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2


would have been lights in the world, if they had not, in the
outset, adopted a false faith and attempted to practice upon
a false principle. Upon a discovery of this error, they jump
to the other and greater, that there are no true principles in
medicine. To them, all are equally false. They become the
Micawbers of the profession, the expectants. He who will
honestly follow the second course, will soon discover that the
great duty of his life has been much misrepresented and
misconceived.  He is not to treat diseases, flaf2es, things,
imagined somethings, which have somehow found their way
into live humanity and made it suffer and perhaps are bringing its existence into peril. H-Ie will realize after a while,
though not perhaps immediately, that that with which he has
to do is not an entity which somehow has effected bodily
entrance into his poor patient, like demons into the possessed, though all surrounding and sympathizing friends
regard the matter somewhat so, and fully expect him to exorcise the intruder.
He will find, that what he has to treat is the patient himself, and not an extraneous intruder within him. Till he is
fully master of this fundamental principle, and in its light has
abandoned all thought of treating diseases, as something distinct from the patient, which produces suffering and danger,
he is in no way qualified for the practical duties of the
high calling to which he has devoted himself. He is to treat
sick men, women, and children,--patients, and not diseases.
It may be late in the history of practical medicine to inculcate this principle. No doubt it is.  But its truth and
importance will admit of no longer postponement. Delay
has neither diminished its truth or value. Rightly appreciated, it at once disposes of that complacent piece of arrogance which has asserted a superior science in the old school
of our profession, because that school treats diseases while
ours treats only synmptoms. This principle clearly asserts the
fact, that true science treats patients, and not diseases. It
may be, and probably is true, that the old school treat diseases, or attempt this, and think they succeed, but it is not



8


there be doubt as to which of these medicines is required for
a given case, it may help to remember that this affection
requiring Cham. is painful, and is more frequently in place
in the affections of childhood than of adult life. That for
Dulc. is attended with prostration of strength; with Puls. the
mucus is acrid;, with Pod. the diarrhcea occurs for the mpst
part mornings or forenoons, the pains in the abdomen and
back are worse during the evacuation and continue after. The
discharges are excited by eating and drinking. With Puls.
the pain is before the evacuation, is likely to be attended
with much rumbling of the bowels, and the peculiar disposition of mind so characteristic of this drug.
Yellow mucus has Dulc., Pod., Rhus, Sulph. acid.
Dulcamara is especially indicated where the color of the
slimy stools frequently alternates between green, white and
yellow,, and the desire to evacuate is attended with nausea,
or where the attack is the result of chill. Podophyllum is
called for when the yellow color is dark, and the evacuation
has the odor of carion; with Rhus the stool is mixed sometimes with blood or red slime, or consists of billious looking
matter, and all very thin.  In Sulph. acid the stools are like
chopped mucus, saffron yellow   and stringy.    The above
examples of the first step in the analysis of the evacuations in
diarrhcea are given not as instances of the completed process
in this first step, but only as illustrative of the mode of proceedure in relation to the two elements of nature and color.
It is not enough that the discharge be mucus, nor that it be
also green or yellow to decide the choice of the curative. We
must know more, even all the peculiarities of the evacuations, and much more than this, as will be seen as we
advance. For it is not to be forgotten that the object of this
paper is not so much to put into the hands of the practitioners
a " short and easy method " by which all cases can be cured
with little or no labor on their part, as to point out the way
in which they may obtain a success worthy of honest minds,
and of the system of medical science we profess to practice.
If our object were otherwise, its folly would be rebuked by



10


The discharge which in this class is peculiar to Arn.
resembles yeast or lees of beer. In Asaf. the evacuation is
extremely and nauseatingly offensive. In Graph. it is in part
made up of half digested substances, and of insupportable
fetor. Magn. c. has a liver-brown colored discharge, with
tenesmus, followed by burning in the anus. It is characteristic of this, and all the varities of diarrhcea produced by
Nux v. that the evacuations are small in quantity, they are
more frequent in the morning and after eating, and are for
the most part accompanied by tenesmus and pain in the back
of a drawing character. In this variety there is also smarting and burning in the anus. In Psorin. it is dark brown,
very thin, and offensive. In Squill. it is dark brown or even
black, slimy, very offensive, and ejected in frothy bubbles, by
flatulence, and sometimes with ascarides and whitish shredsGreen watery diarrhceas are met by Cham., Gratiola'
Magn. c., and Sulph. acid. It may not be out of place to
remark here, in relation to this class of the affections under
consideration, that it is perhaps more frequently misunderstood, and, therefore, more frequently wrongly treated than
any other. Much of the disappointment necessarily consequent on such a course, may be avoided by remembering, in
the first place, the too often overlooked, but vastly important,
necessity of making the first prescription a right one; and in
the second, that Ars. does not cure this variety of diarrhceas.
If there be any exception to this, they are cases where the
remedy accomplishes the result by virtue of its characteristic
relationship to the constitutional symptoms of the case. Of
this we may have more to say hereafter. It has not been an
unfrequent experience of the writer, to sep cases of this
variety of diarrhcea, in consultation, and among them, the
most intractable to treatment have been those which had
Ars. as their first medicament. That this has often proved a
serious embarrassment to the subsequent successful management of these cases, he has no doubt. The frequency of this
false prescription is, perhaps, explained by the force of habit.
Ars. cures so many forms of diarrhoea, that the frequent
**-**.... * 



