J- It O TPHIC {CII OP? 'BY L LAUjR IElMD. LICEIMIAT2 01? TIE;,LOYAL COLLEGE, OF SUIJEOLONS, EDINBURH AID E)CNUTN IYITNU T11)1'11TAIINLMA1-NNIAN MEDICIAL ICW1 lTUION. ISTlO(jOND AM11I"ITCA'N LDITIO-N,EN! LARLI) A.\DI) IMLCOVEI), BY.A. GELRALD 1K 1' MD AND -A.kN A- A PT IION.,IN.TE-,RM),~ITTEN'TPE E1 J. S). DOUTGLAS, A.Ml, MtI.D. I'll11,AD ELPHIJIA: PUBLIS111ED BY 11R'ABEMTACRER & SHEER, 2009 ARICH SRE Njg,ýrdYOREK: AW'1 B.ADDE,1322 BR'OAD-WAY. ST. LOUI13S: J. G.. WE-,SSE,]LIJOEFT, 64 iFOURTIISTRET., 18S5"3. Entered according to Act of Congress, in the year 18052, by PlADEMACHER, ANND SIIEEK, In the Clerk's Offlice of the Eastern. District of Pennsylvania. Angel, lEngel & Hewitt, Printer'.; I s. I Spine street. CONTENTS. INTRODUCTION. PAiGH Regimen.......... 2 Choice of the Remedy. Potencies of the Medicaments.... The Choice of the Proper Remedy........ ib. The Potency, Attenuation, or Dilution of the Medicament... The Dose and its Repetition..... 10 Remarks....... 14 NATURE AND FORM OF IIOM(EOPATIIIC MEDICINES.. 16 Of Vehicles which serve for the Preparation of Homeopathic Medicines 19 1. Of Alcohol....... 20 2. Sugar of Milk..... 23 3. Sugar Globules..... 26 4. Water........ 27 5. Ether.......... 28 Of the Preparation of Homceopathic Medicines in their Primitive State 30 1. Observations and General Rules...... ib. 2. Particular Rules for the Preparation of Fresh Plants-Tinctures 34 3. Preparation of Exotic Vegetable Products... 36 4. Preparation of Mineral and Animal Substances-Triturations 38 Of Homoopathic Attenuations..... 41 1. Of Attenuations in general...... ib. 2. the Preparation of Attenuations..... 50 Of the Dispensation and of the Preservation of Homoeopathic Medicines 55 1. Of the Dispensation of Medicines...... ib. 2. the Preservation of Medicines...... 56 TIE FORMULXE OF HOMCEOPATHIC PRESCRIPTIONS. Signs and Abbreviations used in Hommopathic Prescriptions.. 58 I. Prescriptions of Powders......... ib. a. Where all the powders are to be Medicated... ib. b. When a part of the Powders only are to be Medicated.. 59 c. Medicated Powders in alternation...... ib. II. Prescriptions of Aqueous Solutions....... 60 a. When all the Doses are to be taken within twenty-four hours ib. b. When the Doses are to extend over more than twenty-four hours, in which cases a few drops of spirits of wine are required.......... ib. c. Aqueous Solutions in alternation..... 61 III. Prescriptions of Triturations....... ib. a. When all the Powders are to be medicated. ib. b. When part only are to be medicated..... 62 c. When the Powders are to be used in alternation... ib. List of Medicines adapted to particular temperaments, &c.... 63 A x CONTENTS. PAGE Table of Medicines, with abbreviations..............615 Synopsis of the Rules for Diet under Homceopathic Treatment.617 Aliments allowed....................ib. Aliments prohibited...................68 PART I. ON THE SYMPTOMS, CHARACTER, DISTINCTION AND TREATMENT OF DISEASES. FEVERS. General consideration of Fever.................6 Causes..........................ib. General Trentment in Fever nnd Diet...............71 Simple or Ephemeral Fever. ]7ebris simnplex.............72 Inflammatory Fever, Synochal Fever. Pebris inflammatoria simplex. Syneehe. Febris synochalis.................73 Nervous Fever. Slow Fever. Febris nervosa. Typhus 17' Putrid Fever, Pestilential' Fever, or Malignant Typhus. Typhus putridus. Typhus abdominenlis...................94. Contagious Typhus, Camp Fever, Jail Fever, Petechial Fever. Typhus contagiosus......................95 Accessory Treatment. Prophylaxes, &c...............96 Febris lenta nervosa..................97 Intermlittent Fevers. Ague. Febris interinitteutes... 98 Raphania. Vorbsus cerealis, Uonvulsio eerealis. Fcelempsia typhoides 109 The Plagrue. Pestis. Pestis bubonice. Typhus pestilentielis. 112 Remittent Fever. Yellow Fever. Febris flave. Typhus icterodes 1151 Hectic Fever. Febris hecticce..................1'7 Mucous Fever. Febris pituitosa. Febsismsucosce.. 121 Gastric Fever. Bilious Fever. Febris gestrica biliosci 126 Eruptive Fevers.......................128 Scarlet Fever........................ib. Scarlet Rash. Furpura rubra, s. Afiliesis Hahuesnaussi. Scarlatina milieris, miliformis, papulosa. ililiaria purpurea.. 135 Measles. Rubeola......................154: Small-pox. Variola.....................15'7 Chicken-pock. Variola spuria, Vericella, 68 Miliary Fever. Miliaria. Milieria alba. Afiliaris sudetoria. Sudor miliaris.......................164 Nettle-rash. Urticarics...................16'7 DISEASES OF ORGANS CONNECTED WITH THlE DIGESTIVE SYSTEM. Toothache. Odontalgia....................170 Sore Throat, or Quinsy. Aphithous Sore Throat. Angina faucium, Tonsillitis phiegmonoides, Cinanche tonsilleris. Angina aphthose, &C.......................1'74 Ulcerated Sore Throat. M1alignant Quinsy, M1alignant, Putrid or Gangrenous Sore Throat. Angina maligna, Tonsillitis maligna, Cynanche meligna...................182 Inflammation of the (iEsophagus. (Esophagitis...........18'7 Mumps. Parotitis. Angina parotidea..............189 Indigestion or Dyspepsia...................190 CONTENTS. xi PAGE5 Want of Appetite. -Apepsia. -Anorexia.............202 Derangement of the Stomach, Eructations, &c............20~7 Flatulency. Flatulentia. Flatus. Tympanitis intestinalis 210 Spasm of the *Stomach. Gastrodynia, ('ardialgia, Gastralgia 212 Heartburn. Black-water. WTater-brash. Pyrosis 219 Vomiting of Blood. Hceinatemesis.................b. Costiveness, Constipation, Obstipation. Uonistipatio, Obstipatio, Obstructio elvi......................222 Piles. IHemorrhoidls.....................227 Stricture of the Rectum....................230 Abscesses in Ano. Fistula in Ano................234 Proctalgia.........................238 Protrusion of the Intestine. Pralapsus ani ib. Colic. Enteraigia......................239 Determination of Blood to the Abdomen. Congestio viseeruns abdominis. ('ongestio ad abdomen................244 Looseness of the Bowels. JDiarrhea...............245 Dysentery. -Dysenteria. IFebris dysenterica............251 Cholera..........................259 Asiatic Cholera. Malignant Cholera (Cholera -Asiatica, epidemica, spasmnodica)......................262 Phenomena of Asiatic Cholera, as it appeared in this country 271 Cholerine.........................284 Liver Complaint.......................ib. Acute Inflammation of the Liver. Hepatitis............285 Liver Complaint, or. Chronic Inflammation of the Liver. Hepatitis chronica.......................288 Jaundice. icterus......................289 Inflammation of the Spleen. S~plenitis..............291 Stomach. Gastritis.............293 Bowels. Enteritis..............297 Peritoneum. Peritonitis............303 Invermination. Worms. Helminthiasis. Pebris helininthiaca 305 Blenorrhma........................313 DISEASES OF THlE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. Catarrh, or Common Cold. Catarrhal Fever.............18 Inflammation of the Larynx.- Laryngitis.............323 Hoarseness. Ilaucitas......................325 Cold in the Head. ('oryza..................328 Cough. Tussis.......................330 Ilooping-cough. Tussis convulsiva. Pertussis...........343 Croup. -Angina membranacea. -Angina perniciosa. C'ynanche laryngea. ('ynanche tracheitis, s. Trachealis, &ce., &c...........348 Ilnfluenza.........................352 Determination of Blood to the Chest. Uongestio adpectus.. 355 Inflammation of the Mucous Membrane of the Bronchinl Tubes. Cold on the Chest. Pulmonary Catarrh. Bronchitis o 358 Inflammation of the Lungs. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmonitis....................367I Peripneumo-nia Notha, s. Occulta. Catarrhus Bronchiorum. Spurious Peripneumony.....................393 xii CONTENTS. Typhoid, or Congestive Pneumonia...............395 Inflammation of the Pleura. Pleurisy. Pleuritis... 396 Spurious, or Bastard Pleurisy. Pleurodynia, Pseudo-Pt esoit'is, Plenritis mnuscularis......................406 Diaphragmitis.......................407 Spitting of Blood. Hemorrhage from the Lungs. S~putums eruentum. Hcernorrltagia pudmonum.. Hcernoptysis............409 Pulmonary Consumption. Phtleisis psdrnonalis...........415 Asthma..........................420 DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS 5Y5TEM.N Determination of Blood to the Head, Congest ior ad caput.. 428 Inflammation of the Brain and its Tissues. Brain Fever. Phrenitis. Encephalitis.....................433 Apoplexy. Apoplexia....................43'7 Acute Inflammation of the Spinal Cord and its Membranes. Myelitis. Mieningitis spinalis...................443 Palsy. Paralysis......................446 Tetanus.........................447 Delirium Tremens Potatorum.................450 E pilepy iepsia. -2lforbus sacer. M21orbus eaducus.Mobsdvu..2lorbus Iserculeus..Aorbus eomitialis..............453 Neuralgia. Ceplialalgia. ('ephaicea. ('ephleallgia artirritica. ('ephalalgia niereosa. Hemiercinia (mnegrim). ('lavus hystericus.. 458 DISEASES OF THlE CIRCULATI'NG SYSTEM-N. Angina Pectoris......................471 Pericarditis........................4'74 End-ocarditis........................486 Carditis..........................514 CUTANEOUS DISEASES. St. Anthony's Fire. Rose. Erysipelas51 Boil. Putruneutus. -Abscessus nuclleotus.................20 Carbuncle. -Anthirax. Futrsinei.ulus malignont~s. Pustvda nigra 522 Chilblains. Periones.....................ib. Corns. ('tori peetis......................23 Abscess. Lymphatic Tumors. Diseases of the Conglobate Glands 524 Itch. Seabies. Psora....................527 Whitlow. Parongehia. Panaris................530 Irritation, or Itching of the shinl. Prutrigo...............31 Ringworm (Harpetic or Vesicular). HerpIes cir-cinnatus. Herpes serp)igo........................532 Ring-wormi of the Scalp. Pustular Ringworm. Porrigo seseubata.. Tinea capitis. Tinea annutarie. Eavns confertus 5330 1iitertrigo.........................53'7 Psoriasis..........................38 Pemphigus. Febris bsettosa, PomP'photg.................539 Shingles. Zone. lherjpes zesiter. ('ingulvizn. Ignis sacer, &c. 541 Ulcers. Ulecra..........................543 DISEASES OF THE URINARY A-N'D GENITAL ORGANS. Inflammation of the Kidneys. Nephritis................50 CONTENTS. Xiii *PAGB Inflammation of the Bladder. Cystitis..............553 Retention of Urine. Iseleuriee....... 555 Difficulty in Discharging the Urine. Dysuria. Stranguria 558 Suppression of Urine.....................561 Stricture of the Urethra...................563 Urinary Abscess and FistuLla. Fistules in perincew 565 Incontinence of Urine.....................666 Diabetes..........................568 Heematuria. Nietus cruentus..................5?71 Discharge of Bloo'd. from the Urethra. (fret horrhegia. I! orrhegia seretlerce. StYmetosis...................674 Inflammation of the Urethra. Clap. (fret hretis. Conorrlscea. Blenorrhcea.....................ib. Inflammation of the Gianus Penis. Balanitis. Baleno-6lenorrlscecs 581 Inflammation of the Testis. Swelled testicle. Orehitis. ilerniet humnerelis.......................ib. Sarcocele.........................582 Varicocele........................583 Hydrocele.........................585 Venereal Disease. Syphilis. Luers renereee............588 Phimosis.........................605 Paraphiroosis........................ib. Herpes Preputialis......................606 Sycosis..........................607 DISEASES OF PARTICUTLAR 0OR GANS AND REGIONS, OR OF THlE SYSTE.M IN GENERAL. Gout. -Arthritis......................627 Rheumatism. Rheumatic Fever. F ebris rsewonetieee Rkewnastimsno 629 Lumbago.........................638 Inflammation of thc Psoas Muscle. Psoitis............639 Sciatica..........................640 Pain in the Hip. Hip-gout. Rheumntism in the I-ip. Coxelgie, Coxegra. Tecicias...................642 Hip-disease. Morbus coxeriees.................644 Determination of Blood to the Abdomen. Uonyestio vi scerurn abdo-Minis. Congestio ad ebdoosn...................646 Acute Inflammation of the Eyes. Ophthelmnia...........647 llordeolum. Stye......................654 Ectropium............................655 Entropium. Irichiasis....................656 Inflammation of the Ears and Earache. Otitis. Otalgia 657 Bleeding of the Nose. E~pistaxis................660 Swelling of the Nose.....................664 Canker of the Mouth. Scurvy in the Mouth. Caertncoruo s.Cengrenac anis. Stomeee.......................666 Scurvy. Seorosetus.....................668 Inflammation of the Tongue. Clossitis..............670 Offensive Breath.........................672 Cramp in the Legs........................673 Bronchocele. Goitre. Derbtyshire neck-.............ib. Sweating Feet..........................674 Sleeplessness. Agrypnice...................675 Xiv CONTENTS. PAGB Nightmare. Incubus. Ephialtes................691 Rupture. Hernia......................692 Incarcerated Ruptures. Hernice incarcerate...........69'7 Fainting. Swooning. S3yncope.................704 Pains in the Loins. Notalgia..................'07 Dropsy. Hydrops......................707 Ascites..........................708 Dropsy of the Cellular Tissue. Anasarca............71 Dropsy of the Chest. Hydrothorax. Hy drop s pectoris. Hydrops thoracis.......................716 Scrofula..........................719 Ostitis. Caries. Necrosis. Exostosis...............721 Rickets. -Rachitis.......................729 CASUALTIES. Concussion, Bruises, Sprains or Strains, Wounds, Dislocations, and Fractures..........................730 Burns and Scalds. Ambustiones.................747 Fatigue...........................749 Overheating. Exposure to Heat.................750 Stings of Insects.......................751 Sea-sickness........................ib. Apparent Death, Asphyxia...................753 Hydrophobia.........................75 Mental Emotions.......................764 PART IL. TREATMENT OF FEMALES, AND OF THEIR PECULIAR AFFECTIONS. Chlorosis.-Erncnsio snensium..................766 Amenorrh ea.. Suppressio snensiuin................'69 Mcnstruatio Nimia. Menorrhagia.................770 Dysmenorrhcea........................772 Hysterics. Hysteria. Passio hysteriea..............ib. Inflammation of the Ovaries. Ovaritis..............7'74 Inflammation of the Labia majora and Vagina............776 OBSERVATIONS ON PREGNANCY. Air and Exercise.......................779 Clothing..........................'80 Diet...........................782 Employment of the Mind and Habits during Pregnancy ib. Influence of External Objects upon the unborn Infant '783 Mental Emotions......................ib. DERANGEMENTS DURING PREGNANCY. Menstruation........................785 Morning Sickness......................ib. Constipation........................786 Diarrhoaa during Pregnancy..................787 Fainting a~nd Hysteric Fits...................ib. Toothache.........................'88 Swelled Face........................792 CONTENTS. XV PAGH Varices, or Swelled Veins...... 93 Pains in the Back during Pregnancy. Lumbo-sacral Pains.. 95 Miscarriage. Abortus....... ib. TREATMENT BEFORE PARTURITION. Preparation of the Breasts...... 800 Remedies before Labor..... 801 False Pains....... 802 Parturition 803 Tedious or Complicated Labours.... 804 Spasmodic Pains, Cramps, and Convulsions...... 807 TREATMENT AFTER DELIVERY. After-pains....... 809 Duration of Confinement...... 811 DISEASES FOLLOWING PARTURITION. Suppressed Secretion of Milk...... 811 Excessive Secretion of Milk........ 812 Perspiration after Delivery, Suppression or Excess of.. 813 Milk Fever..... ib. Irregularities of the Lochial Discharge..... 815 Diarrhoea in Lying-in Women..... 816 Abdominal Deformity..... ib. Falling off of the Hair...... 817 Leucorrhoea after Parturition...... 818 Internal or Uterine Swelling and Prolapsus..... 819 Inflammation of the Womb. Inflammatio uteri. Metritis... ib. Weakness after Delivery...... 822 OBSTACLES TO SUCKLING. Disinclination of the Infant..... 822 Excoriation of the Nipples..... ib. Inflammation of the Breasts....... 824 Mental Emotions affecting the Milk..... 825 Deficiency in the Secretion of Milk. Suppressed Secretion of Milk. ib. Deterioration and Discoloration of Milk...... 826 Mothers not Suckling their Children...... ib. PART III. TREATMENT OF INFANTS AND CHILDREN. Introductory Remarks..... 827 Treatment after Birth..... 828 Asphyxia........ 829 Swelling of the Head...... 830 Navel Rupture in Infants...... ib. Meconium, Expulsion of...... 831 Suckling of the Infant..... 832 XVI CONTENTS. PAGE The Choice of a Nurse.... 834 Diet during Nursing.... ib. Supplementary Diet of Infants...... 835 Duration of Suckling. Weaning.... 837 Sleep. Sleeplessness.......... 839 Exercise.... 841 DISEASES OF INFANCY., Inflammation of the Eyes in New-born Infants..... 843 Cold in the Head.......... 844 Crying and Wakefulness of New-born Children..... 845 Regurgitations of Milk. Acidity, Flatulence, &c. 847 Spasmodic Asthma. Spasms in the Chest..... 848 Milk-Crust. Milk-Scab. Mlilk-Blothes. Crusta lactea. Porrigo larvalis. Eczemacfaciei, Tineafaciei...... 849 Thrush or Aphthe........... 850 Constipation. Obstructio alvi neonatoru......n 852 Bowel Complaints of Infants. D.Eiarrhcea neonatorunm. ib. Excoriations. Excoriationes neonatorum. intertrigo. 861 Jaundice. Icterus neonator..um...... 862 Induration of the Cellular Tissue. Infantile Erysipelas. Esysipelas infantum......... ib. Lock-jaw of Infants. Trismus nascentium...... 863 Heat Spots...... 864 Derangements during Teething....... 865 Convulsions of Yonng Children. (By A. G. HULL, M.D.) 867 Water in the Head. Dropsy of the Brain. Dropsy of the Head. Hydrocephalus nembranarumn et ventricularum. 879 Asthma of Millar. Laryngismnus stridulus.... 881 Infantile Remittent Fever......... 882 Atrophy. Atrophia..... 887 Vaccination......... 888 APPENDIX: Intermittent Fevers, by Dr. DovUALAs.... 889 INDEx............. 929 TABLE OF MEDICINES CONTAINED IN THIS WORK. REMEDIES, THEIR SYNONYMES AND ENGLISH NAMES. Acon., Aconitum. (Aconitum napellus. Monk's hood) Act., Actaea. Actma spicata. (Herb Christopher or Baneberry.) ýE th., Ethusa cynapium. (1Ethusa. Garden Hemlock) Agar., Agaricus muscarius. (Amanita. Bug agaric.) Agn Agnus. (Agnus Castus. Chaste tree.) Al, Aloes gummi. (Aloe spicata. Aloes.) Alum., Alumina. (Oxide of Aluminum. Pure clay.) Ambr., Ambra grisea. Ambra. Ambergris) Am. c., Ammonium carbonicum (Ammonia e carbonas. Carb. of Ammonia) Am. m., Ammonium muriaticum. (Ammoniac murias. Muriate of anmmonia ) Anac., Anacardium. (Anacar. dium oriental. Malacca bean.) Anis., Anisatum stellatum. (Semen anisi stellati. The seed badian.) Ang., Angustura vera. (Cortex angusturm. Bark of Bonplandia trifoliata.) Ant., Antimonium crudum. (Antim. sulphuret. Crude antimony ) Arg., Argentum. (Argentum foliatum. Silver.) Amrn., Arnica montana. (Calen. dula alpin. Leopard's bane.) Ars., Arsenicum album. (Ar. senicum. Arsenic.) Art. v., Artemesia vulgaris. (Radix parthenii. Meugwort.) Arum m., Arum maculatum. (Arum vulgare. Common arum.) COMPARE WITHAmrn., ars., bell., bry, cann., canth., cham., coff. croc. dros., dulc., graph., mere., nux v., op., phos., puls., ruta, sabin., sep., spig., spong. Acon. is indicated afte rarn. and sulph. Cic., con., cupr., and the other remedies belonging to that family. Acon., bell., ceff, graph., nux v., phos., puls, staph. Bov., cupr., natr. mur., nitr. a., olea, plat., sel., sep. Carbo v., puls., sabin., sulph., calc. c., cham., jal., nux v. Cham., ign., ipec., lach., phos., plum., rhus, sil., sulph. Nux v, phos., puls., phos. a., staph., verat. Am. mur., arn., ars., hep., lach., phos., puls., rhus. Am. carb, and its analogous remedies. Acon., ars., calc., natr. m., nux V., oleand., plat., sep., sulph. ac., nux mosch. Brue, canth., carb. a., carb. v., coff., mur., plat. Amm., am. caust, ars., hep., ipec., mere., puls., sep, sulph., tart. em. Asa f., aur, bell, chin., hep., mere, puls. Acon., am., ars., bell, bry., cham., chin., cic., cina, fer., ipec., puls., rhus, ruta, staph., verat. Arn., bell., carb. v., cham., chin., coff., ferr., graph., nux v., phos., puls., sulph, veratr. Cans., puls., ruta, sec., stram. Canth., mezer., ranune. b, rhus, verat. ANTIDOTES. Acetum vinum, camph., nux v. Acon. is an antidote to cham., coff, nux v., petrol., sulph. Vegetable acids. It is an antidote to opium. Camph., coff. tosta, puls., vinum. Camph. Vinegar, vegetable acids. Bry., chamin., ipec. Camph., nux v., puls. It antidotes staph., nux v. Am., amrn., camph., hep. Ars, camph., cofi, hep., hydr. ac., lauroc., mitr. sp. Camph., coff., juglans. Coffea. Hep., mere., puls. Ant. c. is an antidote to ars., iod., mere., plumb. Merc., puls. Camph., caps., ipec., ign., veratr., vinegar. It antidotes am. c., chin., cic., ferr., ipec., seneg. Camph, chin., iod., ipec., nux v., tabac., op., chin., sulph. Vinegar. B 91 TABLE OF MEDICINES. REMEDIES, THEIR SYNONYMES AND ENGLISH NAMES. Asa f., Asa fwetida. (Asa fretida. Gum resin offerula.) Asar., Asarum Europaum. (Asarum off. Asaret of Europe) Aur., Aurum. (Aurum metallicum..Metallic gold) Aur. f., Aurum fulminans (Fulminating gold, the oxide of gold with ammonie ) Aur. mur., Aurum muriat. (The muriat of gold.) Bar. c, Baryta carbonicum. (Baryte carbonas. Carbonate of balrytes.) Bar. m., Baryta muriatica (Baryte murias. (furiate of baryta.) Bell., Belladonna. (Atropa belladonna. Deadly nightshade) Berb., Berberis vulgaris. (Berberis dumetorum. Barberry.) Bis., Bismuathum. (Bismuthi subnitras. Nitrate of bismuth) Bor., Borax. (Borax veneta Subborate of soda) Bov., Bovista. (Lycoperdon bovista. The puf-ball.) Bry., Bryonia. (Bryonia alba. White bryony.) Bruc., Brucea anti-dysenteri ca. (Ferruginea L'Her. False Augustura.) Cal., Caladium seguinum. (Caladium. Poisonous pediveaux.) Calc., Calcarea carbonica. (Calcis carbonas. Carbonate of lime.) Cale. ph., Calcarea phosphorica. (Calcis phosphos. Pktosphate of lime) Camph., Camphora. (Laurus Camphora. Camphor) Cann., Cannabis. (Cannabis sativa. Hemp.) Canth., Cantharis (Meloe vesicatorius. Spanish fly.) Caps., Capsicum. (Capsicum annum. Cayenne pepper.) Carb. a., Carbo animalis. (Carbo carnis. Animal charcoal.) Carb. v, Carbo vegetabilis. (Carbo ligni fag. Charcoal.) Casc., Cascarilla. (Croton cascarilla. Croton cascarril la.) Cast, Castoreum. (Castoreum sibiricum. Castor.) Caust., Causticum. (Tincture acris, sine kali Caustic.) COMPARE WITHCaust., phos ac., puls, thuja. Acon., cham., chin., hep., ipec., mere., puls., sep., stram., aur., graph. Bell., chin., mere., nitr. ac., puls., nux v., spig., calc. See aurum. Alum. bell, cale.,m agn., mere., natr., phos., sep., sil, sulph., tart. e. Bar. c, ant, chel., cic, dig., dulc., fer. mur., hyos., au. roc., op. Acon, agar, alum., am, arn., ars., aur, bar, calc., canth, caust., cham., chin, coff, coloc., con., cop., cupr., dig, dulc., fer., hep., hyos. lach., mere., nitr. a, op., phos., plat., rhus, seneg, sep., sil., stram., valer., puls. Aloe, ars., asa f, cale, carb,. v., cham., chin., lye., nux v., puls., rheum, tart. eon. Cale., veratr., zinc., ant. c., caps., carb v., nux v., plumb. Chamn, coff, mere., natr., puls, sulph. Bell., bry, carb. a., carb. v., kali, mere., puls., sep., sil, stron. verat. Alum., arn., cham., ign., lach, nux v, puls., rhus. Angust. vera., bell. cham., coffW, nux v., op., sec., phos., stram. Caps., carb. v., chin., graph., ign., mere., nitr. a, phos. Alum., amrn., bar., chin, cupr., lye., magnes., nux v., phos, sil, sulph., verat. Cale., carb. Canth., cocc., hyos., kali, lauroc., op. Amrn., bry., canth., nux v., op., petrol., puls., stan. Acon., bell., camph, cann, caps., chin, puls., rhus, seneg., sulph. Arn., bell., calad., chin., cina, ign., nux v., puls., veratr. Bov., calc., carb. v., ign., ipec., mere., natr. mur., rhod., sel., Sil. Ars., carb. a., chin., fer.,graph., mere., aux v., sulph. a., sep. Chin., nux v., rhus, valer. Amm., asa f, camph, cham., croc. op., valer., zinc. Amm., asa f, bell., coff., coloc. ign, lach., lye., rhus, sep., stann., nux v. ANTIDOTES. Camph., china, caust. Camph., vinegar, vegetable acids. Bell., china, cnpr., mere. Aur. antidotes mere., spig. Bell, camph., dulc., mere. The white of an egg is the best antidote of large doses. See bar. c. Black cuff, camph, hep sulp., op, puls., vinum, zinc. Bell. antidotes acon., cupr., fer., hyos, kali chlor., mere., plat., plumb. Camph. Cale., caps., nux v. Cham., coff. Camph. Acon., chnam., ign., nux v. It antidotes alum, rhus. Cham., coff, op., tereb. Caps. The root of the plant against poisoning by leaves. Camph., nitr. ac., nitr. sp., sulph. Op, nitr. sp. dulios, vinegar, wine. Camph. Camph., vinegar, alcohol. Camph. Caps. antidotes calad., chin. Camph., ars., coff., lach. Ars., camph, coff, lach., nitr. "p. Camph., op. Coff., coloc., nitr. sp., nux v. TABLE OF MEDICINES. 