical conditions of the chest just
pointed out, the abruptness and violence of the symptoms,
and the comparative good health enjoyed between the attacks, are sufficient to distinguish the disease.
CAUSES.-Irritation of the centre of respiration and of the
nerves concerned in the respiratory act. This irritation may
result from deranged digestion, in consequence of the intimate nervous connection existing between the digestive and
the respiratory organs; or it may be produced by hygrometric
changes of the atmosphere; or, again, by the introduction
of some poisonous but subtle material floating in the atmosphere, and brought by inspiration into contact with the
respiratory surface, such as the minute particles, or the
mere odour, which passes off from powdered ipecacuanha or
hay; or the vapour of sulphur. Excessive exertion and
mental emotion often bring on a paroxysm. After it has
once occurred, asthma is easily reproduced by indigestion,
especially after heavy suppers; a frequent repetition of the
fits leads to the dilated state of the air-passages and air-cells
of the lungs, the dilation of the right cavities of the heart,
and the general displacement of that organ which uniformly
exist in persons who have long suffered from this disease.
The disease may also be hereditary, it being one of those
maladies, a disposition to which is transmitted from parents
to children.



ASTHMA.


151


TREATMENT.-Ipecacuanha.-One of the first and chief
remedies to be used; especially if there is a feeling of tightness about the chest, panting and rattling in the windpipe,
which feels as if full of phlegm; coldness, paleness, anxiety,
and sickness. A dose every ten or fifteen minutes during an
attack; afterwards every three or four hours.
Arsenicum.-Short, anxious, and wheezing breathing;
aggravation of the sufferings at night by lying down, and
upon the least movement; attacks of suffocation, spasmodic
constriction of the chest, with pale or bluish face. It is
especially useful in chronic asthma, and when the disease
occurs in old persons, or in feeble and impoverished constitutions; and is attended with burning heat of the chest, cold
sweats, and general debility; also in bad cases occurring
after suppression of an eruption or catarrh.
Bryonia.-Obstructed respiration, aggravated by exercise
or by talking; tightness and oppression at the chest and
abdomen during inspiration; inclination to vomit, the patient
being fretful and irritable.
Nux Vomica.-Suitable for strong, robust persons; to attacks occurring about three or four o'clock in the morning,
or after a heavy meal; when the disease has been induced
by prolonged study, sedentary habits, or alcoholic beverages.
It is more particularly indicated when heartburn, flatulence,
or costiveness have preceded the paroxysm.
Belladonna.-Paroxysms of short, difficult, irregular, and
suffocating breathing, accompanied by dry cough, severe
beatings of the heart, vertigo, and headache.
Ant. Tart.-Oppression, with profuse secretion of mucus
low down in the chest, suffocative cough, palpitation of the
heart, retching, especially in children and aged people, and
when the paroxysm occurs in the evening.
Veratrum.-Violent paroxysms of spasmodic asthma, with
great prostration, coldness of the nose, ears, and feet, and
cold perspirations.



152      DISEASES OF THE ORGANS OF BREATHING.
Lobelia Inflata.-Spasmodic asthma occasioned by a humid
state of the atmosphere, with a constrictive, suffocative sensation, wheezing breathing, vomiting, prostration, giddiness,
spasmodic cough, intermittent pulse, cold sweats, and pains
in the abdomen.
Sulphur.-Chronic asthma apparently connected with some
constitutional taint; also after other medicines have been
unsuccessful.
Additional Remedies.-Calc., Cann. Ind., Digit., Samb.,
Stram., Spong., China, Puls., Phos., and Carbo V.
ACCESSORY MEANS.-Persons who are predisposed to asthma
should strictly avoid all its exciting causes, more especially
wet feet, damp clothes, sudden changes of temperature, indigestible food, and heavy suppers.    The homoeopathic
diet should be adhered to, for, as may be inferred from
what is stated under Causes, the slightest disorder of the
stomach might occasion an attack. Pastry, high-seasoned
dishes, and too great a variety of articles, or too great a
quantity at one meal, coffee, and heating beverages, should
be avoided. "More is to be done for asthmatic patients
on the side of the stomach than in any other direction."
In many cases the diet should be weighed, the hours of
meals fixed, and adhered to most rigidly.
During a fit, striking relief may often be obtained by
putting the feet and hands into hot water.      Smoking
Stramonium at the commencement of a fit, is said to remove,
it like a charm in some; in others, however, it fails altogether. Smoking tobacco is often useful in relaxing the
spasm; a few whiffs are usually sufficient. Tobacco should
never be indulged in by the asthmatic patient, except during
a paroxysm, for then only will it be of any advantage.
Relief is often obtained by the fumes of burning nitre,
which is effected by placing some pieces of blotting-paper,
previously saturated in a solution of the nitrate of potash,



ASTHMA OF CHILDREN.


153


about the size of the hand, on a plate; one of these pieces
being ignited, the fumes are diffused throughout the room,
and their influence is soon made evident. At the same
time, the windows should be thrown wide open to admit
the air. The best means, however, to fortify the body against
this malady is the shower bath; the sudden application of
the water improves the tone of the whole system, and
renders the body less sensitive to atmospheric changes.
10.-.Asthma of Children (Asthma Millari).
The attack generally comes on with great suddenness, and
generally at night on waking from sleep, or after a fright,
and sometimes without any apparent cause. The spasms set
in with wheezing and great difficulty of breathing; the
child gasps for breath, the face turns pale or blue, there are
frequent clenching of the thumbs, spasmodic contraction of
the toes, or convulsions. This disease is often mistaken for
croup, but is distinguishable from it by the absence of fever,
by the spasmodic character of the attacks, and by the
absence of any previous symptoms of a common cold. It
usually occurs in delicate, strumous children, and is often
fatal if homoeopathic medicines are not promptly used.
Sambucus.-Extreme dyspnoea, almost amounting to suffocation; suffocative paroxysms after twelve o'clock at night.
A dose every fifteen to thirty minutes during an attack.
Ipecacuanha and Arsenicum are also useful remedies, and
may be administered if the foregoing does not fully succeed.
(See the preceding article.)
11.-Inflammation of the Pleura (Pleurisy, Pleuritis).
The disease to which the above terms are applied consists
of acute inflammation of the pleura, or serous membrane
which invests the lungs and lines the thoracic cavity. In
health, this membrane has a smooth, lubricated surface, to
L



154     DISEASES OF THE ORGANS OF BREATHING.


permit the free motion of the viscera they enclose; inflammation destroys this polished surface, so that movement
of the membranes, or of the lungs, is rendered difficult and
painful.
SYMPTOMS.-The disease comes on suddenly and violently,
with rigors, fever, and lancinctting, stabbing pains, often
called "a stitch in the side," commonly felt below the
nipple, and usually affecting only one side; the pains are
acutely increased by coughing, by pressure, or by the
least attempt at a deeper inspiration, which the patient
soon refuses to take. There is tenderness at the intercostal spaces, and the breathing is diaphragmatic, the movements of the ribs being restrained, and the lungs only
partially filled with air. There are also short, frequent, dry
cough, parched tongue, flushed face, hard, wiry, quick
pulse (about 100 in the minute), scanty and high-coloured
urine, and the patient constantly desires to lie on the affected
side, or on the back. Should the lung also be involved, the
expectoration will be very copious, and streaked with blood.
The inflammation, however, soon terminates in resolution,
and the two surfaces of the pleura regain their smooth, moist
character; or the roughened and inflamed surfaces become
more or less adherent; or efusion takes place, and a dropsical
fluid separates the surfaces, a condition known as Hydrothorax. In severe cases, the effusion may be so excessive as
to compress the lungs and heart, and to suspend their
functions.  Sometimes there is a large collection of true
pus, which fills the pleuritic cavity, when it is termed
Empyema. This condition is likely to arise in bad constitutions, and also when the inflammation has resulted from
injury, and the presence of foreign matter in the cavity.
The quantity of effusion may be estimated by the dyspncea
with which the patient suffers, and will be greater in proportion as the lung is more completely compressed.



INFLAMMATION OF THE PLEURA.


155


PHYSICAL SIGNS.-On applying the stethoscope to the afffected part of the chest at this period, the dry inflamed surfaces may be heard rubbing against each other, and producing
what is called a friction sound; this rubbing may also be
felt by placing the hand on the corresponding part of the
chest; it is probably due to the pleura being preternaturally
dry by exhalation, or to its being roughened by effusion of
fibrine. This sound is only to be heard for a short time,
because the opposite surfaces become glued together, or,
more probably, separated by serous effusion; in this there is
dullness on percussion at the lower part of the chest as high
as the level of the fluid. To the same extent, the respiratory
murmur is also lost.!Egophony (a shrill, vibratory sound
of the voice) may also be heard there. At the same time
the patient, though at first he preferred to lie on the sound
side, is compelled to turn to that which is affected, so that
the movements of the healthy lung may not be impeded by
the superincumbent weight of the dropsical pleura.
CAUSEs.-Exposure to atmospheric vicissitudes, and sudden checking of the perspiration, are the most frequent
causes, especially in persons of unhealthy constitutions;
surgical operations and mechanical injuries are frequently
exciting causes; thus the rough ends of a fractured rib may
set up inflammation of the pleura. It may also be excited
by extension of other diseases. The cause of the disease
may materially alter the treatment.
TREATMENT.-Acon., An., Bry., Ant. T., Pkos., Ars., and
Rhus Tox.
Aconitum.-This is appropriate in the early and inflammatory state of the disease. After administering two or three
doses, its beneficial effects are often marked by the occurrence
of abundant perspiration, which contrasts most favourably
with the hot, dry skin, urgent thirst, quick pulse, and
general suspension of the secretory functions which existed
before the exhibition of the remedy.



156      DISEASES OF THE ORGANS OF BREATHING.
Bryonia.-This is a remedy of great power in pleurisy,
even in its most violent forms. Its special indications are,
laboured, short, anxious, and rapid respirations, performed
almost entirely by the abdominal muscles; stinging,shooting,
or burning pains in the side, aggravated by breathing or
movement; painful, dry cough, or cough with expectoration
of glairy sputa; weariness, disposition to retain the recumbent position; irritability, restlessness, etc. A dose every
one to three hours, alone, or in alternation with Aconitum,
until the pain and difficulty of breathing are removed.
Phosphorus.--Pains in the chest of a severe, sticking
character, excited or increased by breathing or coughing;
the breathing is short, the cough dry, the expectoration,
owing to a small quantity of blood mixing with it, is of a
rusty colour, and there is rapid prostration of strength.
This remedy may be given alone, or in alternation with any
other indicated by the symptoms.
Antimonium   Tart.-Cough with rattling of mucus, oppressed breathing, sometimes nausea, profuse expectoration,
violent throbbings of the heart, and a feeling of suffocation.
Arnica.-Pleurisy supervening upon, long-continued and
laborious exercise, or from external injury; especially when
pain and soreness remain, or when much fluid has been
effused; in the latter case, Am. tends to promote its absorption.
Belladonna.-Congestion of blood to the brain, red face,
delirium, or typhoid symptoms. It is generally required in
alternation with Aconitum, at short intervals.
Arsenicum.-Tedious cases, with extreme prostration of
strength, painfully oppressed breathing, occasional attacks
of suffocation, coldness of the body, low   delirium, and
general exhaustion.
Sulphur.-When the lancinating pains in the chest have
yielded to Bryonia, or any other remedy, a dose of Sulphur



FALSE PLEURISY.


157


every six or twelve hours, for several days, will often complete the cure. It is also advantageous as an intercurrent
remedy when recovery proceeds very slowly, and when the
breath and expectoration have a feetid character.
GENERAL TREATMENT.-Diet, as in   Inflammatory Fever,"
pages 55-6. Applications of heat, in the form of poultices,
flannel wrung out of hot water, etc., applied to the painful
part, will often afford striking and immediate relief. Bleeding in every form should be avoided.
12.-False Pleurisy (Pleurodynia).
This affection is often mistaken for pleurisy, but with a
little care may be readily distinguished from it. It is of a
rheumatic character, and chiefly  affects the intercostal
muscles. The patient complains of aching and stitching
pains in the chest, which are aggravated by ascending stairs,
or other kinds of exertion. The cough is slighter than in
pleurisy, the pain is increased only by hard pressure, and
there is little or no fever, or other constitutional disturbance.
TREATMENT. -Arnica.-A few doses, at intervals of three
or four hours, will generally effect a cure.
Bryonia.-If the pain is sharp, cutting, and increased by
breathing, also if the patient is feverish and restless. A
dose every third or fourth hour.
ACCESSORY MEANS.-Warm applications, as recommended
in the last section, generally afford relief. A liniment,
medicated with Arnica or Bryozia, well rubbed into the
affected part, will aid the internal use of these remedies in
removing the disease.
13.-Inflammation of the Lungs (Pneumonia).
This disease consists of acute inflammation of the substance
of the lungs, in contra-distinction to that which affects the
air-tubes which ramify these organs, and called bronchitis.



158       DISEASES OF THE ORGANS OF BREATHING.
Pneumonia may affect one or both lungs; or, in medical
language, may be double or single. In two cases out of
three, the right lung is the one diseased; and in about
one case out of eight the inflammation extends to both
lungs. The lower, posterior part, and base of the lungs,
are the portions that are most often affected.
It frequently exists with pleurisy, when, if pneumonia
forms the chief disease, the double affection is called pleuropneumonia. If, however, pleurisy predominates, it has been
termed pneumo-pleuritis.
SYMPTOMS.-Pneumonia generally comes on insidiously,
with restlessness and febrile disturbance, and sometimes has
made great progress before the true character of the disease
has been discovered.    There is deep-seated, dull pain,
referred to the scapulae, or felt as an oppression under the
sternum; but there is a great feeling of illness, and
frequent, short cough, with expectoration of a viscid matter,
of a green, yellow, or pale colour, sometimes tinged with
with blood, which form such tenacious masses, that inversion
of the vessel containing them, will not detach them. The
breathing is rapid and difficult; the skin hot, especially in
the regions of the ribs and armpits; there exist great
thirst; interrupted, hesitating speech; the pulse is variable,
being sometimes rapid and full, at other times hard and
wiry, or quick and weak; the urine is scanty, red, and
sometimes scalding; and the patient lies either on the affected
side or on his back. If the disease is unchecked the face
often exhibits patches of redness and lividity; the bloodvessels of the neck become swollen and turgid; the pulse
weak, irregular, or thready; and the patient may sink,
either from exhaustion, or from obstruction of the lungs.
PHYSICAL SIGNS.-On percussing the chest of a person in
health, a hollow resonant sound is returned, proving the
presence of air. If we also apply a stethoscope to the chest,



INFLAMMATION OF THE LUNGS.


159


we may hear, as the patient breathes certain sounds, produced
by the air entering the air-cells, which are described as
the "o esicular murmur," and have been compared to the
breeze among the leaves or the cooing of doves. In pneumonia these sounds become changed; instead of resonance
there is dulness on percussion; and, in the first stage, by
auscultation, minute crepitation may be heard, which has
been compared to the sound produced by the rubbing a lock of
hair between the finger and thumb close to the ear. In the
next stage, the sound just described cannot be heard, for
as the inflammation proceeds, the soft and spongy character
of the lung is lost, and it becomes consolidated by effusion
and organization of fibrine in the air cells, and resembles
the cut surface of the liver; this condition is called Hepatization. Percussion elicits great dulness over the whole of
the affected part. During convalescence, as the air cells
open, minute crepitation may be again heard, and afterwards
the natural vesicular murmur.
In the next, or third stage, purulent infiltration occurs,
which consists of diffused suppuration of the lung tissue.
In rare cases, a circumscribed abscess forms, and on apapplying the ear to that part of the chest, a gurgling
sound may be heard; this condition is usually preceded
by rigors; and a hollow or cavernous sound follows when
the abscess has been emptied by coughing and expectoration. The occurrence of cbpious expectoration of whitish
or yellowish mucus, general perspiration, a sudden abundant
discharge of urine, with copious sediment, diarrhoea or even
bleeding of the nose, may be regarded as forming a crisis,
encouraging the hope of a favourable termination.
Occasionally, in old or enfeebled constitutions, gangrene
of a portion of the lung may occur.-This condition is easily
recognised by a most intolerable odour of the patient's
breath, resembling that proceeding from mortification of the



160     DISEASES OF THE ORGANS OF BREATHING.


external parts. Unless the gangrenous portion is extremely
limited, the case is almost certain to terminate fatally.
TREATMENT.--Inflammatory symptoms, Acon., Bry.
Bloody sputa, weak pulse, etc., Phos., Rhus Tox.
To loosen the tenacious phlegm, Ant. Tart.
Complicated with pleurisy, Bry. and Phos., especially after
the use of Acon.
Spasmodic cough, worse at night, Hyos., Bell.
From violence, or with hemoptysis, Arn.
Persons addicted to alcohol, Nux or Opi.
Old, feeble, scrofulous patients, Ars., Verat.
With threatened gangrene, Arsen., Carbo V.
With cerebral symptoms, Bell., Hyos., or Opi.
For the symptomatic indications, see under Pleurisy, the
treatment in each case being very similar.
ACCESSORY MEANS.-A large, thick linseed-meal poultice,
or spongio-piline, to fit the chest in front and back. The
patient must be kept very quiet, have mucilaginous drinks
and farinaceous diet, and be treated generally as directed
under Typhoid Fever, pages 67-76.
14.-Croup (Cynanche Trachealis).
Croup is a disease almost peculiar to childhood, most
cases of it occurring during the second year of life. There
are two forms of it which can easily be distinguished, the
spasmodic and the inflammatory.
SPASMODIC CROUP (Laryngismus stridulus) occurs at the
youngest age, before the end of the first dentition.
SYMPTOMS.-It comes on suddenly, usually in the night,
with a spasm of the muscles of the throat, so that the child
struggles to get its breath, with a choking noise, and
becomes livid in the lips. It usually occurs during dentition,
or irritation in the stomach or bowels. Under proper treat



CROUP.


161


inent the attack usually soon passes off, although it may be
premonitory of disease of the brain.
TREATMENT.-Acon., Spong., Bell., Cup., Ipec. For the
symptomatic indications, see further on.
INFLAMMATORY CROUP (Cynanche Trachealis) is less frequent, and often occurs after the primary dentition to near
puberty. It is one of the most dangerous diseases of
children, and under the treatment of the old school practitioner, is most formidable and fatal in its results, the
mortality being formerly four out of fie, and at present
probably at the least one-half the children attacked die.
Under skilful Homoeopathic treatment, however, especially
if commenced early, the disease is curable. We possess
prompt, efficient, and specific remedies which arrest the
inflammatory process, and so save the life of the patient.
The records of Homoeopathic treatment show a large balance
in its favour as contrasted with the old system, in all acute
as well as chronic maladies.
SYMPTOMS.-It is a peculiar inflammation of the mucus
membrane of the larynx and trachea, the vessels of which
exude a fibrinous or albuminous material, which concretes
and forms a false membrane.       It usually begins as a
catarrh, the first indication being hoarseness in the voice or
cry of the patient, with a peculiar barking cough, or sore
throat, and after one or two days or even without any premonitory indisposition, usually at night, the symptoms become
aggravated, the sleep being interrupted by paroxysms of hoarse
coughing, the child throwing its head back to put the
windpipe on the stretch. A metallic ringing sound is heard
in the inspiration and in the cough, which has been compared to the crowing of a young cock, or to the barking of a
puppy; and although the respiratory efforts are great, it is
evident, from the turgescence of the face and neck, and the
carrying of the child's hands to its throat, that an insufficient


/
ii



162       DISEASES OF THE ORGANS OF BREATHING.
quantity of air enters the lungs. After the fit has continued
for a variable time, from a few minutes to an hour or more,
there is an interval of relief usually of several hours duration.
The pulse is frequent and wiry, with loss of appetite, thirst,
and great distress.
As stated above, croup is not always preceded by the
symptoms of catarrh, but may appear suddenly. In the
course of the night, a child may go to bed apparently well,
and have an attack of the complaint in the worst form. It
is, probable, however, in these sudden attacks of croup, that
the subjects of them had been exposed to cold or damp on
the previous day, although no symptoms of catarrh were
noticed.  Whether the symptoms occur thus suddenly or
after the precursory indications of a cold, the disease almost
always comes on in the night, with      remissions towards
morning.
DANGERS.-The attack may prove fatal in two to four days,
from exhaustion, suffocation, convulsions, or the formation
of a coagula in the heart. If the local symptoms are very
severe, and the paroxysms recur frequently, the prognosis is
unfavourable. The tendency to death is by apncea (privation of air), the false membrane contracting the naturally
narrow passage for air at this part. As the fatal termination
approaches, the breathing becomes so greatly impeded that
the blood is but slightly oxygenated; the lips and cheeks
become livid, cold, and covered with clammy sweats; the
eyes red and sunken; the entire organism prostrated, and,
unless speedily relieved, the child expires in a state of suffocation; or coma and      convulsions ensue, and   end the
struggle.
CAUSEs.-The predisposing cause of croup may undoubtedly be explained by the anatomical fact that the trachea
and its orifice are very small in infants, and do not enlarge
in proportion to other parts of the body till after the third



CROUP.                     163
year; after this period, the calibre of the trachea enlarges
rapidly, and the liability to croup diminishes in proportion.
The exciting causes are cold, dark, damp, and unhealthy
localities; sudden changes of temperature, wet feet, poor or
scanty food, especially the adoption of improper diet when a
child is weaned; insufficient clothing, or previous illness.
One attack acts as a strong predisposing cause to subsequent
ones. ILike most diseases of the respiratory organs, it is
most fatal in the winter and spring. Low and moist districts
are the most favorite localities of croup. Towns situated
near the banks of rivers have an extra share of it; and it
has been noticed to prevail especially in such places, among
the children of washerwomen, clearly showing the relationship of cause and effect. Dr. Alison observed it often
occasioned by children sitting or sleeping in a room newly
washed, and that he noticed its frequent occurrence on a
Saturday night, the only day in the week it was customary
for the lower classes in Edinburgh to wash their houses.
TREATMENT.-Acon., Spong., Bell., Iod., Hepar Sulph.,
Sambucus, Bromine, etc.
Until a homceopathic practitioner arrives, proceed promptly
with one or more of the following remedies, according to the
symptoms that are present.
Aconitum.-In very urgent cases, this medicine should be
administered every fifteen minutes, and in less urgent cases
every one or two hours, if there exist great heat, and dryness
of the skin, thirst, short dry cough, and difficult breathing.
Acon. is often of priceless value in the early stage of the
disease. Warm and gentle perspiration following this
medicine is a favourable symptom, and especially if the
child falls asleep, which should on no account be prevented.
On waking, the patient should have Hepar Sulph.; a dose
repeated every four or six hours, for two days, and afterwards, at longer intervals, for a week. In favourable cases,



CROUP.


165


thirty minutes; in less severe cases, or as improvement
ensues, every one, two, three or four hours; during recovery,
thrice daily.
DIET AND REGIMEN.-During the attack, water is almost
the only article admissible, and may be given in small
quantities when thirst exists. During recovery, milk and
water, arrowroot, gruel, etc. In the case of delicate children,
or if great weakness suddenly occurs during any course of
the disease, it may be necessary to support the patient by
the essence of beef, and wine-and-water, or brandy-andwater, which should be administered in small quantities, at
regular and frequent intervals. In the case of an infant at
the breast, the mother should adopt the dietetic suggestions
contained in the chapter on "Indigestion."    The feet and
the surface of the body generally should be kept warm, and
the air of the apartment raised to about 650 Fahr., and this
temperature uniformly maintained by day and night; watery
vapour should be thoroughly diffused therein by keeping a
kettle of water constantly boiling on the fire, or over the
flame of a spirit lamp, and fixing a tin or paper tube to the
spout to convey the vapour near to the patient. A partial
or complete warm bath, and sponges well squeezed out of
hot water and applied to the throat, are often useful measures.
During the treatment everything should be avoided that
would be likely to excite or irritate the patient. In very
severe cases, a tent may be formed over the patient's bed,
and steam  conducted under it by a tube from boiling water.
During cold weather, or in very susceptible patients, it is
often necessary to keep the child in a large apartment, the
air of which is made artificially warm and moist, for ten or
fourteen days.
PROPHYLAXIS.-It may scarcely be necessary to remark,
that when cold and cough are noticed in a young child,
especially with hoarseness and loss of voice, he should be



166     DISEASES OF THE ORGANS OF BREATHING.


sedulously watched, and guarded against influences likely to
excite or aggravate inflammation, including protection from
cold and damp, and a carefully-selected, light diet. If any
feverish symptoms exist, a dose of Aconitum should be administered; in the absence of fever, a dose of Hepar Sulph.
The question of Tracheotomy is an important one; but as
it is exclusively a professional subject, any further reference
to it here would be out of place.
15.-Diphtheria.
DEFINITION.-Diphtheria is an acute epidemic disease,
characterised by a peculiar spreading inflammation of the
mucous membrane of the pharynx, with exudation of lymph,
attended with great general prostration, and sometimes
remarkable nervous phenomena.
SYMPTOMS.-Diphtheria is divisible into two classes. In
one, happily the most numerous, the symptoms are at first
so mild as to excite little complaint beyond slight difficulty
of swallowing, or pain in the throat, and is readily cured by
one or more remedies selected according to the accompanying
symptoms. Very little constitutional irritation exists, there
is no albumen in the urine, the appetite and sleep are natural,
and no nervous symptoms or other sequelee follow. In the
second class of cases, however, the disease is ushered in with
severe fever, rigors, vomiting, or purging, sudden and great
prostration and restlessness; the patient has an anxious
expression of countenance, and it becomes evident that the
system is labouring under some overwhelming disease. The
skin is hot, the face flushed, the throat is sore, occasioning
difficulty both of swallowing and breathing, and the urine
scanty and high-coloured. On examining the throat, the
tonsils are seen to be swollen, and the mucous membrane has a
bright-red colour; but soon grey or white patches of deposit
appear on the tonsils, small at first, but gradually enlarging,



DIPHTHERIA.


167


so that one patch merges into another, forming a false lining
membrane to the throat. In some cases, the false membrane
has been detached, and after extreme efforts ejected, presenting nearly an exact mould of the throat. The exudation
of diphtheria may be distinguished from a slough by its
easily crumbling, by the facility with which it can often be
detached, and by the surface thus exposed being red, but not
ulcerated.  The false membrane looks like dirty washleather; and between it and the true membrane an offensive
bloody discharge exudes, imparting to the patient's breath a
most repulsive odour. The glands of the neck are always
enlarged, sometimes pain is felt in the ear, and there is
generally stiffness of the neck; the inflammation is liable to
extend rapidly, in' consequence of the continuity of the
lining membrane of the throat with the mouth, nose, windpipe, and even the air-tubes of the lungs. If the disease
progresses, the patient refuses to swallow, and earnestly
entreats to be left alone, the restlessness passes into stupor,
and the difficulty of swallowing food or liquid, or of breathing,
increases, till the false membrane is forcibly ejected, or the
patient dies from suffocation, the exuded membrane blocking
up the air-tubes; or the patient sinks from exhaustion,
similar to that observed in Typhoid Fever.
DANGEROUS SYMPTOMS.-A quick, feeble pulse, or a very
slow pulse; vomiting, especially if it is persistent; drowsiness and delirium; epistaxis; dyspnoea; suppression of
urine, or albumen in the urine. Diphtheria is most fatal in
very young children, and it usually occurs from extension of
the disease to the larynx; in adults the fatality is generally
due to the systemic disease.
DIAGNOSIs.-Diphtheria resembles croup in the exudation
of a false membrane on a mucous surface, but differs from
it in several points. 1. The local inflammation begins in
the pharynx instead of the trachea, although it may after



168


DISEASES OF THE ORGANS OF BREATHING.


wards spread to the fauces, oesophagus, and respiratory
tract. 2. It attacks adults as well as children. 3. It is
attended with extreme depression of strength, and in adults
is usually fatal by asthenia, but in children sometimes by
asphyxia, by obstruction of the larynx. Some have thought
that diphtheria was only scarlatina without an eruption;
but, although there is some analogy between these diseases,
further investigation has shown that they are distinct affections.
CAUSES.-Impure air, from imperfect drainage, living too
near stables, manure deposits, slaughter-houses, or where
animal substances in a state of decomposition are exposed,
with an insufficient supply of water. Thus atmospheric
poisoning imparts to what might have been an ordinary sore
throat the peculiar and dangerous symptoms of diphtheria.
TREATMENT.-The treatment recommended in the articles
on Quinsy and Croup, should be consulted, as the remedies
there prescribed are often required in Diphtheria.
The mild variety of Diphtheria is generally curable by the
administration of a few alternate doses of Aconitum and
Belladonna, and afterwards of Mercurius or Nitric Acid, the
remedy being selected according to the existing symptoms.
Bell. is especially useful if the tonsils are greatly swollen.
" If there is any truth in the Homceopathic law, Bell. and
Merc. are the chief remedies in diphtheria" (Morgan).
The dangerous form of the disease requires one or more of
the following: Bell., Merc., Iodine, Muriatic Ac., Baryta
Carb., Nit. Ac., Hepar Sulph., Rhus. Tox., Ars., China.
Iodine is probably the most truly Homoeopathic of any
medicine to the special characteristics of this disease, both
in its constitutional and local manifestations.   Dr. Kidd
remarks on the use of this drug, "Diphtheria plainly enters
the blood through the air-passages, and on its entrance,
excites a violent local action on the pharyngeal mucous.



DIPHTHERIA.


169


membrane at first, and subsequently on the laryngeal. The
local action seems an expulsatory effort to cast out the
poisonous miasm, and the constitutional result is, that of a
depression on the nervous system, and of a disorganizer, on
the entire mass of blood. The local and constitutional
results are also at once sudden and severe in most cases.
In every one of those special peculiarities, Iodine is an exact
analogue.  The inhalation of its vapour causes sudden
irritation of the mucous membranes of the air-passages,
nares, pharynx, and larynx; it also excites a vesicular
exudation of an acrid nature.
"When absorption of Iodine has occurred to any extent, a
sudden prostration, languor, anorexia, extreme restlessness,
and constitutional irritation, are produced, with a tendency
to syncope.  Salivation is likewise rapidly produced nithout
ulcers of the gums or soreness of the teeth, as in mercurial
salivation, and the salivary glands, as well as the common
glands, are suddenly irritated, and rendered painful. Aphthae
appear on the mouth, and the restlessness gradually passes
into stupor and drowsiness. In addition to this very close
analogy of the local and constitutional symptoms of diphtheria to those of iodine, we have its clinical experience in
croup (in which it is the best of all remedies), in aphthae, in
glandular swellings, together with its powerful action as a
disinfectant in throat diseases, in which it is of more value
even than chlorine. In the early stage of the disease,
especially when there is much glandular irritation, and
where the disease extends to the larynx, it seems especially
indicated. To produce a prompt and perfect influence over
the disease, it is best to administer it-similia similibus
curantur-in the mode of entrance of the disease itselfthat is, by infinitesimal inhalation.  This is done by placing
iodine in substance or in tincture, in an open vessel in the
room of the patient, as it is thus very slowly evaporated,
Ml



170       DISEASES OF THE ORGANS OF BREATHING.
and mixes with the air in a highly divided and very active
form. This need not interfere with its internal use, which
should be frequently repeated. If Hahnemann were alive
to prescribe for diphtheria, he would be as likely to advise
the lowest dilutions-in substantial doses frequently repeated-as when he advised the strongest solution of
camphor in cholera."*
Muriatic Acid.-Dr. Kidd thinks this remedy ranks next
in importance to Iodine, and is especially valuable after the
latter drug has diminished the glandular irritation.    Its
indications are, pain and swelling of the mucous membrane
of the throat, suffocative tightness of the chest, with cough,
great prostration of strength, and fcetid breath. For internal
use, half-a-dozen drops of strong acid may be mixed with a
table-spoonful of honey, (using a glass or porcelain spoon),
and a small quantity taken every one or two hours.
Mercurius.-This remedy is indicated by putrid salivation,
pain and swelling of the salivary glands, difficult swallowing,
regurgitation of food through the nostrils, etc.
MJerc. Iod.-This remedy has proved of great value in
many cases of diphtheria, and is, by many practitioners,
preferred to every other preparation of mercury, and should
be administered as soon as any exudation patches are observable in the throat, or even when swelling of the glands of the
neck is first noticed. The first or second dec. trituration is
the form and strength in which we chiefly use it.
Arsenicum, in the last stages of the disease, is of immense
value, particularly when the prostration of strength is very
marked or is increasing; when there are cedema, and putrid
odour of the throat and air passages, and when there is a
tenacious fcetid discharge from  the lining membrane of the
nostrils.  Even in the first stage of diphtheria Ars. is
required if the disease takes on the malignant type.
"* British Journal of HoImeopathy, No. LXVIIIL



DIPHTHERIA.


171


China, the strong tincture, may be alternated with Ars.,
if the vital energies are nearly exhausted.
ACCESSORY MEANS.-In the commencement, a large, thick,
hot poultice should be applied round the throat; but in
advanced severe cases external applications are inadmissible
as they rather tend to increase the cedema and extend the
disease. The inside of the throat may be steamed from an
inhaler, with the vapour from water with acetic acid. A
wine-glassful of vinegar to a pint of water, is the proportion
recommended.   The temperature of the room  should be
maintained at 68~ Fahr., and the atmosphere should be
made moist by the steam from a kettle with a long spout
constantly boiling on the fire. A moist warm atmosphere
is easily secured for a child by forming a tent with blankets
over the bed, and then bringing a pipe under it from the
kettle-spout, or a spirit lamp.
In addition, narm baths are valuable accessories in the
treatment of diphtheria.  The skin is hot and dry, the
urine is often suppressed, the bowels confined, and thus
the poison is retained in the system. Warm baths, and the
free use of cold water as a beverage, often call into vigorous
action the functions of the skin, and the secretions from the
bowels and bladder are restored.
DIET, ETC.-The strength of the patient must be well
sustained, from the very commencement of the disease, by
food and nourishment in the most concentrated form, and
he must be urged to swallow such nourishment in spite of
the pain which it occasions. Eggs beaten up in brandy,
with hot water and sugar; beef-tea thickened with a little
rice or pearl barley; arrow-root or sago with port or sherry;
port wine, and sometimes stout or pale ale. Sudden, extreme prostration sometimes occurs, requiring wine or brandy
in considerable quantities, at frequent intervals.
In the case of children who persistently refuse to swallow,



172       DISEASES OF THE ORGANS OF BREATHING.
recourse must be had at the very outset, in bad cases, to
nutritive injections. Dr. Kidd recommends the yolk of an
egg beaten up with a tablespoonful of new milk, and two teaspoonfuls of fresh essence of rennet, or an ounce of extract of
beef with a scruple of pepsine. Injections should be commenced immediately the true character of the disease is
recognised, be repeated every two to four hours, and consist
of about one ounce at a time.
Ice, kept almost constantly dissolving in the mouth, has a
very beneficial action; it affords comfort to the patient, and
as a diluent it favours the action of the kidneys. If vomiting
occurs, constantly sucking small pieces tends to allay it.
The use of ice, therefore, in all cases of diphtheria, of croup,
and of all sore throats, should never be forgotten.
LOCAL TREATMENT.-Dr. Madden recommends the tonsils
to be painted three or four times a day with glycerine, and
about every twelve hours to paint the whole affected surface
with the pure tincture of LMuriate of Iron. Under this treatment, he remarks, the swelling and redness of the mucous
membrane subsides, the foetor of the breath rapidly decreases,
swallowing becomes easier, and the deposit shrivels up and
soon falls off. Internally he gives Mere. lod., and Bichromate of Potass, or if there is great prostration, Arsen.
and Anmm. Carb. The most experienced practitioners object
to rough topical treatment, even the attempting to detach
the false membrane, as it rarely fails to be reproduced in
a few hours.   T'racheotomy is sometimes performed, but it
can hardly be expected to save life, inasmuch as the disease
and false membrane extend down the trachea to the bronchi,
beyond the reach of this operation. Much caution and patience are required during convalescence, as relapses are
prone to occur. Nourishing diet, rest, and change of air
are of great utility. Nothing does so much good as a
thorough change of air.



CONSUMPTION.


173


PREVENTIVE MEASURES.-The cesspools should be emptied,
and if too small or defective, new ones built. The house
and local drainage should be thoroughly examined, and imperfections scrupulously rectified; the water-closets carefully
trapped and ventilated, and, if necessary, chloride of zinc or
of lime constantly kept therein, and thrown down the drains.
All dust-holes and accumulations of refuse should be cleared
away; while a plentiful supply of water should be kept in
the house, and every room regularly well cleaned, whitewashed, and thoroughly ventilated.
16.-Consumption (Phthisis).
DEFINITION.-Phthisis is a morbid constitutional condition, in which there is a growth or exudation in the lungs
of certain bodies called tubercles, in which the processes
of suppuration and ulceration are set up for their discharge,
and is expressed by a gradual and persistent wasting of the
body, heightened temperature, hectic fever, and other symptoms.
The growth of tubercle in the lungs, then, is only a local
lesion-an effect of which phthisis is the cause. The weak
and hurried pulse, the difficult breathing, the cachectic
appearance, the nocturnal perspirations; these are but expressions of an all-pervading constitutional diathesis.
We are desirous at once to convey the opinion that consumption is the disease of a cachexia-a bad habit of body
--and that no treatment can be effectual which does not
tend to correct the constitutional predisposition to the
further growth of tubercle, or even to anticipate, if possible,
the development of the constitutional state which gives rise
to such growths. The most scientific and practical observers
are agreed that it is pre-eminently a disease of youth,
" when nutrition is directed to the building up the tissues of
the body," that symptoms of phthisis most often arise,



174     DISEASES OF THE ORGANS OF BREATHING.


which under proper treatment cease, " and years elapse
before there is any renewal of the disease; and, were advantage taken of the intervening period to correct the
constitutional cachexia, the cure might prove complete"
(Carsqvell).
PATHOLOGY OF PHTHISIS.-The nature and origin of Tubercle having been briefly considered in the chapter on"
Scrofula, it is only necessary here to explain its connection
with Consumption.
Tubercles, so called because to the naked eye they appear
round, but are really starred or spiked, are about as large as
millet seeds, and seem to have a preference for certain
parts, especially the upper portions of the lung. Even
when the tubercular substance is scattered throughout the
whole lungs, the growth is here most abundant; it is here
also that it runs a more rapid course, and first becomes
ready for expectoration. The tubercular exudations in the
lungs take place in the areolar tissue between the air-cells,
in the air-cells themselves, and in the smaller bronchial
tubes communicating with them.
They are at first hard, grey, semi-transparent, and called
miliary tubercles, and may remain latent for an indefinite
period. The practical conclusions of Lennec, Clark, Bennett, and other scientific observers are, that if the further
growth of tubercle can be arrested, those already existing
may diminish in size, become absorbed, and the part cicatrize; or they may remain dormant, without exciting any
symptoms, after undergoing a process called cretefication.
Frequently, however, from indigestion, defective hygienic
conditions, bronchitis, or other cause, tubercles undergo a
succession of changes; they become yellow, opaque, and
soft, first in the centre, that part being the oldest and most
removed from living influences; then, like foreign bodies,
they excite inflammation, suppuration, and ulceration in



CONSUMPTION.


175


the neighbouring lung tissue; the products being usually
coughed up and so expelled. The groups often continue to
enlarge by fresh deposits till several groups communicate
together, and form an abscess, or, in medical language, a
vomica; this bursts, and discharges its contents into an
adjacent bronchial tube, and the matter is conveyed into the
windpipe, and thence to the mouth, to be evacuated. Unless the disease is arrested by remedial measures, other
abscesses form and unite, till the lung substance is so
diminished in volume, and its continuity so completely
destroyed, as to be incompatible with life, and the patient
dies from exhaustion. In other cases, as before explained,
either as the result of improved hygienic means, or the
interposition of medical skill, the tubercular matter, with
the inflammatory products it excited, are removed by expectoration or absorption, the tissues around the cavity
contract and obliterate it, and so the disease is cured.
The frequent manifestations of this constitutional cachexia
in the organs of breathing is probably owing to the great
vascularity of the lungs, their loose and spongy texture, and
their ceaseless movements.
' SYMPTOMs.-The early symptoms are obscure, and may
arise at any age, but most frequently from the eighteenth to
the twenty-second year; they are, impaired digestion; more
or less cough; irregular pain of the chest; dyspnoea on slight
exertion; debility or languor; progressive loss of flesh;
flushing and quickening of the pulse in the evening; disturbed sleep with morning perspirations; and heightened
temperature of the body. The cough is usually dry and
short, and is most troublesome in the morning, or at any
time during exertion; it seems to occur without any sufficient
cause, such as catarrh, and may continue for some time
without being aggravated, or without the supervention of any
other symptoms. Frequently, but not invariably, there is



176       DISEASES OF THE ORGANS OF BREATHING.
hemoptysis (spitting of blood), and this gives the first
intimation to the patient of the real nature of the malady;
and its occurrence either before or soon after the commencement of a cough always renders consumption probable,
especially if the patient has received no injury of the chest,
has no disease of the heart, or of the uterine system. The
amount of blood discharged is sometimes very small in the
early stage, merely streaking the sputa, or there may be a
few teaspoonsful, and it proceeds only from the small
vessels that are congested in the neighbourhood of the
tubercles; but in the latter stages there is sometimes a
copious and even fatal haemoptysis, arising from some large
vessel being opened by ulceration and rupture of an artery in
a vomica; but this is comparatively rare, because the vessels
become plugged with coagula before the ulceration opens
them.    The patient complains of great languor; slight
exertion excites an amount of fatigue quite disproportionate
to the cause, quickens the breathing, and often gives rise
to palpitation. Emaciation, one of the earliest symptoms of
consumptive disease, extends to nearly every tissue of the
body, the adipose, the muscular, and the bony; even the
intestines and the skin become thinner; it often proceeds
uniformly from the commencement to the termination, and
appears to bear a closer connection with the constitutional,
than with the local, affection. It is, indeed, liable to be
increased by extensive disease of the lungs, of the intestines,
of the mesenteric glands, and by hectic fever; but in the
absence of these symptoms in their ordinary intense form,
wasting still goes on to the fatal termination, the patient
sustaining a total loss of one-third to half his entire weight.
Slow  and gradual emaciation    is far more indicative of
phthisis, than a rapid or irregular diminution of weight.
At length, Hectic Ferer makes its appearance; the patient
is feverish and flushed in the'evening, and in the morning



CONSUMPTION.


177


is found drenched with perspiration: a most decided proof
that the disease has proceeded to the second stage. There
is soon a loss of appetite, accompanied by nausea and
vomiting, incessant thirst, and abdominal pains. The face
is frequently flushed, and on each cheekbone a circumscribed
red spot may be seen, especially after exertion or eating.
Burning heat is experienced in the palms of the hands and
soles of the feet.  Exhaustion and emaciation, from impairment of the digestive functions, are now confirmed and
persistent symptoms; while the increased susceptibility to
cold renders the patient liable to frequent attacks of
bronchitis, and even pneumonia.
In the third stage, all the symptoms are gradually intensified; the dyspncea becomes very distressing, so that the
patient is unable to make any active exertion, or even to
read a short paragraph without pausing; the sputa is more
purulent, and as the disease advances, pus is often expectorated pure, in roundish masses that remain distinct in the
vessel into wlich they are spat; the disease often spreads to
other organs, as the lymphatic system and the intestinal
canal, in which a deposit of tubercle takes place, similar to
that in the lungs, which afterwards bursts into the intestines,
leaving an ulcer; and thus the entire alimentary canal is
affected, and diarrhoea produced. The respiratory mucous
membrane may also be ulcerated, producing huskiness, and
even loss of voice, but more fiequently the former, from the
thickening and increase in vascularity which it undergoes.
Aphthe of the mouth, pharynx, etc., or cedema of the legs,
ensue.  It is therefore but seldom that the local affection
of the lungs alone causes death.
The most characteristic symptoms are:-undue shortness
of breath after exercise; cough; excessive sensitiveness to
cold air; spitting of blood; progressive emaciation; rapid
pulse; hecticfever; and, lastly, diarrhea and aptcua.



178       DISEASES OF THE ORGANS OF BREATHING.
DIAGNOSIS.-On this point the thermometer affords us
most valuable information. The ordinary symptoms and
signs are often obscure, not well marked, or their true cause
may be doubtful; especially in the early stages of the
disease, when alone our treatment is likely to be of permanent avail. The importance of the aid of the thermometer in this case will be recognised by the fact, that
during the deposit of tubercle in the lungs, or in any organ
of the body, the temperature of the patient is always raised
from  98~ Fahr., the normal temperature, to 1030 or 104~,
the temperature increasing in proportion to the rapidity of
the tubercular deposit. This heightened temperature may
be detected by the thermometer for several weeks before
reduced weight or other signs indicate the undoubted existence of tubercles. Hence the temperature not only affords
us certain information as to the existence of phtlisis, but the
degree of elevation enables us to estimate the extent and
progress of the disease.
PHYSICAL SIGNs.-These are chiefly elicited by the following methods of diagnosis: Inspection, or ocular examination
of the external form, size, and movements of the chest;
Mensuration, an aid to the senses of touch and vision in
ascertaining the comparative volume of the two sides of the
chest, as well as their expansion and retraction during
breathing; Percussion, or striking, first on one side of the
chest, and then on a corresponding spot on the other, to
ascertain the relative degree of dulness or resonance; and
Auscultation (ausculto, to listen), which is the investigation
of internal disease by the sense of hearing, and is either
immediate when the ear is placed in direct apposition with
the surface of the body, or mediate when some conductor
of sound, as a stethoscope, is placed between the ear of the
auscultator and the patient.
The chief signs are fattening of the chest, from shrinking



CONSUMPTION.


179


of the lung substance, in consequence of the air-cells being
filled with tubercular matter, so that they cannot expand
fully; they become wasted; and the part thus affected does
not permit the same amount of respiratory movement as on
the healthy side.   The clavicles become very prominent,
owing to the flattening of the supra and infra clavicular
regions.   On percussing the chest, there will be found
impaired resonance due to the consolidation of tubercular
deposit, the dulness becoming more marked as the disease
advances. The chief auscultatory signs are, feeble breathing,
or harshness, in which the natural soft and breezy respiratory
murmurs are lost; a prolonged expiration, jerking inspiration,
and increase of vocal resonance. To appreciate these and
numerous other signs, and to interpret their significance,
such an amount of medical knowledge is necessary, and
extended practice both in healthy and diseased persons, as
cannot be expected in a lay practitioner; it is, therefore,
unnecessary in a domestic work further to refer to them.
All doubtful cases, affecting organs so essential to life,
should be early submitted to medical treatment.
CAUSES OF PHTHISIs.-The tubercular form of inflammation is sometimes congenital, but most often arises,in youth,
or before the middle period of life, from an enfeebled condition of the system-the tuberculous cachexia-induced by
a confined atmosphere, deficiency of sunlight, unhealthy
occupations, poor food, distress of mind, or cruel treatment, to which    hereditary predisposition and scrofulous
diathesis greatly contribute. We believe that the want of
pure air consequent on the imperfect ventilation of sitting
and sleeping rooms is one of the most frequent and potent
causes of tubercular. disease.  In the mining districts of
' Cornwall and Devonshire, among the most healthy portions
of our island, one half the entire number of the miners,
deprived of pure air and light, die of phthisis. The reports



180       DISEASES OF THE ORGANS OF BREATHING.
of the Kegistrar-General show also that the deaths from
this cause among the inhabitants of towns are 25 per cent.
greater than in the country districts; notwithstanding the
fact that the dietary and general comforts of the former are
often greater than those of the latter.
Nor is this statement restricted in its application to man.
Observations made on the health and habits of the inferior
animals confirm the fact, that defective ventilation and an
insufficient supply of pure air is a fertile cause of tubercular
disease in them. The cow, imprisoned in the town shed,
the penned sheep, the confined monkey, the caged lion,
tiger, or elephant, almost invariably suffer from tubercular
disease, the cause being defective ventilation and want of
healthy exercise in a free atmosphere.
In respect to the hereditary predisposition, it is not
necessary that parents should be consumptive in order to
transmit the consumptive constitution to their children.
Almost any form of disease which invades the general system,
especially when both parents are involved, is sufficient to
render the offspring liable to phthisis. Observations tend
to prove that there are families in which the elder children
are healthy; but that if the health of the parents deteriorates
during the increase of their family, the younger are feeble,
and ultimately become the subjects of tubercular disease.
The connexion therefore of the parental health with phthisis
seems to be the transmission of the tuberculous cachexia;
the efficient producing cause is " the impoverished nutrition
resulting from impure air, and an improper quantity, quality,
or assimilation of food; and so long as misery and poverty
exist on the one hand, or dissipation and enervating luxuries
on the other, so long will the causes be in operation which
induce this terrible disease" (Bennett).
DURATION OF PHTHSIS.-The average may be said to be
from nine months to two years; but in an acute case,



CONSUMPTION.


181


the tubercles grow rapidly through the entire substance of
both lungs, and it may prove fatal in two or three months,
or even in as many weeks.
TREATMENT.-This may be preventive, remedial, or palliative. Useful remedies may be found among those recommended in the treatment of "Cough," "Bronchitis,"
" Pneumonia," and other diseases of the organs of breathing;
to which the reader is referred. This being a disease in
which the assistance of a medical man is so necessarily
required, we only refer here to a few remedies, as the treatment must be adapted to each individual case according to
the nature and extent of the local and constitutional disease.
First Stage of Phthisis:-Amm. Carb., Bry., Calc., Carbo
V., Ferrum, Lyc., Merc., Nux, Phos., Phos. Ac., Puls.,
Stan., Sulph., Zinc.
Second Stage:-Acon., Calc., Carbo V., Coni., Hepar S.,
Nit. Ac., Phos., Samb., Sulph.
Third Stage:-Ars., Chin., Hep. S., Phos., Sil., Verat.
Profuse debilitating perspirations:-Phos. Ac., Sulph. Ac.,
China.
Hoemorrhagefrom the lungs:-Acon., Arn., Ipec., Ham. V.,
Dros., Kreo., Phos., China.
Colliquative diarrhcea:-Verat., Ars., Phos. Ac., Merc. C.
In painful and incurable cases, an injection of starch and
opi., or linseed mucus and opi., as directed under " Enemata."
See the index.
Calcarea.--Extreme sensitiveness to cold or damp;
general emaciation; fatigue after slight exertion; imperfect
digestion and diarrhoea; cough with expectoration of offensive, greenish, or yellowish matter, sometimes with blood;
and, in girls, profuse arid too frequent menstruation.
Kali Carb.-A    remedy scarcely less important than
Calcarea, both in incipient and confirmed consumption, and
chiefly indicated by racking cough, producing vomiting, or



183       DISEASES OF THE ORGANS OF BREATHING.
cough with purulent expectoration; also in females who
have been impoverished by nursing many children, or by
frequent miscarriages.
Phosphorus.-Indicated alike in early or confirmed cases,
in children, and especially in young girls of a delicate
constitution, with frequent, dry, short cough, so constant
as to lead to complete exhaustion of strength; shortness of
breath; tendency to diarrhoea or perspiration, emaciation,
etc. The patient complains of pain and soreness of the
chest, loss of appetite, dry or hot skin, and small and quick
pulse.   A  marked improvement frequently     attends the
timely use of this remedy.
Stannum.-In the first stage, with profuse expectoration
of colourless mucus; or when neglected catarrhs threaten to
terminate in phthisis.
Iepar Sulpk.-For scrofulous young persons, in the early
stages of the disease. The chief symptoms are, hoarse,
rough, or weak voice, hollow cough, accompanied by expectoration of mucus, sometimes of blood; dyspnoea, especially on lying down; night sweats; pain after eating the
smallest quantity of food; clay-coloured or greenish stools.
Lycopodium.--Cough with purulent expectoration, spitting of blood, saltish mucus or pus, or general consumptive
symptoms.
China.-Indicated after repeated attacks of pulmonary
bahmorrhage, or in debility arising from bloody evacuations,
profuse perspirations, or other discharges. Ferrum is often
of essential service after China.
Silicia.-Useful under similar conditions to Plosphorus,
especially in indigestion with sour taste of food, pressure at
the pit of the stomach, water-brash, or nausea; great sensibility to chills and cold; profuse acid perspirations; excessive emaciation and weakness; hoarse, hollow cough,
with expectoration of pus or blood; fcetid breath; laboured
and short breathing.



CONSUMPTION.


183


Arsenimcm.-A valuable medicine in all stages of the
disease, especially in the last, and when diarrhoea, rapid
wasting, exhaustion, and distressing dyspnoea, are prominent
symptoms.
Arnica.-Vomiting or expectoration of bright-red, clear,
or frothy blood; it may be alternated with China.
Drosera.-Severe fits of coughing, causing frequent discharges of blood. Phosphorus and Ipecacuanha are also
important remedies under similar circumstances.
Sulphur.-As an intercurrent remedy; also for patients
who have been troubled with eruptions or sores on the skin.
As a remedy it is closely allied to Calcarea.
Aconitum.-Often useful and soothing; two or three doses
may always be administered when inflammatory symptoms
develop themselves.
ADMINISTRATION.-As a preventive, before any active
symptoms have declared themselves, a dose night and morning will be sufficient, for a few days; afterwards continuing
the remedy for a week or two, once every twenty-four hours;
in acute cases, every three or six hours.
GENERAL MEASURES.-To describe in detail the general
treatment of consumptive patients, were to write a treatise
on hygiene; we shall therefore only throw out hints on the
most important points.
1st. Nutritious Food.-The diet should be nourishing,
digestible, and sufficiently abundant to meet the particular
requirements of each case. As a general rule, it should
include animal. food once or twice a day; fish, especially
oysters; good home-made bread, not less than one day old;
puddings of arrowroot, rice, sago, or tapioca; various kinds
of green vegetables and mealy potatoes; good milk is a
fundamental article; raw eggs, swallowed whole, or beaten
up with a little milk, or wine, or rum, are strongly recommended; and, if the patient is benefitted by its use, a,



184      DISEASES OF THE ORGANS OF BREATHING.
moderate allowance of beer or wine. Pork, in any of its
forms, should be avoided-ham, sausages, lard; also veal;
fish not having scales; pastry; and all articles that give
rise to irritability of the stomach, nausea, eructations, or
any other symptoms of indigestion.
The importance of selecting digestible food exclusively,
is evident from the fact that tubercular deposit never takes
place, except during a period of imperfect nourishment of
the body from loss of tone in the digestive organs. By
whatever means we increase the nutrition of the body, in
the same ratio we remove or retard the advance of consumption; an invariable sign of improvement being an
increase in the patient's weight. The system is invulnerable
to consumption so long as it is well nourished by a healthy
digestive apparatus.
Cod-liver oil may be considered as an item of food, and
its power in checking emaciation and improving the healthy
tone of the muscular structures, are too well known to require much comment here. At one hospital in London
(Brompton) more than 600 gallons are consumed every year.
It may be advantageously given in scrofulous diseases, and
in any case in which there are indications of weakness,
emaciation, languor, troublesome cough, especially if occurring in a family in which consumption has been known
to exist. It should never, however, be given in quantities
so large as to excite nausea or eructations. At first it
should be administered in teaspoonful doses, twice a day,
gradually increasing the quantity as it can be borne. When
there are insuperable difficulties to the internal use of the
oil, enemata containing it may be tried; or it may be
introduced into the system by inunction, or by applying
lint, saturated with it, to the chest, sides, or between
the shoulders. The continued use of this agent nourishes
the body, improves the tone of the pulse, checks the ex



CONSUMPTION.


185


pectoration and night sweats, and diminishes the cough. It
should not, however, be alone relied on, but used only as
an adjunct to such remedies as Calc., Phos., Stann., Lyco.,
Zinc., etc.
As a substitute for cod-liver oil, which often disagrees
with the stomach, Dr. Baikie informs the author that he has
found Cream of great value. To prevent its sitting heavy
on the stomach, a teaspoonful of French brandy, or, what is
better, a tablespoonful of cold, strong, black tea may be
mixed with it.
2nd. Clothing.-This should be sufficiently warm to maintain in vigour the cutaneous circulation; the extremities
especially should be kept warm, to obviate congestion in the
chest or abdomen. Flannel should be worn both in summer
and winter; in the former, it neutralizes any variation
of temperature; in the latter, it supplies direct warmth.
In winter, the addition of a chamois leather vest may be
advantageously worn over the flannel.     The notion that
children may be hardened by habitually exposing them to
atmospheric changes, when but imperfectly clad, is erroneous
in all cases, and in the instance of children of tuberculous
predisposition, often leads to the worst results. It is in the
spring that our climate is so treacherous, and this season
especially requires careful attention to clothing.
3rd. Bathing and friction of the skin.-Except in confirmed pulmonary consumption, bathing is generally beneficial; even sea-bathing may be often recommended. The
best season of the year is from July to October; and the
best time of the day is perhaps about two hours after breakfast. The object sought is, to produce a vigorous reaction;
and to secure it the nervous and circulating systems should
be in some degree of excitement, and there should be a
slight augmentation of the temperature of the skin, although
it should not be in a state of perspiration. But on no account
N



CONSUMPTION.


187


the development of the body, and by the gradual nursing of
the breathing powers " (Aitken).
If possible, exercise should be so taken as to bring all the
muscles into moderate and agreeable action, and with the
body in an erect posture. Walking exercise best secures
these conditions; at the same time riding on horseback
has the advantage of permitting the patient to breathe a
large amount of fresh air, while the exercise does not occasion great difficulty of breathing. Excessive exertion of
the brain should be avoided, and an interest taken in the
objects and operations of nature, such as the garden, the
farm, and the hill-side.
5th. Pure Air.-The want of an abundant supply of fresh
air and the retention of carbonic acid gas in our sittingrooms and bedrooms is a potent agent in the production of
phthisis. Provision should be made for the uninterrupted
but imperceptible renewal of the air. The sleeping-room
should afford a space of 1,000 cubic feet; and one room
should on no account perform the double offices of a sittingroom and a bed-room. One of the most vital elements of
tonic treatment exists in fresh air; while everything which
impedes or interrupts the free and complete interchange of
air breathed, favours the development of tubercle.
6th. Healthy Residence.-A person predisposed to tubercular disease should select a moderately-warm climate.
Warm air soothes the trachea and bronchial tubes, and the
external warmth tends to keep the blood to the surface of
the body, and so obviates cong estion of the lungs; and
further, the warm air being rarified, less oxygen is inspired,
and less carbonic acid given off, so that less vigorous breathing is required; and, also, the liver in the warmer climates
seems to take on some of the offices of the lungs. The
climate, however, must be dry, as damp is prejudicial. The
writer is strongly convinced that entire change of climate, if



188       DISEASES OF THE ORGANS OF BREATHING.
adopted before the disease has produced irreparable changes
in the lungs, is the most effective and permanent remedy.
The climate of Australia is perhaps the best for the permanent residence of consumptive patients, contrasting most
favourably with the long-esteemed resorts of Southern
Europe, which, however grateful they may be in winter, are
almost intolerable in   summer.     One of the prominent
characteristics of the climate of Victoria is the small mean
annual range of its temperature. From observations made
in Melbourne, in the years 1860, 1861, and 1862, Dr. Bird*
states that the greatest heat recorded during the day was
780, and the greatest cold 460. While the average summer
heat is only 4~ higher than that in London, the lowest
temperature ever experienced in winter, and that very rarely,
is 320.  Comparing    the southern and western     coast of
England with the climate of Victoria, the same gentleman
states, "The former is moist, cloudy, and relaxing, while
that of Victoria is dry, sunny, and stimulating." The following statistics are very confirmatory of the great advantages
which Australia offers to persons with a predisposition to
diseases of respiration, and we recommmend the work of
Dr. Bird from which they are taken, to all interested in the
subject.
" In the British Islands, 40 per cent. of the annual mortality
at all ages is caused by disease affecting the respiratory
organs, that is to say, pulmonary consumption, bronchitis,
pneumonia, pleurisy, hydrothorax, asthma, quinsy, laryngitis; while the same diseases, on an average of six years,
from 1854 to 1860, caused in Victoria only 15 per cent. of
the total mortality at all ages."
Confining ourselves to the several varieties of the tubercular order, we find that in 1861 (an unusually wet year)
* "On Australasian Climates, and their Influence in the Prevention and
Arrest of Pulmonary Consumption."



CONSUMPTION.


189


only 434 deaths were registered as occurring from this cause,
that is to say, about 12 per cent. of the total mortality.
In Europe, pulmonary consumption alone causes about 20
per cent. of the     whole   mortality.    In  Melbourne, this
disease caused, in 1861, rather over 7 per cent, of the
whole mortality.      These, however, were      town   statistics.
Dr. Bird believes that "the deaths from         pulmonary consumption in the colony at large are probably not more than
41 or at the utmost 5 per cent." of the total mortality.
It is, however, only in the very early stages of the disease
that we advise a voyage to, and a residence in, a colony
15,000 miles distant.    A long sea voyage, though extremely
beneficial in cases of incipient tuberculosis, would aggravate
the sufferings of a patient in advanced stages of the disease,
and hasten the fatal issue.     Patients should not, therefore,
on any account be sent away from home and friends without
a reasonable expectation that the case admits of benefit by
such change, as it has too often happened that patients
have left home merely to die.      When removal to a foreign
climate is impracticable, Torquay, the Undercliffe of the
Isle of Wight, Hastings, and Queenstown,* are places in our
own country to which consumptive patients may often resort
with great benefit.
* Dr. Tuthill Massy has shown in a recent paper published in the British.Journal of Hominopathy, that Queenstown has a climate for consumptive
patients superior to any on the south of England or France. The winters are
mild and the summers are cool. Spring and autumn have equal advantages,
from the peculiar geographical and geological position of the island, situated
as it is in the beautiful harbour of Cork. Dr. Massy writes:-"The river
from Cork to Queenstown is full of life, with steamers plying up and down
every hour, and frequently going to the back of the islands, and out to the
mouth of the harbour and light-house, giving gentle sea-air and exercise,
without sea-sickness, to the invalid. In no part of Europe are there better
adapted, or more elegant steamers, combining cheapness with cleanliness and
excellent accommodation; and for the consumptive, whose very life is airpure, phosphoric, mild, out-of-door air-I know no watering-place, or winter
residence, which offers so much and so many advantages as this 'noble seaa/vesue to orkc,' which has been compared to the Bosphorus, filled with classic
tale and history."



190       DISEASES OF THE ORGANS OF BREATHING.
7th. General Hints.-All excesses must be avoided,
whether in the pleasures of the table, wine and liquors,
exercise, or in the gratification of any passion, which overstimulates the mind or the body. Business and intellectual
pursuits should not be followed to the extent of inducing
mental or bodily fatigue, but should be laid aside as early
in  the day as possible, and while there is sufficient
strength remaining to permit of the patient's engaging in
healthy exercise.
17.-Domestic Accessories Useful in Various
Inflammatory, Debilitating Diseases.
In the feverish and languid state of the body accompanying
severe or protracted constitutional affections, when the thirst
is great, appetite gone, and the needed nourishing food is
rejected, it is desirable to have some means at hand by which
to palliate the sufferings of the patient. We therefore suggest the following, as being at once nourishing and soothing:
Essence of beef.-Beef-tea is best made as originally directed by Liebig. " Mince, as fine as possible, a piece of
lean beef; let it stand in its own weight of cold water (a
pound to a pint) for six minutes; place on the fire till it
boils; then let it simmer for fifteen or twenty minutes;
strain, and add a little salt." By this method excellent
beef-tea is quickly prepared, an important consideration when
an exhausted patient is waiting for food. Druitt directs its
preparation as follows:-" Take a pound of lean beef, free
from  skin, bone, and fat; chop it up; put it into a large
earthen jar with cover; cement the edges with flour paste;
tie it up tightly in a cloth; plunge it into a saucepan, and
let it boil for two hours; pour off the liquid essence from the
coagulated muscle; let it stand till cold; skim off the fat."
This contains a large quantity of nutriment, is generally



DOMESTIC ACCESSORIES IN INFLAMMATORY DISEASES.    191
pleasant to the palate and stomach, and is particularly
suited to patients in the last stages of consumption; also
to patients generally after profuse haemorrhage, in great
debility, extreme emaciation, etc. A few teaspoonfuls may
be given every three or four hours..Barley- Water.-Take two ounces of pearl-barley (Robinson's Prepared Barley is the best), pour boiling water over
it to wash it; after it has drained, pour on it a quart of
boiling water, and boil for fifteen minutes; then strain it,
and flavour with currant jelly, orange juice, or sliced liquorice
root. This is a valuable demulcent in colds, affections of
the chest, hectic fever, and consumption generally. It is
also useful in   strangury (painful urination) and    other
diseases of the bladder and urinary organs.
Gum- Water.-Gum is a nutritive substance of the mildest
character, being less stimulating than any other form of
nourishment. On this account it is admirably adapted to
inflammation of the mucous membranes generally, as in
catarrh, bronchitis, etc.  Gum- Water is prepared by adding
two ounces of gum-arabic, and from half-an-ounce to an
ounce of white loaf-sugar, to one quart of hot water.
Nitric Lemonade.-Add ten drops of Acidum Nitricum to
one pint of pure cold water, and flavour with honey or loaf
sugar; from a teaspoonful to a tablespoonful, according to
age, two or three times daily.     This is very useful for
allaying sickness in consumption, hooping-cough, asthma,
chronic bronchitis, loss of blood from the bowels, foetid smell
of the skin or urine, cold feet, night sweats, etc.
Linseed  Tea.-This is prepared by adding one ounce
of linseed, and half an ounce of sliced liquorice root, to
two pints of boiling water, and macerating in a covered
vessel near the fire for two or three hours; it should then
be strained through a piece of muslin, and two tablespoonfuls taken as often as necessary. It forms a cheap



192       DISEASES OF THE ORGANS OF BREATHING.
and useful drink, which soothes the irritation existing in
coughs, catarrh, consumption, pneumonia, diarrhoea, dysentery, inflammation of the bowels, leucorrhoea, difficult
micturition, and   other inflammatory   diseases. See also
" Barley-water" and " Gum-water," which are useful in
like affections, one being used when the patient gets tired
of another.
Injections.-Injections up the lower bowel, by means of
the enema syringe, are of great utility, not only in cases of
confined bowels, piles, and fistula, but as a kind of internal
fomentation to the intestinal canal, and often succeeds in
allaying the most distressing irritation, thus producing tranquillity when other means fail. In low hectic fever, when
the contents of the bowels stimulate to frequent or involuntary evacuation, or in abrasions of the intestines and
tenesmus, the following enemata may be used:-Pour a quart
of boiling water on two ounces of linseed, let it macerate
near the fire for two or three hours, strain, and when cool,
throw up the bowel a small quantity of the mucus thus
obtained (two to four ounces): the patient should retain the
horizontal posture, and otherwise favour the quietude of the
bowel. In instances of ulceration of the bowels, with severe
pain and sleeplessness, a teaspoonful of opium wine or
laudanum, may be added to the linseed mucus, as a
palliative.



DIGESTION.


193


CHAPTER IV.
DISEASES OF THE ORGANS OF DIGESTION.
1.-Digestion.-Why we eat.
HUMAN life has been compared to a fire; and the analogy
holds good from more than one point of view. Just as fire
requires fuel that it may burn, so life requires food for its
sustenance. Further, the processes of life are attended with
the production of a certain amount of heat, as fire is, and
the result of the combustion of the materials of food resembles that of burning fuel in a fire, the consequent heat
being the same in both cases. The body, moreover, is in a
condition of perpetual change, by the various processes, and
the wear and tear, of life. This change continues under all
circumstances, so that there is a constant waste of structure
in the sustenance of the living body, even when the condition of the body is one of almost absolute repose.
While a person lies at rest, there is an unremitting expenditure of material, which must be drawn from the external
world, to maintain the strength and integrity of the bodily
functions; the heart continues to beat, respiration goes on,
the blood circulates, the brain is in action, and numerous
other processes uninterruptedly go forward, from which alone
a waste results which must be repaired.
Under ordinary circumstances, however, when both the
mind and body are actively employed, the waste of human
tissue is much more rapid, and a large amount of new
material is required for its reparation. A man, for example,
weighing from ten to twelve stones, loses in twenty-four
hours three to four pounds of matter in the performance of
the various duties of life. Now the matter thus expended
is replenished by the introduction of food into the stomach,



194


DISEASES OF THE ORGANS OF DIGESTION.


and which passing along the alimentary canal, is acted upon
by various secretions, by    which  process the nutritious
particles are elaborated and conveyed to the different tissues
of the body. But before the materials thus introduced are
adapted to enter into the animal tissues, they must be assimilated by certain organs, namely, those of Digestion, Respiration, and Circulation. The first of these receive the food,
and change it into a milky fluid, the Chyle, which being
conveyed with the venous blood into the right side of the
heart, is propelled by the contraction of that organ into the
lungs; here it is intimately exposed to the atmospheric
air, and thus the conversion into bright arterial blood is
completed.    It is now received into the left side of the
heart, and thence into the general circulation, and in the
capillaries (minute, hairlike vessels), it enters into the
various tissues of which the body is composed. Again, the
result of the functional activity of the body is that it is
maintained at a certain temperature. If a thermometer is
placed under the tongue, the temperature will be found to
be 980 Fahr., which is greater than that of the atmosphere,
this heightened temperature being the result of the combustion of food in the system. The function of digestion,
then, first repairs the waste of the body; and, secondly, it
maintains it at a proper temperature.
2.-Indigestion (Dyspepsia).
Digestion has just been described as the grand process by
which nature repairs the wasted tissues of the body, which,
when the individual is in health, is performed with great
faithfulness and regularity, and without giving rise to any
disagreeable sensations.   Indigestion  is a disease which
consists of a deviation from this healthy function, and is one
of the most common affections the physician has to treat.



INDIGESTION.


195


SYMPTOMS.-These vary greatly both in their character
and intensity, but there is commonly one or more of the
following.:-Impaired appetite; flatulence, from imperfectly
digested food, or food in a state of putrefactive change in
the stomach; nausea and eructations, which often bring up
bitter or acid fluids; furred tongue; foul taste or breath;
heartburn; pain, weight, and inconvenience or fulness
after a meal; irregular action of the bowels; headache;
diminished mental.energy and alertness; dejection of
spirits; palpitations of the heart, and various affections
in other organs.   Disturbances in remote parts may be
due to refex. action, or to the effects of distension of
the stomach, which, encroaching on the space occupied by
the lungs, heart, or other organs, impede their healthy
action.
CAUSES.-Irregularities in diet; such as indulgence in the
luxuries of the table, partaking of rich, highly-seasoned,
heavy, fat, sour, or bad food; eating too quickly; imperfect
mastication of food; eating too fiequently, or, on the other
hand, too long abstinence from food; warm and relaxing
drinks; the use of green tea, coffee, tobacco, wine and
alcoholic drinks; too little out-door exercise; excessive
bodily or mental exertion; late hours; exposure to cold and
damp, etc. Business, or family anxieties, are frequent
causes of dyspepsia, and their operation is very general and
extended, implicating not only the mucous coats of the
stomach, but the liver, the bowels, and often the whole
nervous system. "The battle of life" is too often fought,
not only with much wear and tear, but with almost overwhelming anxieties and disappointments; and the digestive
organs are often the first to suffer from depression of
the mind.   In this respect, the cause is often put for
the effect, the common remark being that depression of
spirits accompanies indigestion, but the reverse of this is



196


DISEASES OF THE ORGANS OF DIGESTION.


the truth, namely, that indigestion accompanies depressed
spirits. When the mind is depressed by disappointment,
anxiety, or trouble, there is a corresponding depression of
the energies of the nervous system, and so the stomach, in
common with other organs, loses a portion of its vital
energy. As medical men, we are often called upon to
minister to "wounded spirits;" and no more touching
revelations are anywhere made than in the consulting room
of the conscientious physician.
TREATMENT.-The use of medicines and the observance of
proper dietetic rules and habits, as suggested a little further
on, must ever go hand-in-hand; for the former, however
carefully selected, will, alone, be unavailing.
SLEADING. SYMPTOMS IN INDIGESTION.-Recent Dyspepsia.Acon., Ipec., Puls., or Nux Vom.
Chronic Cases.-Hepar Sulph., Carbo. Veg., or Sulph.
Dyspepsia in Children.-Cham., Ipec., Puls., or Sulph.
In the Aged.-Ant. Crud., Carbo Veg., China, or Nux.
From too little Exercise.-Bryonia, Nux Vom., Sepia,
Sulph.
From excessive use of Cold Water, Ices, or Fruits.-Arsen.,
China, or Verat.
From too Prolonged Watching.--Carbo Veg., China, or
Nux Vom.
From Grief.-Ignatia, China.
From Cold.-Acon., Ars., Mere.
Fromfat Food or rich Gravies.-Ant. Crud., Puls., Ipec.
Caused by Sexual Excesses.-China, Phos. Acid, or Staph.
From Debilitating Losses, such as diarrhcea, lhemorrhage,
suppuration, etc.-China, Ferrum, or Phos. Acid.
From excess of Food.--Ipec., Nux Vom.
In Hysterical Females. - Puls., Sepia, Veratrum, or
Platina.



INDIGESTION.


197


From the use of Intoxicating Drinks, Tobacco, Cofee, etc.Acon. (strong tincture), Nux Vom., Ipec., or Sulph.. When almost any kind of Food Disagrees.-Carbo Veg.,
China, or Hep. Sulph.
Nux Vomica.-Distension, tenderness, and fulness of the
stomach after meals; heattburn, sour acid risings, flatulence,
frequent vomiting of food and bile, sour or bitter taste in
the mouth; the head is confused, as after intoxication; the
patient feels indolent and sleepy after a meal, and unfitted
for mental or physical exertion; there is a sallow, yellowish
complexion, and constipation. Nux is particularly indicated
in persons of dark bilious complexion, who take too little
exercise in the open air, eat too much, or drink alcoholic
liquors. A   tendency to piles is a further indication for
Nux Vomica, and also for Sulphur, which may often advantageously follow it.
Pulsatilla.-Generally more suited to females with deranged period, or to individuals of a mild, easy character,
with a disposition to much secretion of mucus, or to heartburn, with acid, bitter, or putrid taste in the mouth;
frequent and loose evacuations; also for indigestion from
the use of too much fat food or pastry.
Antimonium Crudum.-Aversion to food, or loss of appetite; sensation as if the stomach were overloaded; eructations, tasting of the food, nausea and inclination to vomit,
or vomiting of mucus and bile; escape of flatulence by the
"mouth or rectum, with an almost immediate reproduction of
the symptoms; alternate diarrhoea and constipation; also
when the disease can be traced to overloading the stomach.
Pimply eruptions on the face, or sores on the lips or nostrils,
are further indications for this remedy.
Ipecacuanha. -Distressing nausea, a sickly feeling, vomiting of food, retching with vomiting of mucus and bile,
often with diarrhoea.



198      DISEASES OF THE ORGANS OF DIGESTION.


Bryonia.-Aversion to food, and craving for stimulants;
frequent bitter eructations; bitter taste; nausea or bilious
vomiting; stitch-like pain, extending from the pit of the
stomach to the shoulder blade-bones; painful soreness at
the pit of the stomach on coughing or taking a deep breath;
confined bowels; obstinate and irritable disposition.
Chamomilla.-Bitter or putrid taste in the mouth; dirty,
yellow-coated tongue; vomiting of greenish mucus or
bilious matter; fretfulness, irritability, restlessness, and
sleeplessness.  Particularly suitable for women and children.
China.-Indigestion from loss of animal fluids, such as in
hamorrhage, diarrhoea, or other discharges; or when it
occurs in damp or foggy weather, or in localities where the
atmosphere is loaded with exhalations from standing waste
marshes, and the air is filled with fog and noxious vapours;
the patient is weak and inclined to rest after slight exertion,
has a poor appetite, with uneasiness and drowsiness.
Ignatia.-Indigestion from care or grief, or in persons of
a nervous temperament, with disinclination to company, and
desire for solitude, inclination to brood over real or imaginary
troubles. The general symptoms are, pale or sallow countenance with an expression indicating despondency; feeling
of weakness or distress at the stomach after eating; fulness
and distension of the bowels; variable appetite; a thick
white fur on the tongue; dread of approaching evil, and
despair of recovery.
Mercuriuts.-Putrid, sweetish, or bitter taste; dislike to
solid food, especially meat; desire for cooling things;
pressure and tension in the region of the stomach; nausea
and inclination to vomit; constipation, with frequent,
painful, and ineffectual urging to stool.
Hepar Sulphuris.-CChronic indigestion; nearly all kinds
of food disagree; craving for stimulants; also if Mercury
has been freely given.



INDIGESTION.