11
demand for its use, creates a kind of habit of prescribing it.
Against this we protest.
The cases for Chanm are for the most part those of early
childhood, during the process of teething and from taking
cold. The green watery passages are often mixed with feces
and mucus. The green and frothy evacuations of Grat, may
be watery or thin fluid or slimy.  It is a remedy worthy of
more attention, in diarrhceas, than it has generally received,
especially with those of children, in the summer season.
Those of Magn. c. are preceded by pinching pains in the
bowels, especially in the right side, with distended abdomen,
are mostly in the forenoon, and may be both sour smelling
and frothy. Sulph. acid is frequently the right remedy in
this variety of diarrhcea. In the absence of the characteristic signs of the other medicines, it may be given in preference, and especially if there be great prostration of
strength with irascibility of temper.
Yellow watery diarrhoeas are met by Ars., Chin., Grat.,
H-yos. They may be found in the pathogenesis of a few
other drugs, but the four above-named are the principal
remedies, and rightly used will succeed with most of these
cases. Here, as in the brown variety, Ars. and Chin. are
near together. Both have attacks more frequent at night
and after eating and drinking, with great prostration. But
Ars. has tenesmus, Chin. has not. Ars. has thirst with
diarrhoeas, Chin. has not.  Ars. has a painful constriction
above the anus, extending to the loins. With Ars., in this
variety, the discharges are small, while in many others they
are copious. But if, as is not at all unlikely, the peculiar and
distressing restlessness so characteristic of Ars. be present in
any case, there need be no hesitation in the choice between
the two drugs. The yellow watery diarrhoea of Grat. is
painful, copious and frequent, preceded by rumblings and
cuttings in the abdomen, and. nausea.     The pain is not
relieved by the evacuation, but is by the escape of flatulence.
Opposed to this is Hyos., which has similar discharges,
without pain, often involuntary, and unnoticed in the bed,






16


say that all symptoms are equally important in their bearing
on the selection of a curative, but that none are to be overlooked, for till considered carefully in itself and in its
relations, we must be in ignorance of the true value of any,
and perhaps of every, symptom. A careful consideration of
the constitutional symptoms, and general conditions, is not
limited to cases of undigested evacuations.  It is a duty
which is integral in every true prescription.
Acrid diarrhoeas, those in which the evacuations irritate
the external parts with which they are brought in contactare a class too important to be passed without notice. They
are related to many drugs, in the action of which this quality
of the evacuations is evinced in different degrees. The most
acrid are from Ars., Chin., Ign., Mere. and Puls.  The next
in severity are, Ant. crud., Cham., Dule., Fer., Graph., Kali
c., Nux vom., Phos., Staph., Sulph. and Yerat. And in still
less severe are Acon., Alum., Nat. mur., and Sabina.  This
difference in the intenseness of a symptom is often of great
importance and never to be overlooked. With some drugs
intenseness seems to characterize most of their actions on the
organism, and this goes far at times in individualizing those
drugs. Ars. is an eminent instance of this; and no one need
fail to distinguish between the painful rawness of the surface
around the anus, characteristic of the drug, and the slighter
and comparatively insignificant irritation of Aeon. Rightly
to appreciate this quality of symptoms, and always to give
it its just place in a prescription, is an accomplishment of the
master, and with him it is an element of great power. It can
be cultivated by all, and be carried t6o a degree the tyro is
not likely at first to suspect.
There are however other differences in connection with
this symptom,, expressed in the pathogenesis of some of the
above drugs, which are so far our guides, though often we
may be left to the significance of general or other special
elements of the case. Thus Ars. has black, burning, excoriating evacuations, with restlessness. Mere., dark green with
pressure in the abdomen. Puls., soft evacuations in the
morning.