3 REMEDIES, THEIR SYNO- COXPARE WITH- ANTIDOTES. NYMES AND ENGLISH NAMES Chain., Chamomilla. (Matri- Aeon., alum., am., ars., hell., Acon., coec., coff, ign, flux V., carla ehamomilla. Common bor., bry., edna., coec, cof, Puls. chamomile.) coloc., hep., hyos., ign., magn., merc., nux v., pulS., suiph. Chel., Chelidonium. (Cheli- Thuja, nitr. ae., sulph. a., op, Campl donium mnajis. Great celan- helleb. dine.) Chin., China officinalis. (Chin- Am., arss, bell, eale., earb. v., Arn., ars., bell, cale., caps., eons. Peruvian bark.) cine, fer., graph.,ipee.,merc., ipee., Dux v., sulph., veratr., natr. i., nux v., puls., sulph puls. Cie., Cleuta virosa. (Cienta. Am., eon, lach., lye., mere., Arr., tahac. Water hemlock. op., pullS., thuja, veratr. Cin, Cina. (Artemesia ju- Am., am., ars., hell., hry., Bry., chin.,hyos., ipec. daiea. Mauwortof Jieda) oleand., phos., sahad., sil, eaps., cham., chin., ipec. Cinn., Cinnabamis. (Hydrargy- Mere., sulph., nitr. ac., thuja Nitm. ac., ehin., op., suIph. ri suiphuretum ruhrum. Red sulphur of mercury.) Cinnaro, Ciunamonum. (Cinnaman.) Cist., Cistus eanadenois. (Black Bell., carb. v., phos. rose.) Citr., Citri acidum. Clem., Clematis erects. (Up-. Am., ars., hell., bry., eanth., Bry., for tle tootlasehe caused right virgin's bower.) caps., eaUSt., eon., mere., by elem. Camph. rhuo, sil., sulph. Coecion., Coecionella. (Coec. Bell, chai., nux v., puls., septempunetata. (Cochi- rhus, staph., thuja. neal.) Coce., Coceulus. (Coeculus Ars., chai, coff, eupm., ign, Campl., nux v. superosus. Indian cockel) nux v., oleand, tact. em. Coff., Coffea eruda. (Coffea Aeon., agai., ams., bell., eauot., Aeon, chai., ig-n., mere., nux Arabica. Raw cofee.) chain., coce., fux v., op, v., sulph. suiph. Colch., Colehicuin. (Colehi- Aeon., ars., chin, coce., mere., Vinegar, caust. am., coec., nux cum autumnale. Meadow nux v., op., puls., Sep. V., puls. saffron ) Coloc., Colocynthis. (Cuccu- Am., bell., eantb., caust., Camph., caust., chai., coff., mis colocynthis. Bitter cu- chain., coff., dig., staph., ye- staph. cumber.) ratr. Con., Conium. (Conium ma- M)g., dule., lye., magn. mum., Coff, nitr. sp. culatum. Common hemlock.) nitr. nc., nux v., puls. Cony, ConvolvuluS. (Conv. Arvensis. Bind-weed.) Copaiv., Copaivm balsamom. Cuheb., merc., tereb. Mere, mere. corr. (Copaiba. Balsam ofcopaiva.) Coral., Comallia. (Corallia mu- Cale. carb. Cale. csrb. bra. Red coral.) Croc., Crocus. (Crocus sati- Aeon., hell., opplat. Aeon., hell., op. vus. Saffron.) Crot., Croton. (Croton tigliuin Jatmoph., euphorh., tart, em., It antidotes plumb. Purging croton.) hell., coloc. Cub., Cubebm3. (Piper cubeba. Caps., cop, tereb. Opium. Cubebs ) Cupr., Cuprui. (Cuprum me- Bell, eale., chin., coce., hep., Bell, eale. e., chin., cocc., dule., tallicui. Copper ) ipec., mere., fux v., puls. hop. s., ipec., mere., cur. Cyc., Cyclamen. (Cyc. Euro- Am., ass f., chin., fux v., Puls. pmum. Sow bread.) pulS., rhus, sil. Daph., Daphiia indiaew. (In- Ambm., canth., caps., chai., Bry., dig, rhus, sil., sep., zinc. dian daphne) eaphor, hell., mere. Diad., Diadema. (Amanea diad. Mere. Papal cross spider.) Diet., Dictainnus. (Diet. albus. Angust., artem., ruta. White dittany.) Dig., Digitalis. (Dig. purpures. Ars., hell., chin., eon., mere., Nux v., op. Fox glove.) nux v., op., puls. Dros., Drosera. (Dros. motun- Ipee., veratr, aeon., alum., Camph. difolia. Sundew.) amm., bry., cine, nitr.,nux v Dale., Duleamara. (Solanum Aeon., ars., hell., cupr., Inch., Camph., ipec,, mere. dule. Bittersweet.) mere., fux v., rhus. Eug., Eugenia jambos. (Jam- Opium. Coffee. bos. Malabar plum-tree ) 4 TABLE OF MEDICINES. REMEDIES, THEIR SYNONYMES AND ENGLISH NAMES. Euphor., Euphurbium. (Euphur. ufficinarum. Spurge.) Euph., Euphrasia. (Euph. offi cinalis. Egebright.) Evun., Evunymus. (Evon. Europmnus. Spindle-tree.) Fer., Ferrum. (Ferrum metallicum. Metallic iron.) Fer. ch., Ferrum chioratum. Fer. magn., Ferrum magneticum. (Lapis nagneticus. Loadslone.) Fil m, Filix mas. (Aspidium flix mas. Malefern.) Frag., Fragaria vesca. (Common strawberry ) Gran., Granatum. (Punica granatum. Bark from the rool of lhe pomegranate tree.) Graph., Graphites. Plumbago. Black lead.) Grat., Gratiula. (Grat. officinahs. Hedge hyssop) Guaj., Guajacum. (Guaj. ufficinalis. Resin of guoj.) R1mm., Heumatuxylum (Baem campachianum. Legstood.) Hell, Halleborus. (Hell. niger. Christmas rose.) Hap., Hepar suiphuris. (Hap. sulph. calcaraum. Sulphseret of lime.) HIyos., Hyoscyamus. (Hyos. niger. Black henbane) Jalap., Jalapa. (Cunvulvulus jalap. Jalap.) Jatr., Jatrupha. (Samina ricinis majoris. Barbadoes nuts.) lgn. Iguatia. (Ign. amara. St. Ignatius bean.) lnd., Indigo. (Indigofara tinctoria. Ind. planet) Iod., [odium. (Iod. jodina. Iodine.) paec., lpacacuanha. (Ipecacuanha) Kal c., Kali carbonicum. (Potassa carbonas. Sub-carbonate of potash.) Kal chli., Kali chluricum. (Chlorate of potash.) Kal. hyd., Kali hydriudicum. (Putasse iodium. Hydriadate of potash.) Kreos., Kreosotum. (Kreo. sote.) Lach., Lachasis, (Tnigonocephalus lach. Lachesis.) Lac, Lactuca (Lactaa virusa. Poisonous lettuce ) Lam. alb, Lamiumn album. (Lam. fuliosum. Dead nettle.) Laur., Laurucerasus. (Prunus laur Cherry laurel.) COMPARE WITHBell., mere., mezar., nitr. ac. Am., mere., DuX v., puls., sanag., spig. Phus., spig., thuja. Ars., chin., hep., ipec., puls, veratr. See Ferrum. See Ferrum. Ars.?, iod.?, filix in., chin. Aneo., ars., calc., carb. v., lye., magn. c., fux v., phosph., sil. Bell., dig., euphorb., fux v. Graph., mere., nux v. Marc. Bell., bry., chin., stann., strai, varatr. Am. c., ant. c., ars., ball., bry., chain., cupr., ferr., iud., lach., mere., nitr. ac, sil., zinc. Bell., caust, eupr., up., puls. Croton Oil. Alum, ars., am., caust., chain, chin., cutE, ipec., nux v., puls., ruta, zinc. Ign., lyc., nux v. Ars., caust., coff., con., mere, rhus, varatr. Alum, ars., arn., chain., chin., cucc., cupr., duic., farr., ign., lauruc., nux v., op., phosph, tab., tart., veratr. Ars., carb. v., laur., lyc., phusph., puls. Bell., natr. in., nitr. ludium. Nitr. ac., ars, iod., mere., phuaph., rhus, sac. Alum., ars., ball., caps., carb. v., caust., dulc., hap., natr. iD, nux v., phos. ac., rhus, samb. Am. c., ars, earb. v., byns., ipac., nux v. Caic. c., chin., farr., puls., see. c. Hydr. ac., ipee, kali c, lach, mere. ANTIDuTES. Camph, citri sue. Campb., puls. Ars., chin., hap., ipec, puls. See Ferrum. Camph, Ars., fux v., vinum. Graph. antidutes ars. Campph.? Grat. antidotesiod. Camph. Camph., chin. Bell., chai., against the colic and diarrhce.a. Vinagar. Vinegar, ball., campb., chin. Camph.? 01L croton, camph. Puls., chai. Camph? op.? Ars., up., hyos, phosph.. Am., ars., chin., nux v. Camph., cuff. Puls., bell. Am. i., ars., chin., sulph,, valer. Acon., nux v., chin.? ars.? coc.? Ars., bell.. phuaph. a. Fur the bite of the serpent, ars., bell. Vegetable acids and coffese. Tart. em., coff, up. TABLE OF MEDICINES..6 REMEDIES, THEIR SYNONYMES AND ENGLISH NAMES. Led., Ledum. (Led. palustre. Mfarsh tea.) Lyc., Lycopodium. (Lyc. eravatum. Wlf's foot.) Magn. c., Magnesia carbonica. (MNagn. alba. Carbonate of magnesia.) Magn. m, Magnesia mnuriatica. (Mlagn. Salita. Muriate of magnesia) Maim. sulph., Magnesia sulphurica. (SuIphas magnesiw. Sulphate of mceg'aesic.) Mang., Manganum (Mlanganesii oxydum. Afanganese.) Meny., Menyanthes. (Trifo. lium fibrinum. Buck bean.) Meph, Mephitis. (Meph. putonis. The skunrk.) Mercurius. (Lydrargyrum..Mcrcur/.) Merc. c., Mercurius subl. corr. (Hydrargyrum muriaticurn corros. Corrosive sublimate.) Mez., Mo-zereum. See Daphnee. Millef., Millefolium. (Achillea millef. Mi/foil, yarrow.) Mose., Mosehus. (Mose. verus. MErusk.) Mur. a., Muriatic acid. (Aci. dum hydrochioricum. Muriatic acid.) Natr. carb., Natrum carhonicum. (Sodne carhonas. Carbonate of soda.) Natr. i., Natrum muriaticum. (Sodii chioretum. Muriate of soda) Natr. n., Natrum nitricum. (Sodea nitras. Nicrate of soda.) Natr. sulph. Natrum sulphuricum. (Sodw sulphas. Sul phate of soda ) Nic., Niccolum. (Nic. carboni cum. Nickel.) Nitrum. Kali nitrum. Nitrate of potash. Nitr. ac., Nitri acidum. (Aci dum azoticum. Nitric acid.) Nitr. apir. dul. (Spiritus nitri dulcis. Nitrous ether.) Nux i., Nux moschata. (Myristica. Nutmeg.) Nux v., Nux vomica. (Strychnos nux vomica. Poison nut.) COMPARE WITHBry., lyc., mere., nux v. Ars., bry, cale. e., chin., graph., led., mag. m., nitr~ac., petr., phosph., puls., rhus, sep., sil. Ars., cale. e, chai., graph., kali c., lye., iago. m. See Magn. c. Gale., carh., iag. m., puls., sulph. Am. e, sarsap., thuja, vuratr. Aeon., chin., nux, veratr. Am., ant, sag., am., asa f., arum, bell, carb. v., chin., clein., coff., coich., cupr., dule, guaj., hop, iod., lach., lye., mez., nitr. a., nux v., op., phosph., puls., sarsap., sep., sil., ataphys, thuja, valer., veratr. See Mercurius. Asa f., hell.. camph., chin., coce., coff., laur, nux v., nux In. Bell., bry., cale., chin., lye. Am., ars., carh. v., chin., mere., natr. i., nux V., puls. See Natr. carb. See Natr. carb. Am. c., am., cale., nitr. sp. Aur., bell, eale. C., eon, hep., iod., kali, nitr., lye., mere., mez., mur. ac., natr. earb. et mur., op., petrol., phosph. et ac., puls., rhus, sup., suiph. et ac. Con.. ign., mosch, nux v., op., puls., sep. Aeon., ambr., am. i., am., ars., cale. e., caps., carb. v., chain., chin., cocc., con., cupr., dig., dule, graph., ign., ipee., lach., mere., mur. ac., natr. in., op., petrol., phos., pulo., sep., stran., 1 sulpb., tab. ANTIDOTES. Camph. Camph., polo., cup of coffee. Chai., puls., mere. sol. Ars., chai. Camph. Coffea, mere. s. Camph. Camph. Nitr. ac., phos., am. c., am. asa f., aur., bell., camph.., carb. v. chin., con., cupr., dulc., elec., ferr., guaj., iod., hep., kreo., lacb., lye., mez., natr. i., nux v., op., phos., plumb., sara., sil., staph., sulph. White of an egg, chin., hep. Camph., coff. Magn., sapo, bry., eamph. Arm., camph., nitm. ap. See Natr. carb. See Natm. carb. Nitr. sp. Soap, cale. c., camph., con., hep., merc., moz., petrol., phos., solph. Camph. Wine, coffK, campb., op., bell., chai., coce., op., puls., stram. 6 TABLE OF MEDICINES. R&MEDiES, THEIR SYNOXYMES AND ENGLISH NAMEs. Oleand, Oleander. (Nerium oleand. Lauerel rose ) 01. -a., Oleum Bnimale. (01. a. oatber. Purified animal oil of dippel) 01. jec., Oleum jecoris. (0]. jee. morruic Cod-liver oil) Onis as., Oniscus asellus. (Milliped. Wood-louse.) Op., Opium. (Laudanum. If/site poppy,) Pv on., Pfeonia. (Peonyj.) Par., Paris. (P-ar quadrifolia. Trite love.) Petr., Petroleum.' (Oleum ypetra-c. Naphtha petraco. Stone oil. Naphitha.) Petros., Petroselinum. (Apium petros. Parsley.) Phel., Pliellaudrium. (Water fenenel.') Phosph., Phosophorus. (Peaosphoroes.) Phos. a.. Phoophori acid. (Phosphtone acid.) Pinl., Pinus. (Pin. sylvestrio. The pine.) Plat., Platina. (Plat. do Pinta. Platioco.) Plumb., Plumbum metallicum. (Lead.) Finn. sp, - Pruuus spinosa. (Acacia nootra. Sloe tree) Pubs., Pulsatilla (Pulsatilla pratensis. Puloatilla, uigricans. Pceosee flower. Ran., Eanlunculus. (Rianunculus bulbosus. Bulboues root ed erozefoot.) Ran.- sc.. ]Ran unculus seeleratus, Mcersh ecrowfooct) Rat., Ratanhia. (Krameria tri C031PARE WITHICoce., nux V., puls. Anac., amn., cure., ign., nux v., op., phos., rhus. Aeon., bell., camph., coil' coleb., dig., lyos., ipee., lach., lact., more., inoseb. Hell,) ign., natr., nux v. Chain., ign., lye., nitr., nux V., plios., siL., sulph. Cann., mere., nux v., puls., Sep. Bry., pills., Sop., Stan., sulyll. Aeon., agar., alum., asr., bell., bry., Calc. e., chin., coff., merc., nux v., rhus, Sep., 511. Asa f., chinl., lye., mere, op., phos., rhus, see. e. Ass f, bell., eroc., plumb., puls. Mere., natr. in., nux v., phos. Agarn., ambin., ant. e., anguot., sen., aoa f., aur., bell., ciain., ehin., eolch, eon., eupr., fer., ign., ipee., lach.. lye., nitr aci., rhus. Sep., Si1., suipli. Mrs., bry., mere., nux V., puls., 'ran. Seel., rhuS. Puls., ran. b., rhus. ANTIDOTES. coce., nux v. flux V., op. Bell., eampll., eoff., byos., ipee., nux V., plumb., strain., vi. num. Campb., coff. Aeon., nux v. Campb,flux v., coil'., vinum. Campb., coff. Nitin. sp., dule., puls. Bell., mere., nux V.1 op., plst. Campb. Chain., coff., ign., nux v., vinegar. Bry., campli., rhus. Puls. Rheum. (Rhlabarbarum. I/hu- Ars., chain., coff., ipee. Campb., chain., coft barb.) Rbod.. Rhododendron. (Ibbod. Chlin., dule., led., -nux v. Camph, elem., rhus. chrysanthum. Yellowe Ihod.) Rhus, Elms tox. (Poison Am. c., amn., aro., coce., coff., Bry., eampb., coil'., sulph. oak.) eon, dule., lach., led., lye., nux v., phos. et ac., pubs., RhusV.711hu verni. (hus rhod., samb., sep., sil. venenata. Varnish tree) Rut., tunts graveolens. (Gar- Aeon., bell., ign., mbus, pubs. Camph. den rute.) Sabod.. Sabadilla. (Veratmum Bell., byes., pubs., rhus, veratr. Camph., puls. sabad. indian caustitc barley.) Sabin., Sabina (Junipemno. Aeon., agn, bell., ferm., staph., Campb., pubs. Sac loe trece.) thiuja. Samb., Salnbucus. (Samb. Aeon., bell., cei., ipee., strain., Ars., campb. ni,,ra. Elder tree.) spong. Sang. e., Sanguinaria eanadenSis. (Polyandria. Indian puccoon.) Sap., Sapo. Samoa. Sarsaparilla. (Smilax Mere., pubs., man. Camph. sassa. Sarsaparilla.) See., Secale cornutum. (Cla- Ars., plumb., rhus, vematr. vais scealis. Ergot of s-ye.) TABLIE OF MEDICINES. 7 ~-------- I I--------- REMEDIES, THEIR SYNO3YMES AND ENGLISH NAMES. Selen., Selenium. (Selenium.) Seneg., Senega. (Rattlesnake.ý): Sen., Senna. (Cassia senna. Senna.) Sep., Sepim. (Sepifi succus. The luice of the cuttle fish.) Sil., Silicea. (Silicious earth.) Sol. M., Solanumi mamiosui. (Nightshade.) Sol. H., Solanum nigrui. (Garden nightshade.") Spig., Spigelia. (Spig. anthelmis. Indian pink.) Spon., Spongia. (Spong. marina tosts. Burnt sponge.) Squill., Squilla. Scilla maratins. Sea onion.) Stan., Stannum. (Tin.) Stram., Stramonium. (Datura strai. Thorn apple.) Stron., Strontiana. Stron. carbonics. Strontian.) Suiph., Sulphur. (Brimstone.) COMPARE WITHAmbr., bry., lach., more. Arn., scil., Stan. Acon., led., lye., nux., puls., rhuS, sarsa., verstr. Gale. c., graph.. hep., lach., mere., rhus, sulph. Euphr., laur., mere., natr. i., veratr. Aeon., dros., hep., iod., phos. Bry., dros., rhus, spong. Puls., seneg., sil., linc. Aeon., bell., hlyos., mere., fux v., tab., veratr. Asa f., graph., stan., sil., sulph. Aeon., ant. e., ars, bar., bell., bry., eale. c., cauth., caps., caust., chai., dule., graph., ign., ipec., nux v., petrol., ANTIDOTO. [gn., puls., chin. Am., bell., bry. Aeon. nitr., sp.,'dnlc., tart. Cainph., hep., sii Sulph. ac., Snlphuris acidui. Puls., ruts, suiph. (Sulphuric acid.) Tab., Tabacum. (Nicotiana Bell., Ipec., nux v. tab. Tobacco.) Tan., Tanacetum. (Tan. vulgare. Conmon tansey.) Tarax., Taraxacum. (Leonto- Con., nux v., spig., valer. don tarax. Dandelion.) Tart, em., Tartarus emeticus. Aeon., ant. c., bar., chai., coce., (Antimonium tartaricum. ign., ipec., nitr., fux v., Sep., Tartarus stibiatus. Tartar veratr. emetic.) Tart. s., Tartari acidui. (Acidui vini. Tartaric acid.) Tax. b., Taxus baccats. (Jew.) Tereb., Terebiuthins. (Oleum Aeon., bell. caiph., canth., nin terebinthinfi. Turpentine.) v., puls. Teucr., Teucrium. (Marum Ign. verum. Wall germander.) Thea, Thea sinensis. (Tea.) Ther., Theridion. (Ther. cu-Gale. c., phos. ac. rassavicum. Ther. of Curagao.) Thuj., Thujs. Thuja oceiden- Mere., puls., sabin., Sep., ass f., dentabis.) bry., can. Ton., Tongo. (Baryosma. Tonkin bean.) Tuss., Tussilago petasites. Urt., Urtica urens. (Dipterix odorats. Stinging nettle.) Uva, Uva ursi. (Arbutus uva ursi- B3ar's bei-ry.) Valer, Vaberiana. (V aler. offici- Camph., coff.,puls. nalis. Valerian.) Veratr.,Veratrum. (Veratrum'Am., ars., chin., coff., cnpr., album. White hellebare.) dros., hell., hyos., ipec., laur., phoS. sa., Sep., spig., Staph., Straim. Verbas., Verbascui. (Verbascuin thapsus. The yellow mullein.) Vine., Vinca. (Vines minor.Hep., sulph., lye. Wintergreen.) Viol. od., Viola odorats. Sweet Bar., caps., violet.) Aur., casph. Csiph. Caiph. Pils. Vegetable acids and vinegar. op., tab., strai. ainph. Aeon., caiph., cham., chin., mere., nux v., puls., Sep. Puls. Caiph., ipec, nux v., vinunm. Caiph. Chin., ipee., asm f, coce., op., puts Camph. Caiph., canth. Camph., ign. Chin., ferr., thuja. Chai., coce., mere. Acetui. Camp., coff. Acon., caiph., coff. Caiph. Vegetable acids. Canp. 8 TA13LE or IMEDICIN ES. REMEDIES, THEIR SY"0- COMPARE WITH- ANTIDOTES. NYMES AND ENGLISH NAMES. Viol. tri., Viola tricolor. (Jacea. Baryt. caps., merc., suip. Camph. Heart's ease.) Zinc., Zincum. (Zincum.roe- Anac., ars., bell., bry., hyos., Crtmlpb., hep., ign. tallicu Z. no) flux v., phos.,pat Se nc. Zinc. 8ulp. icum suipliuri- See Zincuro.Se icm euro. (&l~phurate qf zinc.)' Zing., Zingiber. (Zingiber officinalis. Ginger.) M~gs., Magnus artfficialis. M. arc., Magnetis polus areticus. M. aus., Maguetis polus austra PREFACE AND INTRODUCTION, A CONSIDERABLE portion of the conents of this work has already appeared under the title of " Homceopathic Domestic Medicine, arranged to serve, in some measure, as a Practical Work for Students." But, in consequence of the growing attention which medical men are beginning to bestow upon our science, the Author has been advised to give the result of his labors in a separate form to the professional public. He has accordingly made considerable alterations in those parts of the aforesaid work which must necessarily be retained in the present one, and has added many articles which were purposely omitted in what was chiefly designed to be a treatise on domestic medicine. The Author therefore trusts that, notwithstanding its manifold imperfections, this humble effort to furnish the professional inquirer with " an elementary practice of physic according to the homceopathic principle," may be viewed with that kind indulgence which the occasion calls for, and ardently hopes that it may be instrumental in creating a desire for more extensive information to be gleaned from works of greater pretensions. In compiling the work, the Author has derived much assistance from Hahnemann's Kronischen Krankheiten, Jahr's Nouveau Manuel de Medecine Homeopathique, Hartmann's Therapie akuter Krankkeitsformen, Bcenninghausen's Manuel de TAera peutique Homeopathique, Hering's (of Philadelphia) Hausarzt, and Noack and Trinks's forthcoming Handbuch der Homeopatischen Arzneimittellehre; which, together with the MATERIA MEDICA PURA, the Organon of Hahnemann, that of Rau, Hamilton's Guide to Homaoopathy, Black's Principles and Practice of Homoeopathy, and the following periodicals-the British Journal of Hom9oopathy, the American Homoeopathic Examiner, the American Journal of Homceo* The above German and French works on Homoeopathy have been published in the English language by Wm. Radde, 322 Broadway, New York. (See Catalogue at the end of this work.) 1 2 INTRODUCTION. pathy, the Archiv fiur HIomomopatische Heilkunst, the Allgemeine Homceopatische Zeitung, the Ilygea, the Oesterreichische Zeitschrift fir HomoeopatLhe, the Journal de la Mddecine Homceopathique, and the Journal Icahnemannien, the Author would particularly recommend to the professional student who may be desirous of cultivating an intimate acquaintance with the science of Homoeopathy. It will be found that the Author has introduced into the work a number of diseases which are not ordinarily included in writings on the practice of physic. In deviating thus from the beaten track, he has been led by the conviction that the line of demarcation which has been attempted to be drawn between diseases that are considered to belong to the province -of the surgeon, and those which have been allotted to the sphere of the physician, is by far too artificial to admit of its being rigidly adhered to in a practical point of view. Palpably apparent as this must be to the allopathic practitioner, it is still more strikingly so to the experienced homceopathist who has had repeated opportunities of witnessing the cure of a variety of affections by the instrumentality of medicine, which he had formerly been taught to believe to be removable by the knife alone. The principal points it is now purposed to allude to are the Regimen-the Choice of the Remedy-the Potencies in general use-and the Dose. REGIMEN. The homceopathic regimen consists merely of the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the actions of the medicines and the proper functions of the alimentary system. Consequently, among liquids, the articles generally proscribed, particularly in the different forms of dyspepsia, as also in affections of the liver, in gout, hemorrhoids, and in disorders of the bladder, are: green tea or strong black tea, coffee, malt liquors, wine,* spirits, and stimulants of every description, * Wine should invariably be forbidden in cases where Nux v. is the remedy prescribed; and coffee when Puls., Ignatia, etc., are being taken. REGIMEN. 