199


Sulphur.-Suitable in most cases of long standing, and as
an intercurrent remedy, when only partial relief has followed
the use of other remedies. It is particularly required in
strumous constitutions, and for indigestion associated'with or
following acute or chronic eruptions, piles, constipation,
irritability, glandular swellings, affection of the eyes, or
other scrofulous affections.
r-Dose and Administration. - See page 49.
SAcCESSORY MEASURES.-The following points in the treatment and prevention of indigestion are of great importance.
1st. ]Mastication.-The reduction of food to a state of
minute division in the mouth is a most essential step towards easy and perfect digestion. Digestion really means
solution; and just as solid substances, intended by the
chemist for solution, are first reduced in the laboratory by
the pestle and mortar, so must the teeth perform a precisely
similar process with the food. Not a particle capable of
being further reduced by the teeth should be admitted into
the stomach, as the appropriate work of the former can
never be faithfully performed by the latter. A stomach,
especially if weak, acts tardily and imperfectly upon food
introduced into it in an incomplete state of comminution.
The consequences are, the warmth and moisture of the
stomach evolve gases, acids are formed, and the offending
mass is either vomited, or it passes into the bowels and
becomes a source of irritation during its entire passage
along the intestines. Further, food requires to be carefully
chewed, not only to break down the food into minute
portions, but also that it may be duly mixed with saliva.
In front of the ear we have the parotid gland; beneath the
jaw at the sides, the submaxillary; and under the chin, the
sublingual; all these secrete saliva, which pours into the
mouth through minute openings during mastication. This
salivary secretion is not only intended to moisten and



200      DISEASE9 OF THE ORGANS OF DIGESTION.


lubricate the food, but is a most essential chemical aid to
digestion, such as no other liquid can supply. We therefore
warn the busy, the studious, the solitary, or on the other
hand those persons who talk too much during meal-time,
against the danger of neglecting the perfect mastication of
their food.  The loss of teeth is a frequent cause of indigestion, but now, happily, easily preventible; for when the
natural teeth are lost, the skill of the dentist supplies us
with useful substitutes.
2nd. Overloading the Stomach.-Too large a quantity of
food interferes with digestion in two ways. (1) By so distending the stomach as to interfere with those churning
motions which it undergoes during the process, and impairing its subsequent necessary contraction. (2) Because
the secretion of the gastric fluid is probably of a uniform
quantity; therefore an inordinate amount of food would not
be duly saturated with that fluid which is indispensable to
good digestion. The limits of the normal capacity of the
stomach are always exceeded when food has been taken in
such a quantity as to produce an uneasy sense of distension.
After long abstinence from food, as in the case of persons
who dine late, there is great danger of eating too much;
under such circumstances the meal should be taken slowly,
or finished before the sensations of hunger are completely
appeased. The same danger is likely to arise when there
are too many dishes, or too stimulating articles of food are
used. A morbid craving for food is thus excited long after
the natural appetite would otherwise have been satisfied.
3rd. Suitable Food.-As a rule, animal food is easier of
digestion than vegetable, it being nearer in composition to
the textures with which it is to be incorporated. The human organs of digestion are more like those of a carnivorous
than a graminivorous animal, and it is well known that a
weak stomach is much more liable to flatulence, and other



II I


INDIGESTION.                 201
symptoms of indigestion, after vegetable food than after
animal. Indeed, the teeth of man partake of an intermediate character, as he is no doubt destined to subsist both on
animal and vegetable food. So that a due admixture of
both,-broiled or roasted or boiled meat or fowl, with thoroughly cooked vegetables,-is probably more easily disposed
of by a weak stomach than a more or less exclusive use of
either. It is important to remember 4hat starch is not a
nitroginous or flesh-forming substance. Foods, therefore,
the chief constituent of which is starch, as potatoes or rice,
should be eaten only as additions to food containing a large
amount of nitroginous materials. If, then, we eat potatoes,
rice, sago, or tapioca only, we are eating food that possesses
little or no flesh-forming materials, and feebleness and disease can only result from such a diet. Further, it is especially necessary that the dyspeptic should select animal food
that is tender and so cooked as to retain all the juices which
enter into the composition of the tissues. Hard, dried, and
cured meats-ham, tongue, sausages, and the like-are
especially to be eschewed. In the same category we may
place veal, pork, twice-cooked meats, salmon, lobsters, crabs,
salads, cucumbers, raw vegetables, cheese, new-baked bread,
coffee, and all substances known to disagree with the patient.
4th. Appropriate Drinks.-We unhesitatingly state that,
as a general rule, which admits, however, of some exceptions, patients who suffer from indigestion would be better
without malt liquors, wines, or spirits, and that in general,
men, women, and children, can best maintain a high standard of health without the use of alcohol at all. No doubt,
certain acute cases of indigestion, or cases in which the
powers of life are greatly enfeebled, are benefitted by a
moderate and temporary use of beer, wine, or spirits. But
if even the sparing use of these beverages is followed by
excitement, flushing of the face, or any other inconvenience,
0



202


DISEASES OF THE ORGANS OF DIGESTION.


they should at once be given up. Even when their use is
at first attended by apparent benefit, they should be discontinued when the circumstances which required them no
longer exist. In my own practice I have found that the
most severe and obstinate forms of indigestion occur as the
result of the excessive use of alcholic beverages. In addition to Cocoa for the morning, and tea for the afternoon
meal, the moderate use of pure owater is almost the only
fluid required. This liquid, so often despised, and even
regarded as inimical to the well-being of man's frame, is
one of the most potent means for preventing or curing dyspepsia. Drinking water, however, must be done in moderation. Two or three glasses a day is enough for most people.
It is best to avoid drinking much cold water at meals, not
as is generally supposed because it dilutes the salivary secretion or the gastric juice, but because it lowers the temperature of the stomach.-(See Beaumont on Digestion.)
5th. Disposition in vwhich to eat.-A cheerful and tranquil
frame of mind, especially during meals, is a most essential
point in the treatment and cure of indigestion. At meal
times, the mind should be disburdened, the conscience untroubled, and study, straining the head, business anxieties,
and everything that occupies the mind either too intently,
or disagreeably, should be avoided.    None of the other
functions of the body are more completely under the influence of the emotions than those of digestion. The sight
and smell of food make the "mouth-water" in anticipation
of the sweet morsel to "roll under the tongue," and the
pleasant excitement of agreeable associations enhance the
enjoyment of eating. On the other hand, distress, fear, or
any sudden unfavourable intelligence, exercise an influence
directly the reverse.  "Dryness of the mouth," as Dr.
Russell remarks, " is a symptom of terror, suggesting the
expression, 'the tongue cleaves to the roof of the mouth.'



INDIGESTION.


203


In India, a thief is detected by desiring him to chew rice in
his master's presence; the saliva will not flow from fear, for
Sconscience doth make a coward of us all,' and the thief is
unable to make any impression upon the dry, hard grain.
So much for the importance of recommending social meals,
and the obvious risk of throwing an undue amount of labour
upon the stomach by bolting food. Possibly this habit,
which is said to be so common in America, is one of the
causes of the remarkable leanness of that people."*   Let,
then, meals be taken with pleasant and cheerful companions,
or if compelled to eat alone, let some light and entertaining
publicatioh become the associate.    The aliment received
under such pleasurable circumstances, may be expected to
furnish in abundance, and in the highest state of perfection,
those secretions which are necessary to good digestion.
6th. General Habits.-Mental or bodily occupations should
not be resumed immediately after a full meal; nor should
food be taken without a few minute's pause after exhaustive
fatigue. The weary man, whether weary from the sweat of
the brow or the sweat of the brain, should rest before he
eats. Regularity in the habits of life, such as taking food,
sleep, daily fecal evacuations, exercise, etc., is an important
condition in the treatment of dyspepsia. An occasional
change of air, and place, and scenery, divesting the mind at
the same time of its ordinary train of thought, business, or
family anxieties, or a gloomy pondering over personal ailments, will exert a wonderful influence, whether in removing
or preventing an attack of indigestion. Fortunately, our
railway system is now so perfect, and widespread, and withal
so economical, that few, by the exercise of a little foresight,
need be deprived of so potent an aid to good health.


"* "Hints on Diet."



VORACIOUS APPETITE-BILIOUSNESS.


205


"Arsenicum.-Loss of appetite, with great debility, especially
in elderly or feeble persons, or when there is a sinking or
burning at the pit of the stomach.
Consult the section on Indigestion.
GENERAL TREATMENT.-Stimulants must be avoided, and
water, in moderate quantities, should be the principal drink.
The former may excite an artificial appetite, but is often
followed by reaction and aggravation of the primary symptoms. -Daily ablutions, free ventilation, and moderate exercise taken daily in the open air, are important adjuncts in
the treatment.
4.-Voracious, or Depraved Appetite.
These conditions are here classed together, as their treatment
is often very similar. A morbid craving for food is generally
but a symptom of other disease, or it may sometimes result
from  an immoderate gratification of the appetite. The
remarks on " Loss of Appetite " may be referred to.
TREATMENT.-A remedy may generally be found in the
annexed classification:
Excessive appetite in worm afections:-Cina, Silic., Mere.,
Calc.
In convalescence from disease:-China, Calc., Verat.
During pregnancy:-Nux V., Nat. Carb., Sepia.
Constant kunger:-Staph.
5.-Biliousness.
This is a popular term for various symptoms of indigestion,
erroneously supposed to be due to functional derangements
of the liver.
SYMPTOMS.-Yellow colour of the skin, fulness and oppression in the pit of the stomach, eructations, loss of appetite,
thirst, headache, constipation alternating with relaxation of
the bowels, etc.



206


DISEASES OF THE ORGANS OF DIGESTION.


CAUSES.-The intemperate use of alcoholic beverages, inSdulgence in the pleasures of the table, or a want of proportion
between the food consumed and the active exercise taken.
TREATMENT.-One of the following remedies, according to
the particular symptoms, with a restricted simple diet for
the following twenty-four hours, and cold water ad libitum,
will usually complete the cure:-Nux Vom., Puls., Bry.,
MAerc., Verat., or Ars.
Nux Vomica.-Suited to patients of sedentary habits, of
hasty temperament, with a tendency to constipation or irregularity in the action of the bowels.
Bryonia.-Headache, vomiting, chills, with irritability of
temper, especially during warm weather, or in persons subject
to rheumatism.
Mercurius.-Yellow skin; yellow-coated tongue; foetid
breath; nausea; loss of, or an inordinate, appetite; pain in
the region of the liver, with aggravation of the symptoms
at night.
Pulsatilla.-Relaxation of the bowels, especially if fat
food has brought on the attack.
Arsenicum.-Severe griping and purging; prolonged vomiting; burning sensation in the stomach or abdomen; great
exhaustion.
Veratrum.-Severe vomiting, or diarrhoea accompanied
by a distressing headache, cold perspirations, and great
weakness.
The whole section on " Indigestion" should be consulted.
6.-Spasms or Pain in the Stomach (Gastrodynia).
SYMrTOrs.--Severe pinching, gnawing, or contractive
pains in the stomach, generally after taking food, often
even of the simplest kind and smallest quantity.
CAUSEs.-Highly seasoned or indigestible food; the use



HEARTBURN.


207


of stimulants, coffee, and tobacco; long fasting; exposure
to cold or damp; mental emotions, etc. It is but a symptom
and effect of indigestion.
TREATMENT.--Chief remedies.--Nux V., Cocc., Coloc.,
Acon., Ign., Cham., Camph.
AcCESSORY TREATMENT.-In severe cases of spasms, two
or three folds of flannel, well wrung out of hot water and
applied as hot as can be borne; in mild cases, warmed
dry flannels.
/7.-Heartburn (Cardial.qia).
This is a disagreeable burning sensation, commencing
in the stomach, and extending along the canal between it
and the mouth (cesophagus), coming on a short time after
taking food, and leaving an acrid or scalding sensation at the
back of the throat.
CAUSES.-Acid dyspepsia in patients of a gouty constitution and plethoric habit; taking habitually an excess of
animal food, or general indulgence in the pleasures of the
table; these lead to an excess of acid secretion in the
stomach and bowels, which thus usurps the place of urea,
and being less soluble, is liable to, concrete into gravel or
crystals in the bladder.
TREATMENT.-NUX., Carbo V.t Puls., Ar&, SulpA. For
the symptoms, see under these remedies in the chapter on
' Indigestion," or the " Materia Medica."
AccEssoRY MEANS.-The quantity of ingesta (food eaten)
must be diminished so as to introduce as little nitrogen into
the system as possible; greasy kinds of food, stews, twicecooked meats, raw vegetables, port wine and beer, must be
withheld. The healthy action of the skin should be promoted by baths, and frictions by rough towels, for thus
much excrementitious and acid matter may be removed from
the system. Further, free exercise, short of induc1ing fatigue,



208       DISEASES OF THE ORGANS OF DIGESTION.
must be taken in the open air, to give tone to the digestive
organs, and by promoting the respiratory functions, more
carbonic acid will be thrown off the lungs, and urea, which
contains less carbon, will be probably formed in the system,
instead of uric acid.
8.-Waterbrash (Pyrosis).
SYMPTOMS.-The affection is characterised by frequent
eructations of an acid or tasteless watery fluid, sometimes in
considerable quantities. It is often accompanied with pain,
and is sometimes a symptom of organic disease of the
stomach or liver.
CAUSES.-Indigestible, or a too exclusive vegetable diet;
it often occurs in persons who are poorly fed.
TREATMENT.-NzU      V., Carbo. V., China, Ars. See the
previous section.
9.-Nightmare (Incubus).
SYMPTOMS.-The condition thus named includes all kinds
of confused, restless, and unpleasant dreams, especially
those of a horrible or frightful character.   The sufferer
experiences a sense of weight or pressure in the chest,
impeding breathing, and producing great anguish, or he
fancies himself in imminent danger or difficulty, from which
he vainly strives to extricate himself, until at length he
succeeds in uttering a cry, or moving, when the distressing
condition terminates.
CAUSES.-Nightmare may attend various kinds of disorder
connected with the digestive organs, but it most frequently
follows a late supper, especially if hot or heavy food is
taken. It may also be induced by fatigue, or an uneasy
position in bed; sometimes the cause is very obscure, and
requires professional treatment.



NIGHTMARE.


209


TREATMENT.-Aconitum.--Feverishness at night; sudden
flushes of the face; anxiety and palpitation; oppressed
breathing, etc. A few doses at intervals of three or four
hours; afterwards one of the following may be administered:Nux Vomica.-If the patient indulges too freely in the
pleasures of the table, or in stimulating beverages, or takes
Stoo little out-door exercise.
Opium.-Indicated in those forms of the disease in which
	he patient lies in a state of lethargy, and can scarcely be
ioused, with half-open eyes and mouth, snoring and rattling
in the throat, spasmodic breathing, jerking of the limbs,
etc.
Puls., Cham., and Sulph., are also useful remedies.
ACCESSORY MEANS.-The exciting cause of the attacks,
especially indigestible or excessive quantities of food, must
be avoided. Suppers should be discontinued, or consist of
very'light food taken early, and followed by a little out-door
exercise. For patients troubled with night-mare, a glass
of cold water is often an excellent substitute for supper.
The patient should sleep on a mattress in preference to a
soft bed, and the head be moderately well-raised on a pillow.
The whole section on Indigestion should be consulted.
10.-Vomiting.
CAUSEs.-Improper, or too large a quantity of food; a
disordered condition of the digestive functions; disease or
irritation in other organs, as the brain, kidneys, uterus, etc.;
cancer of the stomach; mechanical obstruction of any part
of the intestinal canal; morbid states of the blood; it also
occurs in most of the eruptive fevers.
PROGNOSIS.-Nausea and vomiting occurring in diseases
of the brain, as in epilepsy, are unfavourable indications;
in pregnancy, or hysteria, on the contrary, no alarm need be
felt, as they are merely symptomatic of irritation conveyed



210      DISEASES OF THE ORGANS OF DIGESTION. 
by the nervous system  to the stomach. We may learn
much by observing the time of the occurrence of vomiting,
the nature of the matters ejected, and the extent and i
urgency of the symptoms. If vomiting affords relief, and
the nausea, oppression of the chest and stomach, and headache cease; the case may be considered favourable; if, on
the other hand, the symptoms preceding vomiting are not
relieved by it, but increase, the disease must be regarded
as having taken an alarming form.
TREATMENT.-Should vomiting arise from overloading the
stomach, or from the use of indigestible food, it should be
encouraged by drinking warm water, or tickling the throat
with a feather, until the offending material is expelled.
In such cases it is truly a conservative act, and should be
encouraged within proper limits.  Under other circumstances, a remedy may be selected according to the causes
which gave rise to the vomiting, and the symptoms which
exist. One of the following will often prove efficacious:Pulsatilla.-Vomiting from the use of fat food, pastry,
or eating too freely; especially when it is attended with
dizziness, or looseness of the bowels, and when the smallest
quantity of food brings it on.
Ant. Crudl.-Nausea, heaviness of the stomach, foul
tongue, and dislike to food, which continue unabated after
free vomiting.
Ipecacanha.-Simple copious vomiting, with a disagreeable sickly feeling; also when vomiting is attended with
diarrhoea.
Tux Vomica.-Vomiting from    the use of strong drink,
late irregular hours, with dryness of the mouth, disturbed
sleep, and constipation.  In the "Morning Sickness" of
pregnancy,* this remedy often affords striking and permanent relief.
* For the treatment of " Morning Sickness" in pregnancy, see the " Lady's
Homceopatlhic Manual."



SEA-SICKNESS.


211


Arsenicum.-Vomiting, purging, great prostration, with
a burning sensation in the stomach and throat, and coldness
of the hands and feet. When caused by cancer or malignant disease of the stomach, it is often relieved by this
remedy.
Arnica.-Sickness from a fall or any mechanical injury.
Dose and Administration.-See page 49.
ACCESSORY M[EANs.-Small pieces of ice placed on the
tongue are very grateful and tend to allay the sickness.
The diet must be simple, nourishing, and free from any
irritating principle. Beef-tea is, probably, the most suitable
form of nourishment, and may be given every one to three
hours in small quantities, till other food can be borne.
The stomach will often retain a small quantity of bland
liquid diet, while it would reject a larger quantity.
11.-Sea-Sickness (Nausea Marina).
SYMPTOMS.-These need not be described, as they are too
well known by persons embarking for the first time,. especially during the early part of the voyage, and when stormy
weather prevails.   The patient experiences a distressing
sense of giddiness, nausea, and uneasiness in the stomach,
succeeded by vomiting, first of food previously taken, and
afterwards of bilious matter.  The retching and vomiting
frequently recur, with intervals of extreme physical prostration, a sinking sensation at the pit of the stomach, vertigo,
headache, etc. The symptoms, especially the vertigo, are
most severe in the upright posture, and are at once relieved
by a strictly horizontal posture.
CAUSE.-The motion of the vessel. The seat of the affection is in the brain, and the sickness probably arises from
a deficient amount of blood supplied to that organ. Persons
of delicate and sensitive organization, with a weak heart, a
quick pulse, and a tendency to palpitations, are most liable



212       DISEASES OF THE ORGANS OF DIGESTION.
to be affected, and are sometimes subject to similar derangement from the oscillations of a carriage, or the movements
of a swing.
TREATMENT.-NUX Vomica.-As a preventive, this remedy
should be taken thrice daily for several days previous to
embarkation. It will greatly modify, often entirely prevent,
sea-sickness, if, at the same time, strict dietetic rules, and
other measures afterwards referred to, are observed.
Cocculus.--Indicated when nausea, vomiting, palpitation
of the heart, and faintness are prominent symptoms. In
cases in which Nux Vomica is not admissible, this is ah
excellent preventive, and may be taken every four hours
during a few days before embarkation, and continued a day
or two afterwards.
Arsenicum.--Severe and protracted sea-sickness, attended
with extreme weakness.
Pulsatilla.-If the odour of the vessel evidently aggravates
the uneasy sensation, a few doses of this remedy will often
be of great service.
Veratrumr.-Extreme weakness and faintness with cold
sweats, very feeble pulse, and cramp-like pains in the
abdomen and legs.
Petroleum is also recommended for this affection.
ACCESSORY MEANS.-If the previous statement is correct
that sea-sickness is caused by an insufficient supply of blood
to the brain, our first effort should be an attempt to facilitate
the afflux of blood to that organ, by a favourable position,
and by impartingstrength to the heart's action. The horizontal
posture, therefore, should be enjoined, and small quantities
of good beef-tea, and small doses of brandy, should be given
at short intervals; or, when the symptoms are subsiding and
the appetite is returning, a cup of good coffee sweetened
with loaf sugar, without milk, with a plain biscuit or a small
slice of toast, is often grateful.



FLATULENCE.


213


PREVENTION.-For several days before embarking, the
traveller should avoid all indigestible food, overloading the
stomach, or any irregularity in diet, and at the same time
take one or more of the remedies recommended. During
the early part of the voyage he should remain on deck as
much as possible, in a recumbent posture, where there is
least movement, but avoid looking at the motion of the
waves. A girdle, moderately tight, round the waist and
abdomen, has also been recommended as a means of obviating or moderating sea-sickness.
12.-Flatulence (Inflatio).
It would be unnecessary to devote a separate section to
what is only a symptom of Indigestion, but that flatulence is
so frequent, and often so prominent and persistent a symptom, as' to seem to justify a distinctive notice, and requires
for its removal one or more of the medicines mentioned
in a previous chapter.
CAUSES.-Defective nerve-force, or debility from any other
cause; food may be detained in the stomach, anid undergo
fermentation, or simple putrefactive change, owing to imperfection or arrest of the vital and chemical processes which
are constantly in progress in 'the healthy system. At other
times it is apparently secreted by the mucous membrane of
the intestinal canal; for the symptoms are very apt to arise
in dyspeptic persons when a meal is delayed beyond the
accustomed hour, or when the stomach is empty. In some
instances, the air is thrown up by eructations, or passed
downwards, and is often associated with faintness, nausea,
and other disagreeable sensations.
TREATMENT.--China.-This is a valuable remedy when the
affection follows the use of flatulent food, indulgence in tea,
or occurs after drinking beer or water; or in patients who



214       DISEASES OF THE ORGANS OF DIGESTION.
have sustained debilitating discharges, as in diarrhoea,
hammorrhage, or profuse perspirations.
Cocculus.-Distension of the stomach, uneasiness, griping,
or flatulent colic.
Nux Vomica.-Flatulence in patients who are troubled
with constip ion, and particularly if it can be traced to the
habitual use of alcohol, coffee, or too little out-door exercise.
Pulsatilla.-Flatulence after the use of rich food, or pork,
veal, etc.; or when it arises in persons of a quiet, gentle
disposition.
Carbo Veg.--Flatulence when the emissions and discharges are foetid.
Dose and Administration.-See page 49.
ACCESSORY MEANS.-Regularity in the hours of taking
meals; a careful exclusion of flatulent kinds of food; and
the general measures suggested in the chapter on Indigestion,
will usually suffice to remove " Wind in the Stomach."
13.-Constipation-Confined Bowels.
DEFINITION.-A collection or impaction of excrementitious
substances in the rectum, the residuum of the various processes concerned in the nourishment of the body; and
occasioning irregularity in the evacuations from the bowel,
increase in their consistence, and often a sensation of fulness,
tension, and flatulency in the bowel and surrounding parts.
Now, while we admit that such a condition is not desirable,
and may almost invariably be avoided by such measures as
are pointed out further on, yet a tendency to costiveness is
not so prejudicial as many persons suppose it to be; indeed,
people thus predisposed generally live long, unless they
injure themselves by purgative medicines; while those who
are subject to frequent attacks of diarrhoea are soon debilitated, and seldom attain old age. The importance of an



CONSTIPATION.


215


evacuation from the bowels taking place once a day, as
nearly as possible about the same hour of the day, is very
generally admitted; but the fact is by no means so generally
known that more than one evacuation a day is as unfavourable as the former is favourable. But the most erroneous
and dangerous idea on this subject is that extremely popular
one,-that aperient medicines contribute to health, not only
during sickness, but also occasionally in health, inasmuch
as impurities are thereby expelled from the body.
The fallacy of this statement may be easily demonstrated:
Let purgatives be taken for a week, and however good may
have been the state of health previously, at the termination
of this period all sorts of impurities will be discharged,
especially after taking jalap and calomel.      As this is an
invariable result, even in the case of those who have never
been ill, it seems to prove that these impurities have been
produced by the drugs.
Aperients during sickness, are also most injurious.
"Temporary relief is afforded by powerful purgatives, but the delicate
mucous membrane of the intestinal tract is weakened, a sort of chronic
catarrh is induced, and the very condition sought to be removed is
aggravated tenfold" (Habershon).
The unphilosophical practice of resorting to purgatives is
well put by Dr. Yeldham, who argues that as disease
weakens the whole system, so
"The bowels, in common with the legs, the arms, the stomach, the
brain, and every other organ, partake of the general debility, and become
deprived of that power by which, in a state of health, they are enabled
to discharge their proper functions.  Why, then, should they, more
than the other organs, be impelled to the performance of a duty to which,
at the time, they are totally unequal?
" Again, under the process of disease, the whole vital power is devoted
to the struggle which is going on in the affected part. The attention of
the system is, as it were, drawn off as well from the bowels as from every
other organ not immediately engaged in the contest. On this account



216        DISEASES OF THE ORGANS OF DIGESTION.
also they remain quiescent; and any interference with that quietude, by
diverting the vital energy, weakens that force which nature requires to
be undivided, to enable her to conduct her combat with disease to a
successful issue-an additional reason why purgatives should be avoided.
Constipation is an effect, not a disease. If it were, there might be some
show of reason in the use of aperients. But being merely a temporary
loss of power, we can no more restore that power by forcing the action
of the bowels, than we can impart strength to a weakened leg by compelling it to walk. In the latter instance, we should instinctively rest the
part, until, by the removal of the disease, motion might be resumed.
The same reasoning applies with equal force to the removal of constipation. The exercise of a little patience, and the employment of judicious
means for the eradication of that disordered condition on which the
inaction depends, will as infallibly restore the bowels to their duty, as in
every other instance the effect must cease when the cause is removed."*
SYMPTOMS.--The following are associated with, or follow,
constipation:-Headache; feverishness; pressure        or distension in the stomach and bowels; pulsation or pain in the
abdomen; piles and varicose veins; uneasy breathing;
disturbed sleep; depression of mind, etc.     If constipation is
a persistent symptom     it may be attended with vomiting,
and by repeated but fruitless efforts to evacuate the contents
of the bowel.
CAUSES.-Sedentary      habits; dissipation;    an   improper
quality  or quantity of food; the use of superfine flour;
neglect in attending to the call of nature to relieve the
bowels; mental anxiety; diseases of the liver; derangement
of the digestive    organs, inducing    diminished   contractile
power in the coats of the rectum; mechanical obstruction
preventing the progressive motion of the contents of the
tube; inflammatory disease of the intestines, brain, or
spinal cord, or their membranes.      But a frequent cause of
constipation is the loss of tone of the mucous lining of the
bowels, produced by the habitual use of purgatives, a prac* "Homceopathy in Acute Diseases."



218       DISEASES OF THE ORGANS OF DIGESTION.
TREATMENT.-When constipation is accompanied with
headache, dry or parched tongue, hot skin, or gives rise to
local suffering from the evacuation of hardened faeces, a
remedy may be selected from the following list. These
remedies, let it be observed, are not intended merely to act
upon the bowels, but to correct derangements of the system
upon which the constipation depends.
Constipation from  sedentary  habits.-Nux., Bry., Lyc.,
Opi., Sulph.
Following diarrhcea.-Ant. C., China, Nux., Opi.
During pregnancy.-Alum., Bry., Lyc., Nux., Sep.
Chronic constipation.-Lyc., Sulph., Plumb.
In aged persons.-Opi.
With piles.-Nux., Sulph.
In children, with large and bulky stools.-Alumina.
Bryonia.-Constipation in warm weather, from a deranged
stomach, with chilliness, headache, pain in the region of the
liver, irritation; also in persons having a tendency to chills
and rheumatism.
Nux Vomica.-Constipation occurring in connexion with
other affections; habitual constipation, with frequent ineffectual efforts to stool; also with nausea, headache, illhumour, and uneasy sleep. It is especially useful when it
follows over-repletion of the stomach or indigestion, the
use of intoxicating drinks, tobacco, or coffee; and for persons
who take too little out-door exercise.
Opium. - Chronic constipation, especially    after other
remedies have been administered unsuccessfully; also in
recent cases of constipation. It is particularly indicated
when the motions are hard and lumpy, and when there exist
headache, drowsiness, dizziness, congested face, and retention
of urine.  Opium is well adapted to the aged, and to persons
of a torpid or plethoric temperament, who do not respond to
the action of the remedies, as it seems to call into activity
the slumbering energies.



CONSTIPATION.                  219
Lycopodium.-Constipation with rumbling and flatulence;
fulness and distension of the abdomen; heartburn; eructations; stools passed with difficulty, the first portion being
hard or knotty, and followed by soft faeces; pain, contraction, stitches, or burning in the rectum.
Plumbum.-Obstinate cases, either painless, as from palsy
of the intestines, or attended with severe colic, particularly
about the navel (hot fomentations being applied at the same
time); unsuccessful efforts to evacuate, with a painful,
constricted feeling about the anus. For persons of a paralytic
diathesis, and particularly in such as have had attacks of
palsy, epilepsy, emaciation, or dropsy, it is strongly indicated.
PodophJyllum.-Constipation, with headache, flatulence,
and chronic prolapse of the anus; pain in the right side
(liver); constipation with prolapsus of the uterus.
China.-Constipation  resulting  from  debilitating  discharges, such as, in miscarriage, violent or prolonged
diarrhoea, etc. 
Ignatia.-Confined bowels, with prolapsus of the rectum
on slight efforts to evacuate; creeping, itching sensation in
the rectum, as of thread worms.
Sulphur.-Habitual costiveness, with flatulent distension
of the abdomen, piles, etc. As an intercurrent remedy it
acts like opium, but having a wider sphere of action, and
being useful in numerous forms of disease, it is an agent of
far greater value.
ADAINISTRATION.-In recent cases, every four hours; in
chronic, once or twice a day.
DIET AND ACCESSORY MEASURES.-These are of the greatest
importance, for unless followed, no medicines can be of
permanent benefit. / Walking   exercise, with the mind
unencumbered with business or family cares, is useful,
particularly in the morning in the country; but it should



220       DISEASES OF THE ORGANS OF DIGESTION.
not be carried to the point of inducing fatigue or much
perspiration.  Water* is an extremely valuable adjunct,
both for internal and external use. Strong or green tea,
all spirituous liquors, highly-seasoned food, and late suppers
should be strictly avoided.
Meals should be taken with      regularity, animal food
sparingly, and vegetables and ripe fruit eaten freely. Coarse
oatmeal porridge, with treacle, may be taken for breakfast;
and brown bread should always be preferred to vwite.
The last recommendation is of so useful a character as to
demand a moment's further consideration. We obtain a
considerable quantity of fat in the principal grains employed
in making the various kinds of bread, and it is of importance
to know the proportion in which it exists in the different
varieties of breadstuffs, for upon the amount of fat seems to
depend the laxative or binding properties of these articles
"upon the intestines. Professor Johnson gives the following
proportions:In fine English wheaten flour  2 per cent.
In bran of English wheat. 6,,
In Scotch oatmeal...    6
In Indian corn..... 8,
" From this table," Dr. Russell remarks, "we learn that
fine wheaten bread contains only one-third the quantity of
oil that oatmeal or bread made of wheat-meal does; and we
may derive a useful hint from this in the management of
cases attended with constipation. It was generally supposed
that the bran acted as a foreign body upon the mucous
membrane, and that from     the irritation it produced the
peristaltic action was increased. This may be partly true,
but the presence of the oil is undoubtedly conducive to the
greater activity of the bowels. Rice contains very little fat,
"* See article, "Water," pages 16-18.



CONSTIPATION.


221


and hence its constipating tendency. Indian corn, on the
other hand, is very rich in fat, and might probably be more
extensively used in this country with advantage.   All
travellers in America dwell with much gusto on the delicious
cakes of Indian corn that are served up at breakfast. See
also the article on " brown bread," pages 11-13.
FRIcTIONs over the abdomen are frequently of great
utility; they tend to rouse the paralysed action of the
bowels, and to dispel accumulations of flatulence.  The
frictions may be performed by towels, horse-hair gloves, or
with the hand.
ABDOMINAL COMPRESS.-This consists of two or three
thicknesses of linen from about six to nine inches wide,
and long enough to go round the whole body, or the linen
~may only cover the front part of the abdomen, or even only
the seat of uneasiness; this should be well wrung out after
immersion in cold water, and, when applied, covered with oiled
silk or india-rubber cloth to keep in the heat and to prevent
too rapid evaporation of the fluid, and secured by flannel or
linen and with strings so as to keep it in close apposition with
the part which it covers. This may be worn several nights
in succession, the parts being well sponged with cold water
and rubbed with a coarse towel on removing it in the
morning. In obstinate cases, the compress may be worn
night and day for several days, observing to re-wet it
whenever it becomes dry. This application is only contraindicated in aged and weak persons, in whom there does not
exist vital energy sufficient to excite reaction, and the wet
linen continues to feel cold long after it has been applied.
In other cases, the chill produced by the sudden application
of the wet cloth rapidly disappears, and in from five to
twenty minutes a comfortable warmth results, proving its
suitability to the patient.
REGULAR HOUR.--Too much importance cannot be attached



222       DISEASES OF THE ORGANS OF DIGESTION.
to regularity in attending to the calls of nature, as there is
probably no function of the animal economy more completely
under the influence of habit, than that of defecation; nor,
on the other hand, is there any function that may be more
effectually deranged through the influence which the will
can oppose to it. The best time for visiting the watercloset, whether nature is urgent or not, is in the morning,
generally after breakfast. By fixing the mind      on   this
operation for a short time, the bowels will at length respond,
and a habit become established which will tend to procure
both comfort and health.
INJECTIONS.- In obstinate and protracted constipation
attended with feverishness and hardness or fulness of the
bowels, and when it is ascertained that the lower bowel is
obstructed with faecal matter, in too large masses, or too
hard and dry for discharge, and the means before suggested
have not proved at once effectual, the enema may be used
as an almost certain means of obtaining the desired relief.
The injection should consist of about half a pint to a pint
of cold or tepid water, which should be carefully injected
up the rectum by means of the enema syringe. The temperature of the water on commencing the use of injections
should not be lower than 720 Fahr., and gradually reduced
to 640. Unirritating in its operation, and acting directly
on the seat of obstruction, an injection is far preferable to
deranging the whole alimentary tract with strong drugs,
which excite violent action only to settle back into a state
of greater debility and torpor than before.
14.-Colic (Enteralgia).
This disease generally affects the large intestines, and
consists of pain arising from a violent contraction of the
muscular fibres of that portion of the intestinal canal.
SYMPToMS.-Severe twisting, griping pain around the



COLIC.


223


navel, which is relieved by pressure, so that the patient is
found sitting doubled up, lying on his belly, or rolling on
the floor, writhing in agony.   The bowels are generally
constipated, but there is a frequent desire to relieve them,
although nothing passes but a little flatus; there is no fever,
nor is the pulse even quickened, unless after a time it may
become so from anxiety. The paroxysms of pain are owing
to the efforts of the bowel above to force downwards the
mass of accumulated gas and faeces.
DIAGNOSIs.-Colic may be mistaken for Enteritis (inflammation of the bowels), as both are characterised by confined
bowels, pain in the abdomen, especially about the navel,
which is often relieved by the expulsion of wind, and,
frequently, vomiting. It is important, however, to note in
what respects these diseases djfer. In colic, there is no
fever, no acceleration of the pulse, no serious apprehensive
anxiety, the pain is relieved by pressure, and there are
intervals of almost complete relief.  Enteritis, on the other
hand, is attended with fever and extreme tenderness of the
abdomen, causing the patient to avoid any movement which
would bring into action the abdominal muscles, so that he
breathes by the chest alone; and, although there are paroxysms of severe pain, there are no complete intermissions.
Colic may be distinguished from   hernia or rupture, by the
tumour which exists in the latter disease, but which is
absent in the former.
CAUSEs.-Errors of diet, such as eating a mass of heterogeneous, acrid, indigestible food, or acid fruits; cold from
wet feet; suppressed perspiration; worms; constipation,
etc.  It may also arise from    stricture of the intestines
(intus-susception).
TREATMENT.-The chief remedies are, Coloc., Verat., Bry.,
Nux., Ars., Cocc., Mere., Bell., C/am., Puls., Plumb.
Colocynth.-Violent pains compared to stabbing, cutting,



224      DISEASES OF THE ORGANS OF DIGESTION.


clawing, or squeezing, and are constant, or recur with
increased intensity. There is great tenderness of the abdomen, and the pain, so excessive as to cause the patient to
scream, is often limited to one spot.
Veratrum.-Severe crampy pains in the stomach or abdomen; flatulent colic, especially in the night; colic affecting
the whole abdomen, with swelling, or loud rumbling.
Bryonia, in less severe forms of the disease, when in
addition to fulness and distension of the bowels, there are
sharp stitching pains in the sides or in the bowels, and
irritability of temper.
Plumbum.-As may be inferred from the action of lead
upon the bowels in a state of health, whether introduced
into the blood through the stomach or skin, the homceopathic
practitioner will recognise its value in many varieties of
colic, avoiding of course, its use in that form which has been
caused by the poison of lead. The symptoms which indicate
this remedy are,-violent constrictive shooting or pinching
pains in the region of the navel; constant desire to eructate
and expel flatus; torpor, numbness, stiffness, and weakness
in the limbs; pressure and cramps in the stomach; obstinate constipation; face and skin pale, bluish or yellow;
cold extremities; melancholy, etc.
NlAtx Tomica.-Colic from indigestible food, cold, suppressed period, or during pregnancy, with fulness and
tightness in the region of the stomach; severe pinching and
cutting pains; and pressure towards the lower part of the
abdomen; constipation, or constipation alternately with
relaxation; windy colic, etc.
C/amomilla.-Tearing pains around the navel; great
restlessness; accumulations of saliva in the mouth; diarrhcea, the motions being green, watery, or mixed with mucus.
It is well suited to children and females, during excitability
and irritation of the nervous system. In persons of a very
mild disposition Pulsatilla may be substituted.



PAINTERS' COLIC.


225


Administration and Dose.-See page 49.
ACCESSORY MIEANS.-Hot flannels over the abdomen, or
a copious enema of warm water, perhaps two pints, is often
followed by immediate relief. If necessary, the injection may
be repeated. Food of a flatulent character, and every kind
that has been found to disagree with the patient, must be
avoided. Persons subject to colic may be benefitted by
wearing a piece of flannel around the abdomen, and having
the feet well protected from damp.
15.-Painters' Colic-Lead Colic.
SYvPTroM.-In addition to those mentioned under Colic
there are twisting pains around the navel, retraction of the
muscles of the abdomen towards the spine, pain in the back,
and, sometimes, paralysis of the extremities.    This last
condition is very characteristic; the extensor muscles of the
hand and fingers are paralysed, and, when the arms are
extended the hands hang down by their own weight, the
patient having no power to raise them.       The common
expression, drop 9nrist, well describes this condition. The
palsy is at first local, till by persistence in their occupation,
patients fall into a state of general cachexia, become miserable cripples, and, eventually, sink under disease of some
vital organ. A most valuable diagnostic sign of lead colic
is the existence of a blue line round the edges of the gums.
CAUSE.-Exposure to the action of lead; it is chiefly met
with in painters, who use white lead in the preparation of
their colours; it also occurs in other persons whose employments bring them into frequent contact with preparations of
lead. That variety of paint which is to give a dead or nonglistening surface is the most poisonous from its being
mixed with a large quantity of turpentine, which, passing
off by evaporation carries with it a portion of the lead, which



226      DISEASES OF THE ORGANS OF DIGESTION.


is then inhaled or mixed with the saliva, is received into the
stomach, or again, settling on the skin is absorbed.
TREATMENT.- Opium, Bell., SulpA. Ac. (See the preceding
article.) 
ACCESSORY MEANS. - The following cautions, by Dr.
Watson, are of great practical importance.
" 1. To prevent its introduction through the skin, minute
attention to cleanliness is necessary. The face and hands
should be washed, the mouth rinsed, and the hair combed
several times in the day; and bathing and ablution of the
whole body should be frequently performed.   Also the
working clothes should not be made of woollen, but of
strong compact linen; and they should be washed once or
twice a week at least, and worn as little as possible out of
the workshop; and some light impervious cap might protect
the head while the workman is at his labour.
"2. Care should be taken that none of the poison be
admitted into the system  with the food.  The workmen,
therefore, should not take their meals in the workroom, and
should be scrupulous in cleansing their hands and lips before
eating.
"3. The entrance of the poison into the air-passages
during respiration should be guarded against as much as
possible. Masks have been recommended for this purpose;
none probably would be more convenient or more effectual,
than Mr. Jeffrey's orinasal respirator."
16.-Diarrhoea-Looseness of the Bowels-Purging.
DEFINITION.-The condition called diarrhoa or purging,
consists of frequent, abundant, and liquid evacuations from
the bowels, without straining or inflammation of the parts;
it may arise from functional or structural changes in the
small intestines from local or constitutional causes.



DIARRHCEA.


227


FoRMs AND SYMPTOMS.-There are many forms, but we
shall only mention the following: Irritative diarrhkea, from
excessive, stimulating, irritating, or impure food or drink;
Congestive or inflammatory diarrhea, from cold, cold drinks
or ices when the body is overheated, checked perspiration
or suppressed accustomed discharges; Summer diarrhka;
Diarrhkea lienterica, or discharges of unaltered food from
arrest of the digestive and assimilative functions. The most
common symptoms are nausea, flatulence, griping pain in
the bowels, followed by loose motions of an unnatural
character, which may vary as regards consistence, being
watery or fluid; in their nature, being slimy, bilious, or
bloody (dysentery); also as to their odour and colour. There
are generally superadded, a furred tongue, foul breath, and
acrid eructations.  The circulation,. breathing, and other
functions are usually unaffected. In summer diarrhoea, or
English cholera, the discharges are chiefly bilious, and there
are often violent pains in the abdomen, cramps in the legs,
and great prostration.
CAUSES.--. Excess in the Pleasures of the Table.-Overrepletion of the stomach may occasion irritation and diarrhoea
by the mere quantity of the aliment introduced, but these
results much more frequently follow the mixture of various
kinds of food and drink in one meal, each of which, separately, might have been well borne by the stomach, and have
contributed to the nourishment of the body.
2. Impure Water.-This is a fruitful cause of diarrhoea.
Water contaminated with sewage or sewage gases, or with
decomposing animal matter, is almost certain to occasion
diarrhoea, especially in recent visitors to a neighbourhood
supplied with such water. The general existence of diarrhoea
in a district should suggest the importance of submitting
the water used for drinking or for cooking purposes to competent examination.



228


DISEASES OF THE ORGANS OF DIGESTION.


3. Indigestible kinds of Food.-Such are, especially, sour,
acid, unripe, or decaying fruits or vegetables; badly-cooked
food; various kinds of shell-fish; putrid or diseased animal
food. Numerous proofs are furnished in the public journals
that the flesh of animals slaughtered in a state of disease is
extensively sold for human food. The following statement
will suggest great caution as to the selection and purchase of
animal food, and may serve as an explanation of frequent
attacks of diarrhoea.
Mr. Gamgee, who was recently appointed by the Lords of
the Privy Council to institute a full inquiry into the subject
of diseased animal meat as used for human food, and to
visit any of the markets and slaughter places in the United
Kingdom   to collect all necessary information, issued his
report, from  which we make the following extract:-He
finds that
"u Disease prevails very extensively in the United Kingdom
amongst horned cattle, sheep, and swine; that the diseased
state of an animal not only does not lead the owner to withhold it from being slaughtered for consumption as human
food, but, on the contrary, in large classes of cases, where
the disease is of an acute kind, leads him to take immediate
measures with a view to this application of his diseased
animal; and that, consequently, a very large proportion,
perhaps a fifth part, of the common meat of this countrybeef, veal, lamb, mutton, and pork-is derived from animals
considerably diseased. Horned cattle affected with pleuropneumonia are much oftener than not slaughtered on account
of the disease, and when slaughtered are commonly eaten,
though the lung-disease shall have made such progress as
probably to taint the carcase. Animals attacked by ' foot
and mouth disease' are not often -slaughtered on account of
it; but if they should happen to be slaughtered, are uniformly employed as food. Animals with 'anthracic and



DIARRH(EA.


229


anthracoid disease' are, with the exception of the gangrenous
parts, very extensively used; and the presence of parasites
in the flesh of an animal never prevents the owner from
selling it as food. Carcases, too obviously ill-conditioned
for exposure in the butcher's shop, are sent in abundance to
the sausage-makers, and are also 'pickled' and cdried;' and
though specially diseased organs are generally thrown aside
by most sausage-makers, some will even utilise the most
diseased parts that they can obtain. Finally, in connection
with some slaughtering establishments, pigs-destined themselves to become human food-are habitually fed on the offal
and refuse of the shambles, and consume, with other abominable filth, such diseased organs as are below the tmore
conscientious sausage-makers' standard of proper condition!"
When diarrhoea is caused by eating such kinds of food, it
may well be regarded as a conservative action, by which the
system endeavours to rid itself of deleterious or poisonous
materials.
4. Atmospkeric Influences.-The heat of summer, the hot
days but chilly nights and mornings of autumn, are frequent
exciting causes of diarrhoea; so is the application of cold to
the perspiring body, or the sudden checking of perspiration.
Hot weather is a frequent exciting cause of diarrhoea, termed,
on this account, summer or English cholera. Dr. Farr says
that diarrhoea " is as constantly in English towns when the
temperature rises above 600, as bronchitis and catarrh when
the temperature falls below 32~."  Probably to the influence
of the change of temperature, from the excessive heat of
the day to the cool of the evening in the autumnal months,
may be added bad drainage, and the impurities of our rivers
and springs which then exist.
5. iMental Emotions.-The depressing influences of fear,
or -the violent excitement of anger, are frequent exciting
causes. A sudden fright or fear excites in many persons the



230


DISEASES OF THE ORGANS OF DIGESTION.


action of the bowels as certainly as, and much more quickly
than, a black draught.
6. Diarrhaea is often a symptom of other diseases, as hectic
and phthisis, when it is called colliquative diarrhcea, because it
appears to melt clown the substance of the body; the diarrhcea
of typhoid fever; cachectic diarrhcea, as from chronic malarious diseases; bilious diarrhoea, from  excessive flow of
bile, as in hot weather or after passing a gall-stone. Looseness of the bowels is also a very common precursor of
cholera, when that disease is epidemic.
TREATMENT.-In the treatment of constipation we have
discouraged the use of aperients, both on account of the
injury they occasion, and their failure of producing anything
beyond a brief palliation.  In like manner, the attempt to
arrest diarrhoea by the astringent measures of the old school
has, in many ways, a most prejudicial effect; for should one
symptom be relieved, it is too frequently followed by aggravation of others. When loose evacuations afford relief to a
patient, they should not be interfered with, for in such cases
they are Nature's mode of curing disease. The evacuations
following the too free indulgence of the table, or those of
children during teething, are of this class. It is well, therefore, in almost every instance, to pause awhile, or onlyresort
to medicines when the disease continues so long as to be
evidently injurious.
Diarrh/ca from improperfoocd.-Ant. C., Ipec., Puls., Nux.
Diarrha from frutits or acids.-Chin., Ars., Puls.
Diarrhcca in hot weather.-Camph., Bry., Dulc., Merc.,
Chin.
Diarrhc a with colic.-Coloc., Merc., Ars., Bry., Cham.,
Verat., Dulc., Nux V.
Diarrhoa with vomiting.-Ant. Crud., Ars., Ipec., Ver.
Diarrhoea with discharges of blood.-Ipec., Capsicum, Rhus
Tox., BIerc. Cor.



DIARRHoEA.


231


Bilious or mucous diarrhoa with griping.-Merc., Puls.,
Dulc., Bry., Nit. Ac., Ipec.
Diarrhwea during dentition.--Cham., Mere. Sol., Rheum,
Cina, Calc. C.
Chronic diarrhoea.-Calc. Carb., Phos. Ac., Secale, Sulph.
Diarrhoea from mental causes.-Cham., Ign., Coff., Coloc.
Relaxation with frequent daily evacuations.-Calc., Kreasotum, Nit. Ac., Phos., Sulph.
Diarrhoea in weak persons.-Chin., Ferr., Sec., Phos. Ac.
Hectic diarrhcea.-Calc., Sulph., Nit. Ac., Ars., Ferr., Chin.
In aged persons.-Ant. C., Bry., Phos., Sec.
Diarrhoea from worms.-Merc., Cina, Ferr., Calc. C.
Camphor.-In sudden and recent cases, with chilliness,
shivering, cold creeping of the skin, severe pain in the
stomach and bowels, cold face and hands, or cramps in the
legs or stomach. Two drops on a small piece of loaf sugar,
repeated every twenty or thirty minutes, for three or four
times; afterwards at longer intervals.    For the general
indications for this remedy, consult the Materia Medica,
article, " Camphor."
Dulcamara.-Diarrhoea traceable to cold, particularly in
the summer or autumn; when the evacuations take place at
night, and are slimy, bilious, or greenish, and attended with
sickness; colic, and griping round the navel; impaired
"appetite, and dejection of spirits.
Ant. Crud.-Watery diarrhoea, with disordered stomach,
loss of appetite, white-coated tongue, eructations, and
nausea. It is more especially indicated in aged persons;
females during pregnancy, or after accouchement; also in
some cases of diarrhoea during dentition.
Bryonia.-Diarrhea during the heat of summer, especially
if caused by cold drinks, or a fit of passion, vexation, etc.
-It may often be used successfully after Cham. has proved
inefficient.



232      DISEASES OF THE ORGANS OF DIGESTION.


11fercurius Cor.-Watery, slimy, bilious, or bloody stools,
preceded by colic and griping, and followed by painful straining, called tenesmus.
Ch/amomilla.-Watery, bilious, or slimy stools, of a yellowish, whitish, or greenish colour, particularly in children;
discharge of undigested food (lientery); restlessness, rumblings, or pain of a tearing kind in the bowels; fulness and
hardness of the stomach; thirst, coated tongue, and disagreeable taste in the mouth.
Pulsatilla.-Purging from fat and rich food, with slimy,
bilious, or watery stools, which have a fcetid odour, and
excoriate the anus; the patient complains of bitter taste
in the mouth, nausea, eructations, and colicky pains, especially at night.
China.--Diarrhcea of a greatly prostrating  character,
especially after eating, or in the night, and containing undigested food, with colic; or painless diarrhcea, with debility,
thirst, and loss of appetite.
Veratrun.- Cutting, griping pains, cramps, vomiting,
rapid sinking; coldness of the body; evacuations of a thin,
watery character, especially the " rice-water evacuations,"
attended with symptoms resembling those of cholera. Recourse may also be had to this remedy if any of the above
fail to produce relief in twenty-four hours.
Phosphoric Acid.-Exhausting, painless diarrhoea, particularly when there is involuntary action of the bowels.
Arseicium.-Diarrhcea accompanied or ushered in by vomiting, with great heat in the stomach; and a burning sensation
attending the effort of expelling the motions, with griping
or tearing pains in the abdomen. It is well indicated in
cases marked by extreme weakness, emaciation, coldness of
the extremities, paleness of the face, sunken cheeks, etc.
Calcarea Carb.-Chronic diarrhea, with weakness, emaciation, pale face, and sometimes excessive appetite. It is
especially useful in scrofulous children.



DIARRHCEA.


233


DIET.-In recent cases of diarrhoea, food should be given
sparingly, consisting of light, non-irritating articles-gruel,
rice, arrowroot, and other farinaceous substances, which
should be taken cool. In chronic diarrhoea, the diet should
be nutritious, but restricted to the most digestible kinds of
food-mutton, chicken, pigeon, game, and white fish are
generally suitable, if not overdone. Beef, pork, and veal,
and all tough portions of meat should be avoided. Starchy
foots--arrowroot, sago, etc., are insufficient for prolonged
cases of diarrhoea, but are improved by admixture with good
milk.   Old rice, well cooked, with milk, taken directly it is,prepared, is excellent nourishment, if it agrees with the
patient. Raw or half-cooked eggs, and wholesome ripe
fruits in moderation, may generally be taken. Mucilaginous
drinks-barley-water, gum-water, nitric lemonade, linseed
tea, etc., are the most suitable. See " Domestic Accessories,"
pages 190-2.
-ACCESSORY MEANS.-The extremities should be kept warm,
and exposure to cold or wet avoided.       Rest, in the recumbent position, is desirable. Severe griping pains may
be relieved by warmed flannel, or flannel heated by immersion in hot water applied to the abdomen. Individuals
liable to diarrhoea, and having a feeling of coldness about the
abdomen, should wear flannel waist-belts. Night air and
late hours predispose to attacks. Except in severe cases,
moderate out-door exercise should be taken daily.        On
recovery from diarrhoea, relapses should be guarded against,
by shunning all exciting causes, as in food, clothing, etc.;
mental excitement and excessive or prolonged exertion
should be avoided.


Q



234       DISEASES OF THE ORGANS OF DIGESTION.
17.-Dysentery (Dysenteria)-Bloody-Flux.
DEFINITION.-This is a specific febrile disease, consisting
of inflammation and ulceration of the minute lenticular and
tubular glands of the mucous membrane of the large intestine, attended with tormina (severe griping pains), followed
by tenesmus, and scanty mucous or bloody stools.
HIsTORY.-Dysentery being an attendant upon war, a
practice both old and universal, it was well known to the
most ancient writers on medicine. It has attended and been
the scourge of all the great armies which have traversed
Europe during the last two hundred years, being particularly
fatal in all unsanitary camps and garrisons. "It is the disease of the famished garrisons, of besieged towns, of barren
encampments, and of fleets -navigating tropical seas, where
fruits and vegetables cannot be procured. During the Peninsular war, the first Burmese war, and the late war with
Russia, dysentery was one of the most prevalent and fatal
diseases which reduced the strength of the armies."
Even in England, before the sweeping changes which have
followed in the wake of the sanitary reformer, it was as
frequent and as fatal as it is now in unsanitary tropical
countries. To the higher degree of.civilization we enjoy,
including Anl its train well-constructed, well-ventilated, and
well-lightgd-dwelling-houses and streets, a more general and
perfect system of drainage, with an abundantsupply of good
water, temperate and cleanly habits of the population,'and
enlarged general information on the laws of health, we may
in truth ascribe our present comparative exemption from
dysentery and analagous,diseases.
SYMPTOMS.-These vary considerably with the type of the
disease. Simple cases occur,.and.run their courses, with
little constitutional,istuar,bce; but.gn.acute attack commences with a chill or rigor, a'nd is soon followed by fever,



DYSENTERY.


235


the pulse being quick, the skin hot, the face flushed, and
often pain in the head, thirst, furred tongue, natisea and
vomiting. Griping, irregular pains in the abdomen, called
tormina, are experienced, and the patient is often tormented
by a sensation as if there were some excrementitious matter
in the bowel ready to be evacuated, and he is irresistibly
impelled to strain violently to remove the irritation. This,
the most marked symptom of dysentery, is called tenesmus,
and although the desire to go to stool is frequent and urgent,
the patient is unable to pass anything except a little mucus
and blood, shreds of fibrine which     the patient often
thinks to be the coats of his own bowels, and, sometimes,
balls of hardened faeces, called Scybala. In hot climates its
attacks are acute and violent, the pain being very severe
'around the navel and at the bottom of the back-bone. The
ýbladder often sympathises with the rectum, exciting frequent
efforts to pass water. In unfavourable cases, these symptoms
are followed by loss of strength and flesh, very small and
*irapid pulse, anxious and depressed countenance, the abdomen
becomes increasingly tympanitic, with bearing-down of the
lower bowel, burning heat, hiccough, sudden cessation of pain,
cold sweats, sharpened features, delirium and death. In
favourable cases, the strength is not much reduced, while
warmth and moisture of the skin, and a more natural
character of the evacuations, indicate a tendency to recovery.
CAUSES.-" I believe dysentery to be caused by the action
on the blood of a poison having a peculiar affinity for the
glandular structures of the large intestine. This poison I
believe to be a malaria generated in the soil by the decomposition of organic matter" (Maclean). It is probable, therefore, that the following are efficient agents in the propagation,
rather than in the causation of dysentery:-Exposure to
extreme and sudden changes of temperature, as from heat
of day to the cold and damp of night; impure water;



236       DISEASES OF THE ORGANS OF DIGESTION.
insufficient protection from cold and wet, as sleeping on the
ground with the abdomen insufficiently covered; intemperance; a poor or irregular diet, etc. It is therefore often
epidemic among people reduced by privation, particularly
soldiers in camps, and in India, the Chinese sea, and other
hot climates.
TREATMENT.*--Prompt treatment is of great importance,
as the disease often progresses rapidly, and may produce
irreparable mischief.
Aconitum.-If febrile symptoms are well marked, the early
use of this remedy often arrests the disease at its onset.  It
should be administered several times, at intervals of an hour.
Afterwards, if required, one of the following:
Mercurius   Corrosivus.-Bloody  evacuations, or mucus
mixed with blood, or dark, bilious, foetid, discharges; severe
pain and straining before, and still more so after, a discharge,
as if the bowels would be jerked out; violent colic, debility,
trembling, and cold sweat on the forehead.
Colocynth.-This remedy is often required after Mercurius,
especially when the colicky pains occur periodically, are very
severe, and when the abdomen is distended, the tongue
coated white, and the discharges are slimy and bloody, and
mixed with green matter or lumps.
Arsenicum.-Burning pain with the evacuations; excessive
weakness; coldness of the extremities; cold breath; putrid
and offensive faeces and urine, often passed involuntarily. It
is especially indicated in nervous and dropsical patients, and
in constitutions enfeebled by previous disease.
Ipecacuanha.-Autumnal dysentery, with nausea and vomiting, great uneasiness, straining, and colic; the evacuations
are green, frothy, foetid, and afterwards bloody mucus. This
* Dr. Tcste recommends Ipecacuaiha and Petroleum, in alternation, as
curative of dysentery under all circumstances. In case of intense fever, one
or two doses of Acw. to be first administered.



DYSENTERY.


237


remedy is often administered advantageously in alternation
with Bryonia.
China.-Dysentery in marshy districts; putrid and intermittent dysentery.
Rhus Tox.-Involuntary nocturnal discharges; cutting
pains in the abdomen; almost constant urging to stool.
Sulphur.-Obstinate cases, where ordinary remedies fail in
affording relief, especially where there is constitutional taint,
or heemorrhoidal disease; also as an intercurrent remedy.
Admniistration.-In urgent cases, a dose every twenty
minutes, half-hour, or hour; in less severe cases, every three
or four hours.
CHRONIc DYSENTERY.-P/iOS., Nit. Acid., Rhus, Sulph.,
C/ina, Calc. C., Verat., and _Phos. Ac., are our chief remedies.
ACCESSORY,MEANs.-The patient should remain in bed,
and in severe cases use the bed-pan instead of getting up.
A flannel wrung out of hot water should be applied over
the abdomen, covered by a dry one, and renewed when it
becomes cold, a second hot flannel being ready when the first
is removed. The drink should consist of cold water, toastwater, gum-water, barley-water, etc.; the diet must be
restricted to cold milk, previously boiled,, and bread, arrowroot, pure cocoa, broths, ripe grapes, and other liquid
forms of food.    Animal food and stimulants should be
avoided till recovery has considerably advanced, except in
cases unattended by fever, when beef-tea and other animal
broths may be taken. Cold, or sudden changes of temperature, should be particularly guarded against. The most
decided benefit often results from the employment of injections, if there be not too much inflammation to admit of the
introduction of the injection tube. They may be administered after each evacuation, if they prove beneficial.  The
first two or three injections may consist of from half a pint
to a pint of tepid water, the temperature being afterwards



238        DISEASES OF THE ORGANS OF DIGESTION.
gradually reduced.     Mucilaginous injections are also frequently of service.
PREVENTION OF DYSENTERY.-The following passage is
important and suggestive:
"The remarkable decline of dysentery in this metropolis has been contemporary with that of some other severe disorders, and is due to the
same combination of causes. For nearly two centuries we have had no
plague among us. Agues, formerly very rife in London, have almost
disappeared. Continued fevers, which used to break out annually in hot
weather, are comparatively unfrequent. I believe that we may trace
these great blessings to an event which was regarded by many, at the
time, as a national judgment-I mean the great fire that, in 1666, consumed everything between Temple Bar and the Tower. The streets and
houses thus destroyed had been filthy in the extreme, close, densely
crowded, and consequently most unhealthy. The impurity of the air
excited, perhaps, some maladies, and it certainly predisposed those who
dwelt in it to various kinds of disease, 'the seeds of which,' says Dr.
Heberden, ' like those of vegetables, will only spring up and thrive when.they fall upon a soil convenient for their growth."'"
18.-Asiatic Cholera.
DEFINITION.-An      epidemic disease of great and rapid
mortality, characterised by premonitory diarrhoea, vomiting
and purging of a watery fluid, collapse with extreme depression of all the functions of life, coldness and dampness
of the surface of the body, cold breath, craving thirst, suppression of urine, sunken countenance, etc., terminating in
death, or reaction, leaving various dangerous sequels.
In this disease, which resists the efforts of the old system,
Homceopathy has won brilliant and undying triumphs.          The
success of our new system in the prevention and cure of
cholera, and other violent diseases, has contributed greatly
to its rapid spread in every part of the world. It may be
interesting to refer here to the visitation of cholera in
* Watson's "Principles and Practice of Physic."



ASIATIC CHOLERA.


239


1848-49, when the Government, concerned for the future
welfare of the community, determined to adopt the surest
means of deciding what was really the most efficient treatment of this disease. A medical committee of the Board
of Health, with the President of the Royal College of
Physicians at its head, was formed, and an           experienced
Medical Inspector of the        Cholera   Hospitals   appointed.
Printed forms were furnished to each hospital, so that all the
circumstances of each case, its symptoms, treatment, and
results, might be recorded daily, under the constant supervision of the appointed inspector. The statistics thus obtained were considered and digested by this medical board,
and, finally, reported to the Government. It is indeed a
humiliating fact to record that this paid board, to whom the
Government had confided so important a trust, actually
suppressed the statistical report of the IHomceopathic Cholera
Hospital!    This report was afterwards obtained by order of
Parliament, and published in a Parliamentary return, dated
May 21st, 1855, entitled " Cholera." ' It testified that, by
the homceopathic treatment of Asiatic cholera, the deathrate was 16'4 per cent., while, according to, the aggregate
statistics of the other hospitals, it was 59-2 per cent.*    "In
what language," said the late Dr. Horner, " can I truly
designate this conduct of the medical board, but as a conspiracy against the truth and against humanity?"
* In an article in the Lancet of July 28th, 1866, entitled "Cholera in the
Metropolitan Hospitals," the writer states, "We visited the cholera wards on
Saturday and Tuesday last. There was no mistaking the severity of type
displayed by the cases. They have been marked by all that intensity which
is characteristic of the first cases in an epidemic, and, we regret to say, by the
usual amount of fatality. Some have died within nine hours of the attack,
others have lingered on in a state of collapse for several days. Some have
rallied from collapse and succumbed afterwards with symptoms of local congestion in various organs. It is scarcely necessary to say that no effort has
been spared by the physicians." After recording various metlods of treatment, it is added, "It is a melancholy fact to record, but at the time of our
last visit no case of undoubted cholera had recovered."



240       DISEASES OF THE ORGANS OF DIGESTION.
That the record of the treatment furnished by the Homceopathic Cholera Hospital was strictly correct, Dr. Macloughlin, their own Medical Inspector, testified:-All I saw
were true cases of Asiatic cholera, in the various stages of the
disease; and I saw several cases that did well under the
Homceopathic treatment which I have no hesitation in stating
would have sunk under any other."   The same gentleman
added:--"Although an allopath by principle, education, and
practice, yet, was it the will of Providence to affect me with
cholera, and deprive me of the power of prescribing for
myself, I would rather be in the hands of a homoeopathic
than an allopathic adviser."
The history of cholera furnishes a beautiful practical illustration of the worth of that fundamental principle of Homoeopathy, namely, that we must ascertain the powers of medicines
by testing them upon the healthy body, before they can be
properly applied to the removal of disease. Possessed of
this knowledge, a medical man can treat a perfectly new
disease, or one with which he is totally unacquainted, the
symptoms of which correspond with those of any medicine
previously so tested. Medicines'being tried upon medical
men and their friends when in a state of health, the organs
of the body they have a special affinity for, and the symptoms they are capable of producing, are ascertained, and we
are often able to employ them with almost mathematical
certainty in diseases having   similar symptoms.    Thus
Hahnemann, from a mere description of the symptoms of
cholera, and before he had seen or treated a single case,
selected from his Materia Medica those very remedies which
were subsequently so triumphantly successful in the hands
of homceopathic practitioners.
CAUSE.-An aerial, or certainly an air-borne poison, which,
absorbed, infects the blood. Except under the influence of
a poison, no person in good health has ever been known in



ASIATIC CHOLERA.


241


a few minutes to become shrivelled up, the surface of the
body to be deadly cold, the tongue icy to the touch, the face
and extremities to turn purple, and with or without vomiting
of a fluid like rice-water, to die in a few hours. Dr. Milroyd
relates that within little more than five minutes, hale and
hearty men were seized, cramped, collapsed, and dead. Instances of death taking place in two, three, four, or more
hours, are extremely common. At Teheran, those who were
first attacked dropped suddenly down in a state of lethargy,
and at the end of two or three hours expired, without any
convulsions or vomiting, but from a complete stagnation of
the blood. Such records prove the essentially poisonous
nature of the disease, and that its action is often rapid,
powerful, and overwhelming.* The experience gained during
former visitations of cholera teaches us that it seizes the
poor in a far greater proportion than the rich, that the most
potent conditions favourable to its spread are poverty, overcrowding, filth, intemperance, and impure wvater, and that as
we prevent the accumulation of filth, foul air, and other causes
of general disease, and supply the people with wholesome
food and pure water, so we render inoperative the powerful
agencies by which this dreaded disease chiefly spreads.
TREATMENT.- Camphror.-We are glad to quote Dr. Rubini's method of treatment by the Spirits of      Camphor,
which consists of equal parts by weight of Camphor and of
spirits of wine-a preparation made by distilling spirits of
wine till it attains to 60 degrees overproof, when it will
dissolve and hold in solution its own weight of Camphor.
With this Saturated Spirit of    Camphor, Dr. Rubini, in
1854-5, treated 377 cases; Dr. Sabbatini 27; Dr. Salutanzii
56; Dr. Spitelli 80; Dr. Ricci 1; and every case recovered.
Dr. Rubini's cases were treated at the following public institutions in Naples: 200 at the Royal Alms House (1854);
"* See Aitken's "Science and Practice of Medicine."
It



242


DISEASES OF THE ORGANS OF DIGESTION.


11 in the Royal Poor House (1855); and 166 in the Infirmary of the 3rd Swiss Regiment (1855). That these 377
cases were all genuine cases of Asiatic cholera, and some
terribly severe," and that all recovered, is avouched by
the following distinguished individuals, with their official
seals attached:--I Generale Governatore Ricci; II Maggiore
Commandante Nicola Forni; II Capitano Commandante
Carlo Sodero; Generale Commandante Fileppo Rucci;
Colonel Eduardo Wolff. In addition to these 377 cases in
1854 and 1855, Dr. Rubini treated 51 cases in 1865 with
the same result. So that not in one epidemic only, but in
three, has the Saturated Spirit of Can2phor been tried and
found equally efficacious.
Nor can it be said that the cholera did not exhibit itself in
a severe form in Naples on these occasions; for we learn
from Dr. Rubini, that the death-rate under Allopathy there,
in 1854 and 1855, was 70 per cent; and with respect to the
visitation of 1865, a graphic account will be found in the
January number of the Cornhill Magazine, from which it
appears that that epidemic was not less fatal than its predecessors; and " the correspondent" of the Daily Newvs,
whose despatch appears in that journal of the 7th December
last, says, " The hotels were empty-a perfect panic prevailed-the people were crazy with fear."
DIRECTIONS FOR TREATMENT.-The directions given by Dr.
Rubini, as respects dose and diet, are as follows:-" When
a man is seized with cholera, he should at once lie down, be
well wrapped up in blankets, and take, every five minutes,
four drops of the Saturated Tincture of Camphor. In very
severe cases the dose ought to be increased from five to
twenty drops every five minutes. In the case of a man of
advanced age, accustomed to take wine and spirits, where
the drug given in drops has no effect, give a small coffeespoonful every five minutes, and in a very short time the



ASIATIC CHOLERA.


243


coveted reaction will occur. Ordinarily, in two, three, or
four hours, the reactionary fever will set in, with abundant
perspiration, and then cure will follow."
"The preventive method," writes Dr. Rubini, " is this:Let those who are in good health, whilg living in accordance with their usual habits, take every day five drops of the
Saturated Spirit of Camnphor upon a small lump of sugar,"
(water must never be used as a medium, or the camphor will
become solid, and its curative properties cease,) "and repeat
the dose three or four times a day, if there is any reason to
fear an attack. Spices, aromatic herbs, coffee, tea, and
spirituous liquors should be avoided."  Dr. Rubini allows
his patients to drink cold water in small quantities at short
intervals; and when the reactionary fever has passed off, he
allows a little light broth and farinaceous diet.
The remedies hitherto usually recommended in addition
to Camphor, are, Veratrum, Cuprum, Arsenicum, Miercurius
-Cor., and Ipecacuanha. After the statements made on Dr.
Rubini's treatment by Camphor alone, it seems superfluous
to add any remarks on the above or other remedies, except
to state that one or more may be required after reaction has
set in, the selection of which must be determined by the
nature of the complications that may arise, or the sequelae
that may follow. Whatever remedies are administered, the
following two sugestions should ever be acted upon:1. The patient should have absolute rest in the recumbent
posture, from the very commencement of the initiatory diarrhoea. 2. A hopeful and cheerful state of mind should be
fostered: a firm presentiment of death is always unfavourable.
SANITARY AND HYGIENIC MEASURES.-The following excellent advice has been given, and should be adopted on the
earliest indication of cholera:



244


DISEASES OF THE ORGANS OF DIGESTION.


The house should be well aired, especially the sleeping
apartments, which should be kept dry and clean.
All efluvia arising from decayed animal or vegetable
substances ought to be got rid of; consequently, cesspools
and dust-holes should be cleaned out, and water-closets and
drains attended to.
All exposure to cold and wet should be avoided, and on
n account should anyone sit in damp clothes, particularly in
damp shoes and stockings.    Care should be taken to avoid
chills or checking the perspiration.
The clothing worn must be sufficient to keep the body in
a comfortable and even temperature.
Habits of personal cleanliness should be cultivated, and
regular exercise in the open air enforced; late hours forbidden; regularity in the periods of repose and refreshment
observed; and, as much as possible, all anxiety of mind
avoided.
The diet should be wholesome generally, and adapted to
each individual habit. Everyone should, however, be more
than ordinarily careful to abstain from any article of food
(whether animal or veqetable), no matter how nutritious and
digestible to the generality, which may have disordered his
digestion upon former occasions, and to avoid all manner of
excess in eating and drinking.
Raw vegetables, sour and unripe fruits; cucumbers, salads,
pickles, etc., should not be allowed.
The more wholesome varieties of ripe fruits, whether in
their natural or cooked state, and vegetables plainly cooked,
may be partaken of in moderation, by those with whom
they agree.
Non-acid wines and beer, of good quality, may also be
used in moderation by those accustomed to them.



WORMS.


245


19.-Worms (HIelmenthiasis).
IT is a curious fact, and a humiliating one, that the human
body should furnish both a dwelling-place and food for a
host of animal parasites, not only after death, but also
during life. Indeed, helminthologists are constantly making
additions to the existing list of verminous creatures who
get within, and subsist upon, the human body.      It has been
well remarked, " The wisdom of creative design is not easily
fathomed when we see the higher orders of animals, and
man himself, perishing in order to afford food and a means
of propagation to the marvels of organization which appear
to us always obnoxious and destructive--born for evil, and
not calculated to play in this world's r6le any other than
an offensive part."   " Most animals," remarks Dr. Aitken,
" have each their own peculiar parasites-that even parasitic
animals are themselves infested with parasites-an observation embodied in the Hudibrasian couplet:These fleas have other-fleas to bite 'em,
And these fleas, fleas, ad infinitum.'"
In the human body, these parasites burrow beneath the skin,
infest portions of its surface, occupy internal organs, such
as the liver, and even the brain,' and especially the intestinal
canal.  Indeed, there is scarcely a tissue or organ of the
body that has not been invaded by them. The Guinea-worm
penetrates the skin, and takes up its residence in the subcutaneous areolar tissue, producing great uneasiness and
* The Registrar-General, in his sum-total of deaths from cerebral diseases,
includes those in which the brain appeared perfectly healthy, except that its
integrity and functions had been interfered with by the pressure exercised by a
growing parasite. No doubt they were introduced into the stomach with
water, to which they first gained access by escape from the parent tape worm;
thence they have bored their way into the circulating medium by penetrating
the coats of the stomach, and being transported by the circulating medium to
the head, have voluntarily lodged there.



246


DISEASES OF THE ORGANS OF DIGESTION.


itching, and, ultimately, suppuration. The chigo selects the
skin of the feet, beneath which it forms a little cyst, and
there deposits its eggs. The Ec/inococcus, or hydatid, is a
microscopic object in the form  of a mouth, surrounded by a
circle of hooks, and is most frequently found in the liver.
The Cysticercus cellulosus has been found in the muscular
tissue of the heart, and in the brain, the eye, and the
tongue. But it is the intestines that are most frequently
infested with worms; it is, therefore, to the symptoms they
there produce, and the necessary treatment, that we purpose
chiefly devoting the-present chapter.
VARIETIES.-There are many species of worms which infest
the human body, but we shall only refer to the following,
which are the chief, viz., Asearis, Lumbrici, and Tcenia.
1.-The Ascaris Vermicularis, or thread worms, infest the
rectum (lower bowel). They are very small, measure about
a quarter to half an inch long, multiply rapidly, occur chiefly
in growing children, and occasion much local irritation.
The chief symptom is intolerable itching about the anus in
the evening, aggravated by the warmth of bed; also picking
of (lhe nose, fcetid breath, depraved appetite, nervous symptoms, and disturbed sleep. If an examination be made after
the patient gets warm in bed, thread worms may be detected
crawling about the entrance to the bowel.
2.-Lumbrici, or round worms, also exist in children, their
habitat being the small intestines, where they feed on the
chyle, and attain a length of six to sixteen inches. The
symptoms, often obscure, are pain of the belly, fretfulness,
grinding of the teeth, disturbed sleep, or other convulsive
attacks; also itching of the nose and anus. The child becomes sallow, its limbs waste, but its belly is enlarged, hot,
and tense; the appetite is uncertain, often voracious; the
breath is offensive, and the stools contain much slimy mucus.
The worms sometimes travel upwards into the stomach, and;



WORMS.


247


are vomited, or downwards into the colon, and are passed
with the stools.
3.-Tcenia, or the tape worm, is nearly white, flattened,
and of a jointed structure.; it attains a great length, even
many yards, by repetition of the joints; it occurs in adults;
the symptoms being masked, its presence is unsuspected
until portions are passed in the motions, which do not,
however, destroy it. There is seldom more than one worm
present at a time, and yet its eggs are millions, each joint
possessing an ovary, but they are discharged with feces, and
devoured by unclean animals-swine, ducks, and rats; in
these creatures they become developed, but not always into
tape worms, for they appear to go through several generations before returning to the jointed form. They are probably introduced into the human body by eating unwholesome
animal food, especially tripe and sausage skins imperfectly
cooked. It is supposed that the ova sometimes reach the
circulation, and in the liver or qther organs are developed
into encysted entozoa, commonly called Hydatids.
GENERAL SYMPTOMS.-Sudden changes in the colour of
the face; dark semi-circles under the eyes; copious flow of
saliva; nausea; insipid, acid, or fcetid odour of the breath;
a voracious, alternating with a poor, appetite; a frequent
feeling of malaise; itching of the anus; talking and grinding the teeth during sleep; thick and whitish urine; tightness and swelling of the lower part of the abdomen; and, if
much irritation is occasioned by the presence of worms, the
nervous system may become implicated, and convulsions,
epilepsy, chorea, or delirium, ensue.  Perhaps the only
irrefragable sign is the presence of worms in the stools, or
in the matter vomited.
PRODUCTION OF WORMS.-Intestinal worms spring from
germs introduced from without, and which find in the
interior of other living bodies the only conditions compatible



248


DISEASES OF THE ORGANS OF DIGESTION.


with their development and growth. To suppose the spontaneous origin of intestinal worms would be to strike at the
root of that fundamental argument of natural theology,
which infers the existence of a first intelligent Cause, from
those evidences of adaptation and design which are-impressed
upon all portions of the visible universe. There is no
instance of a living structure being developed from inanimate
matter, except through the instrumentality of a previously
existing principle. The myriads of insects which teem in
the earth, air, and water, have all sprung from creatures of
a like kind, and have derived their life through countless
generations from the first of their species. In the case of
parasites affecting man, they are of complex but harmonious
organization, furnished with digestive organs, instruments of
locomotion, and with male and female organs of generation.
This last fact is conclusive that they proceed from ova or
germs, which quicken whenever they are introduced into
their proper element. If they ever arise spontaneously, why
should they be furnished with a generative apparatus? Some
of the entozoa are peculiar to certain localities, and strangers
visiting such places contract them. The tape worm invades
the intestines of persons travelling in the country to which
it belongs; thus the tape worm of England is the Taenia
soliun, that of Switzerland is the Tenic lata; but an
Englishman visiting Switzerland is liable to the Tenia lata,
and, on the other hand, a Swiss in England is liable to that
variety common to our country. The following curious story
was related by Mr. Abernethy:-" A shepherd had to drive a
flock of healthy sheep to a distant part of the country. The
journey occupied two or three days. On the road one of the
animals broke its leg, and was carried the rest of the way
on horseback. All the flock, except this hurt individual,
were turned for one night into a marshy pasture. The
broken limb was set, and the patient got well, and was the



250       DISEASES OF THE ORGANS OF DIGESTION.
generally free from worms which are likely to exist in the
body of man. The Irish pig, allowed the free range of house
and road, where every kind of filth is devoured, charged with
the ova of parasites expelled by man or some of the lower
animals, is most commonly injured by entozoa.      " The
observations of helminthologists prove that it is not unattended with danger for human beings to sleep together when
one is affected with tapeworm or trichina. How much more
dangerous, then, for animals to live with people who disregard all habits of cleanliness! Though we refuse.to believe
that filth breeds parasites, we must not forget that dirt
protects the ova and favours their transmission from one
nest to another. The terrible hydatid disease, which is the
direct cause of one-fifth of the human mortality of Iceland,
is due to negligence and dirt. The Icelanders slaughter
their animals, and leave the offal to decompose. Dogs
devour the entrails, which abound in entozoa, and, breeding
tapeworms within them, disseminate eggs over the whole
country (Gamgee).
TREATMENT.-Intestinal worims being frequently the products of certain morbid states, especially imperfection in the
digestive and assimilative functions, the treatment should
be directed against the disease itself, rather than against the
product it engenders. The effect of most allopathic remedies
is, at the best, to excite a discharge of the worms from the
system, without correcting the morbid condition on which
their existence depends.
Remedies for thread worms: Acon., Ign., Merc., Cin.,
Calc. Carb., Sulph.
Remediesfor round worms: Acon., Bell., Cin., Merc., Sil.,
Spig., Sulph.
Tape worms: other remedies than those included in our
list, and in massive doses, are necessary for the mechanical
expulsion of tape worms; the one we are in the habit of



WORMS.


251


trusting to is, the etherial oleo-resinous extract of male fern.
If the symptoms indicate it, one of the remedies recommended for the other varieties may be afterwards administered.
Aconitum.-At bed-time, for fever, restlessness, and
burning and itching at the seat.
Cina.-A valuable remedy for thread worms (ascarides),
or round worms (lumbrici), with the following symptoms:boring at the nose; livid circles round the eyes; tossing
about, or calling out suddenly during sleep; voracious
appetite, even after a full meal; nausea and vomiting;
griping; itching at the anus, and crawling out of thread
worms when the patient is warm in bed; white and thick
urine, sometime passed involuntarily; wetting the bed; occasional convulsive movements in the limbs; lassitude, etc.
fercurius.-This is an invaluable remedy in worm affections, but is more indicated by the nature of the evacuations
than, by the presence of worms. The motions are whitish,
pappy, greenish, and sometimes bloody, with straining and
ineffectual urging; there may be also distension of the
abdomen, difficult teething, moaning, restlessness at night,
foetid breath, augmented secretion of saliva, etc.
Belladonna.-Congestion to the head, starting during sleep,
headache, fever, etc. If there is much fever, a few doses of
Aeon. should be first administered.
Nux Vomica.-For both thread and round worms, hard
stools, and after the use of indigestible food.
Ignatia.-Intolerable irritation and itching in the rectum
and anus, with or without prolapsus of the bowel; spasmodic
twitchings. Iynatia is generally appropriate in mild, sensitive individuals, particularly women and children, and is
generally more useful than _nrux Vomica.
Sulphur.-After the prominent symptoms have disappeared, to complete the cure..,* 



252


DISEASES OF THE ORGANS OF DIGESTION.