18


c., semifluid, scanty, with colic, arid followed by tenesmus.
Phos., semi-fluid, scanty, escaping with force.
Evening: Aloes, Alum., Bov., Carbo an., Dig., Dulc.,
Indigo, Kali c., Kali nit., Lach., Mang., Mere., Mur. acid, 01.
an., Phell., Stann., and Zinc. Aloes, very thin, deep yellow,
with undigested food. Alum., soft, flatulent, with burning
in the anus, followed by tenesmus. Dig., with ascarides.
Dulc., acid smelling, copious, thin, relieves the pain, while
the patient feels weak.  Lach., great urgency to stool, with
throbbing in the anus after the evacuation. Mang., preceding
shootings in the bowels. Mur. acid, severe burning in the
anus after the evacuations. 01. an., soft feces, with cuttings
in the bowels before, during and after the stool, followed by
burning in the anus like fire. Stann., with sensation after
the evacuation as if there were still more to pass. Zinc,
first a little solid, then scanty, soft evacuations.
At night: Arn., Ars., Aur., Bov., Bry., Cast., Caust.,
Cham., Chel., Chin., Graph., Grat., Kali c., Mag. c., Mere.,
Nat. carb., Puls., Sil., Sulph., Tabac. Aur., with much burning in the rectum. Bov., with tearing pains in the bowels
and tenesmus. Bry., with burning in the anus. Cast., semifluid, feces extremely offensive with stinking flatus. Cham.,
with cuttings in the bowels which double up the patient.
Mag. c., before midnight and painless. Puls., unnoticed,
watery, in sleep.  Sil., painless.  Sulph., frequent, fluid,
frothy, with tenesmus.
The next element to consider is the exciting cause of the
attack. If it be from
Acms.-Ant. crud., thin with pain in the rectum. Ars.,
Lach., attacks are slight. Phos. acid.
TAxING CoLD.-Bell., with vomiting. Bry., Caust., Cham.,
Dulc., watery, at night, with pains in the bowels, in summer,
or with prolapsus ani. Nux mos., Nux v., watery. Phos.,
with cutting and drawing pains in bowels and loins, as far
into the thighs. Sulph.
DRINKING.-Ars., Caps., of slime. Rhod., painless.



19
EATING.-Ars., Borax, with rumblings or weakness in the
joints and legs, relieved by walking. China, Coloc., with
colic after the least nourishment.  Fer. mag., Rhod., painless. Verat, after the least ingesta.
FRUIT.-Ars., Chin., Cist., Rhod., with sensation of weakness in the stomach and nausea while walking.
MILK.-Lyc., Nux mos., Sep.
In prescribing for attacks from the above causes the applicability of those remedies here named, without symptoms, is
determined by their general characteristics, or by the special
analysis and ascertained resemblance of their symptom to
those of the individual case. The same principle governs in
treating the cases of
LNFANTS.-For which Cham., Jalap., Rheum, Sena. and
Sulph. acid are more frequently required than other remedies,
although it may be remarked of Jalap. that its passages are
watery, and accompanied with intense cuttings in the bowels;
of Rheum, there are mixed feces and slime; of Senn., dark
colored water, with cutting pains also, but less severe than
those of Jalap. and more or less flatulent. And also in those
of infants while
TEETHING, for which we have Colch., Carbo., Cham., Graph..
Mere. sol., Nux mosch., Pod., Sulph. In selecting a remedy
from among these, it may help, to bear in mind the resemblances and differences of the symptoms of these medicines.
Cale. and Graph. are alike in these particulars: both have
very  offensive discharges, but that of,Calc. is yellow,
Graph., dark, half digested. Both have acid discharges, that
of Graph. is only soft; Calc., thin; Calc. has undigested,
hard or thin; Graph. half digested.  It is also quite characteristic of Graph. that the discharges are followed by great,
but transient prostration.  Calc. and Cham. have much
similarity of some symptoms, but the differences of others
make the distinction between the two not difficult. Both
have the smell of bad eggs, those of Cham. with this property are also excoriating.  With Cham. the passages are
often green, with Calc. never. The diarrhoea of teething


A



31


swallowing hindered by a sensation of nausea; repugnance
to animal food and broths; wishes to drink constantly, but
does not know what, all drinks are alike offensive; tenesmus
of the neck of the bladder; fruitless urgency to urinate;
putrid smell of the breath'; chill of the back and front of
thighs. It is Arnica.
If there be great thirst while the patient drinks but little
at a time; blueish tongue; stools smelling like old foul
ulcers; greenish urine; perspiration sticky; great restlessness, and tossing about the bed; pains relieved by external
heat; despair of life; sensation as if the abdomen would
burst, before the stool; sensation of contraction just above
the anus, at the stool; burning in the rectum and trembling
in all the limbs after the stool; heart beating and distension
of the abdomen, after the stool; tenesmus with burning in the
rectum and anus; face sunken, pale, and features distorted;
great exhaustion after each stool; petechial, milliary, and
nettle rash eruptions; cold dry skin alternates with cold
sweat; pain relieved after the evacuation, we can hardly fail
to recognize in each symptom the elements of distinction for
Arsenicum. These are some of its characteristics, which
may be found in any case of dysentery, none of which are
found so clear and strongly expressed in the pathogenesis of
any other drug.   Where these symptoms are present Ars.
will rarely fail to cure.
Belladonna is appropriate, especially in the early stage,
of those cases where the inflammation extends to the serous
tissues of the intestines, which is known by sensibility of the
abdomen to external pressure, the sense of soreness being
deep in the abdomen, while with Hyos. (Hyos. has both the
superficial and deep-seated soreness). Puls. and Sulph., it is
superficial. Bell. in this accords with Nux vom. and Yerat.
It is the morei certainly indicated where there is constant
pressing to the anus and genitals; the pains are more in the
left side, and are aggravated by bending the body to that
side; violent delirium; pains of a constricting character,
relieved by bending forward; painless inability to swallow;
sensation of dryness of the mouth while the tongue is moist.