3 lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters. Cocoa, unspiced chocolate, toast-, rice-, or barley-water, oatmeal gruel sweetened with a little sugar, or raspberry or strawberry syrup, if desired; whey, milk and water, or pure milk, not too recent from the cow, boiled milk, and in some instances buttermilk, or in fact any non-medicinal beverage is allowable.* In animal food, pork, young meats-such as veal, lamb, &c., and among poultry, ducks and geese, had better be avoided, especially when derangement of the digestive function exists. Beef, mutton, venison, and most descriptions of game, if not too long kept (high), pigeons, larks, rabbits, are allowable at discretion.t (Vide SYNOPSIS.) Ham, and neats' tongues under certain restrictions. Fish is a wholesome article of diet, and may, in most cases, be partaken of without scruple, with the exception of the oleaginous species, such as eels, salmon, &c., or shellfish, as oysters, lobsters, &c. Eggs, raw or soft boiled; butter, if free from rancid or unusual taste; cream, plain unseasoned custards, and curds. Stimulating soups and made dishes are so evidently opposed to homceopathic regimen, as scarcely to require further notice. Beef-tea, veal, or chicken broth, &c., thickened with rice, macaroni, or sago, and seasoned merely with a little salt, are of course allowable. Among vegetables, all of a pungent, aromatic, medicinal, or indigestible description, or greened with copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horseradish, celery, parsley, mint, sage, mushrooms, tomatoes, * The idosyncrasies in some individuals, in respect of diet, are remarkable; as for example, some cannot take the smallest quantity of milk without serious inconvenience; others throw out a rash after partaking of fish; and again, others loathe the very sight of animal food. These peculiarities should not only be attended to in prescribing a suitable course of regimen, but should also be taken into account in the selection of the remedies. f In some forms of dyspepsia meat requires to be prohibited for a short time, or taken only every second or third day. (See DYSPEPSIA.) The same rule, it may be added, may sometimes be advantageously followed when the patient is under the action of particular remedies, such as Calcarea, Silicea. 4 INTRODTCTTION. beets, artichokes, parsnips, &c.; but others free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, spinach, seakale, &c., may be used with the needful precaution of avoiding any particular article of diet, whether of the animal or vegetable kingdom, that may seem to disagree with the individual. Lemon or orange-peel, laurel-leaves, bitter almonds, peach-leaves or kernels, fennel, aniseed, marjoram, are objectionable; acids, and the ordinary condiments, such as pepper, mustard, pickles, &c., and salads, ought either to be sparingly partaken of, or entirely abstained from, particularly by the dyspeptic. Salt and sugar in moderation are admissible. Acids or unripe fruits are clearly objectionable, and even ripe fruits possessing little or no acidity, if fresh or prepared by cooking, such as peaches, raspberries, sweet cherries, grapes, and dried or preserved fruits, as figs, prunes, apples, pears, should be used in moderation, particularly by dyspeptic individuals, and by those subject to cholic or diarrhoea not at all. Cold fruits, such as melons, and raw vegetables, such as cucumbers, &c., are inhibited; nuts of every description are forbidden. All kinds of light bread * and biscuit, free from soda or potash and such like, not new-baked; also simple cakes composed of flour or meal, eggs, sugar, and a little good butter; or light puddings, such as bread, rice, sago, semolina, without wines, spices, or rich sauces, are admissible; but colored confectionery, pastry, and also honey, are not so. Regularity in the hours of meals should be observed, and too long fasting, as well as too great a quantity of food at one time, should be avoided.t During fevers and inflammatory affections, the patient must * Unfermented bread is perhaps to be recommended in preference to any other. There are instances, however, in which bread so made does not agree, and produces symptoms of indigestion. In such cases the use of bread, in the making of which German yeast has been employed, will often prove of easier digestion. t In almost every instance where it is necessary to make a great alteration in the diet of the patient, it is advisable to do so gradually and cautiously, particularly in the case of those persons who have been long accustomed to the daily use of stimulants of various kinds. PROPER CHOICE OF THE REMEDY. 5 of course be kept upon a low regimen; gruel, barley-water, &c.; and at the commencement of convalescence a light pudding, with a little weak beef-tea or mutton- or chicken-broth, should form the whole of the nourishment given. Nature, however, is our best guide, and when she takes away appetite, thereby intimates the necessity of not taxing the digestive functions. (See also SYNOPSIs of the diet rules.) The use of any medicinal or aromatic substances in the arrangement of the toilet, such as camphorated or otherwise medicated dentifrices, lip-salve, smelling salts, or cosmetics, is detrimental to the action of the medicines, and had therefore better be avoided. CHOICE OF THE REMEDY. POTENCIES OF THE MEDICAMENTS. DOSE AND ITS REPETITION. In homeopathic practice there are three points which merit most particular attention: the first and principal is the Choice of the Proper Remedy; the second the Potency at which it should be exhibited; and the third the Dose and its Repetition. THE CHOICE OF THE PROPER REMEDY. To accomplish this, in accordance with the law similia similibus, Hahnemann has directed us to form "a correct image of the disease," by committing to writing every detail of the case; commencing, in the first place, to note down all those particulars which generally bear on the case, as its history, the previous health of the patient, hereditary predisposition, presumed cause of the disease; the former treatment; the patient's age, temperament, and appearance; his mode of living, occupation, and disposition, and whether his malady has in any degree altered his normal disposition. In the next place, the questions put must bear minutely upon the disease itself, not only for the purpose of ascertaining those of an important and primary description, but also those which are purely sympathetic or secondary, from the circumstance that the latter, in addition to their being frequently very characteristic of the disorder, are moreover the 6 INTRODUCTION. indices to the selection of the individual specific remedy from amongst a class. This part of the examination, as a general rule, is to be commenced at the head, external and internal, proceeding to the senses-sight, hearing, smell, and touch-thence to the mouth, tongue, throat, and the digestive organs: from thence to the genital, the urinary, and the thoracic organs; and then the back and the superior and inferior extremities. Afterwards the skin, with particulars as to its temperature, secretion, appearance (the anterior or present existence of eruptions), the sleep, dreams, moral symptoms, pulse, &c. The character, as well as the seat of the symptoms is of great importance. Thus it is of little use to our purpose when the patient intimates that he has a very severe pain, but he must describe its nature as accurately as possible, as whether it is gnawing, throbbing, aching, burning, shooting (darting), pricking, cutting, dragging, piercing, &c. Whether the symptoms are increased by movement or by rest (walking, lying, standing, or sitting), at night or during the day, in the house or in the open air, by heat or cold, dampness or dryness; after eating, drinking, or during abstinence. If worse after particular kinds of food; if continuous or periodical; and if increased by mental exertion, emotion, &c. With females, it is essential to pay attention to the following additional particulars: pregnancy, labor, lactation, miscarriage, sterility, and the state of the menses. In reference to the latter, it is requisite to learn whether an irregularity exists, suich as too short or too long an interval between the returns; if the discharge exudes uninterruptedly or only at intervals; if it is copious or scanty; its color; and if attended with pain; the state of the body and mind previous to, during, and subsequent to the catamenia should also be inquired after; and if the patient is affected with leucorrhcea, its nature, quantity, the periods at which it occurs, or the circumstances under which it manifests itself should be ascertained. The selection of the proper remedy is, farther, materially facilitated by the nature of the cause of the disease; we should never omit, therefore, to elicit that information when practicable. POTENCY, ATTENUATION, ETC. 7 THE POTENCY, ATTENUATION, OR DILUTION OF THE MEDICAMENT. In proceeding to the consideration of this second point, I may make the preliminary remark that it is a subject which is as yet by no means finally determined under what circumstances and conditions the lowest (viz. the 1st, 2d, 3d, and 6th, &c.), the highest (the 18th, 24th, 30th), or the recently promulgated so-called highest potencies (the 100th to the 2000th, and even upwards), are to be preferred. The majority, however, especially amongst the more modern homoeopathists, may be said to have decided hitherto in favor of the lower, and particularly the 3d and 6th in acute, and the higher, especially the 18th, 24th, 30th, &c., in chronic diseases. The main point to be attended to is the correct selection of the remedy; nevertheless, as the Author is of opinion that some importance is to be attached to the dilution, attenuation, or potency in the treatment of the multifarious forms of disease which come under the observation of the medical man in extensive practice, he ventures to throw out the following suggestions, premising at the same time that much depends upon the discrimination of the practitioner, and that it is almost impossible to give any rule to which there are not exceptions. The principal points to be attended to are, the susceptibility of the patient to medicinal influence, how far modified by circumstances, the age, sex, temperament, and habits-the disease itself, and further, the nature of the medicament employed. As regards the first, the susceptibility of the patient,. we find four classes: First class. Those who are comparatively insensible to medicinal influence, particularly at high potencies, upon whom the medicines show neither marked action nor reaction. Such individuals are generally of what is denominated the leucophlegmatic temperament; they require generally low potencies and frequent repetition-such cases are not without their parallel in allopathic practice. Also, in disease, we find some persons who appear to enjoy a peculiar exemption from infectious and even contagious influence. To this rule, however, of giving the low potencies in such cases, there are excep 8 INTRODUCTION. tions; I have found in practice, after a careful study of the individual, and the selection of a remedy suitable to tempera-, ment, a marked action and reaction produced by a very high potency, where a lower of the same medicament had failed to elicit any apparent effect, and vice versa. Second class. A marked susceptibility to medicinal action without a corresponding reflex action; such patients are generally of a highly nervous temperament, exceedingly difficult to treat, and require particular study; here the higher potencies are generally called for, although we frequently find benefit in resorting to the lower. Third class. Those in whom no marked or a scarcely perceptible medicinal action declares itself, but a well-marked reaction; in such cases we must be guided by other indications in the selection of the potency; watch the effect carefully, and avoid too frequent a repetition. Fourth class. Those in whom the medicines show a wellmarked action and reaction; here, also, we must be guided by other circumstances in the selection of the potency, so as to obtain the greatest possible benefit without materially increasing the sufferings of the patient. We generally find a particular susceptibility to medicinal influence, at any potency, in persons dwelling in the country, of robust frame, simple habits, and regular lives, who are not subject to any peculiar dyscrasia. In towns, particularly in large densely-populated cities, this susceptibility is greatly developed, but the reaction less evident; however, much depending upon the individual's employment, habits, and pursuits, it is difficult to give any fixed rule. AGE. In infancy and early childhood, we find a marked receptivity to medicinal influence, a decided action and speedy reaction, consequently the higher potencies are the most applicable in their diseases, and they rarely require so frequent a repetition; however, in acute diseases of any of the more noble organs, we may exhibit lower potencies, particularly of some of the less energetic medicines, for example, Sambucus, Ferrum, Ipecacuanh a, Chamomilla, etc., a globule constituting the maximum dose. Some further remarks upon this subject have been made in Diseases of Infancy. SEX. Females, for the most part, possess a higher degree TEMPERAMENTS.-DISEASE. 9 of susceptibility than males, in which they approach nearer to children; for them the higher and medium potencies are generally most suitable; to this rule, however, there are many exceptions, particularly in those who are engaged in laborious employments. TEMPERAMENTS. In the Sanguine temperament, there is considerable susceptibility to all the potencies and a speedy reaction. In the Nervous, we find great susceptibility, sometimes without an equivalent reaction: here we should be cautious in administering, and generally use the higher potencies. In the Bilious, there is generally but little susceptibility, but the reaction, when roused, is powerful, and prolonged; hence a necessity for low potencies, generally given at long intervals. The Lymphatic being the least susceptible of all temperaments, the medicines may be given at low potencies, and frequently repeated till some effect is produced. Since these temperaments often occur in a mixed form, the rules above given must be modified accordingly. We may observe that the remarks above made refer principally to chronic and subacute diseases. THE DISEASE. In severe, acute diseases, we are usually in the habit of resorting to the low potencies, and in tinctures, from the circumstance that we have commonly found them more certain in their effect than the 12th, 18th, or 30th in such affections. In the cases of children an exception may be made, as already observed. In ordinary cases the best range is from the third to the twelfth potency; this rule should, of course, be modified, according to the remedy itself, the disease, and the individuality of the patient. The seat, character, and the exciting cause of the disease are generally considered of importance in regulating the dose and potency; thus, in inflammation of the brain, or in erysipelas of the head, with implication of the meninges and delirium, Belladonna is not required at so low a potency (2, 3, or 6) as it is called for in erysipielas of the extremities. Dulcamara is more efficacious at a low potency (3) in catarrhal affections, or diseases of any kind proceeding from exposure to cold, than at a high one. Aconitum is more suitable at a low attenuation, when given to allay the violence of the accompanying fever in inflammations, than when it is prescribed as the specific remedy to the 10 INTRODUCTION. inflammation itself. And, finally, the low dilutions are held to be the best adapted to inflammations of a torpid character; the high to inflammatory. affections with increased arterial action. It is undeniable, however, that deviations from the above rules may often be made without disadvantage. THE NATURE OF THE REMEDY. Medicaments which, in their crude state, possess little or no appreciable medicinal property, but whose virtues have been developed by trituration and segregation of particles, such as Zycopodium, Natrum muriaticum, Calcarea carbonica, Sepia, Carbo vegetabilis, Silicea, &c., should generally be used at the higher potencies. Others also, which have been found from experience to display considerable efficacy, even when greatly attenuated, such as Sulphur, Zachesis, Acidum nitricum, Arsenicum, &c. On the contrary, some which have a short-lived, but wellmarked action, may be used in some cases in the original substance; for example, Mfoschus, Valerian, and Camphor, but in exceedingly small doses. Others again have been found most useful at the first, second, or third potency, such as Tartarus emeticus, Ferrum, Ipecacuanha, Hepar sulphuris, Stannum, Bhus toxicodendron, Opium, and in many cases Cinchona. Still, all these remedies, in peculiar cases, act well at the higher. THE DOSE AND ITS REPETITION. Although it is almost impossible to give any general rule that will serve in all cases, much more depending upon the discrimination of the administrator, and a careful observance of the symptoms than routine, the following remarks may prove of some service to beginners, for whom indeed, as has already been intimated, the contents of the entire work are almost exclusively intended. From the diversity of opinion which as yet exists as to the "potency of the medicament," it may readily be surmised that various differences prevail as to the mode of prescribing or administering the homoeopathic remedies. Some there are who invariably give one or more drops, or grains; others, again, adhere as rigidly to globules; whilst a third party give drops in acute, and globules in subacute and in chronic cases. DOSE AND ITS REPETITION. 11 To the beginner, whose former habits may very naturally incline him to err on the side of excess, by invariably flying to mother tinctures, low dilutions, first triturations, &c., in large and rapidly-repeated doses, we should say, "Strive ever to cure by means of the smallest possible dose, and do not imagine that because with a minute dose you have done much, that by increasing it you will do more-more indeed you may do, but that may as likely prove to be to the detriment as to the welfare of your patient." For ourselves, we may state that on most, although by -no means on all occasions, we are in the habit of prescribing drops, in the diluted form we have mentioned in certain parts of the work (see PNEUMONIA, PLEURITIS, &c.), in the treatment of acute diseases; whereas in subacute and in chronic affections, we very generally, if not exclusively, confine ourselves to the employment of globules, varying the form of prescription according to the age, sex, and temperament of the patient. On ordinary occasions, in the treatment of chronic maladies, we order a couple of globules to be taken every night in a dessertspoonful of pure cold water at bed-time for a week, and then allow the remedy to act for from four to eight days, and even upwards in particular cases and under particular circumstances, before repeating the remedy, or selecting another. But where the patient is extremely susceptible to the action of the medicines, and, usually, in young subjects, we give only one, or at the most two doses (one night and morning), consisting of one or of two globules, either undissolved or in a tea-spoonful of water, and allow the remedy to act for the same period as above specified. In many cases of a chronic description, and particularly when the patients are found to be moderately sensitive, we give a dose for four successive days, and then wait for two to six days for a development of improvement. We, as already stated, occasionally vary our mode of prescribing, being guided in doing so by the sex and constitution of the patient, the character of the disease, and the nature of the remedy (see POTENCIES OF THE MEDICAMENTS), but ever prefer the smallest possible dose to a large one, and globules in place of drops of the tincture, even when from no other motive than that of prescribing a medicine free from taste 12 INRODUCTION. an advantage of no small importance in the treatment of children-whenever we feel convinced that we.can do so without fear of allowing the disease to gain head, or of retarding recovery by the insufficiency of the dose. Slight diseases are often removed by a single dose of a well-chosen medicine, but more severe and deeply-seated disorders require a frequent repetition. In acute diseases, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or amelioration declare itself, after an interval of from two to four hours at the utmost, but the disease seems to gain ground, repeat the medicine. In cases of high inflammatory action, or the severest forms of acute diseases, as cynanche laryngea, cholera, pneumonia, pleuritis, dysenteria,. febres nervosse, phrenitis, cystitis, &c., attended with signs of imminent danger, the dose must be repeated every quarter, every half, every hour, or every three or four hours. If a medicinal aggravation* take place, followed by amelioration, we must let the medicine continue its action, until the amelioration appears to cease, and the disease again make head; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but an amelioration follow, we may safely await its approach to its termination, ere we again administer. If any symptoms remain from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employment. In chronic, subacute, and indeed almost all cases, when a very striking improvement takes place, it will generally be * It is necessary to remark that very striking medicinal aggravations are, comparatively speaking, very rarely met with. In chronic maladies occurring in highly-sensitive persons, and proceeding from or attended with cerebro-spinal irritation, we encounter them more frequently than in acute diseases. They are, in general, more prone to take place in the instances alluded to, with considerable intensity, after the employment of the higher than the lower attenuations. So at least the author's experience teaches him to conclude. DOSE AND ITS REPETITION. 