Calcarea.-After discontinuing   the other remedies, in
patients having an hereditary predisposition to worms, with
enlargement of the abdomen, glandular swellings, and other
strumous symptoms.
Dose and Repetition.-See page 49.
ACCESSORY MnEANS.-The food should be simple, easy of
digestion, and include wholesome, properly-cooked animal
food, especially mutton, beef, fowl, and rabbit; pastry,
sweetmeats, sweet-made dishes, pork, and veal, should be
strictly avoided. Salt, as a condiment, may be advantageously taken with the food. A draught of spring water
should be swallowed every morning on rising, and the whole
body, the stomach in particular, bathed with cold water, and
afterwards rubbed till the whole skin is in a glow; daily
exercise taken in the open air; also injections as recommended in the next paragraph.
INJECTIONS.-These are most useful as means for expelling
the worms; half a pint of water, in which a spoonful of
common salt has been dissolved, once or twice repeated,
will often suffice to relieve a patient of these troublesome
creatures. An effort should be made to retain the salt
injection for some hours, or even during the night. Afterwards, a simple cold or tepid injection should be used
regularly about three times a week, for two or three months,
to wash away the slime in which the ova exists. But the
general and medicinal treatment can only be relied upon for
improving the health and preventing their re-formation.
PREVENTION OF TAPE WORMS.-1.        Avoid open waters,
either for drink or for use in the preparation of food, into
which the carcases of dogs are sometimes thrown, or into
which tape worm eggs may be washed by rain, or other
agencies, or to which even dogs or other animals have
access. All suspected water should be previously boiled,
distilled, or finely filtered. 2.-Doubtful pieces of meat,



INFLAMMATION OF THE LIVER.


253


suspected to contain entozoa, should be destroyed by fire;
if thrown to dogs, or allowed to accumulate on the ground,
or even buried, tape worms are propagated, and human
health and life endangered. 3.-Raw or underdone meat,
especially hams, bacon, sausages, etc., should be carefully
avoided. Cooks, butchers, etc., are more liable to be infested
with tcenia than other persons; and in countries where
uncooked flesh, fowl, or fish, is consumed, tape worms
abound. Good cooking ranks next in importance to the
attempt to exterminate parasites from the animals we eat,
or the water we drink. 4.-Vegetables and salads, eaten
raw, should be first most scrupulously washed, as it is
through such media that the ova of cysticerci and eciinococci
often find their way into our bodies.
CHAPTER     V.
AFFECTIONS OF THE LIVER.
1.-Inflammation of the Liver (Hepatitis).
THE liver, the largest gland in the body, is a secretory
duct and a blood-elaborating apparatus. Acute inflammation
of this organ -is not a frequent disease in this country, although it does sometimes occur, but it is very common in
tropical climates.
SYMPToMS.-Acute' inflammation of the liver is usually
ushered in by rigors, which are quickly followed by hot skin,
thirst, and scanty urine, the fever sometimes assuming a
typhoid character; pain more or less severe in the region of
the liver, aggravated by pressure, deep breathing, or coughing; fullness from enlargement of that organ; a yellow
tinge of the conjunctive, and often a general jaundiced



2.54


AFFECTIONS OF THE LIVER.


state of the skin; the breathing is short and thoracic, being
performed almost entirely by the intercostal muscles; sympathetic cough and vomiting.
The symptoms vary according to the portion of the gland
implicated in the inflammatory process. When the disease
is in the convex side of the liver, it is accompanied by a
burning, stitching pain in the right side, which extends
into the chest, under the clavicle (collar-bone), between the
shoulder-blaces, to the top of the right shoulder, and sometimes down the arm, and is aggravated by external pressure.
If the inflammation is in the inner portion of the liver,
there will be the symptoms already indicated, namely, nausea
and vomiting; white or yellow-furred tongue, bitter taste,
scanty or saffron-coloured urine, and yellow colour of the
eyes and skin. If the substance of the gland is involved,
the pain is of a dull, tensive character; if the thin serous
covering which invests the organ, the pain is sharp and
lancinating.  Whatever part of the liver is diseased, increased secretion of bile, some degree of jaundice, dyspncea,
cough, etc., are present.
TERMINATIONS.-L. Resolution.-This is indicated by an
amelioration of the febrile symptoms, copious perspiration,
and an abundant deposit in the urine. 2. Abscess.-Matter
forms, the patient experiencing throbbing, pulsating sensations in the part, with the general symptoms of hectic
fever, the abscess discharging itself into the stomach, duodenum, or colon, or externally. 3. Chronic inflammation.
CAUSES.-Acute inflammation of the liver is most frequent
in India, from the climate and diet not suiting European
constitutions, and is seated in the substance of the liver:
in this country it arises from cold and other causes,
and is then seated in the peritoneal serous covering, resembles pleuritis, and ends in adhesion to the diaphragm
or other surrounding parts. Functional derangement, with



INFLAMMATION OF THE LIVER.


255


suppressed secretion, sometimes accompanies congestion of
the gland. Dram-drinking often leads to a hard, contracted
condition of the liver, called Cirrhosis or hob-nailed liver,
which leads to dropsy.
TREATMENT.-The following are the chief remedies in the
domestic treatment of this affection-Aeon., Merc., Nux V.,
Chin.
Aconitum. - Feverish symptoms, anguish, restlessness;
foul, yellow-coloured tongue, acute pains, impeded breathing,
white clay-like stools, and red urine. A dose every two or
three hours. In very acute cases the strong tincture of the
root may be used with great benefit. A few drops may be
let fall into a tumbler (see page 48), which should then be
half filled with cold water, and a dessert-spoonful taken every
two or three hours for several times.
Mercurius.-Pressive pains under the ribs, which prevent
the patient from lying long on the right side; yellow tinge
of the whites of the eyes, and sallow appearance of the skin
over the body; shivering, frequently followed by profuse,
clammy perspiration; want of appetite, thirst, a foul taste
in the mouth, with a relaxed or torpid condition of the
bowels; formation of hepatic abscesses.
Bryonia.-Severe pains of a shooting, stinging, or burning
character, increased on pressure, with enlargement and hardness of the liver, and obstinate constipation. It is especially
useful after Aconitum.
Belladonna.-Severe pains in the region of the liver, extending to the chest, right arm, and stomach; headache,
giddiness, intense thirst, restlessness, anxiety, with tendency
to head symptoms. It may be alternated with, or follow,
Aconitum.
China.-Paroxysmal attacks, worse every other day; pain,
swelling, and hardness in the region of the liver" bitter
taste, and thickly-coated tongue; yellowish eyes and skin.
A dose every four hours.


^



256


AFFECTIONS OF THE LIVER.


IHepar Sulph. and Silicea.-One or both of these remedies
may be indicated in diffused or circumscribed abscesses of
the liver.
Arsenicum.-In extreme cases, with great weakness, intense burning pain, vomiting of bile, and exhausting diarrhcea. A dose every two or three hours; when improvement
has taken place, thrice daily.
hNux Vomica.-Hepatitis from intoxicating drinks, excessive or stimulating food, or too little out-door exercise, with
constipation, and high-coloured or deep-red urine. A dose
every four hours.
ACCESSORY MEANS.-The whole of the affected part should
be covered with two or three thicknesses of linen, squeezed
out after immersion in a lotion of half a drachm of the
strong tincture of the root of Aconitum to half a pint of hot
water, and covered with oiled silk and flannel, or spongiopiline. In mild cases, and in patients of vigorous health,
the compress may be applied cold. The general treatment
is the same as recommended under  Inflammatory Fever,"
page 55-6.
2.-Chronic Inflammation of the Liver-Liver
Complaint.
SYMPTOMS.-These are similar to those of the acute form,
except that they occur in a less marked degree. A prominent
feature is depression of spirits, with indigestion, distension
of the stomach, constipation, clay-coloured evacuations, languor, lassitude, and a kind of dread of some impending evil.
There is also sallowness of the complexion, sometimes
emaciation, and the organ itself may be either enlarged or
diminished in size.
CAUSEs.-The chronic form of hepatitis frequently follows,
and is a consequence of the acute, or it may be due to other



LIVER COMPLAINT.


257


diseases of the liver, intemperance, especially in spirituous
liquors, deficient muscular exercise, misfortune, depression
of spirits, suddenly suppressed perspiration, etc. Mercurial
preparations, such as calomel and the blue pill, are frequent
causes of liver complaint.
TREATMENT.-Similar remedies to those prescribed in the
previous section; also the following-Podophyllum, Aurum,
Nit. Ac., Lye., and Sulph.
Aconitum.-Inflammatory symptoms.
Podophyllum.-Chronic inflammation of the liver, with
indigestion, heartburn, constipation alternating with diarrhoea, piles, prolapsus, etc.
Aurum.-Indicated for patients who have taken much
mercury, and have pains in the bones, soreness of the flesh,
and are dejected and melancholy.
Lycopodium.-Continuous pain in the right side and great
torpidity of the bowels.
Nitric Acid.-Chronic hepatitis, in constitutions shattered
by repeated attacks from residence in tropical climates, or
by the constant abuse of strong drink, and especially if the
patient has been drugged with calomel and drastic purgatives.
Sulphur.-Shooting pain in the liver; chronic or obstinate
constipation and haemorrhoids.
For other indications see the previous section.
ACCESSORY MEANs.-Change of air; if the patient resides
in a hot climate, early removal to a temperate region is
necessary. In chronic hepatitis, as it exists in this country,
cold or tepid sponging or bathing, and vigorous friction with a
coarse towel immediately afterwards, to promote the healthy
functions of the skin, will be found a valuable auxiliary.
The addition of Sea-salt to the water, as recommended page
31, will add to the invigorating effects of the water. The
patient should avoid stimulants, pastry or rich food, spices
and coffee, and strive to live regularly and contentedly.



258


AFFECTIONS OF THE LIVER.


One or two hours out of twenty-four should be spent in outdoor walking or horse exercise. If these suggestions are
early carried out, before the disease has effected disorganization of the gland, a permanent cure may be expected,
and earthly existence rescued from the disabilities and sufferings inseparable from disease.
3.-Jaundice (Icterus)-The Yellows.
The above terms are used to express a group of diseases,
in which many of the tissues and fluids of the body become
yellow, especially the whites of the eyes and the connective
tissue of the body. It is often a symptom of some acute or
chronic affection of the liver, rather than a distinct disease.
SYMPTOMS.-Yellow tinge of the skin and whites of the
eyes; yellow-coloured or deep-brown urine, which stains the
linen yellow; whitish or drab-coloured faeces; constipation;
lassitude; anxiety; pain in the stomach; bitter taste in the
mouth; and generally febrile symptoms. Sometimes, especially in children, the bowels are relaxed with diarrhoea,
from the food not being properly digested and becoming
irritant. There are also, usually, depression of spirits, prostration of strength, and slowness of the pulse. The presence
of the yellow tint in the conjunctive and urine is very conclusive that the patient is suffering from jaundice, and not
merely from   the sallowness of anemia. If nitric acid be
added to the urine, it changes it to a deep green colour.
When there is obstruction from a gallstone, the most acute
suffering is induced; the pains come on in paroxysms, and
are often accompanied with vomiting and hiccough.
CAUSES.-Jaundice, as pointed out by Dr. Budd, may be
produced in two ways:-(lst) By some impediment to the
flow of bile into the duodenum, and the consequent absorption of the retained bile; and (2nd) by defective secretion


(*'



JAUNDICE.


259


on the part of the liver, so that the constituents of the bile
are not separated from the blood.
The most common impediment to the flow of bile is the
impaction of a gallstone in the natural channels of the bile.
A gallstone consists of bile in a crystalline form, it having
been released from its solvent properties.  Derangement in
the functions of the liver connected with the secretion of
bile are fiequent causes, and are consequent on atmospheric
changes, dietetic transgressions, dissipation, unrestrained
fits of passion, etc. The excessive use of quinine, rhubarb,
or calomel in some fevers, may also be stated as a cause, as
these drugs obstruct the bile-duct. Pressure of the enlarged
womb in pregnancy, or the growth of tumours, causing obstruction of the gall-ducts, are also occasional causes of
jaundice. But sedentary occupations and high living are
probably the most frequent causes.
TREATMENT OF JAUNDICE:1. From an impacted gall-stone.-Acon., and the application of a large hot compress over the seat of pain.
2. Caused by arrest of bile from  congestion.-Merc., or
Podoph.
3. From mental emotions, as grief, anger, or fright.-Ign.,
or Cham.
4. From constipation.-Nux V.
5. In infants.-Cham., or Mere.
Aconitum.-Jaundice with symptoms of acute inflammation and great pain in the region of the liver.
fMercurius.-This is one of the most valuable remedies,
and will often effect a speedy cure; it is especially useful
after the use of Aeon.
Podophyllum.-Arrest of bile, from torpor or congestion of
the liver and bile-ducts.
Chamonmilla.--Jaundice in passionate, irritable, or fretful
patients, especially children.



260


AFFECTIONS OF THE LIVER.


China.-If the disease is caused by marsh miasm, the
fever is intermittent, or the patient has been weakened by
diarrhoea or loss of blood.
Nux Vomica.-Jaundice attended with costiveness, sensitiveness in the region of the liver, or arising from sedentary
habits, or indulgence in spirituous liquors.
Jaundice during pregnancy, or from cancer or other tumour of the liver, must be treated according to the circumstances of each particular case, and require professional
attention.
DIET.-This should be light, and easy of digestion, consisting  of chicken-broth, weak   beef-tea, toasted  bread,
scalded with hot water with a little sugar, roasted apples,
and as much cold water as the patient desires. See under
"Inflammatory Fever."
ACCESSORY 3MEANS.-Flannels squeezed after immersion
in hot water, or a hot hip-bath relieves the pain attending
the passage of gall-stones. Jaundice from inactivity and
chronic congestion of the liver requires change of air and
scene, travelling, regular walking or horse exercise, the use
of the abdominal compress, as described page 221, with
regular and temperate habits.
CHAPTER      VI.
DISEASES OF THE ANUS.
1.-Piles (Hamnorrhoids).
DEFINITION.-Piles, the most frequent disease of the anus,
are small tumours, consisting of folds of mucus and submucus tissue, in different stages of inflammation, congestion,
or permanent enlargement; they are situated within or just
outside the anal aperture, and originate from dilatation of
the heemorrhoidal veins.



PILES.


261


VARIETIES.-Piles are classified as internal or external,
according as they are situated within the rectum or at the
verge of the anus. The external are covered by skin, and
are outside or just around the orifice of the bowel; they vary
in number from one intensely painful swelling to numbers
clustering'together like a bunch of grapes. The internal are
covered by mucous membrane, and are always within the
bowel. Piles are of a pink or purplish hue, forming one or
more distinct pendulous tumours, varying from the size of a
pea to that of a damson or walnut. Piles that do not bleed are
called blind; this variety is prone to inflammation when they
become tense, appear ready to burst, and are so excessively
sensitive, that the patient can scarcely sit, walk, or lie.
Internal piles are very liable to bleed, especially during the
passage of feces. The blood thus lost is of a bright-red
colour, being arterial, and proceeds from the capillaries of
the vascular surface of the tumours, and varies in quantity
from a few drops to such a profuse discharge as is truly
alarming; if hemorrhage is long continued, an ansmic
condition is induced that is highly prejudicial to the constitution. They are seated in the vertical folds of the mucous
membrane which lines the bowel; that portion of membrane
which invests the piles being extremely vascular, numerous
minute vessels of brighter colour than the body of the piles
may be seen ramifying on the surface.
SYMPToBs.-These vary     considerably according to the
amount of inflammation present. When indolent, the chief
inconvenience arises from their bulk and situation; or from
getting within the sphincter muscle, occasioning more or less
pain when the bowel is acting, prolapse, and often a sense
of weight and discomfort, which quite unfits the mind for
subjects requiring deep thought. But when inflamed, or, in
common language, " during a fit of the piles," there are
pricking, itching, shooting, or burning pains about the anus,



PILES.


263


and frugal classes. Age and sex appear to exercise considerable influence on this disease. In early life, it is probably
much more frequent in young men than in young women;
during pregnancy, and at a later period of life, it occurs
much more frequently in women. The comparative exemption of young women is readily accounted for by the monthly
discharge from the uterus, obviating congestion that might
otherwise occur in its vicinity. At a later period, after the
cessation of the menses, or during the pressure of the gravid
uterus in pregnancy, congestion is apt to occur in certain
neighbouring organs, and so give rise to piles.
TREATMENT.-The following are the chief remedies: Acon.,.Nux' Vom., Hfam., Ars., Sulph.
Bleeding Piles: Acon., Ham., Bell., Phos., or China.
Burning and painful: Capsicum, Petroleum, Carb. Veg.,
Ars., or Graph.
Piles discharging mucus: Merc.,Ant. Crud., Puls., or Sulph.
Swollen and protruded: Lyc., Nit. Acid., Mur. Acid, Sepia,
or Aloes.
Ulcerated: Mere., Silicea, Arsen., or Sulph.
During pregnancy: Nux Vom., Opium, Puls., Bry., or
Platina.
Chronic: Carb. Veg., Nit. Ac., Hep. Sulph., Baryta Carb.,
Calc., Graph., or Sulph.
Nux   Vomica.-Piles associated with sedentary habits,
luxurious living, indulgence in stimulating beverages, depressing mental emotions, confined bowels, pressure, prolapsus, or loss of power of the muscular structure of the
bowel. Nux Vomica is also required when the disease occurs
during pregnancy, from swelling of the abdominal organs,
or structural defects of the rectum and adjoining parts.
Dose:-thrice daily, for two or three days; afterwards, if it
does good, night and morning for a week' or ten days.
Sulphur may advantageously follow this remedy, a dose being



264


DISEASES OF THE ANUS.


given night and morning for four or five days; or Sulphur
and Nux Vomica may be given in alternation, the former in
the morning and the latter at night.
Aconitum.-Piles in an inflamed condition, with feverish
restlessness, a sensation of heat, and during the discharge
of mucus or blood, a feeling as if warm fluid escaped from
the bowel. A few drops of the strong tincture in half a
tumbler of water, giving a dessert-spoonful every two hours
for several times; afterwards, less frequently, or another
remedy may be selected.
Carbo Veg.-Protruding piles, blue and swollen, with soreness, pain, or a burning sensation after an evacuation,
discharge of blood or mucus from the rectum, itching of the
anus; also bleeding from the nose, determination of blood
to the head, great weakness, confined bowels, etc. This
remedy is also useful for the sudden arrest of a discharge of
blood, with a burning feeling in the anus. After administering it thrice daily for three or four days it may be followed
by Arsenicum; and if these remedies are beneficial they may
be continued during alternate weeks, morning and night,
repeating the course several times.
Mercurius.-Acrid and bloody evacuations excoriating the
anus, with itching and smarting; also when in place of blood
the discharge is mucus, with swelling of the mucous membrane; piles accompanying inflammation of the liver, jaundice or bilious diarrhoea.
Hamamelis.-A valuable remedy in bleeding piles; or
even when there is only a varicose condition of the haemorrhoidal veins, particularly if the patient is also troubled with
a varicose state of the veins of the lower extremities. For
cases in which there is considerable loss of blood, it should
be used both internally and externally, a lotion being made
by adding thirty drops of the strong tincture to four ounces
of water, and applied by means of two or three folds of
linen, covered by oiled silk, and renewed several times daily.



PILES.


265


Arsenicuzm.-Inflammatory hemorrhoids, causing a burning sensation, and sometimes a feeling compared to passing
red-hot needles through the tumours, with intolerable pain
in the back, protrusion of the tumours, emaciation and prostration of strength. A dose thrice daily. It may precede,
follow, or be alternated with, Carb. Veg.
Sulphur.-This remedy is regarded as one of the most
valuable in every variety of piles, especially chronic cases,
or piles occurring in scrofulous individuals, with frequent
ineffectual inclination to stool, or thin evacuations mixed
with blood; great pain both internally and externally; the
tumours protrude considerably, and are pushed back with
difficulty; also smarting pain in passing water. Sulph. may
often be alternated with Nux, giving the latter at night and
the former in the morning; or Sulph. may follow Nux to
complete the cure.
Arnica.-When the tumours are swollen, sore, and painful,
and caused by external injury, such as riding on horseback.
China.-Where the loss of blood has been considerable,
and the patient is much debilitated. It is most useful after
a discharge of blood has been arrested by Acon., IHam., or
any other remedy.
DIET AND ACCESSORY MEANS.-Patients should avoid coffee,
peppers, spices, stimulating or highly-seasoned food, the
habitual use of beer, wine, spirits, and all kinds of indigestible food. Light animal food, a liberal quantity of wellcooked vegetables, and ripe and wholesome fruits, form the
most suitable diet. During an attack of piles animal food
should be sparingly used.
Sedentary habits and much standing, on the one hand,
and extreme fatigue on the other, are prejudicial; as also is
the use of cushions and featherbeds. The pain attending
blind piles may be relieved by ablution in cold water, or in
tepid water if that is found more agreeable. Bleeding piles
s



266


DISEASES OF THE ANUS.


may be relieved by drinking half a tumbler of cold water,
and then lying down for an hour. The horizontal position
should be maintained as much as possible, that being most
favourable to recovery. When piles protrude, the use of
petroleum soap will be found of great utility.
INJECTIONS.-Great relief and permanent benefit will also
follow an occasional injection of from half a pint to a pint
of cold or tepid water up the lower bowel, by means of an
india-rubber syringe, with an ivory tube. This acts beneficially, by constricting the blood-vessels and softening the
feeces before evacuation, and by giving tone to the relaxed structures. Injections of cold water are also of service
after each evacuation, when any feculent matter remains
behind which may thus be removed; at the same time
the application of water exercises a most favourable influence
on the blood-vessels and nerves of the bowels. As a rule,
tepid injections are most suitable for patients of a full habit
of body, and cold ones for those of relaxed constitutions.
When piles are excessively sensitive or painful, the patient
should sit over the steam of hot water, or keep his bed, or
recline during a great part of the day on a couch. Strict
cleanliness is also essential. The parts should be frequently
washed with soap and cold water; or when the tumours are
inflamed and painful, with tepid water. A warm bath, or
the vapour- bath, may be occasionally used at night, when
the liver is inactive and the skin dry and harsh. It should
be followed in the morning with a cold bath, or the body
should be rapidly rubbed, first with a wet cold towel, and
then with a dry one. By such means the general circulation
is promoted, the vital functions are more vigorous, and the
functions of the skin (the greatest safety-valve of the body)
being healthily performed, the system is relieved of any
accumulated morbid secretions.
The Abdominal Compress, as described in the section on



PILES.


267


" Constipation," is strongly recommended as preventive of
piles, and should be adopted directly the first symptoms are
felt; also as a curative means in connexion with others
pointed out.
Another most important point for patients troubled with
piles is, that the habit should be acquired of going to stool
at night, immediately before retiring to bed, instead of
morning, so that the horizontal position may favour the
early subsidence of the tumour, instead of its remaining in
an inflamed and prolapsed condition, to the great annoyance
and distress of the patient, and to the permanent injury of
the parts.
SURGICAL MEASURES.-" Radical " remedies for the treatment of piles are, chiefly, Nitric acid, for destroying the
diseased surface; the Ligature, a piece of hempen twine
firmly secured round the base of each pile; and Excision,
which is variously performed. For a description of these
methods for the cure of piles, surgical writers must be consulted, especially Erichsen, Druitt, Smith, and Lee. Happily,
active interferences, such as those just named, are rarely
required under homceopathic treatment, the most inveterate
cases generally yielding to our prescriptions without the use
of the knife, the ligature, or nitric acid.
2.-Protrusion of the Lower Bowel (Prolapsus ani).
DEFINITION.-An inversion of the lower portion of the
rectum, and its protrusion through the anal aperture. In
slight cases the protrusion only takes place after the action
of the bowel, and goes back of itself, or is easily returned;
if unrelieved, however, it may     protrude from    riding,
walking, or even standing, and be replaced with difficulty.
CAUSES.-The disease may be due to constitutional laxity
and delicacy of structure, but more frequently to immoderate



268


DISEASES OF THE ANUS.


straining at stool, or when urinating; also to constipation,
piles, stone in the bladder, or stricture of the urethra.
Although not confined to them, it is most frequent in
children.
TREATMENT.-Ignatia.--This remedy is often specific, and
is generally the first to be used, especially for infants and
children. The indications are, frequent ineffectual urging to
stool, straining, difficult passage of faeces, itching, and
prolapse of the bowel.
Nrux Vomica.-As a rule, for males and adults of either
sex of a vigorous constitution, this remedy should be selected
instead of Ignatia.
lercurius.-Prolapsus, with much itching, diarrhoea,
discharge of a yellowish mucus, and hard, swollen abdomen.
Lycopodium. - Symptoms preceding     actual prolapseitching, soreness, and general relaxation and emaciation;
also in obstinate cases, after other remedies have only
effected a partial cure.
Podop7yllum.-Prolapsus occurring in the morning, with
chronic diarrhoea, especially in children and women; irritation from teething, and diarrhcea with straining and offensive
stools, are additional indications.
Calc., Sep., Ars., Bry., and Sulph., are also useful remedies
in many forms of this complaint.
Dose and administration.-See page 49.
ACCESSORY MEANS.-These must include-(1.) The return
of the protruded parts, which. should be carefully washed
and replaced by pressure with the forefinger, well oiled, and
pushing it up into the anus, carrying the protruded part
before it. If the prolapsed part be large, a surgeon's aid
should be procured.  (2.) Removal, if possible, of the cause.
If, as is most frequently the case, indigestion, constipation,
or piles, is the cause, the suggestions contained in the
chapters on those subjects should be observed. The diet



FISTULA IN ANO.


269.


should be plain and nourishing. Bathing the parts night
and morning, with cold water, will be very serviceable; also
an injection of cold water every morning for a week, and
afterwards every second or third day, for a few weeks
longer. The habit of going to stool just before retiring to
bed, recommended in the section on piles, should also be
observed in prolapsus of the bowel.
3.-Fistula in Ano.
DEFINITION.-A fistula may be described as a narrow pipelike track, lined by a false membrane, resembling a mucous
membrane, secreting pus, with a narrow callous opening,
with no disposition to heal. A fistula in ano is such a track
within a short distance of the verge of the anus, and
generally originates in an abscess by the side of the
rectum.
SYMPTrons.-There first appears on one or other side of
the rectum a small hard lump, which, as it continues to
enlarge, occasions considerable pain, and not unfrequently
much constitutional disturbance.   The surrounding parts
soon become much swollen, and the skin red, which is
quickly followed by suppuration. During the formation of
the abscess, the patient complains of pain in passing his
motions, which are sometimes slightly tinged with blood.
Great relief follows the discharge of the abscess, which is
generally of a most offensive character, and the swelling
subsides; but there still remains a small opening near the
anus, and upon pressure a hardened track may be felt,
conducting towards the bowel. This is the fistula. The
external orifice of the fistula is very small, like a pin-hole,
and is often difficult to find in the folds of the thin skin
near the anus, and even this opening is sometimes concealed
by a small papilla.



270


DISEASES OF THE ANUS.


VARIETIES.-There are three kinds of fistulas-(1) the
blind external, which opens only through the skin; (2) the
blind internal, which opens only into the bowel,'usually from
11 to 1 inches within the rectum, and is detected by a
finger or probe, or may be seen by a speculum; and (3) the
complete, which opens both ways. The blind external and
the complete fistula are indicated by a hardened track which
may be felt, leading towards the bowel; but the blind
internal is indicated by pain in going to stool, and discharge
of pus and blood with the feeces.
CAUSES.-They originate in abcesses, which are prevented
from healing by the movement of the sp/incter ani and the
bowel itself; or by the ulceration of the mucous membrane
of the rectum, and consequent escape of feculent fluids and
gases, which gradually excite progressive ulceration towards
the surface.    The disease is frequent in     consumptive
patients, probably  from   deposit of tubercle under the
mucous membrane of the rectum, or the areolar tissue about
the rectum losing its fat, and falling into a watery, unhealthy condition.
TREATMENT.- A     fistula is often   mistaken   by nonprofessional persons for a boil, and the treatment being in
accordance therewith, is generally useless. In some cases a
fistula can only be cured by an operation, which consists in
dividing the sphincter ani, so as to obviate contraction of
that muscle for a time, and slitting up all ramifications and
burrowings of the fistula under the skin.      This should
never be undertaken except by a qualified surgeon. If the
operation is skilfully performed, and the patient's health is
not too much impaired, the disease is generally curable, as
the sphincter, being divided, leaves the parts at rest, and a
free escape is given to feculent fluids and gases, which no
longer force their way through the fistulous passage. If,
however, the patient is decidedly phthisical, or has any



ITCHING OF THE ANUS.


271


serious disease of the kidneys or liver, no operation would
be justifiable, as the artificial wound would probably never
heal. A selection from the following medicines will assist
the cure, or if employed early may render unnecessary any
operative measures.    The choice must be made strictly
according to the indications present;-Silicea, Calc., Caust.,
Lyc., Phos., and Sulph. These medicines will also be of
essential service in those cases in which an operation is
deemed inadmissible, or when a patient from other reasons
objects to operative measures.
ACCESSORY   MEANS.-An      occasional poultice; frequent
washings with cold or tepid water, a daily use of the sitzbath, and injections, as directed in the section on piles,
are of the greatest utility, both as affording comfort to the
patient, and preventing the extension of the disease. Nourishing diet is necessary to fill up the space of the ischio-rectal
fossa and to increase the reparatory powers of the system.
4.-Itching of the Anus (Pruritus ani).
DEFINITION.-A peculiar morbid itching of the anus; at
first of a voluptuous character, but afterwards it becomes a
violent and almost unbearable affection.
SYMPTOMs.-Crawling, tingling, irritating sensations about
the anus, often most troublesome at night, as the patient
gets warm in bed, and preventing sleep. It is frequently
complicated with an excoriated or fissured condition of the
anus.
CAUSES.-Irritation of piles; worms; lodgment of feces;
suppressed period, or any suddenly suppressed discharge or
cutaneous eruption. Frequently itching of the anus is only
a symptom of disease of the liver, of some portion of the
digestive apparatus, especially the rectum, or of some part
in immediate proximity thereto.



272


DISEASES OF THE URINARY ORGANS.


TREATMENT.-This must entirely be guided by the cause.
One or more of the following remedies, selected according to
the cause and the symptoms present, will generally be found
efficacious: Acon., Carbo Veg.,.Nit. Ac., Sulph., Ant. Crud.,
Sepia, Lyec., Ign., or Mere.
If connected with piles, worms, or indigestion, the directions given in other portions of this work, under their.
respective headings, will usually suffice to remove this
troublesome affection.
CHAPTER VII.
DISEASES OF THE URINARY ORGANS.
1.-Inflammation of the Kidneys (Nephritis).
A MINUTE description of the symptoms and treatment of
these affections would not be compatible with the limits of
this manual. Hence a brief notice of them must suffice.
Diseases of the urinary and sexual organs are often of too
serious and complex a nature to be treated other than by an
educated and conscientious medical man. At the same time
the writer's experience enables him to state that in the
great majority of cases they are perfectly and rapidly
amenable to skilful homceopathic treatment.
SYMProMS.-Inflammation of the kidneys begins with the
ordinary febrile symptoms-chills, hot and dry skin, thirst,
frequent and hard pulse, and attended from the first, or
quickly followed, by deep-seated aching pain in one or both
loins near the spine, in the region of the kidneys, which
soon becomes acute and pulsative, and is greatly aggravated
by the slightest movement. The urine is diminished in
quantity, or bloody, with a frequent desire to urinate, or it
is entirely suppressed; in severe cases there is inability to



INFLAMMATION OF THE KIDNEYS.


273


walk, or even to stand in the erect posture. Pressure over
the inflamed kidneys does not cause much pain, but any
movement which calls into action the deep-seated dorsal or
lumbar muscles excites intense pain. The pains extend in
the course of the tubes which convey the urine to the bladder
(ureters), or follow the spermatic cord to the testicles, causing
retraction of these organs. There are also, generally, nausea,
vomiting, constipation, anxiety, and severe constitutional
disturbances.
Nephritis and Lumbago.-These diseases may readily be
distinguished by attention to the following points:-In
nephritis, the pains follow the direction of the ureters or the
spermatic cord; there are also nausea, vomiting, and frequent
desire to pass water, partial or almost entire suppression of
the urine, and sympathetic pains in the rectum; symptoms
which are absent in lumbago.
CAUSES.-Sudden checking of perspiration; strains from
lifting heavy weights; the irritation of calculi; the abuse of
medicinal substances, such as cantharides or oil of turpentine; or the disease may arise without any appreciable cause.
TREATMENT.-Aconitum may be first used to subdue the
febrile symptoms, and, in slight cases, will be sufficient. In
severer cases it may be alternated with Cann., Canth., or
Tereb., according to the indications.
Cantharis.-Burning in the urethra; painful micturition,
passed in drops, sometimes with blood. Should the disease,
however, have been caused by the application of a Cantharides
blister to the region of the bladder, two drops of the strong
saturated tincture of Camphor, or two pilules medicated with
the same, will be the appropriate remedy.
'Cannabis.- Same symptoms as Cantharis, except that
there is no discharge of blood.
Terebinthia.-Burning and drawing pain in the region of
the kidneys; urination is preceded by cutting pains, and the
urine smells like violets.



274


DISEASES OF THE URINARY ORGANS.


Arnica.-Nephritis following concussion, a strain, or any
external injury.
Nux Vomica.-Nephritis in patients addicted to the use of
spirits, coffee, etc.; or troubled with constipation, piles,
gravel, colic, retraction of the testicles, etc.
Sulphur.-Chiefly suited to strumous patients, and in such
constitutions should always follow the use of other medicines.
AccESSORY MEANS.-During the acute symptoms, flannels
wrung out of hot water, or heated flannels, should be applied
over the inflamed kidney, and the patient should remain in
bed. In subacute cases, the cold wet compress may be worn
around the loins, and will assist the cure, and also tend to
prevent a recurrence of the disease. In the acute stage,
little or no solid food should be taken, but mucilaginous
drinks-barley-water, linseed-tea, etc.-(see page 191), may
be used ad libitum.
2.-Inflammation of the Bladder (Cystitis).
SYMPTOMS.-This, like the last disease, commences with
general febrile symptoms. The pain is in the region of the
bladder,. and travels upwards towards the loins, thus distinguishing it from nephritis, in which the pain extends from
the loins down to the bladder. On emptying the bladder, the
pain is instantly diminished, but returns immediately that a
small quantity of urine collects. Slight movement, evacuating the bowels, and especially efforts of micturition,
cause extreme pain; and the urine deposits a mucous, or
muco-purulent sediment. The irritation frequently extends
to the rectum, and the patient's sufferings are aggravated
by tenesmus.
CAUsEs.-Extension of inflammation from      neighbouring
parts, prolonged retention of urine, injuries resulting from
difficult or instrumental accouchement, external injuries,



DIFFICULTY IN PASSING URINE.


275


stone, stricture, or gravel. But perhaps the most frequent
cause is gonorrkcea, neglected or unskilfully treated.
TREATMENT. --Acon. (inflammatory symptoms); Canth.
(bloody urine passed in drops); Nux (spasmodic pain in the
bladder); Bell. or Hyos. (agonising pain in micturating,
from spasm); Carbo V., Lyc., and Sulph. (in chronic affections of the bladder and urethra). See the preceding disease.
3.-Difficulty in Passing Urine (Strangury).
SYM1PTOM.-In this condition the urine is passed with
extreme difficulty, in small quantities or in drops, and is an
invariable symptom of the preceding affections; it may also
occur independently.
CAUSEs.-Spasm of the neck of the bladder; gonorrhoeal
inflammation; impacted freces in the rectum; the lodgment
of gravel or stone at the neck of the bladder; allopathic
doses of Cantharides; exposure to cold, especially in persons
of a gouty habit.
TREATMENT.-Acon., Bell., Camph., Hepar, 2Mere., Nux,
Puls., Sulph.
The treatment is the same as for the two preceding diseases. But the age, sex, temperament of the patient, and
the cause of the complaint, must be duly considered in
selecting a remedy. As a general remedial measure, at the
commencement of the difficulty, when little fever exists, and
when the strangury is severe, the homceopathic preparation
of Camphor may first be resorted to. A dose every one to
three hours, repeated three or four times.
AccEssoRY MEANS.-It is important to recollect that
strangury is not a substantive disease, but a symptom
resulting from various causes, the removal of which is
necessary before the bladder can regain its healthy sensibility and tone. Bearing this in mind, we can confidently



276


DISEASES OF THE URINARY ORGANS.


recommend mucilaginous drinks (see formulae, page 191),
a light digestible diet, and warm hip-baths for local irritation
remaining after the cause has been removed.
4.-Incontinence of Urine (Enuresis).
In this disease there may be partial or entire loss of power
to retain the urine in the bladder. The patient has almost
constantly an urgent inclination to pass water, which, if not
immediately responded to, results in an involuntary discharge. If the patient is troubled with a cough, the inconvenience is much increased, as during each paroxysm the
urine escapes. When the loss of voluntary power is more
complete, the urine continues to dribble away as fast as
secreted. The constant discharge excoriates the parts, so
that the patient can only move about with pain; at the
same time an offensive urinous odour is exhaled from the
person, thus rendering the condition one of a most distressing
character.
CAusES.-Paralyis of the muscular fibres which surround
the neck of the bladder (sphincter), which are designed to
open or close that organ; this may result from   injuries,
tedious labours,* the pressure of tumours, calculous deposits,
syphilitic diseases, the irritation of worms, or from constitutional causes.
TREATMENT.- Canth., Cann., Uva U., Nux, Puls., Nit. Ac.,
Calc. C., jRhus, Lye.
Nux Vonzica.-The urine is either retained with difficulty,
or passed involuntarily, in consequence of the large quantity
secreted.
Cantharis.-Irresistible desire to urinate, and discharge of
only a few drops of bloody and acrid urine.
* For urinary difficulties in pregnancy, see "The Lady's Manual of
Homceopathic Treatment."



WETTING THE BED.


277


Cannabis.-If sand or gravel appear to excite irritation,
and consequent involuntary emissions.
Phosphoric Acid.-If a relaxed condition of the neck of
the bladder has been caused by self-pollution. It may be
followed by China or Sulph.
Cind.-Frequent desire and involuntary emission at night,
especially if connected with the irritation of worms.
Nitric Acid.-Incontinence most troublesome at night;
or in patients who have taken much Mercury.
Mercurius.-If the disease is traceable to cold, or to syphilis.
Aconitum and Belladonna may also be required in inflammatory conditions.
Dose and Administration.-See page 49.
5.-Wetting the Bed (Nocturnal Enuresis).
As this condition so frequently exists in children, a brief
distinctive notice seems necessary.
CAUSES.-Irritation of the bladder by worms; strumous
constitution; too large a quantity of fluids, especially warm,
or if taken towards evening; improper food or drink, giving
rise to acid urine, which iriitates the mucous coats of the
bladder; etc. An examination of the urine of children who
wet their beds an hour or two after falling asleep will find it
loaded with lithic acid crystals.
TREATMENT.--It is often an obstinate complaint, requiring
professional treatment. Acon., Bell., Canth., Calc., Lyc.,
Cina, Nux, and Sulph.      See the preceding article, and
" Materia Medica."   If worms are suspected as the cause of
the difficulty, the chapter on that subject should be consulted.
J ACCESSORY MEANS.-As incontinence of urine is generally
the result of disease, punishing children cannot remove the
annoyance, but only suitable medicinal and general treatment, which must be entirely regulated by the cause. All salt,



278


DISEASES OF THE URINARY ORGANS.


sharp, and sour articles of food, malt liquors, spirits, tea, and
coffee should be avoided. Meat maybe eaten in moderate quantities, but only a small quantity of fruit, and no flatulent food.
Milk and water, or cocoa, may be taken in the morning, but
nothing hot in the after-part of the day. Cold water or
mucilaginous drinks may be taken in moderation, as they
tend to diminish the acrid properties of the urine. Children
who wet their beds ought to sleep on hard mattresses, with
light clothing at night, take much exercise in the open air,
and have shower baths or daily ablutions with cold water.
The whole process of ablution, including drying with a rough
towel, should not occupy more than five minutes.
6.-Retention and Suppression of Urine.
Retention and suppression of urine, although often confounded together, are very distinct affections. In retention,
the urine is secreted by the kidneys, but the bladder has lost
its power of evacuating its contents; but in suppression, the
function of the kidneys, which is that of secreting urine, is
suspended; the latter, however, is attended with extreme
peril, as the urea and other elements of urine accumulate in
the blood when the kidneys have fallen into disease, and no
longer secrete the urine; the patient becomes uneasy, then
drowsy, and soon coma and effusion upon the brain supervene. Suppression may be easily distinguished from retention, for in the latter disease the bladder is distented with
urine, and may be felt at the bottom of the abdomen;
while, in suppression, the bladder is empty and can scarcely
be felt. If it be deemed necessary to introduce the catheter,
the diagnosis will be confirmed, for in retention, whether
from stricture or enlarged prostrate, the bladder will be
found full, but in suppression, empty. The diagnosis is
referred to here because the treatment should be materially
different in the two cases.



RETENTION OF URINE.


279


CAUSES OF RETENTION.-Acute febrile disease; injury,
causing paralysis of the lower part of the spinal cord; loss
of tone in the muscular structures of the bladder, leading
to paralysis of that organ, common in old age.
TREATMENT.-AS the causes of the disease are so various,
and their course and progress so diversified, and as life is
often jeopardised, the treatment should, if possible, be confided to a homceopathic practitioner.
Aconitum.-Inflammatory symptoms, often in alternation
with some other remedy, especially Cantharis.
Camphor.-Spasms at the neck of the bladder, especially
if caused by Cantharides (a drop on a piece of loaf sugar
every fifteen minutes for three or four times).
Cantharis.-Urging to pass water, with cutting and tearing
pains.
Nux Vomica.-Painful ineffectual efforts to urinate, caused
by abuse of wine or spirits.
Sulphur.-In alternation with the last remedy, if the
patient is troubled with piles.
Arnica.-Retention from mechanical injury, or the irritation of calculi.
In addition to the above remedies, the following are often
useful:-Cann., Tereb., Uva U., Phos. Ac., Bell., Iod., Ars.
ATTENUATION.-To persons who have a choice of the
attenuations of medicines, the writer recommends the lower
in these affections; and the dose to be repeated from one to
four hours.
ACCESSORY MEANS.-The introduction of the catheter, so
frequently resorted to under the old treatment, is often
superseded by the more efficient remedies we employ; still
it may be necessary in some cases; but as this requires
professional skill, it is useless to refer to it further in
this manual. External applications, such as warm baths,
hot or cold baths, hot or cold cloths, fomentations, bland



280


DISEASES OF THE URINARY ORGANS.


drinks, and injections by the rectum, will greatly aid the
medicines in restoring the functions of the parts, if there be
not incurable organic disease. The diet must be sparing,
and, in some severe cases, restricted to demulcent drinks,
such as barley-water, gum-water, etc.
7.-Inflammation of the Urethra (Urethritis, Gonorrhcea).
The term gonorrhoea is used to signify inflammation of,
and a muco-purulent discharge from, the mucous membrane
of the urethra, and of other portions of the genitals in the
male, and of the vulva and vagina in the female.
QAUsEs.-Gonorrhcea is usually produced from the application of a specific and highly-contagious animal poison
during impure or indiscriminate sexual connexion, to the
parts implicated. But although the application of infectious
matter during an impure intercourse is, undoubtedly, the
most frequent cause, yet it is well known that the urethra
may become inflamed, and pour out a purulent discharge
from connection with a perfectly chaste woman not infected
by a third person. Of the truth of this statement we have
had ample and decided proofs. The menstrual fluid, profuse
or acrid leucorrhea, or the want of proper attention to
cleanliness in the female, may give rise to a discharge
having the characteristics, severity, and obstinacy of a
specific gonorrhceal disease.
The generally-received opinion is, that gonorrhoea is
always the result of sexual intercourse with a person already
infected; this incorrect notion has often led to unfounded
imputations on the chastity of individuals for which there
existed no other ground. The poison of gonorrhcea, then,
though by far the most frequent, is but one among many
causes capable of exciting inflammation of, and purulent
discharge from, the male urethra.



INFLAMMATION OF THE URETHRA.


281


SYMPTOMS.-These have been divided into three stages,
the initiatory, the infammatory, and the chronic. There is,
then, first experienced, a tingling or itching sensation, with
some degree of heat, at the orifice of the urethra, especially
when urinating. The lips of the urethra soon become red
and swollen, and on squeezing it a little, muco-pus exudes.
As the inflammatory stage sets in there are burning or
scalding pains on passing water, with increased secretion
from  the affected part, at first thin, but soon becoming
thick, milky, yellow, green, or even bloody; there is also,
during this stage, a good deal of constitutional disturbance,
and complications, such as are afterwards mentioned, are
prone to arise.
After the disease has continued for about ten days or a
fortnight, the chronic stage sets in; the inflammatory
symptoms begin to subside, leaving more or less irritation
in passing water, and a yellow discharge, which, under
unfavourable circumstances, may persist for a long time, and
then terminate in an obstinate, thin, transparent, painless
discharge (gleet); this is especially likely to occur in
strumous, phlegmatic, or gouty constitutions, and in patients
subject to chronic cutaneous diseases.
COMPLICATIONS OF GONORRH(EA.-(1.) Irritation, congestion,
or even true inflammation of the urinary organs, causing a
frequent desire to pass water, but extreme difficulty in
doing so; or there may be complete retention of urine. (2.)
Frequent, painful, and involuntary erections, crooked and
painful, occurring chiefly during the night (Chordee). (3.)
A thickened and constricted condition of the glans penis,
and effusion under it, so that the foreskin     cannot be
retracted (Phimosis). (4). Inflammation of the lymphatic
glands of the groin (Sympathetic bubo). (5.) Inflammation
of the testicles (orchitis), coming on at a later stage of the
disease, when the discharge has nearly ceased, and is
T



282


DISEASES OF THE URINARY ORGANS.


probably an extension of the inflammation from the urethra;
it is marked by pain, greatly increased by allowing the
organs to hang unsupported, excessive tenderness, great
swelling, fever, and often vomiting.
TREATMENT.-IIn the treatment of this disease homoeopathy
offers great advantages over the old system, for her medicines
are safe, pleasant, effective, sometimes rapidly so, and do not
interfere with the comfort, occupation, or health of the
patient. The following list includes undoubtedly the most
effective remedies for the internal treatment:-Acon., Cann.,
Canth., Apis., Copaib., Mere., Thuja, Tereb., Puls., Sulph.,
Ferrum, Caps., Iodine, Cicuta, Nit. Acid.
The writer deems it proper here to state, that he has found
the ordinary dilutions of the above remedies wholly inefficient in the treatment of gonorrhoea; while, on the other
hand, with a selection of one or two remedies from the above
list, in a more or less concentrated form, modified by the
symptoms and stages of the disease, he has removed the
complaint in an almost incredible short period, at the same
time that the patient has steered clear of all or most of the
usual sequelma. The following classification may assist the
practitioner.
(1.) The precentive period, which intervenes between
the exposure to the infection and the occurrence of any
symptom, averages about three days.
(2.)  The forming stage, when the symptoms of disease
first occur, are slight redness and tingling at the end of the
penis, and an augmentation of the natural secretion of the
parts. This stage lasts from   twelve to forty-eight hours.
The treatment in these stages, before any acute symptoms
have set in, is an astringent lotion, prepared according to
one of the following formule:Argenti nitras, gr. ij; aque des. ýviij.
Zinci sulph., gr. viij; aquwe des. ýviij.



INFLAMMATION OF THE URETHRA.


283


The selection of the lotion, and the frequency of its use,
must be determined by the circumstances of the case. A
glass syringe, of a suitable size and form, is necessary for
the application of the lotion to the diseased surface; also
tact and care in the mode of injecting, upon which much of
the efficiency of the lotion depends. This proceeding is
strictly homceopathic, and if employed early will almost
certainly arrest the disease. If, however, acute symptoms
have set in, it would be a most dangerous course. Avoidance of intoxicating beverages and stimulating food, with
quiet and rest, in the horizontalposture, will greatly facilitate
the cure.
(3.) The acute inflammatory stage usually continues from
eight to fourteen days, but may be shorter or longer,
according to the treatment adopted, and the constitution of
the patient.  The most useful remedies are:-Acon., Cann.,
CanthZ., Apis, MIer. Cor., Copaibce.  In addition to the
administration of one or more of the above, the treatment
must embrace moderate diet, linseed-tea, gum-water, barleywater, or similar demulcent drinks, taken ad libitum, and,
generally, the exclusion of fermented liquors. Also frequent
ablutions with warm or cold water, and keeping the parts as
free as possible from the irritating discharge. It is probably
the infectious nature of this matter which renders the
disease so obstinate, for it operates as a continual exciting
cause.
(4.) The fourth or chronic stage is that form  of the
disease termed gleet. Here also we may employ the local
measures before pointed out, together with the internal
administration of one or more of the annexed medicines:
Ferr., Aerc., Lye., Nux V., China, Puls., Petro., and Sulph.
Combined with these remedies, cold baths, or if practicable,
sea bathing, regular and early hours, and good but temperate
living, are necessary to ensure successful results.



284


AFFECTIONS OF THE HEAD.


We have entered less fully into the treatment of this than
of many other diseases included in this manual, because of
its difficult nature, and the annoying consequences which
it might entail on the patient, and also by exposing another
to the risk of contagion, if the best curative measures are
not adopted.   In certain constitutions the complaint is
sometimes very tedious, requiring a judicious course of
medicinal and general measures, such as only long experience
can suggest, to eliminate the poison from the system.
CHAPTER VIII.
AFFECTIONS OF THE HEAD.
-1.-Various Mental Disorders.
EMOT-IONS of the mind, of great intensity, long continuance,
or sudden occurrence, are prejudicial to the health in various
ways. It might, indeed, seem    improbable that material
drugs should have power to control mental disorders. We
have, however, ample experience to prove that the mind, or
the nervous system through which perhaps the mind acts, is
most powerfully influenced by medicines. Large quantities
of certain drugs produce distressing mental aberrations;
and our patients are constantly bearing testimony to the
power of properly selected small doses to promote a cheerful
and hopeful disposition.
By way of caution, it may be necessary to state that the
treatment should be general as well as medicinal, and that
as far as possible the cause of the disorder should be removed
or modified, if we desire the prescriptions to be completely
effective.
1. FRIGHT.-The consequences to the nervous system



VARIOUS MENTAL DISEASES.


285


resulting from the shock of a sudden fright may be palpitation of the heart, rush of blood to the head, feverishness,
headache, etc. Under such circumstances, Aconitum is indicated, and should be administered immediately, and repeated
every one to three hours for several times, if necessary.
Should fright be succeeded by confusion or stupor, from
which the patient can scarcely be rousedj Opium should be
selected in preference to Aconitum, and administered in the
same manner.
2. GRIEF.-This passion may occasion results both numerous and varied of an unfavourable nature; as a rule the
effects of grief or disappointment will be best counteracted
by Ignatia. A dose thrice daily for several days. If necessary,
Aurum or Staph. may also be considered.
3. PASSION-ANGER.-TO obviate any untoward effects
from a fit of anger, administer Chamomilla, if the subject
be a female or child, or Bryonia, in the case of an adult
male. A dose immediately, and repeated from one to three
hours. See also Hyos. or Coloc.
4. DISAPPOINTED LOVE.-To prevent the ill effects it might
occasion, Ign., Ilyos., Aur., or PAos. Ac., may be had recourse
to. A dose of Igyn. thrice daily for several days; afterwards,
if necessary, the same may be continued, or one of the other
named remedies substituted.
5. ExCEssIvE JoY.-Joy, if too great, may be hurtful;
to quiet the nervous excitement which it occasions, especially
in women, children, and delicate persons, Cofea should be
administered; a dose immediately after the exciting cause,
-  and repeated as may be necessary.
6. MENTAL,FATIGUE from    prolonged  study, or night
watchings, especially if combined with the use of stimulants,
or too little out-door exercise, requires NVux Vomica; a dose
thrice daily. In some cases this remedy should be preceded
by a few doses of Aconitum.



286


AFFECTIONS OF THE HEAD.


2.-Lowness of Spirits (Hypochondriasis).
This is a desponding state of mind, probably due to a disordered condition of blood, functional disease of the liver,
stomach, or urinary organs, imperfect secretions, or some
cause of exhaustion. Hypochondriasis is especially liable to
occur in persons whose social position renders regular occupation unnecessary, or in those who have retired from
business to enjoy in repose the fruits of their previous
industry; or, on the other hand, it may arise as the result
of excessive exertion of the brain or prolonged mental
anxiety. The painful operation of this mental condition is
forcibly described by Cowper, who when writing to congratulate a friend on his recovery from an acute disease,
remarks, " Your illness has indeed been a sad one, causing
great distress to yourself, and considerable anxiety to your
relatives and friends. But, oh! what are your bodily sufferings, acute as they undoubtedly were, to the unceasing
mental torture I suffer from  a fever of the mind?"
The hypochondriac is apt to imagine himself the subject of
some serious internal disease, and is often haunted with the
dread of insanity or of death. The affection bears the same
peculiar relationship to the male sex that hysteria does to
the female. It should be remarked, however, the patient's
maladies may not be all fanciful, and his statements and
symptoms should be carefully examined by his medical
confidant.
TREATMENT.-Aurum.-Hypochondriasis with melancholy,
which nothing seems to affect; loathing of life, or a suicidal
tendency; religious melancholy; uneasiness, apprehensiveness, sullenness, and indisposition to conversation.
Nux Vomica.-Hypochondria associated with affections
of the liver; irritability of temper, and inclination to
quarrel.



LOWNESS OF SPIRITS.


287


Staphysagria.-Melancholy and dissatisfied disposition;
indifference; depression, with an irritable, refractory, and
repulsive mood.
Ignatia.-Dejection  caused by the death     of friends,
pecuniary losses, disappointments, or any other depressing
circumstance.
Pulsatilla.-Patients inclined to weep, and of a quiet and
gentle disposition, the reverse of the Nux temperament.
China.-Lowness of spirits, with a feeble, impoverished
constitution.
ACCESSORY MEANS.-The weary mind should be relieved,
and vigour of body and cheerfulness of spirits secured by
a course of out-door exercises, physical training, bathing,
and suitable dietetic arrangements. Horse exercise is particularly advantageous. If " Indigestion " exists, the article
under that heading should be consulted. Hypochondria from
sexual vices requires the aid of a physician.
3.-Hysteria.
DEFINITION.-Hysteria is a disturbance of the nervous
system, marked by extreme exaggeration of the sensational
symptoms, chiefly affecting women, simulating the phenomena of almost any disease the patient may happen to
witness or hear described, and presenting consequently a
great variety of symptoms, which commonly assume a
paroxysmal, convulsive character. It is analogous to hypochondriasis, which affects the male sex.
The term hysteria implies the origin of the disease to
be in the womb; but the name is inappropriate, as except
occasionally, no such connexion exists between the womb
and the remarkable symptoms which are described under
this term.
SYMPTOMS.-" There are two mental conditions," says Mr.
Druitt, " generally found in hysteria, although they are not



288


AFFECTIONS OF THE HEAD.


peculiar to it, but belong rather to invalidism in general.
One is a tendency to imitation, in which the patient believes
she is afflicted with any disease whatever which may strike
her imagination, or which she chances to hear of, or which is
the subject of general conversation. The other is a diseased
egotism, which makes the patient delight in being ill, so as
it secures the undivided attention and sympathy of those
about her. This is at the bottom of those marvellous and
otherwise unaccountable tricks which hysteric patients resort
to in feigning disease."
Hysterical symptoms may be grouped under three classes.
First, that in which the sensation of a ball rising in the
throat (globus kystericus), or in which a.feeling of suffocation
is experienced by the patient, but without convulsions;
second, its paroxysmal form, in which the sensation of a
ball rolling in the stomach or chest, gradually rises to the
throat, where it produces a choking sensation, and panting
breathing; this is succeeded by partial insensibility, shrieks
and screams, irrepressible crying or laughter, convulsions,
etc.; third, those irregular forms which often arise in the
intervals of severe attacks. Hysterical paroxysms most
frequently occur about the menstrual period.
Hysteria is remarkable for the wide range of symptoms
it may occasion, and the multitudinous diseases it may
mimic; we may instance, especially, stricture of the oesophagus, laryngitis, pleurisy, neuralgia, loss of voice, difficulty
in passing water, a barking cough (more annoying to the
hearer than to the subject), disease of the spine or joints,
and many other inflammatory diseases. In these cases the
patient deceives herself, and endeavours by extreme statements of her sufferings to mislead others. An observant
medical man, however, need never be deceived. In addition
to the diagnosis referred to in the next paragraph, even the
external conformation of the features may be referred to as



HYSTERIA.


289


often  sufficient to indicate  the existing   tendency.    The
"facies hysterica" may be recognised by the remarkable
depth and prominent fulness of the upper lip, which is more
or less thick.   There is also a fulness of the eye, with a
tendency to drooping of the upper eyelids (AitKen).
HYSTERIA    AND   INFLAMMATORY     DISEASES.-Although      a
medical man may for a moment experience difficulty in
deciding whether a patient is suffering merely from hysteria,
or from a serious disease, he is. able by the use of the
Thermometer to determine the point. The temperature of
patients in acute inflammation is invariably raised; but the
temperature of hysterical persons is always natural (98~
Fahr.).   Thus we possess in the thermometer a sure means
of diagnosing between these conditions. If the temperature
be normal, the patient is not the subject of acute inflammatory disease.    Further, the state of the pulse, the intermittent character of the pains, and the general integrity of
the nutritive processes, furnish additional proofs of the real
character of the disease.
EXTENT OF HYSTERICAL AFFECTIONS."You may deem them," says Mr. Skey, " to be exceptional. I assure
you they constitute the rule of disease, and not the exception. Real
disease is the exception. Speaking of one variety, and they have all
characters in common, Sir B. Brodie says, 'I do not hesitate to declare
that, among the higher classes of society, at least four-fifths of the female
patients who are commonly supposed to labour under diseases of the
joints, labour under Hysteria and nothing else.' I would venture to
enlarge this statement as regards the 'upper classes)' by including a large
proportion of the lower; for much of my own experience of Hysteria has
been obtained from the wards of St. Bartholomew's Hospital; and in
reference to spinal affections in young persons, I unhesitatingly assert
that real disease is not found in a greater proportion than one case in
twenty, and even this is a liberal allotment."
Respecting supposed cases of diseases of the spine, the
same gentleman remarks,



290


AFFECTIONS OF THE HEAD.


" Thirty or forty years since these cases were, happily for our time, far
more common than at present. At that date, and for how many years
anterior I know not, all the sea-side towns were crowded with young
ladies between 17 and 25 years of age, and beyond it, who were confined
to the horizontal posture, and were wheeled about on the shore in Bath
chairs, on the supposition that they were the subjects of spinal disease.
They were placed under much medical and dietetic discipline, not of the
most invigorating character, and the large majority carried a pair of
handsome issues in the back! Brighton, Worthing, Hastings, and other
places on the South Coast were largely tenanted by these unfortunate
females, to which a moderate sprinkling of young gentlemen was added.
What has become of all these cases? They appear to have vanished just
in proportion as the eyes of the surgeon have opened to the absurdity
of inferring that pain alone which locates itself with remarkable precision
in Hysteria on a given vertebra can indicate the presence of organic
disease of the body of the bone without collateral evidence in its favour.
When the spinal column is really diseased the case is obvious at a glance;
the health is degenerate, and the whole system proclaims to the eye of the
surgeon the presence of a great evil. These examples are but a miserable
mockery of the reality, and a fraud on the judgment of the ignorant."
HYSTERIA AND EPILEPSY.-There are some points of resemblance between hysteria and epilepsy, but the following
will be sufficient to distinguish between these affections.
In epilepsy there is entire loss of consciousness; in hysteria
it is seldom complete, never occurs at the outset of a fit, and
the patient is able, although she does not always choose, to
repeat observations made at the time. In epilepsy, the face
is usually livid, the patient foams at the mouth, the expression
is frightful, and the convulsive movements are often more
marked on one side than the other; symptoms which are
not present in fits of hysteria. An hysterical attack is less
severe than an epileptic, and is not followed by profound
sleep, nor is the tongue bitten. Hysteria is not only almost
entirely confined to women, but chiefly to that period of
their life in which the sexual functions are, or should be,
fully developed and in their greatest vigour.



HYSTERIA.


291


CAUSEs.-Natural or acquired feebleness of constitution;
mental suffering; and derangements of the sexual system,
such as profuse menstrual or leucorrhoeal discharges, delayect
development of the generative organs, or too strong sexual
propensities. The unmarried are most liable to the disease,
and those who suffer from "Amenorrhoea" or "Menorrhagia;"
when married women suffer it is usually just after conception,
or before childbirth, or afterwards, as the result of prolonged
nursing. Although essentially a disease of a neivous nature,
it is easily excited into activity by any circumstance that
operates powerfully upon the economy, like suppressed,
irregular, or profuse menstruation, leucorrhoea, depressing
emotions, fright, the loss of a husband, child, or friend,
disappointed love, novel reading, and a luxurious mode of
life. Persons whose circumstances do not compel them to
be industrious, and can command the attendance of the physician and the sympathy of friends, often fail in that mental
resolution which is necessary to throw off the sensations of
lassitude and unreal fatigue.   Such a person often says
she is tired, and could not walk another step. She even
thinks so; and without any inducement does not call into
exercise that reserved fund of physical strength which is so
rarely exhausted. Poor persons cannot afford this indulgence, and by putting forth energy resist the sensations.
TREATMENT.-This includes the measures necessary to be
adopted during a fit, and those in the intervals. During a
fit, the patient's clothes should be loosened; she should have
abundance of fresh air, and be prevented from     injuring
herself. The sudden, copious, and continuous application of
cold water to the head and face will be almost certain to cut
the fit short. There is more virtue-in cold water than in any
other single remedy. In hospitals the practice is often
adopted, to draw the head quite over the side of the bed, and
pour on it from a considerable height a large quantity of



292


AFFECTIONS OF THE HEAD.


water out of a pail, jug, or other large vessel, directly over
the mouth and nose of the patient, so as to arrest her
breathing and force her to open her mouth. Previous to the
adoption of this practice, three or four patients might be
seen simultaneously in the same ward in an hysterical
paroxysm. Now, however) hysterical fits are rare, and seldom happen twice in the same person, and never become
epidemic (Watson, Aitken).
Mr. Skey states that, on one occasion, nine young women
were affected at the same time; some of them so violently
as to call for the assistance of sisters, nurses, and other
servants; and as a person under the influence of hysteria
brings into action all the latent strength of her muscular
frame, which is greatly in excess of her apparent strength,
the services of these attendants were scarcely sufficient The
attack commences in the person of a girl, the subject, perhaps, of a trifling operation, or under the influence of
mental emotion. No sooner is this condition observed by
her fellow-patients, than it spreads from bed to bed, the
others taking the disease in the order of their constitutional
liability.
These curious attacks, though they appear to the subjects
of them irresistible, are yet but the result of what has been
termed a surrender, and might be prevented by an adequate
motive. The mode adopted to arrest the malady consists in
making some strong and sudden impression on the mind
through the medium of, probably) the most potent of all
impressions, fear, Sympathy, kindness, tenderness of voice
and manner, aggravate rather than mitigate the evil. On
two occasions a few quarts of cold water suddenly thrown on
the person of a chief delinquent) instantly brought the ward
to a state of reason and tranquillity, the disease succumbing
to the indignity of the treatment.
On standing by the bedside of a patient in a paroxysm,



HYSTERIA.


293


advantage may be taken of her apparent unconsciousness,
by speaking in a subdued voice, but sufficiently loud for her
to hear, of some mode of action which she will be certain to
disapprove of, especially the free use of cold water, and the
very mention of which may be sufficient to terminate the
fit.
If there is coldness of the surface, two pilules saturated
with the strong preparation of Camphor may be given every
few minutes during the fit, or the strong tincture may be
applied to the nose.
In the intervals, the following medicines and general
treatment may be resorted to, according to the symptoms
present.
REMEDIES:-Ign., Coc., Plat.; also Puls., Valer., Staph.,
Bry., Nux., Aur., Bell., Hyos., Clam., Sep., Mosh., Stram.,
Verat.
Ignatia.-This is generally a valuable remedy when the
temperament of the patient corresponds, particularly in
hysteria from disappointment, mortification, or any intense
mental excitement, with hysterical convulsions, the sensation
of a ball rising in the throat, or a suffocative constriction
and difficult swallowing, or a feeling as of a nail penetrating
the brain. If necessary, it may be followed by IHyoscyamus
or Aurum.
Cocculus.-Hysteria with a weeping or irritable mood;
dejection, especially in the afternoon; uterine spasms, with
suppressed or irregular menstruation; profuse discharge of
watery urine; leucorrhoea; fainting fits; etc.
Pulsatilla.-Hysteria evidently depending upon, or associated with, suppressed period or uterine disorders, especially
when the Puls. temperament corresponds. It may be followed by Sabina or Silicea.
Platina.-Congestion to the uterus; too early, profuse, or
too prolonged menstruation, preceded by bearing-down,



294


AFFECTIONS OF THE HEAD.


labour-like pains; melancholy, anxiety, trembling, or nervous debility. This remedy is well suited to the spasmodic
affections of hysterical persons of an irritable, sad, peevish,
or reserved disposition, and to those of proud and haughty
manners.
Valeriana.-Mental excitement, visual illusions, a dreamy
tendency, agitation, and occasionally spasmodic movements;
alternate mirthfulness and dejection; dyspeptic or heart
symptoms, such as are complained of by hysteric persons.
The provings of this drug show its special adaptation to
numerous forms of hysteria.
Nux Vomica.-Hysteria arising from torpid action of the
bowels, with disagreeable taste in the mouth; bitter or acrid
eructations, flatulence, hiccough, distension and pain in the
stomach, headache, giddiness, faintness, and tendency to
convulsions. After administering it for several days, Sulphur
may be substituted.
ACCESSORY MEANS. - Crowded and heated churches or
rooms, theatrical exhibitions, novel reading, tight stays, and
late hours, both in retiring at night and rising in the morning, should be imperatively forbidden. At the same time,
the following directions cannot be too strongly insisted upon,
as absolutely necessary in the removal of the affliction. The
daily use of the shower-bath; regular out-door walking
exercise; cheerful society and conversation; and physical
and mental occupation, of a useful character.      Healthy,
-useful employment should become a uniform habit, and the
patient made to feel that life is not a mere holiday to be
spent in gaiety, frivolity, and idleness, but a most important
period of existence, every day of which should be passed in
active usefulness.



DELIRIUM TREMENS.


295


4.-Delirium     Tremens-Brain Fever of
Drunkards (Ebriositis).
DEFINITION.-This disease is essentially one of exhausted
cerebral and nervous power, from the excessive use of alcohol
in its various forms, the most prominent feature being a
suspicious, but generally controllable, delirium, with tremors,
sleeplessness, frequent pulse, furred tongue, and a cool moist
skin.
EFFECTS OF THE INTEMPERATE USE OF ALCOHOL.-The
physical action of alcohol when taken in large, or in frequent
small, quantities, not only tends to impair the coats of the
stomach, but even when taken considerably short of producing any marked effect on the nervous system, may
interrupt the process of absorption, and consequently of
nutrition, and   thus insidiously lay the foundations of
irreparable disease. The first pernicious result of the introduction of spirituous liquors into the stomach is the coagulation of all albuminous portions of food or fluid with which
they come in contact.     This coagulation is very different
from the physiological one effected by the gastric fluids, and
in fact, tends to render the substances more difficult of
solution by the gastric juice; changes, partly of a chemical
and partly of a vital nature, are induced; the general
nutrition of the body suffers, and if the habit is persisted
in, an incurable cachexia results.
The effects of alcohol on the brain is very marked and
disastrous when taken daily, though to an extent short of
producing intoxication.
"The functions of the nervous system are more or less imperfectly
performed. The want of a proper controlling influence of the nervous centres is seen in the trembling hands and shambling gait;
the brain, through over-excitement, is under-nourished, and there is
a want of intellectual power and decision of will. Sleep, the great



296


AFFECTIONS OF THE HEAD.


restorer of nervous power, is irregular and disturbed; the membranes
of the brain become congested, and there is headache; giddiness also
frequently occurs on any sudden movement. The intellectual functions
are sometimes greatly disturbed, and hallucinations of various kinds are
observed. The feelings also become blunted and perverted. If timely
warning is not given and taken, derangement more or less complete of the
cerebral functions comes on, and the person becomes insane. The records
of our lunatic asylums afford abundant evidence of the fact, that undue
indulgence in alcoholic beverages is a fiequent cause of insanity"
(Lancaster).
SYMPTOMS OF DELIRIUM     TIEMENS.-The disease may only
appear after a long course of alcoholic stimulation, or it
may be suddenly developed after a protracted debauch.     The
earliest symptom    is one of great mental and       physical
depression. The patient is pale and chilly; he fancies he is
haunted by spectres, and is afraid to be alone. A state of
excitement and delirium   follows, in which he becomes the
victim of various painful delusions, chiefly having reference
to his business, which he thinks is irretrievably ruined, or to
his friends, whom    he believes are plotting against him.
The delirium is of a timid, suspicious, jealous nature; he
suspects everyone around him, is constantly talking or
muttering, and, haunted by spectral illusions and imaginary
horrors, he desires to get up, and often makes violent efforts
to flee from foes and danger. Sleep almost wholly forsakes
him; he becomes restless in the extreme, trembles all over,
and is frequently    endeavouring   to change his place or
posture; he moves his hands over the bed-clothes, and
declares that rats, mice, beetles, etc., are about or under
them, that strangers are in the room, or will insist upon
getting into his bed, or that listeners are at the door or
concealed behind the curtains. The patient is, however,
easily subdued, and induced to remain quiet, at least for a
time. His eyes are very restless, and the conjunctivae are
red and injected; his face pale, but sometimes flushed and



SDELIRIUM TREMENS.


'297


wild-looking; his skin is commonly moist or clammy; his
pulse weak and compressible, the action of the heart is often
violent, and there is entire loss of appetite.
" All these symptoms indicate a brain thoroughly disorganised, and, in
a large number of cases, the disease proceeds till coma or convulsions
terminate the existence of the unhappy victim.  That this disease
is entirely dependent on the action of alcohol is seen by the fact,
that, in cases of recovery, the symptoms subside just in proportion
as the alcohol is given time to pass out from the system. So dependent
are the symptoms of this disease on the want of sleep, that it would
appear that the alcohol acts on the brain by over-stimulating it and
preventing that rest in sleep which is necessary for its nutrition. The
delirium is generally arrested when the patient gets sleep, hence the
general practice of medical men in this disease is to give opium till
sleep is procured; at the same time, it has been shown, that by waiting
till the alcohol gets out of the system, natural sleep comes on, and the
affliction disappears without the administration of opium at all. This
fact is a very important one, as there is not wanting evidence to show
that the administration of opium may hasten that comatose state in which
the patient is sometimes carried off" (Lancaster).
DIAGNOSIs.-The character of the pulse, skin, and tongue
is sufficient to distinguish the disease from   inflammation of
the brain or its membranes; the pulse is frequent and soft;
and the skin and tongue are moist, the latter being covered"
with a white fur.
CAUSES.--Excessive, long-continued excitement, most
frequently from the use of spirituous liquors, wine, or beer.
The habitual use of opium or other narcotics, or even
extreme and prolonged mental excitement, often produce an
analagous affection. According to some writers, delirium
tremens sometimes sets in as the result of the sudden withdrawal of the accustomed stimulants; but this is an error.
The occasional development of the disease under this circumstance is known to be nothing more than a coincidence.
The experience derived from hospital practice, or from prison
u



298


AFFECTIONS OF THE HEAD.


discipline, abundantly proves that a person who indulges
very freely in stimulants may suddenly abandon them without any risk. Indeed, as with other poisons, the great
danger to be feared arises from their continued employment.
TREATMENT.--NUX, Opi., Thyos., Stram.
nux Vomica.-Pain in the pit of the stomach; pale or
bloated countenance; spasmodic vomiting of bile; desire to
be in the open air; unimpaired consciousness. This remedy,
if administered early, will often arrest the disease.
Opium.-Stupefaction; gloomy or suicidal feelings; frightful or fantastic visions; moist, cold skin; tremor; grasping
at imaginary objects.
Belladonna.-Delirium; red, flushed face; congested or
swollen eyes, with sparks before them; tongue and mouth
red, hot, and' dry; thirst; starting suddenly from sleep;
suppressed secretions. It is. particularly adapted for the
delirium of patients of a full plethoric habit, with a tendency to congestion of the head.
Stramonium and IHyoscyamus are useful in cases complicated with convulsive movements; epileptic paroxysms;
muttering delirium; suppression of the secretions; and in
extremely irritable, noisy, and unmanageable patients.
AccEssoRY MBEANS.-Skilful, careful nursing is of the first
importance. The patient must not be left one moment
alone, and restraint, if necessary, should be of the gentlest
nature, and not exercised an instant beyond the requirements
of the case. The patient should remain in a quiet, darkened
room, and everything be done to induce sleep, and obviate
mental irritation.
DIET.-The immediate cause of danger is from exhaustion;
hence the importance of supporting the strength by nutritious,
digestible diet, in a fluid form,-beef-tea, soups, yolk-of-egg,
etc., in small quantities frequently repeated. " The stimulus
of such a spice as cayenne pepper, given in soup, on the



EPILEPSY.


299


atonic stomach, will have a favourable influence on absorption " (Aitken). A cup of coffee is sometimes useful to quiet
the nervous excitement. If sleep was not procured, nor
nourishments administered, the patient would sink and die
from exhaustion.
5.-Epilepsy (Epilepsia).
DEFINITION.-This condition is characterised by sudden
and complete loss of consciousness and sensibility, with
spasmodic contractions of the muscles; a seizure lasts from
two to twenty minutes, recurs at variable intervals, and is
followed by exhaustion and sleep.
The suddenness of an epileptic attack is very characteristic,
and is expressed in the name of the disease, which literally
means a seizure; so that almost in a moment, the patient
falls to the ground, struggling, foaming, and insensible.
"This disease has been known from the earliest antiquity,
and is remarkable as being that malady which, even beyond
insanity, was made the foundation of the doctrine of possession by evil spirits, alike in the Jewish, Grecian, and
Roman philosophy" (Aitken).
SYMPTOBIs.-Here we may include those which precede,
those which attend, and those which follow an attack. The
symptoms which PRECEDE a fit are sometimes, but not in the
majority of cases, sufficient to warn the epileptic of what is
approaching; they vary both in character and duration;
sometimes being too brief to allow the patient to remove
from the fireplace, the edge of a precipice, or the vicinity of
water, to dismount from horseback, voluntarily to lie down,
or even to intimate to those around him what is about to
happen.    In other instances, an approaching seizure is
clearly indicated for many minutes, or even hours, before its
actual occurrence. The kind of warning is very variable in
different cases, often consisting of such symptoms as head



300


AFFECTIONS OF THE HEAD.


ache, giddiness, indistinctness of vision, irritability, gloomy
mood, spectral illusions, etc. Dr. Gregory, of Edinburgh,
was informed by a patient of undoubted veracity, that in his
case an attack was always ushered in by an illusion in
which he saw a little old woman in a red cloak advance
towards him, and strike him     a blow  on the head, on
receiving which he immediately lost all recollection and fell
down. But the most striking premonition is that called the
aura epileptica.  This is a sensation which is variously
described by different patients; thus it is likened to a stream
of warm or cold air, to the trickling of water, or to the
creeping of an insect. The sensation commences at the
extremity of a limb, and gradually runs along the skin
towards the head; or, occasionally, it gets no further than
the pit of the stomach; and, as soon as it stops, the fit
occurs. A knowledge of these circumstances is of considerable importance, as it respects the comparative safety of the
patient during an attack, and, also, in some instances, time
is afforded to interpose remedies that may avert the paroxysm.
AN EPILEPTIC FIT.-An epileptic seizure is sudden; the
patient, apparently in the enjoyment of sound health, utters
a loud piercing shriek or scream, and falls suddenly to the
earth, convulsed and insensible. The cry, which is frequently,
but not invariably uttered, is so peculiar and terrifying, that
women are often thrown into hysterics on hearing it. " On
one occasion," Dr. Cheyne states, "a parrot, himself no
mean performer in discords, dropped from his perch, seemingly frightened to death by the appalling sound." During
a fit, the convulsive movements, especially of the head and
neck, are often very extreme, one side being frequently
more affected than the other; there is violent closure of the
jaws; the tongue is liable to be protruded and bitten; a
foam issues from the mouth, often coloured by blood; the
eyes quiver and roll about, and sometimes are fixed and



EPILEPSY.