13 found advantageous to cease to administer the medicine as long as the improvement continues, and only to repeat as soon as the slightest symptoms of activity in the morbid phenomena reappear. But when a sudden or marked improvement of comparatively short duration follows the first dose of a remedy, and on repeating the dose, the symptoms of the complaint increase, instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selection of which it will be necessary to choose one related to the remedy first prescribed. When the action of a well-chosen remedy has been disturbed or arrested by some incidental cause, such as an error in diet, exposure to cold, &c., some intermediate medicine should be prescribed against the new symptoms thus developed, and on their removal the remedy first employed should again be resorted to. The distinguishing of the medicinal aggravation from that of the disease being a point of material consequence, we shall here endeavor to give the usual characteristics of each. The medicinal aggravation comes on suddenly and without previous amelioration: the aggravation of the disease more gradually and frequently following an amelioration. 3Moreover, in the former, several of the medicinal symptoms, some of which we may meet under the indications for the remedy, and not before remarked, declare themselves. Too much stress cannot be laid upon the necessity of carefully watching the effects of each dose, as, in addition to the temporary aggravation of the symptoms which sometimes sets in, a development of collateral or pathogenetic signs occasionally takes place, particularly after frequent repetition of different remedies in susceptible patients; by a want of attention to this important point, we may incur confusion, and may be unconsciously treating a medicinal disease of our own creation. Such, unhappily, but too frequently occurs in allopathic practice from ignorance of the real properties of the drugs employed. We must also guard against falling into the opposite extreme, and allowing the disease to gain head unchecked. In severe acute affections we may often repeat the same medicine at the same dose, at regular intervals, as long as it 14 INTRODUCTION. does good; but this rule has many exceptions, and the directions already given at the commencement of this article should be borne in mind. In chronic cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible; in such instances if the improvement remain stationary, or progress slowly, we may alter the attenuation, or, still better, give at suitable intervals some other remedy or remedies of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelioration follows each administration, we should allow a longer interval to elapse before repeating, by which means, the system gradually recovers itself, and the susceptibility to the medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases; in such instances a higher potency should be selected, or vice versa if that employed has been one of the most minutely subdividedprovided the remedy still appears to be appropriate,-and the intervals between the exhibitions lengthened. This occasionally occurs when the medicine has been frequently repeated, and given in solution. When the beneficial effect of a medicine is interrupted by an attack of cold, diarrhoea, &c., some other medicine must be given for the new affection, on the removal of which, the medicine which was previously acting favorably must be recurred to. REMARKS. In the Selection of the Remedy, it is not necessary that all the symptoms noted should be present; at the same time taking care that there are no symptoms not covered by the medicine, or more strongly indicating another. When the symptoms are few in number, not characteristic or wellmarked, attention to the following points is of material assistance: the period of the day at which they occur, or become most prominent; the side of the body which is affected; the disposition of the patient; his propensities or peculiar habits and likings; the agreeing or disagreeing of different kinds of food; the longing and craving for, or the unconquerable aversion to certain aliments, &c. BEMARKS. 15 When it is requisite to keep a medicine in solution for some days, a few drops of proof spirit may be added to the water, which should be as pure as possible, in order to preserve it from decomposition. Homceopathists prescribe only one medicine at a time; but in some complicated cases considerable advantage is to be derived from the alternate employment of. two remedies, which are equally indicated in the case under treatment. It may be scarcely necessary to explain the Pharmaceutical Signs used in this work, to signify the -potency and quantum of the dose; but, as the book is intended for beginners, and may fall into hands otherwise wholly unacquainted with the science, we do so as a measure of precaution; it will, therefore be sufficient to remark, that Tinct. Aeon. 3 gtt. ij, means two drops of the third attenuation or potency of Aconite; Tinct. Bry. 6 gtt. iij, three drops of the sixth of Bryonia, and the same with any other medicine. The Germans commonly make use of the Roman numerals to denote the attenuation, and as only every third attenuation is very generally used (particularly in northern Germany) the above signs would be written thus: Tinct. Acon. I, gtt. 00 or 2. Tinct. Bry. II, gtt. 000 or 3. The Roman numeral multiplied by 3, indicating the attenuation meant. When we wish to prescribe globules, the contraction gl. is usually employed. (See also Formulae, etc.) The medicines should be taken fasting, and food or drink, as also excessive bodily or mental exertion, abstained from for half an hour to an hour afterwards. The homceopathic remedies should be kept in a clean, dry, dark place, free from odors. Every description of allopathic medicine, patent or domestic, is prohibited; likewise bleedings, blisters, medicated fomentations, perfumery, and everything containing camphor. In cases of obstinate constipation, recourse may be had to an enema, or lavement of cold or of tepid water when the former disagrees, to which may be added, if necessary, a tablespoonful of olive oil. We shall conclude these introductory observations with some extracts from JAIrm's New Homoeopathic Pharmacojpeia and Posology,* for the information of those of our readers who are * Tratnslated, with additions, by James Kitchen, M.D., Philadelphia. The second enlarged and improved edition, with the NEW REMEDIES, by C. J. Hempel, M.D. Published by Wm. Radde, 322 Broadway, New York. 16 INTRODUCTION. ignorant of the method in which the homceopathic medicines are prepared, &c. "NATURE AND FORM OF HOM(EOPATHIC MEDICINES. "1. We make use of the same simple substances in homceopathy as in the old school; but, instead of making of them, as in it, compound remedies, we seek, on the contrary, to procure each medicine in all its purity, and to administer it without any admixture which might alter its proper virtues. Without going into detail here on the preference to be given to this mode of administration, we should, nevertheless, observe that it is bound to the principle of homceopathy in so firm a manner, that it cannot be sundered without injury to the practice. In consequence of the principle, that no medicine can be employed with success, except so far as it is known in its pure effects, homceopathy has subjected to examination a number of simple medicines, which it is important now to reproduce, such as they have been experimented on, if we wish to rely on these observations. Even for the medicines which have not yet been experimented on, it is not the less important to submit them to these experiments in all their purity and simplicity; for though each compound remedy forms, after all, also a kind of remedial unity, which may be studied in its effects, still we can never reproduce a second time precisely the same effects as the first, whilst the productions of nature exhibit at all times, and in every place, the same properties. "2. In thus rejecting all the compound remedies of the old school, as improper to be submitted to study and to be employed in practice, homceopathy claims not, however, the pretension to use only perfectly simple bodies, such as sulphur, for example, metals and other elementary substances; she derives, on the contrary, her medicines from three kingdoms of nature, the same as the old school, and all the various chemical combinations, which, after invariable laws, are constantly produced in the same manner, can be of use to it as remedial means. " In one word, the simplicity of homceopathic preparations, of which we speak, has no reference to the primitive substance, which serves for the medicine, but to the medicine itself, which, as such, ought to be composed of only one remedial substance, REMARKS. 17 and prepared in such a manner that the virtues of that substance beas pure and as developed as possible. "3. If all substances endowed with remedial virtues, presented themselves under a form as convenient as some mineral waters, for example, nothing would be more natural, nor more rational than to employ them as nature presented them. But, with a great many of these substances, the real virtue is found in a state more or less latent, and could not be put into activity except by the destruction of the primitive matter, and the addition of another substance, which, in quality of simple vehicle, receives the developed virtue, and transmits it to the organism. In other substances, on the contrary, the remedial virtue is found developed, but it is so energetic, that, without the addition of a substance which can moderate the effects, we cannot employ them without danger to the health, or even the lives of the sick. In fine, there are yet other substances which, though their virtues need not to be either developed or moderated, present themselves under a power which is opposed to their dispensation as well as their preservation, and which, in consequence, equally require the addition of foreign substances, in order to be conveniently prepared for use. 4. The preparation and administration of medicines being then impossible under any mixture, it is important to discover substances which, at the same time operating under the form of medicines, are innocent enough in themselves not to alter the virtues of them. This condition, simple as it may appear in theory, is not, however, so easy to fulfil as it appears-for, perhaps, there exists not a substance in the world, which, under such and such circumstances, may not exercise a pathogenetic influence, and, consequently, alter the specific effects of a medicine with which it may be mixed. Even _pure water, the substance the most innocent that we know, is not completely exempt from this inconvenience; and even were it so, it would not suffice alone, neither for the preparation nor the preservation of medicines. In consequence, homoeopathy has substituted two other vehicles, viz.: 1. AlcoIol or spirits, of wine, for the preparation of liquid or soluble substances: 2, Sugar of milk, for the preparation of dry substances; and though these two substances are not entirely void of medicinal effects, the practical facts are still the same as if these substances 2 18 INT3RODUCTIO'N. were entirely pure, since all the preparations which are made in this manner are constantly the same among themselves. "5. By means of these two substances, pure alcohol and sugar of milk, homoeopathy makes all its medicinal preparations, without exception, whether under the form of tinctures or powders. The first are obtained, that is, the tinctures, in mingling with alcohol the juice recently expressed from fresh plants, or in infusing in this liquid the dry substances, the active principles of which can be extracted in this way. The powders, on the other hand, are obtained by the trituration of the insoluble substances with a suitable quantity of sugar of milk. The alcoholic tinctures and the powders, are then the only preparations known in homoeopathy. All kinds of essences, syrups, pastes, ptisans, and other inventions of the old school, are entirely foreign to it. " 6. From this, however, it does not follow that homoeopathy always employs the primitive preparations of medicines; on the contrary, in the majority of cases she considers them too energetic to be administered such as they are obtained. But, instead of seeking to diminish their energy by the means which the old school call correctives, homoeopathy endeavors to obtain this end by the simple attenuation of the primitive substance. It is thus that, seeing that a grain or a drop of the primitive preparation of a poisonous substance, for example, would be too active, she attenuates this drop or this grain in mingling it with a new quantity of vehicle, until a preparation is obtained, which is neither too strong nor too weak to operate the cure, or too energetic to fear any unfortunate consequences. Homoeopathy thus prepares out of each substance a series of attenuations, of which the following one contains ordinarily the 100th or sometimes the 10th part of the active principle of the preceding one, and it is generally from one of these attenuations, and rarely from the primitive preparation of a medicine, that the homoeopathic physician administers to his patients. " 7. Finally, as to the form under which the homoeopathic physician dispenses his medicines, it is not less simple than the preparation, and is equally made without any other mixture than that of the least medicinal substances, such as alcohol, pure water, sugar of milk and globules composed of sugar OF VEMERCLESI ETC. 19 and starch. The attenuations of each medicine being previously prepared, the patient receives of them the dose prescribed, either in form of solution, with a convenient quantity of pure water, or water mixed with alcohol, or in form of powder, mixed with a small quantity of sugar of milk, or yet again in forms of globules impregnated with the alcoholic, attenuation of the medicine. " 8. How simple soever may be the preparation of homoeopathic remedies, as to its principle, it nevertheless exacts much precaution, and very particular care, if we would be sure to have medicines as active and as sure as possible in their effects. To this end, also, homceopathy has prescriptions and positive rules, which it is important to know before all, in order to follow them with exactitude, and to prevent thus the faults, which, diminutive as they may appear in themselves, are, nevertheless, very serious in practice. In the following chapters we shall pass in review all these rules and prescriptions in treating successively-1. Of vehicles which serve for the preparation of medicines. 2. Of the preparations of medicines in their primitive state. 3. Of attenuations. 4. Of the dispensation and preservation of homoopathic medicines. These four chapters, containing all that has reference to the general pharmacopceia, we shall occupy ourselves in the second part of this work with the special pharmacopoeia, that is to say, with the rules to be observed in the preparation of each medicine in particular, and with the description of primitive substances which homceopathy has introduced into its pharmacy. " OF VEHICLES, WHICH SERVE FOR THE PREPARATION OF HOM(EOPATHIC MEDICINES. " 9. The vehicles which homoeopathy uses for the preparation of its medicines are, in all, of the number of four, viz.: 1. Alcohol, or spirits of wine. 2. Sugar of milk. 3. Globules composed of sugar and starch. 4. Pure water. Some physicians have wished to add a fifth to the above, viz., ether, and we shall see below to what destination this liquid is suitable. As to the four vehicles which we have just cited, homceopathy has thus far used them for all its preparations; and it is im 20 INTRODUCTION. portant to obtain them as pure as possible, in order to be sure to obtain preparations, in every respect, identical with those with which Hahnemann, and his disciples, have made their pure and clinical observations. This purity is not, however, always the distinctive quality of the objects which we find in commerce, or that nature furnishes, and that is the reason why it is almost indispensable that homoeopathy should know how to prepare herself vehicles, or at least to render them proper for the use she makes of them. We shall endeavor to give in this chapter the instructions necessary to this end. " 10. Alcohol (spiritus vini, spiritus vini alcoholisatus, spirits of wine, alcoholized spirits of wine) is never found in nature-it is always the product of art---but it is formed every time that sugar is found in contact with a fermentable matter in water, and at a suitable temperature; that is to say, that it is developed in the course of fermentation, to which has been given, after this phenomenon, the name of spirituous or alcoholic. As all liquors which have undergone the spirituous fermentation contain alcohol, and as those which abound in the saccharine material, are by that susceptible of affording it, it results that we may obtain it from a great number of vegetable substances, such as wine, beer, cider, malt, grape dregs, sugar-cane juice, germinating cerealia, pounded cherries, molasses, juice of carrots or beets, potatoes, honey, &c. The Tartars extract it even from the milk of their mares. "11. From whatever substance we obtain it, alcohol is identical; but we must always have recourse to means more or less complicated to obtain it pure. In every case it contains a more or less large quantity of water, and very often it is mixed either with acetic acid, or a small proportion of prussic acid or empyreumatic oil, &c., according to the substances from which it has been extracted. The alcohol which seems to be the best for homoceopathic preparations is that obtained from the dregs of grapes (marc de raisin)* without the addition of other substances, or else the alcohol of rye or wheat. The least suitable kinds are such as come from the laboratories of chemists or pharmaceutists, and which, for the * This is the refuse of the grape, after the juice has been pressed out, in the process of making wine. OF VEItCLES, ETC. 21 most part, are drawn from the residue of some chemical preparation, such as the resin of jalap, &c. Alcohol extracted from potatoes is not more suitable for homceopathic preparations, since it contains a large quantity of empyreumatic oil, of which even the chemical proceedings, which consist in clearing it by the chloride of lime and powder of charcoal, do not entirely purify it. This oil is often found even in the alcohol from rye or wheat; but, in this case, it is sufficient to mingle this spirit with a suitable quantity of pure olive oil, and to shake it from time to time for several days; in this way the empyreumatic oil combines with the olive oil, and swims on the alcohol, whence it may be easily taken. "12. Alcohol pure and perfectly anhydrous is a colorless liquid, of a remarkable fluidity, of a sweet and penetrating odor, of a hot and burning flavor, and whilst it is rubbed between the hands it should not lather, nor emit any foreign odor. Its specific weight is much less than that of water, in which it dissolves perfectly and in all proportions, with disengagement of heat. Exposed to the air it evaporates in part, and the part which remains loses its power in becoming saturated with the humidity of the atmosphere, of which it is exceedingly greedy. At the approach of a candle, or by the effect of the electric spark, alcohol burns rapidly, with a flame white at the centre and blue at the edges, and leaves no residue. Put in contact with other substances, it dissolves a great many, such, among others, as phosphorus and sulphur (both in small quantities), the fixed alkalies, balsams, resins, camphor, sugar, volatile oils, extractive matter, &c. Acids have a marked action on it; some dissolve in it simply, whilst others are transformed into ether. " 13. Alcohol, in the state of complete purity, has a specific gravity of 0'791. It then contains not a trace of water, and marks by the alcoholmeter 100 degrees of force. But it is never employed at this stage of concentration; that which commerce presents, as well as that which we find in medicine, is always more or less weakened. According to the proportions with which water is mixed with it, we may generally distinguish four kinds, viz.: 1st. Spirits of wine of commerce, the weakest quality, having a specific weight of gravity of but 0"910 to 0"920. 2d. Rectified spirits of wine, the quality 22 INTRODUCTION. which is obtained by mingling 7 parts of water with 17 parts of the best rectified spirits of wine (see 3d); the specific gravity of this spirit is from 0-890 to 0-900, and its degree of concentration 600. 3d. The best rectified spirits of wine, superior quality, the specific gravity of which is from 0-830 to to 0"840, and its degree of concentration 850. 4th. Alcoholized spirits of wine, or absolute alcohol, the most concentrated quality, having a specific gravity of 0-810 to 0-820, and containing from 96~ to 1000 of alcohol. For the preparation of the mother tinctures of homceopathy, the most suitable quality is the absolute alcohol of 950; for the attenuations, we may, in the majority of cases, be content with a spirit of wine of 60~ to 700. " 14. In order to obtain an alcohol as anhydrous as possible, recourse has been had to various chemical measures, which succeed well enough, as regards the concentration, but the majority of these measures (lime, acetate of lime, sulphate of soda, alum, &c.) constantly produce a more or less powerful alteration in this liquid. Even chloride of lime is not exempt from this fault, which may easily be recognised, in burning rectified alcohol, by this means, after having added to it nitrate of silver, and afterwards examining the residue. This is the reason why the homceopathist should never make use of alcohol rectified in these chemical ways, but endeavor to obtain the desired quality by more innocent proceedings. That which appears to be the most suitable, consists in obtaining the concentration by simple evaporation. For a long time it has been remarked, that alcohol preserved in vessels closed with prepared bladder acquires strength, whilst it loses strength if closed by caoutchouc, insomuch that to concentrate it is only necessary to put it in beef- or pig-bladders, and suspend them in a warm or dry place. To this effect, after having carefully cleansed the bladder, we paint it with a thin coat of fish-glue; then we fill it with the alcohol we wish to concentrate and suspend it, well closed, in a perfectly dry place, and at a temperature of 200 to 250 R. The drier the air that surrounds the bladder, the more prompt is the evaporation of the water; and in leaving the bladder in proper conditions until we perceive the odor of alcohol, we may be sure of obtaining a quality as anhydrous as possible. SUGAR OF MILK. 23 "15. The most simple and the most sure method of obtaining an alcohol as concentrated and as pure as homceopathy wants would then be, to take the first-quality brandies and to concentrate them after the method indicated above. Alcohol obtained in this way is generally in a state of concentration of 95~ to 96~, and thus is perfectly suitable for the preparation of alcoholic extracts; only, before employing it, it should be once again rectified by a new distillation. For this we should be careful to use only glass apparatus, since copper or tin vessels often give out to the product of distillation some of their material, an adulteration, which is the more to be guarded against, as, often, chemical means are not capable of revealing it, though it should be strong enough to alter the effects of medicines which might be prepared with a product of that kind. " 16 Respecting the brandies from which we might wish to obtain alcohol, we have said above that the best were those obtained from the dregs of grapes or else from rye. But in taking these liquors such as they are found in commerce, we should always be well assured that they are pure. Often we find in them lead, which we may detect by treating them with the liver of sulphur, which causes a brownish or blackish precipitate. Should they contain copper, liquid ammonia produces a blue color. The adulteration of brandies by alum may be discovered by the addition of a solution of potash, and the mineral sulphates by acetate of barytes. In fine, be sure that the alcohol we use is really made of the wished-for substance, we mingle 30 parts of it with 0'15 parts of liquid caustic potash, and heating this mixture with spirit of wine, we permit it to evaporate until there remain but four parts. We take this residue, to which we add four parts of weak sulphuric acid, in a well-stoppered small flagon, taking care to shake the mixture; in unstoppering the flagon afterwards, we shall perceive a perfect odor of the substance of which the brandy has been made. "Sugar of Milk. "17. Sugar of milk (saccharum lactis), is a salt of a sweet taste, slightly sugary; it forms masses moderately thick, hard, 24 INTRODUCTION. crystalline, semi-transparent, colorless and inodorous. By its properties, both physical and chemical, this substance, which is exclusively proper to the milk of different animals, seems to be intermediate between sugar and gum. Sufficiently purified, sugar of milk contains no azote; it dissolves in twelve times its weight of cold water, and four times its weight of boiling water. Alcohol dissolves it but in a very small proportion, and ether not at all; it does not alter by the air, is not susceptible of undergoing the vinous fermentation, melts, puffs up, and is transformed into a kind of gummy matter by the action of fire, decomposes the acetate of copper the same as common sugar; in fine, treated with nitric acid, it forms mucic acid, and by sulphuric acid or muriatic acid diluted, the sugar of grapes. Its proportion, as that of the other constituent principles of milk, varies in the different kinds of mammiferse. In general it abounds more in the milk of the ass than of that of the cow, or mare, or goat, &c. According to Berzelius, one thousand parts of skimmed milk give 35, and the same quantity of cream gives 44 parts of sugar of milk, mingled with saline matters. "18. It is in the mountains of Switzerland that the sugar of milk is prepared which we find in commerce. It is prepared from the evaporation of the whey, which they obtain in such large quantities in the preparation of cheese. It presents many varieties, according to its degree of purity. The crystalline sugar in grape form is considered the most pure; the other kinds always contain more or less animal matter. We often also find, in commerce, under the name of sac. lac. inspissatum, the whey of milk solidified and dried; but this is a kind that in no wise is proper for homceopathic preparations. The sugar of milk which we find at the druggists is, in the majority of cases, more or less altered by mortars of copper or iron in which it has been pulverized, and still more often impregnated with exhalations of a quantity of aromatic substances, in the midst of which it is preserved. Hence the necessity of the homceopathic physician to prepare it himself, every time that he has it in his power, or at least to purify it by a new crystallization, if he is obliged to provide himself with it from the druggist. This, however, is not without difficulty, since the sugar of milk does not crystallize, in watery SUGAR OF MIX. 2 Solution, but very slowly, and always in an incomplete manner. It is only by treating it with equal parts of alcohol and water that we can succeed well; the operation, it is true, becomes more costly, but considering the advantages which this procedure offers., we think that the cost is no reason for its rejection. "119. To purify the sugar of milk in this way, we dissolve about two and a half pounds of the best quality in ten pounds of rain-water or distilled water in a boiling state, then filter the solution through filtering paper, in a vessel of porcelain or glass, and mix it with four kilogrammes of absolute alcohol; after which place the vessel containing this mixture in a dry place,.and leave it perfectly still. The sugar of milk being insoluble in absolute alcohol, and this being very attractive of water, drawing away a large quantity, the crystallization advances pretty rapidly, and often at the end of three or four days -a crust of white and brilliant crystals may be obtained, of the weight nearly of the sugar of milk that was dissolved in the water. When this crust is formed, it is taken away, washed with distilled water, to which has been added a little alcohol, and then dried on blotting paper. That done, we may consider the sugar as altogether suitable for all the homzeopathic preparations, even the most delicate; it is completely colorless and inodorouLs-tested by the most active reagents it shows not a trace of foreign salts. " 20. Notwithstanding the process we have described above, it would be of little avail, were the sngar of milk not of a good quality in the first instance. In order to be sure of that, it should be separated from all fatty substances and other foreign matters which milk contains, which is recognisable by its perfectly white color, by its due degree of resistance to the atmospheric air, and its odor and pure and natural taste. The adulteration of sugar of milk with common sugar may be known by its sugary taste-with alum, by the aid of acetate.of lead or oxyd-ulated nitrate of mercury. To examine sugar of milk that has been boiled in copper vessels, we dissolve a certain quantity in water and pour on it some caustic ammonia which colors it blue, should it contain any of that metal. Nitrate of silver detects the presence of kitchen salt, and ace 26 INTRODUCTION. tate of lead that of sulphuric acid. When prepared from sour whey, it reddens the tincture of tournesol. " 21. To reduce the crystallised sugar of milk to powder, we first break the crust in the direction of the crystals, upon a sufficiently thick piece of wood, with a wooden hammer and a strong knife; then we put the pieces in a mortar of porcelain, when we break and triturate them until the powder becomes sufficiently fine for use. That done, we pass the powder through a sieve of crape which we have fitted above and below with parchment. The finest part, after being sifted, is found below the sieve, whilst the grosser part above should be triturated again. To preserve sugar of milk, it should be placed in a dry place, in order to keep it from the moisture of the air and prevent it from spoiling. " 3. The Sugar Globules. "22. The sugar-globules (globuli saccharini) are small nonpareilles destined to be saturated with homceopathic medicines, in order to be able to dispense these last with more facility. They are generally found at the confectioners, who prepare them from sugar and starch; but as the sugar of the cane or the beet, which enters into this preparation, is not pure enough for the purpose indicated, it is better to have globules made expressly from sugar of milk, or else with the ordinary purified sugar. As to the size of these globules they should not be too large, so that we may be able to dispense the smallest doses. Hahnemann proposed to give them the size of a poppy seed, so that about 40 of them would weigh about one and a half grains (one centigramme). This form has been adopted by a majority of homceopaths; some, however, use them of the size of a millet seed. " 23. To charge these globules with the active principles of the medicine, and to prepare them so that in a large quantity they may not deteriorate, we imbibe them first with those alcoholic attenuations which we desire; then, after being well assured that all have been well impregnated, we dry them and put them in a well-stoppered bottle. The complete desiccation of the globules before bottling them is absolutely indis WATER. 27 pensable, since without that precaution they fall into powder in a short time, and afterwards lose, in becoming decomposed, their medicinal virtue. This is the reason why, after imbibition in a suitable bottle, it is well to turn them out on paper with raised edges, where they may be agitated until they do not adhere one to the other. Should we wish afterwards to put them into the same bottle in which we have imbibed them, we should take care to dry it also, before making use of it, or to empty it afresh, and dry the globules until they do not adhere to the bottle. All the globules so imbibed have a dry and smooth hue, whilst in their natural state they are white and brilliant. "4. Water. "24. Among all the vehicles there is not one that is more free from medicinal virtue, properly so called, than pure water; but on the other hand, nothing is more rare than to find in nature this fluid in a perfectly pure condition. Under whatever form water presents itself, it is more or less charged with foreign matters, such as gas, salts, earths, &c. The purest quality of water is rain-water, which, as well as distilled water, has neither odor, nor taste, nor color; besides atmospheric air, which this water contains, there is but a small portion of fixed matters,-only after a storm, we find, occasionally, a trace of nitric acid combined with ammonia. The water of springs and wells constantly contain many kinds of neutral salts, earths, and muriatic compounds. As to the waters of rivers, lakes, and ponds, in inhabited countries, it is far from the conditions of pure water to merit attention here. "25. Homceopathy uses water for three different purposes, viz.-1, for the chemical operations, which require the purification of many primitive substances; 2, for the preparation of some of the attenuations; and 3, for the administration of medicines in the form of watery solution. For the last of these uses we may well enough make use of river or springwater well filtered; for the chemical operations, rain-water procured during a calm answers in all cases; but for the preparation of the attenuations, we must have the purest water we can possibly obtain. For this, distilled water, which is 28 INTRODUCTION. found in the pharmacies, is not suitable; for even if it has not been distilled in copper or other metallic vessels, it is always to be feared that it is impregnated with foreign matters, derived from substances which, perhaps, but a short time previously had been distilled in the same apparatus, and of which the ordinary care employed in cleansing them is far from discharging the whole. " 26. To obtain a perfectly pure water, the homoeopath must himself undertake the distillation in vessels of porcelain or glass, as indicated under the head of alcohol. The most suitable water to distil is rain-water, above all, if we take care, as we have above remarked, not to procure that which falls during a storm, or when the sun shines. We must not, even in an ordinary rain, gather the first rain that falls, since this commonly contains the impurities suspended in the air; it is only after rain has fallen four or six hours that we are able to gather it in its purest possible condition. Still this water contains a certain quantity of carbonic acid, and hence, before submitting it to distillation, we should do well to boil it in a porcelain vase and let it cool. Respecting the distillation itself, we must be cautious gradually to augment the fire under the apparatus, and to preserve, by wet cloths, the neck of the retort at a moderate temperature, so that the vapor, in passing, may not dissolve from the sides of the vessel even a trace of silex or alkali. The first distillation should be rejected, and when the liquid in the retort is diminished two thirds we must cease. A good distilled water should leave no residue on evaporation; it should be perfectly limpid, insipid and inodorous, and neither precipitate by muriate of barytes, nor nitrate of silver, nor hydrosulphuric acid, nor the hydrosulphates. To preserve it, it should be put into bottles or new jars of yellow glass, that we have been careful to cleanse at first with a part of the same water, and which we put afterwards in a place as cool as possible. " 5. Ether. "27. Sulphuric ether, or ether par excellence (cether sulphuricus, spiritus sulphurico-ethereus), is a light, volatile, odorous and inflammable liquid. Like the other hydratic ETHER. 29 ethers, as the p/osphoric, arsenic ethers, &c., it is composed of two volumes of bicarbonated hydrogen gas and one volume of vapor of water, so that it may be considered either as alcohol deprived of a certain proportion of the elements of water, or as a hydrate of bicarbonated hydrogen. Recently prepared, it is neither alkaline nor acid, and when burnt, it shows no trace of sulphuric acid, an evident proof that the sulphur enters for nothing into its composition. It unites with difficulty with water, which requires ten times its weight to dissolve it, but with alcohol and all the essential oils it unites in all proportions. The fixed oils, also, the strong acids, balsams, several kinds of resins, phosphorus, sulphur, bromine, and many hydrochloric salts, are perfectly soluble in ether. "28. In homceopathy, we as yet are not acquainted with any etherial preparation, except phosphorus, which some have proposed to substitute for the alcoholic preparation of this substance. This substitution of ethereal tinctures for alcoholic tinctures, not only for phosphorus, but also for many other substances, appears to us to be suitable in a great many cases, and we should not hesitate in the least to advise it to all the homceopathic physicians and pharmaceutists, were we well assured that the medicines would not undergo any modification in being indifferently treated by the one or the other of these vehicles. The knowledge of the chemical constituents of which ether is composed is not sufficient for us to conclude on its pathogenetic effects, and so long as this doubt is not settled by pure experiments, we think that all those who wish to be guided by the observations contained in the homceopathic materia medica will do well to procure such preparations as have been employed by the authors of these observations. From this, however, it does not follow that we should not prepare any ethereal tincture, and we are ourselves far from wishing to interdict it here, but we only insist on the necessity not to confound them with those of alcohol, and to note at least on the label the vehicle with the aid of which they have been prepared. " 29. Ether, such as it is found in our shops, under the name of rectified ether, is ordinarily pure enough; it only sometimes contains a little alcohol, of which, however, it ought to be freed. To do this, we shake it a short time with 30 INTRODUCTION..double its volume of water, and when it is separated from it we pour it on quicklime, with which it should be shaken at intervals for some days. In afterwards distilling this mixture, until there remains in the retort about two-thirds, the third which has passed into the recipient is perfectly pure ether. Often, however, we find it adulterated with a quantity of sulphuric acid or other acids. The adulteration with water is known by the watery residuum evident, whilst at a mean temperature we expose a small portion of ether to evaporation. The presence of sulphuric acid betrays itself by its disagreeable odor, and that of other acids by its reddening tournesol. Finally, to preserve ether free from all deterioration, it should be put into little bottles, the mouths of which terminate in points, so that they may be hermetically sealed by the flame of a lamp. When ether has been deteriorated by the action of the air or the light, it is less volatile, of an acrid and burning taste, and miscible with water in all proportions. " OF THE PREPARATION OF HIOM(EOPATHIC MEDICINES IN THEIR PRIMITIVE STATE. "1. General Observations and Rules. "30. In order to obtain good homceopathic preparations, it is necessary, first of all, to procure the primitive substances of the best possible quality, and in the state most suitable for their destination. All the substances which are furnished us by the animal and vegetable kingdoms always lose more or less of their power in drying, and this is the reason why every homoeopathic physician and pharmaceutist should endeavor to procure them himself, as much as possible, in the fresh state, and immediately to submit them for preparation. As to the substances which are only found in far distant lands, and which, in consequence, we can only obtain in the tincture, prepared on the spot where they grow, or else the substance itself in a dry state, it is better to accept this last, in this state, than to trust to a preparation, of the purity of which it is impossible to be sure. The cunning of our age has carried to such an extent the falsification of drugs, that it is impossible, with confidence, to make use, for homceopathic prepara OBSERVATIONS AND RULES. 31 tions, of the products of commerce, and among them, the tinctures are those which are the worst, and consequently, the least proper. As to the substances, which are generally sold in powder, we need equal precaution; above all they should be clear, as amber, castor, &c. Should it be impossible to procure them in their natural state, we should never accept them, unless we are perfectly assured of their purity. The same may be said of all the chemical products which are found in commerce; there is not a single one which homoeopathy can make use of without a previous careful examination of its quality. "31. A point, not less important than the good quality of substances, is the exact choice of the particular kind which homoeopathy makes use of, and this is a point upon which we believe ourselves bound to insist so much the more, since not only some pharmaceutists, but also homceopathic physicians, have often thought to introduce a real advantage, in substituting, for substances used in homceopathy, others which appeared to them either more energetic or more pure in their chemical qualities. However great these advantages may be in a scientific view, it is not the less certain, that the least essential change introduced into the preparation of a medicine may cause the most disastrous consequences to the safety of practice. What is most important to the practitioner is, not that the preparation should be more or less scientific, but that it should be similar with that which has been employed in the experiments, and the more the conformity in this point of view, so much the more the preparation will be perfect to the end it ought to fulfil. Thus, to obtain the calcarea or subcarbonate of lime, for example, such as is employed in homceopathy, it is absolutely necessary to prepare the oyster-shell just as Hahnemann prescribed, though such preparation is far from containing the pure subcarbonate of lime. It is thus also that cinchona, opium, nux vomica, &c., such as are used to prepare the tinctures of the same names, can never be replaced by the quinine, the morphine, the strychnine, &c., without inconvenience, notwithstanding these last substances are reputed to contain the active principles of the first in a perfectly pure state. " 32. It is absolutely the same as to the measures adopted 32 INTRODUCTION. by homceopathy in the pharmaceutical preparation of its medicines. Here, as in the gathering and chemical preparation of substances, the strictest observation of prescribed rules is binding. All the substances which homceopathy transforms into tinctures, should be prepared alone with alcohol, and those which are neither soluble in this fluid nor in water, by the simple trituration with sugar of milk. The vehicles, such as alcohol, sugar of milk, water, &c., ought to be perfectly pure and good. At the same time, the proportions indicated for the mixtures, as well as the manipulations prescribed for the solution and division of substances, ought to be observed with the utmost possible exactitude. Often, it is true, these indications and prescriptions are of a nature to leave a certain latitude in their execution, according to the use we wish to make of the medicines, or the degree of energy which we propose to give to them; but even in this last case, the principles which have dictated the rules ought always to serve as guides in their application; and in every case, where the indications are positive, homceopathic physicians and pharmaceutists have no business, under any pretext whatsoever, arbitrarily to depart from them. " 33. In addition to the precision to be observed in the process of the preparation, it is also necessary to prevent, with the greatest care, any foreign influence, so that the virtues of the medicines be not changed, and the action thus rendered uncertain. For this it is requisite, in the first place, to make them in a place where the temperature is not above that of houses in general, and where the substances are not exposed to the direct rays of the sun. At the same time, the atmosphere in which we work should be pure and exempt from every odor or vapor, but, above all, of every medicinal emanation, such as are generally found in the pharmacies in ordinary; for all these exhalations, placed in contact with homceopathic preparations, are liable to change their virtues. The same may be said respecting vessels or other instruments which have been used for the preparation of substances very odorous or susceptible of adhering tenaciously, as musk, essences, arsenic, corrosive sublimate, &c. We should never make use of such vessels, without having previously cleansed them with the most perfect care. As to small bottles and OBSERVATIONS AND RULES. 