301


staring; the hands are firmly clenched, and the thumbs
bent inwards upon the palms; faeces, flatus, semen, and
urine sometimes escape involuntarily; the breathing is
impeded, and performed with a hissing sound and a spasm
of the larynx; the cheeks and lips become purplish and
livid, and the veins of the neck and forehead are greatly
distended, the heart acts tumultuously, and death seems
inevitable. Gradually, however, there is a remission of
these terrible symptoms; and the patient is left insensible
and apparently in a sound sleep, from which he recovers
confused and exhausted, having no knowledge of anything
that has passed.
SYMPTOMS FOLLOWING A FIT.-Some few patients recover
perfectly in a few minutes; some regain consciAlsness and
then sink into profound repose; but more frequently patients
do not recover consciousness upon the cessation of the convulsions, the slumber succeeding the struggles without any
lucid interval. On emerging from the slumber, the patient
may merely feel languid and inert, or like a person stunned,
or in a state bordering upon idiocy.
CONSEQUENCES OF EPILEPSY.-Repeated attacks of a severe
kind are liable to enfeeble the memory, impair the intellectual faculties, and in some instances, unhappily, terminate
in irremediable imbecility. It is the liability of such a
termination as this that invests the disease with such painful
interest. "Every successive attack strengthens the habit,
and renders the individual more obnoxious to future seizures"
(Sieveking).
CAUSES.-These are very varied, but doubtless the most
frequent is hereditary tendency.  It is well known that
epilepsy is most frequent in confirmed lunatics and idiots, as
the result of some malformation of the brain. Injuries of
the skull, such as fracture, tumours, inflammations, and
malformations of the skull, as one half being unlike the



302


AFFECTIONS OF THE HEAD.


other, abnormal, osseous deposits within        the cranium,
especially spiculee of bone formed on the inside of the dura
mater.    In post-mortem   examinations, the bones of the
head are sometimes found thickened or otherwise diseased.
The most frequent exciting causes are, derangement of the
nervous or sexual systems; immoderate sexual indulgence,
as well as too prolonged abstinence from sexual intercourse;
self-abuse, and prostration of nervous power from any
cause.
"The most powerful predisposing cause of any, not congenital, is
masturbation-a vice which it is painful and difficult to allude to in this
manner, but still more difficult to make the subject of inquiry with a
patient. But there is too much reason to be certain that many cases of
epilepsy owei their origin to this wretched and degrading habit; and
more than one or two patients have voluntarily confessed to me their
convictions that they had thus brought upon themselves the epileptic
paroxysms for which they sought my advice."''
We may enumerate fright, fits of rage, derangements of
the digestive organs, the irritation of worms, menstrual
difficulties, repelled eruptions, especially those about the
head, and    the   sight of other epileptics, as additional
exciting causes.
DIAGNOSIS OF FEIGNED EPILEPSY.-Impostors often feign
epilepsy with the view of exciting charity; but two or three
circumstances will generally lead to their detection.   1.-In
epileptic seizures, the eyes are partly open, and the eye-ball
may be seen rolling and distorted; an impostor almost
always performs with closed eyes, and, if narrowly watched,
may be seen now and then to open his eyes, to learn the
effect of his exhibition upon the bystanders.     2.-The skin
during an epileptic paroxysm is usually cold, but that of an
exhibitor is hot and perspiring, manifestly the result of his
severe voluntary efforts.  3.-The genuine sufferer, if he has


* Sir Thomas Watson, M.D.



EPILEPSY.


303


any signs of an approaching attack, selects a retired spot, or
his own house; the impostor selects a crowded thoroughfare
as the most suitable place for a performance, and never his
own home; at the same time avoiding situations in which
he is likely to sustain any personal danger. Lastly.-In
true epilepsy the patient is insensible to external impressions; it is quite otherwise with the feigned, and hence
pressing the thumb-nail violently under that of the supposed
impostor, which causes severe pain without serious injury,
often leads to the detection of the sham. Mr. Hutchinson
relates the case of a sailor who was suspected to be a cheat,
in whom the convulsions were instantly removed by blowing
some fine Scotch snuff up his nostrils through a quill. This
brought on another kind of fit-a fit of sneezing, which
lasted nearly an hour; and there was no return of epilepsy
so long as Mr. Hutchinson remained in that ship. The
same expedient was tried in cases of real epilepsy, but
without producing any similar results. There was a beggar
in Paris, who often fell into epileptic fits in the street; one
day some compassionate spectators, fearing that he might
injure himself in his struggles, obtained a truss of straw
and placed him upon it: but when he was at the height of
his paroxysm, and performing remarkably well, they set
fire to the straw, and he presently took to his heels.
TREATMENT DURING A FIT.-The patient's tongue should
be put back into his mouth, and a linen pad or cork fixed
between his molar teeth; he should be laid on a bed or rug,
fresh air freely admitted around him, his head slightly
raised, and all ligatures relaxed that interfere with circulation and respiration.   Throwing cold water on the face
appears to do no good; and restraint should not be exercised
beyond what is necessary to prevent exposure or to guard
against falls or injury. In cases preceded by the aura
epileptica, a firm ligature applied above the part where the



304


AFFECTIONS OF THE HEAD.


sensation is felt, is said to prevent the attack. After the
fit, the patient should be allowed in comfort to pass the
period of sleep which usually follows.
TREATMENT BETWEEN    THE   FITS.-In  addition to the
administration of one or more judiciously-selected remedies,
an endeavour must be made to discover some exciting cause
of the malady, and then to attempt its removal. If possible
the patient should be under the care of a homeopathic
physician.
Bellaclonna.-Great irritability of the nervous system, the
patient starting at the least noise; tremor, and twitchings
of the muscles; unnoticed escape of famces or urine; sparkling of the eyes, intolerance of light; stammering; congestion of blood to the head; also when the disease occurs
during teething. If administered as soon as the earliest
indications of an attack present themselves, if not sufficient
to entirely stave it off, it will in all probability mitigate its
severity.  Stramonium  may often advantageously follow
Belladonna, or be alternated with it.  After an attack, a
dose may be given every six hours, for two or three days.
Cuprum.-Commencement of the symptoms in the fingers,
toes, or arms, moving towards the head, until there is loss
of speech and consciousness; salivation, flushed face, and
red eyes; recurrence of the fits about every month,
especially in females at the menstrual period.
ignatia.-The patient is nervous, sensitive, and pale;
great anxiety and deep sighs precede the attacks; daily
paroxysms; and when violent grief or injured feelings seem
to bring on a fit.
Nux TVomica.-Indigestion, constipation, and ill-humour
between the fits; the patient takes too little out-door
exercise; epilepsy associated with prolonged indulgence in
intoxicating beverages.
Opiumn.-Epilepsy caused by fright; also if the patient



EPILEPSY.


305


falls down with a cry, after which deep sleep and stertorous
breathing come on. If, after a fright, the symptoms point
to Belladonna, Opi. and Bell. may be given alternately.
When the disease occurs as the consequence of inebriating
drinks, with the above symptoms, Opium and Nmx Vomica
will often effect a cure, providing the intemperate habit is
permanently reformed.
Phosphorus.-Epilepsy from onanism, or sexual abuse of
any kind. If the habit in question is discontinued, the
judicious employment of this remedy, or any other indicated,
may be of great service.
China.-For some patients this remedy may be selected
instead of, or after, Phosphorus.
Chamomilla.-Epilepsy in children; when the attack is
caused by anger, preceded by colicky pains, and followed by
sudden stretching of the limbs and clenching of the thumbs;
the attacks are often   accompanied by    sour vomitings,
paleness of one cheek and redness of the other.
Cina.-If the affection is attributable to the irritation
of worms.
Sulphur.-Chronic epilepsy; or when the disease is connected with the suppression of an eruption or discharge; it
is especially suitable for scrofulous persons.
One of the following remedies may sometimes be required:-Stram., Stan., Cocc., Calc. C., Silic., Caust., Agar.
Musc., Valer., Verat., etc.
Dr. Marcey states that if the paroxysms have been caused
by fright, grief, chagrin, or from some other sympathetic
emotion, we may often prevent an attack (homoeopathically)
by exercising the patient with some more potent mental
influence, which shall supersede the original cause. It was
upon this principle that Boerhaave cured a number of
epileptics, at the hospital for orphans of Haarlem, who had
been attacked in consequence of fright, from     seeing an



306


AFFECTIONS OF THE HEAD.


epileptic-brought into the hospital during a paroxysm. In
these instances he had a red-hot poker kept ready, in order,
as he assured these girls, that he might apply it to their
heads as soon as there was any indication of an attack. The
fright caused by this idea entirely overwhelmed the other
cause, and cure was the general result.
Dose and Repetition.-See page 49.
ACCESSORY MEANS.-Regular healthy exercise is beneficial,
but it should never be carried too far, as fatigue often
excites an attack. Epileptic patients require much rest.
Plain food of a nourishing kind, in moderate quantities;
cold  ablutions every   morning, and    cheerful company.
Patients having a tendency to plethora or congestion, should"
entirely avoid stimulants; also violent emotions, excesses of
every kind, more especially sexual, and the inordinate use of
food and drink. The treatment of epilepsy occurring in
children during teething, is precisely similar to that recommended in the section on " Infantile Convulsions," and is
almost uniformly successful.
6.-Hydrophobia (Rabies).
This terrible malady gives rise to great sufferings, and
almost universally terminates fatally. Its chief characteristics are, severe constriction about the throat, spasmodic
action of the diaphragm; a peculiar dread of fluids, and
difficulty of swallowing them; anxiety and restlessness; and
exhaustion, delirium, and death. Although incurable, we
will offer some suggestions, which, if acted upon, may
prevent the accident which gives rise to this disease, or
render it comparatively harmless.
Hydrophobia generally occurs as the result of a bite of a
rabid dog, or simply from its licking an abraded portion of



HYDROPHOBIA.


307


the skin;* and as " prevention is better than cure," we will
first point out the
SYMPTOMS OF RABIES IN THE DoG.-The earliest symptoms, according to Mr. Youatt, are unusual sullenness,
fidgetting, and frequent shifting of posture; loss of appetite; lapping his own urine, and disposition to lick cold
surfaces, such as stone and iron; to eat straws, litter,
excrementitious matter, and other rubbish, and fighting with
his paws at the corners of his mouth.
A very early and constant symptom is change of voice.
Every sound uttered by a rabid dog is more or less changed,
but there are two in particular; one being a hoarse inward
bark, with a slight elevation of tone, and another a perfect
bark, ending abruptly, and very singularly, in a howl, a fifth,
sixth, or eighth higher than the commencement.
The amount of ferocity in rabid       dogs varies; some,
showing extreme fondness, are perpetually trying to lick the
hands and face of those they know, whilst others snap and
bark, and rush to the end of their chain to meet an
imaginary foe; or if loose, rush out, biting every one they
meet. There is no dread of nrater, as in human beings, but,
on the contrary, great thirst, which the animal tries to
appease by lapping as long as he has power over his jaws;
or when paralysis of the muscles of the mouth and jaws
occurs, the poor creature plunges his muzzle into water up
to the very eyes, in order to convey fluid to his parched
mouth and throat.    When the disease is fully matured, there
are delirium, more or less ferocity, alteration of voice,
distressing thirst, and viscidity of the saliva, which adheres
* The following accident, narrated by Mr. Lawrence, shows the impropriety
of permitting caresses from a dog. "A lady had a French poodle, of which
she was very fond, and which she was in the habit of allowing to lick her face.
She had a small pimple on her chin, of which she had rubbed off the top; and
allowing the dog to indulge in his usual caresses, he licked this pimple, of
which the surface was exposed. Thus she acquired hydrophobia, of which
she died."



308


AFFECTIONS OF THE HEAD.


to the corners of the mouth, causing great annoyance. In
the last stages of the disease, the eyes become dull; the
hind legs, and afterwards the muscles of the jaw, are
paralysed; and the poor dog dies exhausted, in from four
to six days. Next to the dog, probably the wolf, the fox,
the jackall, and the cat, are most liable to hydrophobia.
CAUSES.-Close confinement, want of fresh water, unwholesome food, sudden changes from heat to cold, and
unsatisfied sexual desires. Male animals are more frequently
affected than female. The most common cause in dogs is a
bite from another animal already affected with hydrophobia.
It is asserted and generally believed in India, that rabies
never originates in dogs, but can always be traced to a mad
jackall or wolf entering a village or town, and biting
the dogs.
HYDROPHOBIA IN MAN.-Hydrophobia is always the result
of contagion, either from  a bite or from a rabid animal
licking some abraded surface of the body. A bite is less
dangerous when inflicted through clothing, than on an
exposed part of the body, as the teeth are wiped, and the
poison may be arrested by the clothes. Hence many persons
may be bitten by the same rabid animal, but not more than
one or two fall victims to hydrophobia.
SYMPTOMS IN MAN.-These are not manifested till a period
after receiving the infection, varying from about six weeks
to three months, possibly extending to one or two years;
the wound having probably healed, and the scar presenting
no remarkable appearance. Shooting pains of a rheumatic
character, and twitching and itching sensations are sometimes felt in the vicinity of the wound prior to an attack.
Sometimes there is stiffness, or numbness, or partial palsy;
or the wound may be red and swollen; there is an indistinct
feeling of uneasiness and anxiety, with giddiness, chills,
heats, and a general feeling of being unwell. The special



HYDROPE OBIA.


309


symptoms are arranged by Mr. Erichsen under three heads;
consisting (1) of a spasmodic affection of the muscles of the
throat and chest. The act of swallowing commonly excites
convulsions, and the recollection of these sufferings makes
them afraid to repeat the attempt; hence that horror of all
liquids which is so remarkable a feature of the disease.
There is also a catch in the breathing somewhat resembling 
that which is experienced when an individual plunges into a
cold bath. (2) An extreme degree of sensibility of the
surface of the body, probably the most marked symptom.
The cutaneous nerves become so sensitive that the gentlest
current of air, the movement of the bedclothes, the opening
or shutting of the door of an apartment, the reflection of
light from a mirror, a sound, or even a look, is sufficient to
bring on the convulsive fits. (3) M1ental agitation and terror
is another early and persistent symptom. Profound despair,
with a horror and dread at the impending fate, frequently
marks the disease throughout.   Delusions of a spectral
character often prevail, the patient fancying himself surrounded by horrid forms; these delusions may alternate
with maniacal fury; and occasionally, but rarely, mental
composure may prevail. To these symptoms we may add,
extreme thirst; the secretion of a remarkably viscid saliva,
the effort to discharge which brings on the convulsive fits;
sometimes there is vomiting; the convulsions increase in
frequency and violence; the lips and cheeks become livid,
and perpetually quiver; till, at length, one fit lasts long
enough to exhaust the remaining strength, and death
releases the patient from his misery.
TlEATMENT.-This must be chiefly of a palliative character, for the cure of the disease, when once established, seems
in the present state of our science an almost hopeless
attempt.
Immediately after a person has been bitten by a sus



310


AFFECTIONS OF THE HEAD.


pected animal, the wound should be sucked with all the
force the patient can command; and if he is too much
alarmed or otherwise unable to do it himself, a friend should
do it for him. As soon after this as possible, a surgeon
should excise* the wounded part, care being taken to remove
every portion touched by the animal's teeth, and to obtain a
clean raw surface. The wound must then be washed by a
stream of warm water, and, afterwards, the nitrate of silver
freely applied. The patient should be put under chloroform,
so as to enable the surgeon deliberately and effectually to
carry out these necessary measures.       Should  the above
means be neglected many days, or even weeks, excision may
be performed at any time before the disease appears, or even
immediately after the first symptoms manifest themselves;
although they would then be done with less hope of a successful result. No measures should be regarded as superfluous which offer any possible chance of escape from so
fearful a malady.
The chief homoeopathic remedies are:-Belladonna, Cantkaris, Hyoscyamus, and Stramonium. These medicines are
on no account to supersede the local means just pointed out,
but to follow them, as further preventives, and also to be
used as palliatives, should the disease unhappily break out.
Belladonna, according to Hahnemann, is the most sure
preventive against hydrophobia; and certainly no        other
drug has the power of simulating the disease to the same
extent. Several very interesting cases of genuine hydrophobia, said to have been cured by this drug, are quoted in
Hempel's new " Materia Medica," (page 337-342, American
* Youatt objected to excision because he said the point or blade of the
instrument used was apt to be touched by the virus and thus infect the sound
parts. He recommended the free use of caustic, which decomposed the virus,
and formed a sort of cake enveloping it. He had himself been bitten many
hundred times by rabid dogs without infection, having always used caustic;
nor did he think it scarcely ever too late to take this precaution.



HYDROPHOBIA.


311


edition). As palliatives in this disease, we may further
mention the inhalation of chloroform, the use of opium,
the application of ice to the spine, etc. Even if a cure is
out of the question, still it is an important point to afford
some mitigation to the severe sufferings which attend this
disease.
PRECAUTIONS AGAINST HYDROPHOBIA.-" I think it right"
says Dr. Sumpter, " to call attention to the very obvious
error committed by most people suffering from the bite of a
dog, whether proved to be rabid or not, after examining the
wound, of directly replacing upon the part or parts bitten
the very same garment or covering through which       the
may-be envenomed fangs have passed, thus supplying the
very conditions necessary to the local absorption of most
poisons-i.e., an abraded cuticular surface, and an opposed
'virus;' for it may be taken for granted that when the
rabid dog's tooth passes through clothing before reaching
the flesh, more of the 'virus' of hydrophobia is in the
covering than in the wound. I call public attention to this,
for I believe the only measures of any use are directly after
the bite. First, to remove the poison by local suction or by
cupping-glass and excision; secondly, to improve general
health, and thus predispose against any after ill effects."
One additional precaution may be added. After a person
has been bitten by a suspected dog, the animal should on no
account be killed, for after all it may turn out that it was
not really mad; and by shutting it up and allowing it to
live, the non-malignant character of the affection may be
ascertained, which would be a source of unspeakable comfort
to the patient's mind, who would thus be relieved of a most
harassing fear, that might otherwise have tormented him
for months or years.



312


AFFECTIONS OF THE HEAD.


7.-Headache (Cephalalgia).
This condition frequently exists as an incidental symptom
of various acute and chronic diseases, such as common cold,
dyspepsia, typhus, or deranged period, and can scarcely be
isolated as an independent malady. Occasionally, however,
it is such a predominant and almost exclusive symptom,
from a more or less local affection, from some irritation of
the cerebral nerves, as to justify a distinctive consideration.
There are several varieties of headache, three of which we
will first briefly consider, and afterwards point out the general
symptoms and treatment of this and other affections of the
head. Other varieties are referred to in the table a little
further on.
8.-Gastric Headache-Sick Headache.
This, often erroneously called "bilious headache," is the
headache of indigestion, and appropriately    called  Sickkeadache. It may be only a temporary condition, from one
or two dietetic transgressions; or a more permanent one,
such as exists in persons constantly troubled with dyspepsia.
SYMPTOMS.-Nausea and sickness; stupefying or agonising
headache, generally commencing in the morning, and often
confined to one spot on the side of the head, on the forehead,
or over the eye, and attended with giddiness, dizziness, or
swimming in the head (vertigo), dimness of vision, or
intolerance of light, etc.
CAUSES.-Errors of diet; indulgence in wine; sedentary
habits; or it may occur in a weak stomach without any
immediate dietetic infraction.
TREATMENT.-ACOn., Ipec., Puls., Bry., Bell., or Nux V.
See " Symptomatic indications," page 315, and the section on
" Indigestion."



CONGESTIVE HEADACHE.


313


ACCESSORY MEANS.-Abstinence from rich or too fat food,
confectionery, coffee, and, generally, alcoholic beverages, are
indispensable in the successful treatment of this affection.
9.-Congestive or Plethoric Headache.
SYMPTOMS.-This form is marked by determination of
blood to the brain, the cerebral blood-vessels become greatly
congested, with flushed face; giddiness, especially on
stooping; throbbing pain in the head, increased by movement; a sense of pulsation in the ears, and beating of the
arteries in the neck. An attack sometimes occurs with
such suddenness and intensity that apoplexy appears inevitable. There are also distressing retching, chilliness, coldness
of the extremities, especially the lower, the pulse being
heavy, weak, slow, and intermittent.
CAUSES.-Living too freely; late hours; an inactive life.
Menstrual derangements in females often occasion congestive
headaches.
TREATMENT.-Acon., Bell., and Glon., are the chief remedies; sometimes Puls. and Ant. T.   For the symptoms
requiring these remedies, see pages 315-17.
ACCESSORY MEANs.-Headache attended with symptoms
of fulness, heat and heaviness, and also that arising from
indigestion, requires simple and light diet; animal food
should only be taken in small quantities, with a liberal
admixture of vegetables; rich, fat food, over repletion of t/e
stomach, and alcoholic beverages are particularly to be
abstained from.  Immoderate excitement, heated rooms,
fits of passion, or severe exertion, may be followed by
dangerous symptoms. Gentle and regular out-door exercise,
occupations which do not require a stooping posture, or too
great physical effort, and sponging over the whole surface of
the body every morning on rising, are likely to exert a most
salutary influence in congestive headaches.



314


AFFECTIONS OF THE HEAD.


10.-Nervous Headache (Hemicrania).
In consequence of this variety of headache being located
in the nerves about the eyes, and recurring every day, every
second day, or every fortnight or month, it is often called
bron~-ague.
SYMPTOMS.-A sudden and gradual attack of severe tearing
or throbbing pains, of a neuralgic character, the painful
part feeling sore, or even as if a nail were being driven into
the brain; light or noise are almost intolerable, and the
patient is hypocondriacal, hysterical, and low-spirited. An
attack generally sets in early in the morning, and is often
attended with retching and vomiting.
CAUSES.-Debility and exhaustion; mental or physical
fatigue; any local affection of the body with which the brain
sympathises. In the case of females, too prolonged nursing
often causes it.
TREATMENT.-Ign., Nux., Ars., Bell., Puls., Cham., Coff,
Acon., Chin.
ACCESSORY MEANS.-A nutritious, liberal, and digestible
diet, except during an attack, when it should be light and
sparing. Regular out-door exercise in a bracing atmosphere,
and the avoidance of mental or bodily fatigue or excess, are
essential.
11.-Tables of various kinds of Headache, and
their Remedies.
1. Headache vith derangement of the stomach:-Ant. C.,
Ipec., Puls., Nux, or Sulph.
2. With catarrh:-Acon., Ars., Cham., Dulc., Merc., Puls.
3. With constipation:-Bry., Nux., Opi.
4. With congestion of blood to the head:-Acon., Bell.,
Glon.
5. From intoxicating beverages:-Nux., OpL



VARIOUS KINDS OF HEADACHE.


315


6. From external injury:-Arn., if feverish with Acon.
7. From emotions:-Opi. (fright), Coff. (joy), Ign. (griefy,
Cham. or Coloc. (angel), Verat. (fear), Acon. (anxiety).
8. From atmospheric changes:-Bry., Rhus., Carb. V.
9. Mental labour, vatching, etc.:-Cocc., Nux., Chin.
10. Rheumatic headache:-Acon., Arn., Bry., Merc., Nit. Ac.
11. Nervous headache:-Bell., Bry., Cham., Coff., Ign.,
Nux, Puls., Sep.
12. IHysterical headache:-Acon., Cocc., Ign., Nit. Ac.,
Sep., Valer.
13. Chronic headache:-Calc. Carb., Sep., Silic., Sulph.
In the last-named variety of headache, remedies are most
suitably administered in the intervals between the paroxysms;
and if selected with judgment, at the same time that the
general habits of the patient are directed in accordance with
the laws of health, the headache may certainly be modified,
if not cured.
SYMPTOMATIC INDICATIONS.-To render the selection of a
remedy as easy as possible, the following indications are
subjoined.
Belladonna.-This remedy is useful in more severe forms
of headache, with fulness, pressure, and heaviness on the
forehead above the eyes, aggravated by motion, noise, or
light; congestion to the head, with redness of the face,
glistening of the eyes, and excessive sensitiveness to external
influences; the pains are shooting, tearing, or throbbing,
darting from one point to another, and never fixed. A dose
every one or two hours until relieved; afterwards, less
frequently. This remedy is often useful after, or in alternation with, Aconitum.
Aconitum.-Heat in the head, from excitement, aggravated
by motion and the erect posture, but relieved by cold water;
throbbing in the arteries of the head, and full, bounding
pulse; sickness, vomiting of bile; a sense of coldness, etc.



316


AFFECTIONS OF THE HEAD.


In rheumatic, bilious, and apoplectic headaches, the strong
tincture of the root may sometimes be administered with
good results.
Glonoine.-This remedy is valuable in congestive.eadache;
dizziness, vertigo, throbbing in the temples, giddiness when
walking in the open air, etc. Being very volatile it should
be mixed as required. As a rule, 3x. is a good dilution.
7Nux Vomica. Headache from intoxicating drinks, sedentary habits, too close attention to study or business; headache with nausea or vomiting of sour and bitter substances;
stupefying headache accompanied with giddiness and heaviness in the head, occurring early in the morning, as from
intoxication, or when it comes on after meals, and is
connected with other symptoms of indigestion. It is strongly
indicated by a dark or bilious complexion, an irritable
disposition, and a torpid action of the bowels. Headache
caused by intoxicating beverages sometimes requires the
strong tincture.
Opium.-Headache with stupor, heaviness, wandering expression, sluggish action of the bowels, and after afrighit.
Ipecacuanha.-Headache, with distressing retching, either
empty or of bile and mucus; nausea, vomiting of food, and
an inability to retain anything in the stomach, especially
after excessive eating, indigestion, exposure, etc. It should
be given directly these symptoms are indicated, and repeated
at intervals of thirty or forty minutes, till improvement
ensues.
Pulsatilla.-Headache after eating rich food or fruits, or
with acidity of the stomach, heaviness of the head, pain on
one side of the head, shooting into the ears, paleness of the
face, fretfulness, and shiverings. Also, when it occurs in
females from suppression or derangement of the menses, in
consequence of a cold, exposure to wet, etc.
Chamomilla.-Headache from     the sudden suppression of



VARIOUS KINDS OF HEADACHE.


317


perspiration caused by a draught; tearing pain on one side
of the head; frequent changes in the colour of the face;
redness and burning, often confined to one cheek, with coldness and paleness of the other.
China.-Headache from loss of the fluids of the body, as
after heemorrhage, diarrhoea, etc.
Bryonia.-Headache occasioned by cold, most troublesome
in the morning, or after a meal; the pain is of a digging,
tearing character, with a feeling as if the contents of the
head would protrude through the forehead on stooping. It
is also indicated in rheumatic headache; also when it is
accompanied with bleeding from the nose, chilliness, burning
and watery eyes, or constipation.
Coqfea.-Nervous headache; pain as from a nail being
forced into one side of the brain; great sensitiveness to
noise, etc.; especially suitable for nervous females and
children.
Aurum.-Rush of blood to the head when stooping;
roaring noise as of rushing water; hemicrania with severe
throbbing pains; excessive pain in the bones of the skull.
This remedy is chiefly required in constitutions tainted with
syphilis, or injured by large doses of Mercury, with a hypochondriacal, melancholy disposition.
Ignatia.-Pressure on the brain, the pain extending to the
root of the nose; headache from grief or other depressing
emotions; also for nervous or hysterical patients.
Arsen., lod., Mere., Phos., Plat., Rhus, Sulph., and Verat.,
are also remedies required in various forms of headache.
PREVENTIVE TREATMENT.-An attack of headache may
often be warded off, if immediately the first symptoms are
noticed, a dose of Nux Vomica, if from   dyspepsia-or of
Aconitum, if from a cold-is taken.
GENERAL ACCESSORY MEANS.-Regularity of meal-time;
proper adaptation of clothing to the requirements of our



320


AFFECTIONS OF THE HEAD.


ness, deafness, or noises in the ears; momentary loss of
consciousness, with or without indistinctness of speech or
incoherent talking; flashes, motes, etc., before the eyes;
numbness or tingling in the hands or feet; unsteady gait;
partial paralysis, sometimes involving the muscles of the
face, sometimes those of a limb.
The above symptoms indicate a morbid state of the
circulation in the head, and it is proper to observe that one
or several of them may occur as the result of indigestion.
Far greater importance, however, should be attached to them
if associated with the followingAPOPLECTIC PREDISPOSITIONS.-(1) Persons of a stout,
plethoric habit of body, with a short thick neck, florid face,
protuberant belly, and above fifty years of age. After fifty
years of age, apoplexy is one of the most frequent causes of
death. (2) Those whose predecessors have been afflicted
with apoplexy. (3) Certain habits of life, such as intemperance, excessive eating, uncontrolled passion, pressure
about the neck, and too close mental labour, or any habit
favouring congestion to the head. (4) Disease affecting
the heart, kidneys, or blood-vessels of the brain; also the
too sudden suppression of an accustomed discharge, as
suppressed haemorrhoids, or the menses.
MODES OF ATTACK.-Apoplexy may come on suddenly or
gradually.  The patient may be suddenly struck with insensibility, falling, at once bereft of motion and consciousness.  Such a case is termed primary apoplexy.     More
frequently, however, he is first seized with either pain in
the head, or with giddiness and sickness, or with partial
paralysis, as of one side of the face, or one arm, and then
being carried to bed gradually becomes comatose; or sometimes drowsiness gradually increases to perfect coma. This
is called ingravescent apoplexy, because the symptoms become
gradually worse, and is far more serious than a primary case,



APOPLEXY.


321


because we have evidence that the cause of the symptoms
are still in operation, and because such cases are always
haemorrhagic, and the brain has undergone organic and
permanent changes. On the other hand, a primary case
may be of a congestive, serous, or simple variety, and the
condition may pass off without any permanently injurious
result.
SYMPTOMS.-In the early stage of an ingravescent case,
before the patient becomes comatose, there is great depression
in the circulation from the shock to the nervous system;
the surface is cold, pale and clammy, and the pulse frequent,
small and weak. As coma comes on, the pulse becomes full,
slow and laboured (passes slowly under the fingers); the
surface warm, sometimes preternaturally so, and perspiring;
the countenance has a peculiar bloated appearance, and is
often congested; the pupils are insensible to light, and
usually dilated, although one or both may be contracted;
the breathing is stertorous from paralysis of the soft palate,
which, hanging loose, cuts the current of the air in its
passage to the lungs; the urine is retained from inaction of
the bladder, and the bowels are sluggish.
DIAaNosIS.-Apoplexy and Epilepsy.-The latter begins
with a piercing scream, is always attended by convulsions,
and much frothing at the mouth, symptoms which do not
occur in apoplexy. From intoxication or poison with opium,*
the history and circumstances of the patient must be considered; as whether he is likely to have been drinking, the
presence or absence of the odour of spirits in the breath, or
whether he has been low-spirited or in any difficulties likely
to have led him to swallow poison. It is from such circumstances that we must make our diagnosis, as the condition
of the brain, especially in the advanced stages, is the same
* For a tabular statement of the chief differences between apoplexy and
poisoning by opium, see the chapter on "Toxicology," section "Opium,"
in the larger edition of this work.



322


AFFECTIONS OF THE HEAD.


in all these cases. The importance of promptly recognising
apoplexy from alcoholic or narcotic poisons arises from the
difference in the immediate measures that would be taken in
the one or the other case. An emetic, or the stomach pump,
might remove in the one case what, if suffered to remain,
might lead to serious or even fatal results; while in the
other case an entirely different procedure would be necessary.
TREATMENT.-This disease assumes such numerous forms,
and is of so dangerous a character, that none but a medical
man can safely conduct the treatment. As, however, a fit
may occur suddenly, when no medical man can be immediately procured, the following directions should be promptly
acted upon.
TREATMENT DURING A FIT.-1. If possible, convey the
patient immediately to a large apartment where the cold air
can freely circulate around him. 2. Loosen the neckerchief,
stays (in the case of females), and bandages of every kind,
and place the patient in a warm bed, with his head
moderately raised. 3. Apply warmth to the extremities and
axille (armpits), and a cold wet towel, or pounded ice in a
bladder, to the head; also a sinapism to the epigastrium.
4. At the same time, if the circumstances of the case admit
of the administration of medicine, one of the annexed may
be given:Arnica.-If long-continued or severe bodily exertion, or
any external violence has been the exciting cause.
Belladonna.-Red, swollen face, throbbing of the bloodvessels, convulsive movements of the face or limbs, dilatation
of the pupils, loss of speech, suppression or involuntary
discharge of urine, etc.
Opium.-Drowsiness, heaviness, and stupor previous to
the attack, profound coma, irregular and snoring breathing;
red, bloated face, stupid and besotted expression, eyes half
open, pupils dilated and insensible to light, coldness of the
extremities, etc.



APOPLEXY.


323


Aconitum.-Full, rapid and strong pulse, dry hot skin, and
other prominent febrile symptoms.
ADMINISTRATION.-During a paroxysm, one or two drops
of the tincture placed on the tongue in a teaspoonful of
water, or on a small piece of sugar, every fifteen or thirty
minutes; in threatened apoplexy, a dose every hour; as the
symptoms are subsiding, every three to six hours.
AFTER A FIT.-Should the patient recover from the fit,
great and unremitting care must be observed to prevent
another attack. The diet should be light, but nourishing;
milk, light puddings, boiled vegetables, and fish, are
extremely valuable; a full animal diet should not be
allowed, and, as a rule, stimulants should be avoided, except
a moderate quantity of the light Hungarian or French
wines. The causes of the disease should, as far as possible,
be avoided or modified. Further, the administration of one
or more of the following remedies, if indicated, is recommended:-Nux. V., Acon., Bell., Phos., Rhus., or Opi.
PREVENTIVE MEASURES.-Undeviating temperance in eating
and drinking. Physical and mental exertion; fits of passion
or excitement; sudden changes of temperature, over-heated
rooms, warm baths, wet-feet, etc., must be uniformly
avoided.
13.-Paralysis-Paralytic Stroke (Heminplegia, etc.).
Haemorrhage occurring within the cranium  does not
always produce apoplexy, but sometimes hemiplegia.
HEMIPLEGIA is that form of paralysis in which one lateral
half of the body is affected from disease of the opposite half
of the brain, the parts generally involved being the upper
and lower extremities, the muscles of mastication, and the
muscles of one side of the tongue, and the patient is said to
have had a "paralytic stroke." The pathology, causes, and
treatment, are the same as pointed out under apoplexy.



324


AFFECTIONS OF THE HEAD.


Hemiplegia may be very partial, as when it affects the
3rd nerve only, causing dropping of the upper eyelid, to
which that nerve sends branches, so that it cannot be raised
except by the hand. This condition is termed ptosis. The
eye is -also sometimes turned outwards or inwards from    a
similar affection.  This condition must be distinguished
from facial palsy, or paralysis of the portio dura nerve from;
cold upon one side of the face, and quite independent of
disease of the brain.
PARIPLEGIA is a form of paralysis, more or less complete,
of the lower half of the body, in which the legs, and perhaps
also the muscles of the rectum and bladder are implicated.
It is caused by disease of the spinal marrow, or of its
membranes or vertebrea, in which the marrow is either
pressed upon or disorganized.  It may also arise as one of
the symptoms of chronic cerebral disease.
MYELITIS, or inflammation of the spinal marrow, is
generally caused by blows or accidents, but sometimes from
constitutional causes. It generally ends in softening. It
may be distinguished from lumbago or hip disease by the
absence of pain, but chiefly by a paralytic condition of the
parts below the seat of inflammation.
TREATMENT OF PARALYSIS.-This must be guided. by the
cause of the disease, and the accompanying symptoms. The
chief remedies are-Amr., Rhus Tox., Nux V., Bry., Bell.,
Hyos., Cocc., and Sulph.
ACCESSORY MEANS.-1. Electricity, or galvanism, judiciously employed, after the acute inflammatory symptoms have
subsided, is an agent of great value. 2. The cold douche,
bathing with salt water, or, if the patient is capable of the
effort, sea-bathing tend to promote the nutrition of the
spinal marrow.    3. Regulated exercise-active when the
patient is capable of it, passive when he is not, is of great
utility in overcoming muscular rigidity, and restoring the
functions of paralysed limbs. 4. Well-directed frictions.



CATARRHAL OPHTHALMIA.


325


CHAPTER IX.
DISEASES OF THE EYE.
OPHTHALMIA is a general term   for inflammation of the
conjunctiva, or mucous membrane which lines the eyelids
and the front part of the eyeball. Formerly, when the eye
and its diseases were less understood than they are at
present, nearly all inflammatory affections of the organ were
included in this term. There are several varieties of ophthalmia, the most frequent being the following.
1.-Catarrhal Ophthalmia.
SYMPTOMS.-A pricking pain, especially on moving the
eye, comparable to saud or a little fly between the lids;
sensitiveness of the membrane to cold air; watering of the
eyes, and a secretion of mucus, gluing the lids together on
rising in the morning; bright redness of the conjunctiva,
owing to its superficial vessels being enlarged and tortuous.
The most marked symptoms are-scarlet redness, an increased
discharge, and a pricking pain. This last symptom so closely
resembles a grain of sand, that the patient can scarcely be
persuaded that there is no foreign substance in the eye; and
this is no doubt due to the irregular distension of the vessels,
which disturb the part mechanically, just as dust or a fly
might irritate it.
CAUSES.-Vicissitudes of temperature, easterly and northeasterly winds, cold and damp, and especially draughts of
cold air.
TREATMENT.-Acon., Bell., Mfercurius. For the symptoms
"-requiring these remedies, see under " Medicines for different
forms of Ophthalmia," pages 329-31.



326


DISEASES OF THE EYE.


ACCESSORY AMEANS.-The patient should avoid exposure to
currents of air, cold and damp, and if the weather is inclement
during an attack, he should remain in a room of uniform
temperature.   Persons predisposed to ophthalmia should
guard against all needless exposures during the prevalence of easterly and north-easterly rough winds. A piece of
lint, wetted in tepid or cold water, as may be most agreeable
to the patient, should be laid over the eye. When the eyes
are agglutinated in the morning, they should on no account
be opened without being first well moistened with saliva or
tepid water; but any gumming together may be entirely
prevented by smearing the lids at night with a little cold
cream or olive oil. The food should be simple, nourishing,
and digestible; the habits regular and early; and bathing
practised  as directed in  the article on   that subject,
pages 29-32.
2.-Strumous Ophthalmia.
This variety occurs in children, and in young persons
advancing towards puberty, of scrofulous habits, and living
chiefly in low, damp, and badly-drained situations.
SYMPToMS.-The three prominent symptoms are-Extreme
intolerance of light, so that the child obstinately holds its
head down; and only with the greatest difficulty can open
its eyes. Spasmodic contraction of the muscles, the lids being
everted by the spasmodic action. Profuse flowing of tears,
so that the skin of the cheeks is often excoriated or covered
with an itching eruption. And when, at length, the eyes
are opened, there is little or nothing to be seen at all commensurate with that dread of light which the patient
manifests, for it is more a nervous than a vascular disease.
These symptoms are generally accompanied by others which
mark the scrofulous constitution-enlargement of the absorbent glands about the neck, sore ears, a large and hard



OPHTHALMIA IN INFANTS.


327


belly, grinding of the teeth, general debility, and other
signs of struma.
CAUSES.-As above stated, the predisposing cause is a
strumous habit; the exciting causes are, undue exposure to
cold, bright light, irritating vapours, want of cleanliness, etc.
TREATMENT.--MerC. Cor., Cale. C., P/ios., Hep. Sulph.,
Aeon., Bell., China, etc. For the indications, see page 329.
ACCESSORY MEANS.-As a lotion, cold or tepid water should
frequently be applied during the acute stage, or tepid milk
and water will often be found very soothing. When the
chronic form sets in, an occasional stimulating collyria; but
as this application cannot be made with safety except by a
medical man, we make no further reference to it. See also
" Catarrhal Ophthalmia," p. 325-26.
DIET, etc.-Plain, nourishing food, cod-liver oil, and pure
country air.
3.-Ophthalmia in Infants (Ophthalmia neonatorum).
This generally occurs within three days from birth, but
occasionally not for two or three weeks, and is undoubtedly
caused during birth from contact, in the vaginal passage, of
leucorrhceal or gonorrhoeal discharge with the eyes of the
child. Possibly irritation of the eyes from neglect of cleanliness, or exposure of the eyes to a bright light or a strong
fire, may be a cause in other cases.
SYMPTOMS.-A profuse discharge of thick yellow    pus,
which collects between the eyelirs and the globe; this being
removed, the conjunctiva is seen swollen, and so vascular as
to resemble crimson velvet; the cornea looks smaller than
natural, and as if sunk in the bottom of a pit. The infant
is very restless and feverish.
TREATMENT.-Mercuirius should be administered    thrice
daily for one or two weeks. If necessary, it may be preceded



328


DISEASES OF THE EYE.


by two or three doses of Acon., and followed by the administration of Sulphur; a dose night and morning for a week.
ACCESSORY MEANs.-These are of the first importance,
and consist chiefly in the observance of great cleanliness,
the eyes being sponged or syringed out very many times in
the day. The preventive measures-must have for their object
the improvement of the mother's health prior to parturition,
including the arrest of the local symptoms which are so
frequently a cause of the disease in the infant.
4.-Purulent Ophthalmia.
This is a more violent and destructive form of ophthalmia
than either catarrhal or strumous. The tingling sensations
first experienced are soon followed by acute pains, which
extend through the eyes to the temples and brain itself; the
flow of tears is changed into a profuse secretion of pus, the
lids are swollen, and there is almost total loss of vision.
There are also constitutional symptoms, such as headache,
nausea, quick pulse, hot skin, etc.
VARIETIES.-There are three forms of purulent ophthalmia-purulent ophthalmia of adults, or Egyptian ophthalmia,
gonorrhceal ophthalmia; and purulent ophthalmia of newlyborn children. The last-named has already been described.
Egyptian or contagious ophthalmia, arises when people
are crowded together in filthy habitations, and was first
brought into this country from Egypt by our troops, early
in the present century; hence its name.
CAUsEs.-Sudden     alternations from  heat to cold, the
irritation of sand in the eyes; metastasis of measles,
scarlatina, smallpox, etc.; also endemic and epidemic
influences.



MEDICINES SUITED TO OPHTHALMIA.


329,


5,-Gonorrhceal Ophthalmia.
This arises from direct contact of gonorrhoeal matter, and.
not, as some suppose, a metastasis of the disease from the
organs of generation to the eyes.   It presents similar'
symptoms to the Egyptian variety, differing only in their
greater intensity.
In both forms there is great danger that the conjunctiva
should swell extremely and overlap the margin of the cornea,
and lead to its sloughing, apparently by strangulation of the
vessels by which it is nourished.  When this condition
occurs, it is called Chemosis.
TREATMENT.-Acon., Bell., Hepar Sulph., Here., Sulpi.
ACCESSORY MEANS.- Assiduous bathing, fomentations,
etc.; astringent collyria, and, sometimes, surgical measures.
6.-Medicines suited to the different forms
of Ophthalmia.
Belladonna.-Pain, redness, and swelling: throbbing
pains in the temples; flushed cheeks, glistening eye, and
great intolerance of light.  Half a dozen drops of the
tincture may be mixed with as many table-spoonfuls of
water, and a spoonful given during the acute stage every
hour, and afterwards every three or six hours. This medicine is often required in alternation with Aconitzum if there
are much heat and dryness of the skin, thirst, etc.; or one
or two doses of Aeon. may precede Bell.
[Mercurius Cor.-In the most violent forms of acute
ophthalmia with Chemosis, the 1st or 2nd dilution of this
remedy will often cut the attack short.
Mercurius Sol.-Ophthalmia marked at first by a copious
discharge of watery fluid, which afterwards changes to
mucus and pus; agglutination of the lids in the morning;
smarting heat and pressure, with aggravation of the pains
Y



330


DISEASES OF THE EYE.


when moving or touching the eyes. There is not much
fever present, but considerable itching and irritation.
Arnica.-All inflammations affecting either the mucous
membrane, or the deeper structures of the eye, from mechanical injuries. The eye should be bathed with a lotion made
by adding twenty drops of Arnica q to four table-spoonfuls
of water. After being well bathed, a piece of lint or linen
should be saturated with the lotion, and applied to the eye,
then covered with oiled-silk, and secured by a handkerchief.
The cure will be much accelerated if the external use of this
remedy is accompanied by its internal administration, giving
two pilules, or one drop of the attenuated tincture, every
three or four hours.
Aconitum.-Ophthalmia with constitutional symptomsquick pulse, dry skin, and thirst.
Arsenicum.-Obstinate ophthalmia, from cold, rheumatism,
or gout, in weak and nervous patients, particularly if the
secretion is of an acrid, corroding character, with burning,
tearing, or stinging pains in the globe and lids, aggravated
by exposure to light.
Nit. Acid.-Purulent ophthalmia; swelling and redness
of the mucous membrane and lids; secretion of viscid
mucus or pus; burning and smarting in the eyes; photophobia; nightly agglutination, and pains in the bones and
parts around the eyes..Nit. Acid is indicated in cases
originating in syphilis, or aggravated by mercurial preparations.
Hepar Sulph.-This is an excellent remedy in similar
cases, and may follow or be alternated with Nit. Acid.
Phosphorus.-Chronic and obstinate cases of ophthalmia
which have resisted the usual remedies. There are sensitiveness to light, heat and itching of the eyes, sudden
attacks of blindness, black spots floating before the eyes,
and secretion of viscid mucus.



SUMMARY OF REMEDIES FOR OPHTHALMIA.


331


Grapkites.-Scrofulous ophthalmia, with extreme intolerance of light, especially when, in addition to the affection
of the eyes, the patient presents the usual signs of a
strumous constitution.
Calcarea Carbonica.--Valuable in the treatment of various
forms of chronic ophthalmia, especially when occurring in
debilitated, scrofulous children. We can fully endorse, from
extensive use of this remedy, the following remarks of a
homoeopathic physician:-" Calcarea is one of our most
important ophthalmic medicines, and is surpassed by none
in its applicability to the generality of cases of scrofulous
inflammation, whether of the eye itself or its lids; and is
indispensable where there is marked scrofulous diathesis,
indicated by swelling of the glands," etc.
Other remedies may be required,--Sulph., Sil., Puls., Lye.,
Aur., Euph., R/) us Tox., Spig., etc.
SUMMARY OF LEADING REMEDIES FOR OPHTHALMIA, ETC.
Ophktalmia from cold.-Acon., Bell., Mere., Dulc., or Puls.
Folloning measles.-Puls., or Carbo Veg.
Following scarlatina.-Bell., or Hep. Sulph.
Following smallpox.-Merc., or Sulph.
From suppressed cutaneous eruption.-Sulph.
From debilitating causes.-Chin., Phos., Nux., Sulph.
In scrofulous persons.-Calc., Hep. Sulph., Graph., Mere.
Iod., Bell., or Acon.
In gonorrhaeal or syphilitic patients.-Acon., Mere., Nit.
Ac., Aur., Cann., Thuja, or Sulph.
From abuse of alcohol.-Nux Vom., or Opi.
Watery eyes.-Petro., Euph., Bell., Spig., or Phos.
Paralysis of the eyelids.-Bell., Zinc., or Verat.
Blear eyes.-Euph., Puls., Merc., or Rhus Tox.
ACCESSORY MEASURES.-In the treatment of the various
forms of ophthalmia, and weak and imperfect vision gener



332


DISEASES OF THE EYE.


ally, the causes of the disease should, if possible, be
correctly ascertained, so that they may be, as far as possible,
obviated and guarded against. Patients in crowded and
unhealthy towns should remove to the country, at least for a
time, where they may take daily out-door exercise, and
enjoy a pure and bracing air. The food should be plain and
nourishing, avoiding coffee and fermented drinks; the habits
early and regular, and frequent bathing should be practised.
A small wet compress, covered with oiled-silk or india rubber,
worn over the nape of the neck, is a valuable counterirritant, when the more violent inflammatory symptoms have
been subdued. See also " Accessory Measures," previously
pointed out, especially under " Catarrhal Ophthalmia."
7.-Cataract.
DEFINITION.-Cataract is an opacity in the crystalline lens,
or its capsule, or both, causing obscuration, or total loss
of vision.
VARIETIES.-In the schools, several are described, such as
hard cataract, of a brownish colour and almost peculiar to
old people; soft cataract, the lens being of a white glossy
appearance, having a wider circle; fluid cataract, which may
be recognised by being seen to move with different positions
of the head. The last two forms occur chiefly in young
people, but the hard is the most frequent, for it is one of the
changes incident to old age.
SYMPTOMS.-The opacity comes on in a gradual manner,
first affecting one eye, but afterwards both, and is often
discovered by accident only. The lens becomes of an amber
colour and somewhat less, and the central part first becomes
opaque. Objects appear to the patient as if seen through a
mist, and a flame is observed surrounded by a halo. Vision
is less affected in a weak light, such as twilight, or when
the patient has his back to- the window; for, under such



CATARACT.


333


circumstances, the pupil dilates widely, and the light enters
at the circumference of the lens, which is less opaque than
the centre. The patient also sees better in an oblique than
in a straight direction, because the lens, being shrunk, does
not completely    cover the   vitreous  humour.     From    the
gradual way in which the disease comes on, the patient has
a natural, easy manner, and very different from the fixed,
vacant stare which marks complete amaurosis. Indeed, the
patient never becomes so blind but that he can distinguish
day from night, the position of the window, and the shadow
of passing objects, and find his way about his own house
with little difficulty.
OAUSES.-Exposure of the eyes to irritating vapours;
mechanical injuries; congestion of blood to the eyes from
exercise in the hot sun, or before hot and bright fires;
chemical and mechanical irritants; long-continued use of
the eyes in looking at too minute objects; hereditary predisposition.
TREATMENT.-On the treatment of cataract, Dr. Malan
makes the following sensible remarks:"No medicine or internal treatment has, as yet, been of any avail in
confirmed and ripe cataracts; this was left for better days in medical
science, and Homoeopathy has given us means of cure which were totally
unknown before. I do not mean to say, be it well understood, that
Homceopathy will entirely supersede surgery, and that we are not to trust
this latter means, or even employ it-no; but I wish to draw attention to
these three remarks only, that-(1) in many cases Homceopathy will
cure, completely cure, real cataracts, even old and ripe ones; (2) in many
more it will prevent the progress of the cataract on the other eye, when
as yet only one is affected; and (3) that if it does not always succeed in
curing, it will always prepare the whole constitution for the surgical
operation, prevent inflammatory accidents after it, and secure its
success.
" This part of medical treatment has been to this day too much neglected, because, to our eyes, this more or less exorganic body seemed not
fit for medical treatment; and because we have been accustomed to hear



334


DISEASES OF THE EYE.


that surgical operation only is of any use, we have left aside the internal
treatment, which will often be crowned with far more success than is
generally expected. Not the least process in the human body, morbid or
natural, can take place without the whole constitution taking some part
in it. We cannot expect that an organ of the body, be it ever so small,
can become affected quite independently of the organism, but rather that
it becomes affected in consequence of a morbid process existing, though
not seen, in the organism itself. I am as far from admitting such confined
notions as I would be to admit that the very same organ has no common
tie with the rest of the body, and is not one constituent part of it, by its
nerves, its vessels, and all its textures.
" If, therefore, one part of the body is diseased, we must not direct our
treatment to it solely, and use what is called a local treatment alone.
We must act on the whole constitution in the same way as we would
direct our attention to the whole tree when it bears decayed fiuit."
Even in cases which require the surgical operation of
couching or extraction, this should be deferred so long as the
patient has useful vision with one eye, lest an operation
should produce inflammation, which might extend to the
other, and thus both be lost.
The most important remedies for this disease are-Cann.,
Sulph., Caust., Sil., Pos., Calc., Euph., and       Con.; but
the selection must be determined by the cause of the disease,
and the most characteristic symptoms present.
8.-Iritis.
The iris is a movable curtain, having a circular aperture
nearly in its centre, and occupies the space between the
cornea and crystalline lens. Its use is to regulate the amount
of light which shall be admitted into the eyes; for this
purpose its inner circumference is capable of dilating and
contracting, in obedience to certain influences, whilst its
outer circumference is immovably fixed.       Iritis is an acute
inflammation of the iris, and may be of several forms,
namely, traumatic, syphilitic, rheumatic, or scrofulous.
TnAUMATIC IRITIS generally occurs in artisans, such as



IRITIS.


335


engineers, blacksmiths, etc., from injury, as a stab, cut, or
blow. It has been called common iritis, because it is a cause
of common inflammation, without any specific or constitutional
taint.
SYMPTOMs.-Deeply-seated orbital pains, which extend to
the temples and even to the back of the head; great impairment of vision; a radiating zone of vascular redness
surrounding the cornea, etc.
TREATMENT.-Arn. (both internally and externally), Acon.,
Bell., Sulph.
SYPHILITIC IRITIS generally occurs about the middle period
of secondary syphilis, after the patient has suffered from
sore throat, etc., but before the periosteum and bones become affected. It chiefly differs from the traumatic variety
in the comparative absence of pain, except during the night,
-and in its being a more subacute or chronic disease.
TREATMENT.-MIerCUriUS Sol., Iodide of Mercury, Nit. Acid,
Sulph.
RHEUMATIC IRITIS arises from cold or is the consequence
of rheumatism; it is very painful, because the sclerotic,
which is an unyielding membrane, is so much implicated.
Unless skilfully treated, it has a great tendency to recur at
intervals, so that a person may have an attack once or twice
a year during the remainder of his life.
TREATMENT.-Bell., Aurum, Nux Vom., etc.
ACCESSORY MEANs.-Fomentations and poultices, astringent
collyria, and, perhaps, other surgical measures.
9.-Amaurosis (Gutta serena).
DEFINITION.-Amaurosis is imperfection of vision from
loss of nervous power consequent on some change in the
retina, optic nerve, or brain.
The word is derived from the Greek, and means obscure
or dark; for it may be of various degrees, from the slightest



336


DISEASES OF THE EYE.


defect of vision to complete blindness. In partial amaurosis,
the patient sees as through gauze, or sees only part of the
object, or sees doubly, or only sees when the eye is in
a certain position in respect to the object. The patient
finds himself incapable of estimating distances, so that he
misses his aim when attempting to snuff a candle or pour
water into a glass. In complete amaurosis the patient cannot
distinguish day from night.
" The transparent parts of the eye, the several media, so
skilfully and exquisitely adjusted for the due refraction and
collection of the rays of light into an image of the object
from which they flow, may all be perfect and in order; but
the beautiful apparatus is useless-the patient cannot see
with it. The fault is in the nervous matter, that should
receive and transmit the impression, and render it an
object of perception to the mind. And persons in this
condition are said to have amaurosis."
SYMPTOMs.-The symptoms of approaching amaurosis are
-pain in the forehead and temples, diminishing as the
disease advances, and ceasing when it becomes complete.
The patient sees best in a bright light, and objects usually
appear perverted, being only partially seen, or of an unnatural
colour, or double, or dark bands cross the field of vision, or
floating dark spots (muscce volitantes), or flashes of light.
The pupil is dilated, and if there is complete loss of vision,
it will be fixed and insensible to light, but it will be
beautifully black and clear; hence the disease has been
called Gutta serena.
Amaurosis is not peculiar to any age, but occurs at almost
any period of life, and may come on either rapidly or
gradually, but generally rapidly.,
VARIETIES.-Amaurotic cases are divisible into two classes
-organic and functional. This is a very important division,
because a functional case may be cured, if its cause is ascer



THE OPHTHALMOSCOPE.


337


tained and appropriate treatment adopted; on the other
hand, the organic is generally incurable, and the patient is
liable to die of disease of the brain. The diagnosis is now
greatly assisted by the use of the ophthalmoscope.
THE OPHTHALMOSCOPE.-This instrument, invaluable as an
aid to the diagnosis and treatment of obscure forms of disease leading to blindness, may here be briefly explained. It
is a concave circular metallic mirror, which reflects a bright
light into the pupil of the eye, from an oil lamp, or an
argand burner that slides on a vertical rod; the mirror has a
small hole pierced in the centre, through which the surgeon
looks. A magnifying lens is placed between the mirror and
the eye to be examined, at such a distance, and so adjusted,
as to make the focus of the lens coincide with the pupil of
the eye. The rays of light reflected from the polished
mirror illuminate, and the lens magnify, the very recesses of
the ocular globe. Thus the surgeon is enabled to extend
his observations through the inner chambers of the living
eye, not only to unfold its wonders and its beauties, but
aiding him, leisurely and accurately, and quite painlessly to
the patient, to determine the precise local condition of those
parts of the eye, in which vision resides, and through which
it is regulated. The ophthalmoscope is most valuable in
diagnosing all cases of impaired vision, estimating with
great fidelity the nature of the changes that may be taking
place, whether they are functional or organic, stationary or
progressive. The instrument is pre-eminently useful in
diagnosing the changes attending those early stages of diseases, which, without the interposition of remedial measures,
inevitably lead to blindness. The use of the ophthalmoscope
is only contra-indicated when extreme intolerance of light
exists.
CAUSES.-Organic amaurosis arises from some disease of
the retina, optic nerve, or brain, or of some neighbouring



338


DISEASES OF THE EYE.


structure interfering with those parts. Functional amaurosis
arises from various causes:-excessive use of the eyes on too
bright or too minute objects; constitutional derangement or
debility, such as anaemia from prolonged nursing, excessive
sexual indulgences, etc.; abuse of stimulants; too much
sleep, or other circumstances which produce determination of
blood to the head, and over-stimulate and exhaust the retina,
but does not primarily damage the structure of the nervous
apparatus of the eye.
TREATMENT.-Belladonna.-This is an excellent remedy in
threatened amaurosis, with headache, bright flashes before
the eyes, and a sensation of weight and pressure in those
organs. It is particularly suited to stout, plethoric persons;
also if the disease has been caused by inflammation or congestion of the optic nerve, retina, or some part of the brain.
Nux Vomica.-Intermittent obscuration of vision; stupefying headache; or temporary loss of sight which occasionally  accompanies intermittent diseases. This remedy is
further indicated in amaurotic complaints traceable to too
close confinement within doors, excessive mental labour, or
to indulgence in stimulants.
China.-Indistinct vision, sudden obscuration of sight,
great general debility, and in all cases in which the disease
is due to profuse discharges of blood or pus, prolonged
nursing, or tedious diseases.
Phosphorus.-The pupils and eyes are of a natural appearance, and distant objects are seen as if enveloped in mist;
black spots appear before the eyes, and there is diminished
vision. It is especially indicated if loss of animal fluids, or
self-abuse have led to the disease; also when it occurs in
enfeebled or aged persons.
Arnica.-Amaurosis from an external injury, such as a
stun from a blow or a fall.
Other remedies are often required, especially-Aur., Euph.,
Cann., lyos., Stram., Sulph., etc.



GRANULAR LIDS.


339


Dose and Administration.-See page 49.
ACCESSORY MEANS.-By referring to the paragraph under
Causes, it will be obvious how necessary it is that there
should be a strict avoidance of all habits likely to have
produced the malady. If there is evidence that the blindness is connected with exhaustion or debility, nourishing
diet, pure air, and frequent ablutions, are necessary. If, on
the other hand, the patient is plethoric, or if the blindness
follow a stroke of apoplexy, a vegetable diet, with little
animal food, should be adopted, and alcoholic beverages
withheld.
10.-Granular Lids (Ophthalmia tarsi).
DEFINITION.-Ophthalmia tarsi is a chronic inflammation
of that portion of the conjunctiva which lines the eyelids,
with disordered secretion of the Meibomian glands; the conjunctiva becomes thickened and its villi enlarged, giving rise
to constant irritation, similar to that produced by foreign
bodies. It is often called granular ophthlalmia.
SYMPTOMS.-The granulations are roughk and uneven, and
may sometimes be detected by the touch; there is an
abundance of pus secreted, so that the eyelids stick together,
and become encrusted with dried mucus during sleep, which
weakens and irritates the eyes, keeping up a constant
inflammation. It is chiefly confined to the upper lids, but
sometimes extends to the lower.
CAUSES.-A strumous constitution, or debility arising
from disorders of the digestive and other organs. It occurs
chiefly in the young, and is popularly called blear eyes,
but is much less seen now than formerly.
TREATMENT.-This must be both local and constitutional.
The chief internal remedies are-Calc. Carb., Hep. Sulph.,
Graph., Nit. Ac., and Sulph.



340


DISEASES OF THE EYE.


11.-Inversion of the Lids (Entropion).
This condition consists in an unnatural growing inwards
of the eyelashes, so as to occasion great disfigurement, and
constant irritation of the globe of the eye, and often leads
to chronic ophthalmia. It generally occurs amongst the
lowest ranks of society, especially the Irish, and often
requires for its removal a surgical operation.
12.-Eversion of the Eyelids (Ectropion).
This is an eversion of the lower eyelid, resulting from
burns on the face, or from thickening of the conjunctiva
from tarsal ophthalmia. The treatment is by surgical measures, which are, however, by no means always successful.
ACCESSORY MEANs.-Both this and the former condition
may be greatly benefitted by frequent cold or tepid baths,
and occasionally employing Calendula lotion (ten drops of
Calendula c to two table-spoonfuls of water). If the deformity result from a cicatrix on the cheek, such as from a burn
or abscess, and surgical measures have to be adopted for
its removal, this will be an excellent topical application.
13.--Stye on the Eyelids (Hordeolum).
DEFINITION.-A stye is a small, painful boil, with slight
inflammatory symptoms, projecting from the margin of the
eyelids, having most probably its seat in a ciliary follicle.
CAUSE.-Scrofula or debility.
TREATMENT.-Aconitum.-Inflammation, pain, and restlessness. If given when the stye first begins to form, it
often disperses it.
Pulsatilla.-This is the principal remedy, and should be the
first administered when inflammatory symptoms are not very
marked. It may also be given after, or in alternation with,



FOREIGN BODIES IN THE EYE.


341


Aconitum, if the latter remedy was not given sufficiently
early to arrest the disease.
Sulpkur.-A dose night and morning, for a few days, for
preventing a recurrence of the disease.
Silicea and Calcarea.-These medicines should be administered one week, each in succession, allowing an interval
of two or three days between, and afterwards if necessary,
repeating the course, to patients who are often troubled with
these annoying swellings, especially in those of a scrofulous
constitution.
AUXILIARY TREATMENT.-If the swelling is much inflamed
it should be fomented with tepid water, and a bread-andwater poultice applied over the eye at night. If the stye is
tedious in breaking, it should be opened with a lancet, or
punctured with a needle, and the matter pressed out.
14.-Foreign Bodies in the Eye.
If sand, flies, or hairs, are between the lids and the globe,
they should be removed immediately by bathing the eye in
cold water; but if the substance cannot be removed in this
manner, the eye should be gently wiped with a soft, moistened handkerchief, or with a feather, or a bent bristle may
be used, the two ends being held by the finger and thumb.
In one of these ways, with a little perseverance, the offending
substance may generally be removed.
If small pieces of flint or iron become fixed in the front
part of the eye, they should be most carefully picked out
with a needle or point of a lancet.
When the foreign body is removed, a weak Arnica lotion
should be applied to the eye by means of lint or soft linen,
as before directed.



342


AFFECTIONS OF THE EARS.


15.-Wounds of the Eye.
Wounds or blows of the eye are very serious, as they may
cause dislocation of the lens, and the globe to become filled
with blood.
TREATMENT.-Arnica.-The whole eye should be well
covered with a piece of lint or linen, saturated with Arnica
lotion (ten drops of strong tincture of Arnica to two tablespoonfuls of cold water); this should be covered with oiledsilk, and kept in position by a handkerchief. At the same
time, two pilules or a drop of the diluted tincture of Arnica
may be taken every three hours. If febrile symptoms are
present, Aconitum may be alternated with Arnica; a dose
every three or four hours.
ACCESSORY MEANS.--In all cases of blows or wounds, in
addition to the use of Arnica, the patient should remain in a
darkened room, and be kept quiet and cool, with the head
slightly raised.
CHAPTER X.
AFFECTIONS OF THE EARS.
1.-Inflammation      of the Ear (Otitis)Earache (Otalgia).
THE condition described by these terms is -one of the most
common affections of the ear. In strict language, earache
ought to be confined to neuralgia of the ear, a condition
known by sudden acute pain, which comes and goes capriciously, is not throbbing, does not increase in severity, and
is not attended with fever.*
We have, however, classed these affections together, as
* For the Treatment, see "Neuralgia."



i I


INFLAMMATION OF THE EAR.             343
what is popularly called earache is pain of an inflammatory
character.
SYMPTOMS.-Sudden and intense pain in the ear, sometimes so severe as to cause delirium; tenderness and
soreness in the ear and its vicinity; various unnatural noises
heard by the patient (tinnitus aurium); partial or complete
deafness, or, in rare cases, a morbid sensibility to sound;
the meatus is more or less swollen, red, tender, and dry. In
very bad cases suppuration takes place, and the inflammation
may even extend to the brain, and terminate fatally.
CAUSES.-Cold, especially currents of cold air; injudicious
bathing; not drying the ear after washing; improper probing
or syringing an inflamed ear. Inflammation may also come
on during the course of general fever, more especially during
" Scarlatina;" it may also arise from rheumatism or gout.
TREATMENT.- Aconit/m..-Recent inflammation, from   a
cold, with severe throbbing or shooting pain. A dose every
three or four hours, for several times.
Belladonna. -When the inflammatory     symptoms are
strongly marked, extend to the brain, and are attended
with tearing or burning pains in the head, delirium, vomiting, coldness of the extremities, or other alarming symptoms.
A dose every two to four hours. When the inflammatory
symptoms are less violent, or after they have been controlled
by Aeon. or Bell.,
Pulsatilla is an effective remedy; its special indications
being-sticking or tearing pains in and behind the ear,
swelling, and a feeling as if the internal ear were closed. A
dose every four or six hours.
Chamomilla.-Earache from cold or suppressed perspiration, the pains being almost unbearable; extreme sensitiveness, susceptibility, and irritability.
Mercurius.-Shooting pains in the internal ear, extending
to the cheeks and teeth; soreness; discharge; swelling of
the neighbouring glands.



344


AFFECTIONS OF THE EARS.


Sulphur.-A dose night and morning for several days,
is often of great utility after the employment of other
remedies.
ACCESSORY MEANS.-Hot fomentations, poultices, or the
steam of hot water, will mitigate the severity of the symptoms. A large boiled onion is a good domestic remedy; it
should be applied soft and hot to the ear, and maintained in
apposition by a bandage. Warm water, applied by a sponge
or a piece of soft linen, will mitigate the pain without doing
harm. Other applications, such as oils, ointment, cramming
cotton into the ears, etc., should be avoided, as they often
damage the parts. For other hints, see " General Remarks"
(page 349-50).
2.-Discharge from     the Ear (Otorrhcea).
This troublesome and offensive disease consists of a
purulent or muco-purulent discharge from the external
ear-passage, and should, if possible, be treated by a medical
man.
CAUSES.-It is commonly met with in scrofulous children,
and, in such constitutions, is likely to follow " Scarlatina,"
and other eruptive disorders, or any exhausting illness.
TREATMENT.- Mlercurius.-When the discharge is thick,
bloody, and fcetid, when it is accompanied by tearing pains
in the affected side of the head and face; when the complaint follows Scarlatina, Measles, Smallpox, etc.; also,
when there are swelling and tenderness of the glands about
the ear. A dose thrice daily.   If otorrhoea appear after
Scarlet-fever, this remedy may be administered in alternation
with Belladonna; an alternate dose every four hours.
Pulsatilla.-Discharge of a thin, watery character, and
when it follows AMfeasles.
Hepar Sulp/.-Discharge of pus and blood, and when the
patient has been dosed with Mercury.



DISCHARGE FROM THE EAR.


345


Arsenicum.-Excoriating discharge, in feeble constitutions..
Calcarea and Sulpkur may follow any of the above remedies, especially in tedious cases, to complete the cure; the
former may be administered morning and night for a week,
to be followed, a couple of days intervening, by the latter.
GENERAL MEASURES.-The intractable character of this'
affection is often, in great measure, due to the neglect of
that strict cleanliness which is so necessary to be observed.
The irritating discharge, if allowed to accumulate within the
meatus, undergoes decomposition, and gives rise to changes
in the deeper structures of the ear, the nature of which may
be inferred from  the irritation and excoriation, so often
existing in the external orifice. A little fine wool may be
put into the ear when the discharge is declining, and
frequently changed, to protect it in cold weather; but even
this should be done with great caution, particularly if the
discharge smells offensively, for nothing can be more prejudicial than stopping the ear with cotton wool to prevent
its escape. In this affection, the use of the syringe by
non-professional hands, is probably productive of more harm
than good, and had therefore better be discarded; at least,
it should only be used with great caution and gentleness to
cleanse the ear, which should be immediately afterwards
carefully dried. The improvement of the general health of
the patient is a point of great importance; for this purpose,
in addition to the remedies prescribed, change of air, and in
the autumnal months, sea-air, is often attended with marked'
beneficial results. In the absence of sea-air, country-air, in
a bracing district, is of great advantage.
3.-Deafness (Dyseccea).
This is often a symptom of general disease of the system,
the removal of which is necessary in order to restore the
function of hearing.
z



346


AFFECTIONS OF THE EARS.


CAUSES.-Sudden loud noises; blows on the head, or
fracture, which lead either to concussion or rupture of the
auditory nerve. A frequent cause is obstruction from swelling
of the lining membrane, accumulation of ear-wax, or other
substances lodged in the ear-passage. Deafness sometimes
occurs in connection with chronic diseases of the ear, or as
the result of organic alterations in the brain.
PRoGNosIS.-Recent cases of deafness are generally quickly
cured by skilful homoeopathic treatment; even when the
deafness is of long standing, and both ears are affected, and
the case presents greater difficulties, still a persevering use
of appropriate remedies is often rewarded by greater or less
success.
TREATMENT.-Classified cases of deafness.1. Deafness from cold or rheumatism: Merc., Calc. Carb.,
Puls., Bry., Bell., Ars., or Sulph.
2. After fevers and nervous disorders: Phos., Phos. Ac., or
Verat.
3. After a suppressed discharge from the nose or ears:
Hep. S., Bell., or Puls.
4. After measles: Carbo V., or Puls.
5. After scarlatina: Bell., or Hep. S.
6. After small-pox: Merc., or Sulph.
7. From enlargement of the tonsils: Mere. Iod., Aur., or
Nit. Ac.
8. From abuse of mercury: Hep. S., Aur., or Nit. Ac.
Mfercurius. -Deafness accompanying rheumatism or catarrb,
when the throat and glands of the neck are swollen, or after
a suddenly-suppressed discharge from the nose or ears.
Also for deafness after small-pox, roaring and buzzing
sounds in the head, and tendency to profuse perspiration.
Dulcamara.-Deafness with a cold from exposure to damp
or wet.
Nux Vomica.-Buzzing, tingling, or whistling noises,



DEAFNESS.


347


particularly whilst eating; with derangement of the digestive organs.
Calcarea Carbonica.-Sensations as if the ears were obstructed; humming noise, or throbbing and heat in the
ears; too great dryness or discharge from the ears; oppressive headache.
Phosphorus.-Deafness of nervous persons, or following
any nervous disorder.
Mosckus.--This is also an excellent remedy in deafness
with great nervousness, or following any nervous fever.
Bryonia.-Deafness in rheumatic persons, especially if the
head or neck has been affected by rheumatism.
Administration.-In recent cases, the remedy may be taken
three times a day; in chronic, once or twice.
AcCEssoRY MEANS.-If possible, the cause of deafness
should be ascertained with a view to its removal. If found
to arise from an accumulation of hardened ear-wax, this
should be extracted by skilful hands as early as possible.
Before attempting its removal it is generally necessary to
syringe the ear with tepid water.  All reputed remedies
which have to be dropped into the ear should be eschewed,
however much they are recommended.
WET COMPRESS ON THE NECK.-A small wet compress,
covered with oiled-silk or tissue, worn over the nape of the
neck, as recommended for ophthalmia, is equally applicable
to affections of the ear, especially of an obstinate nature;
and if persevered in steadily for some time will frequently
cure, or at least relieve, deafness.
4.-Foreign Bodies in the Ears.
Children seem to take pleasure in introducing various substances into the ear-passage; hence, peas, slate pencil, glass
beads, shells, etc., or cotton wool which has been forgotten,



348


AFFECTIONS OF THE EARS.


or a portion of which only has been removed, are occasionally met with. If permitted to remain, such substances
may occasion immediate symptoms of inflammation and
deafness; in other instances, they may continue a long time,
till difficulty of hearing or uneasiness in the ear, leads to an
examination of the tube. Any such body should be removed
as speedily and as gently as possible, either by syringing the
ear with warm water, or by means of small dressing forceps,
or other suitable instruments. If it cannot be removed by
gentle means, the case should be submitted to a surgeon, so
that a careful examination may be made by means of the
ear speculum, and the aid of sunlight or a lamp. This
examination is necessary for two reasons; for although a
foreign body, if present, may generally be seen without
such means, still the absence of such body cannot be
affirmed without a complete exploration    of the tube.
Further, instances often occur in which surgeons are requested to remove a foreign body when none exists, and a
proper examination with the speculum would often prevent
any injudicious meddling of the ear with instruments. A
late eminent hospital surgeon is said to have dragged out
the little bones of the ear (stapes) whilst attempting to find
a small nail, which was not in the ear at all! A careful
exploration of the canal, as above suggested, would have
prevented such a serious practical mistake. Any soreness or
inflammatory symptom that may ensue from the foreign
body, or the attempts at extraction, should be met by
washing the ear with a weak Arnica lotion (six drops of
Arnica q to two tablespoonfuls of water), and afterwards
enveloping the ear with a rag wrung out of the lotion, and
covered with oiled-silk.



NOISES IN THE EA-RS. 


349


5.-Noises in the Ears (Tinnitus aurium).
These noises are variously compared to the whistling of
the wind, the hissing or singing of a tea-kettle, the ringing
of a bell, the beating of a drum, etc. For their treatment,
a medical man should be consulted. These symptoms seldom
exist alone, being generally connected with the incipient
stages of some disease of the ear, such as deafness, otorrhcea,
etc., or they may be produced by cold.
When peculiar ringing noises in the ears occur in acute disease, they are generally the result of congestion of the cerebral
vessels, too strong throbbing of the arteries of the temples, or
some morbid condition of the brain itself. When this deprivation of the sense of hearing is more or less constant, and not
depending upon disease of the ear, or closure of the
Eustachian tube, it may be regarded as a grave symptom
indicating derangement of the vessels of the brain, and the
harbinger of apoplexy or paralysis. Old people who neglect
to take sufficient out-door exercise, and women who suffer
from nervous exhaustion, or uterine disease, often complain
of these annoying sounds. In these latter cases, the phenomena often cease on the removal of the causes which gave
rise to them.
6.-General Remarks on Affections of the Ear.
1st.-A  frequent cause of disease of the ear is the
reprehensible practice of leaving the head and ears of
children wet or imperfectly dry after bathing or washing.
This danger is the more necessary to be guarded against
if there already exists any discharge from the ear. After
bathing, or the ordinary morning or evening wash, the
greatest care should be taken to dry the hair and ears
thoroughly, especially if the health is not robust. As a



350


AFFECTIONS OF THE EARS.


further precaution in such cases, a piece of fine linen or a
piece of blotting paper should be twisted into a coil, and
introduced into the cavity of the ear, to absorb any remaining moisture.
2nd.-Parents, governesses, and others, who have the care
of children, should be aware of an accident very liable to
occur from blows on the head or boxing the ears, as it is
termed, namely, laceration of the membrana tympani, a
membrane which closes the bottom     of the meatus, and is
stretched something like the parchment of a drum. The
accident may be recognised by a sense of shock in the ear,
deafness, and a slight discharge of blood from the orifice;
and if examined by an ear speculum, the rent may be seen.
If treated by a non-professional person, the writer advises
complete rest for several days, and the use of Arnica lotion,
as directed under " Foreign bodies in the Ears."
3rd.-Another point of considerable importance, to which,
attention has been called by Mr. J. C. Forster, is the case in
which a child, from being slightly deaf, has been thought to
be stupid or obstinate. "Very sad," as that gentleman
observes, " is it to think how often a child is thus punished
for his misfortune, and, it may be, irremediable injuries
inflicted on the mind or temper of this poor victim of unintentional injustice. It is hardly necessary to insist upon the
care which is requisite in examining the state of the hearing
power in a child, or to refer to the fact that children will
often say, and doubtless think, that they hear a watch when
they do not."
4th.-Lastly, a remark may here be appropriately made,
bearing on the treatment of the diseases of the ear. In all
chronic affections of this organ, the higher dilutions (6 to 12)
of the different medicines are generally more efficacious than'
the lower (1 to 3).



OFFENSIVE BREATH.


351


CHAPTER XI.
AFFECTIONS OF THE MOUTH, TEETH, NOSE, ETC.
1.-Offensive Breath.
IN perfect health, the odour of the breath is sweet and
agreeable; on the contrary, foetid breath is usually a concomitant of disordered digestion, scurvy, malignant sore
throat, etc.; it is also disagreeable and infectious during the
progress of the eruptive, typhoid, and pestilential fevers;
but in no disease is it more offensive than in gangrene
(mortification) of the lung; indeed, this condition may be
recognised by this symptom alone.
Sometimes offensive breath arises from inattention to the
mouth and teeth; in this case the remedy is obvious,
namely, careful cleansing of the teeth and mouth after
meals, especially when animal food has been eaten.
TREATMENT.-Ascertain, if possible, the cause.      If it
appear to depend upon indigestion, or any other complaint,
proceed according to directions given in other parts of this
manual.   Competent advice, however, founded upon the
history and circumstances of the individual case, is almost invariably required. In the absence of the advice of
a physician, the following medicines may be tried.
Carbo Veg.-Putrid odour of the breath from       decayed
teeth, bad condition of the gums, large doses of Mercury,
or other causes. A dose thrice daily, for eight or ten days,
or as long as may be necessary.
Hepar Sulph., or Nitric Acid, may follow this remedy,
especially when it is insufficient to correct the evil, and
when the complaint is the result of previous salivation with
Calomel.



352


AFFECTIONS OF THE MOUTH, ETC.


lMercurius.-Fcetid breath from a sore or aphthous condition of the mouth.
NTix Vomica, or Pulsatilla, should be selected when the
complaint cannot be traced to any definite cause. A dose
night and morning, for a week or ten days.
SulZphur, night and morning for a week, may follow any
of the preceding remedies, and complete the course. After
an interval of a few days, if necessary, the course may be
repeated.
Aur., or Puls., are suitable remedies when the complaint
occurs in females advancing towards womanhood.
ACCESSORY MEANS.-General attention should be given to
diet, the internal and external use of water, pure air, regular
out-door exercise, and such other means of promoting good
health as are indicated in the first chapter of this book.
Animal food should be eaten with great moderation; and
the teeth and mouth should be carefully cleansed at least
twice a day.
Consult also " Local Measures," under " Toothache."
2.-Thrush (Aphttha)-Frog.
SYMPTOMS.-Small vesicles or white specks appear upon
all parts of the lining membrane of the mouth, and are sometimes so connected as to form a continuous covering over the
tongue, gums, palate, and, in bad cases, through the intestinal canal. Though arranged under " diseases of the
mouth," it is by no means limited to this part. It is
usually accompanied with other symptoms, such as feverishness, sickness, diarrhea, and, in fatal cases, with typhoid
symptoms. The disease most frequently occurs in infants at
a very early age.
CAUsEs.-A weakly, unhealthy constitution; a bad quality
of milk from an unhealthy or intemperate nurse; an improper quality or quantity of food in children brought up by



353


THRUSH.


the bottle or spoon; neglect of cleanliness, etc. When
thrush occurs in adults, it is usually the result of some other
malady; it is then always serious, and often an indication of
speedy dissolution. In consequence of the disease chiefly
affecting infants, or adults in the last stage of disease, it has
been called the first and the last disease.
TREATMENT.-    fercurius. -Is indicated by dribbling of
saliva, diarrhoea, colicky pains, offensive breath, and by the
eruption shewing a tendency to ulceration. If this remedy
is administered when the white specks first appear, it is
often sufficient to cure without the aid of any other remedy.
A dose every six hours for several days.
Borax.-This is an old but very appropriate remedy; and
is an instance of the accidental practice of homoeopathy
before its principles had been recognised.   It is chiefly
indicated when the disease has extended to the coats of the
stomach and intestines, and is but rarely required at the
commencement of the disease, when Mercurius will be found
more efficacious. The patient's mouth may be washed with
a solution of Borax (four grains of Borax to one ounce of
water) by means of a soft brush; or the aphthous parts
painted with a mixture composed of one-third of Borax and
two-thirds of honey.    The application should be made
several times a day; and is alike required whether the
disease occurs in adults or infants. The local application of
Borax should be accompanied by its internal use; a powder
of the 3rd dec. trituration thrice daily.
Arsenicum.-Dangerous forms of thrush, the eruption
becoming brown or black, bleeds easily, and emits an offensive smell; the disease covers the entire mouth, throat, and
even extends to the alimentary canal. The patient becomes
much exhausted and emaciated, and there is often distressing
diarrhoea. A dose every four hours.*
* Directions for the doses of infants are given at page 49.



354


AFFECTIONS OF THE MOUTH, ETC.


Carbo Vegetabilis.-This has similar indications to the
last remedy, and may be given if that fail to effect more
than a partial cure.
Sulphuric Acicl.-In tedious cases, accompanied by debilitating diarrhcea, night sweats, etc., this remedy often
either arrests or modifies the disease, when other remedies
fail. It may be given internally, and as a weak gargle.
Sulphur.-This remedy may follow Mercurius, or any other,
if the latter is insufficient to cure; or, when the eruption
has nearly subsided, to  prevent a relapse.    Cutaneous
eruptions, sour-smelling breath, etc., are indications for this
remedy. A dose morning and night.
GENERAL DIRECTIONS.-Cleanliness, ventilation, fresh air,
and proper diet, are necessary in preventing or curing thrush.
When the complaint has been caused by ill-health of the
mother or nurse which cannot be soon cured, the infant
should be weaned and fed with Sugar of Milk, by which a
nearly exact imitation of maternal milk may be formed. In
all cases in which infants are wholly or partly deprived of
breast-milk, or if the mother's milk is deteriorated in
quality, this article may be substituted.  It is economical,
easily prepared, and is undoubtedly superior to all other
kinds of food for tender infants deprived of a proper supply
of healthy breast-milk.*
Formula.-It is prepared for use as follows:-Dissolve
one ounce of the Sugar of Milk in three quarters of a pint
of boiling milk.  Mix as wanted with an equal quantity of
fresh cow's-milk, and feed with a suckling bottle.
3.-Hare-Lip.
VARIETIES.-This is a congenital fissure of the upper lip,
of which there are several varieties. It is called single
* Sugar of Milk for infants' food, with appropriate bottles, may be procured
at any Homceopathic Pharmacy.



HARE-LIP.


355


hare-lip when it affects one side; double, when it is present
on both sides. It may be confined to the lip, or it may
involve the hard and soft palate to any extent. In the
latter case, the malformation is much more serious, and
children so affected being unable to form a vacuum in the
mouth to suck, usually die at a very early age.
CAUSES.-Arrcst of development, and want of union of
the lateral with the central portion of the lip.      Like
some other deformities, hare-lip often runs in families,
instances occurring in which several children of the same
parents have been so affected.
TREATMENT.-A surgical operation is in all cases necessary,
and it may be consolatory to those having children so affected
to know that under,favourable circumstances the operation
is completely successful. An important point connected
with the operation is the time at which it should be performed; namely, either before the child is six months old,
or after it is two years old, but not between these periods;
because the primary dentition may be going on, and the
child's system being irritated, adhesion will not easily take
place; or if it should, the wound may easily break open
again. Of the two periods, the earlier is the better, as the
child is not under the influence of fear, is consequently
more manageable, and the cicatrix will be less apparent in
after life. If the deformity extends to the upper jaw-bone,
so that the mouth is laid open into the nose and prevents
the child imbibing a sufficient amount of nourishment, the
operation should be performed at the very earliest period;
for although the danger from loss of blood is greater than at
a later period, it is much less than that from the imperfect
nutrition which results from the deformity.



TOOTHACHE.


359


Aconitum.-Full-habited patients, with flushed face, hot,
swollen gums, thirst, restlessness. It is also well adapted to
children during teething, often in alternation with Bell.
Administration.-About every fifteen or twenty minutes
till the pain is mitigated; afterwards, every three or four
hours.
LOCAL MEASURES.- STOPPING CARIOUS TEETH.--If the
caries be recent and slight, the decayed portions should be
removed, and the cavity filled with a suitable material, by a
skilful dentist. If the patient be suffering from     severe
toothache, this should be first removed before the cavity is
stopped. When it is not practicable to have a tooth stopped
by a professional dentist, its cavity should be filled with
white wax, which, by excluding the atmospheric air and the
irritation of food, retards the progress of decay. But a
better and more durable stopping, for non-professional
persons, is gutta-percha,* which, if carefully introduced,
after thoroughly cleaning out the affected tooth, may prdserve it as a useful member for years.
EXTRACTION    OF TEETH.-In a few      cases, probably not
more than two in a hundred, the only remedy for toothache
is extraction; especially if the decay has proceeded so far
as to blacken the tooth, rendering it loose and useless for
mastication, prejudicial to neighbouring teeth, and a cause
of offensive breath. On the other hand, say in ninety-eight
cases out of a hundred, considerable experience justifies us
in stating, that the most distressing cases of toothache are
promptly cured by Homoeopathic remedies. Our advice,
therefore is, never extract a tooth merely because it aches, or
has begun to decay; skilful treatment is usually sufficient to
remove the pain; and, subsequently, local and        general
measures will prevent a recurrence of the trouble.
"* Gutta-percha, prepared for this purpose, may be procured from most
Homceopathic chemists.



TEETHING.


361


permanent set, which is not completed till the commencement of adult life. The order in which the milk teeth
appear is generally as follows:-about the sixth month the
two middle incisors of the lower jaw, followed in a few
weeks by the corresponding incisors of the upper jaw; next
appear the two outside incisors of the lower jaw, and soon
after those of the upper; after another interval of perhaps
about two months, the first four molars, then the eye teeth,
and, lastly, four other molars, completing by about the
second year the teeth of the first set. Should there be any
little deviation from this order, or should dentition be a little
prolonged, no great importance need be attached to it.
The changes occurring during the first dentition render
the period an important one in the child's history. Concurrently with it, the whole organization appears to receive a
new impulse. The face, hitherto without expression, receives
distinctness of features; the eye acquires expression, the
mind appearing to speak through it; the rounded facial
outline becomes oval, the teeth separating the jaws further;
the forehead becomes more expanded, and the general
expression of the features are but signs of an evolution
which is pervading the whole organism, of which the change
in the teeth forms but an inconsiderable part.
DANGERS OF TEETHING.-This process being a natural one,
should not certainly be regarded as in itself a disease, still
less a dangerous one, but simply a natural period of the
development of the child's organism. At the same time,
the increased activity and excitement in the vascular system,
combined with the nervous irritation which almost invariably
attends dentition, may, in delicate or strumous children,
give rise to a greater or less amount of local or constitutional disturbance. The period at which dentition occurs is
important. In too early dentition, the constitution is rarely
sufficiently strong to sustain the evolutions it has to under2 A



362


AFFECTIONS OF THE MOUTH, ETC.


go; while in late dentition, there is a languid condition,
indicative of a scrofulous constitution.    In either case,
domestic treatment should scarcely be trusted to.
SYMPTOMS.-Irritation in the mouth, swollen or tender
gums, and increased flow of saliva; frightened startings or
interrupted sleep; sudden occurrence of febrile symptoms;
various eruptions on the head or body; derangement of the
digestive organs-either diarrhoea or constipation, and sometimes spasms and convulsions. These symptoms are referred
to under the several remedies which follow, and most of
them are separately treated of in other parts of this volume
under their respective headings, and may be found by the
index.
CAUsEs.-Frxcessive quantities of food, or improper food;
keeping the head too hot; strumous constitution, and local
affections of the gums, as inflammation, or disproportion
between the jaw and the number and form of the teeth.
TREATMENT.-Aconitum is generally the proper remedy at
the commencement, when there exist heat, redness, pain,
restlessness, swollen gums, etc. Acon. is a remedy of much
importance in the diseases of children.
3Mercurius.-Nocturnal diarrhoea, the motions being bilious,
mucous, or bloody, with straining, colic, perspiration, etc.
Chamomilla may follow Acon. when there exist dry cough,
short breathing, much crying, tossing about, twitching of
the mouth and face, loose, green, or frothy stools, and
griping pains.  Cham. is a sovereign remedy in many of the
ailments connected with dentition.
MTux Vomica.-Torpidity and sluggishness of the intestinal
canal, especially in irritable children with dark complexions,
and when costiveness is traceable to improprieties in the
diet. This remedy, if it does not fully answer, may be
followed by Opium or Bryonia.
Belladonna.-Great agitation; frightened starts during



TEETHING.


363


sleep; red, brilliant, convulsed, fixed, or unsteady eyes;
convulsive movements of the limbs; congestion and throbbing of the blood-vessels of the head.
Cofoea.-Extreme irritability, excitability, sleeplessness,
frequent changes from   tears to laughter; especially in the
absence of fever.
Calcarea.-Slow or late dentition, especially in strumous
children, liable to relaxed bowels, with loss of flesh and
strength.
Silicea.-Similar symptoms to those of Calcarea, especially
when the teeth, though on the point of coming through,
are still tardy. This medicine, as also the former, often
supersedes the operation of lancing the gums.
Ars., Ipec., and   Sulpk., are remedies also sometimes
required.
ACCESSORY TREATMENT.-See under the next section.
6.-Infantile Convulsions-Fits.
Infantile convulsions are the most frequent of the cerebral
affections of children, and are usually from some eccentric
cause, as teething, but sometimes the forerunner of hydrocephalus.
SYMPTOMS.-In slight cases, the child suffers from twitchings of the muscles of the face, some difficulty of breathing,
rolling of the eyes, etc. In severer cases, the child suddenly
becomes insensible, and the muscles of the head, neck, and
extremities, are convulsed in various directions; the eyes are
insensible to light, and turned rigidly up and to one side;
the face is congested but sometimes pale; the lips livid, and
there is frothing at the mouth; the hands are generally
firmly clenched, and the thumbs turned inward, with the
fingers on it; the soles of the feet are turned together, with
the great toe bent into the sole, from the greater irritability
of the flexor muscles. After one or two minutes the con



INFANTILE CONVULSIONS.


365


Opium.-Spasms, followed by stupor, laboured breathing,
confined bowels; convulsions from fright.
Cuprum.-Red, bloated face, shrieking before the attack,
convulsive movements, the paroxysm resembling an epileptic
seizure.
Cina or Ignatia.-Convulsions from thread worms.
Aconitum. - Fever, restlessness, flushed face; also for
threatened convulsions.
Dose and Repetition.-See page 49.
ACCESSORY TREATMENT.-Diarrhoea arising during dentition, unless very excessive, should not be interfered with.
It may be regarded as an effort of nature to relieve congestion to the head. " Keeping the head cool and the feet
warm," washing the child, especially the head, with cold
water daily, and taking it out much in the open air
in favourable weather, render it much less liable to illness
during teething. From this it may be inferred that caps
and warm   coverings to the head, even during the night,
are prejudicial; they tend to produce determination of blood
to the brain or its coverings, which may occasion alarmingor fatal consequences. Purgatives should be avoided, and
the bowels regulated by suitable diet, or by Homoeopathic
treatment. In obstinate constipation, injections should be
had recourse to; also in convulsions occasioned by worms.
Costiveness in infancy is entirely due to errors in diet. The
mother or nurse should carefully abstain from all articles of
food and drink of an indigestible or stimulating character.
As an article of diet for children brought up by hand, we
strongly recommend the Sugar of Milk, as referred to under
" Thrush."
DISEASED MILK.-The highly objectionable character of
the milk yielded by cows in the cowsheds of London and
other large cities, is a subject of great importance to children
fed by the bottle. Even with all the advantages arising



366


AFFECTIONS OF THE MOUTH, ETC.


from the recently-legalised inspection and licensing of cowsheds, and   the constant cleansing, whitewashing, and
improved ventilation, the milk of stall-fed cows is poor,
watery, innutritious, and in many cases, from containing
globules of pus, is decidedly unwholesome, many instances
of disease and ulceration of the alimentary canal of infants
being readily traced to the diseased milk on which they are
fed.   So strongly has this evil impressed itself on the
Vestry of St. James's, Westminster, that they have now
determined not to license any cowshed in the parish.
7.-Polypus of the Nose.
DEFINITION.-A    polypus is a pendulous mass growing
from  any mucous surface, but chiefly from  the nose, ear,
throat, womb, and rectum. The term is used to denote any
kind of pendunculated tumour attached to a mucous surface.
A nasal polypus is usually of the gelatinous kind, composed of the elements of mucous membrane, expanded; it is
pear-shaped, yellowish, and consists of several soft strawcoloured tumours, streaked with a few blood-vessels, hanging
from the upper spongy bone, which are apparently hypertrophied growths from the submucous areolar tissue, and of
the subjacent parts, to which it is attached only by a very
narrow neck. It is of such loose texture as to imbibe the
atmospheric air, which renders it larger in damp weather
than in dry.
SYMPTOMS.-A    nasal sound in the voice; the patient
acquires the habit of keeping his mouth open to facilitate
breathing; difficulty of swallowing liquids; the nose is
enlarged externally on the affected side; and on looking up
the nostril the polypus may be observed. In consequence of
the symptoms of stufing which a polypus occasions, it may
at first be mistaken for a cold in the head. At times, however, the polypus rises into the upper part of the meatus,



POLYPUS OF TEE NOSE.


367


leaving this portion of the air-passage free, thus enabling
the patient to breathe almost naturally. But on the nose
being violently blown, the polypus descends and appears
near the orifice, causing the obstruction to return, contrary
to the usual result of such an operation.
TREATMENT.-The following remedies are most to be depended upon in this affection:-Calc., Phos., and Sepia;
and sometimes Puls., Staph., or Silic. Commence with
Cal., a dose night and morning for ten or fourteen days;
then wait a few days and repeat the remedy, or commence
with the one next mentioned.
If discovered early, the above medicines may prove successful in arresting its growth, and so altering the condition of
the mucous membrane, that it will no longer favour such
growths. Should a polypus, however, attain such a size as
considerably to obstruct the passage, it should be removed
by a surgeon, by means of the silver wire snare. After
this, a persevering use of one or more of the remedies may
be adopted, in the confident hope that the tumour will not
grow again, but without which it almost uniformly returns.
8.-Loss of Smell (Anosmia).
When this is owing to a cold, which sometimes induces a
paralytic condition of the olfactory nerve, Merc., Puls., or
Sulph. will be appropriate. When this condition has become
chronic, a selection may be made from the following, and its
use persevered with for ten days or a fortnight: Silic., Sep.,
Cakl. Carb., or Zinc.
9.-Ozcena.
NATURE.-Ozcena, so called from its foetor, consists of
ulceration of the Schneiderian membrane (the mucous membrane lining the nose), from which an offensive purulent
matter is discharged through one or both nostrils.



368


AFFECTIONS OF THE MOUTH, ETC.


SYMPTOMS.-Inflammation and swelling of the sides of the
nose, attended with sneezing; discharge of mucus obstructing the nostrils; sometimes slight haemorrhage; or, as the
disease extends, the mucus assumes the character of pus.
CAUSES.-A scrofulous constitution is a frequent predisposing cause, and a severe or neglected catarrh is an exciting
cause. Sometimes it has a syphilitic origin.
TREATMENT.-Aconitum.--Half a dozen drops of the strong
tincture of the root, in a tumbler of water; a dessertspoonful every three hours, for a day or two. Afterwards,
one of the following remedies may be selected.
Aurum.-Very offensive discharge, especially if the disease
has arisen from the abuse of Mercury.
Nitric Acid.-Syphilitic ozcena. This remedy is particularly indicated if the patient has been drugged by large
doses of Mercury.
Iodide of Mlercury.-Purulent, thick, and offensive discharge, in an advanced stage of the disease, and when it
arises from syphilis or scrofula.
Arsenicum.-Ichorous, fcetid, and malignant discharge,
particularly if the patient is much shattered in constitution.
Puls., Lyc., Sulph., may also be required in the early
stage of the disease; Calc., IHep. Sulpl., Mlere., Coni.,
Tli]ja, in the latter stage.
Dose and Administration.-See page 49.
ACCESSORY   MEANS.-The nasal cavity should       be well
syringed out, once or twice a day, with tepid water, to
which a few drops of the chloride of zinc have been added,
so as to wash away all clots and collections of matter. This
affords considerable comfort to the patient, modifies the
foetid odour of the breath, which is so offensive to others,
and facilitates recovery. If the disease arise from catarrh,
the inhalation of the steam of boiling water every evening,
and removal to a dry, bracing atmosphere, will be appropriate adjuncts to the medicinal treatment prescribed.



QUINSY.


369


10.-Quinsy-Sore Throat (Tonsilitis-Cynanche Tonsillaris).
DEFINITION.-Quinsy, or common inflammatory sore throat,
consists in acute inflammation of the tonsil or tonsils, and of
the subjacent mucous membrane, and is indicated by pain
and considerable swelling of the tonsils, and general fever.
SYMPTOMS:--It comes on quickly, with rapid swelling of
one or both tonsils, severe throbbing pain, hoarseness, and
difficult swallowing and expectoration, occasioning a painful
and almost a constant effort to bring up and detach the
viscid mucus which adheres to the inflamed surface; headache; pain in the back and limbs; foul tongue; offensive
breath, and general febrile symptoms. In ordinary cases, or
even in severe, if the disease is promptly and skilfully
treated, the pain, swelling, and other inflammatory symptoms subside in a few days, leaving the tonsils enlarged;
otherwise, matter forms, which is indicated by rigors, and
throbbing, darting pains in the throat, extending to the
ears. When the abscess is fully mature, it bursts, to the
immediate relief of the patient. Often the abscess forms in
one tonsil, and after its discharge another forms in the other.
CHRONIC ENLARGEMENT OF THE TONSILs.-Repeated attacks
of acute inflammation, or attacks but partially cured, are
followed by chronic enlargements and indurations, causing
difficult swallowing, hoarse voice, noisy and laborious breathing, especially during sleep, affections of the ears from
continuity of the mucous membrane, and extreme liability,
from slight causes, to a frequent recurrence of acute inflammation.
CAUSES.-The predisposing causes are, scrofulous constitution, the abuse of Mercury, disorders of the digestive
organs, and previous attacks of quinsy. The exciting causes
are-cold, atmospheric changes, wet feet, etc. Quinsy is
most frequent in young persons of plethoric habit, between



370


AFFECTIONS OF THE MOUTH, ETC.


fourteen and twenty years of age, and for several years is
liable to occur frequently unless preventive means are
adopted.
DANGERS.-When the inflammation extends to the uvula,
the soft palate, the salivary glands, the pharynx, and particularly to the root of the tongue, and when the breathing
becomes difficult, it is then extremely perilous. But early
and skilful treatment will ordinarily prevent the malady
assuming such serious forms.
TREATMENT.-Aconitum.-The patient is feverish, chilly,
thirsty, and complains of headache, dizziness, and restlessness; he experiences a sensation of stinging, pricking,
fulness, or even of choking in the throat, which on examination looks red as if scorched.
Belladonna.-Dry throat, with burning, rawness, and, on
drinking, a kind of suffocating spasm in the neck, which is
swollen; redness of the face, glistening of the eye, and
pain and difficulty in swallowing.  A valuable remedy,
either after, or in alternation with, Aconitum.
1Mercurius. - Swollen throat; copious accumulation of
saliva in the mouth; swelling of the gums and of the
tongue; shooting pain on swallowing; an inclination to
swallow the saliva, although painful; a disagreeable taste in
the mouth; foetid odour of the breath; ulcers on the sides
of the mouth; pains extending from the throat to the ear.
Profuse perspiration, and aggravation of the symptoms at
night, also point to this remedy. If the practitioner has a
choice of remedies, the Iodide of Mercury will be found more
efficacious than either of the preparations given in the list,
page 47.
lHepar Sulph.-Inflammation of the tonsils (tonsilitis)
after matter has formed. It is especially useful in scrofulous constitutions, and for patients in whom a liability to
the disease has become established.



QUINSY.


371


Arsenicum.-Severe forms of quinsy, attended with great
general prostration, the tonsils assuming a putrid or gangrenous character.
Rhus Tox.-If the febrile symptoms assume a typhoid
character, this remedy may be administered alternately with
Ars. or Bell.
Nux Vomica or Pulsatilla, as may be best indicated by the
condition of the patient, is often useful when derangement
of the stomach appears to be the cause of the complaint, or
is evidently associated with it.
Administration.-In acute cases, a dose every one or two
hours, till some improvement ensues; in subacute, every
three or four hours; during convalescence, every six or twelve
hours. If swallowing is extremely difficult or impossible,
one or two drops of the tincture on about two grains of
sugar of milk, and placed dry on the tongue.
AccEssORY MEANS.-The most effectual local application is
the steam of hot water, and equally so whether the object be
to bring about resolution or to facilitate the suppurative
process. Steaming the throat assiduously with the steam of
hot water, acts as a fomentation, and removes the mucus
from the crypts and follicles of the tonsils. In order to
carry out this suggestion efficiently, an Inhaler is necessary;
a very useful one may be procured for about 2s. 6d.; and
considering the utility of such an apparatus for general
throat affections, coughs with copious expectoration, etc., so
small a sum may thus be well expended. For the sake of
the poor, or in emergencies, the following will be found a
good substitute for an inhaler. Pour boiling water into a
teapot, up to the bottom of, but not sufficient to cover, the
aperture which conducts to the spout, and with the lid of
the teapot closed, draw up the steam into the throat. This
may be repeated half a dozen times a day, or oftener, as
long as the throat continues painful.



372


AFFECTIONS OF THE MOUTH, ETC.


In some cases a warm milk-and-water gargle, frequently
used, will be found useful and soothing. Further, in severe
attacks, a hot poultice should be applied across the throat,
extending nearly to each ear; in mild attacks, the wet
compress, described pages 133-4, may be used. The patient
should remain indoors, and in bad cases, in bed.
PREVENTIVE TREATMENT.-Freely bathing the neck, jaws,
etc., and gargling the mouth and throat every morning with
cold water. After exposure to cold, and especially if the
first symptoms of sore throat show themselves, the wet
compress, covered with oiled-silk and flannel, as recommended in the last paragraph, should be at once applied.
11.-Mumps (Parotitis-Cynanche Parotidoca).
Mumps may be classed among the epidemic diseases; for
when it affects one person in a family or school, it usually
extends to others. It is much more prone to attack children
than adults, and seldom occurs in the same person more
than once.
METASTASIS.-A curious but important circumstance connected with this affection is, that in many cases, as the
swelling of the neck and throat subsides, the testicles in the
male, and the mamme- in the female, become tender and
swollen. Occasionally, but more rarely, the metastasis is
from the neck and throat to the brain, and then it becomes
a very serious disease.
The transference of the disease from the part first implicated to the testicle, mamma, or brain, is much more likely
to supervene when the tumefaction suddenly subsides, as on
exposure to cold, or from cold applications.
CAUSES.-A    specific morbid miasm, generated during
peculiar conditions of the atmosphere, which spreads by
contagion. Cold and damp are especially favourable to its
appearance.



MUMPS.


373


SYMPToMS.-Swelling and soreness in one or both parotid
regions, preceded by febrile symptoms.   The swelling
generally extends from the ears to the glands under the jaw
and chin, and the parts are hot and tender. Sometimes one
side, and sometimes both sides, are affected; and there is
often considerable deformity, with difficulty and pain in
moving the jaws. On or about the fourth day, in favourable
cases, the inflammation and swelling have reached their
height, and by about the eighth or tenth day all traces of the
complaint have disappeared.
TREATMENT.--Mercurius is the chief remedy, and is often
sufficient to effect a cure, especially when caused by cold,
and attended with pain during mastication, and impaired
appetite. A dose two or three times daily. As in quinsy,
the Iodide of Mercury is the most efficacious preparation.
Belladonna, when the pain is very severe, with a tendency
to lethargy and delirium; when the inflammation becomes
erysipelatous, and when the mumps occur after measles.
Aconitum.-If there is much fever present; two or three
doses may precede any other remedy.
Metastasis, with iflamnmation and slupjzration.-Merc.,
Puls., Sil., Coni., or Aur.
Sudden occurrence of delirium or coma.-Bell., Opi., or
other cerebral remedies.
ACCESSORY MEASURES. -It is highly important, as may be
inferred from what has already been remarked, that there
should be no exposure of the patient to cold or damp during
the progress of the disease. Cold local applications, to
reduce the swelling, are quite inadmissible, and if used
would favour the tendency to metastasis of this disease to
more important organs. Warm fomentations are beneficial,
the parts being covered in the intervals with one or two
thicknesses of flannel roller. In mild cases, a flannel roller
is the only local application necessary.



U74            AFFECTIONS OF THE MOUTH, ETC.
Quinsy generally terminates by resolution; but should
suppuration ensue, poultices must be substituted for fomentations.
Lastly, mental and physical excitement are to be avoided,
so as further to guard against troublesome metastasis.
12.-Goitre-Derbyshire Neck (Bronchocele).
DEFINITION.-This consists of a chronic morbid enlargement of the thyroid gland, from the use of water containing
-in solution the salts of lime.
The swelling is unattended with pain or danger, until it
acquires a size sufficient to produce deformity, and, by its
pressure upon the trachea and cesophagus, interfere with
respiration and swallowing.     Women are more subject to it
than men, the proportion being about twelve to one; and
the right lobe is more often enlarged than the left. It is
most commonly met with in chalky districts and mountainous countries, and in the latter is often associated with
cretinism.*
CAUSEs.-This is called an endemic disease, because it is
prevalent in particular localities, such as Derbyshire (hence
called Derbyshire neck), and the chalky parts of England
generally, and various Alpine and mountainous districts of
** Cretinism is a strange disease, a sort of idiocy, accompanied by deformity
of the bodily organs, which has a close but ill-understood connection with
goitre. Most cretins are goitrous; but the latter may exist without the
former. The cretin is found principally in the valleys of the Alps, the
Pyrenees, and the Himalaya mountains. Idiotism of the lowest grade is often
his lot; sometimes he is deaf and dumb, or blind; and in short, if neglected,
he more resembles an animal than a human being. I say, if neglected, for the
humane Dr. Guggenbiihl has proved, that by pure mountain air, exercise, a
nourishing diet, into which milk largely enters, and moral and mental
training, much may be done for these apparently hopelessly-wretched beings
(Tanner).
As this chapter is passing through the press, the author regrets to learn
from a correspondent and visitor to the sanitary establishment founded some
years since for cretins by Dr. Guggenbiihl, that this valuable institution is
now changed into the Hotel Bellevue and Pension. The Doctor has died and
the children are dispersed to their homes.



GOITRE.


375


Switzerland and other countries. It is due to some specific
action of the drinking water which flows from rocks of
magnesian limestone. Chemical examination of the water
used by the inhabitants of the various places where goitre
prevails, always finds in it large quantities of carbonate of
lime; whereas the water from clay-slate rock, drunk by the
inhabitants who did not suffer from goitre, contained none.
In Yorkshire, Derbyshire, Nottinghamshire, Hants, and
Sussex, where the disease prevails, there is a ridge of magnesian limestone running from north to south through the
centre of the district. All along that line goitre prevails to
its greatest extent; and, diverging to either side, the disease
is found to diminish (Inglis). In a goitrous district in Switzerland, there are some waters issuing from certain rocks,
and trickling along crevices in the mountains, the drinking
of which will produce goitre, or increase goitrous swellings,
in eight or ten days; while the inhabitants who avoid these
waters are free from  the disease. In Oude, where goitre
affects animals as well as man, it is stated that the water of
wells known to be injurious, in consequence of their excessive impregnation with lime, has been abandoned, and other
water substituted for drinking; great benefit has resulted,
and goitres have diminished in size, even though the subjects
of them have continued living in the same village as before.
IMost persons who have goitre find it enlarge during any
derangement of the general health, especially from uterine
vailments, difficult labours, an anaemic condition of the
system, and also strains, twists of the neck, etc.
TREATMENT.-Spongia.-This is an excellent remedy for
reducing the swelling, and may be administered night and
morning for a week; then, after pausing a few days, the
course may be repeated as often as it proves beneficial.
Mercurius lodatus.-In cases of long standing, and when



376


AFFECTIONS OF THE MOUTH, ETC.


the tumour is enlarging so as to impede the function of
breathing, we have used this remedy with excellent results.
Bromine, Calc. Carb., Caust., Kali Hiydriod, lod., Staph.,
and Sulph/., are additional remedies, from which a selection
may sometimes be made; but Spong. or Mere. Tod. is the
first to be used. We have sometimes conjoined external
applications of the same drug as has been given internally
with good results.
An entire removal of the swelling is not always possible;
still, much is gained if the tumour is lessened, or its further
enlargement prevented. Any impairment of the digestive
or uterine functions should, if possible, be corrected, for, as
before stated, under such disorders a bronchocele is much
more likely to attain inconvenient and even alarming
proportions.
AUXILIARY MEASURES.-One most essential point in the
treatment is the removal of the patient from the district
where the infection occurs. The necessity of this may be
inferred from the fact that persons taking up their residence
in affected localities soon acquire goitre, while others who
leave such localities, affected with goitre, soon lose it. A
dwelling on the coast, and sea-bathing, are advantageous,
and under such circumstances the remedies prescribed may
be employed with much greater hope of success.
Water used for domestic purposes should first be boiled or
distilled. Next to removal from a goitrous locality, this'is
the most essential point in the treatment and cure of
bronchocele.



PALPITATION OF THE HEART.


377


CHAPTER     XII.
DISEASES OF THE ORGANS OF CIRCULATION.
1.-Palpitation of the Heart (Palpitatio cordis).
IN a perfectly healthy condition, we are scarcely sensible
of the heart's action; when, however, its pulsations become
much increased in force or frequency, or both, the unpleasant
sensation known as " palpitation " is experienced.
In the following Table, abridged from   Dr. Aitken's
"Science and Practice of Medicine," the chief characters of
palpitation from structural disease of the heart, are placed
in contrast with those from mere functional disorder.
TABLE OF THE CHIEF DIFFERENCES BETWEEN ORGANIC
AND FUNCTIONAL DISEASE OF THE HEART.


ORGANIC DISEASE.
I. Palpitation usually comes on
slowly and insidiously.
2. Palpitation, or distressed action, though more marked at one
time than another, is constant.
3. Percussion elicits increased extent and degree of dulness in the region of the heart.
4. Lividity of the lips and cheeks,
congested countenance, and anasarca
of the lower extremities, are often
present.
5. Palpitation often not much complained of by the patient, but occasionally attended with severe pain extending to the left shoulder and arim.
(See "Angina Pectoris.")
6. Palpitation is increased by exercise, stimulants and tonics, but is
relieved by rest.
7. Is more common in the male
than the female.


FUNCTIONAL- DISEASE.
1. Palpitation generally sets in
suddenly.
2. Palpitation is not constant, having perfect intermissions.
3. Dulness in the region of the
heart is not extended beyond the natural limits.
4. There is no lividity of the lips
and cheeks, countenance often chlorotic, and, except in extreme cases,
no anasarca.
5.  Palpitation much complained of
by the patient, often with pain in the
left side.
6. Palpitation is increased by sedentary occupations, but relieved by
moderate exercise.
7. Is more common in the female
than the male.
2B



PALPITATION OF THE HEART.


379


Belladonna.-Oppression, tremor, pain about the heart;
palpitation extending to the neck and head.
Spigelia.-Palpitation with strong pulsations of the heart,
sometimes so as to be heard and seen through the clothes;
pain; tremulous motion of the heart.
Digitalis.-Irregular action of the heart, the pulsations
being violent at one time and scarcely felt at another; contractive, spasmodic pains with anguish in the region of the
heart.
Ignatia. -Palpitation  caused  by  long-continued, silent
grief.
Cofcea.- Wakefulness and nervous restlessness; palpita'tion from sudden joy.
CGkamomilla,-Palpitation from passion.
Opium.--Palpitation caused by a fright.
Veratrum. -Palpitation from fear.
Pulsatilla.-Hysterical symptoms, and in females suffering
from deranged period.
Administration.-During a sudden attack, a dose should
be administered immediately and repeated every thirty to
sixty minutes; as the symptoms decline, or in mild cases,
every three, six, or twelve hours.
ACCESSORY MEASURES.-In severely-painful affections of
the heart, the application of a large hot bran-poultice over
the region of the heart for about fifteen minutes at bed-time,
will relieve the distressing sensations. See the next section.
The patient must avoid excessive physical exertion, mental
excitement, stimulants, coffee, sleeping draughts, etc.  Pure
air; cold water, used internally and externally; regular
exercise in the open air, short of inducing fatigue; a
contented and tranquil disposition, with light and nourishing
diet, are excellent auxiliaries in the treatment of this
affection.



380       DISEASES OF THE ORGANS OF CIRCULATION.
2.-Angina Pectoris-Breast-Pang.
DEFINITION.-Sudden, severe paroxysms of pain, or spasm
of an enfeebled or diseased heart, with a constricted, burning
sensation, intense anxiety, and dread of immediate death,
chiefly occurring in elderly persons, or past the middle period
of life.
SYMPTOMs.-The patient is seized with a sudden dreadful
pain, which centres in the heart, and extends over more or
less of the anterior portion of the chest, up the shoulder in
the line of the costo-humeral nerves, and down the arm.
There is an agonizing feeling of anxiety, faintness, fear of
instant death, palpitation and'dyspnoea, so that if walking
he is compelled to stop and to fix on the first object that
offers support, and so remains dreadfully pale and covered
with a clammy perspiration. The paroxysms may terminate
in a few minutes, or last for hours, and are liable to recur
with increased severity, till at length one proves fatal.
CAUSES.-Generally, organic disease of the heart, as valvular
disease, fatty degeneration, or ossification, thickening, or
obstruction of the coronary arteries, in consequence of which
the muscular fibres of the heart are impaired. Under such
conditions a paroxysm     is brought on by over-exertion,
mental excitement,* indigestion with flatulent distension of
the stomach, and, after repeated attacks, even a frightful
dream.
TREATMENT.-The most useful remedies are,-Acon., Dig.,
Verat., Arsen., Samb., etc.
Aconitum.--Recent cases, and      for plethoric patients.
Digitalis.-Cases in    an  advanced stage, the paroxysms
" John Hunter, the celebrated surgeon, suffered greatly from this disease;
he considered his life in the hands of any person or circumstance which acted
powerfully on his mind, and at last died in St. George's Hospital, from strong
but suppressed feelings on a point in which he was interested.



ANIEMIA.


381


recurring frequently and suddenly.   Veratrum.-Slow, intermittent pulse, cold extremities, cold perspirations. Arsenicum.-Extreme dyspnoea, increased by the slightest
movement, marked debility, pale and haggard face, feeble
and irregular pulse, and dread of immediate death. Sambucus.-Violent dyspnoea, awaking from sleep with a suffocative sensation, and dreadful anguish about the heart.
Nux Vomica.-Indigestion, the attacks being attended or
followed by flatulence.
ACCESSORY TREATMENT.-Brandy or some other diffusible
stimulant, in frequent small doses; a large hot bran poultice
over the region of the heart, and warmth to the extremities.
3.-Anoemia.
DEFINITION.-This is a morbid condition, often called
" poverty of blood," in which the composition of the blood
differs from the normal standard; the liquor sanguinis being
watery, the albumen poor, and the red blood-corpuscles,
which give to this fluid its characteristic colour, deficient.
SYMPTOMs.-The skin, the lips, and the mucous membrane
generally, are pallid and have a bloodless appearance, and
the face looks like wax; the lining of the gums and mouth
is white, and the tongue is large, flabby, and pale; the
pulse is feeble, thready, beats about 80 times in a minute,
and is easily excited. The patient becomes very weak and
languid, is easily fatigued and loses breath; there is indigestion, loss of appetite, flatulence, and irregular action of
the bowels; the temperature of the extremities and surface
generally is below the healthy standard, and there is,
generally, cedema of the ankles or even of the feet. There
is also dejection of spirits, and morbidly heightened nervous
sensibilities.
CAUSES.-Copious or frequent small discharges of blood,



382    DISEASES OF THE ORGANS OF CIRCULATION.


as in hemorrhoids, repeated discharges of blood from the
womb, venesection, etc. Profuse or prolonged evacuation
of fluids which contain much of the organic constituents of
the blood, also gives rise to this condition, as in diarrhcea,
dysentery, ague, etc. Insufficiency of proper nutriment to
replenish the blood, or disturbances in the assimilative functions. Lastly, aneamia may result from the mind or body
being overtaxed, or from acute or chronic disease, especially
phthisis, diabetes, cancer, etc. Under such circumstances,
the blood becomes scanty or watery, the common saying
being almost literally true-"The blood i; turned into
water."
TREATMENT.-Aneemia from loss of animal fluids (blood,
etc.)--CAin., Pios. Ac., Nux., Verat.
From severe diseases.--Calc. Carb., Ars., Ferr., Phaos.,
Carb. Veg., Sep., Sil., etc.
ACCESSORY MEANS.-Nourishing, digestible diet, in quantities as large as can be assimilated-milk, eggs, animal
broths, and afterwards, fish, poultry, game, mutton, etc.
Combined with suitable food, moderate daily out-of-door exercise in a pure air, and bathing, especially sea-bathing, are
necessary to the restoration of the patient.
4.-Aneurism.
This disease consists of a tumour communicating with an
artery containing blood. In its first stage, it contains fluid
blood, and pulsates; in its second stage, it contains coagulated blood, deposited in numerous thin layers, like the
leaves of a book.  It is of two kinds: the idiopathic, arising
from disease of the coats of an artery; the traumatic, from
the wound of an artery. Aneurisms are more common in
men than women, and are the cause of death in England,
annually, of 300 to 400 persons.



VARICOSE VEINS..383


5.-Varicose Veins (Varix).
This condition is one in which the veins are so dilated that
their valves, which do not undergo a corresponding enlargement, are no longer efficient. It occurs most frequently in
the superficial veins of the lower extremities, and not usually
in the deep-seated veins, because they are supported by the
muscles and fascice. When this condition occurs in the
veins of the spermatic cord, it is called Varicocele; when in
the veins of the anus, it constitutes a form of piles.
SYMPTOMS.-The affected veins are tortuous, dilated,
knotted, of a dull leaden or purplish blue colour, with much
discoloration of the parts, and some cedema of the limb. If
a great many small cutaneous veins are alone affected, they
present the appearance of a close network of blue veins
under the skin. After taking the horizontal position, the
enlarged veins and the local swelling diminish.
CONSEQUENCES.-(1) Severe aching pain, with a sense of
weight and fatigue, especially after long walking, or remaining for some time standing in one position. (2) The
vein may burst by injury, and occasion severe and dangerous
hemorrhage. (3) Ulcers may arise from the imperfect circulation and nutrition of the skin, usually on the lower part
of the outside of the leg. (See the next section.) (4) They
incapacitate for hard or long-continued work, being associated
with constitutional debility.
CAUsEs.-The cause of varix may be generally stated to
include such conditions as induce more or less permanent
distension of the veins. Thus strains, or over-exertion of a
part, may cause such an afflux of blood into the veins as to
lead to their distension; so also standing occupations favour
the gravitation of blood to the lower extremities; and,
further, the length of a vein, such as the internal saphenous
vein, may lead to its undue distension in consequence of the



384.     -DISEASES OF THE ORGANS OF CIRCULATION.
long column of blood it contains. Obstacles to the return
of venous blood, such as tight garters or stays, a tumour,
the pregnant uterus,* or even impacted fseces, pressing upon
one of the large venous trunks, may occasion its permanent
distension as well as that of its branches. In other instances,
varix seems to be due to an hereditary predisposition, constitutional debility, deficiency of tone in the active organs of
circulation, or to an enfeebled and relaxed condition of the
walls of the veins.
TREATMENT.-Hamamelis, administered internally, and applied as a lotion externally, by means of a compress, and
well covered with oiled-silk, is often specific. See " Lady's
Manual," pages 93-4.
Pulsatilla.-Swelling of the veins and of the entire limb,
with pain and inflammation; the parts presenting a bluish
appearance. This remedy may be administered every four,
or six hours. Sometimes its use should be preceded by a
few doses of Arnica, particularly if fatigue or injury has led
to the varix.
Nux Vomica.-This may be substituted for Puls. when the
varix is attended with constipation, piles, or an irritable
disposition.
Arsenicum.-In addition to the symptoms just mentioned,
there is severe burning or stinging pain, and an enfeebled
condition of the constitution.
Carbo Veg..-The symptoms resemble those of Arsenicum;
the former may be used when the latter has been but partially
successful.
Lycopodium.-Chronic cases, and after, other remedies
have failed.
Aconitum   or Belladonna. - Very painful inflammatory
symptoms, local or general.
* For the treatment of this common affection during pregnancy, see "The
Lady's Manual of Homceopathic Treatment."



VARICOSE ULCERS.


385


ACCESSORY MEANS.-Moderate compression by bandages
and laced-stockings, so as to afford that support to the blood
which the valves can no longer give, and to prevent an
increased distension. The pressure should be very gentle and
uniform, and be applied in the morning, before the patient
puts his feet to the ground, and maintained until he retires to
bed. Should only a small portion of a vein be enlarged, a
piece of strapping plaster, well applied, may afford the
requisite support. Prolonged exercise or standing should
be abstained from, and, after taking moderate exercise,
the limb should be raised, and maintained in a horizontal
posture.  Standing is more unfavourable than walking.
The leg should be well washed, and rubbed quite dry every
day.
6.-Varicose Ulcers.
Their treatment is precisely the same as that of "' Ulcers"
generally, and is sufficiently pointed out in the article on
that subject, with the exception of the following directions:
Should a varix burst, excessive hemorrhage may suddenly
take place, inducing fainting, or even death. The treatment
is immediately to place the patient flat on the floor, and
raise the leg, when the hemorrhage generally ceases. A
compress and bandage should then be applied to prevent
subsequent bleeding. Excoriations or tender spots about
varicose veins should have appropriate attention, to obviate
the formation of ulcers.



386


AFFECTIONS OF THE SKIN.


CHAPTER      XIII.
AFFECTIONS OF THE SKIN-CUTANEOUS DISEASES.
1.-Itching    or Irritation    of the Skin     (Prurigo).
THIS condition consists of an eruption on various parts of
the body, sometimes nearly imperceptible, which occasions
the itching. It is important to note that this condition is
frequently but the external manifestation of chronic disease
of the skin, or of some internal organs; and that these are
much more serious than the sensations thus occasioned.
In some instances, however, prurigo seems to exist as an independent affection.
SYMPTOS.--Similar to, but much severer than, urticaria,
so that patients scratch and tear themselves till the blood
flows; their sleep is frequently disturbed, and their existence
is often almost unendurable; or the impulse to incessant
scratching is so powerful as to induce the patient to seek
seclusion.  Sometimes the itching is diffused irregularly
over the surface; at other times it affects the extremities;
frequently it occurs round the anus, or on the scrotum, or
on the female genitals. It is often a horrible and most
obstinate disease.
CAUSES.-The predisposing are, constitutional taint, chronic
disease, etc. Exciting causes are, rich, indigestible food,
stimulating drinks, extreme heat or cold, etc.
TREATMENT.-A conitum.-Furious itching all over the skin,
with febrile symptoms, especially towards night or when
getting warm in bed.
Sulphur.-Severe itching, attended with thirst, dryness of
the skin, and worse in the evening and in bed. This is
generally a prominent remedy, and it is frequently specific.



ITCHING OR IRRITATION OF THE SKIN.


387


Carbo Veg.-Obstinate cases, and when Sulph. only partially cures.
Rhus Tox.l- Itching with swelling and redness of the
affected parts.
Arsenicum.-Itching with burning or an eruption emitting
watery-fluid like sweat, and attended with much constitutional weakness.
Mlercuzrius.-Itching occurring day and night, but worse in
the evening also when the parts bleed easily after scratching.
Ignatia.-Itching of the skin of a fine, pricking character,
resembling flea-bites, and changing from one part to another.
Other remedies are sometimes required:-Calc. Carb.,
Conium, Puzs., I epar Sulph., or Sepia.
AccESSORY MEANS.-The skin must be strengthened by
wholesome and regular diet, frequent exercise in a bracing
air, and daily ablutions with cold or tepid water, sponging,
shower baths, etc. Without these measures medicine will
be of little permanent use. Stimulating food or drink,
pastry, rich sauces, pickles, and indigestible food generally,
must be avoided. The external application of ointments is
highly injurious. In severe cases, temporary relief may be
obtained by bathing the parts with alcohol and water, in
equal proportions, or by sponging the skin, on retiring to
bed, with a warm infusion made by pouring boiling water
on bran.  The Wet Compress.-Prurigo, if confined to one
or two places is much benefitted by the constant use of a wet
compress over the affected part; for although it often increases the irritation at first, it finally assists nature in
expelling the morbid matter.
2.-Itch (Scabies).
SYMPTOMS.-A vesicular eruption, presenting numerous
watery conical pimples, attended with itching, often very
violent, and aggravated by scratching. The violence of the


I*.



388


AFFECTIONS OF THE SKIN.


symptoms, however, depends on the number of the acari
present, the length of time the patient has been affected,
and the degree of sensibility of the patient's skin. The
disease may occur on any part of the body, but the acari
generally prefer delicate parts of the skin, such as the thin
skin in the flexures of the joints, especially the wrists and
between the fingers.
CAUSE.-The burrowing in the skin of the female acarus
scabiei, for the purpose of depositing her eggs. The canal
formed for this purpose is between the layers of the epidermis
of the human skin, about a line from each vesicle, and
varies in length from half a line to three or more lines.
After forming the canal, the female cannot return, owing to
the spinous processes which project backwards; and when
she has deposited her eggs, which she does at the rate of
one a day till fourteen are laid, she dies.
TREATMENT.-Nothing perhaps is more effective than the
free application of Sulphur ointment, or Sulphur baths, by
which the insect may be destroyed. After thoroughly rubbing
the whole body with soft soap and water, and afterwards
washing in a hot bath, or with hot water, the ointment
should be well rubbed in and allowed to remain on the body
all night. On the following morning a tepid bath, using
yellow soap, to wash off the ointment left on overnight,
completes the cure. If the application of the ointment
and the ablutions have not been thoroughly made, the
processes should be repeated once or twice. At the same
time the internal use of Sulphur in pilules or tincture, night
and morning for two or three days, is recommended. All
contaminated washing clothes should be put into boiling
water; other garments should be well ironed with a hot
iron, or exposed to hot air at a temperature not less than
1500 or 1800 Fahr., or well fumigated with the vapour of
sulphur.



NETTLE RASH.


389


3.-Nettle Rash (Urticaria).
SYMPTOMS.-Similar or more intense than those produced
by nettle stings, Urtica being the Latin for a nettle. The
eruption consists of white elevations, occurring in streaks or
wheals of an irregular shape on a red ground; the character
of the rash becomes much more marked after scratching
or rubbing, and is generally worse in the evening, and when
the body is exposed to cold air. There is much smarting
and itching, and often the eruption, after disappearing
suddenly from one part, shows itself in another. The spots
contain no fluid, and end in desquamation of the skin. It
is not contagious, and may occur in the same person
repeatedly.
CAUSES.-Derangements of the digestive organs, following
the use of some particular kinds of food, among which we
may specify bitter almonds, cucumbers, mushrooms, oatmeal;
shell-fish are a common cause of nettle-rash, especially
mussels; also certain kinds of medicines, such as cubebs,
copaiba, etc. Chronic and intermittent urticaria is often
associated with uterine or other diseases.     Cold, rapid
changes of temperature, and, in children, teething, favour
its development, especially in patients predisposed.
TREATMENT.-Acon., Rius Tox., Puls., Bell. Merc. Calc.,
Bry., Ars., Nit. Acid, Nux V., Sulp/h.
Aconitum, thrice daily, when the rash is attended with
febrile symptoms.
Dulcamara.-Nettle rash from exposure to wet or during
damp weather, with a severe stinging sensation, restlessness,
pain in the limbs, diarrhoea, dark urine, etc.
Rhus Tox.-In the more severe forms of the disease; also
when it has been caused by eating prawns, crabs, mussels,
etc.
nAux Vomica.-Urticaria from indigestion or intoxicating
beverages, and when the bowels are confined.



390


AFFECTIONS OF THE SKIN.


Pulsatilla.-If the complaint follows the use of fat food,
with relaxed bowels, distended stomach, and loss of appetite.
Calcarea.-Chronic nettle rash, especially in scrofulous or
cachectic constitutions. It is often necessary to continue the
use of this remedy, for one or two weeks, administering a
dcse morning and night.
IpecacuanAa.-In nettle rash accompanied by dyspncea,
oppression at the chest, or vomiting.
Bryonia.-If the eruption suddenly disappears without an
improvement in the other symptoms, or with an aggravation
of them; a dose frequently, till the eruption re-appears.
GENERAL TREATMIENT.-Smearing with bacon fat, as recommended page 114, gives great relief. Also dusting the
skin with powdered starch or fine flour. The patient should
enjoy a dry, uniform, and moderate temperature; have plain
food; take plenty of exercise in the open air; and observe
great cleanliness. In this, as in all cutaneous diseases, the
eruption should be retained upon the surface, to prevent the
disease developing itself internally.
4.-Ringworm     (Herpes circinnatus).
SYMPTOMS.--Small round vesicles, filled with clear or
yellow fluid, mostly on the head, at the roots of the hair,
and varying in size from a shilling to that of a crown-piece.
The patches gradually enlarge; the hair upon them changes
its colour; as the disease progresses, the hair perishes at the
roots, falling with the scabs, leaving irregular patches of
baldness. In chronic cases the whole scalp becomes affected.
CAUsEs.-Neglect of cleanliness; a scrofulous constitution; an emaciated and feeble condition, especially in children
not supplied with good food and plenty of exercise in the
open air, or who live in filthy, ill-ventilated, dark dwellings.
The most frequent immediate cause is contagion; thus it may
be transmitted by combs, brushes, caps, towels, or anything



RINGWORM.


391


which has been in contact with the head of an affected
child.
TREATMENT.-Sepia is considered a specific in a majority
of eases, and should be administered thrice daily for several
days; if it does go6d, it should be continued at longer s
intervals for a week or ten days; but should the disease
extend, and other rings make their appearance, the next
remedy should be tried.
Rhus Tox. is indicated when the skin is red-looking, and
the eruption irritable, and especially if a greenish-pus is
secreted, and there is nocturnal itching.
Hepar Sulphur.-When the complaint is not limited to
the head, but extends to the face and neck, and has a foetid
smell; and when it is attended by affections of the eyes
and ears. In slight forms of the eruption, and if used
early, this remedy will often effect a cure.
Sulphur.-When the eruption is obstinate, or when fresh
places break out, with much smarting and itching. A dose
thrice daily, for two or three days; afterwards, once or twice
a day, for a week or ten days.
Calcarea, Lycopodium, JMercurius, or Phosphorus may be
required, the indications for which will be found in the
Materia Medica.
GENERAL TREATMENT.-Cleanliness is of great importance.
Cut the hair short with fine-pointed scissors, and wash the
head with tepid water, using a little mild soap. The hair
and head should be frequently well brushed, so as to excite
the vital action of tle skin. An occasional tepid bath will
facilitate recovery. A plain but nutritious diet is necessary,
avoiding the use of salted meats. Scrofulous, emaciated
children will be benefitted by a teaspoonful of good cod-liver
oil, which may be taken twice a day for several weeks; also by
change of air. Sudden and extreme variations of temperature
should be guarded against.      Popular remedies, as ink,
tobacco-water, etc., are dangerous.



392


AFFECTIONS OF THE SKIN.


5.-Scald Head (Tinea Capitis-Favus).
SYMPTOMS.-A pustular chronic eruption, chiefly upon the
hairy scalp, but sometimes on the face, neck, or limbs. At
first small red pustules appear, and afterwards suppurate,
the matter from which hardens into yellow scabs, which itch
excessively. The discharge is very irritating, so as to lead
to ulceration of contiguous portions of the skin. It is an
obstinate complaint, lasting for months or even years.
Under homceopathic treatment, however, the cure is comparatively rapid.
CAUsEs.-See under "' Ringworm," the causes being
identical.
TREATMENT.-1  iUS Tox., Arsen., Ar erc., Mere., D., Graph.,
Staph., and Sulph. For the indications, see the previous
section and the Materia Medica.
ACCESSORY TREATMENT.-Strict cleanliness is essential.
The head should be kept very clean by washing with warm
water and mild soap, and the hair cut close to the scalp, or
pulled out by suitable forceps. The scabs should not be
forcibly removed, nor the head covered with oiled-skin caps.
The patient should be much in the open air, if possible on
the sea-coast, or in the country.
6.-Loss of Hair-Baldness (Alopecia).
CAUSES.--Defective nutrition of the hair follicles, and
dryness of the scalp, resulting from a languid condition of
the capillary circulation, by which the hairs are exclusively
nourished. A defective supply of blood in advancing age,
from imperfect capillary circulation, may also be assigned,
in many cases, change in the colour of the hair.   That
deficient vascularity is a cause of baldness is evident from
the fact that persons prematurely bald are almost uniformly
found to have a languid circulation. At other times, loss of



LOSS OF HAIR-BALDNESS.


393


hair follows a severe disease, such as typhus or typhoid fever,
inflammation of the brain, etc. Baldness likewise occurs in
persons who are otherwise quite healthy; in -such cases a
medical man should be consulted. A modern physiological
author attributes the more frequent baldness among the
male as compared with the female sex, to the heat and
compression from the hats that are usually worn. The
following causes and remedies may be considered.
1. Loss of hair from debilitating causes:-China, Ferrum.
2. After severe inflammatory disease:-Calc., Hep. Sulph.,
Silic.
3. From frequent attacks of headache:-Phos., Nit. Ac.,
Sep.
4. From excessive use of Mercury:-Carb. V., Hep. Sulph.
5. After excessive grief or trouble:-Ign., Phos. Ac., Staph.
6. For recent baldness, and in cases where the hair begins
to fall off in early life, or from hoemorrhages, syphilis, etc.,
Cantharadine Pomade, prepared of a strength proportionate
to the effect which it is desirable to produce, should be applied externally. At the same time, a dose of Cantharis
may be taken internally, night and morning, for a few days.
After waiting a short time, if necessary the remedy may be
repeated.
AcCESSORY MEANS.-The head should be kept very clean
by frequent bathing with cold water; and the hair and
scalp be thoroughly brushed several times a day, so as to
excite the vital action of the skin, and stimulate the hair
bulbs by friction.
7.-Dandriff (Pityriasis).
DEFINITION.-This is a chronic inflammatory affection of
the skin, attended with itching, slight redness, and by the
production of minute white scales in large quantity.
TREATMENT. -YVhen scurf forms on the head and comes
20C



394


AFFECTIONS OF THE SKIN.


off in small scales, and when there is headache or itching of
the scalp, a dose of Ljycopodium, night and morning for a
week, will probably do good. This remedy may, if necessary,
after a few days, be repeated, or one of the following may
be substituted:-Graph., Calc., Staph., Sulph.
ACCESSORY MEANS.-Strict attention to cleanliness. The
hair should be cut off close to the scalp. If there is much
irritation, the application of glycerine, diluted with water, is
very useful.
8.-Pimples (Papules).
DEFINITION.-Pimples are minute hard elevations of the
skin, chiefly of the forehead and face, which are generally
absorbed, or disappear in small bran-like desquamation;
occasionally they lead to ulceration.
CAUSES.-Excessive or too rich food; the use of stimulants;
too little recreation or out-of-door exercise. Weak digestion
is a predisposing cause.
TREATMENT.-Arn., Hep. Sulph., Sep., Puls., Ant. Crud.,
Mere., Nux V., Sulph., Aeon.
Arnica.-Pimples or small boils, especially about the
forehead and face, with inflammatory symptoms, or a bruised
sensation of the parts.
Hfepar Sulph/.-Chronic pimply eruptions; especially suited
to patients of unhealthy skin.
Ant. Crudum.-Pustular pimples; white blotches with
red areola. It is chiefly indicated when the derangements in
the digestive and nutritive functions correspond with this
remedy. See " Materia Medica."
Mercurius.-Small itching pimples upon the face or nose,
with redness and swelling, especially of a catarrhal or
syphilitic origin.
Sulphur.-For obstinate eruptions, and as an intercurrent
remedy.



ABSCESS.


395


ACCESSORY MEANS.-The diet should be wholesome and
nourishing, and taken at suitable intervals. Regular outof-door exercise, and an occasional warm bath in the evening
for cleansing the skin, and a cold bath or cold sponging in
the morning for tonic purposes, are necessary for correcting
that condition of body which favours the growth of pimples.
The " Accessory Treatment" prescribed in the section on
"Indigestion" may be consulted with great advantage.
9.-Abscess.
DEFINITION.-An abscess is a collection of matter, resulting
from diseased action, formed within a sac or cyst of organized
lymph, and supplied with absorbent and secreting vessels.
The frequency of its occurrence, the importance of the
parts it may involve, and the injury it may occasion,
especially if deeply-seated, by bursting into serous cavities
or mucous canals, seem to demand special consideration.
SYMPTOMS.-Acute abscess commences with the ordinary
signs of inflammation, namely, inflammatory fever, throbbing pain, bright redness, and swelling; these symptoms
are soon followed by suppuration, which is marked by an
alteration in tie colour of the skin, and a change in the
character of the pain. The skin loses its bright arterial
colour and becomes livid, and the pain is less severe, now
more resembling a sense of weight and tension.    The
swelling becomes softer, and, as the matter forms, its centre
begins to point, and fluctuation can be detected by pressure with the fingers. " After this, the parts between the
abscess and the surface become successively softened and
disintegrated. The tumour becomes more and more prominent; the centre exhibits a dusky-red or bluish tint, the
cutis ulcerates, the cuticle bursts, and the pus escapes.
But where pus is formed under dense fasciae, or deep in the
breast or pelvis, and cannot quickly make its way to the



396


AFFECTIONS OF THE SKIN.


surface, the pain is not relieved but much aggravated by
the increase of distension; and the constitutional fever and
chills are much more intense " (Druitt).
CHnoNIc ABSCESS first appears as an indistinct tumour,
the fluctuation being more or less marked according to the
distance from the surface. The inflammatory symptoms of
the acute variety are altogether absent, unless far advanced,
or accidentally irritated.
CAUSES.-Abscesses, with few exceptions, are indicative
of constitutional debility, and are a frequent sequel of low
exhausting fevers. In proof of abscess being a sign of
debility, we may refer to the
MAMMARY ABSCESs, which occurs after parturition, chiefly
in ill-fed and poorly-nourished women; more frequently
after giving birth to twins than to single children, and in
women after protracted labours, or after profuse flooding.
Mammary abscess is rarely met with in strong healthy
women, of vigorous circulation.
Abscesses may, however, result from blows, or from
foreign bodies introduced into the skin or flesh, such as
splinters, thorns, etc.
TREATMENT.-Hepar Sulphur.-This remedy is often serviceable in promoting the suppurative process in acute
abscesses, and may be administered every four hours for a day
or two, and afterwards every six hours, during suppuration.
At the same time local measures should be adopted, as
pointed out further on.
SSilicea.-If the discharge is tardy and continue for a long
period, this remedy may be substituted for, and administered
in the same manner as, Hepar Sulph.
Mercurius.-Painful abscess, attended with chilliness and
thirst, and a copious discharge of thick matter; with aggravation of the pains at night.
Calcarea.-After suppuration is completed, this remedy



ABSCESS.


397


will assist the healing of the abscess, and the elimination
of the disease from the constitution.
Belladonna.--Severe pains, headache, and much constitutional disturbance.
Arsenicum.-Severe burning pain, great debility; abcess
having a gangrenous appearance.
China.-When abscesses follow prolonged disease, excessive
loss of blood, or diarrhoea. Incipient abscess may often be
cut short by the early and frequent use of this remedy.
Aconitum.--It need scarcely be added that whenever
feverish symptoms are well marked, this remedy should be
administered either alone, or in alternation with any other
which the symptoms indicate.
LOCAL TREATMENT.-Abscesses arising from local injury
should be freed from all sources of irritation, such as thorns,
splinters, etc.
POULTICES.-When it becomes evident that the matter in
an abscess cannot be absorbed by the blood-vessels, poultices, made of bread-and-water, linseed-meal, or bran,
should be applied. The utility of poultices consists in their
power of relaxing the tension of the skin, and so mitigating
pain; in promoting perspiration; facilitating the formation
of pus; and in determining its progress towards the surface.
To secure these objects they should be sufficiently large, soft,
and light. As a substitute for a poultice, the warm-water
dressing, that is, two or three thicknesses of linen wrung out
of warm water, and covered with oiled-silk; or the spongiopiline, may often be used with advantage, especially during
the daytime, and when they are required by persons who are
pursuing their ordinary avocations; also during the formation
of an abscess, and for sores which are very irritable; but
when there is much pain, the most soothing application is a
large, soft, well-made warm poultice. The application of
poultices should be continued till the pain has subsided, and



398


AFFECTIONS OF THE SKIN.


the cavity begins to granulate; then a cold compress should
be applied, and the parts bandaged.
OPENING OF ABSCESSES.-In ordinary cases of acute abscesses, the use of the lancet is but seldom required, especially when they point and become pyramidal, without
enlarging in circumference. In the following cases, however,
the early use of the lancet will expedite recovery, and prevent
the extension of the disease. The formation of an abscess
under strong fasciae or ligamentous textures, which ulcerate
with difficulty; in such a case, unless an artificial opening
be made, the pus burrows, extending the abscess to distant
parts, and may set up great constitutional disturbance.
When an abscess occurs on an exposed part, and it is
desirable to avoid the scar which generally ensues when it
bursts spontaneously, it should be opened by a surgeon.
The use of the lancet is also demanded when abscesses are
so situated that they may burst into some internal cavity,
such as the chest or windpipe. It may be hardly necessary to add, that when an artificial opening is required the
operator should be certain that the knife has entered the
cavity of the abscess, and that, if possible, the opening
should be made at the most dependent part. It may be well
further to add, for the' comfort of those who dread pain even
in the trifling operation here referred to, that by the use of
local anaesthetic agents, nearly all surgical operations may
be painlessly performed.
After an abscess has been opened, and its contents discharged, the Calendula lotion (one teaspoonful of the tincture
to three tablespoonfuls of water), will greatly expedite
recovery. It may be applied by saturating a piece of lint,
or two or three thicknesses of linen, with the lotion, and
covering it with oiled-silk. The dressing should be repeated
two or three times a day.
DIET.-As abscesses are generally indications of debility,



BOILS.


399


a liberal allowance of nourishing food is of great importance;
it should include good animal broths, broiled mutton chops,
chocolate or cocoa, and, in many cases, good beer or wine.
10.-Boils (Furunculi).
NATURE.-A boil is a hard conical tumour of the true
skin, resulting from inflammation and a deposit of unhealthy
lymph in the part.
Boils are very tender and painful, and end in suppuration.
They often occur in crops, or one appears as soon as the
preceding one has healed.
CAUSEs.-Boils generally indicate a disordered condition
of the blood, from unwholesome food, from some unknown
atmospheric causes, or from depressing influences generally.
TREATMENT.-Arnica relieves the pain, soreness, and
tenderness; and, if given early, may prevent the full
development of the boil. A dose every three or four hours,
for several times.
Aconitum.-When the Arnica symptoms are accompanied
with considerable feverishness, it may be alternated with
Aconitum every three hours.
Hepar Sulpkur.-When the pain is of a pulsative character,
indicative of suppuration, and the point of the tumour
changes to a whitish or livid colour, this medicine will
facilitate the suppurative process, and, to a great extent,
prevent its subsequent extension.
China.-Boils attended with considerable general debility.
This remedy may be administered first, in alternation with
any other which the local symptoms may require; and
afterwards, alone, but combined with nourishing, digestible
diet.
Calcis Muriatis.-When boils occur under circumstances
when their maturation would be inconvenient, the appli



400


AFFECTIONS OF THE SKIN.


cation of a lotion of Mur. Calcis (3ss. ad. aq. ~iv.), will often
check them.
Ferri ]furiatis.-This is a valuable remedy in oft-recurring
boils. The 3rd dec. dil., three to five drops thrice daily.
Sulphur, night and morning for eight or ten days, to
prevent a return of the complaint.
GENERAL TREATMENT.--A   soon as Hepar Sulphur is indicated, a poultice, covered with oiled-silk, should be applied
and renewed twice or thrice daily, until suppuration is
completed. When boils are of an acute variety, and the
skin covering them is very thick, a free incision over them
with a sharp lancet will do good service.
In order to prevent a recurrence of boils, attention must
be directed to the constitutional causes which originated
them. If, as is often the case, they arise from derangement
of the digestive organs, abstinence from meats, gravies,
pastry, sweetmeats, etc., is imperatively necessary. Correct
diet, cleanliness, and healthful exercise will do much towards
eradicating a predisposition to boils and other skin affections.
11.-Carbuncle (Anthrax).
DEFINITION.-This is of the nature of a malignant boil,
marked by a circumscribed inflammation of the subcutaneous
cellular tissue, of a flat circular shape, varying in size from
one to six inches in diameter, or even larger; of a dusky-red
hue; hard, very tender, and painful. It generally occurs on
the posterior portions of the neck or back, where vitality is
less active.
SYMPTOMS.-As the red swelling gradually increases, the
skin covering it assumes a purple or brownish-red tint, and,
in a few days, softens, suppuration taking place at several
points. The latter is of a thin, watery character, and is
scantily discharged, but if pressure be made, a thick glutinous



CARBUNCLE.


401


matter may be squeezed out. It is generally attended by
considerable constitutional disturbance, and, if large, and
especially if seated on the head, by violent fever, and may
result in great and even fatal prostration of strength.
DIAGNOSIs.-Carbuncle differs from a boil in its greater
size; its broad, flat shape; in its usually appearing singly;
in giving way and discharging from several openings, like a
sieve; in the dusky redness of the inflamed integument,
and in the great constitutional disturbance and irritation
which accompany it.
CAUSES.-A disordered condition of the blood, usually met
with in individuals in a broken state of the constitution, as
the result of chronic, exhausting diseases, or severe acute
maladies.  In the cholera year of 1854, there were in
England nearly 400 deaths from carbuncle. Unlike boils,
carbuncle is rare in young people; but is usually met with
in debilitated persons, who have passed the middle period of
life; and much more frequently in males than in females.
TREATMENT.-The chief remedies are, Ars., Silic., Canth.,
Hyos.; also Acon., Bell., Secale, Lye., Rhus, and China.
Silicea.-A dose every four hours, if given early, will often
render the disease of a less painful and serious nature.
When it does good, it may be continued for several days.
Arsenicum.-If the carbuncle is very large and painful,
and the constitutional prostration very great, this remedy
may be given every three or four hours.
Aconitum.-Severe inflammatory fever. It may precede,
follow, or be alternated with any other remedy indicated.
Carbo Veg.-Languid circuFation, low grade of inflammatory action, a dark, livid appearance of the tumour, with
signs of putrescence.
Sulphur, night and morning for a week, when the disease
is on the decline, to prevent a recurrence of the affection.
LOCAL TREATMENT.-Early fomentations, followed by a



402


AFFECTIONS OF THE SKIN.


linseed or bread-and-milk poultice, will mitigate pain by
relieving tension, and hasten the cure. In many cases, the
simple cold water compress will be the best local application.
Extension of the disease may often be prevented by an
early and free crucial incision, dividing the tumour into
quarters, thus most effectually relaxing tension, and allowing
the free escape of pus and slough. But a surgeon should
determine when so severe a remedy is necessary, and also
make the incisions. In the absence, however, of great
tension, very severe pain, or extension of the inflammation,
the care of these tumours may be safely confined to nature,
attention being directed to such constitutional treatment and
soothing applications as each particular case may require.
If there are any signs of putrescence, a yeast poultice
should be applied, and sprinkled over with a powder of the
first trituration of Carbo Vegetabilis. This should be renewed every six hours, till the parts have a more healthy
appearance.
DIET.-The diet should be nourishing, consisting of such
articles as strong beef-tea, the essence of meat, wholesome
wine, etc., at frequent and regular intervals. In very debilitated cases, the brandy-and-egg mixture does great
service.
12.-Ulcers.
NATURE.-An ulcer is a chasm      on any organ caused by
the stripping off of its proper cuticle or epithelium, or by
the destruction of a portion of its substance by disease or
injury which has not been rdpaired. The process of ulceration consists of the progressive softening and disintegration
of successive layers of the ulcerating tissue.
VARIETIES.-There are many varieties, such as the healing
ulcer, in which the granulating process goes on uninterruptedly to reparation; the inflamed ulcer, hot and painful,



ULCERS.


403


with a red, bleeding surface and a thin ichorous discharge;
the indolent ulcer, marked by an imperfect form of organization, so as to be incapable of healing; the fistulous ulcer,
consisting of a narrow channel, with a false mucous membrane, produced by abscesses which have not healed from the
bottom; the spreading ulcer, in which the destructive process
which formed it still existing causes it to extend; the raricose
nlcer, which generally forms on the lower extremities as the
consequence of a varicose condition of those parts. There
are also other varieties which need not be further referred to
here.
CAUSES.-Ulcers may result from   a bruise or burn, or
some general derangement of the system    occasioned by
improper food; or they may be openings of nature for
ridding the system of impurities, which, if retained, would
produce serious disturbances.  " The constitutions most
liable to ulceration are those which are debilitated by intemperance or privations, tainted with syphilis or scrofula,
or broken down by the excessive use of mercury, or in which
the blood is impure from inaction of the liver, skin, and
kidneys. The parts most disposed to it are those whose
circulation is most languid, such as the lower extremities.
On this account, tall persons are more frequently affected
with ulcers than the short" (Druitt).
TIEATMENT.-Belladonna.- Red, inflamed, and painful
ulcers, accompanied with feverishness and headache.   If
the general feverishess is very marked, two or three doses
of Acon. should precede Bell., or be alternated with it. A
dose every four hours.
Arsenicm.--Ulcers presenting a livid aspect, readily discharge blood or thin matter if touched, and especially if
there is much burning pain.
Carbo Veg.-Ulcers having an offensive odour.
AMercurius.-Deeply penetrating ulcers, emitting a bad
smelling discharge.



404


AFFECTIONS OF THE SKIN.


Sulphur.--Obstinate ulcers of long standing.
Hydrastis Canadensis.-This is a valuable remedy in
unhealthy ulcers; in addition to administering it internally,
it may be used as a lotion to the part.
LOCAL TREATMENT.-The ulcer may be covered with a little
soft linen or lint, wetted with cold or tepid water, as is most
agreeable to the patient, covered with oiled-silk, and lightly
bound over with a bandage. Sometimes it will be desirable
to use Calendula lotion (thirty drops of the tincture to a
teacupful of water), instead of the simple water compress.
ULCERS ON THE LEGS.-In addition to the above treatment,
the limb should be well and evenly bandaged from the toes
to the knee, applying the bandage more tightly below and
more loosely by degrees as it ascends. Laced stockings, or
elastic stockings, are very convenient substitutes for the
bandage, and are more easily applied. The frequency with
which the dressings should be changed depends on the
amount of the discharge. If that is considerable, they
should be changed every day; otherwise three or four times
a week will suffice. In the treatment of ulcers on the leg,
as, indeed, on every other part, perfect cleanliness is most
essential. The filthy habits of many persons, who allow
their feet and legs to remain unwashed for weeks together,
induce such an imperfect vitality of the skin, that ulcers
assume that indolent form which renders them so disagreeable and obstinate in their results.  Washing the lower
extremities daily is one of the most potent means of
preventing and curing the disease, and restoring the lost
vitality of the parts.
Moderate out-door exercise may be taken during recovery;
but the patient should not stand much, nor sit with the legs
hanging down.



CHILBLAINS.


405


13.--Chilblains (Perniones).
NATURE.-A     low  kind of inflammation of the skin,
generally of the hands or feet, attended with itching,
tingling, burning, swelling, and, sometimes, ulceration.
CAUSEs.-Exposure to cold, damp, or to sudden transitions
of temperature, such as warming the hands and feet by the
fire when cold and damp. Delicate persons, with a constitutional predisposition to skin diseases, are mostly affected.
TREATMENT.-Arnica, in nearly all cases, may be used
with decided benefit. Bathe the parts twice or thrice daily
with a lotion made by adding twelve drops of the strong
Tincture of Arnica to two tablespoonsful of water; or Arnica
may be used in the form of a cerate, the parts being gently
rubbed with it; or the cerate may be smeared over the
chilblains, and then covered. Should the skin be broken,
and ulcers exist, Calendula may be substituted for Arnica,
and applied in the same manner. Internal medicines are
generally required.
Arnica.-Hard, shining skin, with much pain and itching;
a dose thrice daily.
Belladonna. -Considerable inflammation, pulsative pain,
fiery redness, and swelling of the affected parts.
Arsenicum.-Much burning pain, accompanied by ulceration.
Sulphur.-Chilblains of a blue-red colour, with itching,
aggravated by warmth. This remedy may also be given to
prevent a recurrence of chilblains.
AcCESSORY MEANS.-If ulceration takes place, apply poultices, or other mild applications to the parts, until relieved.
To prevent the development of chilblains the following lotion
may be occasionally used for the hands or feet of persons
predisposed:-half a dozen drops of the tincture of Cantharis
or Arnica to a table-spoonful of water; that remedy being



406


AFFECTIONS OF THE SKIN.


chosen which agrees best with the patient. Pork, salted
meats, irritating substances, such as pepper, too much salt
and all articles of food that disagree with the patient, should
be excluded from the bill of fare. Extremes of temperature
are to be avoided, such as a cold stone floor, and warming
the feet on a fender or close to the fire. On coming in from
the cold external air the fire should not be suddenly approached, and if the extremities are very cold, friction should
be resorted to.
ADDITIONAL CURATIVE AND PREVENTIVE MEANS.-The following hints are extracted from correspondence on the subject
in The Lancet of November 11th and 18th, 1865.
" I and all my brothers and sisters," writes one correspondent, " suffered
for years from very bad chilblains. Remedies of all kinds were tried, but
failed to give relief. An old lady, remarkable for her common sense, who
was visiting our house, suggested the free use of a skipping-rope. The
prescription answered beyond all expectation. In a few weeks all our
chilblains had disappeared, and never returned. Persons suffering from
this complaint should wear thick woollen stockings, and avoid warming
their feet by the fire."
"According to my experience," Dr. Spencer remarks, " in the treatment of
chilblains, the best thing to do locally is to strap them with strips of plaster
equally and rather firmly all over. I find that this, by the support it gives
to the distended capillaries, hastens the cure more than any form of liniment. As chilblains generally occur in those whose circulation is languid,
plenty of exercise in the open air, good living, etc., are required to'prevent
their recurring again and again."
Dr. Rattray remarks:-" We all know the proverb, 'Prevention is
better than cure.' If ' A Chemist's Assistant,' who seems to be in torment
with the above annoyance, will only bear in mind the indispensable
necessity of guatding against severe and sudden alternations of cold with
heat, whether in toes or fingers, I am sure he will be much'relieved; at
the same time not forgetting to abstain from the common and vulgar
practice of exposing the part so affected immediately to the fire. But
besides, he should wear wash-leather socks, and gloves lined with washleather, or woollen socks or gloves, as the case may be. Soap plaster
spread on linen is an excellent means to keep the chilblains unbroken."



WHITLOW.


407


Another correspondent directs:-" Rub gin on the inflamed part for
some time, and wrap the foot in linen saturated with it. Of course it
should not be applied to any broken places; but if applied to the parts
affected before, it will effectually cure them. Wear slippers with warm
lining as well, and get as much exercise as possible."
Mr. Hugh Taylor writes:-" The plan I have found most successful is
simply to apply to the inflamed part a piece of soft linen rag thoroughly
soaked in cold water, which must then be covered over with a piece of
oiled-silk, a trifle larger than the piece of rag. This, by equalizing the
temperature of the part, greatly diminishes the tendency to the formation
of chilblains."
14.--Whitlow      (Onychia).
This is an inflammatory swelling at the end of the finger
with a tendency to suppuration. Whitlow is very liable to
reappear in persons who have once suffered from it; hence
the importance of treating the affection not merely as a local
disturbance, but as a constitutional disease.
VARIETIES.-The cutaneous whitlow is an inflammation of
the surface of the skin of the last phalanx, with burning
pain, and effusion of a serous or bloody fluid, which raises
the cuticle into a bladder. The subcutaneous is attended
with great pain and throbbing, and suppuration under the
skin at the root of the nail, which often comes off.
CAUSES.-Cutting the nail to the quick; a bruise, burn,
or other mechanical injury; the introduction of poisonous
or acrid matter into scratches on the finger; unhealthy
constitution.  It most frequently prevails at the spring of
the year, when it often appears to be epidemic, large
numbers of persons thus suffering without any apparent
local cause.
TREATMENT.-As soon as the first indications of whitlow
are noticed, the finger should be held in a raised position in
hot water, as hot as can be borne, for two or three hours or
longer, and a dose of Mercurius taken every three hours.
Thus its formationl may often be prevented. Should the



410


AFFECTIONS OF THE SKIN.


hereditary predisposition sometimes seems to favour their
development.
TREATMENT.-Arnica.-As soon as corns appear, the surrounding skin should be softened by a warm foot-bath, the
hard head of the corn gently extracted with the finger nail,
or some convenient instrument, and the thickened skin pared
off, wounding the adjacent parts as little as possible. The
corn should then be dressed with a lotion prepared by adding
thirty drops of the strong Tincture of Arnica to a wine-glassful
of water, and next morning a piece of Arnica plaster, or an
Arnicated corn-plaster, applied. The dressing may be repeated several times, till the inconvenience is removed. The
Arnicated amadou orfelt plaster, having a hole punched in it
to receive the corn so as to relieve it from pressure, is a very
useful contrivance.
If internal treatment is necessary, Calcarea and Sulphur
will be the most suitable medicines. Calcarea may first be
administered every night and morning for a week or ten
days; and then, after waiting a few days, Sulphur in the same
manner. After pausing four or five days, if necessary, the
course may be repeated.
SOFT CoRNs.-These are best treated by cutting off the
thickened skin with sharp scissors, taking care to wound the
surrounding parts as little as possible; then applying a drop
or two of the strong tincture of Arnica, and always wearing
a layer of cotton-wool between the toes, changing the wool
daily.
ACCESSORY MEANS.-Patients afflicted with corns can only
be permanently relieved by wearing ample boots and shoes,
often washing the feet with cold water, and frequent change
of stockings.