33 corks which have already been in use, they should never be employed but for the same substance, no more than the cloth which has been used for filtering or expressing the juice of a plant; for, notwithstanding all the endeavors we may use to clean them, we can never be sure that we have entirely purged them of all particles which may adhere to them. "34. Homoeopathy exacts a much greater cleanliness than is ordinarily given to vessels of pharmacy, notwithstanding the care bestowed on it. Even the washing in large quantities of water, as in rivers, which has been recommended, are far from fulfilling the conditions. No matter how we look on it, a vessel, for example, which has served for the trituration of substances such as sulphur, musk, asafcetida, &c., constantly preserves its odor, even after having been washed and dried several times. As to the cleansing with certain chemical articles, such as acids, chlorine, lime, potash, &c., it cannot be tolerated in any case, since these substances themselves, whilst they have been in a vessel, need to be carefully cleaned out. Some have still imagined to clean the vessels with spirits of wine, but even this is a great error, for either the spirits of wine dissolves the substance we wish to get rid of, or it does not dissolve it; in this last case, it will clean out nothing, and, in the first, it will form, with the rest of the substance, a medicinal preparation, which, though weak, will always be stronger than one of the last dilutions, and no homoeopath in effect will look upon these preparations as suitable for the end proposed. The best way to obtain the perfect purity of vessels is, at first to clean them with boiling water several times, and then to expose them to the continual action of a strong heat, as for example of an oven, or else to burn, several times, in them absolute alcohol of the greatest purity. As to the stones which have served for the pulverisation of a metal, we should cleanse them before employing them again for the preparation of another substance, by scraping their surface with a piece of glass. " 35. Finally, as to the vessels themselves, it is necessary that all which are used in homoeopathic preparations should be of a substance not calculated to alter the effects of substances. Hence, all the mortars, pestles, and spatulas, as well as the spoons and other instruments needful, should be of 3 34 INTRODUCTION. quartz, porphyry, glass, porcelain, or horn; those of metal, marble, serpentine, or wood are absolutely inadmissible. To close the bottles, stoppers of glass are always to be preferred to those of cork, above all for the substances prepared with sugar of milk, to which the cork stoppers often give a disagreeable odor. For the corrosive substances, such as the acids, iodine, kreosote, &c., glass stoppers are indispensable. If, for the alcoholic preparations, we would, nevertheless, use stoppers of cork, we should procure them of the best quality, never before used. Before making use of them, we should temper them in pure water, after which we should wash them in spirits of wine, and let them dry at a moderate temperature. It has also been advised to boil them, in order to make them larger and softer; but prepared in this way, they become very susceptible of imbibing the humidity of the air and of constantly changing their size. " 2. Particular Rules for the Preparation of Plants in the fresh State. Tinctures. "36. That the plants may be entirely suitable to medical use, we should gather them a little before or, better still, during their flowering, and we should never take those which grow on a very humid spot and deprived of the sun and of the free air, unless the nature of the plant require those conditions. In the majority of cases, it is important not to gather the flowers and the leaves during a continued cold or damp time, since then the ethereal oils, the corrosive resins, and the alkaline matters do not become developed as they should, and it permits the separation of albumen but in a very incomplete manner. The most favorable moment is when, after several warm days, there has been a shower of rain; for it is then that the formation of the active principles and the free development of hydrogen are the most favored. In every case, where homoeopathy indicates nothing particular, we constantly use the entire plant, flowers, body and root. Before submitting it to preparation, we wash it carefully with fresh water, in order to wash away the dust and other inpurities adhering to it. "37. After this, to prepare the plant, in order to bring TINCTURES. 35 together all the properties of its different parts, we cut it up as small as possible, we put it into a mortar of stone and reduce it to a fine paste, which is put into a piece of suitable cloth, in order to submit it to the action of a press of wood expressly constructed, thus to obtain the juice of the plant. This juice is at once mixed intimately with an equal quantity of alcohol, and put into well-stoppered bottles. At the end of 24 hours we decant the clear liquor, which swims on the precipitate of fibrine and albumen, and we put it apart for medical use. Alcohol prevents fermentation from taking place in the vegetable juice, and the virtue of this is thus preserved completely, without alteration, and for ever, provided we only take care to keep it from the rays of the sun and in wellstoppered bottles. The medicine thus obtained by expression, and by the mixture of the juice with an equal quantity of alcohol, is the mother tincture of the plant, obtained by expression (per expressionem). "38. The preparation of the mother tincture, by expression, is, however, only applicable to plants abounding in juice; for those plants containing much thick mucilage and albumen, it is better to make their preparations by macerating them in a double proportion of alcohol. To do this we should at first half dry them in exposing them in the shade, in an airy place, and at a slightly elevated temperature, after which we cut them as fine as possible, and then add the necessary quantity of alcohol. As to those plants which have but an excessively small quantity of juice, such as the laurel, rose, thuja, &c., we should begin by pounding them alone; then, after reducing them to a fine and moist paste, we imbibe this paste with the double of alcohol, so that the juice, thus mixed with this liquid, may be expressed more easily. The medicine obtained after this method is the mother tincture by maceration (per macerationem). "39. In addition to these two measures for obtaining the mother tinctures, there is yet a third, which, though inferior to the two preceding, deserves, nevertheless, to be mentioned, as convenient in some particular cases. It is, above all, whilst the circumstances do not permit us to express the juice of the fresh plants, immediately after having gathered them; and that, fearing that their withering, no matter how little, may injure their virtues. Under these conditions we may 36 INTRODUCTION. remedy this inconvenience in digesting separately in alcohol each part of the plant. To do this we begin by sundering the root into four, and cutting it into little pieces-we do the same with the leaves; then, after putting each of these two parts into a separate bottle of sufficient size, we pour upon them an equal quantity of alcohol. In thus digesting the separate parts during some time, and reuniting afterwards in one bottle the obtained products, we have a mother tincture by digestion (per digestionem), which will not only be perfectly pure, but also sufficiently impregnated with the active principles to merit confidence. For the rest, in every case, unless absolutely obliged to have recourse to this proceeding, the preparation of the mother tinctures by expression and maceration is far preferable; but every time that we are obliged to hunt the plants which we want, in distant countries, where we cannot carry the apparatus necessary for expression, we should prefer preparing them at once, by digestion, to carrying them home withered and bereft of their active principles. 3. " Of the Preparation of Exotic Vegetable Substances. " 40. All exotic vegetable substances used in homoeopathy, such as plants, bark, grains, resins, wood, &c., should be selected in the crude state, and never when in powder. For, even should we fear no adulteration with other matters, the ordinary means employed in pulverising them are not of a kind to prevent all adulteration possible. All vegetable substances, even when perfectly dried, still contain, when entire and in the crude state, a certain amount of humidity, which becomes useless in the state of powder, and which, if not dissipated, deteriorates the powder in a short time. " If, then, the homoeopath would be perfectly sure of having a powder not only pure, but also susceptible of preservation without any alteration, he must himself undertake the necessary preparation. "41. Hahnemann first taught the best method to reduce foreign substances to an unalterable powder, and free from all humidity. This consisted in spreading the powder on a3flat surface of tin with raised borders, and to shake it till it no longer forms lumps, until all the particles equally and easily slip EXOTIC VEGETABLE SUBSTANCES. 37 on each other, like fine sand. To succeed well, we must take care to keep the heater constantly full of water of an equable temperature, so as not to expose the powder to a too elevated heat, as it would destroy organic substances. By enclosing the powders thus obtained in bottles well stoppered and sealed, and protecting them from the sun's rays and the light of day, we may preserve them a long time without deterioration. It is still doubtful whether, by this procedure, those substances of volatile principles do not lose their virtues during the operation, and whether, in consequence, it would not be preferable to make an alcoholic tincture of them immediately after pulverization. "42. To prepare the tincture of dry substances, we begin by breaking them in a mortar of marble; then, after having reduced them to a fine powder, we add twenty parts of alcohol, in which we digest them six or eight days, after which we decant the clear liquor, to preserve it for use. Those substances which are very susceptible of attracting the humidity of the air, should either be deprived of it before pulverization, or powdered in a warm mortar, and, if particularly hard and tenacious, they should be grated or filed. As to the proportion in which alcohol ought to be added, many physicians have proposed to make it 1 to 10, instead of 1 to 20, that is to say, to pour but 10 parts of alcohol on the pulverized substance; but, independent of the certainty there is in the proportion of 1 to 20, the vehicle will necessarily take up all the medicinal virtues, and the tinctures of many, as cinchona, opium, ratanhia, &c., seem to be so fully saturated in this proportion, that it is very doubtful whether, in the proportion of 1 to 10, they would really acquire more energy. "43. Lately, Hahnemann has advised that dry vegetable substances should not be prepared ih the form of tincture, but made after the manner of solid mineral substances; that is to say, by triturating them with the necessary quantity of sugar of milk. It is evident that, for all the substances which we wish to employ at a certain degree of concentration, and to mix with the vehicle in the proportion of 10 to 100, this procedure would, as far as regards the preservation of the preparations, be subject to all the inconvenience that we have spoken of in the beginning of this article. Even in weighing 38 INTRODUCTION. the substance with the vehicle, in the proportion of 1 to 100, the humidity it would communicate to the trituration would still be too sensible to obviate all fear of the alteration of the preparation, should it be put into stoppered bottles. But the question differs when we wish to use only a preparation of a low attenuation (6, 15, 30); in this case, the proposed plan would do, in effect, not only for dry vegetable substances, but also for all the fresh plants which contain too small a quantity of juice to afford tinctures by expression; when we do not wish to preserve any of the low attenuations above the third trituration, this would always be sufficiently exempt, for example, from vegetable humidity, to leave nothing to desire, and the triturations being, in general, less subject to alteration than the tinctures, this proceeding would unite the double advantage of preserving all the active principles of the medicines, and of rendering their preparations as unalterable as possible. "4. Of the Preparation of Mineral and Animal Substances- Trituration. "44. All the non-vegetable substances made use of in homceopathy, such as animal substances, mineral bodies, and chemical products, are generally prepared by trituration with sugar of milk, whether, in their natural state, they are liquid or solid, soluble or non-soluble in alcohol. Certain substances only, such as the acetate of copper, several acids, and all those of which the chemical qualities do not permit a mixture with sugar of milk, should be prepared in a particular way, which will be specially indicated under the head of each substance. As to the substances which are soluble in alcohol, we can equally well prepare the tinctures of them by solution in 20 parts of this liquid; but, for the safe preservation of the preparations, and the development of the medicinal virtues, the trituration with sugar of milk merits by far the preference. Even for those recent animal substances, which are commonly prepared by digestion in 20 parts of alcohol, after a reduction to a fine paste, trituration is infinitely better. "45. To submit all these substances to trituration, we may, in the majority of cases, take them as they are found in their pure state; only as to the metals, if we cannot procure them TRITURATIONS. 39 in very thin leaves, like gold, silver, tin, &c., it is necessary to reduce them to powder. To effect this, we may treat them in two ways; the first of which consists in rubbing under water a small fragment of the regulus against a good hone, until we have obtained a sufficient quantity of metallic powder. The majority of homoeopaths employ this measure, but, should the stone we use be too soft, the powder obtained in this manner is rarely pure, and, in such a case, it is better to obtain it by the decomposition of the solutions of these metals in acids. In plunging in such solution a small polished rod of a metal whose affinity with oxygen is stronger than that of the metal in solution, it is immediately precipitated on the rod, and adheres to it in the form of powder. To obtain, then, this powder, perfectly pure, we wash it frequently with distilled water, until it does not show a trace of acid. The reduction to powder of metals by the file, is a proceeding which is suitable to iron alone, since, by the observation of Wells, it is proved that the metal thus obtained easily acquires the virtues of that against which it has been rubbed. " 46. As the trituration of substances with sugar of milk has chiefly in view the development of all the active principles, by the division of molecules, it is essential that the proportion in which the medicine is mixed with the vehicle be not too great, and that the quantity that is submitted to trituration at one time be small enough to be well manipulated. To effect this, Hahnemann has proposed never to make a trituration which contains more than 5 grammes (100 grains) of sugar of milk, and to mingle the medicine in the proportion only of 1 to 100, that is to say, of the weight of 5 centigrammes (1 grain) nearly, so that the trituration being made, each gramme of this contains but one centigramme of the primitive medicine. This proportion of 1 to 100 is, in general, that upon which all the homceopathic physicians rely; but, as for many substances, the volume of five centigrammes of their weight is too small in proportion to that which the sugar of milk makes; and, as it is essential that the whole should be impregnated with the medicine, many physicians have lately preferred making all the frst triturations in the proportion of 10 to 100. In consequence, instead of taking but five centigrammes (1 grain) of the medicine, they take 50 (10 grains) 40 INTRODUCTION. to mix with five grammes (100 grains) of sugar of milk, so that each gramme of the trituration, when finished, contains 10 centigrammes of the medicine. It is easy to see that this proceeding has the preference in every case, since it not only affords a greater surety for the exactitude of the mixture, but also because afterwards, to establish the proportion indicated by lIahnemann, we have only to take 50 centigrammes (10 grains) of the obtained trituration, and triturate them anew with five other grammes (100 grains) of sugar of milk. " 47. As to the operation of trituration, Hahnemann recommends the following:-After having weighed the necessary quantity of the medicine, and of the sugar of milk, take about a third of this last and place it, with the entire quantity of the medicine, in a mortar of porcelain; mix these two portions with a spatula of bone or horn, and triturate with sufficient force six minutes; detach with the spatula the mass from the sides and bottom of the mortar and pestle, and mingle them anew, after which continue the trituration for another six minutes; that done, again detach the matter from the mortar and pestle, and add the second third of the sugar of milk, which mingle with the rest with the spatula, and triturate afresh during six minutes; detach, triturate and detach afresh, as for the third; finally, add the last third of the sugar of milk, which is mingled, triturated and detached in the same way, and during the same space of time as with the first two. In thus triturating each third during twice six minutes, and counting about four minutes for the time taken up in detaching and remingling the powder, we shall occupy one hour in the preparation of each trituration. " 48. In the first article of this chapter we have already observed that, for the triturations, mortars of serpentine can in no way be admissible, and that the best are of porcelain. Wood and glass are not more suitable either; the first, on account of its porosity; the second, because the rubbing detaches from it particles, which contain sodium. As to those of porcelain, the unpolished ones are to be preferred, since the smoother the surface, the less true is the rubbing, and this is the reason why, if we can only obtain mortars of polished porcelain, we must unpolish them by working them previously with sand. The pestle should be of the same material as the ATTENUATIONS. 41 mortar, and treated in the same way. To prevent, with the greatest certainty, all possible alteration of the preparations, either by particles of silex which the porcelain might afford, or by the remains which previous triturations might leave in the mortar, it has been proposed to coat this, as well as the pestle, with a thin covering of pure ichthyocolla, mingled with a little sugar of milk, and to renew this covering for each new preparation. We cannot decide on the absolute necessity of this method, but we think, nevertheless, that it merits, at all times, the serious attention of practitioners. "49. As to the form of mortars, it is easy to see that those with flat bottoms are no ways suitable, since, in such, the substance would tend to enter the corners, which would impede the trituration being made equally. The best form to give the interior of mortars is that of the butt-end of an egg. At the same time, it should have a large enough capacity to allow the rubbing with the necessary force, and hindering the powder from dispersing; its sides should be level, and without the least inequality, and its weight such as, during the process, it can easily be held in the left hand without fatigue. The pestle should be large enough at its base to fit exactly to the concave bottom of the mortar. In order to detach the triturated mass which adheres to the pestle and mortar, Hahnemann advises us to use a spatula; but this operation is much better accomplished with a hard brush of a suitable form, made for the purpose. As to the other necessary instruments, such as the spatula, spoon, &c., we have already said that they should be of bone, or horn, or porcelain, and that those in metal are absolutely inadmissible, except the mortars of iron to break down certain substances of considerable hardness before preparing them for trituration. "OF HOM(EOPATHIC ATTENUATIONS. " On the attenuations in general. "50. In speaking of the nature and form of homoeopathic medicines, we have already observed that, instead of correcting the too energetic effects of some substances by the addition of another medicinal substance, homceopathy seeks to mollify them by the preparation of a series of attenuations, in 42 INTRODUCTION. which the medicine is found mingled in the vehicle but in a very small proportion. In the commencement of his medical career, Hahnemann limited himself in these attenuations to 1 to 100; that is to say, in mingling a very small quantity of the concentrated substance with a quantity 100 times larger of a substance non-medicinal; but seeing that these preparations often acted too powerfully still, he soon went further and prepared a second, and then a third attenuation, in mingling for the second the 100th part of the first, and for the third the 100th part of the second, with 100 parts of the vehicle. This third attenuation, though only containing the medicine in the proportion of 1 to 100-3, or of 1 to 1,000,000, Hahnemann still found at times too active, which induced him to carry the attenuations yet further, and to go from attenuation to attenuation, in order to find'the one the most appropriate. It is thus that, latterly, he has carried the number of attenuations, for all the medicinal substances without distinction, up to 30, so that, in this last attenuation, the medicine is found mingled with the vehicle but in the proportion of 1 to 100-30, or of 1 to 1,000,000-10. " 51. However absurd the first view of these infinitesimal attenuations may appear, it is not the less true that, even the 30th, far from having lost all efficacy, often shows itself too energetic; and Dr. Korsakow, of St. Petersburg, who has carried the attenuations as high as 1500, has declared the same fact as to the last preparation of his series. In effect, on examining attentively the degree of intensity with which the various homceopathic attenuations act, we may easily perceive that the diminution of their energy is in no way proportioned to the diminution of their matter. On the contrary, many substances which, in their state of concentration, have little or no action on the body, as lycopodium, vegetable charcoal, &c., often become very active at the second or third attenuation, so that we are almost inclined to believe that the mode of preparation adopted by Hahnemann rather contributes to develop than to weaken the virtues of medicines, or, at any rate, to render them more apt to exercise, in the smallest doses, their influence on the organism. Hence Hahnemann has, for a long time, ceased to look upon these preparations as dilutions, in the true acceptation of this word; and if, at the ATTENUATIONS. 