BUNIONS.


411


16.-Bunions.
NATURE.-A bunion is an enlarged normal or adventitious
bursa over the metatarsal joint of the great toe. If recent,
it may be thin, and easily burst under pressure; it may be
thick, tender and inflamed, and contain liquid; it may be
indolent and thick, but not tender; or it may be in a state
of suppuration.
CAUsEs.-The pressure of narrow-pointed boots or shoes,
throwing the great-toe over or under the contiguous toes; in
this way a sharp angle is made on the inner side of the
joint of the great toe, and on this angle the bunion is formed.
SYMPTOMS.-Pain, redness, and swelling of the part, which
soon subside on removal of the cause.   Should, however,
undue pressure be continued, the pain, redness, and swelling
increase until pressure becomes unendurable. On discontinuing the offending boot or shoe, the pain and redness
subside; but a permanent bunion has been formed, and
inflammatory symptoms are at any time liable to recur from
irritation.
TREATMENT.-The direction of the toe must be changed by
wearing properly-shaped boots, made with the inner side of
the sole straight from the toe to the heel. If irritation be
accidentally excited in the part, the warm foot-bath should
be used, and afterwards it should be bathed with a lotion
made by adding twenty drops of Arnica P to two tablespoonfuls of water, and continuously applied for two or three
days. If Arnica disagrees with the patient, Calendula may
be substituted. Should the inflammation be followed by the
formation of matter, a linseed-meal poultice will be more
suitable; at the same time a dose of Hepar Sulphur may be
given every four hours.
Veratrum Viride painted on bunions is generally a rapid
and perfect relief. The fact will suffice without citing the



412


ACCIDENTS.


cases. There is no agent comparable to Verat. Vir. for
bunions or inflamed corns (J. G. Wilkinson).
PREVENTION.-If the Arnica or Verat. Virid. lotion be
used immediately the first inflammatory symptoms arise,
and all undue pressure at once and permanently discontinued,
the formation of a bunion may be altogether prevented.
CHAPTER XIV.
ACCIDENTS.
1.-Bruises (Contusions).
DEFINITION.--A   bruise is an   injury inflicted on the
surface of the body without laceration of the skin (subcutaneous). The injury may be slight, involving only the
rupture of minute blood-vessels, and perhaps the tearing of
some muscular fibres; or there may be a large blood-vessel
torn, or even a complete disorganization of the tissues
beneath the skin, as from  a spent cannon ball. The remarkable properties of elasticity and toughness possessed by
the skin often permit serious damage to its underlying
structures while it remains entire.
CAUsEs.-Usually from    a blow by a hard, blunt body;
from being forcibly squeezed between two forces, as a wheel
passing over a limb and crushing it; or indirectly, as when
the hip-joint is contused by a person falling on his feet from
a height.
TREATMENT.-In the less severe form    of bruises, which
alone come under domestic treatment, the object should be
to excite as speedily as possible the absorption of extravasated
blood. To this end the bruised part should, if practicable,
be raised, and a warm lotion applied, consisting of one part



414


ACCIDENTS.


depth exceeding the breadth, such as stabs; lacerated, the
parts are torn and the lips of the wounds irregular; and
contused, effected by bruising as before considered. We may
also add, gun-shot and poisoned wounds, and, according to
law, burns.
TREATMENT.-The following points require attention:1st. To arrest the bleeding. In most cases, the elevation
of the part, keeping the bleeding surface uppermost, the
application of cold, moderate pressure, and the coaptation
of the sides of the wound, suffice to check bleeding. A
lotion made of Arnica or Calendula will greatly facilitate the
arrest of heemorrhage, and also check the suppurative process. In severe wounds involving arteries, the parts should
be laid open by a surgeon, and the wounded vessels ligatured.
This point is considered further on.
2nd. The removal of foreign bodies. Dirt, hairs, glass,
clots of blood, etc., should be speedily removed by the
fingers, forceps, or sponge and water. Even blood is no
bond of union, and any present in a wound would act as a
foreign body and lead to suppuration. If there is ever so
little blood it must be absorbed, and a little delay and
exposure of the wounded part to the cold air are useful,
because the mouths of small vessels contract under such
stimulus, and oozing of blood is thus prevented.
3rd. To bring the injured parts into nice apposition. Any
muscular fibres likely to prevent complete union should be
relaxed or divided, and after the sides of the wound
have been accurately adjusted, they must be kept so by
strips of adhesive plaster, first applied to that side of the
wound which is most movable, and then secured to the
other.   As a substitute for plaster, collodion, or thick
mucilage, may be used, observing, before applying it, great
care in bringing the edges of the wound together. But in
extensive wounds of the eyebrows, ears, and in all wounds



WOUNDS.


415


of unsupported muscular parts, and others where good union
is most desirable, as well as in all extensive wounds where
plaster would be insufficient, sutures should be employed.
There are four modes of suture-the interrupted, the uninterrupted, the twisted, and the quill suture. The circumstances
of each case can only enable the surgeon to select the kind
most appropriate.
4th. To promote adhesion. To secure this the wounded
part should be kept at rest, and, if the injury is severe, the
patient should keep in bed to prevent the exuded lymph
from  being disturbed or decomposing.    If bandages or
sutures cause pain and swelling they must be removed, for
the wound cannot, under these circumstances, heal by the
first intention. Fomentations and poultices must be applied
till the inflammation has subsided, or suppuration is established. Afterwards the parts may be gently approximated,
that they may heal by the second intention.
5th. A wound thus attended to, under favourable circumstances, will heal by what we have called first intention, that
is, without the discharge of any matter, and leaving but a
trifling cicatrix (scar). On the other hand, if the wound
suppurates, it requires weeks, sometimes months, to heal,
and leaves a larger cicatrix.
6th. When a wound is dressed, say once in every twentyfour hours, a rag should be wetted with warm water, and
laid over the dressing, so that it may be removed without
the risk of disturbing the surfaces which may have begun to
unite. Sometimes the lotion may be renewed by removing
the oiled-silk only, and pouring a little'lotion on the rag or
lint by means of a spoon, and then replacing the oiled-silk.
7th. To control dangerbus bleeding, as from a severe cutwound. The greatest danger is usually from a sharp-cutting
instrument, and presence of mind and intelligence are
necessary for proper treatment. If the blood flows from the



-416


ACCIDENTS.


wound in a steady stream, and is dark-coloured, it is from a
vein, and can generally be checked by applying cold water,
and exposing the cut surface to the cold air. But if large
veins are wounded, they should be compressed with the
fingers, or by a compress bound to the part. A few thicknesses of linen, with steady compression, are more efficient
than heaping on a large quantity. If the blood is bright-red
and flows in jets, it is arterial hemorrhage, and the same
means must be adopted as just pointed out for venous blood,
unless the bleeding is excessive, in which case, a handkerchief should be tied round the limb, just above the wound,
and between it and the heart; a stick should be inserted
under the handkerchief, and a firm compress over the course
of the blood-vessel; the stick should then be twisted until
it stops the circulation, and consequently the bleeding.
These measures are, of course, only temporary, as wounded
arteries of size require to be ligatured by a surgeon before
bleeding can be permanently arrested. If no surgeon can
be obtained, a clever manipulator should grasp the wounded
artery with a pair of forceps, and draw it slightly and gently
forward, so that it may be securely tied by means of a
strong ligature of silk.
8th. Should a wound or bruise be followed by constitutional disturbances, feverishness, chilliness, and throbbing in
the parts, medicines should be administered internally.
Alrnica (as prepared for internal use) and Aconitum will
generally meet the requirements of such cases, and should
be administered every three hours, in alternation, for
several times.
Belladonna.-If the injured part is very painful and
swollen, a few doses may follow the above.
lepar SulpAi.-When suppuration is established.
Silicia.-Unhealthy suppuration.



CUTS-BURNS AND SCALDS.


417


3.-Cuts.
A moderate-sized cut requires nothing more than the
bringiing together of the edges of the gaping wound, and
maintaining them so by narrow strips of Arnica plaster, and
then, if necessary, applying a bandage over the plaster.
After three or four days, the plaster should be wetted with
warm water, carefully removed, and replaced by new. If,
however, pain or inflammation occur, lint, saturated with
Calendula lotion, and covered with oiled-silk, should be
applied over the plaster for a few days. For further treatment, see under 1" Wounds."
4.-Burns and Scalds.
Burns may be divided into three classes-those producing
mere redness, which soon terminate in resolution; those
causing vesication, in which the inflammation is more serious,
leading to the exudation of serum, and the formation of
vesicles, which, in slight cases, soon dry up and heal, or, if
the skin has been much injured, may be succeeded by very
obstinate ulcers; and those attended with mortification from
destruction of the tissues. The last-mentioned, although
probably exempt from pain, are far more serious. The
danger of burns depends more upon their superficial extent
than upon' the depth of the injury. Burns on the trunk,
head, or neck, are far more perilous than those of an equal
extent on the extremities. Children appear to suffer much
more severely from burns than adults.
The constitutional disturbances, and the periods of danger
consequent on burns, in whatever degree, have been divided
into three stages: 1. Depression and congestion, during the
first four or five days; 2. Reaction and inflammation, in
which the patient may sink with an affection of the head,
chest, or abdomen; 3. Suppuration and exhaustion, which



418


ACCIDENTS.


may continue from the second week to the close, and is often
associated  with  hectic, inflammation   of the lungs, or
pleurisy.
TREATMENT.-A most important object to be attained is to
cover the injured part with some suitable material that will
exclude atmospheric air, which should not be removed till the
cure is complete. The following are the local applications
most frequently used:
1. Cotton Wool.-This should be immediately used to cover
thoroughly the burnt part, after it had been first well
saturated with oil. It must be so closely applied and in
such layers as to preclude the access of air. If the wound
is large, and the cotton becomes hard and uncomfortable, it
should be softened by pouring a little oil upon it, without
removing it.
2. Soap.-Moisten white or brown soap in water, and rub
it on a piece of linen so that the soap forms a coating on the
linen as thick as a shilling, and larger than the wound it is
intended to cover, so that it may the more perfectly exclude
the air.
3. Flour.-This is an excellent substitute in the event of
either of the above not being at hand. The finest wheaten
flour, or finely-powdered starch, should be uniformly and
thickly applied by an ordinary dredger; it soon forms a
thick crust by admixture with the fluids discharged from the
broken surface, and thus excludes the air. It should be
repeated from time to time as any portions fall off.
4. Hot alcohol.-The writer has used this in severe burns
with the very best results, in the following manner. Several
separate layers of rags, steeped in the spirit, should be laid
over the burnt surface, immediately after the accident, and
directly covered to prevent evaporation, and to maintain the
heat. If an extensive surface of the body is injured, a
person may be almost constantly occupied in removing one or



BURNS AND SCALDS.


419


two external layers and rewetting those next to the skin, but
which must be by no means disturbed, and immediately
covering them again. Bottles containing the spirit should
be placed in a bowl filled with hot water, so that a constant
supply of warm alcohol may be at hand. As the dressing
must be continued through the night, caution is necessary in
reference to the candle or lamp, as the alcohol is highly
inflammable. The application of a strong stimulant like
alcohol is probably by far the most efficacious plan of treatment, mitigating pain and hastening recovery. Turpentine,
or other strong spirits, may be substituted for the alcohol.
5. Another remedy is Cowdung.--" A most primitive but
very effectual remedy," says Dr. Thomas, "in the treatment
of burns and scalds, is cowdung; and, from its being so
rich in phosphorus, must exert a specific as well as a
mechanical action to cure injuries resulting from fire. I
mention it here, having known several severe burns and
ulcers to be promptly and successfully cured by its use; and
in order to make this article useful in all circumstances, I
think it would hardly be complete without reference to
this cure."
Having selected the local remedy, the points of greatest
importance are, its immediate application to the injured
surface, the complete exclusion of atmospheric air, and the
changing of the dressings as unfrequently as possible, not,
indeed,,until they have become loosened or fcetid from the
discharges. A complete change of dressing often causes the
detachment of portions of the new skin, occasions severe
pain and depression, and so materially retards the cure. '
If, after the removal of the first dressing, ulcers are found
to exist, Arnica or Glycerine cerate will be a suitable application. If there is much discharge, it should be carefully
and frequently removed, and the parts kept as cleanly as
possible.
INTERNAL TREATMENT.-Except in very slight cases this is



420


ACCIDENTS.


always necessary, and must be suited to the part injured,
its extent, and the constitutional symptoms present. As a
general rule, Aconitum will do good, by allaying any febrile
symptoms, mitigating pain, and moderating reaction.
SCALDs.-When blisters are produced, cover them with a
layer of cotton wool steeped in Cantharides lotion (one part
of tincture of Canth/dris P to ten or twelve parts of water);
at the same time administer Cantharis internally.
5.-Sprains.
DEFINITION.-A sprain is an overstretching of the ligaments and tendons, generally with a rupture of some of
their fibres, at the wrist, knee, ankle, and other joints. It
is an injury of frequent occurrence.
TREATMENT.-The chief point is to keep the parts at
perfect rest, by the application of a roller nicely applied, and
tle motions of the joint controlled by a splint. This is
almost invariably necessary; as, unless rest is secured by
these means, injuries of joints recover very slowly.
Before applying the roller over the injury, the joint should
be covered with one or two. thicknesses of, linen rags saturated with Arnica lotion (one teaspoonful of Arnica 0 to
two tablespoonfuls of water), and covered with oiled-silk to
prevent evaporation. At the same time, Arnica, as prepared for internal use, may be administered; a dose every
four hours.
Aconitum, in alternation with Arnica, may be given, if the
joint becomes swollen and painful; and, especially, when
constitutional disturbance attends the injury.
When the pain and swelling subside, the joint may be
partially liberated, and gentle motion allowed; but the
greatest care must be exercised for several weeks in using
the hand, or attempting to walk, as the injury may easily be
reinduced, and then the cure becomes much more difficult
and tedious.



MUSCULAR FATIGUE.


421


6.-Muscular Fatigue from         Over-exertion.
Unaccustomed, excessive, or too prolonged exertion, as
from walking, rowing, cricket, etc., often results in a bruised
or painful feeling in the limbs and joints.
TREATMENT.-Arnica.--Excessive fatigue, with soreness or
pain on moving.
Rius Tox.-Pains in the joints, from    lifting or other
violent exertion.
Aconitum.-Disturbance of the circulation-palpitation,
pain in the side, difficulty of breathing, etc.-from running
or violent exercise of any kind.
Bryonia.-Pains in the chest and limbs, increased by
breathing or moving. Bry. is often useful after Acon.
Veratrum.--Fainting from fatigue.
ARNICATED BATHS.-If the feet are swollen or blistered,
or the ankles ache after walking or running, a warm footbath may be used, to which a teaspoonful of the strong
tincture of Arnica is added, the relief afforded being generally
immediate and permanent.    If the hands or wrists ache
from excessive or unaccustomed exertion, they may be
bathed in about a pint of water, to which twenty or thirty
drops of Arnica have been added. If necessary, in one or
two hours, the application may be repeated. In muscular
fatigue from long-continued, or short but severe exertion,
affecting the hips, thighs, etc., a hip-bath, to which a
drachm of the strong Tincture of Arnica has been added, is
an excellent remedy. The patient should remain in the
bath about five minutes. Arnicated baths, to whatever part
applied, should be warm if used in the evening, or soon after
exertion. If, however, the bath is used after the night's
rest, it should be cold. If Rkus Tox. is selected for internal
use, it should also be used externally, as directed for Arnica.



422


ACCIDENTS.


7.-Concussion of the Brain-Falls-Stuns.
DEFINITION.--Concussion is a partial interruption to the
functions of the brain from a mechanical shock, such as a
fall or heavy blow, and may vary in degree from a slight
stun to extinction of life.
SYMPToMS.-Insensibility; pale face; small, sometimes
imperceptible pulse; stertorous breathing; cold extremities, etc. By shaking the patient, or calling his name loudly
in his ears (which should, however, never be done), he will
probably give a surly answer, and soon become insensible
again. After a time, longer or shorter according to the
severity of the injury, reaction comes on, and consciousness
returns, often with vomiting. At first the reaction may be
imperfect, and it is often several days or weeks before the
power of the mind is restored.
TREATMENT.-Arnica.-Place two pilules upon the tongue,
or moisten it with a few drops of the tincture by means of a
feather or quill, and repeat the dose every hour for several
times, or until another remedy is required, in consequence of
reaction, or inflammation coming on.
Aconitum should be administered alternately with Arnica,
if fever attend the return of consciousness. Belladonna will
be most suitable if the head aches, becomes very hot, or
other head symptoms predominate. A dose every hour,
repeated several times.
EXTERNAL APPLICATIONS.-Should there be any bruise or
external wound, two or three folds of linen-rag wrung out of
Arnica lotion (twenty drops of the strong tincture to four
tablespoonsful of water), should cover the injured part, and
be protected with oiled-silk.
GENERAL TREATMENT.-The patient should be placed in a
warm bed, with his head at first moderately low, and warmth
applied to his extremities and axillce (arm-pits).  On no account should he be induced to eat or drink, but be kept very



CONCUSSION OF THE BRAIN.


423


quiet, without attempting to arouse him. When reaction comes
on, the head should be raised a little, and cold evaporating
lotions applied to it, keeping the patient at the same time in
a cool, quiet room, with the light modified, and noise and
conversation shut out.     He must be under care for two or
three weeks, lest some insidious inflammation should arise
within the head.
The following case, treated in the Doncaster Homoeopathic
Hospital, is quite to the point, and is an interesting illustration of the treatment:" Some boys were running on the parapet of a bridge that crosses the
railway, when one boy knocked his playmate, who was six years old,
over, and he fell on his head on the rail beneath. He was picked up and
brought in an unconscious state to St. James' Hospital, where he remained
in that condition forfour days and nights. During this time he had no
evacuation either of urine or fieces. A drop of the third dilution of
Arnica was put into his mouth every hour; and on the fourth day the
little fellow opened his eyes, and seeing his father sitting by his bedside,
he said, 'Dadda, where am I?' He rambled occasionally for seven days,
when complete consciousness returned. He voided a little urine on the
fourth day, and on the eighth day he had a small evacuation from the
bowels. He left the hospital on the fourteenth day after his accident,
and has remained in perfect health ever since. This patient only took
Arnica and Belladonna. It may be said there is nothing extraordinary
in this recovery, and it can in no wise establish the benefits of Arnica in
restoring health to the injured part; but imagine for a moment what the
allopaths would have done. It is not likely they would have been satisfied with a drop of Arnica. It is more likely that leeches would have
been applied to the head, that calomel purges would have been tried to
rouse the torpid bowels to action, and that various devices, such as
mustard poultices to the calves of the legs or soles of the feet, or some
other mode of torturing the poor victim would have been resorted to, ansl
yet the patient might have recovered in spite of all this. But consider
the difference-the convalescence in one case, and the protracted cure in
the other! Had the allopathic treatment been adopted, many weeks
must have been occupied in simply recovering the patient from the
state of prostration to which that treatment would have brought him"
(Yeldham).



424


ACCIDENTS.


8.-Collapse (Prostration-Shock to the nervous system).
DEFINITION.-Collapse is that general depression of the
vital powers and actions which immediately follow any
severe injury. If the vascular system is most implicated,
the heart's action is so depressed that the pulse is scarcely
perceptible; if the brain or nervous system, the patient is
insensible, or bewildered, and his speech incoherent, as if he
were intoxicated or had taken a narcotic poison.
CAUsEs.-Sudden and overwhelming grief or fear; corrosive poison; great loss of blood; and mechanical injuries,
especially of vital organs, or that cause severe pains, or
occur in very aged or enfeebled persons.
TREATMENT.-SUCh measures should be adopted as are
calculated to stimulate the heart and brain to moderate
reaction-hot brandy-and-water; essence of beef; heat applied to the arm-pits, the feet, and between the thighs, etc.
See the preceding article on " Concussion."
9.-Suspended Animation.
DIRECTIONS FOR RESTORING THE APPARENTLY DEAD
FROM DROWNING.
From   experiments conducted by the Medico-Chirurgical
Society of London, it has been proved that the heart's action
continues on an average for three minutes fifteen seconds
after the animal has ceased to make respiratory efforts.
On this fact rests our hope of recuscitating persons
suffocated, if artificial respiration be opportunely resorted to
and persevered in. The best method of performing artificial
respiration is described and illustrated in this section. The
annexed important Instructions for Restoring the Apparently
Dead from Drowning, are the result of very extensive and
careful enquiries instituted by The Royal National Life-Boat



SUSPENDED ANIMATION.


425


Institution, amongst medical men, coroners, and others
throughout the United Kingdom. The accompanying illustrations and instructions, issued by the above valuable
Institution, cannot fail to be understood by any intelligent
person.
I.
Send immediately for medical assistance, blankets, and dry
clothing: but proceed to treat the patient instantly on the
spot, in the open air, with the face downwards, whether on
shore or afloat, exposing the face, neck, and chest to the
wind, except in severe weather, and removing all tight
clothing from the neck and chest, especially the braces.
The points to be aimed at are-first and immediately, the
restoration of breathing; and, secondly, after breathing is
restored, the promotion of warmth and circulation.
The efforts to restore breathing must be commenced immediately and energetically, and persevered in for one or two
hours, or until a medical man has pronounced that life is
extinct. Efforts to promote warmth and circulation, beyond
removing the wet clothes and drying the skin, must not be
made until the first appearance of natural breathing; for if
circulation of the blood be induced before breathing has
recommenced, the restoration to life will be endangered.
II.-To RESTORE BREATHING.
To Clear the Throat-Place the patient on the floor or
ground with the face downwards, and one of the arms under
the forehead, in which position all fluids will more readily
escape by the mouth, and the tongue itself will fall forward,
leaving the entrance into the windpipe free. Assist this
operation by wiping and cleansing the mouth.
If satisfactory breathing commences, use the treatment
described below to promote Warmth. If there be only slight
breathing, br no breathing, or if the breathing fail, then2E



426


ACCIDENTS.


To Excite Breathing-Turn the patient well and instantly
on the side, supporting the head, and excite the nostrils with
snuff, hartshorn, and smelling-salts, or tickle the throat with
a feather, etc., if they are at hand. Rub the chest and face
warm, and dash cold water, or cold and hot water alternately,
on them.
If there be no success, lose not a moment, but instantlyTo Imitate Breathing-Replace the patient on the face,
raising and supporting the chest well on a folded coat or
other article of dress.
Turn the body very gently on the side and a little beyond,
and then briskly on the face, back again; repeating these
measures cautiously, efficiently, and perseveringly about
fifteen times in the minute, or once every four or five
seconds, occasionally varying the side.     (By placing the
patient on the chest, the weight of the body forces the air out;
when turned on the side, this pressure is removed, and air
enters the chest).
On each occasion that the body is replaced on the face,
make uniform but efficient pressure, with brisk movement,
on the back, between and below the shoulder-blades or bones
on each side, removing the pressure immediately before
turning the body on the side. During the whole of the
operations let one person attend solely to the movements of
the head and of the arm placed under it.  (The first measure
increases Expiration, the second commences Inspiration).
*** The result is Respiration or Natural Breathing; and
if not too late, Life.
Whilst the above operations are being proceeded with, dry
the hands and feet; and as soon as dry clothing or blankets
can be procured, strip the body and cover or gradually
reclothe it, but taking care not to interfere with the efforts
to restore breathing.



SUSPENDED ANIMATION.


427


FIG. 1.--INSPIRATION.


FIG. 2.-EXPIRATION.


Figs 1. and 2.-To illustrate the position of the body during the employment of
Dr. Marshall Hall's Method of Inducing Respiration,


III.
Should these efforts not prove successful in the course of
from two to five minutes, proceed to imitate breathing by
Dr. Silvester's method, as follows:Place the patient on the back on a flat surface, inclined a
little upwards from the feet; raise and support the head and



428


ACCIDENTS.


shoulders on a small firm cushion or folded article of dress
placed under the shoulder-blades.
Draw forward the patient's tongue, and keep it projecting
beyond the lips: an elastic band over the tongue and under
the chin will answer this purpose, or a piece of string or
tape may be tied round them, or by raising the lower jaw
the teeth may be made to retain the tongue in that position.
Remove all tight clothing from about the neck and chest,
especially the braces.
To Imitate the Movements of Breathing.-Standing at the
patient's head, grasp the arms just above the elbows, and
draw the arms gently and steadily upwards above the head,
and keep them stretched upwards for two seconds.   (By this
means air is drawn into the lungs). Then turn down the
patient's arms, and press them gently and firmly for two
seconds against the sides of the chest. (By this means air
is pressed out of the lungs).
Repeat these measures alternately, deliberately, and perseveringly, about fifteen times in a minute, until a spontaneous effort to respire is perceived, immediately upon
which cease to imitate the movements of breathing, and
proceed to induce Circulation and Warmth.
1V.-TREATMENT AFTER NATURAL BREATHING HAS
BEEN RESTORED.
To promote Warmth and Circulation.- Commence rubbing
the limbs upwards, with firm grasping pressure and energy,
using handkerchiefs, flannels, etc. (By this measure the blood
is propelled along the veins towards the heart).
The friction must be continued under the blanket or over
the dry clothing.
Promote the warmth of the body by the application of hot
flannels, bottles, or bladders of hot water, heated bricks,
etc., to the pit of the stomach, the arm-pits, between the
thighs, and to the soles of the feet.



430


ACCIDENTS.


power of swallowing has returned.*   The patient should be
kept in bed, and a disposition to sleep encouraged.
General Observations.-The above treatment should be
persevered in for some hours, as it is an erroneous opini(n
that persons are irrecoverable because life does not at once
make its appearance, persons having been restored after
persevering for many hours.
Cautions.-Prevent unnecessary crowding of persons round
the body, especially if in an apartment.
Avoid rough usage, and do not allow the body to remain
on the back unless the tongue is secured.
Under no circumstances hold the body by the feet.
On no account place the body in a warm       bath, unless
under medical direction, and even then it should only be
employed as a momentary excitant.
Appearances whiich generally accompany Death.-Breathing
and   the heart's action   cease entirely; the eyelids are
generally half-closed; the pupils dilated; the jaws clenched;
the fingers semi-contracted; the tongue approaches to the
under edges of the lips, and these, as well as the nostrils,
are covered with a frothy mucus. Coldness and pallor of
surface increase.
"* The Homceopathic preparation of Camphor is a valuable stimulant in such
circumstances.
CHAPTER XV.
HMEMORRHAGE (Loss of Blood).
By the term "' hbemorrhage " is meant the escape of blood
from those vessels in which it is naturally contained, whether
the discharge be external, or into one of the internal cavities
of the body. Hamorrhages may have a constitutional origin,
or they may be accidental (traumatic), as when a blood



BLEEDING OF THE NOSE.


431


vessel has been divided. It is to the constitutional or
spontaneous variety that we refer in this chapter. Accidental hemorrhages are considered       in  the sections on
"Wounds"     and   "Cuts."     Hmmorrhages, especially     if
profuse or long-continued, are so dangerous, and the results,
even after the discharge of blood has ceased, are often so
serious that it is most. undesirable, except in emergencies,
to trust to domestic treatment. In consideration, however,
of the frequently unexpected nature of such occurrences, of
the impossibility of securing at all times the immediate
attendance of a medical man, and of the importance of
being prepared to act promptly for their temporary relief,
we have devoted a short chapter on the immediate treatment
of several forms of hemorrhage of frequent occurrence.
1.-Bleeding of the Nose (Epistaxis).
Epistaxis is of frequent occurrence in children. A fit of
sneezing or coughing, sharp exercise, a slight blow, or even
the heat of summer, is often a sufficient exciting cause.
Bleeding of the nose also occurs during the course of many
diseases, or at their termination, and often affords considerable relief. It should not, therefore, be interfered with
unless it is excessive, recurs too frequently, and takes place
under a weak condition of the system. When it is the
result of injuries, or occurs in persons already reduced by
disease, remedies should be administered.
CAUSES.-An unnatural state of the circulation, and undue
fulness of the blood-vessels of the head, which being
enclosed in an unyielding case of bone, an escape is thus
provided for a temporary superabundance of blood.         In
children there is a foramen which transmits a blood-vessel
from the brain to the nose, and through which the gorged
vessels are relieved.  Children, uncontrolled by reason, often



432


HAEMORRHAGE.


put themselves in dreadful fits of rage, and under such excitement the amount of blood in the brain becomes greatly
increased, so that the face gets almost black from the veins
which meander in the neighbourhood of the nose. At this
juncture the nose often bleeds, and thus, probably, disastrous
results are warded off. In adult life, however, when the
passions should be under the control of the reasoning
powers, no such provision exists, this foramen being then
obliterated.
In some adult persons, under peculiar conditions of the
system, epistaxis occurs periodically, and then its cessation,
rather than its continuance, may become, without judicious
treatment, a source of danger. In men it is apt to succeed
the hemorrhoidal discharge, and in young women it may be
vicarious of the menstrual function, and is frequently present
during suspended menstruation. In other cases it forms a
part of a constitutional hemorrhagic diathesis, or it may
result from local disease of the nostrils.
TREATMENT.-Ipec., Am., Sec., Sulph. Ac., C/in., Croc.,
Acon., Bry., Ferr., Calc., Carbo Veg.
Aconitum.-Bleeding after being over-heated, or in plethoric patients, with fever, strong pulsations of the arteries
of the temples and neck, and hurried, full pulse. A dose
every fifteen, twenty, or thirty minutes for several times.
Arnica.-Epistaxis from external violence, such as a blow,
fall, or excessive bodily exertion, preceded by heat and
itching of the nose.
Pulsatilla.-If it occur in females from  suppressed or
scanty monthly discharge (vicarious hAemorrhage),* Pulsatilla
or Bryonia should be administered, according to the indications that may be present.
Carbo Veg.-Epistaxis with suppression of bleeding piles.


* See "The Lady's Manual of Homceopathic Treatment."



BLEEDING OF THE NOSE.


433


Cihna.-If the bleeding has been so excessive as to weaken
the patient, and produce paleness of the face, tendency to
fainting, etc. A dose three or four times daily for a week
or ten days. The food should be nourishing, and taken at
regular hours.
Sulphur.-In chronic cases, and to correct that constitutional condition which favours the haemorrhage.
ACCESSORY MEASURES.-During the bleeding, the patient
should be freely exposed to fresh air, and be kept standing,
as in this posture fainting is much more readily induced than
in the recumbent; and this is one of nature's methods of
arresting haemorrhage. Stimulating food or drink, together
with every circumstance likely to quicken the circulation,
should be carefully avoided. The application of cold is a
most successful means for arresting hamorrhage; it may be
applied to the nose or forehead by a handkerchief wetted in
cold water, or by ice, or by the sudden application of cold
water to the neck or back, or by placing a cold key or any
other iron instrument to the spine. In these latter instances, the influence of cold is not restricted to the part to
which it is immediately applied; the bleeding is arrested by
the sympathetic constriction of blood-vessels which it produces in remote parts. In most cases, however, the simple
plan of causing the patient to raise his arms above his head,
and holding them so for a short time, promptly arrests
hcemorrhage.
If, in spite of these means, the bleeding continues so long
as to appear to endanger life, the nostrils should be plugged
by means of linen rags rolled together so as to form two
plugs, and in severe cases should not be disturbed for two or
three days. In making the plugs, it should be remembered
that the "cc posterior openings of the nasal fosse " are somewhat oval, about one inch in the long diameter, and half an
inch in the transverse, and that sufficient length of the linen



434


BEMORRHAGE.


should be left outside by which to withdraw them when the
hsemorrhage has ceased.
Plethoric persons, predisposed to epistaxis or to congestions, should lead a temperate life, avoid stimulants, use
frequent ablutions of cold water, and take moderate exercise
daily in the open air.      Immoderate exertion and much
stooping are injurious. On the other hand, delicate persons,
of spare habit, are benefitted by nourishing food.
2.-Haemoptysis (spitting of blood), AND Hsematemesis
(vomiting of blood), FROM RUPTURE OF A BLOOD-VESSEL.
It is not always necessary to determine whether the blood
comes from the lungs or stomach, as the immediate treatment should be the same in either case.         The following
points will, however, enable almost anyone to distinguish
between these conditions:
HIEMOPTYSIS.                   HIEMATEMESIS.
1. In hemoptysis the blood is of a  1. In hematemesis the blood is of
bright-red colour.               a dark colour, from admixture with
hydrochloric acid.
2. The blood is coughed up.      2. The blood is vomited.
3. The blood is frothy and mixed  3. The blood is often mixed with
with sputa.                     food and is not frothy.
4. Is preceded by pain in the chest  4. Is preceded by nausea and stoand dyspncca                    mnach distress.
5. Blood is rarely found in the  5. Blood is generally passed with
stools,                          the evacuations from the bowels.
TREATMENT.-The following are the chief remedies:Acon., Sulp)h. Ac., Ipec., Arn., Chin., Pios., Bell., Ham.,
Nit. Ac.
Aconitum.--Chiefly indicated when flushed face, palpitation, and anguish accompany the hsamorrhage; or for the
premonitory symptoms in frequent attacks, such as shiver



436


HEMORRHAGE.


hints here given are chiefly intended for cases of emergency;
and the patient should be placed as quickly as possible under
the care of a homoeopathic physician.
ACCESSORY MEASURES.-Calmness and judgment are necessary, as the discharge of considerable quantities of blood is
otherwise likely to cause such alarm, both in the patient and
his friends, as to unfit them for carrying out those prudent
measures that are essential for the safety and even life of
the sufferer. The patient should immediately lie down on a
sofa or mattress, with the head and shoulders elevated: all
tight-fitting clothes should be removed or loosened, and
coolness and quiet of the body maintained, and talking on no
account be permitted. There must be no crowding around, no
noise or confusion, and the room be kept cool and airy, at
about 550 Fahr. No food is for some time admissible, and the
only drink that can be allowed is a little cold water, or small
pieces of ice to suck. Should faintness occur, no alarm need
be excited, because, as before stated, it is often nature's
method of arresting the bleeding. After the hamorrhage
has ceased, the patient must still be kept cool and quiet, and
the diet be light and unstimulating, while the position of
the body should be such as to favour the efflux of blood
from the bleeding organ. These measures are necessary to
obviate a recurrence of the symptoms.
3. -Hematuria (Bleeding from the urinary organs).
The sources of the hamorrhage may be the kidneys, the
bladder, the prostate gland, or the urethra.
CAUsEs.-Ha-emorrhage from the kidneys may be due to
the irritation of renal calculi; blows on the loins; congestion,
from  scarlet fever, inflammation, typhus, scurvy, etc. HEemorrhage from the prostate gland, bladder, or urethra, may
be caused by the introduction of instruments, the irritation



HIEMATURIA.


437


of stone, venereal disease, abuse of Spanish fly, or by the
existence of an ulcer or tumour, of which, indeed, it is often
the first manifestation.
DLAGNOSIS.-Heamorrhage from the bladder may be recognised by the discharge taking place principally after the
escape of urine; the quantity of blood is also greater, and
often the clots are larger and more irregular, than when
derived from the kidneys; the severe pain in the lumbar
region, the intimate admixture of the blood with the urine,
and other symptoms that accompany hemorrhage from the
kidney, are not present.
TREATMENT.-Canth., Terebin., Cann., Mez., Arn., Lye.,
Carbo Veg., Acon.
Cantharis.-Discharge of pure blood in drops, or copiously
blended with the urine, especially when associated with
difficulty in passing water, scalding urine, and spasmodic
pains in the region of the bowels. A dose every hour
repeated once or twice; afterwards twice a day.
Camphor.-If the disease has arisen from   the use of
Spanish fly (Cantharides), after the allopathic fashion of
administering that poison.
Arnica.-Haemorrhage from external violence, strains, or
severe efforts. If the patient is robust, and inflammatory
symptoms predominate, Aconitum may be alternated with
this remedy. A dose every hour for several times; afterwards Arnica alone, every four or six hours.
AccEssoRY MEANS.-Demulcent drinks, such as linseedtea, gum-water, etc., may be taken in considerable quantities.
The coldl compress, covered with oiled-silk, over the loins, if
the hemorrhage proceeds from  the kidneys, or over the
whole region of the bladder, if the bleeding proceeds
from that organ, will mitigate the 'pain, and favour a more
rapid cure.
For additional details of treatment, consult the sections,



HIEMORRHAGIC DIATHESIS.


439


to be kept calm, and order and quietness maintained in the
apartment.
For ampler details of treatment, see "The Lady's Homceopathic Manual," article, " Menstruation too profuse."
5.-Bleeding from      the Rectum.
See " HEMORRHOIDS," pages 263-7; and " DYSENTERY,"
pages 234-8.
6.-Hsemorrhagic Diathesis.
In some patients apredisposition to heemorrhage exists which
appears to be hereditary, and is designated the hcemorrhagic
diathesis. In this condition there is, probably, defective
contractility of the arteries, which may also be fragile or
soft from. diseased processes, and so are unable to resist the
forces of the circulation, especially in congestion; also loss of
coagulabilty of blood, from a defective or altered character
of the fibrine, the chief agent in coagulation, and some
change in the red corpuscles. This diathesis is marked by a
tendency to ecchymosis from slight pressure, bleeding of the
nose, or gums in children, or from the urinary passages
or bowels in subsequent years. Hence the most trivial
wound, as the extraction of a tooth, or the laceration of a
blood-vessel, bleeds almost uncontrollably, and even life
may be jeopardized by a slight injury or surgical operation.
The hamorrhagic diatheses may not in all cases be hereditary, but caused by diseases of internal organs, such as the
liver and spleen, which exert a deleterious influence upon
the constituents of the blood. The knowledge of the existence of such a diathesis is most important, as it would
materially modify the medical and surgical treatment of the
patient.



440


SCROFULOUS DISEASES.


CHAPTER      XVI.
SCROFULOUS DISEASES.
1.-Scrofula-Struma (Tuberculosis).
SCROFULA or STRUMA-for the terms are synonymous-is
a disease of the constitution, consisting of debility with a
tendency to indolent inflammatory and ulcerative affections.
It is a congenital disease, consisting probably of chronic
irritation, disturbing the functions by which the proper
nourishment of the tissues in fcetal life is carried on, and
leading afterwards to derangement of the nutritive system.
Indolence is 'a marked peculiarity of scrofulous diseases;
they begin insidiously, progress slowly, are attended with
little heat or pain, but often proceed to the disorganization
of the part affected, by the deposit of tubercle and subsequent
suppuration. The most common external sign of scrofula is
enlargement of the subcutaneous glands, especially those of
the neck. These swellings occur very frequently during
childhood, and are excited into activity by cold, measles,
scarlatina, hooping-cough, etc., and either remain for a long
time inoperative, or proceed to severe inflammation and suppuration.   Not that all enlargements of the lymphatic
vessels and glands are due to scrofula; they may arise from
temporary causes, and their character as such is readily
determined by the history and symptoms of the case.
The blood of scrofulous patients is found, on examination,
to differ materially from  that of healthy persons. In the
former, there is an excess of serum, but a deficiency of the
fibrous constituent; consequently, the materials which are
formed from this blood are lax, feeble, and incapable of
resisting exposure, fatigue, and morbific influences.



SCROFULA-STRUMA.


441


TUBERCULOSIS signifies that state of the constitution in
which there is a tendency to the deposit of a substance
called tubercle, in various tissues or organs. It is at present
uncertain whether scrofula and tuberculosis are different
diseases or not; but it is highly probable that the disease
of the blood which leads to the deposit of tubercle, and that
which gives the specific character to scrofulous affections,
are identical.
CAUSES. -The Predisposing causes are-descent from
scrofulous parents, who may undoubtedly transmit their
peculiar organization and predisposition to disease to their
children; children of syphilitic parents, and still more, of
spirit drinkers, are very liable to scrofula. Two other potent
causes of scrofula, as also of consumption, hydrocephalus,
etc., have been pointed out by Dr. Piddock; they are,
tobacco-smoking on the part of the father, and the existence
of leucorrAosal discharge on that of the mother. To both of
these we would draw special attention.
Indulgence in tobacco-smoking, more especially when the
habit becomes frequent and inveterate, or where it has been
acquired early in life, is, it is believed, a fruitful cause of
struma. The pale, sallow complexion, the frequently disordered digestive functions, and the debilitated or consumptive frames of many young fathers in the present day,
attest the pernicious tendency of the habit in question.
Leucorrhceal, hemorrhagic, or other uterine and vaginal
discharges, often generate scrofula in the foetus during
utero-gestation, which declares itself during infancy in convulsions, hydrocephalus, mesenteric disease, or at or after
puberty, by tubercular consumption. No observant medical'
man can doubt the influence of these causes as tending
largely to the production of disease.
The scrofulous habit, if not congenital, may probably be
produced by any cause capable, directly or indirectly, of
2F



442


SCROFULOUS DISEASES.


lowering the vital energies, such as poverty and wretchedness; meagre, watery, or insufficient food; neglect of healthy
exercise; insufficient clothing; want of cleanliness; frequent
exposure to cold and damp; and, especially, want of pure
air and sunlight.
Respecting the Exciting causes of scrofula, it may be
remarked that the habit may be so intense, that the patient
is attacked with some of the diseases mentioned in this
chapter as peculiar to it, in spite of all care; or, on the
other hand, actual scrofulous disease may not appear unless
the health is first depressed by some other cause, such as
measles or scarlatina.
Dietetic transgressions, and anything that causes derangement of the digestive organs, may excite it into activity. It
rarely breaks out before two or after thirty years of age;
still it may be called into action at any period of life, by
any cause which injures the general health. The time of the
second dentition and puberty are perilous periods.
The climate of Great Britain has often been charged as a
fruitful cause of scrofula, but it is probable that it has no
more influence in causing it than any other. It is certain
that persons whose occupation necessitates their exposure to
the weather at all hours of the day, and in all seasons of the
year, are not nearly so liable to scrofulous disease, other
things being equal, as persons whose occupations are sedentary, and carried on in close, hot, dark, or badly ventilated
rooms.    Pure air and sunlight often make amends for
defects of food and clothing.
SCROFULOUS DISEASEs.-The most marked local lesions of
this constitutional cachexia are, glandular swellings, and
indurations on the neck below the jaws, on the nape of the
neck, then in the axillce (armpits), groins, and afterwards in
any part of the body. These swellings are at first soft,
painless, movable; afterwards, they enlarge, become painful,



SCROFULA-STRUMA.


443


inflame, and eventually suppurate, forming scrofulous ulcers.
They may also occur in the interior of the body, particularly
in the mesentery and lungs; also in the liver, spleen, and
brain. The eyes are also frequently in a state of inflammation, described in another part of this work as " Scrofulous Ophthalmia." Cutaneous diseases; tetters; otorrhcea;
a large and tumid abdomen; swellings and caries of bones;
white swellings (anthrocace), and the hip disease; ozcena;
diseases of the testicle and mammary gland; and convulsions and acute hydrocephalus during infancy.
TUBERCLE.-This is a peculiar substance, and is usually
found in the form of roundish masses, and hence called
tubercle, or else is infiltrated through the substance of various
organs. So far as its naked-eye appearances are concerned,
it is met with in two forms, namely, (1) as a miliary
tubercle, varying in size from that of a pin's head to that of
a small pea; greyish, semi-transparent, and tolerably firm;
or (2) of yellow tubercle, of a dull yellow colour and cheesy
consistence.
Tubercles are incapable of development into any of the
normal tissues of the body, and either remain quiescent, or
wither, or are partly absorbed; or again degenerate into
harmless masses of granular, oily, and earthy matter, and
may so remain till the end of life. This is called cretfication, and is the most favourable course of tubercle.  In
unfavourable cases tubercles soften, first at their centre;
then inflammatory infiltration takes place at the circumference, and pus is formed, which is discharged by ulceration
along with the softened tubercles. This process is too often
attended with an increase of the tubercular deposit around,
which rapidly undergoes the same destructive change, until
the organ affected be destroyed, and, if this be a vital organ,
with it the life of the individual. If the lungs are the
organs implicated, the disease is called p/htisis pulmonzalis or



444


SCROFULOUS DISEASES.


consumption; if the mesenteric glands, tabes mesenterica or
marasmus; if the meninges of the brain, hydrocephalus
or " ater in the head."     Tubercle is usually deposited
slowly, painlessly, and unsuspectedly, during some period of
defective health, and may continue in this condition for an
indefinite period, till it wastes, if the health improves, or
softens and causes abscesses if the health deteriorates. In
many cases, after this, the deposit may be arrested by proper
treatment; under other circumstances, it goes on to a fatal
termination.
TREATMENT.-This is generally tedious, often requiring to
be continued for months, and in some cases for years. As
it is often desirable to persevere with one remedy for a long
period, it is necessary occasionally to suspend its use for a
few days, then to administer a dose or two of an intercurrent
medicine, such as Sulphur or Opium; and again, after
waiting a few days, to resume the former remedy. The
following list includes most of the remedies that have been
found successful in treating scrofula in its various forms:Sulph., Ca(c., Bar. C., Sep., Lyc., Phos., Coni., Hp. S., Sil.,
Aur. iMur., od., Merc., Ferrum, Cina, Bell., Acon., China.
Calcarea.-In children presenting the usual marks of the
scrofulous diathesis, especially in ricketty aff'ctions, curvature
of the spine, or other bones; softening of the bones; indurated or suppurating glands; scrofulous ophthalmia; late or
difficult dentition; scrofulous eruptions on the skin; voracious
appetite; emaciation; chronic diarrhoea. It is also indicated
in the case of girls in whom the menstrual function appears
too early, and the discharge is too copious.     Calcarea is
olten efficacious after Hep. S., Sulph., and Merc., have
failed to do good.
Arscnicum.-This is one of the most important remedial
agents in scrofula, particularly when there is atrophy or
marasmus; when debility is very marked, and the patient is



SCROFULA-STRUMA.


445


troubled with burning dryness of the throat and tongue, pale
and unhealthy skin, frequent and exhausting discharge from
the bowels, sallow complexion, and emaciation.
Aurum.-Often of great service in cases improperly treated
with large doses of Mercury; also in protracted and obstinate
cases, when the strength of the patient is much reduced, and
little benefit has resulted from previous remedies. It is
chiefly indicated in afection of the bones, and in ricketty
patients. Ferrum and China are deserving attention in like
cases.
Belladonna.-This remedy is often useful when sensitive
organs are affected, such as the eye, the ear, and the throat:
there exist heat, redness, and pain in the eye, with great
intolerance of light; roaring or neuralgic pain in the ears;
soreness of the throat, rendering swallowing difficult; painful swelling of the parotid and other glands; pains in the
limbs and joints, increased by movement, and during the
night; swollen and spongy gums, etc.
Silicea.-Scrofulous ulcers with callous edges, fistulous
ulcers, scaldhead, discharge from the ears, and in scrofulous
affections of the bones.   It may advantageously follow
Calcarea, especially in disease of the bones.
Mercurius.- Glandular inflammations characterised by a
diffused redness, much swelling, and pains worse at night in
bed; it is particularly indicated when the glands of the neck
are swollen and painful, and there are excessive discharge of
saliva, disagreeable taste, frequent and unhealthy-looking
stools, and strumous affections of the eyes.
Hepar Sulph.-Scrofulous glands in a state of suppuration, the discharge being indolent or unhealthy, and the
patient frequently troubled with cold in the head or chest.
Sepia.-'lhis remedy is often required in scrofulous
females, who are troubled with menstrual irregularities,
corrosive leucorrhoea, indurations of the uterus, etc.



SCROFULA-STRUMA.


447


Cod-liver Oil, as a supplemental article of diet, is an
agent possessing such remarkable properties of arresting
general or local emaciation, so well known as not to require
further recommendation here. It may be taken in almost
any scrofulous disease, and in any case in which the
patient is losing flesh; it may be given in teaspoonful doses,
two or three times a day, commencing even with half a
teaspoonful if it is found to disagree with the patient.  See
also pages 184-5.
Exercise.-Moderate exercise in the open air is most
essential; and in carrying out this suggestion the patient
should endeavour to take exercise with the mind agreeably
occupied, rather than following it as an irksome task. A
-bracing mountain or sea air, if it can be borne, is the best.
The patient's room should also be uninterruptedly supplied
with pure air. Bathing, both in fresh and salt water, is
invaluable, as a means of promoting a healthy action of the
skin, and of imparting tone to the whole system. The
clothing should be adapted to the season, and should be warm
without being uncomfortable. The extremities, especially
in cold weather, should be kept warm. As a general rule,
flannel* should be worn, but only during the day; in winter
it affords direct warmth, and in summer it tends to neutralize the effects of sudden changes of temperature. The linen
should be frequently changed, always observing that it is
put on perfectly dry.
PREVENTION.-The prevention of strumous diseases consists not alone in the hygienic or medical treatment of the
patients, but primarily in the correction of the habits and
improving the health of the parents, more particularly in
respect to the two points referred to under " Causes." The
habit of tobacco smoking, especially by men under forty,
should be repressed, as it tends to poison life at its source,
* See pages 26-7.



448


SCROFULOUS DISEASES.


the consequences not exhausting themselves on the smoker
himself, but are transmitted in full force to his offspring,
who are often weak, strumous, or otherwise unhealthy.
No less important on the part of the female is the cure of
any leucorrhoeal discharge. If this exist immediately before
or during pregnancy, pure air and a suitable diet will often
be quite ineffective in    preventing  the development of
scrofulous or tuberculous disease in the child.    Children
born of women long troubled with leucorrhoea have often
been observed to die early, and after the cure of that disease
healthy children have been borne.
2.-Rickets (Rachitis).
DEFINITION.-Rickets is a cachectic disease of childhood,
essentially characterised by deficiency of earthy matter in
the bones, so that they yield to weight and pressure, and
are liable to harden afterwards in unnatural forms. There
are also the conditions which result from impaired assimilation-emaciation and general debility.
SYMProITs.-Rickets is generally attended with the usual
symptoms of the scrofulous diathesis, such as are described
in the last section; but its leading characteristics are the
imperfect development, atrophy, softening, and deformity
of the bones, especially those of the lower extremities.
These are soft, and consist of cartilaginous tissue, which
will bend without breaking, and through which a knife
may be readily passed. According to Messrs. Tomes and
De Morgan, rickety bone has the structural arrangement
of the bone without the impregnation with earthy salts.
The articular extremities of the bones are often disproportionately large. The shafts are unable to support the weight of
the body without bending. In slight cases, the ankles may be
only a little sunk, or the shins bent, or the spine curved:



RICKETS.


449


but, in  aggravated   cases, the physiognomy and general
appearance are very peculiar. The stature is stunted; the
head large, with a protuberant forehead; the fontanelles are
slow in closing; the face small and triangular, with a very
sharp-peaked chin, and projecting teeth; the chest narrow
and prominent in front, whence the vulgar term, pigeonbreasted; the spine variously curved; the pelvis small, the
promontory of the sacrum       and acetabula being     pressed
together, rendering the cavity perilously small for childbearing; frequently the long bones are involved, so that the
limbs are crooked, their natural curves being exaggerated.
This disease generally attacks the children of the poor, from
the second to the tenth or twelfth year of their age(Druitt).
CAUSES.-Hereditary scrofulous disposition of the constitution.  It is frequently met with in the children of parents
who have suffered from syphilis, sexual excesses, unhealthy
occupations, or other unfavourable conditions. It, however,
often arises in children of healthy parents from the nonobservance of hygienic laws, and especially from insufficient
or improper food, want of pure air and bright sunlight.     It
being strictly a disease of the nutritive processes, it will
readily be perceived how such conditions as the above should
tend to produce it. Dr. Jenner, in the following passage,
strikingly shows the influence    of improper feedling and
physicking of children in the production of rickets.
" For the first two or three days after birth, their tender stomachs are
deranged by brown sugar and butter, castor-oil and dill-water, gruel and
starch-water; as soon as the mother's milk flows, they are, when awake,
kept constantly at the breast. And well for them if they are not again
and again castor-oiled, and dill-watered, and even treated with mercurials
-for the poor have learned the omnipotent virtues of grey-powder.
" After the first month, bread and water sweetened with brown sugar is
given several times a day, and during the night the child is, wllen not too
soundly asleep, constantly at the breast. As soon as the little ill-used



450


SCROFULOUS DISEASES.


creature can sit erect on its mother's arm, it has at parents' meal-times
' a little of what we have'-meat, potatoes, red herring, fried liver, bacon,
pork, and even cheese and beer daily, and cakes, raw fruits, and trash of
the most unwholesome quality, as special treats, or provocatives to eat,
when its stomach rejects its ordinary diet. Then, instead of being
weaned when from ten to twelve months old, the child is kept at the
breast when the milk is worse than useless, to the injury of the mother's
health, and to the damage of its after brothers and sisters, in the hopes
that thus keeping it at the breast may retard the next pregnancy. The
children are sacrificed that the passions of the parents may not be
restrained" (Medical Times and Gazette, KMay 12th, 1860).
CONSEQUENCES OF RICKETS.-Softening and curvature of
the bones often deprive a child of the use of his limbs, so
that he may be generally seen seated or lying on the floor,
thus adding to the original mischief.   The deformity of the
thorax produces difficult breathing, and       the  abdominal
organs, especially the liver, are constantly compressed in
consequence of sedentary habits.     Sometimes the enlarged
bones inflame, leading to local swelling, suppuration, and
caries.   Derangement of the digestive organs, wasting,
hectic fever, etc., now make their appearance, if they did not
exist before. If the disease do not terminate fatally by
exhausting the patient's strength, it may lead to malformation of the bones, which may be a cause of miscarriage,
unnatural labour, etc. Under favourable treatment, however, and with proper care, the bones become very firm in
adult life, and are remarkably strengthehed by strong ridges
developed on their concave sides.
TREATMENT.-The medicines required may be            selected
from   those prescribed in the section on Scrofula.        The
leading remedies are the following:-H-ep. Sulph., Calc. C.,
Silic., Ars., lod., and Phos. Ac.
ACCESSORY MEANS.-Country, out-of-door air, abundance
of sunlight, and exercise suitable to the case, will wonderfully aid the cure, by imparting tone to the digestive organs,



TABES MESENTERICA.


451


'energy to the nervous system, and, in short, invigorating the
whole constitution. Patients not able to walk should sit or
recline in the open air, warmly clad, during suitable portions
of the day, when not exposed to cold or damp winds. This
will be found far more contributory to recovery than passing
the chief part of the day in the confined air of a sick-room.
~Further, tepid and cold bathing, especially in sea-water; and
nourishing food, which should be well masticated, or if the
teeth are inefficient, pounded in a mortar; the food should
include milk, meat, good animal broths, and cod-liver oil.
Respecting mechanical support, Mr. J. C. Forster remarks:
"I am   quite sure none yet invented is of any service.
Splints on the outside and inside of the leg, boots, irons,
etc., only add to the weight which already overburdens the
feeble limb."
3.-Tabes Mesenterica-Abdominal Consumption.
NATURE.-To connect the intestines, and to support
them in their proper place in the abdomen, they are suspended by folds or duplicatures of the peritoneum, which
are arranged in such a manner as to allow the necessary
freedom of motion to these organs, and to enclose and
protect the mesenteric glands and chyle-producing vessels, as
they carry on the important functions of nutrition.  Tabes
mesenterica is a strumous degeneration of the mesenteric
glands, which, unless arrested by early and judicious treatment, may result in the destruction of these glands, and,
consequently, in the death of the patient, from inability to
repair the waste of the tissues of the body.
SYMPTOMS.-The abdomen is tense and swollen, while the
other parts of the body and the limbs waste, until, in fatal
cases, the degree of emaciation becomes extreme; hence the
term tabes (to melt away). Co-existing with wasting there



452


SCROFULOUS DISEASES.


are also the following symptoms:-pale and flabby skin;
anxious and aged expression; inordinate or fitful appetite;
irregular, but generally relaxation of the bowels, with unhealthy, foetid stools; passage of undigested food; pain in
the bowels, so that the patient draws his legs up towards the
abdomen; at the same time he becomes feverish           and
indisposed to activity. When the disease is established, the
process of absorption is suspended, so that the quantity of
nutriment added to the blood is inadequate to the requirements of the system. At an advanced stage of the disease,
hectic fever often sets in, with obstinate diarrhoea, extreme
thirst, restlessness, and  sleeplessness.  The mesenteric
glands, which can often be felt through the tense and thin
walls of the abdomen, sometimes suppurate, and the patient
dies from  the abdominal disease, or from actual starvation.
If, however, treatment is resorted to before the glands are
irreparably disorganized, the patient slowly recovers.
TREATMENT.-The remedies required in this affection are
the same as those recommended in the section on Scrofula,
a selection from which should be made according to the
existing symptoms. The most important are, Acon., Calc.,
Arsen., Iod., Bell., Merc., Sil., Phos., and Sulph.
The only hope of cure is in early and judicious treatment;
the disease, however, is so serious, that it can only be safely
confided to a Homoeopathic practitioner.
ACCESSORY MEANS.-The food should be nourishing and
suited to the age and digestive functions of the patient. In
general, farinaceous preparations, goats' milk, beef-tea, sodawater with milk, and, twice a day, a small teaspoonful of
cod-liver oil. Pure out-of-door air, and in the case of
children in towns, country-air or sea-air is invaluable. At
the same time the patient's apartment should be spacious
and carefully ventilated. Further, tepid salt-water bathing,



SCROFULOUS DISEASE OF THE HIP-JOINT.


453


warm   clothing, including a flannel bandage round     the
abdomen, so as to guard against the vicissitudes of the
weather, are necessary adjuncts to the treatment of patients.
4.-Scrofulous Disease of the Hip-Joint
(Morbus Coxa).
SYMPTOMs.-In this slow and serious disease, the early
symptoms are of an insidious character. The child is supposed to be suffering from  " growing pains" for months
before the disease assumes an active form. The first distinctive symptoms are, slight pain, chiefly referred to the
knee, lameness, and weariness. There may be even slight
swelling in the knee-joint, so that remedies are often applied
here, but the disease is in the hip. This may be proved
by pressing either in front or back of the hip-joint, or
by jerking the thigh-bone against the joint, as by a sharp
tap on the heel, when pain will be felt in the hip. As
the disease progresses, the nates (buttock) wastes and becomes flabby; the limb is shortened either by caries of the
neck of the femur (thigh-bone), or by destruction of the
ligaments of the joint, and     consequent dislocation  of
the joint upwards on the dorsum ilii. There is increased
fulness about the limb, the pains increase in severity,
especially at night, and there are often startings of the
limb during sleep; abscesses form, and afterwards burst
on the nates or groin, or burrow deeply and discharge their
contents into the rectum. The duration of the disease varies
from two or three months to several years. But it is much
modified, both as to its duration and results, by recent
skilful contrivances. Adults rarely recover; but, in children,
when the strength is not too much exhausted, and the lungs
are unaffected, the disease frequently terminates in anchylosis
(stiff joint).
TREATMENT.-The medicines most likely to prove beneficial



456


GENERAL DISEASES.


night, and in all cases is increased by pressure, so that
even the touch of his medical attendant or nurse, or the
weight of his bedclothes can scarcely be borne.       Often the
patient remains fixed, as it were, in one posture, from which
he dares not move, and declares that he has lost the use of
the limb.   The skin is hot, but covered with a sour sweat,
having an offensive odour, and so highly acid as to redden
litmus paper.    The perspirations, although unattended by
immediate relief, are nature's mode of elimination, for the
pains are always aggravated, and the constitutional symptoms intensified, if they become suppressed. It is only
when the perspirations lose their characteristic sour character that they become useless.      The urine in acute rheumatism is scanty, of high specific gravity, and deposits on
cooling deep-coloured sediments of urates. The pulse is
round and full; the tongue loaded with a yellowish-white
mucus, but the head is unaffected.    This last symptom, the
absence of headache or delirium, is a. prominent distinguishing
point between acute rheumatism and the continued fevers.
" Such are the general and local expressions of a diseased state of the
system in acute rheumatism; and at the height of the disorder it is
difficult to conceive a more complete picture of helplessness and suffering
than that to which the patient is reduced. A strong and powerful man,l
generally unused to disease, lies on his back motionless, unable to raise
his hand to wipe the drops which flow fast from his brow in the paroxysms
of pain, or the mucus which irritates his nostril. Indeed, he is so helpless that he is not only obliged to be fed, but to be assisted at every
operation of nature. The sweat in which he lies drenched seems to
bring him no relief; his position admits of no change; if he sleeps, it is
short, and lie wakes up with an exacerbation of suffering which renders
him fretful, impatient, and discontented with all around him" (Aitlcen).
The erratic character of rheumatism     is very remarkable,
and is usually well expressed; thus it suddenly quits one
joint to appear in another, and then in another, afterwards,



ACUTE RHEUMATISM.


457


perhaps, travelling back to its original seat, the development
of inflammation in one joint being often accompanied by its
rapid subsidence in another, this alternation occurring many
times during an attack.  But the most serious metastasis is
from the joint structures to other fibrous tissues, as the
pericardium or the valves of the heart. This complication
may be expected in very severe attacks, in young persons, in
women oftener than in men, in patients who have been
weakened by disease or other causes, and in persons troubled
with irritability or palpitation of the heart.
HEART-COMPLICATIONS.-When cardiac inflammation arises,
the patient's countenance becomes dreadfully anxious, the
breathing distressed, and pain is complained of in the
heart's region; also there is tenderness between and under
the ribs, and there may be palpitation or irregular action
of the heart. The physical signs of pericarditis may be
detected by the stethescope, and a distinct friction or
to-and-fro sound heard, like the rubbing of paper, owing to
the roughening of the serous surfaces by effusion of fibrine.
This sound may soon be lost, either from the opposite surfaces becoming glued     together, or separated  by serous
effusion. If the amount of effusion is large, both the circulation and the respiration become seriously embarrassed,
the heart beats tumultuously, the sounds become muffled,
and there is increased extent of dulness in the heart's region.
Together with    pericarditis, or separately, endocarditis
(inflammation of the inside lining of the heart, especially
of the valves) may arise. The symptoms are similar to those
of pericarditis, but the physical sign is a bruit (a modification
or an unnatural character of one or both of the natural
sounds of the heart). In consequence of the extreme danger
of these complications all cases of severe rheumatic fever
should be watched daily by a medical man, so that the signs
and symptoms of heart complications, which often come on
2G



458


GENERAL DISEASES.


very insidiously, may be early recognised, and appropriate
treatment at once adopted.
RHEUMATISM AND GOUT.-For a tabular statement of the
differences between these diseases, see the section on " Gout."
CAUsEs.-The predisposing cause is some morbid product
in the blood, a product probably of unhealthy assimilation.
" The circulating blood carries with it a poisonous material,
which by virtue of some mutual or elective affinity falls
upon the fibrous tissues in particular, visiting them and
quitting them with a variableness that resembles caprice,
but is ruled, no doubt, by definite laws, to us, as yet, unknown" (Watson). These materies morbi with which the
blood is loaded, constitute that predisposing cause without
which it is probable the disease would never occur. Hereditary predisposition exists undoubtedly in many persons.
The suppression of an eruption or rash, as measles, or the
sudden stoppage of dysentery, may also act as a predisposing
cause.
The exciting causes are, exposure to cold and wet, especially
evaporation from wet or damp clothes, causing chill. This is
no doubt an explanation why the disease is most common
among the poorer classes of society, who cannot protect
themselves so effectually as their wealthier brethren. The
cold probably excites an attack of acute rheumatism, by
arresting the secretory functions of the skin, by means of
which, in health, morbid substances in the blood are often
removed; now, however, the functions of the skin being
deranged, unhealthy principles accumulate in the blood,
and rheumatism    results. Mere cold, however, is not so
much a cause of rheumatism as extreme atmospheric vicissitudes. Hence it is found that it does not prevail most,
abstractedly, in the coldest regions of the globe, but rather
in those climates and during those seasons remarkable for
damp and changeable weather.



ACUTE RHEUMATISM.


459


TREATMENT.-Aconitum. -Acute rheumatism, at the commencement, when the fever is high, and there are violent
shooting or tearing pains, worse at night, and aggravated
by. touch. Also swelling and redness of the affected parts,
impaired appetite, high-coloured urine, and other febrile
symptoms. This remedy may be administered either alone
or in alternation with Bry., at intervals of one to three
hours.
Bryonia is most frequently required after the use of
Aconitum, or in the absence of acute fever, it may be the
first remedy used. It is chiefly indicated when the pains are
lancinating or stitching, and seem to affect the muscles
rather than the bones; are worse on the least movement, but
are relieved by rest; there also exist heat, headache and
gastric derangement, profuse perspiration, or coldness and
shivering, and irritability of temper. It is the most useful
remedy when the joints are attacked, but it is frequently
necessary to change the remedy to Rhzus, if the tendons
become implicated.
Rhus Tox.--Rigidity of the limbs, deep tearing or wrenching pains, worse when at rest, or on first moving the limb,
and in cold or damp weather, but relieved by motion. It is
suited to rheumatism from getting wet.
Pulsatilla.-Rheumatic pains wandering from one part to
another, and relieved by cold. There is a sensation of torpor
or paralysis in the affected part; also generally pale face,
tendency to relaxation, and amiable temper.
iVux Vonica.-The pains are similar to those of Pulsatilla,
but occur in persons of a dark complexion, hasty temper,
with a tendency to confined bowels, piles, etc.
Arnica.-Pains resembling those caused by a bruise or
sprain; and when the rheumatism    affects the back, and
causes stiffness, or affects parts previously injured.
Belladonna.-Shooting, burning pains, worse at night, and



460


GENERAL DISEASES.


on movement, with shining redness of the parts, congestion
to the head, etc.  Often required alternately with Aconitum.
Mercurius.-Puffy swelling of the affected parts; the
pains feel as if seated in the bones or joints, and are
increased by warmth, and at night; there are also 'chills,
and profuse perspiration, which do not give relief.
el-epar Sulphur.-Tedious cases, after other remedies have
been tried with little or no effect; also for patients who have
been salivated with mercury.
Dulcamara.-Rheumatism from exposure to damp or wet,
or after the sudden cessation of an eruption or discharge,
worse at night, or while at rest, and when there is but
little fever.
Nitric Acid is often very successful both in the acute and
chronic variety of the disease. Its chief indications are,
severe drawing and lacerating pains over the whole body; or
chiefly affecting the joints, bones, and the upper and lower
extremities. The joints are weak, very sensitive, and feel as
if bruised, especially after exertion. The pains are increased
by cold or damp air; and there are trembling and numb
sensations in the limbs.
Sulphur.-Either before the above remedies, or after them,
to complete the cure and prevent obstinate sequelhe; also as
an intercurrent remedy. It is especially useful in rheumatism
from hereditary taint, and when it follows repelled eruptions;
also when the pains are drawing and tearing, worse when
cold, and better when warm.
ACCESSORY MEANs.-During the fever the patient should
remain in bed, and the diet be mainly restricted to water,
milk-and-water, barley-water, gruel, and       arrow-root, at
least at first; afterwards     beef-tea, mutton-broth, etc.
lydropathic treatment in the early stages of the disease is
highly beneficial. Warm    baths, hot-air baths, or hot compresses, are both useful and comforting.      Spongio-piline,



ACUTE RHEUMATISM.


461


made into gloves or caps for the hands, feet, elbows, or
knees, or shaped to cover any large surface, is an excellent
substance for conveying moisture to the parts. The spongy
surface should be moistened with the fluid, and every few
hours re-moistened.   Wet-packings, repeated as often as the
fever returns, enveloping the joints which are most implicated, or even the whole body, with several folds of wet linen,
are most useful adjuncts. Except, however, when the skin
is hot and dry, cold applications are contra-indicated. They
might, indeed, subdue local inflammation in the knee or
elbow; but from the migratory character of the disorder,
great risk would be incurred of repelling the poison into the
circulating fluid, to settle possibly upon the heart or other
internal part. But no danger of this character belongs to
warm fomentations, or to hot compresses, which often afford
great relief to the patient.
Blankets in R/ieumatism.-An invaluable adjunct to the
measures already suggested is that of enveloping the patient
in blankets and flannel. "Bedding in blankets reduces by
a good three-fourths the risk of inflammation of the heart
run by patients in rheumatic fever, diminishes the intensity
of the inflammation when it does occur, and diminishes still
further the danger of death by that or any other lesion; and
at the same time it does not protract the convalescence
(Chambers).
2.-Chronic Rheumatism.
This is sometimes a sequel of the acute form of rheumatism; at other times it is a separate constitutional affection,
coming on quite independently of any previous attack. It
is generally very obstinate and prone to recur. In time, the
affected limbs lose their power of motion, and lameness
results, the knee-joint being often affected; sometimes there
is emaciation of the muscles; sometimes permanent contrac



CHRONIC RHEUMATISM.


- 463


remedies selected should be used, and adds that in his
practice they have been most successful. The chief remedies
are-Bry., Rhus, Led., Caust., Dulc., Hep. Sulph., Lye.,
Phos., Silic., Rhus Rad., Sulph.
Rhlus Tox.-In general, this is the most useful remedy in
chronic rheumatism, especially if worse in bed and at rest.
Bryonia.-Rarely useful except during febrile exacerbations.
Pulsatilla.-When it shifts, is better in cool air, and if
there is acidity and disorder of the stomach.
Ledum.-A valuable remedy when the painful parts are
constantly cold. It should be used in a high dilution.
Sulpkur is always necessary in long-standing cases. Like
the last, in a high dilution.
Arnica.-Rheumatism    affecting a part which has been
sprained or bruised.
Causticum.--When the joints are stiff and the fingers
contracted.
ACCESSORY MEANS.-Patients who are much afflicted with
this complaint, and who are in a position to do so, should
reside in a warm, dry climate. At any rate such patients
should wear flannel and other warm clothing, and protect
themselves against atmospheric changes.  Shoes and boots
should have soles sufficiently thick to protect the feet from
cold and damp. Wet compresses over the joints specially
attacked are always useful.  Sometimes warm   baths, especially of salt water, or vapour, or hot-air, will be found
very serviceable.  To these means may be added friction
with Liniments, especially when medicated with Arnica,
RAus Tox., or whatever remedy is taken internally.  One
more point necessary to refer to is the diet, which should be
easy of digestion, as attacks are often occasioned by disorder
of the digestive organs.



GOUT.


465


and accompanied with uric acid in the blood, and the deposit
of urate of soda in the affected tissues.
SYMPTOMS.-An acute attack of gout is often preceded by
an excessive debauch, or by over-fatigue, impairing the digestive powers, its onset commonly commencing an hour or
two after midnight, when indigestion from a supper or late
dinner arises at its acme. Ordinarily a patient retires to
rest in his accustomed health, but awakes early in the
morning with severe pain, chiefly in the metatarso-phalangeal
joint of the great toe, which on examination is found red,
hot, swollen, and so exquisitely tender that the mere weight
of the bed-clothes is intolerable, and the vibration of a
heavy footfall in his room causes great discomfort. The
veins proceeding from the toe become turgid with blood, and
surrounded with more or less cedema. On the first accession
of the pain there is generally cold shivering, which gradually
subsides as the pain increases, and is followed by symptomatic fever. The patient is perpetually shifting his foot
from place to place, and from posture to posture, change of
place giving no relief. At length, if suitable precautions
are taken, and the foot kept in a horizontal posture, the
pains subside in the early part of the day; but at evening
an exacerbation takes place which persists during most of
the night, and subsides again towards morning, when he
falls asleep in a gentle perspiration.  Sometimes the pains
remit so suddenly that the patient attributes the relief to
his having at last found an easy posture. The same series
of symptoms recur, in a less severe form, for some days and
nights, varying considerably in different cases, and greatly
influenced by the treatment adopted; and then the attack
passes off, not to return for one, two, or after a first attack,
perhaps for three years. After the lapse of years, however,
the intervals between the attacks are liable to diminish until
the patient can scarcely ever calculate upon being free. The



466


GENERAL DISEASES.


joints of the fingers and toes become enlarged and disorganized by deposit within and without the synovial cavity of
a white saline matter, commonly called " chalk stones," but
really urate of soda.
It is not uncommon, even in a first attack of goit, for
both great toes to be implicated, mostly alternately, the
inflammation rapidly subsiding in one joint to appear in the
other, but sometimes simultaneously. In many instances,
after the first attacks, other joints, the instep, ankle, the
heel, or the knee are affected at the same time; in rarer
cases, some joints of the upper extremities.
SYMPTOMS PRECEDING AN ATTACK.-Flatulence, heartburn,
acidity, and other symptoms of indigestion are often present,
and the bowels are either relaxed or confined. In some
patients the function of breathing is implicated, or the
liver deranged; in others the nervous system is implicated,
or there may be palpitation, alteration of the urinary secretion, or a crampy condition of the muscles. Such symptoms are no doubt consequent on the altered state of thp
blood which always exists prior to the development of a
regular fit of gout. Should any organ or function be implicated to a very marked degree, it is then termed irregular
gout.
CHALK-STONE DEPOSITs.-The original condition of these
deposits is that of a liquid, rendered more or less milky or
opalescent from the presence of acicular crystals; as the
fluid part is absorbed, the consistence becomes creamy, and
at last a solid concretion is produced. When the effusion is
confined to the cartilages, unless very excessive, the injury to
the mobility of the joint is comparatively slight; but when
the ligaments are infiltrated, they are made rigid, and the
play of the parts is consequently seriously interfered with.
If a bursa has been infiltrated, the resulting chalk-stone is
free and of uniform composition, but the distortion is con



GOUT.


467


siderable. The visible occurrence of chalk-stones is not
constant, but when external deposits do occur in any patient,
no possible dbubt can exist as to the nature of the case, for,
as the deposition of urate of soda in the tissues occurs only in
gout, its presence constitutes a pathognomonic sign (Garrod).
CAUSES.-Gout may be hereditary, or it may be acquired.
The experience of physicians largely engaged in treating the
disease, proves that more than half the gouty patients can
trace the disease to hereditary influence; and if the wealthy
portion of the community were only considered, the proportion would be much greater. Large-built men, of a full
and luxurious mode of life, particularly if addicted to indulgence in wine and malt liquor, and too much animal food,
combined with too little exercise, are very liable to the
disease, whether a predisposition has been transmitted or
not.  That wine and malt liquor have a greater tendency to
the production of gout than distilled spirits is proved by its
prevalence in those countries or cities in which these beverages are largely consumed, and its absence where distilled
spirits are almost exclusively made use of. Thus gout is
more frequent in London, where porter and beer are largely
partaken of, than in Edinburgh, where the favourite beverage
is whiskey. Gout is very common amongst brewers' men;
also amongst ballast men employed on the Thames, who
often  drink   from  two to three gallons of porter daily.*
Port-wine has a marked reputation, and probably justly,
"* "Observant men are now inclined to discard the doctrine which teaches
the noble origin of gout, and its necessary association with high mental
development. The disease is now certainly common and plebian, as well as
aristocratic. It may have been, in the days of Sydenham, that the gouty
patients of a physician were to be found amongst ' magni reges, dynastce
exercituum, classiumque duces, philosophi, aliique his similes.' Now-a-days
it is no less certain that the physician, in London at least, must pay his visits
and prescribe for gout amongst 'the London labour,' as well as among 'the
London poor.' And his list will number 'coal-heavers, bakers, brewers, draymen, house-painters, butchers, innkeepers, publicans, butlers, coachmen, and
porters in wealthy families especially'" (Aitken).



468


GENERAL DISEASES.


for causing gout and sherry is by no means so harmless a beverage as many suppose. It is chiefly a disease
of the male sex, although occasionally women of a robust
and plethoric habit suffer with it, after the cessation of the
catamenial function. That luxurious living and an inactive
life are at least exciting causes of gout seems evident from
the exemption of working people in rural districts from the
disease. Even when the disease does occur in poor people
it is chiefly in persons who have previously lived fully and
inactively, such as the servants of wealthy families-butlers,
coachmen, etc.,-men who often live more luxuriously and
idly than their masters.
On the other hand, unless the gouty diathesis be very
strong, its actual manifestation may be averted. Let the
son of a rich gouty nobleman take the place of a farm servant, and earn his temperate meal by daily toil, and very
likely he will wholly escape a visitation of the malady.
Probably the operation of this cause explains how it is that
gout leaps over one generation, while the predisposition
descends through those who have never actually had the
disease.
The influence of lead in the production of gout Dr. Garrod
believes to be considerable; he has observed that a large
per centage of the gouty patients that come under his care
in hospital practice consisted of painters, plumbers, or other
workers in lead, forcing him to the conclusion that the influence of this form of metallic impregnation in inducing gout
is considerable.
Among the exciting causes of gout may be mentioned
indigestion, especially that form of it which favours the production of an excessive amount of acidity in the system,
causing a less alkaline state of the blood, and so tending to
the insolubility and deposition of the urate of soda in the
tissues. During an attack of gout, uric acid is said to be



470


GENERAL DISEASES.


CLASSIFIED CASES OF GOUT.1. Inflammatory attacks.-Acon., Colch., Bry., Arn, Puls.,
Nux V., Led. Pal., Rhus.
2.  With gastric symptoms.-Ant. Crud., Puls., Bry., Cocc.,
Merc.
3.  Confined to the great toe.-Led. Pal.
4. Retrocedent (moving     about).-Colch., Puls., Carb.
Veg., Ars., Sulph.
5.  Chronic.-Nit. Ac., Am., Lye., lod., Coni., Zinc., Sil.,
Sulph.
6.  Obstinate cases.-Aur., Graph., Mag. Carb.
7. Gouty concretions.- Mez., Calc. Carb., Ant. Crud.,
Phos., Ferr., Sep., Staph.
Aconitum.--Generally at the commencement of an attack,
and whenever febrile symptoms are prominent. It is generally suited to stout persons.
Arnica.- Soreness, or pains as if the parts were sprained,
bruised, or dislocated.
Arsenicum.-Tearing and burning pains, worse at night
and in the cold, but relieved by warmth; anguish and restlessness; a small, quick pulse; palpitation, with swelling
and stiffness of the joints.
Bryonia.-This is often a valuable remedy, and is chiefly
indicated when bitter taste, yellow-coated tongue, eructations,
confined bowels, and other symptoms of indigestion precede
an attack. The affected part is red, swollen, and pits on
pressure, and the pains are stinging, burning, and aggravated by movement and contact. The patient complains of
coldness and shivering, alternating with febrile flushes of
heat, and is often very irritable.
Nux Vomica.-Accession or aggravation of the symptoms
towards morning, especially in patients of sedentary habits,
hasty temper, and fond of the pleasures of the table, an
attack often following indulgence in wine, or hearty, indi



GOUT.


471


gestible suppers or late dinners; confined bowels, spasms,
piles, etc., are additional indications.
Pulsatilla.- Wandering pains, especially when those dyspeptic symptoms and characteristics exist, for which this
remedy is suited.
Antimonium  Crud.-Gastric derangements, white-coated
tongue, nausea, and increase of the pains after eating; gouty
nodes.
Rihus Tox.-Stiffness and pain in the joints, chiefly felt
on first moving the joint after rest, or on waking in the
morning.   It is indicated in low (typhoid) inflammatory
conditions, Acon. being required when the symptoms are
acutely inflammatory.
Administration.-In acute attacks, a dose may be administered every one to three hours; in chronic, twice or thrice
daily.
For further symptoms and other remedies, consult the
article on " Rheumatism," as remedies possessing a curative
action in that disease will be found useful in gout.
ACCESSORY MEASURES.-In acute attacks, the patient should
be restricted to farinaceous diet-arrowroot, tapioca, sago,
bread, etc., and milk; water, or toast-and-water, ad libitum.
As the febrile symptoms decline, a more generous diet may
be gradually allowed; at the same time, the patient should
resume daily moderate out-of-door exercise as early as he is
able. Flannels wrung out of hot water, hot bread-and-water
poultices, or spongio-piline, after immersion in hot water,
often do good. The general treatment should be the same
as pointed out under " Inflammatory Fever," pages 55-6.
PREVENTIVE TREATMENT.-To prevent subsequent attacks
of gout, or to diminish their frequency or severity, the following suggestions should be acted upon, and will often
prove efficient.
1st. A vell-chosen diet. This should include both animal



472


GENERAL DISEASES.


and vegetable food, of such quality and in such quantities
that the stomach can easily digest, and that will, at the same
time, furnish materials sufficient to nourish the patient, and
out of which pure blood can be formed. White'fish, soles,
whiting, and codfish; mutton, tender beef, fowl, and game
may be partaken of with advantage. Salmon, veal, pork,
cheese, and highly-seasoned dishes, are unsuitable.     The
consumption of animal food should be moderate, and the
tendency to acidity of the stomach guarded against by
avoiding pastry, greasy or twice-cooked meat, raw vegetables,
" made dishes," highly-spiced food, and anything likely to
lead the patient to eat more than is strictly moderate. The
wines most likely to injure are port, sherry, and madeira.
If wine is taken at all, probably good claret, free from sugar,
and without acidity, is best. If gout attacks a patient early,
entire abstinence from all alcoholic beverages is one of the
most likely measures for checking the future progress of the
malady. Aged persons, however, and others whose health
has been much enfeebled, may be allowed a small quantity
of stimulants, such as the particular circumstances of each
case seem to justify. For " although a plan can be sketched
out which may apply to the majority of cases of gout, still
each case not only exhibits its own peculiarities, and becomes
a separate study, but likewise demands,,in certain respects,
a separate treatment " (Garrod).
2nd. Healthy action of the skin.-This should be promoted
by bathing, warm clothing, Baden towels, bath brushes, etc.,
for much excrementitious matter is got rid of in this manner.
Friction over the whole surface of the body is extremely
useful when exercise cannot be taken. The patient should
be well rubbed with a flesh-brush, or with the hands, twice
a day.
3rd. Good habits.-A     life of indolence should be exchanged   for one of activity and     usefulness.  Exercise



NEURALGIA.


473


should be regularly taken, but not of a severe or exhausting
nature. Walking exercise, so as to secure an abundance of
fresh air, must ever be considered the best, but it may be
conjoined, if agreeable, with riding on horseback. Without
sufficient walking or horseback exercise, probably every other
measure will be unavailing. Early and regular hours should
be adopted; and too severe or prolonged mental application
avoided.   In some cases, removal during the winter and
spring to a warm and dry climate may ward off subsequent
attacks.*
6.-Neuralgia-Tic Douloureux.,
DEFINITION.-Violent pain in the trunk or branches of a
nerve, which recurs in paroxysms, at regular or irregular
intervals, and is probably due to some morbid condition of
the nerves of sensation.
VARIETIES.-When the branches of the fifth pair of nerves
are the seat of neuralgia, it is recognised under the name, tic
douloureux (neuralgia facia); when its location is in the
nerves of the stomach, gastrodinia; when certain nerves
about the head, hemicrania or brow-ague; when the cardiac
nerves, angina pectoris; when the sciatic nerves, sciatica,
etc. Of all the varieties of this affection, the one described
as tic douloureux, or trifacial neuralgia, is the most frequent.
SYMPTOMS.-Darting or shooting pain in the course of a
nerve, of different degrees of intensity, at times almost
unendurable; the severe form generally comes on suddenly,
and is of a sharp, darting, or tearing character, coursing
along the trunk or ramifications of the affected nerve.
Sometimes there is spasm in the muscles that are supplied
by the nerve thus affected; in others, heat and redness of
* For the fuller consideration of this disease, the reader is referred to
Sir Thomas Watson's Lectures, Dr. Aitken's Science and Practice of Medicine,
and Dr. Garrod's article in Reynolds' System of Medicine, to which the author
is much indebted.
2H



474


GENERAL DISEASES.


the surface, with augmented secretion from the neighbouring
organs, as a flow of saliva or tears when the nerves of the
jaw or eyes are implicated; at other times the parts in immediate connection with the diseased nerve are' unaffected.
The duration of neuralgia is very uncertain; an attack may
pass off after a few paroxysms, or it may persist for many
days or months, with a well-marked, or irregular, intermittent, or remittent character.
CAUSES.-The causes of neuralgia are very various, and
may be local or constitutional.  1. Local causes are those
which act upon the nerve that is the seat of pain. Thus,
neuralgia may be produced by wounds and other injuries;
by tumours, especially cancer; by spicula of bone pressing
on the nerve (a frequent cause of facial neuralgia); carious
teeth or stumps; or by some disease of the brain or spinal
cord at its origin.  2. Constitutional causes are, loss of blood
and consequent debility; a gouty, rheumatic, or syphilitic
taint; wet and cold; irritation of the skin from eruptions or
wounds; carious teeth; diseases of the alimentary or urinary
organs; lastly, malaria, when, like other diseases arising
fiom that cause, it is generally intermittent.  But all intermittent neuralgia is not necessarily caused by malaria; for
this, as well as other nervous affections, may occur only at
stated periods, although caused by a local source of irritation
that is permanent (Dduitt).
Defecti;e healtA is a frequent cause of neuralgia.  Every
observant medical man knows, that unless the result of
mechanical pressure, or other local cause, neuralgia seldom
occurs in strong and healthy persons, impairment of the
general health standing in the relation of cause to this
disease. Depressing iiyzluences, whether mental or physical,
exposure to atmospheric vicissitudes, exhausting disease,
anemia, etc., often lead to severe neuralgic affections. The
great majority of patients are found among the hard-working,
the poor, and the badly-nourished classes.



476


GENERAL DISEASES.


are aggravated by the slightest movement or touch, and at
night or during repose, and are relieved by the application
of heat.
The judicious employment of this potent mineral is often
attended with the most marked success in neuralgic affections. The homoeopathic law, indeed, leads us to expect
that it would be so, for immoderate doses of arsenic are a
cause of neuralgia. Persons who have attempted to poison
themselves with that mineral are said to suffer often excruciating pains along the course of the nerves of the limbs.
Colocynthis.-Severe paroxysms of rending or darting
pains, chiefly on the left side of the face, or certain parts
of the left side of the body; the lancinations are sudden,
violent, and extend from the point of origin to a distance,
especially to the ears, temples, nose, teeth, and all parts of
the head. It is more particularly indicated in neuralgia from
cold, vexation, anger, etc.
Belladonna.-The appearance strongly contrasts with that
described under Arsenicum, the habit being full or plethoric,
with red or swollen cheeks; and there are spasms or startings
in different parts of the body; headache aggravated by
noise, light, or movement; acute throbbing pains in the
forehead; pains darting from the side of the face to the
teeth and ears; lancinating pains in the thigh, or in the leg,
extending to the sole of the foot; neuralgic pains in the
back and shoulders. The patient is irritable, with a tendency
to delirium; firm pressure affords relief, but slight touches
increase the pains.
S/p,,elia.-Violent neuralgic pains, of a jerking, tearing,
or burning nature, on one side of the face, chiefly the
right, increased by touch or movement of the affected part,
with anguish and general agitation.
Bryonia.-Drawing and lacerating pains, particularly in
patients of a rheumatic diathesis; aggravation of the symp



NEURALGIA.


477


toms by moving the affected parts; irascible and passionate
disposition, with a tendency to chilliness, etc.
Staphysagria.-Neuralgia originating in a carious tooth,
and thence radiating over the whole jaw.
Nux Vomica.-Drawing, tearing pains, affecting the whole
head; toothache affecting various teeth, the pains extending
to the face and temples; gastrodynia with violent cramp-like
pain in the stomach; cramps in the hands, limbs, and feet;
languor and indisposition to mental and physical exertion.
It is chiefly suited to neuralgia in persons addicted to
intoxicating beverages, or who lead a sedentary life, or are
exercised in too much mental labour. It is generally more
suited to males than to females; in the case of the latter,
and in persons of a mild or timid disposition, Pulsatilla is
often more appropriate.
Aconitum.-Congestion to the head, chest, or heart; throbbing pain so severe as almost to drive the patient to despair.
It is especially indicated if the heart seems to be implicated,
and may be followed or alternated with Spigelia.
EXTERNAL APPLICATIONS.-When the pain is excessively
severe, and does not yield promptly to internal remedies, the
writer has sometimes employed, with immediate good results,
an Aconite lotion, prepared by adding about a dozen drops of
the strong tincture of Aconitum to four tablespoonsful of
water. It may be applied hot or cold, as is most agreeable
to the patient, by means of two or three folds of linen
squeezed out of the lotion.
Administration.-To be successful in the treatment of this
disease a variety of attenuations may have to be used to suit
particular cases. The doses may be repeated every thirty to
sixty minutes for several times, lengthening the intervals as
the pain diminishes.
AccEssoRY MEA.NS.-These must include, if possible, the
removal of the cause of the disease, for so long as that exists



478


GENERAL DISEASES.


we cannot expect more than a temporary palliation of the
symptoms. If the consequence of debility, salt-water bathing,
the cold-douche, or sponging, followed by friction, or the manipulations of a clever shampooer, with moderate and regular
out-of-door exercise, will be of essential service. Warm baths,
or holding the head over steam, during a paroxysm of facial
neuralgia, often afford instant relief.  The diet should be
plain and nourishing, and the meals taken at regular hours.
The clothing should be warm, and includefannel. Neuralgia
is often associated with dyspepsia, and any derangement of
the digestive functions may occasion an attack. Exposure
to damp or cold, sudden change of temperature or clothing
are most unfavourable. A change of air, and sometimes
entire change of habit, are necessary to ensure a cure. It
need scarcely be added, that the attempt to cure neuralgia
by division of the afected nerve is both an unscientific and
useless proceeding.
7.-Old Age and Senile Decay.
A BRIEF reference to the changes and dissolution of that
beautiful and wondrous structure-man's material framewill form an appropriate conclusion to this portion of our
work.
The decay of nature is gradual, and does not affect all the
structures of the body equally at the same period; it also
begins in some at a comparatively early period, and in others
not until a considerably advanced stage of life. As illustrations of the changes attendant upon old age, and which
exercise an important influence in accelerating that final one
which is the common lot of humanity, we may note the
following:I. THE BoNES.-As old age advances, these undergo very
characteristic changes. In infancy and childhood the animal
element predominates; hence we can explain why the bones



480


GENERAL DISEASES.


less efficient to propel the blood to the extremities. The
blood failing to complete its circuit, the hands and feet
become cold as the blood leaves them, the decline of temperature gradually extending to the central organs of the
body. This reduced power of the heart, with the disposition
to atheromatous deposits in the coats of the blood-vessels,
referred to in the next paragraph, with subsequent ossification of the valves of the heart, is one of the most common
changes attendant upon old age, and also the most fatal.
These changes as they proceed are generally hidden and
painless. The first indication    of such degeneration of
structure may be, but is not necessarily, the proclamation
of immediately disastrous results.
IV. THE BLOOD-VESSELS.-In the silent progress of
years the arterial system is liable to undergo changes
which are subversive in the highest degree to the performance of its essential functions. The arteries gradually
become converted into ossific or bony patches of greater
or less extent, and often so considerable as to lead to
changes of a vital character by destroying the elasticity
of the arterial tubes, and deranging the circulation of the
blood in the parts to which they conduct. Thus the nutrition of the body is impaired, and the functions of the
nervous and muscular systems are only imperfectly performed. Further, the ossific patches in the coats of the
arteries may become causes of aneurism, gangrene, rupture
of blood-vessels, apoplexy, etc., forms of disease to which the
aged are very liable. Apoplexy, due to this cause, is one of
the most frequent causes of death in old age. The cerebral
arteries become diseased, and as the blood is driven into
them they give way. Even thin persons, whose blood-vessels
and heart are diseased, die from apoplexy.
V. THE VERTEBRZE.-The changes in the spinal column
are very considerable; they not only alter the external form,



OLD AGE AND SENILE DECAY.


481


but often derange the functions of the great organs of the
body. The three graceful curves in the spine, so exquisitely
arranged, both to give space and protection to the internal
viscera, and for the transmission of the weight of the head
and trunk in the line of gravity, become more or less
obliterated in advanced life, and the centre of gravity disturbed. The vertebral column also loses its elasticity; the
disc of cartilage placed between each vertebra, to break the
force of shocks and prevent jarring of the brain, partly
disappears or ossifies; the mobility of the spine is likewise
diminished, and thus a false step or a trifling accident may
be converted into an occurrence of grave importance. The
alteration in the curves of the spine produced by the above
causes, gives that change to the external form which is so
characteristic of old age. Corresponding with these changes
in the spine, as affecting the external form, are others which
affect the bones generally. Owing to the diminished, size of
the muscles, and the absorption of fat from beneath the
skin, points of bone in various parts become more angular
and prominent, and the limbs lose that graceful and rotund
form which was the pride of earlier years.
VI. THE EYES, ETc.-The special senses, as those of
sight and hearing, frequently, and sometimes at a comparatively early period, give evidence of approaching decay.
The arcus senilus, a circumferential opacity of the cornea,
resulting from fatty degeneration, and generally associated
with a like degeneration of the heart, is, as its name implies,
an affection incident to the aged.  Cataract, opacity of the
crystalline lens, or its capsule, or both, seems to be the
consequence of impaired nutrition, and is met with in
elderly persons only, except as the result of inflammation or
injury. But the most frequent cause of impaired or perverted vision is alteration in the form of the lenticular
bodies of the eye-the cornea and the lens-which, losing



482


GENERAL DISEASES.


their natural convexity, interfere with the correct impression
on the retina at the proper fixed point of the object of vision.
Defective hearing is another not infrequent attendant upon
old age, and may result from various causes, the most frequent being impairment of the acoustic nerve.
GRADUAL DECAY.-The varied forms of man's decay are
gradual and progressive. Death may take place suddenly
from heart disease; but it was only its termination, not the
disease, that was sudden.  For years before the fatal issue
the organ had been undergoing degeneration of structure,
until at last it ceased to beat. Death from aptoplfexy is
sudden; but it hardly need be stated, that long before the
blood-vessel gave way in the brain a process of decay had
been going on which led to the result.   Ruptture of an
anearism, or other similar immediate causes of death, are
but terminations of structural changes which had probably
been in progress for years.  Death under such circumstances
has been compared to the fall of some towering cliffs, which
crush everything beneath. The catastrophe is terrible, and
occurs unexpectedly; but it was the slow disintegration
during many preceding winters' frosts that hurled it down the
steep.  Sudden death is a misnomer in language, except as
it takes place from accident or poison.
In alluding to the decay of nature, we may add that we
refer to that which is not " to be measured by number of
years."  It is well known that some persons at fifty, or even
earlier, are in this respect older and more shattered in constitution than others who have attained to the age of seventy
or upwards. Probably as the result of improved sanitary
measures, a more correct and general recognition of the laws
of health, and of the rapid spread of homceopathy, the
attainment of a vigorous old age without the premature
feebleness and decay hitherto so generally observed, will be
of much more frequent occurrence.



OLD AGE AND SENILE DECAY.


483


TREATMENT OF THE AGED.-There are many ailments
peculiar to the approach of old age which require special
medical treatment, or the application of particular measures,
which we cannot enlarge upon here, but in which the timely
use of appropriate remedies, and the prompt employment of
judicious means, are often rewarded in seeing the flickering
flame rekindled, and valuable life considerably prolonged.
On two or three points only can we make general observations.
1. FooD.-Food should be of a much less solid form than
during the vigour of adult life. Just as nature provides
fluid food during infancy before the teeth appear, so the loss
of teeth, a common attendant upon old age, necessitates a
return to a form of food which does not require mastication.
Inattention to this point is, we believe, one of the most
fruitful causes of the impaired digestion, weakness, and
sufferings of the aged. The stomach cannot deal with food
except in a state of minute division; hence we find the
introduction of imperfectly-masticated food leads to serious
derangements of the alimentary canal, and general defective
nutrition. In some instances the skill of the dentist furnishes the aged with the means of mastication. Frequently,
however, artificial teeth cannot be tolerated, and the only
path of safety lies in the adoption of an almost exclusive
fluid diet. We may be permitted to add, we have met with
many cases in which our advice on this point has been
carried out with the most beneficial results.
2. REST.-This is essential to the health and safety of the
fragile frame of the aged. The sports and exercises of
youth, or the exertions of maturer age, would fracture the
bones, rupture the tendinous portions of the muscles, or
occasion a blood-vessel to give way. To the aged, longcontinued exercise, and too little or broken rest, are highly
unfavourable, the reparative processes being only slowly



484


GENERAL DISEASES.


performed. Happily the activities and athletic exercises of
youth become distasteful, and the burdens of mid-day life are
transferred to the succeeding generation, and he now seeks
and enjoys a condition of quiet and repose necessary to the
well-being of his fragile structures.
3. WARMTH.-In the winter season, when sudden changes
of temperature are frequent, provision should be made for
preventing the ingress of the cold night-air, and for maintaining a suitable temperature in the bed-room throughout
the whole night. The temperature of the sleeping apartment should be kept at 600 to 62~, and measured by a
thermometer, as the sensations of persons are not a sufficient
guide. A thermometer should therefore be kept in every
house, and suspended out of a current of air, and beyond
the direct influence of the fire, so that the facts which it
registers may be accurately observed and attentively studied.
It no doubt often happens that the lonely encounter with
death takes place in the stillness of the night-season, from a
sudden access of cold air, which the extreme feebleness of
old age could not resist or endure. Very cold weather
seriously affects the aged, and it is a fact that excites
frequent observation, that soon after the setting in of intense
cold the obituaries of persons in advanced life become
unusually numerous in the public papers. "'An aged man,
with a sluggish heart, goes to bed in a temperature, say of
500 to 550; in his sleep, were it quite uninfluenced from
without, his heart and his breathing would naturally decline.
Gradually, as the night advances, the low wave of heat steals
over the sleeper, and the air he was breathing at 550 falls
and falls to 400, or it may be 350 or 300.      What may
naturally follow less than a deeper sleep? Is it not natural
that the sleep so profound shall stop the labouring heart?
Certainly. The great narcotic never travels without fastening
on some victims in this wise, removing them, imperceptibly



OLD AGE AND SENILE DECAY.


485


to themselves, into absolute rest, inertia, until life recommences out of death" (Richardson).
With a regulated temperature in his apartment, heat-producing kinds of food, such as an enlightened physician would
suggest, warm clothing, and other kindred measures, should
be adopted in the treatment of the aged.
4. MEDICINES.-On this point we can offer no definite
suggestions. The selection of remedies must be determined
strictly according to the symptoms of the disease the patient
may be suffering from, modified by any idiosyncrasy of
constitution that may have been noticed.
Thus the physical frame decays and man passes away,
death terminating the journey of life and the traveller
welcoming the long repose as he had often welcomed sleep
after the fatigues of the day. We have reason to believe that
the phenomenon of dying is as painless as that of falling
asleep.  Thus persons who have been resuscitated after
drowning, and after all sensation had been lost, have
asserted that they experienced no pain. What is often
spoken of as the agony of death is probably purely automatic,
and therefore unfelt. The idea embodied by the poet in the
following lines is literally true"Passing through nature to eternity,
The sense of death is most in apprehension."
There is thus beneficence in man's decline just as in his
growth and maturity, and there is also design. The Christian
philosopher not only submits with resignation to the decay
of his material form, but rejoices in the assured hope that so
perfect a structure, teeming with evidences of beneficent
design, and so highly endowed, has not been constructed
merely to rise, flourish, and then to disappear without a
future grand result, commensurate with so costly an expenditure of wisdom and goodness. INFINITE WISDOM, which



486               GENERAL DISEASES.
designed and called forth man into being, would, it seems,
forbid that such a creation should be comparatively vain,
leaving only a dark blank as the memorial of its existence.
We, therefore, infer that the dissolution of our earthly form
is really but a mysterious transitional process, through which
the good pass from an introductory and transient state of
existence to one that is immortal.



490


MATERIA MEDICA.


specific relation  to the part affected" (Dugeon).     Had
Hahnemann's labours extended no further than the discovery
and demonstration of the wide and inclusive curative power
of this great remedy, it would have entitled him to the
gratitude of countless myriads of his fellow-creatures in every
succeeding generation. He most appropriately ranks it as
first and foremost in his Materia Medica, not because its
name begins with the first letter of the alphabet, but because
of its transcendant power and extended sphere of action: he
terms it a "' precious plant," whose " efficacy almost amounts
to a miracle." Let the sceptic in homoeopathic therapeutics
test its power in acutefevers in accordance with the directions
of this manual, and he will witness a curative action such as
is unknown in allopathic practice.
PROMINENT USES.-As a therapeutic agent, in the hands
of a homceopathic practitioner, Aconitum is one of the first
importance. "This medicine," says Hempel, "constitutes
the back-bone, as it were, of our Materia Medica;" there
being scarcely an acute disease in which it is not more or
less required.   Its physiological effect is depressing, the
pulse diminishing in strength and frequency; respiration
also becomes laboured and slow under its prolonged use;
hence it is important to discontinue its administration when
its action becomes marked. But although it may be often
greatly abused, it is probably more frequeitly indicated than
any other single remedy, especially at the commencement,
and often during the course, of all feverish and inflammatory
affections, marked by pain; a rapid strong pulse; dry heat
of the skin; chills down the back, and general.chilliness,
followed by burning heats; restlessness; scanty and highcoloured urine; constipation, with aggravation of the symp-'
toms towards night. Its reactionary effect tends to moderate
and equalise the circulation, and to remove local congestion,
especially when affecting mucous surfaces, and hence it has
been considered the true specific in all congestive and in



ACONITUM NAPELLUS.               491
flammatory diseases of the abdominal viscera, such as
hepatitis, enteritis, dysentery, etc. Hemorrhage from internal or external surfaces, especially of an arterial character,
with full, bounding pulse, and other inflammatory symptoms.
SKIN.--Dry, hot, and harsh condition of the skin; pricking
sensation as from needles; yellow colour; itching and burning of the skin, as in erysipelas, prurigo eczema, hives, etc.
In eruptive diseases, as nettle-rash, measles, scarlet-fever, and
smallpox, it both moderates the fever and aids in the full
development of the rash. Aconitum is well indicated in the
dry, burning heat of children, or red rash on the skin, with
thirst, short breathing, and tendency to start during sleep.
The occurrence of perspiration on the skin after the use of
this remedy marks its favourable action, and is the token
for its discontinuance.
MORAL GRouP.-Delirium preceding or attending acute
inflammatory disease; mental derangements, especially of
recent origin, and if occasioned by a fright, and marked by
unsteadiness and vacillating ideas-; anxious, complaining
mood; inconsolable anguish and despair; fearful forebodings;
tendency to start; sense of terror, with an appearance of
imbecility.
HEAD.-Vertigo, particularly on raising or moving the
head; fulness, heaviness, and piercing throbbing pain in the
forehead or temples; aggravation of the pains by movement,
drinking, or on rising from a recumbent posture; congestion
to the head; heat and redness of the face; bilious, congestive,
and apoplectic headaches; numb, swollen, or creeping sensation as from ants, in the scalp.
EYES, EARS, AND NOSE.-Acute ophthalmia, with intense
shooting pains in the eyes; heat, redness, swelling, and
dread of light; sparks, black spots, or mist, before the eyes;
sudden attacks of blindness; dilated pupils; sees as through
gauze.  EARS.-Tingling and roaring in the ears; otitis;
extreme sensitiveness of hearing, or intolerance of noise;



492


MATERIA MEDICA.


tingling; humming. NOSE.-Pressive feeling at the root of
the nose; bleeding of the nose; fluent coryza; sneezing.
RESPIRATORY  GROUP.-Accelerated, anxious breathing;
bronchitis, during the inflammatory stage; cough, with
expectoration, thin and frothy, or streaked with blood;
hooping-cough, with febrile symptoms; pneumonia; pleurisy.
HEART.-Inflammatory affections of the heart, and of the
general circulatory apparatus; palpitation, especially in plethoric or sensitive persons; palpitation of a nervous origin,
or as occurring during a paroxysm of hysteria; spasms of
the heart, with great anguish or suffocative sensation, and
accompanied with heat in the face; fainting fits; rheumatism
of the heart; acute disease, or structural change in that organ.
DIGESTIVE ORGANS.-Teeth.-Rheumatic and congestive
tooth- and face-ache, especially from exposure to cold and
draughts of air; throbbing, pressing pains in the teeth or
side of the face; fever attending dentition. Jaws.-Idiopathic, or traumatic trism.us; numbness, shooting or jerking
sensations in the jaws.  Tongue, throat, etc.-Dryness and
swelling of the tongue; white or yellow-furred tongue;
paralysis of the organs of speech; nauseous taste; loss of
appetite; soreness and dry heat in the throat; swollen, elongated uvula; rising of sweetish or acid water in the mouth.
Stomach, etc.-Heartburn; bilious nausea; vomiting of blood
with feverish symptoms (in alternation with Arnica if from
a strain or blow); bilious colic; inflammation of the stomach,
bowels, or peritoneum; constipation, with fever; profusely
bleeding piles; bilious diarrhoea; diarrhoea during teething,
the little patient's cheeks being flushed, with other febrile
symptoms; summer complaint of children (cholera infantvum);
inflammation of the liver; jaundice.
URINARY   GROUP.-Retention or suppression of urine;
painful urging to urinate; high-coloured urine, with or
without brickdust sediment; burning and tenesmus of the
neck of the bladder; inflammation of the kidneys.



ANTIMONITUM CRUDUMTI.


493


2.-Antimonium      Crudum (Crude or Common Antimony).
GEOGRAPHY, HISTORY, ETC.-This mineral exists in great
abundance in nature, more particularly in Hungary, Germany, France, England; also on the island of Borneo, from
which large quantities of the crude ore are imported as
ballast.
The drug was known in the remotest antiquity, and probably to the alchymists, and few have excited so much
notice in the medical world, it being regarded as a panacea
for nearly every disease. After lauding its virtues in many
diseases, the allopathists have at length suffered it to fall
into almost total disuse, except as a chief ingredient in
Plummer's Pill.
In consequence of the native sulphuret being generally
found combined with small quantities of lead, copper, iron,
and arsenic, it requires great care and skill in its preparation.
It is insoluble in water, but easily reduced to powder, which
is of a blackish colour, except when very pure, when it has
a reddish hue. We use the crystalline tersulphuret, either
artificial or native, preferring the latter, and prepare it for
use by trituration.
PROMINENT UsES.-The action of antimony seems to be
more generally expended upon the mucous membrane both
of the stomach and alimentary canal, and is chiefly indicated
by nausea, eructations, flatulence, alternate diarrhoea and
constipation, etc., especially after overloading the stomach,
and in old people. Sensitiveness to cold; arthritic pains in
the fingers; gout with gastric derangements; rheumatic
inflammations; numbness or pain in the legs; cough and
oppression at the chest; spasms in the windpipe, etc.
SKIN.-Red pimples; chronic vesicular or pustular eruption, like chicken-pox; pustules on the scalp or beard;
blotches or unhealthy-looking boils on the nose (grog



496


MATERIA MEDICA.


flushes of heat; marked uneasiness; heat, thirst, copious
sweats; quick, feeble, irregular, tremulous pulse; strong
inclination to sleep.
HEAD, ETc.-Headache, especially over the eyes, with
dizziness and stupefaction; drawing or digging sensation at
the root of the nose; sneezing and fluent coryza; deficient
taste and smell; the first stage of influenza.
RESPIRATORY GROUP.-Rattling of mucus, with short, difficult breathing; dry, hard, barking, or suffocative cough; a
sensation of deficiency of air, compelling the erect posture,
and relieved by coughing and expectoration; pneumonia;
palpitation of the heart, with great oppression at the chest.
DIGESTIVE  ORGANS.-Nausea, vomiting     and diarrhoea;
vomiting preceded by a distressing feeling of nausea, anguish,
yawning, watering of the eyes, and severe pressure at the
stomach; vomiting followed by a drowsy and weary feeling;
loathing; desire for cooling things; pale sunken face; dimness and swimming of the eyes; severe colic and flatulent
distension of the stomach.
4.-Arnica Montana (Leopard's Bane).
GEOGRAPHY, ETC.-This plant is indigenous to the mountainous plains of a great part of continental Europe, also to
America and Siberia; but it flourishes particularly in Switzerland. Its medicinal properties are more especially concentrated in the flowers and roots. The strong alcoholic
tincture is of a brownish, yellowish-green colour, yielding a
strong characteristic odour, which predominates over that of
the alcohol, and whbn properly made, scarcely becomes turbid
by admixture with water. The uses of Arnica as an external
application are stated in the chapter on the " External
Remedies." In many cases, it is desirable to employ this
remedy both internally and externally at the same time.
PROMINENT UsEs.-Affections immediate or remote, local



ARNICA MONTANA.


497


or general, resulting from injuries from falls or blows; such
as a torpid condition of the nerves from a fall, or a blow on
the head, or in any other way producing concussion of the
brain. It aids the reparative process resulting from bruises,
sprains, sores of bed-ridden patients, excessive physical
fatigue, etc. It is also useful in stitching pains in the chest,
rheumatic and gouty affections, bruise-like pains in the
small of the back, varices, loss of blood, etc. It is chiefly
adapted to plethoric persons, disposed to cerebral congestion,
and acts but feebly in those of soft flesh or debilitated
constitutions.
SKIN.-Chilblains, swollen, hot, or tingling; pricking
sensations in any part of the body; small boils; soreness of
the nipple.
HEAD, ETC.-Headache resulting from violence applied to
the head, or of a rheumatic nature, with dizziness; headache
better when lying down, and worse on sitting up; burning
in the head when the body is cool; bleeding from the nose;
red, hot swelling of the cheek; inflammation of the eyes
from injuries or dust; bruised pain, or the escape of blood
from "boxing the ears," or other injuries; convulsive and
spasmodic affections; lock-jaw; active discharges of blood;
vomiting and spitting of blood, and other complaints resulting from  bruises, falls, and similar injuries; severe
concussions, such as often occur in railway accidents, without
leaving external marks of violence; concussion of the brain.
RESPIRATORY GROUP.-Short, panting, difficult breathing;
stitching pains, with aching and bruised feeling in the
chest; false pleurisy; short, hacking, tickling cough; expectoration coloured with blood after cough, or from severe
exertion, as in rowing, running, or singing.
DIGESTIVE GROUP.-Putrid odour from the mouth; foul,
bitter taste early in the morning; heartburn, retching,
vomiting of blood; constipation after an injury.



498


MATERIA MEDICA.


URINARY ORGANS, ETC.-Discharge of bloody urine after a
blow or fall on the bottom of the back or lower part -of the
abdomen; paralysis of the neck of the bladder from injury
to the spine; immediate treatment after childbirth.
5.-Arsenicum     Album (Arsenious Acid, White Arsenic).
COMPOSITION, ETC.-Arsenious acid is the teroxide of the
metal arsenicum, and is usually obtained in Saxony and
Bohemia by roasting or smelting cobalt ores, in which arsenic
is a considerable ingredient. During the roasting the arsenic
rises in vapour, takes the oxygen from the air, and so forms
this acid, which condenses in the chimneys. It is a white
solid, looking like porcelain or white marble, but is really of
a crystalline substance, as may be seen when the powder is
placed under a microscope. It is very sparingly soluble in
water, although boiling water will dissolve much more than
cold. In shops it is generally kept in the form of powder;
and so is easily adulterated with chalk, carbonate of lead,
etc. On this account it is better to sublime the acid for
medicinal purposes, as by this process extraneous substances
can be removed. Taken into the mouth it has no immediate
decided taste, but it soon occasions an acrid sensation.
PHYSIOLOGICAL ACTION.-Its injudicious or prolonged use
occasions a general sinking of the vital powers, with derangement of the digestive and nervous systems, a small, quick,
and often irregular pulse, sleeplessness, and swelling of the
face and extremities. Mr. Hunt states the effects of medicinal doses to be-1, irritation of the conjunctiva; 2, swelling
of the face; 3, desquamation of the skin, only observable
under a magnifying glass; 4, portions of the skin, protected
from light, assume a dirty-brown appearance. Sir Thomas
Watson mentions a peculiar silvery whiteness of the tongue
as one of the symptoms. Poisonous doses produce violent



AURUM METALLICUM.


501


stomach; diarrhoetic stools, with frequent foetid discharges;
tenesmus and burning at the anus; great weakness and
constant coldness; dropsy of the abdomen; ascarides; piles,
with burning and itching; paralysis of the bladder; difficulty
of urinating. Asiatic cholera in the last stage, with cold
breath, etc.
MENSTRUATION.-Premature, pale, profuse, menstrual discharge, lasting too long; amenorrhoea, with acrid, excoriating
leucorrhcea.
6.-Aurum     Metallicum (Aurum Foliatum, Metallic Gold).
HISTORY, ETC.-This metal is found extensively in South
America, California, and New Holland.     The Greeks are
supposed by some, by others the Arabs, to have been the
first to have used it medicinally. The alchymists diligently
investigated its properties, with the view of discovering the
elixir of life and the universal remedy. By some it was
formerly supposed that gold had no curative properties, on
the ground that it was not soluble in the gastric fluid. By
the peculiar process of trituration, first adopted by Hahnemann, and now generally practised in our school, gold and
any other substance can be made perfectly soluble by first
destroying the cohesion of its constituent particles. Recently
the opinions of allopathic medical men have been considerably
modified as to the complete inertia of gold. Our preparations
are made from the finest gold-beater's leaf by the ordinary
mode of trituration.
PROMINENT UsEs.-Hysteric, hypochondriacal, syphilitic,
and mercurial complaints; nightly bone pains; inflammation
and ulceration of the bones; excessive sensitiveness of the
body; palpitation; susceptibility to pain, etc.
MIND.-Hypochondria, sullenness, peevishness, tremulous
agitation, irascibility, religious mania, loathing of life, with



502


MATERIA MEDICA.


suicidal tendency, oppressive anxiety. Our provings of gold
show that it causes melancholy and great depression of spirits.
HEAD, ETC.-Rush of blood to the head: headache, aggravated by reading or reflection; muscce volitantes; pain in the
bones of the head; hysteric hemicrania; mercurial or syphilitic headache, with severe pain in the bones. Ozoena, with
caries of the nasal and palatine bones; congestive toothache,
with rush of blood to the head; foetid breath; chronic
catarrh, with purulent discharge from the nose.
SKIN.-Warts, tetters, ulcers, nodes.
HEART.-Palpitation, with rush of blood to the chest;
suffocative paroxysms; faintness, with blueness of the face.
SEXUAL GRour. -Induration of the prostate gland; swelling and induration of the testes; chronic orchitis, with
aching pain; nocturnal erections and emissions; prolapsus
and induration of the uterus; hysteria, with profuse menstruation.
7.-Belladonna (Atropa Belladonna, Deadly Nightshade).
NATURAL HISTORY, ETc.-This is an indigenous plant, also
of common growth throughout Europe and most temperate
latitudes, flourishing upon a dry soil and the slopes of hills.
It has a fleshy, creeping root, and herbaceous stem, bearing
a beautiful, sweet, but highly poisonous berry, of a violetblack colour, which, when bruised, emits a foetid, nauseating.
odour. The plant is readily known by the livid appearance
of its flowers, and the character of its leaves, which are
ovate-acute, quite entire, and always come off in pairs, of
which one is much larger than the other. It flowers in June
and July, and its berries are ripe in September. The leaves
of the wild plant are considered more valuable than those of
the cultivated. "The leaves of Dulcamara are sometimes
sold by herbalists for those of Belladonna, and consequently
may be sometimes employed medicinally by those who look



504


MATERIA MEDICA.


up with lard oz. 3.  Its medicinal properties are anodyne
and anti-spasmodic. Its power of dilating the pupil calls
it into frequent requisition by the ophthalmic surgeon.
PROMINENT UsEs.-Scarlatina and its sequelae; inflammatory affections of a violent character, in which the minute
blood-vessels (capillaries) are almost ruptured by the force
of the blood. It has a special and powerful action upon the
brain and its membranes; the mucous lining of the throat
is also remarkably sensitive to its action. Its chief characteristics are stinging or burning pains, aggravated by movement; swelling and shining redness of the affected parts;
delirium; pain of a nervous character; trembling of the
limbs; spasms; convulsions; paralysis; anguish about the
heart. It is especially adapted to persons whose brain is in
a state of great functional activity. The extent of the action
of this remedy upon the brain has been well pointed out by
Test, who considers that the deleterious action of Belladonna
is exactly proportionate, in every species as in every individual,
to the degree of development and functional activity of the
organ upn which the poison exercises its specific action, namely,
the brain. This explains to us (1) why, of all animals, man
is most accessible to the action of Belladonna. (2) Why,
among men in a state of health, or to whose diseases (by a
legitimate application of the law of similitude) it corresponds
most exactly, those are most powerfully affected by Belladonna whose cerebral faculties are most liable to become
irritated, or whose brains have the greatest development;
these are, of course, children. In proof of this, Hufeland
states that idiots are protected from the deleterious action of
Belladonna, which they eat with almost the same degree of
impunity as animals of an inferior order, by the inertia and
incomplete development of their cerebral organ.
TEMPERAMENT, ETC.-Belladonna is generally most adapted
to affections of amiable persons, inclined to become fat, of



BELLADONNA.


505


light hair, blue eyes, and delicate, easily-inflamed skin. It
is thus specially adapted to women and children.
SKIN.-Scarlet redness and scarlet spots on the face,
neck, chest, and abdomen; diffused redness and burning
swelling of the affected parts; non-vesicular erysipelas;
rheumatic inflammations, red, hot, and swollen; chilblains,
boils, and painful glandular swellings.
SLEEP.-Drowsiness, or great sleeplessness and restlessness; frequent waking; starting in sleep, or when on the
point of falling asleep, as in affright; screaming, moaning,
or terrifying dreams; unrefreshed sleep; headache when
rising.                                      "
MENTAL GROUP.-Nightly delirium or paroxysmal insanity
with changeableness, being merry and foolish at one time,
melancholy and sad at another, with screaming and violent
rage at another; absence of mind; immoderate laughter;
foolish manners; nervous anxiety in the region of the heart.
HEAD.-Giddiness; violent aching in the forehead, aggravated by movement and stooping; congestive, rheumatic,
and nervous headaches, with symptoms of cerebral engorgement; excessive pulsative and throbbing headache; great
heat and redness of the face; sensation as if the brain were
too large and pressing outwards; inflammation of the brain,
apoplexy, vertigo; epileptic convulsions; hysteria.
EYEs.-Extreme sensitiveness or dread of light; inflammatory redness and burning pain in the eyes; ophthalmia;
amaurosis, complete or partial; perverted or double vision;
musce volitantes; flashes of light; staring or glistening
eyes, dilated pupils.
EARs AND NosE.-Tingling and roaring noise in the ears;
deafness, especially if resulting from the suppression of the
eruption of scarlatina or measles; lacerating pain in the
ears; otalgia, with paroxysms of sharp crampy pain in the
inner ear; noises as of rushing wind, loud reports, etc., in
2 K



506


MATERIA MEDICA.


the ears; otorrhcea; swelling of the glands near the ears;
bleeding at the nose.
MOUTH AND THRoAT.-Rheumatic toothache; throbbing
pains from hollow teeth, extending to the temples with redness and tenderness of the gums, drawing in the ear, beating
in the head, or red, hot face; the teeth feel elongated;
eating and hot drinks aggravate the pains; rheumatic lockjaw; inflammation of the mouth and tongue; tremor of the
tongue; sore throat, with pain, swelling, and difficulty of
swallowing; rawness of the throat; bright-red appearance
of the tonsils and uvula; quinsy; diphtheria; stammering;
weakness of the organs of speech; paralysis of the tongue;
spasmodic constriction of the throat; aversion to all kinds
of liquids, as in hydrophobia.
RESPIRATORY GROUP.-Violent, dry cough, worse at night,
excited by a tickling sensation in the throat, with headache
and redness of the face; painfulness of the larynx when
coughing; spasmodic hooping-cough; hoarseness; aphonia;
laboured and difficult breathing; spasms of the chest.
HEART.-Tremor, anguish, and palpitation; cramp-like
pressure in the region of the heart.
DIGESTIVE GRouP.-Violent pain in the stomach, aggravated by pressure; griping, clawing pains about the navel;
peritonitis; distended bowels; diarrhoetic evacuations with
straining.
URINARY AND SEXUAL GROUP.-Involuntary passage of
urine from paralysis of the neck of the bladder; wetting
the bed; inflammation of the kidneys and bladder; affections
of the womb, involving the head and nervous system;
tumefaction of the breasts; childbed fever; toothache,
spasms, and colic of pregnant women.
BELLADONNA AS A PROPHYLACTIC.-Its power of preventing
attacks of epidemic scarlatina, as well as of curing that
disease, is one of the most striking applications of the



BELLADONNA.


507


principle of similitude, and was first announced by Hahnemann; Hufeland confirmed the statement of Hahnemann,
and it has since been abundantly established by facts. The
following passage is by an eminent allopathic authority:"Belladonna, as a preventive against Scarlet Fever, was first proposed by
Hahnemann in 1807. Bayle, in 1830, published notices of 2,027 persons
who took this medicine during an epidemic, and of those 1,948 escaped.
Dusterberg, in order to test more decidedly its preventive powers, purposely omitted administering Belladonna to one child in every family;
and he states that in almost every case this child alone was seized with
the disease. Dr. Zeuch, physician to the Military Hospital for Children
in the Tyrol, after 84 children had been attacked by the fever, administered Belladonna to the remaining 61. With a single exception, they
were all preserved from its attacks, although the fever was raging around.
Mr. Stievenart, who quotes the above, adduces his own experience in its
favour. Amongst other evidence, he cites the village of Curgies, where
he administered Belladonna to the children of a public school, and allowed them to have communication with other children of the village,
amongst whom the disease was rife. All who took the Belladonna
escaped, but the few who refused to take it were attacked by the fever.
In England it has been tested by Newbigging, who states that he succeeded in arresting the progress of the disease by Belladonna, in a public
institution, after seclusion had completely failed. Similar testimony is
adduced by Schenk, Kbhler, Etmiiller, Meglin, De Lens, and Hufeland;
whilst Lehman, Hoffmann, Windt, Dr. Sigmond, and others, express their
disbelief in its prophylactic power. The weight of testimony is decidedly
in favour of its preventive action " (Waring).
DIFFERENCE BETWEEN BELLADONNA AND ACONITUM.
Belladonna resembles the action of Aconitum in some
respects, but it differs from   it in the following important
particulars:-(1l.) It produces much more intense congestion;
the inflammations occasioned by it attain a higher form and
are marked by symptoms of a much more dangerous character-delirium, coma, convulsions.      (2.) Aconitum is adapted
to simple inflammatory fevers, or to the feverish reaction of
the arterial system generally; Belladonna to fevers with



508


MATERIA MEDICA.


symptoms. more or less strongly indicating inflammatory
action of the brain. (3.) Belladonna has a special affinity
for inflammations affecting delicate organs or tissues, such
as the eye, the ear, the testicle, and to sensitive individuals
of a highly refined organism.
ANTIDOTAL TREATMENT.-In the event of poisoning by
Bellaconna, an endeavour should first be made to remove
the poison from the stomach; twenty to thirty grains of the
sulphate of zinc form a suitable emetic; after vomiting, a
cup of strong black coffee is useful to aid in restoring the
irritability of the muscular fibre, and arrest the tetanic
convulsions.
8.-Bryonia Alba (TWhite Bryony).
HISTORY, ETc.-There are many varieties of Bryony, but
the one proved by Hahnemann, and used by Homoeopathic
practitioners, is the Bryonia alba, indigenous in the north of
Europe, Germany, and some parts of France; and not the.Bryonia dicecia, common in the hedges and thickets of this
country. This latter variety, Black Bryonia, is chiefly used
as an external application in bruises. Professed pugilists
employ it in the form of a poultice, scraping the root, after
removing the bark, very finely, and mixing it with breadcrumbs to a proper consistence, and placing it over the
ecchymosis, renewing it every six or eight hours. It is said
to remove all discoloration in from one to two days. Although the two kinds have many points of analogy, the
Bryonia alba is much to be preferred for homceopathic purposes, especially for internal use. The part of the plant we
employ is the large, fleshy, white root, from which the juice
is expressed, or from which, scraped down, we make a deep
yellow and very bitter tincture. The root of Bryonia alba
differs from the dioecia, being more thickly covered with
tubercles, and more branched, and is an acrid poison.



BRYONIA ALBA.


509


PROMINENT USES.-Although Bryonia occupies a foremost
rank in our materia medica, it probably does so, not so much
from the multiplicity of diseases in which it is curative, as
from the frequent and general occurrence of those diseases,
the chief of which are the following:-Rheumatic and gouty
affections; gastric and nervous disorders; torpidity of the
liver and bowels, the digestive organs being especially under
its control; complaints in which the serous membranes are
involved; and when effusions and exudations have taken
place, as in pleurisy, dropsy, etc.
TEMPERAMENT, ETC.-Bryonia is especially efficacious in
persons of an irritable disposition, and to patients suffering
from hypochondriasis and gloomy depression of spirits; also
to affections brought on by exposure to cold, dry weather,
and piercing wind, and when the symptoms are intensified
by movement or pressure.
SKIN.-Suppression of inflammatory rashes, as in scarlatina,
and measles; erysipelas affecting the joints; yellow-colour
of the skin, jaundice; burning and itching; rashes and
pimples; rash of parturient women, and their infants;
nettle-rash.
FEVER.- Chilliness is the predominant symptom for the
use of Bryonia; intermittent fever; typhoid, gastric, bilious,
and rheumatic fevers, and in those preceding smallpox,
measles, etc.; the fever is generally attended with a dry
cough and stitches in the chest.
HEAD.--Headache with heaviness, nausea, and compressive
pain; giddiness; headache, aggravated by stooping, or any
movement, as opening or shutting the eyes; rheumatic
headache.
FACE, NOSE.-Red and bloated, pale or clay-coloured
cheeks; dry, chapped, or swollen lips; dryness and obstruction of the nose; bleeding of the nose; darting pain in the
head and forehead.



510


MATERIA MEDICA.


RESPIRATORY GROUP.-Violent cough, with expectoration
or hawking up of mucus, sometimes streaked with blood;
painful cough, as if the head and chest would fly to pieces;
acute and chronic bronchitis; asthma; pneumonia; difficult
breathing; stitching pains in the side, which impede the
breathing when lying on the back, and are increased by
every movement; rheumatic afections of the muscles of the
chest; catching of the breath on moving, coughing, or taking a
deep breath.
BACK, ETC.-Painful stiffness and tension in the nape of
the neck on moving the head; braised feeling in the small
of the back; lumbago; limping or cutting pains in the hips;
rheumatic swelling of the joints; gouty swelling of the
feet; chilblains.
DIGESTIVE GROUP.-Dryness of the mouth and throat;
white or yellow-coated tongue; sickly, putrid, or bitter taste;
sour or bitter risings; eructations; vomiting of food, bile,
or mucus; sensation of pressure in the stomach, with great
intolerance of pressure; inflammation of the liver and
stomach; pain in the right side (liver); colic with diarrhoea;
dropsy of the abdomen; inaction of the bowels from sedentary habits; constipation with spasms; red, hot, and scanty
urine; paralytic affections of the bladder from gastric, rheumatic or nervous disorders.
9.-Calcarea Carbonica (Carbonate of Lime).
NATURAL HISTORY, ETc.- Calcarea Carbonica is found
abundantly in nature in the form of chalk, marble, eggshells, oyster-shells, etc. The insolubility of the salts of
lime formed an obstacle to their general use by allopathic
medical men; notwithstanding this they use it occasionally
for its antacid and astringent properties. For homoeopathic
purposes we employ oyster-shells, from which, after washing,



CALCAREA CARBONICA.


511


boiling, exposing to a charcoal fire, sifting, and reducing to
a powder, we first make triturations.
PROMINENT USES.-Diseases of the osseous system; chronic
scrofulous affections; difficult dentition; swelling of the
abdomen from enlargement of the mesenteric glands;
marasmus; glandular enlargements of the neck; chronic
affections of the skin. It is especially useful in many diseases
of infants and young children.
SKIN.-Chronic urticaria; chronic rash and eczema; rough,
readily ulcerating skin; goitre; warts; sweating feet; polypus; fistula; ulcers; ganglia; chronic eruptions on the
face or behind the ears.
HEAD.-Itching eruptions on the scalp and face; dizziness or heaviness in the head; stupifying headache, as if it
would burst; tinea capitis, and falling off of the hair; scurfy
eruptions, and glandular swellings.
EYES, EARS, ETC.-Scrofulous ophthalmia, with swelling
and redness of the eyes; agglutination of the lids; profuse
lachrymation in the open air; specks on the cornea; photophobia; amaurosis. Hardness of hearing, with buzzing in
the ears; roaring, ringing, and hammering noises in the
ears; scrofulous otorrhoea; moist eruptions behind the ears;
polypus in the ear, Scrofulous redness, swelling, and painfulness of the nose; loss of smell; ozoena; stoppage of the
nose, or discharge of pus; foetid odour from the nose; polypus.
TEETH.-Difficult first dentition, with heat, swelling, and
sensitiveness of the gums; fistula dentalis; toothache during
pregnancy, with rush of blood to the head, from cold, aggravated at night, and by taking food.
RESPIRATORY GROUP.-Tuberculous condition of the lungs;
cough, particularly at night, with yellow, green, foetid expectoration, or haemoptysis; feeling of roughness of the
larynx, and oppression or sensitiveness of the chest; difficulty
of breathing.



CANTHARIS.


517


especially the form known as enuresis nocturna of children;
strangury, or discharge of drops of blood; painful gonorrhoea;
also some forms of satyriasis, nymp/omania, sterility, spermatorrhea, etc.  Although, however, sometimes employed
as a stimulant in impotence, it is of doubtful efficacy.
CEREBRAL GROUP.-Convulsions, with distortion of the
limbs and inability to swallow; convulsions, with frightful
noises from looking at water, as in hydrophobia; tetanic
convulsions, epilepsy, chorea, rage.
SKIN.-Erysipelatous inflammation, with burning and
exudation of serum, causing blisters. A weak solution of it
applied locally in the case of burns and scalds, if used
promptly, will generally prevent blisters, and aid the speedy
cure, especially if the air be kept from the injured surface.
It is highly serviceable in falling off of the hair, chilblains,
frost-bites, obstinate ulcers on the legs with painful margins,
gangrenous sores, etc.
CAUTIoN.-An iniquitous administration of this drug is
sometimes resorted to under the impression that it excites
the sexual propensities, and health has often been injured
and even life destroyed by such a procedure.
ANTIDOTES.-The treatment for poisonous doses consists
in the administration of copious diluents, emetics, and afterwards the strong spirits of Camphor.
13.-Carbo Vegetabilis (Wood Charcoal).
PREPARATION, ETc.-Vegetable charcoal is obtained by
burning wood in covered-up heaps or in close vessels, with
but a limited access of air. For medicinal purposes, the
pollard beech of mountainous countries is selected, from the
slow combustion of which a black, tasteless, and insoluble
substance is obtained, rema-rkable for its power of counteracting putrefaction, and for combining with, and removing
the odorous and colouring principles of most bodies. From



518


MATERIA MEDICA.


this wood, pulverized, we prepare our triturations, by which
the latent, inherent medicinal properties of the crude substance are fully developed, so that it becomes a therapeutic
agent of great value.
DISINFECTANT.-The action of charcoal is both disinfectant
and antiseptic. The great fire of London, which banished
the plague, is supposed to have done so, at least in part, by
the disinfecting qualities contained in the vapours arising
from the smouldering wood. Taken internally, it is absorbed
into the system, it prevents putrefactive changes, and removes fcetor of the breath. It has of late been largely used
in the form  of charcoal biscuits. As a tooth-powder, it is
much employed, and is supposed to prevent, or check, caries
of the teeth.
POULTICE.-"' Externally, mixed with linseed meal, it
forms an excellent poultice in gangrenous and foul ulcers.
Ofc. prep. Cataplasma Carbonis. Charcoal poultice. Wood
charcoal in powder, oz. ss.; bread, oz. ij.; linseed meal,
oz. iss.; boiling water, fl oz. x. Half the charcoal to be
mixed in the poultice, the remainder to be sprinkled on the
surface" (Waring).
PROMINENT UsEs.-Cachectic conditions, as weakness, consequent on acute disease, or following the excessive loss of
animal fluids; intermittent fever; typhus putridus; collapse of pulse in the last stage of typhoid fever; offensive
ulcers with feetid secretions; rheumatic or bruised sensation
in the limbs and joints; tendency to perspire; liability to
catarrhal and rheumatic affections from atmospheric vicissitudes; bad consequences from the abuse of mercury or
quinine; gangrena senilis. Between this remedy and Arsenicum and China, there are many striking points of
resemblance.
SKIN.-Chronic nettle-rash; chilblains; excessively itching
eruption; unhealthy, burning, fcetid ulcers; obstinate herpes;
sweats, with putrid smell.



CHAMOMILLA VULGARIS.


519


HEAD.-Beating or pulsatory headache; heaviness of the
head; congestion; falling off of the hair; paleness of the
face; swollen and chapped lips; eruptions on the face;
bleeding of the nose.
RESPIRATORY GRouP.-Cough after slight exposure; cough
with retching and profuse expectoration of mucus; spasmodic
cough; sensitiveness to variations of the weather; chronic
hoarseness; aphonia; roughness and scraping in the throat;
laryngeal phthisis; neglected pneumonia, with foetid expectoration, or threatened gangrene of the lungs.
MOUTH.-Spongy and easily bleeding gums; rawness and
soreness of the throat; toothache with ulceration.
DIGESTIVE ORGANS.-Oppression of the stomach after
eating; flatulent distension of the stomach and bowels;
burning and contractive pains in the stomach; belching of
wind, with rumbling pain and emission of fcetid flatulence;
constipation of the lower bowel; diarrhoea, with a burning
sensation in the rectum; bloody evacuations; piles; worms.
14.-Chamomilla Vulgaris (Common Chamomile).
NATURAL HISTORY, ETC.-This plant is indigenous to most
parts of Europe, and flourishes in corn-fields, waste grounds,
and by the roadside, especially on chalky soils. The name
of the flower is derived from the Greek word Chama (low),
and from Mllatrix (womb), for its supposed specific action on
that organ. For homoeopathic purposes we use the whole
plant, gathered when in bloom, the extract from which is
prepared as a tincture.
PROMINENT USEs.-Biliozus and gastric affections, especially
of children, and offemales of a nervous temperament, during
pregnancy and the puerperal state; colic and diarrhcea of
infants; affections produced by fits of anger; affections of
the uterine system; neuralgic affections, the pains being
of a dragging, tearing, and lancinating character; rash and



520


MATERIA MEDICA.


excoriation of infants.  Chamomilla is often successful in
the febrile attacks of children which do not yield to Aconitum.
MORAL GROUP.-Peevish, quarrelsome, irritable mood;
great restlessness; consequences of anger, jealousy, or vexation; crying of infants, without any apparent cause.
HEAD.-Bilious, nervous, hysteric, or catarrhal headache,
with an irritable mood; darting, tearing, throbbing headache;
heat and redness of one cheek, with paleness and coldness of
the other; sympathetic convulsions of children during teething, or from anger, or pain in the bowels; irritable condition
and excessive sensitiveness of the nervous system.
TEETH.-Throbbing and jerking toothache, with a feeling
as if the teeth were too long; toothache at night, especially
in the warmth of bed, and aggravated by warm drinks, or a
warm room, and sometimes attended with swelling of the
cheeks; difficult dentition, with one of the cheeks red and
hot, the gums swollen and sensitive, the child being very
irritable, and convulsions indicated.
RESPIRATORY GRoUP.-Catarrhal cough, with hoarseness,
wheezing, and rattling of mucus; paroxysmal cough, excited
by tickling in the air-passages, rendering breathing difficult.
DIGESTIVE ORGANS.-Sour or bitter taste; acidity of the
stomach; painful spasms; flatulent colic; diarrhoea of children from cold or during teething, when the discharges are
greenish, watery, slimy, and very ofensive, and preceded by
cutting pains; diarrhoetic discharges of undigested food.
SEXUAL.-Colic before the monthly period; profuse discharge, with dark coagula, and attended with labour-like
pains, or retching and vomiting; excitability during pregnancy, and darting pains at the time the menses would
otherwise have appeared; milk fever brought on by a fit of
passion.



CHINA.


521


15.-China (Cinchona Oficinalis, Peruvian Bark).
NATURAL HISTORY.-The cinchonas are natives of Peru
and the adjacent provinces of South America; but attempts
are now being made to cultivate the more valuable species in
India, Ceylon, Java, Jamaica, etc. Cinchona trees are of
great beauty, with evergreen laurel-like leaves, which diffuse
a delicious fragrance around. None of the cinchonas are
found at an elevation less than 2,500 feet above the sea, and
some extend as far up as 9,000 or to nearly 12,000 feet. In
consequence of the great demand for their bark, they seldom
attain their full growth. Cinchona bark is collected by men
called Cascarilleros, who, trained to the occupation from
their early youth, are exposed    to great privations and
dangers, proceeding in quest of bark-trees over high mountain passes to regions far beyond the habitations of men.
If less exciting, the life of the cascarillero is not less perilous
than that of the chamois-hunter of the Alps; and the
scenes amidst which it is spent are more varied and at least
as grand and awful.
Sometimes the cascarillero wanders in the forest, and
some subsequent traveller finds his bones and his bundle of
bark where, hungry and exhausted, he renounced all hope,
and laid himself down to die.
In homceopathic pharmacy, an alcoholic tincture is prepared from  the yellow Peruvian bark, which has a bitter
taste, and a beautiful deep-red colour.
MEDICAL PROPERTIES.-According to an eminent allopathic
authority, cinchona, in small doses, improves the appetite
and general tone of the muscular and circulating systems.
It checks colliquative sweating in cases of extreme debility.
Its action on the nervous system is shown by its extraordinary
power in arresting diseases of a periodic character. In the
treatment of intermittent fevers, it may either be given in a
2L



522


MATERIA MEDICA.


large dose just before the recurrence of the paroxysm, or in
smaller repeated doses during the intervals (Waring). The
latter course is generally recommended. The efficacy of the
infusion or decoction, according to the same authority, is
greatly increased by the addition of a few drops of dilute
sulphuric acid.
PROMINENT UsEs.-China is of special service in restoring
the vigour of the system after it has been enfeebled by
intermittent and other miasmaticfevers, long-continued diarrhcea, Ahemorrhages, prolonged nursing, the use of purgatives
or mercury, mental exertions, broken rest at night, or sexual
excesses. Debility, disposition to sweat, especially exhausting night-sweats, aneemia, dropsical swelling, etc., are
indications for its employment.
SKIN.-Yellow colour; jaundice; paleness of the countenance; yellow tinge of the eyes.
FEVER GROUP.-Intermittent fevers; chilliness soon followed by acute fever, with hot and dry skin, and afterwards
by profuse perspiration. Acute fevers with copious sweats, of
a periodic type; hectic and putrid fevers; excessive nightsweats; perspiration from slight exertions.
HEAD, ETC.-Intermittent headache, with dizziness, dimness of sight, or singing and roaring in the ears; nervous
or rheumatic faceache; neuralgia, excited or aggravated by
the slightest touch.
DIGESTIVE GROUP.-Sour or bitter taste; loss of appetite;
languor and drowsiness after eating; indigestion; flatulent
distension of the abdomen; vomiting; heartburn; pinching
or cutting colic; enlargement of the liver and spleen; jaundice; diarrhcea, with watery, slimy, yellowish, and very
offensive motions; discharges of undigested food; discharge
of thread worms; involuntary stool and urine from excessive
debility.
MiENSES.-Profuse menstruation; obstinate leucorrhbea.



CINA ANTHELMINTICA.


523


SEXUAL.-Excessive secretions of the seminal fluid, when
arising from sexual vices; debilitating emissions, with undue
excitement of the sexual instinct; spermatorrhoea,* especially
if associated with weakness, hypochondria, and dyspepsia.
16.-Cina Anthelmintica (Worm-seed of Judea).
PREPARATION, ETC.-This plant is a hardy perennial shrub
of Asia Minor, Barbary, etc. For homoeopathic purposes we
employ the seed, from       which we obtain a yellowish-green
tincture, or from which we make a trituration, the latter
process being probably more likely to develop the medicinal
virtues of the plant.
PROMINENT USEs.-Affections arising from, or coincident
with, the presence     of worms in      the intestinal canal, and
indicated by some of the following symptoms: paleness of
the face; picking at the nose; grinding of the teeth;
voracious appetite, alternating with poor appetite; emaciation; itching at the seat; diarrhoetic motions; discharge of
worms; wetting the bed; acute hydrocephalus; cutting pain
"* SPERMATOaRRHEA.-After the major portion of this manual had been
printed off, the author received a request from a correspondent to include in it
a section on spermatorrhxa (seminal weakness), on the ground that the disease
is much overlooked by practitioners of both schools, and that much mentil
and physical suffering, as also charlatanism and imposture, might thus be prevented. There is much truth in this. The evils are far more wide-spread and
deeper than persons who only look at the surface of society have any conception
of. The habit (self-abuse) which leads to the disease is often acquired very
early, from perhaps somewhat older associates, and its practice is continued
under the excitement occasioned by "sensationals," impure conversation,
newspaper reports of Divorce Court trials, etc., and often without the patient
being aware of the consequences of the vicious habit. The chief of these evils
are,-mental depression, often extreme; nervous irritability and excitability;
more or lesss obtuseness of the senses, as of hearing, or loss of memory; an
aged appearance; various forms of indigestion, flatulence, constipation, giddiness, headache, etc.; in extreme cases, impotence, epilepsy, or even insanity.
Happily, a course of judicious homceopathic treatment is sufficient, in nearly
every case, to effect a cure. Some of the remedies required are pointed out in
this ma.teria medica, under appropriate side-headings, -Phos., China, Fer.,
Phos. Ac., etc. But the treatment involves many points of detail as to the
remeldies and general measures to be adopted which cannot be referred to in
this foot-note. A conscientious homceopathic physician should be consulted.



524


MATERIA MEDICA.


in the abdomen; irritation of the genitals; hooping-cough;
hoarse, hollow cough, especially in tuberculous children, or
those affected with worms; also other diseases arising from
inverminous affections.
17.-Cocculus Indicus (Indian Berries).
HISTORY, PROPERTIES, ETC.-This is the fruit of a parasitic
shrub, growing on the mountainous parts of the coast of
Malabar, on the island of Ceylon, and the Indian Archipelago.   Although poisonous, it is nevertheless used in
considerable quantities for imparting an intoxicating property
to malt liquors. By two writers "On brewing" (Childe and
Maurice), it is openly recommended. From its intoxicating
properties it is used for entrapping game and fish; animals,
however, so caught should not be used as food. Externally
it is used in powder or ointment in scabies, ringworm, porrigo, and for destroying vermin. For homoeopathic purposes
we employ the seeds, from which a tincture of a brownish
straw-colour is prepared.
PROMINENT USES.-Disorders implicating the brain, the
stomach, and the spinal marrow. From numerous experiments, Dr. Glover concludes that it acts primarily on the
spinal cord; that under its use the animal temperature is
much increased; that the iris is contractile to a severe
extent, and that it is a powerful acro-narcotic poison, but
less powerful than Aconitum. In all animals killed by it he
observed congestion of the base of the brain.
HEAD.-Feeling as if a ligature were tightly drawn around
the head; vertigo, as if from intoxication; dizziness, with
nausea; sensation as if the head were empty; paralysis.
HEART.-Fainting fits of hysteric females; palpitation of
the heart, of a nervous character.
DIGESTIVE GROUP.-Inclination to vomit, with griping or
sore feeling at the pit of the stomach, accompanied by head



COFFJEA.


525


ache or dizziness; spasmodic, flatulent colic; distended
abdomen; constipation, with hard or difficult evacuations;
sea-sickness, and nausea from riding in a carriage.
GENITO-URINARY ORGANS.-Nervous difficulties accompanying menstruation; premature or delayed, pale, watery
menses, with cramps in the abdomen; menstrual colic;
leucorrzcea; uterine hysteria, with excitability of the sexual
organs; frequent desire to urinate, with copious emission of
watery urine.
3MENTAL.-Depression of spirits; irascibility; hysteria
with an irritable disposition.
18.-Coffbea (Coffea Arabica).
HISTORY, USES, ETC.-This is the product of an evergreen
shrub, about sixteen feet in height, and is extensively cultivated in the East and West Indies, and other countries, for
purposes of commerce; the variety used medicinally is indigenous to the elevated regions of Arabia Felix. The fruit
resembles a cherry, and when ripe is shaken from the tree
and dried by the sun on mats. We obtain an alcoholic
tincture from the seeds of the best Arabian coffee.
PROPERTIES AND ACTION.-It is remarkable for containing
cafreine, the peculiar principle of coffee, which Liebig shows
to be indentical with theine, the peculiar principle of tea.
"Caffeine, or a strong solution containing it, produces in
man restlessness, palpitations, and other nervous symptoms.
It also appears to check the metamorphoses of the animal
body, as shown by the diminished formation of urea, which
takes place under its use. Hence it has been proposed to
administer strong coffee in various febrile diseases in which
there is excessive metamorphosis of the tissues" (Waring).
PROMINENT USES.-Sleeplessness of infants; morbid sensitiveness and irritation of the nervous system, following
unexpected or excessive joy, especially in persons of a



526


MATERIA MEDICA.


nervously sensitive temperament; toothache of a purely
nervous character, especially at night; nervous sufferings
of highly excitable children or hysterical females. Persons
who take coffee as a beverage will fail to receive its full
benefit as a remedial agent.
HEAD.-Headache, as if it were too full; headache, as if
the brain were bruised or torn, or would fly to pieces, with
heat, sensitiveness to noise and light.
SEXUAL GROUP.-Excessively severe labour-pains or afterpains; excessive excitement of lying-in females; delayed or
suppressed menses, attended with colic; excited sexual
propensities.
COFFEE AS AN ANTIDOTE.-In the event of poisoning by
Opium, Aconitum, or other narcotic poisons, a strong infusion
of coffee with a little sugar, but without milk, should be
promptly given, after the stomach has been emptied, in cases
of suspected poisoning in which the patient is stupified,
sleepy, delirious, or insensible. In the depression consequent
on drunkenness, coffee tends to neutralise the poisonous
principle of alcohol, and acts as a sedative.
19.-Colocynthis (Bitter Cucumber).
GEOGRAPHY, PROPERTIES, ETC.-This plant is a native of
Turkey, Egypt, North of Africa, the islands of the Archipelago, etc. It is an annual much resembling the common
cucumber, but is distinguished from it by the fruit, which is
of a globular shape, smooth, and of a yellow colour when
ripe.  Colocynth has been used in medicine from a remote
period, and is one of the plants supposed to be the Pakysth
or 0nild gourd of Scripture. In the allopathic pharmacopoeia
it is a powerful drastic and Hydragogue Cathartic.   As
a hydragogue it is, however, inferior to Elaterium. In
excessive doses it is an irritant poison, causing inflammation
of the mucous membrane of the intestinal canal. It acts



COLOCYNTHIS.


527


primarily on the large intestines, and occasionally produces
griping or tormina, nausea and vomiting. In the old practice it is rarely given, except in combination with Camphor,
Calomel, Hyoscyamus, etc. For homoeopathic use the seeds,
and the pulpy or medullary matter, yield the medicinal product from which we make a straw-coloured tincture.
PROMINENT UsEs.-Colic of a griping, flatulent character,
with diarrhcetic evacuations, the large intestines being more
especially within the range of its operations; neuralgia
affecting certain nerves of the head and face; sciatica;
cramps in the muscles of the legs, etc.  Colocynth is also
useful in some gouty and gastric disorders. Although a
remedy of great power, it has not a wide range of action.
HEAD.-Violent neuralgia of one side of the head
(megri), aggravated by warmth and movement; burning
and stinging pains in one side of the face, extending to the
ear and head; cutting pain in the eyes and head; drawing
pr throbbing toothache.
1NTAL GROUP.-Ill-humour, indignation, great irascibility; peevish mood, and great disinclination to speak.
DIGESTIVE ORGANs.-Squeezing or cramp-like pains in the
stomach; cutting pain in the bowels, as from knives; colic
relieved by bending forwards; colic with diarrhoea after the
least food; diarrhoea with tenesmus; bloody stools; dysentery
with cramp-like pains; blind or bleeding piles; irregular
action of the intestinal or urinary organs, with colic or
flatulence.
SEXUAL.-Pressure in the region of the uterus and vagina,
as of labour, often with pain in the upper part of the thighs;
symptoms resembling those of prolapsus or retroversion of
the uterus, occurring at the monthly period, especially at
about puberty; menstrual colic.
SCIATICA, ETC.-Neuralgic pains of the hips and lower
extremities; stiffness of the knees, cramps in the calves of



528


MATERIA MEDICA.


the legs; tearing in the soles of the feet, especially if
traceable to cold, or connected with gout, or violent mental
emotions.
20.-Cuprum -Metallicum (Metallic Copper).
HISTORY, ACTION, ETC.-This metal occurs pure, in a
native mineral state, and in different forms, chiefly in
England, Sweden, North America, etc. In its pure state it
is not possessed of any medicinal action, but combined with
acids it is a violent irritant poison. Even food cooked in
copper vessels, by dissolving a portion of the metal, becomes
highly poisonous. For homceopathic uses, it is prepared
in the first instance as a trituration.
PROMINENT USES.-Partial or general convulsions; epilepsy; spasmodic affections; hooping-cough; diarrhcea,
cholera; St. Vitus's dance; twitching of the musclespiercing shrieks; paralysis; and cramps in the arms, legs.
and abdomen. It is especially efficacious when any of these
symptoms appear at irregular intervals, and in alternate
groups.
IIEAD.-Delirium; mania; epileptic fits, with foaming at
the mouth, rigidity of the body and limbs; hysteria, with
melancholy; muscular trembling; debility, etc.; attacks of
craziness of an artful or peevish character; vertigo; violent
headache; inflammation of the brain; buzzing and singing
noises in the ears; pale face; sunken eyes; blue lips, etc.
RESPIRATORY GROUP.-Dry cough, taking away the breath,
like hooping-coughl, children turning blue in the face, as if
suffocating; spasmodic cough, with rattling in the chest;
croupy cough; asthma, with a feeling of painful constriction
of the chest, almost amounting to suffocation, and spasmodic
vomiting of mucus after the cessation of a fit.
DIGESTIVE GROUP.-Nausea; excessive vomiting, with



DIGITALIS.


529


colic; violent cramp-like pains or pressure in the stomach
or abdomen, with diarrhoea; violent and copious diarrhoea;
Asiatic cholera, especially if vomiting and diarrhoea are
accompanied by convulsions of the extremities, and pressure
in the pit of the stomach.
TRUNK AND EXTREMITIES.-Jerking of the limbs during
sleep; twitching of the muscles; cramps in the arms and
calves of the legs, the convulsions beginning at the fingers
and toes; paralysis, with weakness of the body and trembling of the limbs.
21.-Digitalis (Foxglove).
HIsTORY, ETc.-Foxglove is a native of England and
Western Europe, and does not appear to have been known
to the ancients. Fuchsius first described it, and named it
digitalis, from digitus, a finger, in consequence of the resemblance of its flowers to the fingers of a glove. It grows on
pastures and exposed hill-sides, and in plantations.    It
blooms in June and July, and ripens its seed in August and
September. The leaves, roots, and seeds are all possessed of
active properties, but for homoeopathic uses we employ the
leaves only; and those of the second year, gathered just
after the first flowers have expanded, are the most valuable.
Those plants which have a purplish 'stem are supposed to
possess most virtue.
AcTION.-In allopathic practice it first excites and then
diminishes the force and frequency of the heart's action.
The intestinal canal, the brain, and organs of sense, are apt
to be disordered by large doses. The kidneys are often
acted on, and the secretion of urine increased. It is a
cumulative medicine, and on the occurrence of nausea or
intermittent pulse, it should be discontinued. It has been
used to control the circulation, in diseases of the heart, in
fever, din inflammations, and in pulmonary affections after



530


MATERIA MEDICA.


the acute symptoms have subsided. It is prescribed in
excitement from nervous irritability, and as a diuretic in
dropsies of all kinds, but is most useful in those associated
with a debilitated and generally diseased state of the
constitution (Royle).
PROMINENT USES.-Organic diseases of the heart, and their
consequences; aneurism; apoplexy; vertigo; jaundice; general cachectic condition. It is supposed to be more serviceable for scrofulous patients, of soft, flabby muscles, than for
those of firm fibre and robust health.
HEART.-Palpitation; increased action of the heart, producing an oppressive sensation, with anguish and spasmodic
pains. Plethora of the heart, with a sensation as if it were
grasped; slow, irregular, and sometimes intermittent action
of the heart; sense of suffocation, especially on lying down;
hypertrophy, with or without dilatation of the left ventricle;
valvular disease; cyanosis (blue disease), with    anguish,
orthopnoea, hzemoptysis, and blueness of the eyelids, lips,
tongue, and nails; hydrothorax and ascites, from organic
lesion of the heart; dropsy of the pericardium; aneurism of
the aorta.
RESPIRATORY GROUP.-Asthma; spasmodic cough; hbemoptysis; pulsation or pain, with a feeling of constriction
in the chest; arterial throbbing in the right side of the
chest; pain in the chest, especially on coughing.
22.-Drosera Rotundifolia (Round-leaved Sundew).
NATURAL HISTORY, ETC.-This plant is indigenous to
elevated situations in Great Britain and most of the temperate climates, and even near the tropics, and flourishes in
mossy, turfy bogs. It is called Drosera (dewy), in consequence of its being covered with glandular hairs, giving the
plant an appearance as if covered with dew. For homoeopathic purposes we express the juice from the whole plant,
gathered in July, from which we make the tincture.



DULCAMARA.


531


PROMINENT USES.-Catarrhal affections after croup; hooping-cough, especially in the convulsive stage, and after the
use of Ipecacuanha and Belladonna; also in cough with a
tickling sensation in the throat; hoarseness; vomiting, or
wheezing breathing, and a sensation of suffocation; early
stage of phthisis, especially of the larynx.
FEVER.-Intermittent fevers with much shivering; vomiting during the chilly stage of ague; fever with headache;
night perspirations; dizziness in the open air.
IRESPIRATORY GRoUP.-Chronic hoarseness after repeated
catarrhs; incipient laryngeal phthisis with emaciation; cough
with vomiting; tickling in the larnyx, inducing a hacking
cough; night cough; cough, with expectoration of blood;
hooping-cough, sometimes with bleeding from the mouth and
nose; hooping-cough, especially in the second and third stage,
with warm perspiration (cold perspiration points to Veratrum); chronic bronchitis; wheezing    breathing, with a
suffocative sensation.
23.-Dulcamara (Woody Nightshade-Bitter Sweet).
NATURAL HISTORY, ETc.-This plants s indigenous to every
temperate latitude, flourishing in moist shady hedges and
thickets, or on the banks of ditches or streams. The root is
woody, the stem shrubby, with climbing branches, attaining,
when supported, to the height of from eight to ten feet. It
has acquired its name from dulcis, sweet, and mara, bitter,
owing to the characteristic transition of tastes which it
yields when chewed.
PARTS USED.-For medical purposes we employ the young
branches and leaves of the plant when      it commences
flowering. The roots are said to possess the same properties
as the annual stems, which are taken up both by water and
spirit.
PROMINENT USES.-Various affections resulting from damp,



532


MATERIA MEDICA.


or a thorough wetting, such as cold in the head, nausea,
cliarrhcea, itching and stinging eruptions on the shin, rheumatism, with pains worse during rest, and relieved by movement, and other conditions following a cold.   If this
medicine be taken immediately after exposure to damp, it
will often prevent the ordinary consequences of a cold.
SKIN.-Stinging and burning eruptions of different parts;
acute and chronic urticaria; severe itching vesicles upon a
red base; suppurating, humid, corrosive tetters, forming
crusts, or dry and peeling off; warts and scurfy eruptions,
particularly upon the face; dropsy after exposure to cold.
CATARRHAL AILMENTS.-Cold in the head with dryness of
the nose and headache; asthma from repelled eruptions;
acute and chronic bronchitis, with abundant expectoration;
rheumatic deafness and amaurosis; bronchial disorders after
measles.
DIGESTIVE GROUP.-Derangement of the intestinal functions, with dirty, white-coated tongue; nausea, or flatulent
distension of the abdomen; diarrhcea from cold, with colic,
particularly in children and in the summer, with nocturnal
watery or slimy evacuations; chronic bloody diarrhcea.
URINE.-Catarrh of the bladder; fcetid-smelling urine;
burning in the urethra, with difficult urination.
GENERAL DISEASES.-Attacks of rheumatism, particularly
of the upper extremities; catarrhal and rheumatic fevers;
violent lancinating aching pains in the arms and back,
especially at night, and during repose, but which are relieved
by movement.
24.-Ferrum Metallicum      (Pure Iron).
GEOGRAPHY, PROPERTIES, ETC.-Iron is a metal which is
more generally diffused over the globe than any other, and
has been known from time immemorial. It occurs native in
small quantities, seldom pure, generally oxidized, and



534


MATERIA MEDICA.


very extensively employed, probably in consequence of its
physiological action not being sufficiently appreciated. As
far as it is understood, the following may be stated as its
PROMINENT USES.-Indigestion, diarrhoea, fluent piles, etc.;
anaemia from   profuse losses, or as a symptom   of general
cachexia; debility from loss of fluids; dropsy from   liver
complaint, or abuse of cinchona; milky leucorrhoea; nocturnal emissions; impotence; sterility; prolapsus of the vagina;
chlorosis, with painful, irregular, scanty, pale, or suppressed
menses; ailments from the abuse of Peruvian bark, or tea;
consequences arising from sexual excesses.
25.-Graphites (Black Lead, Carburet of Iran).
HISTORY, ETc.-The name is derived from the Greek word
grapho (to write); it is used for pencils, and the best comes
from Cumberland. Its components are not uniform. It is
first prepared for use by trituration, which has to be made
with great care.
PROMINENT USES.-Its action upon       the skin is very
marked, especially in   various forms of chronic tettery
diseases of the skin and its appendages; chronic eruptions;
tuberculous affections; chronic cough; weakness of the
stomach; constipation. In many points it corresponds with
the action of Calc., I-Iepar Sulph., Silic.
SKIN.-Unhealthy, trifling itching pimples leading     to
ulceration; dryness of the skin; chronic erysipelas; herpes
crustaceous; fcetid perspiration of the feet; old ulcers with
torpid and callous edges, with a foetid, ichorous discharge;
humid tetter; painful warts; chafing and soreness of the
skin between the fingers, toes, and thighs.
HEAD.-Itching of the scalp, and falling off of the hair;
humid and scabby eruptions; headache, especially in the
morning on waking; vertigo; pain in the bones of the



536


MATERIA MEDICA.