43 present time, he wishes all the medicines to be carried to the 30th attenuation, it is only in the supposition that by this procedure they can best develop all their active principles,* and become more suitable for practice. "52. To explain the extraordinary fact of the efficacy of his attenuations, HIahnemann has endeavored to set down as a principle, that the more we destroy the material parts of a substance, so much the more we develop or loosen the dynamic force, or, in other words, the spirit of the medicine; and that, to augment the energy of preparations to an incredible extent, we have only to carry them from attenuation to attenuation, in submitting them at the same time to a great number of triturations and shakes. If this principle were conformable to experience, it would result that, from a substance, for example, of which one grain would be sufficient to cause death, the same dose of the 30th attenuation would produce the same effect in a much more certain manner, which, however, is not the fact. If we would even limit this principle to those substances which only exhibit their virtues by attenuation, it is still equally adverse to observation that the 30th attenuation, for example, of these substances have an action absolutely more energetic than the 6th, 12th, 15th, &c. On the contrary, to judge from the experience of many homoeopaths, the degrees of energy among the attenuations of a medicine are so small, that thus far a decision has not been formed with certainty whether it is the first or the last attenuations which exhibit the strongest action. This is the reason why, in admitting the efficacy of the attenuationse many homceopaths have rejected the explanation given by iHahnemann, and have considered the procedure by which they acquire their efficacy as analogous to the infection by miasm. According to them, the active principle of the drug being set free by the destruction of the matter, it communicates itself to the vehicle, which thereby becomes infected and as active as the drug itself. " 53. As to the comparison with miasms, this last opinion is, without contradiction, that which merits the most atten* Or be more readily received into the system in consequence of the minute subdivision or segregation of the particles.-J. L. 44 INTRODUCTION. tion; but the explanation it gives is far from satisfying all demands, since, instead of explaining the difficulty, it refers it to another order of facts, which, though generally admitted, are not, however, themselves yet explained. Miasm, though being an imponderable body, is not the less for that, a body; that is to say, matter, and amenable to the laws of matter. Now, every action of matter, whether mechanical or dynamical, is proportioned to the quantity of active atoms which a given volume presents; and every one knows, that not only a large stone weighs more than a small one, but also that a magnet of considerable volume is capable of developing and of manifesting a much stronger action than another which is less voluminous. If, then, we would pretend that there is manifested somewhere the action of a body either ponderable or imponderable, we are absolutely obliged to' admit also the presence of a certain quantity of atoms; and, what is still more certain is, that as this quantity diminishes in a given volume, the action of it will also diminish in energy. Thus we see that, even should we prove that our attenuations, to be able to act, only require to be impregnated with imponderable particles, like miasms, we shall still have accomplished nothing in demonstrating that their energy does not diminish in proportion to the loss of matter which they suffer; or in explaining how an attenuation, for example, which contains but the billionth part of the medicinal atoms of another, manifests an intensity not only equal, but often also superior to that of this last. " 54. These facts are, however, such as we cite them; and, perhaps, we should not have found anything astonishing if, at the beginning, we had reflected better on the manner in which our medicines act in general, and on the changes which substances undergo by our mode of preparation. We ought to have noticed that each medicinal dose contains a great number of atoms which are perfectly inactive, in consequence of their being shut up in the interior of the molecules, and not brought into contact with our organs; it therefore follows that every time we, by any means whatever, come to divide these molecules into smaller corpuscules, and thus augment their whole surface, the energy of the dose will so increase that the smallest part will become capable of exercising an influence, ATTENUATIONS. 45 if not superior, at any rate equal to that of the entire dose in its primitive condition. It is thus that Dr. Doppler, of Prague, has explained the efficacy of our attenuations; and such is, according to him, the effect which the infinite division produces on the molecules, that if the molecules of a fine powder are, at the dose of 5 centigrammes (1 grain), in a condition to constitute, by the sum of their surface, a total superficies of 100 metres square, and if each trituration of 20 minutes only divided each molecule into 100 lesser corpuscules, the molecules of the 30th attenuation would be so divided that, at the dose of one drop only they would occupy, by the sum of their surfaces, a total superficies of many millions of decametres square. " 55. If this calculation, which any one can easily verify, is just, there is nothing, in truth, more easy than to conceive, not only how the 30th attenuation may yet be able to exhibit efficacy, but also how a single globule of this attenuation may still have virtue enough to render a tumbler of water almost as energetic as the pure drug. For let us suppose that the total superficies of a drop of the 30th attenuation can cover, by the surfaces of its infinitely small molecules, even only four thousand decametres square, on imbibing with this drop 200 sugar-globules, each globule will contain enough to cover a superficies of at least 200 metres square, and will act, in consequence, with a force not less than that which 10 centigrammes (2 grains) of a non-attenuated substance would exhibit, but which will be reduced to a powder fine enough for the molecules of each centigramme to cover a total superficies of 20 metres square. Now, if one globule of the 30th attenuation has such power, it is clear that, in dissolving it in a volume of 8 spoonfuls (4 ounces, or 120 grammes) of water, the preparation we shall obtain will in no instance be less efficacious than a mother tincture, which, in 30 grammes (one ounce) of liquid, will contain 5 centigrammes (one grain) of the preceding, and dissolved so that the molecules of this grain may cover a total superficies of 500 metres square. All these calculations are, it is true, not rigorously exact; but if there is error, it is rather on account of having placed the ciphers too low than too high; and if we suppose, which is more than probable, that each trituration of 20 minutes 46 INTRODUCTION. changes each molecule of the primitive substance into more than two or three smaller corpuscules, the result will be still more astonishing. "156. Arguments have been raised against homceopathic preparations, that if the influence exercised by trituration and succussion were really such as the homceopaths pretend, the energy of the attenuations ought not only to increase with the number, but also increase in a prodigious manner, since more powerful means are employed in each attenuation to effect the division of the molecules.,, This is undoubtedly true in principle, and we should daily obtain practical evidence of the fact, were it always possible to make use of the increase in surface which a given volume has gained in the said manner. But the total surface which, after the usual triturations and succussions, a single globule of the 20th attenuation would afford is really so vast, that if time be not allowed, it will never find sufficient space in the organs to develop itself so that all its infinity of molecules can enter into action; and it is thus that all that we could add to this quantity of molecules would only increase the number of those which remain inactive. This is the explanation, also, why two, three, or four globules, and even a whole drop of an attenuation, often appear to produce no more effect than a single spoonful of a solution of a globule in eight spoonfuls of water; and if we seek the reason why these last attenuations are not distinguishable from the first by any other quality than that of a more prolonged action, it is still in the same way that we shall find the means to account for it. " 57. There are, however, certain substances, whose energy really augments in a sensible manner as the attenuations advance, and which, often altogether inert in their natural condition, become by this method of preparation not less active than the most energetic medicines. Such are those substances which, even in the state of the finest powder, have probably their truly active molecules still shut up in a species of envelope, which prevents them from coming into immediate contact with the organs, and which the ordinary means of pulverization and of solution are incapable of destroying. For in rubbing, as is ordinarily done, the substances by themselves, the molecules of a powder, already very fine, escape ATTENUATIONS. 47 the force which tends to render them still finer, and it is only in triturating them with another substance, against the corpuscules of which they can be rubbed, that we can succeed in accomplishing an infinite division. But we shall only accomplish this in a very incomplete way, if, at the same time, we do not take care to separate the newly obtained particles as much as possible, in proportion as the trituration increases the number; since the more the molecules remain agglomerated one with the other, so much the less easily will the whole be divided. This is the reason why many substances frequently do not seem to develop all their virtue till after three successive triturations, prepared so that each new trituration shall contain the 100th part of the preceding. " 58. What we have just said of the trituration of substances in powders, equally applies, in the same way, to the attenuation of liquid substances, and to the succussion of soluble substances with a liquid vehicle. For though the molecules of liquids, on account of their globular nature, are absolutely incapable of being divided by any kind of ordinary rubbing, being triturated with a vehicle in form of powder, or being treated by succussion with a liquid vehicle, they undergo, as well as solid substances, infinite division. The same holds good for all substances ordinarily insoluble in water or alcohol, whilst, by sufficient triturations, their molecules are sufficiently divided to be held in suspension between the molecules of these liquids; they then become abstracted not only from the law which held them in a state of aggregation, but being shaken with the vehicle, which has dissolved them, they also receive all the other ulterior divisions of which liquid substances are susceptible. It is thus that, after the third trituration, the attenuation even of metals may be continued, without the least inconvenience, by the succussion of these substances with the liquid vehicles; and it is thus also that all the attenuations made in this way tend, as well as the triturations, to increase the resources of our doses, so that if we submit to new succussions the solution made with a single globule of the 30th, in 8 ounces of water, we may render this solution such that each drop of it shall form a dose much stronger than that of the globule which was dissolved in it. " 59. If, then, there is a method more than any other capable 48 INTRODUCTION. of furnishing energetic medicines, it is, without contradiction, the mode of preparation adopted by homceopathy. As to the substances, which in their natural state, have their virtues already suitably developed, this proceeding will not, it is true, augment the energy of the usual doses of the school, since, as we have above said, there is scarcely a means of making use of all the resources which these doses may create; but the advantage we shall derive from them will always be that of finding the attenuations of these substances, at the dose of a single globule, not only equally as efficacious as the entire dose of which they have been made, but also more appropriate in exercising a longer and more continued action. The same may be said of those substances whose virtues are latent, when their virtues have been fully developed; the attenuations made beyond this point cannot act with any more striking effect over the energy of usual doses, but the farther we carry them, the more we shall see that the smallest possible dose is still more than sufficient to produce all the effects that can be produced by medicines, given in the strongest usual doses; that may even be carried to the point that if, by simple mixture and without any succussion, we dissolve a single globule of a sufficiently high attenuation in a volume of three or four glasses of water, and even more, each tea-spoonful of this mixture would still be equal to produce all that could be obtained from an entire drop of the ordinary medicinal preparations. " 60. From this we see that if we wish to obtain much from little (multum per pauca), it is indispensable to prepare the medicines after the prescribed method of homceopathy; whilst, if we wish to render the effects of the usual doses, at times already too violent, more prompt and more violent still, this proceeding will be not only useless, but altogether contrary to the end we propose. For though the resources of doses augment by this method of preparation, it is, however, not the less ascertained, that many substances also lose their primitive energy by attenuation, as for example, all poisons, which, as all homoeopaths well know, are much less to be feared in their attenuations than in their primitive state. This Will even be the case with all substances whose molecules, besides the property of being easily absorbed and spread in the organism, ATTENUATIONS. 49 have likewise that of undergoing a certain solution or division. In the attenuations they will still possess the first of these properties, but as soon as art has divided them more than the organism can do, none of the subsequent attenuations can, at a given dose, be in a state to furnish to the absorbing faculty as many active elements as the substance in its primitive condition. Up to this point the energy of doses will even gradually diminish; whilst, this limit passed, their resources will augment in proportion as art shall operate, in the subsequent attenuations, the ulterior division of molecules the same as that which takes place in other substances. " 61. All the theoretic explanations which we have just given would be entirely without value, if practice did not confirm all the facts which we have above mentioned. Many homceopaths, it is true, have supposed that they have observed that the last attenuations which they make use of do not always produce effects conformable to those which they had the right to look for, if the theory, upon which this doctrine is based, were correct. But, according to our view, these exceptions are rather made to confirm the theory than to destroy it; above all, if we remember that these contradictory observations have been made for the most part by individuals who did not prepare the attenuations they employed, or who did not conform more or lss exactly to the indispensable rules to be attended to in their preparation. For it is certain that if we neglect to produce in each new attenuation a new division of molecules, the first attenuations thus obtained may still have sufficient resources; but as we advance in this way, the more will they become exhausted. If the division of molecules in the first triturations has been carried to a sufficiently high degree, it is even possible that, without any new division, we may continue the simple partition of doses up to the 30th, without this last failing in its resources; but the preparations thus obtained will not the less be pure dilutions and not dynamizations, as they would be if, in each one, we had anew augmented the resources of the doses. In the following article we shall give the rules and precautions to be observed, in order to prepare the attenuations so that they shall all be true dynamizations. 4 50 INTRODUCTION. " 2. Of the Preparation of the Attenuations. " 62. We have already said that the homceopathic attenuations are obtained, in general, in such a way that the first contains one grain (5 centigrammes), or one drop of the medicine mingled with 100 grains (5 grammes) of sugar of milk, or 100 drops of alcohol; and that, after sufficient triturations and succussions, the second is obtained in manipulating, in the same manner, the 100th part of the 1st with 100 new parts of vehicle; the 3d, in submitting to the same process the 100th part of the second, and so on to the 30th. This way of making the attenuations, in the proportion of 1 to 100, is that of Hahnemann, and which is always understood when we indicate an attenuation by its number. Latterly, however, it has been found more suitable to make the mixtures only in the proportion of 10 to 100, so that instead of mingling only one grain or one drop with 100 parts of vehicle, we mingle 10 each time. This process has the advantage of giving more certitude that in each preparation the molecules of the medicine are well mingled with those of the vehicle, though, on the other hand, it permits less extension. But as we can easily repair this inconvenience, in preparing two attenuations each time, in the proportion of 10 to 100, instead of 1 to 100, we recommend this process to all the homceopathic physicians and pharmaceutists; cautioning, however, these last that every time that they make use of another proportion than that of 1 to 100, they shall take care to indicate it on the label of the preparations, in order that we may know in what proportion the number which each attenuation bears, is made. " 63. In general, we can lay it down as a principle, that the smaller the proportion in which the medicine is mingled with the vehicle, the more difficult will it be to obtain a perfectly intimate mixture, and to spread the molecules of the drug over all the points of the preparation; likewise, the larger the volume of each preparation, the less easy will it be to make the necessary division of the medicinal molecules. One drop of a medicine poured into a lake will never make a homoeopathic attenuation, though the proportion which this drop bears to the lake in question is far from being a fraction so small as that which is found in the 30th attenuations. But ATTENUATIONS. 51 that which causes this attenuation, notwithstanding the infinitely small proportion in which it contains the drug, to possess, nevertheless, all its virtues is, that it has been obtained by degrees, in preparing at first, at the farthest, but 100 grains, or 100 drops, of a vehicle with 1 or 10 of the drug, and in not employing this preparation to make a second, until it has been thoroughly impregnated with the molecules of the drug. It is thus that we are successively enabled to spread out and increase the number of infinitely small particles, so that at last, at the 30th, they are as much disseminated through the whole preparation as in the first. This is the reason, also, why the attenuations obtained in the proportion of 10 to 100 are much more sure than those of 1 to 100; and it is also the reason why we 8hould never _prepare any attenuation which contains more than 100 grains (five grammnes), or more than 100 drops of the vehicle. " 64. The attenuations of substances which, from the commencement, have been prepared tunder the form of tinctures, are made of alcohol from first to last. For this purpose, if we wish to preserve all the attenuations, we prepare, for each substance, 30 small bottles, quite new, each of the capacity of 150 drops; we fill all these bottles with alcohol to two-thirds of their capacity, and mark, on the label as well as on the cork, the name of the substance we are to attenuate. This done, we take one of these bottles and pour into it, after the process of Hahnemann, one drop of the mother tincture, and give to it 100 or 200 sufficiently strong shakes, after which we mark on the bottle the cipher 1, to indicate that the preparation it contains is the first attenuation. Of this attenuation we in like manner pour one drop into another of these bottles, containing about 100 drops of alcohol, and after having submitted it also to 100 or 200 shakes, we mark it with the cipher 2, to indicate that this one contains the second attenuation. In this manner we continue to prepare and to label to the 30th, in pouring each time one drop of the attenuation just obtained into the bottle which will contain the following attenuation. The rule is the same when we wish to prepare each attenuation in the proportion of 10 to 100; but instead of pouring but one drop each time, we must pour ten; but as, after this method, we want two attenuations each time to equal one in 52 INTRODUCTION. the proportion of 1 to 100, the same ciphers will not be suitable to indicate these two sorts of attenuations, but we may make them agree, in using, for the preparation of 10 to 100, halves, in such a way as to designate the first of this series by, the second by 1, the third by 1-, the fourth by 2, and so on to the 30th. " 65. For the substances which, from the first, have been prepared by trituration, we prefer to obtain the first three by the same process. To effect this, we take one grain (five centigrammes) of the first preparation, obtained by the trituration of one grain of the primitive substance with 100 grains (five grammes) of sugar of milk, and which carries the name of the first attenuation; we mix this grain (five centigrammes) with 100 other grains (500 centigrammes) of sugar of milk, and triturate this mixture as described in the article on the Preparation of Dry Substances. This trituration made, we give to it the name of the 2d attenuation, and we take of it one grain to mingle with 100 other grains of sugar of milk to obtain the 3d attenuation. Of this trituration we then take one grain, which we dissolve in a bottle filled with 100 drops of water to two thirds of its capacity, and shake this mixture, as in the attenuations made with alcohol, to which we give the name of 4thl attenuation. This 4th attenuation should be made with water, or at least with equal quantities of water and alcohol, because the sugar of milk does not dissolve in the least in pure alcohol, but all the following attenuations are then made with pure alcohol, the same as the tinctures. Should we wish to make the triturations, for the first as well as the subsequent ones, not in the proportion indicated by Hahnemann, but in that of 10 to 100, we shall be obliged to make six of them instead of three, and designate the first of this series by the cipher -, the second 1, the third by 1-, and so on. The attenuation made with diluted alcohol should then bear the cipher 3-,. " 66. As we rarely preserve all the attenuations, and we seldom use in practice any but the 1st, 3d, 6th, 9th, 12th, 15th, 18th, 24th, 30th, it would be useless to sacrifice, each time, more bottles than necessary, since, for example, if we do not wish to preserve the 2d attenuation, it will suffice, in order to obtain the 3d, to decant nearly to the last drop the bottle which contains the 2d, to fill it afresh with 100 drops of ATTENUATIONS. 