GENITO-URINARY GROUP.-Diminished secretion of urine,
with general anasarca, and probably hurried or slow laboured
breathing. Menstrual suppression with cedema or dropsy of
the abdomen.
27.-Hepar Sulphuris (Sulphuret of Lime).
PREPARATION, ETC.-Although this compound exists in
nature, for homoeopathic uses we obtain an artificial preparation by calcining in close vessels equal proportions of
sublimed sulphur and minutely pulverised oyster shells,
from which we make first a trituration, and afterwards a
tincture.
PROMINENT   SYMPTOMS.-Skin and glandular diseases;
inflammatory affections of the windpipe and air-cells, as in
croup (in which it often acts most beneficially by arresting
the tendency to effusion); consumptive coughs; scrofulous
enlarged glancls, and scrofitlous afections generally; chronic
clyspepsia; salivation and other consequences resulting from
an excessive use of mercury.  It is milder in its action than
Sulphur, and often more suitable in cachectic conditions.
iJepar Sulphuris promotes the svppurative process to an
extent, probably, beyond any other known remedy.
SKIN.-Disposition  to ulcerate from  the least injury;
unhealthy or chapped skin; nettle-rash; boils, pimples,
chilblains, whitlows; erysipelatous inflammations; falling
off of the hair, particularly after the abuse of mercury;
yellow colour of the skin.
HEAD.-Headache in the forehead, with vertigo, especially
in the morning and evening; nervous irritability; anxious
and frightened dreams, or starting from sleep; scrofulous
ophthalmia; inflammatory redness and swelling of the eyes,
and glueing together of the lids in the morning; discharge
of pus from the ears, sometimes foetid; pain in the bones of
the face from abuse of mercury; darting, jerking toothache;
loose, inflamed, and readily-bleeding gums.



HEPAR SULPHURIS-HYOSCYAMUS.


537


RESPIRATORY ORGANS.-Rawness, roughness, or scraping
sensation in the throat; koarseness; dry, deep, and severe
cough, particularly in the evening, and easily excited by
exposure to cold; croup, (after Acon. and before Spong.);
chronic bronchitis with anxious, wheezing respiration on
lying down; difficult breathing, and spasmodic constriction
of the chest; cough affecting the head, followed by sneezing
or crying.
DIGESTIVE GROUP.-Nausea, waterbrash, heartburn, with
pressure and tension in the region of the stomach after food;
frequent and easily-deranged stomach; difficult motions;
diarrhoea, clay-coloured or bloody evacuations.
GENITO-URINARY ORGANS.-Irritation of the urethra, burning urine, and discharge of mucus; weakness of the sexual
organs; escape of prostatic fluid during or after stool; delayed
menses, and itching during the flow; leucorrhoea with
smarting.
BACK.-Weakness of the spine; bruised or darting pains
in the back and limbs; ulceration and suppuration of the
axillary glands; cramps in the legs and feet; cold sweating
feet; aggravation of pains at night.
28.-Hyoscyamus Niger (Comnon H1-.nbane).
GEOGRAPHY, VARIETIES, ETc.-This plant is indigenous
throughout Europe, growing in uncultivated places in the
neighbourhood of farms, villages, and roadsides. The plant
may be easily recognised by the fetid odour which is exhaled
when it is handled and pressed. There are two varieties
cultivated at Mitcham, one annual and the other biennial;
the latter is preferred for homoeopathic purposes, the fresh
shoots and leaves gathered at the time of flowering yielding
the medicinal product from which the tincture is prepared.
HIyoscyamus and Belladonna appear to exhibit analogous
2M



538


MATERIA MEDICA.


properties, but in some respects they differ most essentially,
especially in their action upon the nervous and vascular
systems. Hyoscyamus has little of that power of exciting
local inflammation which is so marked in the action of
Belladonna. It reduces the irritability of the heart and
lowers the pulse; Belladonna has the reverse effect.
MEDICINAL ACTION.-In allopathic practice it is given to
soothe irritation in the system, allay pain, and relieve spasm,
and is preferable to opium, as it does not cause headache,
confine the bowels, or check secretions. In poisonous doses,
it causes sickness, stupor, dimness of sight, a hard pulse,
dilatation of the pupil, delirium, coma, and, gradually, as
the pulse becomes weak and tremulous, death takes place.
PROMINENT USES.-The -ction of Hyoscyamus is chiefly
expended on the brain, to several severe affections of which
it is strictly homoeopathic; especially derangements characterized by convulsions, spasmodic affections, sleeplessness,
delirium, transient amaurosis, etc.
MENTAL GROUP.-Delirium      of various kinds-furious,
muttering, incoherent; jealousy; rage; grasping at flocks,
or picking at the bedclothes; desire to get up in brain fever.
Illusions of sight; far-sightedness or the reverse; obscuration
of sight; wakefulness, alternating with deep sleep; startings
in sleep, and grinding of the teeth.
HEAD.-Dizziness; inflammation of the brain; stupifying
headache; headache, especially in the forehead; bluish or red
swollen face; spasmodic closing of the eyelids and nocturnal
blindness; red and glistening eyes; squint (recent); tearing
toothache with congestion to the head; partial or entire
paralysis of the tongue and throat; difficulty in swallowing;
dread of drinking.
RESPIRATORY GROUP.-Dry, spasmodic cough, as if produced by tickling in the throat, especially at night, when
lying down, but relieved by sitting-up in bed; hooping cough



IGNATIA AMARA.


539'


with paroxysms, especially at night;. cough of hysterical
persons; difficult breathing; spasms of the chest.
DIGESTIVE ORGANS.-Nausea, vomiting, or bitter eructations; colic with flatulent distension; frequent passing of
thread-worms; painless and watery diarrhoea, especially when
associated with hysteria or typhus.
URINARY GRoUP`.-Retention of urine; involuntary emission; paralysis of the bladder. Profuse menstruation with
hysteric symptoms; puerperal fever and mania.
GENERAL DISEASES.-Fits of fainting; convulsions; St.
Vitus's dance; hydrophobia; epileptic or hysteric convulsions.
29.-Ignatia Amara (St. Ignatius' Bean).
HABITAT, DESCRIPTION, ETC.-This seed is yielded by the
Strychnos Ignatii, a climbing bush, which, like the Strychnos
Nrux Vomica, grows on the islands of the extreme eastern or
south-eastern coasts of the continent of Asia, especially on
the Philippine Islands, and has long been used in India.
The fruit of the Strychnos Ignatii is of the size of a small
melon, or of a large pear, ovoid, smooth, and contains from
fifteen to twenty irregular-shaped, hard seeds, scarcely an
inch long, of a pale-brown colour, and striated on the outside; inodorous, but very bitter, and contain a larger quantity of strychnia than the Nux Vomica seeds.
For medicinal purposes we use the seeds, from which we
obtain a pale, straw-coloured, very bitter tincture.
IGNATIA AND Nux VomICA.-The action of Ignatia, although
very powerful, is less violent than that of  rux Vomica.
" Ignatia Amara appears to operate more especially upon the
gastric and intestinal mucous membrane, although it does
also act upon the ganglionic system; whereas the Strycinos
Nux Vomica, which contains the same chemical components,



IGNATIA-IODIU]fM.


541


of the eyes and lids; ulcerated nostrils; fluent, followed by
dry, coryza; soreness of the inner mouth; increase of
saliva.
RESPIRATORY ORGANS.-Sensation as of a lump or ball
rising in the throat; convulsive, spasmodic cough, especially
on waking; constriction of the chest; dyspnoea at night;
stitches in the chest, especially on the left side; palpitation
of the heart.
DIGESTIVE GROUP.-Distress at the stomach, caused by
food; rising of food or of a bitter liquid, with bad taste in
the mouth; nausea; hiccough after eating; flatulent colic;
periodical spasms, particularly in hysteric persons; sensation
in the stomach as if occasioned by want of food; mucous
stools; constipation from cold; itching, creeping, or prolapsus of the rectum; thread worms.
GENITO-URINARY GRoUP.-Pressure on the bladder; frequent, profuse, watery urine; expulsive, bearing-down pressure on   the uterus, as in labour; premature, profuse,
offensive menses; acrid and corrosive leucorrhcea.
80.-lodium     (Iodine).
NATURAL HISTORY, ETC.-This is an elementary substance,
so called from lodks (violet colour), on account of the beautiful and characteristic blue colour of its vapour. It exists
in the mineral and vegetable kingdoms, and largely in
marine plants. Iodide of silver, and iodide of mercury are
found in nature, in sea-water in minute quantity, and in
some springs; also in the algae, sponge, corals, various
polypi, etc. It is chiefly obtained from incinerated sea-weed
or kelp. Coindet, who first instituted inquiries concerning
the curative properties of Iodine, found that the therapeutic
virtues of Spongia were due to the presence of Iodine in that
substance.
Although lodium has been very much abused by allopathic
practitioners, it has been well observed that they very often



542


MATERIA MEDICA.


successfully prescribe it for the very derangements which
they describe in their works as the injurious effects of iodine
to be guarded against in practice. It is even recommended
as a specific remedy in many diseases in which its curative
virtues entirely depend upon its being homoeopathic to the
malady.
PROMINENT USES.-Scrofulous affections; inflammation
of the larynx and trachea; abdominal phthisis; ozcena;
chronic diarrhea in scrofulous persons.
SKIN.-Glandular swellings and indurations; dry, rough
skin, and unhealthy eruptions, especially in strumous persons; early-morning perspirations; goitre; ganglia; ranula;
swelling of the inguinal glands; hydrocele and ovarian cysts.
RESPIRATORY GROUP.-Chronic inflammation of the larynx,
with hoarseness; chronic sore throat; dry short cough, with
frothy or bloody expectoration; chronic bronchitis; croup,
especially when the exuded lymph begins to consolidate,
with suffocative and croupy inspiration; diphtheria; phthisis.
INFLAMMATORY GROUP.-Fever, with alternate chills and
flashes of heat, or delirium and grasping at flocks; hectic
fever; pleurisy in patients of a strumous constitution, and
especially if effusion into the pleural cavity seem to have
taken place.
SEXUAL.- Chronic, corrosive leucorrhea; ovarian dropsy;
premature or delayed menses in scrofulous females; atrophy
or indurations of the testes; impotence,; hydrocele.
EXTREMITIES.-Scrofulous inflammation of the joints, with
pains and suppuration; white swelling of the knee; rheumatic pain and swelling in the limbs and joints; gangrena
senilis.
ADMINISTRATION.-Iodine may be administerred in tincture,
two to three drops in an ounce of water; or by inhalation;
or applied locally as a lotion; or painted over the affected
surface. For chronic scrofulous or syphilitic affections, the
dilutions are preferable.



IPECACUANHA.


543


31.-Ipecacuanha (Cephdielis Ipecacuanha).
NATURAL HISTORY, ETC.-This is a creeping herbaceous
perennial plant, growing plentifully in the wooded tracts of
Central South America, particularly Brazil. Its root is the
Ipecacuanha (Radix Jpecacuanha) of commerce. For medicinal purposes the full-coloured or dark roots should be chosen;
those without colour or without circular rings should be
rejected. Ipecacuanha root, when entire, is from two to
three inches long, about the thickness of a goose-quill, and
when fresh, is of a pale-brown colour externally.
MEDICINAL AcTION.-As an emetic, in allopathic practice,
it is considered mild and safe; it does not operate so rapidly
as some emetics, and does not leave that amount of depression which follows the use of Tartar Emetic.        It is to be
preferred when vomiting is requisite in delicate patients and
in children; for the latter, the vinum Ipecacuanhýa, in doses
of mrxx.-fl. drm. j., till it cause vomiting, is recommended.
Some persons, from idiosyncrasy, are unable to take Ipecacuanha; in     such, even   the smell of the powdered root
produces a distressing sense of suffocation (Waring).      The
root is almost inodorous, but pulverised it has an unpleasant
nauseous smell, producing in some persons violent sneezing;
in others dyspnoea, resembling asthma.
"If I remain in a room where the preparation of Ipecacuanha is going
on, for instance, making the pulverized Ipecacuanha comp.," writes
Mr. Roberts, surgeon, to Pereira, " I am sure to have a regular attack of
asthma. In a few seconds dyspnoea comes on in a violent degree,
attended with wheezing, and great weight about the precordia. The
attack generally remains about an hour, but I obtain no relief until a
copious expectoration takes place, which is invariably the case; after the
attack is over, I suffer no further inconvenience. I have always considered that the attack proceeds from the minute particles of Ipecacuanha
floating in the atmosphere, acting as an irritant on the mucous membrane
lining the trachea and bronchial tubes.  In some cases the mere odour of
the root seems to excite difficulty of breathing, with a feeling of sutfocation."



548


MATERIA MEDICA.


glands and organs, stimulating some, the salivary glands
and liver in an especial manner. Mercury causes, in many
constitutions, a great amount of irritability, and extreme
susceptibility to all impressions. Long continued, it produces a specific action on the salivary glands, called salivation or ptyalism. The biliary secretion is increased, the
blood  is impoverished; Dr. Farre considering       that it
destroys the red blood globules, as surely as they may be by
venesection. A good idea of the value of Mercury may be
learned from the following enumeration of the ill effects of
its excessive employment. 1. Griping and purging. 2. Sore
throat, ulceration or mortification of the tonsils. 3. Violent
salivation. 4. A renewal of salivation at a future period.
5. Various eruptions of the skin. 6. Eretiismus Mercurialis
(great depression, anxiety, irregular action of the heart, etc).
7. Rheumatic pains and nodes. 8. Mercurial palsy. 9. Cachectic mercurialis (abridged from Waring).
Few drugs have exerted a more beneficial action on man
than mercury, when correctly chosen, and administered in
suitable doses.   In allopathic hands, however, no drug,
excepting, perhaps, Opium, has scattered such wide-spread
devastation in its path. In homoeopathic hands this potent
agent does good without doing harm. "BHahnemann's
provings of fMercury constitute one of the brightest pages
of his Materia Medica Pura, and teach with great certainty
in what diseases we may depend upon Mercury as a curative
agent."
PROMINENT SYMPTOM3s.-Mercurius Solubilis* is specially
useful in sore throat with ulceration and swelling; glandular
swellings and suppuration; syphilitic, scrofulous, or catarrhal
ophthalmia; painful tearing in, and discharge of pus from,
the ears; syphilitic and scrofulous swellings of the inguinal
* Mercurius Solubilis and Mercurius Vivus (quicksilver), are prescribed by
many hom(eopathic physicians indifferently, the effects of both being nearly
identical. The latter we have found most useful in catarrhal affections.



MERCURIUS SOLUBILIS.


549


glands, sometimes with suppuration; syphilitic ulcers, etc.
Two indications for the use of this remedy are, aggravation of
the pains and general symptoms in bed at night, and perspirations, which afford no relief.
SKIN.-Jaundice; itching eruptions having an ulcerative
tendency; itching aggravated by the warmth of bed; healthy
or malignant suppuration; inflamed, swollen, and suppurating glands, particularly in the groin; syphilitic eruptions;
eruptions readily bleeding; suppurating stage of small-pox.
FEVER.-Frequent chills and shivering, profise perspirations without relief. Rheumatic, bilious, or catarrhal fevers.
HEAD.-Rheumatic and catarrhal headache; bilious headache; itching and humid eruptions on the scalp; headache,
especially at night; pains in the bones of the skull, worse
at night.
EYEs.-Ophthalmia; inflammatory affections with itching,
soreness, and burning; yellow-tinge of' the whites of the
eyes; ulcers in the cornea; agglutination of the lids.
EARS.-Tearing or sticking pain; soreness and excoriation
in the internal ear, and sometimes with discharge of pus or
blood; roaring and buzzing noises; swelling of the parotid
gland.
NosE.-Cold in the head, coryza, sneezing, dry, or with
copious discharge of watery or corrosive mucus.
FACE.-Yellow, clay-like complexion; swelling of the
face with toothache; cracks or ulcerations of the lips and
corners of the mouth.
TEETH AND GUmIS.-Looseness of the tceth and swelling
of the gums; scurvy, with spongy or bleeding gums; pain
in decayed teeth, of a tearing, darting, throbbing kind,
especially at night, increased by eating and in the warmth
of bed; the teeth feel too long and loose; inflamed, swollen,
ulcerated, easily bleeding gums.
3IOUTH AND THROAT.-ProfUse flow of saliva with a fcetid



NITRICUM ACIDUM.


551


35.-Nitricum    Acidum    (Nitric Acid).
PREPARATION.-This is a colourless liquid, excessively acid
and corrosive, and is a most effective oxidizing agent. It is
prepared by the action of sulphuric acid on nitrate of potash.
It makes a permanent yellow stain upon the skin, which, unlike that produced by iodine or bromine, can scarcely be
removed.  For medicinal use it has to be purified to free it
from all traces of sulphuric or muriatic acid, with which it is
frequently mixed.
MEDICAL PROPERTIES.-Strong nitric acid is a powerful
caustic and escharotic.  The dilute acid is tonic, alterative,
and refrigerant, and is recommended (allopathically) for renovating the strength and raising the tone of the constitution
after a long course of ilmercury.
PROMINENT USES.--Chronic scrofulous or syphilitic diseases; chronic rheumatism; diseases of the bones; various
affections due to the abuse of Mfercury. It is stated to be
most useful in chronic diseases and in persons who are
habitually troubled with mucous discharges, and, according
to Hahnemann, rarely to those of a constipated habit.
SKIN.-Syphilitic eruptions; itching eruptions like nettlerash; brownish-red spots on the skin; warts; painful corns
and chilblains; foetid sweat of the feet.
EYES, ETC.-Purulent ophthallia of a gonorrhceal or
syphilitic origin; inflammatory affections of the eyes, consequent on the abuse of mercury; dimness or loss of sight.
Deafness; discharge from the ear: noises in the ear; and
other affections of a strumons or syphilitic nature.
NOSE.-Yellow fcetid discharge from the nose; syphilitic
ozoena; foetid smell in the nose; stoppage of the nostrils.
FACE.-Pain in the bones of the face; pale face.
MOUTH AND THROAT.-Ulceration, salivation, with foetid
odour from the mouth; sloughing of the mucous membrane;



MATERIA MEDICA.


loose teeth, and spongy bleeding gums, from abuse of mercury; smarting pain in the throat; hoarseness; sensation
when swallowing as if the throat were raw or ulcerated.
RESPIRATORY GROUP.-Dry, barking cough, especially in
the evening, with purulent or bloody expectoration; shortness of breath, with palpitation on slight exertion.
DIGESTIVE GROUP.-Loss of appetite; emaciation; chronic
diarrhoea, with soreness of the bowels; fistulous and hasmorrhoidal affections; itching and burning of the anus.
GENITO-URINARY GRoUP.-Enuresis, with fcetid or purulent
urine; ulcers in the urethra. Syphilitic affections of the genital organs; condylomata on the sexual organs and anus
(internal and external use); relaxation of the scrotum;
deficient sexual power; nocturnal emissions. Leucorrhcea
of a fcetid or corroding nature, especially scrofulous or
syphilitic.
36.-Nux Vomica (Strychnos Nux Vomica).
NATURAL HISTORY, ETc.-This is the seed of a tree of considerable size, indigenous to the Indian Archipelago, Southern
India, Ceylon, etc. The fruit is a smooth berry, of the
size of a large apple, of a beautiful orange colour, containing several circular flat seeds, covered with fine hairs.
For homccopathic purposes we use the seeds (nuces vomicce
from  which, when pulverized, we prepare a tincture or
trituration.
MEDICINAL ACTION.-The _Nux Vomica is a most active
poison, even more violent than arsenious acid, and is more or
less destructive to all animated nature. It produces tetanic
convulsions, which affect both the limbs and the trunk of
the body, increased sensibility to external impressions,
asphyxia, by suspending the action of the muscles of respiration, and death. The spinal cord is the part chiefly
affected, although probably every part of the nervous system
is specifically acted on by it.



556


MATERIA MEDICA.


functions; and in them, the slightest scratch often degenerates into a foul and ill-conditioned ulcer."
Opium is said to consist chiefly of morphia, narcotine,
gum, resin, oily matter, etc. It has long been employed by
old school practitioners as an anodyne, a sedative, an antispasmodic agent, and administered in very large doses.
Its therapeutic range in that practice is very large, and
its preparations very numerous. Although often used most
prejudicially in the case of adults, we would strongly
denounce its employment in the form      of paregoric, as
a means of quieting young children, in whom it cannot
but produce most disastrous results.  Numerous instances
are on record in which laudanum, or compounds into which
laudanum largely enters, has produced fatal results in children; and its employment would be wholly inexcusable
now that the light of homceopathy shows us such remedies as
Aeon., Bell., Cham., Cof, etc., as safe and potent means of
suppressing the cries and restlessness of little children, by
correcting, and not merely masking, the diseased condition
on which their cries depend.
PROMINENT USEs.-Ailments following fright or other
sudden violent emotions; lethargy; delirium tremens; apoplexy; constipation; lead-colic; ailments of old people, etc.
Oplium is often useful to arouse the deficient nervous energy,
and render the system susceptible to the action of other
remedies indicated. See also Sulphur.
SLEEP.-Stupifying, unrefreshing; snoring, with halfopen eyes; drowsiness, sometimes with inability to sleep;
stupor, with half-closed eyes.
HEAD.-Delirium; stupor, or complete loss of consciousness; frightful fancies; vertigo, as if things were turning
round; delirium tremens; apoplexy; humming and ringing
noises in the ears; bloated and dark colour of the face; distortion of the mouth; lock-jaw.



558


MATERIA MEDICA.


fevers, sexual abuses, wasting diarrhoea, etc; affections of
the throat and chest, and in the early stage of tubercular
disease.
MORAL GROuP.-Weeping; depression of spirits; melancholy; timidity.
SLEEP.-Restlessness; wakefulness; disturbed dreams.
FEVER GROUP.-Hectic fever, with heat and dryness of the
skin in the evening and early-morning perspiration; typhoid
fever, with muttering delirium, paralysis of the rectum or
bladder, etc.
HEAD.-Vertigo; pulsation in the brain; rush of blood to
the head; pain as if the head would burst; dull, stupifying
headache; falling off of the hair.
EYEs.--Amaurosis; muscce volitantes, or a grey mist intercepting the vision; inflammatory redness of the eyes; swelling and agglutination of the lids; dimness or shortness of
sight; attacks of sudden blindness.
EARS, NOSE, ETC.-Humming and whizzing noises, with
dryness, and sometimes oozing of mucus; deafness, especially
after severe acute diseases; stuffing of the nose: bleeding of
the nose; loss of smell; offensive odour from   the nose;
polypus of the nose; earthy complexion.
MOUTH AND THROAT.-Tearing pain in the jaws at night;
toothache from  trifling cold, with swelling in the face; inflamed, sore, or bleeding gums; inflammatory ulcers in the
mouth; dryness and soreness of the throat, with stinging
pain on swallowing; adhesive mucus in the throat in the
morning.
RESPIRATORY GROUP.-Bronchial catarrb, with dry cough,
or with much mucous or bloody expectoration; chronic
bronchitis; tearing or racking cough; haemorrhage from the
lungs; hoarseness, sometimes loss of voice; cough, with
stitches and pain in the chest and throat; soreness and constriction, with difficult breathing; rush of blood to the chest;
palpitation of the heart; pneumonia; tubercular consumption.



PHOSPHORUS.


559


DIGESTIVE ORGANS.-Bitter or sour taste, or loss of taste;
impaired or excessive appetite; indigestion, with pressure
after eating; vomiting; heartburn; colic; stitching pains
in the liver; coldness or burning in the abdomen; loose
evacuations, with paralysis of the intestinal canal, and great
weakness, as in typhoid fever; chronic diarrhoea; heemorrhage
from the bowels.
GENITO-URINARY GROUP.-Involuntary emission of urine;
profuse urine, with white flocculent sediment, or with greasy
pellicles, or oily globules floating on the surface. Delayed,
scanty, or watery menses;. or the opposite state-profuse
menses; leucorrhoea; inflammation, suppuration, or fistulous
openings in the breast. Sexual weakness or impotence, with
trembling, impaired digestion, premature old age, etc.,
especially from previous abuse; frequent emissions; impotence, in old, debilitated subjects.
TRUNK AND EXTREMITIES.-Contusive pain in the back;
stiffness and swelling of the nape of the neck; pain in the
arms and shoulder-blades; rheumatism in the extremities;
arthritic pains; swelling and smarting pains in the feet;
numbness of the fingers; chilblains, with a watery, fcetid
discharge.
BONEs.-Diseases of bones, with nocturnal pains; caries
of bones, from scrofula, or from the abuse of mercury.
39.-Phosphori Acidum       (Phosphoric Acid).
PREPARATION, ETC.-This acid is inodorous, with a very
characteristic taste, and is obtained by the mutual action of
phosphorus and nitric acid in distilled water. It is prepared
in the form of tincture, and should be preserved with great
care.
PROMINENT SYMPTOMS.-Weakness from      loss of animal
fluids-blood, semen, etc.,-consequences of grief, excessive
care, too rapid growth, onanism, etc.; nervous weakness,



PLUMBUM.,


561


pain in   the small of the back; obstinate constipation;
nymphomania in the first stage, with sexual excitement,
shyness and depression of spirits.
41.-Plumbum (Lead).
HISTORY, ETC.-Metallic lead, in its native form, occurs
almost invariably in combination with other substancessulphur, acids, etc. After being purified by oxidization and
subsequent fusion, we make triturations of it.
PHYSIOLOGICAL EFFECTS.-" In small doses, the salts of lead act on the
alimentary canal as astringents, checking secretion, and causing constipation. After absorption, the constitutional effects of lead are observed,
the arteries become reduced in size and activity, the pulse becomes
smaller, and frequently slower also; the temperature of the body is
diminished, and sanguineous discharges, whether natural or artificial, are
frequently checked, or even completely stopped. This constringing and
sedative effect seems extended to the secreting and exhaling vessels; the
discharges from the mucous membranes, the exhalations from the skin,
and the urine, being diminished in quantity. Thus we observe dryness of
the mouth and throat, greater solidity of the alvine secretions, diminution
of the bronchial secretions, and of cutaneous exhalation. When the system
becomes impregnated with the metal, it occasions a peculiar blue or leaden
discoloration of the gums, mucous membrane of the mouth, and teeth.
Salivation, and a bluish colour of the saliva, have also been observed
occasionally. In very large doses, some of the salts of lead, the acetate
for example, act as irritant and caustic poisons, giving rise to the usual
symptoms indicative of gastro-enteritis " (Pereira).
PROMINENT USES.-Paralytic affections, the extensor muscles
being chiefly implicated; general, epileptic, or cataleptic
convulsions; colic, resembling that produced by poison of
lead, with violent pains in the umbilical region and spasmodic retraction of the abdomen; colic relieved by pressure;
constipation, from a too dry condition of the mucous membrane of the intestines, with hard, lumpy stools.       Cachexia
(an unhealthy habit of the body), indicated by pale colour
of the skin; exhaustion; cedema or dropsy; sexual weakness; obstinate nocturnal bone pains, etc.



562


MATERIA MEDICA.


42.-Pulsatilla (Wind-flower).
HABITAT, ETC.-This perennial flower is indigenous to
elevated places in the greater part of Europe, where the
soil is dry and sandy, and the situation exposed. It is
called " Wind-flower," because generally found in an exposed
situation. It blooms in the spring and autumn; but the
spring period of blossoming is the appropriate time for
gathering the plant, from  which, the root not excepted,
we make a tincture of a greenish-brown colour, having an
acrid taste.
PROMINENT USES.-Similar to those of Nuzx Vomica in
derangements of the nervous and digestive organs, but
generally more suited to females and scrofulous persons, of
gentle dispositions, easily excited to laughter or weeping,
rather than persons of firm fibre, and decided temper. In
diseases of the stomach and bowels, Pulsatilla, rather than
Eux   Vomica, is selected when there is a tendency to
relaxation; also in derangements caused by greasy food,
such as pork, rich pastry, etc. It operates upon the lymphatic system and venous blood-vessels; the mucous membranes; the eye; the skin; and immediately upon the
uterine system. The pains of Pulsatilla are worse in the
evening, with warmth and during rest, but abate in the
open air, or during moderate exercise.
HEAD.-Vertigo, especially in the evening, when stooping,
rising up, moving the eyes, or walking; gastric headache,
especially after eating rich, heavy, and indigestible food;
nervous or sick headaches, particularly in hysteric females,
or from night watching; menstrual headaches.
EYES, EARS, ETC.-Profuse lachrymation, with stinging or
burning pains from cold; inflammation of the lids; stye;
ophthalmia, especially after measles. Inflammation of the
car; buzzing in the ear, or noises as of wind, rushing water,



PULSATILLA.


563


singing, etc.; purulent discharge from the ears; deafness;
cold in the head, with loss of smell.
SKIN.-Varicose veins and ulcers; embarrassed venous
circulation generally from pregnancy; erysipelas, wandering
from one part to another; wandering gout; chilblains with
bluish-red swelling, and
MEASLES.-Massive doses of Pulsatilla produce an eruption on the skin similar to measles. Hence we use it as a
curative agent in measles, especially after the inflammatory
symptoms have been controlled by Aconitzum; also for the
after consequences of measles. Pulsatilla is also a preventive
of measles, during the prevalence of this complaint.
MORAL GROUP.-Lowness of spirits; hysteria or melan
choly, connected with milk or menstrual suppression;
anxiety, sadness, and disposition to weep.
RESPIRATORY GROUP.-Catarrhal affections of the air
passages; catarrh with loss of taste and smell; cough when
lying down; cough with expectoration of yellow, green, or
bloody mucus; cough with inclination to vomit; excessive
accumulations of mucus; congestion of blood to the chest
or heart, from rheumatism or suppression of the menses.
DIGESTIVE GROUP.- Toothache, aggravated by warmth or
eating, but relieved by cool air; darting toothache, as if the
nerves were first stretched and then relaxed; foul taste or
smell in the mouth; loss of appetite or thirst; viscid mucus
on the tongue, the food tasting bitter; derangement caused
by rich, fat food; vomiting of mucus or bile; water-brash;
flatulence; colic; painful sensitiveness of the abdomen;
diarrhcetic discharges of yellowish-white mucus, with or
without admixture of blood; nocturnal diarrhoea preceded
by rumbling or cutting pains.
GENITO-URINARY GROUP.-Catarrh of the bladder: difficult emission, or incontinence of urine; discharge of watery
urine; swollen testicle, from a suppressed discharge.



564


MATERIA MEDICA.


Perhaps the most remarkable property of this remedy is
its action upon the female sexual system, in irregularity of
the menses, and various sufferings consequent thereon;
delayed, suppressed, pale, or watery menses; menstrual
colic; leucorrhoea; false, delayed, or deficient labour-pains
(in alternation with Secale); excessive after-pains, suppression of the lochia, and a painful tension of the breasts,
with an abnormal secretion of milk.
43.-Rhus Toxicodendron (Poison Oak).
NATURAL HISTORY, ETC.--This shrub is indigenous to
North America, Japan, etc., and abounds on the borders of
rivers, or in marshy districts, growing very tall in a congenial soil. The leaves are gathered in May, during the
night-season, so as not to be exposed to the rays of the sun,
which are said to render them innocuous. The juice is
expressed, and treated like that of other fresh plants.
PROMINENT USES.-Rheumatism, and its consequences,
characterized by the pains being increased when at rest;
partial or complete paralysis; vesicular erysipelas; semilateral complaints; consequences of getting    wet when
perspiring; chronic diarrhoea; typhoid fevers; straining of
tendons; eruptions (moist) on the scalp, etc.
HEAD.-Sense of fulness in the head, stupifying headache,
as in acute fevers; vertigo and hemicrania; tingling eruption
on the scalp, forehead, etc.; paralysis.
MENTAL GROUP.-Anxiety and fear about the future;
peevish mood; incapacity for mental labour; a feeling of
fright, oppression, and even delirium.
EYES, EARS, FACE, ETC.-Inflammatory swelling of the
lids, with itching; rheumatic ophthalmia; confusion of
sight. Pain and swelling of the ear; swelling and hardness
of the parotid glands; erysipelas of the face, with stinging
or burning; chronic eruptions; tetters; swelling of the
face.



RHUS TOXICODENDRON.


565


SKIN.--Herpetic eruptions; excessive itching; tinea capitis, with itching and inflammatory redness of the scalp, and
foetid discharge under the scabs; nettle-rash; pustules;
purpura /eemorrhagica; chilblains; warts on the hands.
FEVER   GROUP.-Chills, especially in the back; low,
typhoid fever, with the tongue coated thick brown, and red
at the tip, and small quick pulse; scarlatina, measles,
smallpox, with a malignant tendency; abdominal typhus;
typhoid pneumonia.
DIGESTIVE GROUP.-Indigestion, with poor or capricious
appetite; painful distension with colic after a meal; diarrhoea and tenesmus, with   slimy or bloody evacuations.
Paralysis of the neck of the bladder, especially in hysteric
females, or in strumous or aged persons; nocturnal enuresis,
and when a similar weakness extends to the bowels.
TRUNK   AND  EXTREMITIES.- Rheumatism     and arthritic
affections; paralysis of the arms, legs, and feet, and a
feeling of numbness in the feet; sprains and affections of
the ligamentous tissues. "The disease in which I have
most frequently made use of Rhus is rheumatism, characterized by the following  symptoms:-rigidity; paralytic
weakness of the joints, with stinging pain along the tendons
and muscles; swelling and redness on or near the joints.
Rheumatism of the hip-joints and wrists seems to be most
effectually controlled by its action. The greatest rigidity
and pain is experienced on first moving the joints after rest,
and on wahing up in the morning. After the joints are
moved, for a while the pains are lessened" (Neidhard).
44.-Sambucus Nigra (The Elder).
NATURAL HISTORY, ETc.-The well-known elder tree so
common to the hedges and woods near villages of our own
country, as also to a great part of Europe, grows often to
the height of from twelve to fifteen feet, rises with a woody



566


MATERIA MEDICA.,trunk filled with a pith or white medullary substance, and
covered externally with an uneven, ash-coloured bark. The
inner bark is the part generally used for medicine, but some
use the united juices of the leaves and flowers.
PROMINENT USES.-It has a limited range, being nearly
restricted to affections of the respiratory organs of a violent
and dangerous nature, especially the following:-Asthma
Millari; Croup, with stertorous breathing, and the head
drawn back; deep, hollow, croup-like cough; hoopingcough; cough, with profuse saltish    expectoration, and
aching or stitching pains in the chest; difficult breathing;
profuse night-sweats; emaciation; dropsical swelling of the
feet; intermittent fever, with exhausting sweats. It has
been used as a palliative in the debilitating night-sweats of
consumptive patients.  Also in some varieties of rheumatism, with drawing pains in the limbs and loins, diminished
by movement and increased by rest.
45.-Sepia (Sepia succus).
NATURAL IISTORY, ETC.-The sepiae are mollusce of the
seas. They are without shells, and in the abdominal cavity
is a sac containing a dark-brown juicy substance, with which
they darken the water to elude an enemy or capture prey.
It is from this liquid, after being dried, that the medicinal
preparation is made; and though in its crude state is apparently inert, it developes powerful physiological properties,
after undergoing the process of trituration.
PROMINENT UsEs.-Disturbance of the circulation in
females, with deficient natural temperature.  Sensitiveness
to the open air; coldness of the hands and feet, etc.,
especially if associated with the uterine system; chronic
eruptions and morbid affections traceable to interruptions
of the function of circulation. Sepia is more particularly
suited to persons of delicate organization, with fine sensitive



SPONGIA MARINA TOSTA.


569


47.-Spongia Marina Tosta (Burnt Sponge).
PREPARATION.-The medicinal product yielded by sponge
is obtainable by roasting the best Turkey sponge in a coffee
roaster, cleansed from  all sand and calcareous matter by
repeated washings, slow  filtering, and pressing.  The
roasting has to be done very carefully, as it is often carried
to such an excess as to resemble a black coal, depriving it of
its therapeutic virtues, by destroying the iodine constituents.
Iodine is not, however, its only medicinal ingredient, for
then Iodine and Spongia might be used indiscriminately.
Carbonate and phosphate of lime, alumina, silica, bromine,
and organic substances, are found in Spongia officinalis;
these elements are combined in definite proportions, not by
the chemists' compounding, which must ever be of a most
conjectural nature, but by a natural organizing principle,
blending organic and inorganic elements with a unitary'
whole.
PROMINENT USES.-The chief value of this agent seems to
depend upon its specific action upon the mucous surfaces
and secretory vessels of the larynx and air-passages.
LARYNX AND CHEST.-Dryness of the larynx, with short
barking cough, frothy or tenacious expectoration, and difficult
breathing, as if the larynx and trachea were narrowed;
feeble voice, hoarseness or complete loss of voice; wheezing
cough, worse at night, excited by a tickling or burning
sensation; pain in the throat and chest on coughing;
stitching pains in both sides of the chest, resembling
pleurisy; croup, especially in the second stage; asthma,
with deep, slow, hurried, or panting breathing; laryngeal
phthisis; pleurisy, pericarditis, etc.
GOITRE.-As a specific for goitre, Spongia probably ranks
before lodium, more particularly in goitre attended with
pressure and tingling in the swelling, or with a sensation of
constriction.                                2 



STRAMONIUM.


4571


intervals, with severe pains during the flow. Discharge of
prostatic fluid; drawing sensation in the spermatic cord;
aching pain in the testes from  walking or friction; impotence.
49.-Stramonium      (Thorn Apple).
HABITAT, ETC.-This is an annual plant, growing in
various parts of Europe, Asia, and North America, in rich
soils or on manure heaps. Every part of the plant, but
especially the seed, yields the medicinal product.   A
yellowish tincture is made of the seeds, or a dark green one
of the fresh plant before it flowers.
PROMINENT USES.-Dementia, especially of drunkards;
delirium; illusions of the fancy; mania ferox; mania
saltatoria; monomania religiosa; lascivious mania; typhus
fever with delirium; illusions of sight and anxiety; hydrophobic convulsions;   hysteric spasms and convulsions;
puerperal mania or convulsions.
RESPIRATORY GROUP.--Asthma, with spasmodic constrictriction across the chest, and small quantities of viscid
mucus. It has been recommended to smoke Stramonium
like tobacco.
Stramonium is employed for many symptoms so closely
resembling those for which Belladlonna is given, that it is
not always easy to define the indications which distinguish
these remedies.
50.-Sulphur (Flores SuJphiuis).
HISTORY, ETC.-Sulphur is an elementary body, and is
either a volcanic produce, being found in considerable quantities, in a native form, near volcanoes, in amorphous masses,
or in the form of crystals, or it occurs in beds in many parts
of the world. It is also a constituent element of various
organic substances, as albumen in eggs, etc., in some plants,
but most abundantly in minerals and in mineral waters.



572


5MATERIA MEDICA.


It is frequently found in combination with metals, as in the
common ores called pyrites, the sulphurets of iron, lead,
copper, etc., whence it is obtained by roasting.  It is of
a pale-yellow colour, insipid and inodorous, insoluble in
water, slightly soluble in alcohol, but more freely soluble in
ether. In homoeopathic practice, we use either a trituration
or tincture.
MEDICINAL ACTION.-In allopathic doses (gr. x.-gr. xxx.)
Sulphur is diaphoretic and alterative, and in larger doses
laxative. It operates specifically upon the mucous membrane of the intestine. It is absorbed into the system, and
may be detected in the various fluids of the body; a large
portion passes off by the bowels, part is oxidized and converted into sulphuric acid, which is eliminated by the kidneys; and another portion passes off by the skin in the form
of sulphuretted hydrogen. In the last way it proves useful
in cutaneous diseases. Under the continued use of small
doses, it stimulates the various secretions, particularly of
the skin and mucous membranes (TWaring). Administered
in the above fashion, sulphur is attended with many disagreeable circumstances, and is less efficient as a curative
agent, small doses being better appropriated by the system,
and producing more lasting results.
PROMINENT USEs.-Sulphur operates specifically upon the
skin and mucous membrane, and also, but in a less marked
degree, upon all parts of the animal economy. It is a
remedy of prime importance in maladies originating in any
constitutional cachexia, whether from scrofula, bad air, bad
food, or the abuse of mineral drugs, such as mercury. In
all deep-seated chronic maladies it is of essential service,
either as the chief remedy or as an adjunct to others.
Hahnemann placed Sulpkur in the foremost rank of his
antipsorics.
Sulphur is often useful where other medicines, although
clearly indicated, do not effect the necessary improvement;



SULPHUR.


573


in such cases, a dose or two of Sulphur will often arouse the
dormant nervous energies, and render the system susceptible
to the action of the medicines indicated.
SKIN.-Here Sulphur occupies a very high, if not the
highest, rank. Herpes and eruptions of various kinds,
burning and itching, or dry and scaly eruptions; itch;
intolerable itching relieved by scratching; ulcers; chilblains; boils, especially on the nates; chronic and oftrecurring erysipelas; glandular swellings; partial perspirations, chiefly on the head; scald-head; excoriations of infants.
FEvER.-Intermittent fever of patients troubled with
various skin affections; hectic fever, with sour or fcetid
night sweats.
EYES, EARS, ETC.-Purulent discharge from    the eyes;
strumous ophthalmia with thickening of the mucous membrane of the lids; inflammatory swelling or ulceration of the
eye-lids. Deafness with noises, itching, or dampness of
the ear. Scrofulous swelling and ulceration or inflammation
of the nose: depravation of smell; coryza.
RESPIRATORY GROUP.-Chronic catarrh; epidemic influenza; chronic cough, with expectoration of thick phlegm or
purulent mucus; chronic hooping-cough; scrofulous consumption; chronic pneumonia; chronic hmmoptysis; rush
of blood to the chest; palpitation and abnormal irritability
of the heart.
DIGESTIVE GRoUP.-Chronic indigestion, with a sour, bitter,
and insipid taste in the mouth; heartburn, nausea, eructations, etc.; flatulence; chronic constipation; insufficient,
knotty, or hard evacuations; alternate diarrhoea and constipation; chronic diarrhoea; piles; soreness and itching of
the anus; worm colic. Liver complaints.
GENITO-URINARY GROUP.-Incontinence of urine; frequent
urging to urinate; irritable bladder; wetting  the bed,
especially children troubled with worms. Chronic slimy,



574


5MATERIA MEDICA.


burning, or painful leucorrhoea; itching and soreness of the
parts; irregular menstruation; prolapsus of the uterus;
miscarriage; weakness of the sexual organs, as a symptom
of scrofula.
CHARACTERISTIC FEATURES.-Sulphur is pre-eminently indicated in diseases affecting patients previously troubled
with eruptions, ulcers, or sores, or in diseases traceable to
the scrofulous element in the constitution. The pains are
worse at night, from the heat of the bed, and in changeable
weather, particularly in cold and damp, but are mitigated by
warmth of the room.
51.-Veratrum     Album   (White Hellebore).
HABITAT, ETC.-This plant is indigenous to the mountainous districts of Europe, and is found in great abundance
on the Alps of Switzerland. We prepare the strong tincture
from the root, collected in July, dried and pulverized.
PROMINENT USES.-In poisonous doses, its action is rapidly
extended to the organic system of nerves, inducing vomiting,
diarrhoea, reduction of the animal temperature, sensation of
great discomfort and anguish, lowers the action of the heart,
and impedes the breathing. Its influence being directly
exerted upon the brain and spinal nerves, spasms, convulsions, paralysis, delirium, etc., are rapidly produced. Hence
its beneficial action, in homceopathic doses, in Asiatic cholera,
in which disease it is one of our most reliable remedies;
diarrhoea and painful gripings; convulsive stage of hoopingcough; cramps in the bowels or limbs; paralytic pains in the
extremities; vomiting of food and drink; black-vomit;
extreme weakness; faintness; convulsions, etc.
FEVERS.-Remittent fever with a tendency to the fyphoid
variety; cold sweat; coldness of the body with internal
heat; great prostration with nearly imperceptible pulse.
HEAD.-Nervous headache, with nausea, vomiting, and



VERATRUI ALBUBI.


575


paleness of the face; vertigo, with fainting, prostration,
obscuration of vision; headache when stooping or walking;
cold perspiration on the forehead; acute hydrocephalus, with
vomiting on raising the head.
MENTAL GROUP.-Different forms of mania, especially
amorous or religious; brief attacks of delirium and mania
from paroxysms of pain; defective memory; confusion of
intellect; consequences of fright; low, desponding spirits.
FAcE.-Hippocratic countenance, with pointed, icy-cold
nose, sunken cheeks, blue lips, etc. Toothache with nausea,
vomiting, coldness, and great weakness; cold tongue.
EYES, ETO.-Contraction or excessive dilatation of the
pupils; paralytic condition of the lids; black spots and
sparks; double vision; nocturnal blindness; dryness, soreness, or ulceration of the nose.
RESPIRATORY   GROUP. - Suffocative paroxysms in tlle
thlroat; tenacious mucus, impeding the breathing; suffocating cough; hooping-cougk, with blue face, often causing
an involuntary escape of urine; children do not recover their
wonted cheerfulness and brightness between the paroxysms,
are.unable to hold tleir heads erect, are averse to conversation, and complain of chilliness, symptoms which are not
present when ]Drosera is indicated.  Spasmodic asthma.
Palpitation of the heart, with great anguish and oppression
in that region.
DIGESTIVE GROUP.-Extreme nausea and vomiting, excited by movement, or by swallowing fluids, with excessive
thirst; black vomit; cholera infantum; diarrhcea from cold
drinks; Asiatic cholera, with symptoms of paralysis and
asphyxia, insatiable thirst for cold water, a shrivelled appearance of the skin, pinched face, cold tongue, etc.
Violent cramp, with severe cutting pain in the stomach;
greenish, blackish, watery, or involuntary diarrhoea; nocturnal diarrhlea with great prostration.



576:


MATERIA MEDICA.


URINE.-Acrid, burning urine; desire to pass water even
when the bladder is empty; involuntary passage of urine;
urine diminished.
TRUNK AND EXTREMITIES.-Coldness of the whole body;
general cold sweat; epilepsy; general weakness and faintness; paralytic, bruised pain in the back and extremities;
cramps in the calves of the legs; tetanic spasm with flexure
of the fingers and toes; trembling, debility, coldness and
numbness of the hands and feet.
Antidotes.
In the event of an over-dose of any of the above medicines
having been administered, two drops of the Tincture of
Canmphor (page 514), or a strong infusion of coffee, will
arrest any unpleasant consequences.    Antidotes against
poisonous doses are suggested under some of those remedies
the action of which is most dangerous. For the general
treatment of cases of poisoning, the chapter on "Toxicology" may be consulted in the larger edition of this
work.



CALENDULA OFFICINALIS.


579


are cut or lacerated rlther than bruised, witl or without much
heamorrhage.  It deserves preference in all cases of injury in
constitutions liable to erysipelas.  Arnica is more adapted to
contusions, bruises, and sprains.
PROMINENT USES.- Wounds penetrating tle joints; cuts,
whether accidental or inflicted in operations, and injuries
generally in which the lesh is much torn, and which do not
heal without the formation of matter. In such cases it is
preferable to Arnica, and often heals wounds without leaving
any very obvious scar, and the formation of matter, if not
altogether obviated, is greatly modified.  It relieves the
severest pains attending various accidents.  It is an invaluable remedy in ulcers of the. lower extremities, such as
often occur in broken-down constitutions, especially in the
decline of life.
FORMULA.-A lotion may be made by mixing twenty drops
of the tincture in about a teacupful of water. If the bleeding
is considerable, tlle lotion may be made much stronger.
4.-Tincture of Rhus Toxicodendron.
(For its internal uses, see page 564-5.)
PROMIINENT UsEs.-TlJis is an extremely efficacious remedy
as an external applicition in srains, ijuries to ligamJzents,
tendons, joints, and the membranes investing the joints.  It
is especially indicated in sprains in which the rigidity and
pain are most severely felt on first moving the affected parts
after rest. The pains are also worse at night while at rest.
For injuries of this character, it will generally be found more
suitable than Arnica. In oll chilblains, with smarting, itching, and irritation of the skin, it may be applied with great
success.  Warts are often successfully treated by touching
them once or twice a day for a week or two with the strong
tincture.
FORMULA.-A lotion may be made by adding twenty drops
of the strong tincture to a tumbler of pure water.



580


MATERIA MEDICA.


Genuine Medicines.
To obtain a beneficial action from the remedies prescribed
in this Manual, it is best to obtain them from an educated,
trustworthy person, who is exclusively occupied as a Homceopathic chemist. As a safeguard, clergymen, missionaries,
emigrants, and persons remote from Homoeopathic institutions, should consult a medical man before purchasing, who
will be able to direct them where to procure reliable medicines, and to suggest hints as to the remedies, and the forms
of them, most likely to meet special requirements.:~~~~~~~~~L



582


ARD WORDS.


ANEMIA, (a-ne'-me-a).  Deficiency or poverty of blood.  The blood contains
too few red corpuscles, so that on analysis it is found to contain only 80 or 60,
or even in severe cases 30 per 1000, instead of, as in health, 120 or 130.  (See
pages 381-2.)  Death by ancemnia occurs in this wise: a person loses blood
from a wound, or by haemorrhage in disease, to such an extent that fainting
takes place; and if the discharge is not arrested, the state of faint continues,
and the heart's action finally ceases, because its natural stimulus, the blood,
does not enter it in sufficient quantity. The symptoms indicating this mode
of dying are, paleness of the lips and countenance, cold sweats, dimness of
sight, dilated pupils, a weak, slow, irregular pulse, insensibility, and in sudden
and violent lhemorrhage, as in "flooding," nausea, or even vomiting, and convulsions, before death.  The recognition of these symptoms is sometimes very
important, as fatal hemorrhage may be taking place into one of the internal
cavities of the body of which we may have no other evidence.
ANESTHESIA (an-es-the'-zhe-a). Total or partial deprivation of the sense of
feeling.  The chief ansesthetic agent now in use for producing insensibility to
pain is CHLOROFORM, which was discovered in 1831; but its anesthetic properties were only made known in 1847, by Professor Simpson.  By the mere
breathing of this subtle vapour for a brief interval, the patient is lulled into
a caln sleep, and complete insensibility produced, allowing the surgeon
deliberately to perform any, even the most severe, operation. Anesthesia
is a brilliant discovery, saving an untold amount of bodily suffering, a
greater weight, probably, of mental agony in dreaded prospect of the operatiou, and accelerating recovery by mitigating the force of the shock of
an operation to the nervous system. If proper precautions are taken, and
due care observed, untoward consequences are extremiely rare.   We have
been present at many hundred operations in which chloroform has been adninistered without ever witnessing any injurious result from its use. So
potent a drug, however, should never be administered except under the
personal supervision of a medical man. Local anesthesia may be produced
by intense cold, such as applying pounded ice to the skin. At present, however, Dr. Richardson's narcotic spray as a means of producing local insensibility
to pain is being used, and, in many cases, answers well. The narcotic spray
blanches the skin in one or two minutes, and permits more than merely superficial incisions to be painlessly made. It is particularly useful in opening
abscesses and carbuncles, removal of tumours, etc. This method of producing
anesthesia is only in its infancy, and it is impossible at present to predicate
the uses to which it may be applied; this much, however, is certain, it
renders the use of chloroform unnecessary, and consequently improper, for
minor surgical operations, during the performance of which the greatest
number of accidents from clforoform have occurred.
ANOREXIA (an-o-rcx'-e-a).  Loss of appetite irrespective of dislike to food.
It is generally a symptom  of disordered digestion, requiring the measures
recommended under "Indigestion."
APHONIA (af-o'-ne-a).  Loss of voice. Often a symptom of acute or chronic
affections of the throat, resulting from a cold. The chief remedies are, Hepar
Sulpkh., Carbo Veg., Puls., and Phos.
APHRODISIACS (af-ro-diz'-e-aks).  Medicines which increase the functional
activity of the generative organs.
APNCEA (ap'-ne-a).  Privation of air; suffocation.  It is that state of suspended animation which is induced by the stoppage of the act of inspiration
by mechanical or chemical agents, as hanging, drowning, the inhalation of
irrespirable gases, etc.



HARD WORDS.


583


ASPHYXIA (as-fix'-e-a). Suspended animation. It has the same meaning
as apunoa, but is less expressive of the mode of death indicated.
AREOLAR TISSUE (a-re'-o-la). This is composed of a network of delicate
fibres and bands which interlace each other in various directions, forming
spaces or areolae, which communicate freely. In the meshes of this tissu.,
fat is widely distributed through the body.    Fat may be said to consist of a
multitude of cells, filled with oily matter of the ordinary temperature of the
body, and united together by bands of this tissue. This tissue serves as a
protecting medium to subjacent parts; being a fluid and not a solid, it obeys
the laws of fluids, diffusing pressure and breaking the force of shocks by distributing it over a wider surface. It fills up interstices which would otherwise
exist in various parts of the body, at once separating and uniting the various
structures, while at the same time it facilitates motion.
ARTHRITIC (ar-thrit'-ik).  Gouty affections of the joints.
ARTIn-RIT  (ar-thri'-tis).  Rheumatic or gouty inflammation of a joint.
ARTICULAR (ar-tic'-u-lar).  Relating to joints, as articular rheumatism.
ARTICULATION (ar-tic-u-la'-shun).   The mechanism of joints.
ASCITES (as-si'-teez). Dropsy of the abdomen, or more strictly of the peritoneum. The abdomen becomes equally distended with fluid, fluctuates, and
this condition is generally preceded by impaired health, cedema of the legs, etc.
ATroPHY (at'-ro-fe). The wasting of an organ or body. It results from
disuse, a defective supply of blood, or of blood lacking materials necessary for
healthy growth, or of deficient vitality from disease, exhaustion, starvation,
etc. It is the reverse of hypertrophy, which see.
BRONCHIAL TUBES. The divisions and subdivisions of the windpipe, which
ramify and convey air to every part of the lungs.
CACHEXIA (ka-kex'-e-a). A bad condition or habit of body.
CADAVEROUS (ka-dav'-er-us). Having the appearance of a corpse; pale, wan.
CAPILLARIES (from capillus, a hair).    Minute, hair-like blood-vessels, the
minute ramifications of arteries terminating on the surface or in the internal
cavities of the body.
CAPILLARY. Hair-like.
CATALEPSY (kat'-d-lep-se). Suspended voluntary motion, sensibility, and,
for the most part, mental power, so that the patient remains speechless,
motionless, and senseless, while the action! of the heart and lungs continues.
CHOREA (ko'-re-d). St. Vitus's dance. A disease characterised by convulsive
movements of the limbs, occasioning ludicrous and involuntary gesticulations,
there being only incomplete subserviency of the muscles of this class to the
will.  It has been wittily termed insanity of the muscles. The leading causes
are, fright, irritation from  dentition or worms, onanism, deranged uterine
functions, hysteria, and descent from nervous, hysterical women. This brief
enumeration of causes may suggest the appropriate treatment.
CIcATRIX (se-ka'-trix). A scar or seam remaining after a wound or ulcer.
CICATRIZATION (sik-a-tre-za'-shun). This is the natural process of healing
a wound or ulcer, and consists in the absorption of inflammatory products, the
effusion of fresh fibrine, from  which material fibrous tissue, covered with
cuticle, closes over the sore, leaving a sear, which is the new skin formed
over the surface. This new, is much inferior to the old, skin of the body, being
less nourished by blood-vessels, less sensitive, less elastic, is without sebaceous
follicles, sweat-glands or hairs, and is of less vitality, so that it readily ulcerates under pressure, or even during a defective state of the general health.
CoMA (leo -ma). A morbid disposition to sleep, from some cerebral mischief,
in which the power of voluntary motion, sensation, and thought, are suspended.
It may be due to apoplexy, a large dose of opium, intoxication, etc.



584                           HARD   WORDS.
CONGESTION. Excessive fulness of the blood-vessels of some particular
organ.
CONTAGION (kon-ta'-je-on). The communication of disease by contact. A
disease is contagious when it may be communicated by infected persons to persons in health, as small-pox, scarlatina, measles, typhus, etc.; diseases which
are destitute of this property,-ague, influenza, etc,-are termed non-contagious.
DEGENERATION. A morbid change in the structure of parts, by the substitution of a lower for a higher form of tissue, as in the development of a
fatty, in place of a muscular, tissue. The most frequent example of this
occurs in fatty degeneration of the heart.
DESQUAMATION (desqLudmo, to scale fishes.) The separation of lamince or
scales from the skin or bones.
DIAGNOSIS (di-ag-no'-sis). The science of distinguishing the signs or symptoms by which a disease is known or distinguished from another-a science
which can only be acquired by long study and practical observation.
DIATHESIS (di-ath'-e-sis). This word is used in this work to express a particular constitutional tendency, hereditary or acquired, to certain diseases.
The chief diatheses are the scrofulous, consumptive, rheumatic, gouty, and
cancerous.
DROPSY (drop'-se). This is a serous or watery accumulation in one or more of
the natural or serous cavities of the body, and is probably due to a want of
harmony between the two processes of exhalation and absorption. If the watery
accumulation take place in the ventricles of the brain, it is called hydrocephalus;
if the membrane that lines the surface of the lung is distended with fluid, we
express the condition by the term hyrrothorax; if the membrane of the heart,
hydropericardiz m; if the membrane of the intestines, ascites; if of the testicles,
hydrocele.
In health, there is a gentle and uninterrupted oozing forth of fluid, just sufficient to allow of the free motion of the membranes and their contained
organs; if this fluid is arrested (as in inflammation), pain or adhesion may
result; if it take place in excess, or if exhalation takes place more rapidly
than absorption, dropsy results. (See also " (Edema.") We have not included
dropsy in our list of diseases in this work, because it is rather a symptom or
consequence of other disease, than a disease per se. Arsen., Bry., China,
and Hell., are the chief remedies in this condition.
DYSPNcEA (disp-ne'-a). Literally, difficult breathing, from organic or functional change, deranging the natural proportion between the quantity of atmospheric air that reaches the lungs, and the quantity of blood sent to them
from the right side of the heart to be arterialized. (See pages 41, 144, 148).
EccnHYiosis (ek-ke-mo'-sis). Discoloration of the skin from   extravasated
blood. (See page 413).
EFFETE (ef-fete'). Worn out; having lost the power of production.
EMMEN.AGOGUES (em-en'-o-goges). Medicines to bring on the menstrual
discharge.
ENCEINTE (ang-sainte'). Pregnant.
ENDEMIC. Peculiar to a people or locality. Endemic diseases result from
such conditions or agencies as are peculiar to a locality. These endemic
influences are, for the most part, exerted by the geological properties of a
district, and are traceable to the constitution and state of the soil, water, and
air; to elevation above the level of the sea, vicinity of sea, rivers, or stagnant
water, woods, and vegetation; variation of temperature, prevalent winds; in
connexion with avocations, modes of life, quality and quantity of food, indo



HARD    WORDS.                           585
lence or activity, ignorance or mental culture, and, lastly, the political, social,
moral, and religious conditions of the people.*
EPHEMERAL (e-fem'-e-ral). Diurnal; beginning and ending in a day;
short-lived.
EPIDEMic (from two Greek words, among and people). An epidemic is a
disease depending probably upon the absorption of some poison, or the action
of some "influence," from without, which for a time prevails widely among a
people, and afterwards partly or wholly disappears. As secondary results of
these general disorders, the respiratory organs are most frequently involved,
especially during very cold or damp weather, or during sudden and extreme
variations of temperature. At another time the force of the epidemic is expended on the head, affections of which then predominate; or, again, on the
alimentary canal. Ill health always favours the reception and activity of the
epidemic influence.
EPTSTAXIs (e-pis-tak'-sis). Bleeding at the nose.
EXUDATION (egz-u-da'-sJun). The separation of certain substances, humours,
or moisture from the blood, either on the surface or in the substance of organs.
FOMITES (pl. of fomes). Clothing or other materials imbued with contagion.
FONTANEL (fon'-ta-nel). Spaces between the bones of the infant head. The
bony structure which encloses the brain is originally composed of many distinct
bones simply connected by membrane, so that the separate bones can overlap
each other to some extent and thus facilitate parturition. For some time after
birth, portions of the skull-cap remain united by membrane only, as may
be easily proved by feeling the head of an infant. Here, as in the former
instance, we are struck with the evidence of wisdom and goodness in the
formation of man. A yielding, elastic animal membrane interposed between
the bones encasing so important an organ as the brain, breaks the force of
shocks and prevents jars to the brain, to which the helpless infant is so much
exposed. It is those unossified parts which are called "fontanels," from the
rising and falling of the brain beneath them, like the bubbling of a spring
As the child grows, and can extend the arms and otherwise defend the head,
the edges of the bones approximate and dovetail together, forming a solid dome
of bone.
GANGLION. This is an encysted tumour formed by the sheath of a tendon,
or by a new cyst developed in one of the fringes of the synovial sheath, or by
a bursa, whether original or created by friction. It contains clear synovia.
The ordinary causes are twists, strains, pressure, or friction.
GANGRENE (gang'-grene). Mortification of a portion of a living body. This
condition is called gangrene only in its first stage, and when it becomes comSplete and hopelessly irremediable, it is called sphacelus.
GANGRE-NA SENILTS. Dry gangrene of aged persons, commonly resulting
from ossification of the arteries, and the stagnation and coagulation of the
blood consequent on that change.
GENERIC (je-ner'-ik). Pertaining to the same genus or kind.
IHEMOPTYSIS (he-mnop'-te-sis). Spitting or coughing up of blood.
HIEMICERANIA (hem-e-kra'-ne-a). Headache affecting one side of the brow
and forehead. It has been called sun-pain, because it frequently continues
only as long as the sun is above the horizon. It is generally attended with
sickness, is often periodical, and like other forms of neuralgia, most frequently
results from debilitating causes. Malaria is often a cause, and sometimes it
occurs in connection with hysteria.
* See Aitken's Science and Practice of Medicine, Vol. 1.
2P



INDEX.


593


Clonroform, 582
Cholera (Asiatic), 238-44; sanitary and
hygienic measures, 243; testimony,
240
Chordee, 281
Chorea, 583
Chronic bronchitis, 147-8; abscess, 396;
rheumatism, 461-3; inflammation of
liver, 256-8
Churches, badly ventilated, 21-2
Chyle, 194
Cicatrization, 583
Cina, preparation and uses, 523-4
Clavi pedis (corns), 409-10
Cleanliness, in sickness, 68-9, of the legs,
404
Clergyman's sore throat, 132-5
Clergymen, longevity of, 34; weekly holiday, 134-5
Climate of Victoria, 188- of Britain not
more productive of scrofula than
others, 442
Clothing, 25-9; in consumption, 185; of
scrofulous patients, 447
Cocculus, history, uses, etc., 424-5
Cod-liver oil, 184, 447, 391; modes of
administering, 184
Coffaea, history, uses, etc., 525-6
Coffee as an antidote, 526
Cold, how it kills, 484
Cold in the head, 122- causes of, 123;
how to fortify the body against cold,
127-8
Cold bath, 29, 128, 185
Colic, 222-5; painters', 225-6
Collapse, 424
Colliquative diarrhoea, 93, 230
Colocynthis, geography, properties, and
uses, 526-8
Coma, 59, 320, 583
Coma-vigil, 80
Compress for the throat, 133-4; abdomen,
221, 266; in deafness, 347; in prurigo, 387
Concussion of the brain, 422-3
Confined bowels (see Constipation)
Congestion in typhoid fever, 63
Congestive headache, 313
Constipation, 214-22; an effect, not a
disease, 216; brown bread, 220-1;
compress, 221; injections, 222; purgatives in, 217; treatment, 218-22
Consumption, 173-90; definition, 173;
pathology, 174; symptoms, 175-7;
diagnosis, 178; signs, 178-9; causes,
179-80; duration, 180-1; medicines,
181-3; accessories-food, 183-5;
clothing, 185h bathing, 185-6; exercise, 186-7; air, 187; climate, 187-9;
general hints, 190


Consumption of the bowels, 451-3
Contagion, 584
Contusions, 412-3
Convalescence, appetite in, 73-4, 205
Convulsions (teething), 363-6
Cooking animal food, 13-6
Corks, 50-1
Corns, 409-10; soft, 410
Corpulence, 587
Coryza, 122
Cotton wool in burns, 418
Cough, 135-9; preventive measures, 139;
hooping-cough, 139-44
Crepitation, minute, 159
Cretification, 174, 443
Cretinism, 374
Croup, 160-6; spasmodic, 160; inflammatory, 161; dangers of, 162; treatment, 163-5; preventives, 165-6
Croupy cough, after scarlet fever, 107
Cuprum   Metallicum, its history, uses,
etc., 528-9
Cutaneous diseases, 386-412; erysipelas,
119
Cuts, 417
Cynanche parotidea; 372-4; tonsillaris,
369-72; trachealis, 160-6
Cystitis, 274-5
Dandriff, 393-4
Dead, the apparently, how to restore,
424-30
Deafness, 345-7; classified treatment,
346-7
Death, by ancmia, 582; painless, 485;
signs which indicate, 430
Decay of the- aged, 478-86; gradual,
482
Degeneration, 584
Delirium tremens, 295-9
Dentition (see Teething)
Derbyshire neck, 374-6
Diarrhcea, 226-33; colliquative, 93-4;
often a symptom of other disease,
230; during teething, 362-3
Diathesis, 584
Diet for the day. 9-11
Difficult breathing (see Asthma, Bronchitis, etc.)
Difficulties of prescribing, 488
Digestion, 193-4; diseases of the organs
of, 194-253
Digitalis, its history, action, and uses,
529-30
Dinner, best time for, 10
Diphtheria, 166-73; symptoms, 166-7;
dangers, 167; diagnosis, 167-8;
treatment, 168-72; preventives, 173
Directions respecting doses, etc., 49



INDEX.


595


Giddiness, 312
Glandular swellings, 107, 369-71, 442-3
Globules, 45
Globus hystericus, 288
Goitre, 374-6
Gonorrhcea, 280-4; complications of,
281-2; treatment, 282-4
Gonorrhmal ophthalmia, 329
Goose-skin, 86
Gout, 464-73; definition, 464; symptoms, 465; chalk-stone deposits, 466;
causes, 467; how it differs from rheumatism, 469; treatment of, 469-71;
prevention of, 471-3
Granular eyelids, 339
Graphites, its uses, etc.,. 534-5
Grief, effects of, 285
Gripes, 222-5
Guinea worm, 245
Gumboil, 358
Gum-water, how made, 191
Gutta serena, 335-9
Habits, general, 203, 317-8
Hwmatemesis, 434
Hoematuria, 436-9
Heemoptysis (spitting of blood), 434-6;
in consumption, 176
Hoemorrhage (see Bleeding); in typhoid,
62
Haemorrhagic diathesis, 439
Hemorrholds (see Piles)
Hair, loss of, 392-3; its uses, 134
Half-holiday, 318-9
Hall, Dr. M., 427; on Ipecacuanha, 544
Hamamelis, 264, 384
Harelip, varieties of, 354-5
Hats, causes of baldness, 393
Hay fever, 95
Head, affections of, 284-324; cold in the,
122-8
Headache, 312; congestive, 313; gastric
or sick, 312-3; hysterical, 315; nervous, 314; table of various kinds of,
314-5; prevention of, 317-9
Health and occupations, 34-8
Hearing, hardness of, 345-7
Heartburn, 207-8
Heart-complications in rheumatism, 457
Reart-diseases, 530
Heart, palpitation of, 377-9; organic and
functional disease of, 377-8; weakened in the aged, 479-80
Hectic fever, 93-5, 176; diarrhlea, 230-1
Helleborus Niger, its history, uses, etc.,
535-6
Helmenthiasis, 245
Hemicrania, 314, 585
Hemiplegia (paralysis), 323-4
Hepatitis, 253-8


Hepar Sulphuris, its preparation, uses,
etc., 536-7
Hepatization, 159
Herpes circinnatus, 390-1
Hints on nursing, 67-74
Hints to the reaaer, x.,-xii.
Hip-joint, disease of the, 453-4
Hoarseness, 130-2; in croup, 161; of
clergymen, singers, etc., 132-5
Homeopathic provings, 588; remedies
not poisonous, 487
Homeopathy not a mere system of dietetics, 9; its success in violent diseases, 238-40
Hooping-cough, 139-44; complications
of, 141; pathology of, 141
Hordeolum, 340
Hot, dry skin, 42
Humming in the ears, 347
Hunger, physiology of, 201
Hurried meals, 200, 203
Hydatids, 247
Hydropathic applications in typhoid fever,
69-70; in constipation, 221; in sore
throat, 133; rheumatism, 460-1
Hydrophobia, 306-11; symptoms of, in
the dog, 307-8; in man, 308; precautions against, 311
Hydrothorax, 154
Hygiene, 9-38
Hyoscyamus Niger, its history, uses, etc.,
537-9
Hyperoamia, 586
Hypochondriasis, 286-7
Hysteria, 287-94; definition, 287; extent
of, 289-90; points of resemblance to
epilepsy, 290; causes, 291; treatment, 291-4
Hysterical headache, 315
Icterus (jaundice), 258-60
Idiopathic erysipelas, 118
Ignatia Amara, its history, uses, etc., 539
Incontinence of urine, 276; in children,
277-8
Incubation, 586
Incubus (nightmare), 208-9
Indigestion, 194-203; causes, 195; treatment, 196-9; accessories-mastication, 199-200; over-repletion, 200;
suitable food, 200-1; drink, 201-2;
disposition, 202-3; habits, 203
Industry conducive to health, 37
Infantile convulsions, 363-5
Infants' food, 354, 365, 451
Inflammation of air-tubes, 144; bladder,
274-5; bowel, 234; eyes, 107. 325;
glands, 372; kidneys, 272-4; lungs,
157-60; pleura, 153-7; throat,
369-72; urethra, 280-4



596


INDEX.


Inflammatory fever, 53-6
Inflatio, 213
Influenza, 128-30
Ingesta, 207, 5S6
Ingravescent apoplexy, 320
Inhaling in bronchitis, 147; croup, 165;.
diphtheria, 171; quinsy, 371
Injections, 192, 222; in worms, 252; in
piles, 266
Injuries (see Accidents)
Innocent tumours, 589
Insects, stings of, 514
Intermittent fever (see Ague)
Intestinal worms (see Worms)
Intussusception, 223, 586
Iodine in diphtheria, 168-70
Iodium, its properties, uses, etc., 541-2
Ipecacuanha, its history, action, uses,
etc., 543-5
Iritis, traumatic, syphilitic, rheumatic,
etc., 334-5
Irritability of the bladder, 276-7
Irritation of the skin, 386-7
Iron (see Ferrum), 532
Itch, 387-8
Itching of the skin, 386-7
Jaundice, 258-60
Joy, effects of, 285
Kidneys, inflammation of, 272-4
Lead colic, 225-6
Lead, 561
Ledum Palustre, 514
Legs, ulcers on, 404
Lemonade, nitric, 191
Leucorrhaea, 441, 448
Ligatures, 416
Light, 22-4
Linseed tea, 191-2
Lip (see Harelip)
List of medicines, 46-7
Liver, diseases of, 253-60; inflammation
of, 253-6; complaint, 256-8
Liquor amrnii, 586; sanguinis, 586
Loins, pain in (lumbago), 464
Looseness (see Diarrhea)
London, Great Fire of, 238, 518
Loss of blood, 430-9; of hair, 392-3; of
teeth, 200; of appetite, 204; of
voice, 130
Lowness of spirits, 286-7
Lumbago, 464; and nephritis, 273
Lumbrici, 246-7
Luncheon, 10
Lungs, inflammation of, 157-60; symptoms, signs, treatment, 158-60


Lycopodium Clavatum, its history, uses,
etc., 545-6
Malaria, 89; laws of, 87-8; effects of, 88
Malignant cholera, 238; scarlatina, 103;
tumours, 589
Mammary abscess, 396
Mania a potu (see Delirium tremens)
Marasmus, 444, 451
Market-garden vegetables and worms, 249
Mastication of food, its importance, 199
Materia medica, 487-580
Measles, 97-10; sequele of, 100
Medicine cases, 50
Medicines, 45; list of, 46-7; directions for
taking, 48; the dose, 49; repetition
and alternation, 49-50; genuine, 580
Mental disorders 284-99; fatigue, 285;
emotions and diarrhcea, 229
Mercurius Corrosivus, its properties, uses,
etc., 546-7
Mercurius Solubilis, its properties, uses,
etc., 547-50
Mercurius Vivus, 548
Mesenteric disease, 451-3
Metastasis, 372
Miasm, 89
Milk, diseased, 365-6; in fevers, Z1
Milk-teeth, order of their appearance, 361
Millar's asthma, 153
Moderation, in consumption, 190
Morbilli, 97
Morbus coxse, 453-4,,  cholera (see Asiatic)
Mouth, diseases of the, 351-63
Mumps, 372-4
Muscae volitantes, 61, 505
Muscles of the aged, 479
Muscular pains and rheumatism, 462
Myeletis, 324
Natural decay, 478-86
Nausea marina, 211-3
Nephritis, 272-4
Nervous headache, 314; toothache, 356;
system, shock to, 424; pain, 42;
symptoms in typhus, 79
Nettle rash, 389-90
Neuralgia, 473-8
facia, 473
Neuralgic toothache, 356
Nightmare, 208-9
Nitre, fumes of, in asthma, 152-3
Nitric acid lemonade, 191
Nitricum Acidum, its preparation, uses,
etc., 551-2
Nitroginous food, 201
Nipples, sore, 577
Nose bleeding, 431-4; polypus of, 366-7
Nostrils, plugging the, 433



INDEX.


597


Nursing, hints on, 67-74
Nux Vomica, its history, uses, etc., 552-5
Obesity, 587
Occupations and health, 34-8
Odontalgia, 356-60
(Edema, 381, 383, 587
Offensive breath, 351-2
Old age and senile decay, 478-86
Onychia (whitlow), 407-8
Ophthalmia, catarrhal, 325-6; strumous,
326-7; infants', 327-8; purulent,
328; gonorrhceal, 329; medicines
suited to different forms of, 329-32;
leading medicines in treatment of, 331
Ophthalmia neonatorum, 327-8; tarsi,
339.
Ophthalmoscope, 337
Opium, its uses, etc., 555-7; smoking,
5.55
Orchitis, 281
Organs of breathing (see Breathing,
Lungs); of digestion (see Digestion
and Indigestion)
Otalgia, 342
Otitis, 342
Otorrhcea, 344-5
Over-exertion, 421
Overloading the stomach, 200
Ozcena, 367-8
Pack, wet, 33
Pain, its indications, 42 (see Colic, Lumbago, Neuralgia, etc.)
Palpitation, 377-9
Paralysis, 323-4
Paralytic stroke, 323
Paregoric, 556
Pariplegia, 324
Parotitis, 372-5
Passion, effects of, 285
Percussion, 155, 159, 178
Pericarditis in rheumatism, 457
Perniones, 405-6
Perspiration, 43, 86
Pertussis, 139-44
Peruvian bark, 521-3
Phimosis, 281
Phlegmonous erysipelas, 119
Phosphorus, its properties, uses, etc.,
557-9
Phosphori Acidum, its preparation, uses,
etc., 559-60
Phthisis, 173-190,.   mesenterica, 451-3
Physcians often short-lived, 34-5
Physicking children, 449
Physiology, 587
Pigeon-breasted, 449
Piggeries in Ireland, 249-50


Piles, 260-7; varieties of, 261; treatment
of, 263-7; injections for, 266
Pilules, 45
Pimples, 394-5
Platina, its properties, uses, etc., 560-1
Pleura, inflammation of the, 153-7
Pleurisy, 153-7; false, 157
Pleuritis, 153
Pleurodynia, 157
Pleuro-pneumonia, 158
Plugging the nostrils, 433
Plumbum, its uses, 561
Pneumonia, 157-60
Poison, cholera, 240-1
Poisoning, narcotic, 514
Podagra, 464-73
Polypus of nose, 366-7
Poppy, the, 555
Poultices for abscesses, 397
Poultice, charcoal, 518
Pox (see Smallpox, Chicken-pox)
Precautions (see Sanitary Measures)
Pregnancy, voracious appetite in, 205
Professions and health, 34
Prognosis, 588
Prolapsus ani, 267-9
Prolonged nursing, 338
Prostration, 424
Provings in Homceopathy, 588
Prurigo, 386-7
Pulmonary (see Phthisis)
Pulsatilla, history, uses, etc., 562-4
Pulse, in health and disease, 38-40; in
typhus fever, 78
Purgatives, 217
Purging, 50, 214-5
Purulent (see Ophthalmia)
Pyrosis, 208, 588
Quick breathing (see Breath); pulse, 40
Quinsy, 369-72
Rabies, 306-11
Rachitis (rickets), 448-51
Rash (see Nettle)
Raucitas, 130-2
Reader, hints to the, x.-xii.
Recreation, 203, 318-9
Reflex action, 195
Relapsing fever, 57
Relaxation (see Diarrhcea)
Remedies (see Medicines)
Repetition of doses, 49
Residence, healthy, 187-89
Respiration, artificial, 424-30
Rest for the aged, 483-4
Rest for the fever patient, 68
Retention of urine, 278-9
Rheumatic headache, 315; iritis, 335;
fever, 455-61



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