53 alcohol, and to submit this mixture to the necessary number of shakes. It is thus that, should we wish to have but the 30th attenuation of a substance, we can make all the intermediate attenuatidns, by pouring off to nearly the last drop of the attenuation last obtained, and filling up this with 100 fresh drops of alcohol. In a series of attenuations of such a length we can even, as regards those we throw away, make use of distilled water.; but for the last two, that which we wish to preserve and that which precedes it, it is most proper to use alcohol. The alcohol which is proper for the preparation of the attenuations, should not be so concentrated as that used for the preparation of the mother tinctures, but it ought not to be less than 60~ or 70~ Centigrade. " 67. There was a time when Hahnemann, for fear of imparting too great a force to his preparations, advised only one or two shakes to be given to each attenuation, whilst, at present, he counsels the contrary; that is to say, to give each attenuation a considerable number of shakes (200 to 300) so as to be sure of obtaining preparations sufficiently efficacious. It is in starting from this last point of view that many homoeopaths have even tried to construct machines of succussion, by means of which they might submit their attenuations to 2000 or 3000 shakes of the greatest force; whilst others have dreaded even to displace a bottle, lest the movement beyond the prescribed cipher might impart too great energy to the dose. The fact is, that as we have shown the succussion increases the effect of the doses, and if each attenuation ought to be a new dynamisation, the succussion consisting of two shakes only is insufficient. If, as we have also shown, the first attenuations have produced a considerable division of the molecules, we may obtain, perhaps, 10 or even 12 subsequent attenuations, each of which shall possess sufficient power without having been subjected to any new succussion; but, in continuing in this way, we shall inevitably arrive at nothing but mere dilutions, which, deprived more and more of their active elements, shall be by degrees weakened, even to the utter extinction of their virtue. " 68. Hence, however, it does not yet result that, to obtain as many new dynamisations as attenuations, it is indispensable to make use of machines, such, among others, as the 54 INTRODUCTION. famous catapult, invented and recommended by M. Mure, as the only means to obtain efficacious preparations. For, after the explanations which we have just given in the preceding paragraph, it is easy to see that, so soon as the succussions have given sufficient medicinal power to an attenuation, all the surplus added to it can be of no advantage, not even in the small homoeopathic doses, from the circumstance that there would be no means of making use of them. This is why we believe that if we bestow 100 or 200 shakes on each attenuation, this number will be more. than sufficient in every case; and those who have no machines, will find that, apart from the inconvenience of being fatigued, their arms are as appropriate as the best mechanism to communicate to the attenuations the indispensable resources. Do we not constantly find that the homoeopathic preparations which have been carried great distances, during which they have been shaken for weeks at a time, do.not show more intensity in their effects than those which have not undergone, at the farthest, but 200 shakes at each attenuation? an evident proof that the resources which, by this process, they should have gained, had no effect on their indispensable elements, but on what was superfluous. " 69. Another question of no less importance would be to know if, to obtain all the advantages that attenuations can give, it is indispensable to go as far as the 30th. What is certain is, that the mass of new particles which is furnished by the division of molecules must be diminished from time to time, in order to permit a greater extension of the surface of those which remain, and thus to facilitate their ulterior division. But what is equally certain is, that this division of molecules can no longer have any object, as soon as it has succeeded in developing all the virtues of substances of latent virtue, or even in rendering too energetic substances incapable of experiencing any further solution in the organism. This is the case, in all probability, after having arrived at the 6th or even at the 3d attenuation; and if we examine the manner in which all our attenuations act, from the 15th, or even the 10th, up to the 30th, it is easy to discover that this process ceases to exert any influence, in a sensible manner, even in the smallest possible doses; so that we are almost inclined to DISPENSATION OF MEDICINES. 50 think that all we do, beyond the 12th, must be superfluous. Nevertheless, as the attenuations carried out farther do not become less suitable for use than the preceding, provided they have been well prepared, we have not hesitated to carry, according to received usage, the officinal number to 30, leaving to those who may find it too high, as well as those who would go still higher, the choice of the cipher which may appear to them the most suitable. " 70. In the commencement of his homceopathic career, Hahnemann had fixed, for each particular substance, the attenuation at which it appeared to him to be employed with the greatest success but latterly, to simplify the preparation of medicines, and render it more uniform, he has advised to carry them all, without distinction, to the 30th. So in the old homceopathic pharmacopoeias we find, carefully noted, the number of attenuations suitable to each substance-numbers, which many persons respect as a sort of gospel, imagining that all would be lost if they had not the medicine at the attenuation which the authors of pharmacopceias have been pleased to mark out. All homoeopaths, even Hahnemann himself, make use of different attenuations, from the 1st to the 30th, and not one of those who have entered the least into the spirit of homceopathy any longer regards those ancient ciphers than as purely arbitrary marks. 4 OF THE DISPENSATION AND PRESERVATION OF IHOM(EOPATIIIO MEDICINES. " 1. Of the Dispensatio n of Hfomoeopathi/dc 1edicines. " 75. Homceopathic medicines are generally administered in the form of powder. To effect this, we mix the drop or the prescribed number of globules with a few grains of sugar of milk, and inclose it in a paper, to be administered to the patient either dissolved in a spoonful of water or in the dry state. The sugar of milk being only intended in this case to act as the vehicle and not to produce a new dynamization, we have no need of rubbing it up with the medicinal dose; we should even guard against doing it, if we wish that this last should not act with too much force, since by doing so we 00 INTRODUCTION. should still increase the power. Again, should we wish this dose to act more promptly and with more energy, we dissolve it in a spoonful of water, which immediately develops more powers, and presents them to the organs in a greater extension than when the dose is taken dry. In some cases also, in order to avoid the continued administration of a white powder, which might in time become disgusting to the patient, we may add to the sugar of milk a small portion of the powder of cocoa, liquorice, or salep; these powders will give to the doses another color, without interfering in the least with their virtues. The quantity of sugar of milk we ought to add to the dose is usually two, three, or four grains; but for those patients who would not be satisfied with such small powders, we may add as much as they seem to wish. " '6. Another method, not less frequently made use of in homceopathy, is to dissolve the dose we wish to administer in four or six ounces of water, and to give to the patient a single spoonful, or several, at intervals, more or less extended. As, in this case, the water is no more designed than the sugar of milk to augment the powers of the doses, but only to develop them, and render the reception easier, it would be equally adverse to the end proposed to submit this solution to new succussions. In general, the best way to obtain these solutions is, to put the dose in a bottle of a sufficiently large size to permit the wished-for quantity of filtered water to be poured on it, and to leave the medicine to dissolve of itself; after which we give a few shakes to this solution, sufficient only to mingle the parts well, without, however, operating a new division of molecules. We will only add, that if for each solution we employ a new bottle, we shall do better than if we make the solution in a tumbler belonging to the patient himself, for, notwithstanding the most careful recommendations on the part of the physician, these tumblers are scarcely ever cleansed with sufficient care, to prevent an alteration of the medicine by the particles which might remain of the preceding one. " 2. On the Preservation of fHomenopathic lfedcicines. " 81. All the medicines, not excepting the powders, ought PRESERVATION OF MEDICINES. 57 to be preserved in bottles; boxes afford too great access to air, and allow too much evaporation. For the alcoholic tinctures, cork stoppers are the best, since they adapt themselves to the bottle in a more exact manner than those of glass, and more effectually guard against evaporation. As to very strong and very volatile substances, it is better to tie a piece of prepared bladder over the stopper. Moreover, these stoppers ought to be changed from time to time, above all, those of bottles which contain metallic solutions; and in general we should not neglect to do so as soon as we discover that their extremity begins to change color; for in the latter case, alcohol may, without this precaution, dissolve a little of their medicinal virtue, and impair the efficacy of the preparation. Acids do not admit of the use of cork stoppers, they attack them immediately, and the portion dissolved alters the purity of the medicine; we must, therefore, use stoppers of ground glass; but in order to prevent evaporation they, as well as the neck of the bottle, should be coated with wax. " 8s. As nothing has more influence on the preservation of homoeopathic medicines than heat, the rays of the sun, and light of the day, we must be very careful to exclude these as much as possible. The action of the solar light and of the light of day easily acidifies alcohol, and, besides, destroys the virtues of the medicines. This is the reason why we should preserve homoeopathic preparations in a cool and dark place, and assure ourselves, from time to time, that they are in a good state of preservation. We discover when they have become acidified by letting a drop fall on the surface of a piece of pure carbonate of lime, flattened by pressure; if the drop insinuate itself tranquilly, the tincture is still good, but if it form bubbles, it has become acid, and cannot, in consequence, be made use of any more. As to substances and their dilutions, which are more especially sensible to the action of the light, as the prussic acid, phosphoric acid, &c., it is prudent to preserve them in bottles of black glass, or, at any rate covered with black paper. Finally, it is also advisable to put the homoeopathic medicines, particularly the acetate of lime, hepar sulphuris, barytes, and all the preparations which are preserved in the form of powder, beyond the reach of humidity,-as they become deteriorated when exposed thereto. THE FORMULE OF HOM(EOPATHIC PRESCRIPTIONS. The following Formulce will be found very useful and convenient whenever a homoeopathic practitioner, in seeing his patients, is not provided with the medicines and other articles necessary for putting up prescriptions; and particularly in cases where the patients are not to know what preparations were prescribed. The prescriptions of aqueous solutions have been found of great value in cases when patients were either opposed to small powders, or when the physician thought it advisable to conceal the fact from his patient that homoeopathic medicines were prescribed. Homoeopathic preparations of any form (as mother-tinctures, triturations, dilutions and medicated globules or pellets) can be prescribed in aqueous solutions. Signs and Abbreviations used in homo;opathic Prescriptions. Trit. 1. or 3.-The first or third Trituration. Tinct. O.-The mother-tincture. Tinct. 1. or 6.-The Tincture of the first or sixth dilution. gr.-grain (this abbreviation is also used for globules). 9 -scruple (or 20 grains). 3 -drachm (or 3 scruples). 3-ounce (or 8 drachms). I-t-pound (or 12 ounces). gtt-drop. q. s.-Sufficient quantity. Sach. Lact.-Sugar of Milk. Gl.-Globules or Pellets. Aq. Dest.-Distilled water. V. Sp.-Spirits of Wine or Alcohol. I. PRESCRIPTION OF POWDERS. a. When all the Powders are to be medicated. Explanation. 1R Tr. Acon. 3., gtt. j; Take of the 3d dilution of Aconite, 1 drop. for Pulv. Sacch. Lact. each powder, and of pulverized Sugar of q. s.; Milk a sufficient quantity for 6 powders. Pulv. vj. FORMULIE OF HOM(EOPATHIC PRESCRIPTIONS. 59 Or, 1* GI. Acon. 6., gr. ij; Pulv. Sacch. Lact. q.s.; Pulv. vj. Take of the 6th dilution of Aconite, two glo-- bules for each powder, and of pulverized Sugar of Milk a sufficient quantity for 6 powders. b. When a part of the Powzders only are to be medicated. 1 Tr. Bell. 12., gtt. j, 1, 3, 5 2,, 6; Pulv. Sacch. Lact. q. s.; Pulv. vj. Or, SGI. Bell. 12., gr.vj, 1,3, 5 2, 4,6; Pulv. Sacch. Lact. q. s.; Pulv. vj. Take of the 12th dilution of Bellad., 1 drop for each of the first 3 powders, and of pulverized Sugar of Milk a sufficient quantity for those 3 powders, and mark them 1, 3 and 5. Then take the same quantity of pulverized Sugar of Milk for the other 3 powders (without medicine) and mark them 2, 4 and 6. Take of the 12th dilution of Bellad., 6 globules for each of the first 3 powders, and of pulverized Sugar of Milk a sufficient quantity for those 3 powders and mark them 1, 3 and 5. Then take the same quantity of pulverized Sugar of Milk for the other 3 powders (without medicine) and mark them 2, 4 and 6. c. Medicated Powders in alternation. STr. Acon. 3., gtt.j, 1, 3 et 5; Pulv. Sacch. Lact. q. s.; Pulv. iij. Tr. Bell. 6., gtt. j, 2, 4 et 6; Pulv. Sacch. Lact. q. s.; Pulv. iij. Or, S Gl. Acon. 12., gr. iv., 1, 3 et 5; Pulv. Sacch. Lact. q. s.; Pulv. iij. Take of Aconite, 3d dilution, 1 drop for each of 3 powders, and of pulverized Sugar of Milk a sufficient quantity for 3 powders, and mark them 1, 3 and 5; Take of Bellad., 6th dilution, 1 drop for each of 3 powders, and of pulverized Sugar of Milk a sufficient quantity for 3 powders, and mark them 2, 4 and 6. Take of Aconite, 12th dilution, 4 pellets for each of 3 powders, and of pulverized Sugar of Milk a sufficient quantity for 3 powders, and mark them 1, 3 and 5; 60 FORMULAE OF HOMOEOPATHIC PRESCRIPTIONS. G1. Bell. 6., gr. ij, 2, 4 et 6; Pulv. Sacch. Lact. q. s.; Pulv. iij. Take of Bellad., 6th dilution, 2 pellets for each of 3 powders, and of pulverized Sugar of Milk a sufficient quantity for 3 powders, and mark them 2, 4, and 6. II. PRESCRIPTION OF AQUEOUS SOLUTIONS. a. When all the Doses are to be taken within 24 hours. Ik Tr. Aeon. 0., gtt. iij. Aq. Dest., 3j, or 3 ss, or 3ij (as the case may be); Solve. Take of the mother-tincture of Aconite, 3 drops, and of distilled water 1 ounce, or y ounce, or 2 ounces (as the case may be), and shake the mixture well. N. B. In cases where a dilution is preferred, the figure of the dilution is to be inserted where the sign of the mother-tincture stands. Or, 1* Gl. Acon. 12, gr. vj; Aq. Dest., 3j, or 3ss, or 3 ij (as the case may be); Solve. Take, of the 12th dilution of Aconite, 6 pellets, and of distilled water 1 ounce, Y- ounce, or 2 ounces (as the case may be), and shake the mixture well. b. When the Doses are to extend over more than 24 hours, in which cases afew drops of Spirits of Wine are required. * Bryon. 6, gtt. iij; Aq. Dest., j, or 3 ss, or ij (as the case may be); V. Sp., gtt. jv, or viij, or xij (as the case may be); Solve. Or, 1 G1. Bryon., 3, gr. vj; Aq. Dest., 5 ij; V. Sp., gtt. vj; Solve. Take of the 6th dilution of Bryonia 3 drops, and of distilled water 1 ounce, or 1 ounce, or 2 ounces (as the case may be), and of Spirits of Wine (or Alcohol) 4 drops, or 8 drops, or 12 drops (as the case may be), and shake the mixture well. Take of the 3d dilution of Bryonia 6 pellets, of distilled water 2 ounces, and of Spirits of Wine 6 drops, and shake the mixture well. FORMUL1E OF HOM(EOPATHIC PRESCRIPTIONS. 61 c. Aqueous Solutions in alternation.! Tr. Acon., 12., gtt. iij, 1, 3 et 5; Aq. Dest., 3j (or more or less); V. Sp., gtt. viij (or not, according to circumstances, as above); Solve. le Tr. Bell., 12., gtt. iij, 2, 4 et 6; Aq. Dest., 3j; V. Sp., gtt. jv (or not, as just directed); Solve. Or, S* G1. Acon., 12., gr. iij, 1, 3 et 5; Aq. Dest., j; SV. Sp., gtt. viij; Solve. Pl GI. Bell. 12., gr. iij, 2, 4 et 6; Aq. Dest. 3j; V. Sp. gtt. jv; Solve. Take of the 12th dilution of Aconite 3 drops, of distilled water 1 ounce, and of Spirits of Wine 8 drops, and shake the mixture well. Take of the 12th dilution of Belladonna 3 drops, of distilled water 1 ounce, and of Spirits of Wine 4 drops, and shake the mixture well. N. B. The figures 1, 3 and 5, in the first, and 2, 4 and 6, in the second prescription, signify that the patient is to take the medicines in alternation, commencing with Aconite. Take of the 12th dilution of Aconite 3 pellets, of distilled water 1 ounce, and of Spirits of Wine 8 drops, and shake the mixture well. Take of the 12th dilution of Belladonna 3 pellets, of distilled water 1 ounce, and of Spirits of Wine 4 drops, and shake the mixture well. N. B. See N. B. of the preceding prescriptions. III. PRESCRIPTION OF TRITURATIONS. a. When all the Powders are to be medicated. 1c Tr. Ferr. met. 3. trit., Take of the 3d trituration of Ferrum metalligr. j; cum 1 grain and triturate it with a suffiPulv. Sacch. Lact. cient quantity of pulverized Sugar of Milk, q. s.; and make 6 powders of it. Pulv. vj. 62 FORMULAE OF IIOM(EOPATHIC PRESCRIPTIONS. b. When part only are to be medicated. 1 Tr. Hep. Silph. 1. trit., gr. j, 1, 3, 5 2 2, 4, 6; Pulv. Sacch. Lact. q. s. Pulv. vj. Take of the 1st trituration of Hepar sulphuris 1 grain and triturate it with a sufficient quantity of pulverized Sugar of Milk, and divide it in 3 powders, to be marked 1, 3 and 5. Then take a sufficient quantity of pulverized Sugar of Milk for 3 more powders (not medicated), and mark them 2, 4 and 6. c. When the Powders are to be used in alternation. 1* Tr. Sulph. 3. trit., gr. j, 1, 3 et 5; Pulv. Sacch. Lact. q. s. Pulv. iij. Tr. Sepia 3. trit., gr. ij. 2, 4 et 6; Pulv. Sacch. Lact. q. s. Pulv. iij. Take of the 3d trituration of Sulphur 1 grain and triturate it with a sufficient quantity of pulverized Sugar of Milk, divide it in 3 powders, and mark them 1, 3 and 5. Take of the 3d trituration of Sepia 2 grains and triturate them with a sufficient quantity of pulverized Sugar of Milk, divide it in 3 powders, and mark them 2, 4 and 6. LIST OF MEDICINES WHICH ARE WELL ADAPTED TO PARTICOLAR TEMPERAMENTS, CONSTITUTIONS, AND DISPOSITIONS. LYMPHATIC TEMPERAMENTS (characterized by superabundance of the humors with repletion of the cellular tissue, giving a considerable bulk to the whole body, which is, moreover, distinguished by roundness of form, softness of the muscular system, fair hair, pale clear skin, and a lustreless, or hazy, inanimate eye. The circulation is slow, the brain inactive, and the passions languid). M3erc., Sulph., Calc., Puls., Caps., China, Ars., Acid. nit., Bella., Hyos., Phosph., Hell., Dulc., Sep., Ant., Lyc., Carb. v., Arn., Dig., Con., Clem., Sil., etc. SANGUINE TEMPERAMENT (indicated by predominant activity in the circulating system, with a moderately full habit, soft skin, florid complexion, blue eyes, red, auburn, or yellow hair; corporal and mental activity). Acon., Am., Bella., Cale., Hep., Merc., Cham., Nux v., Bry., Lach., Phosph., Ac. nitr., Ars., Cocc., etc. BILIOUS TEMPERAMENT. (By this term is meant that habit of body which is distinguished by black hair, dark eyes and skin, the latter generally inclining to yellow, moderate fulness, but much firmness of flesh;. the countenance strongly marked, and expressive of the great energy of character which this temperament obtains; the passions violent, the pulse strong, hard, and frequent.) Acon., Bry., Nux v., Cham., Cocc., Ars., Arn., China, Sulph., Plat., etc. MELANCHOLIC TEMPERAMENT. (A modification of the bilious, with less activity of the nervous and muscular systems; black hair, dark complexion; the disposition grave, meditative, suspicious, and gloomy. Derangement of the functions of the nervous system, with sluggish bowels, dry habit of body, hard, slow, and habitually contracted pulse, usually attend this, so to speak, abnormal modification of the bilious temperament.) Nux v., Lach., Sulph., Aurum, Staph., Veratr., China, Con., Grat., Mosch. natr., Phosph., Stann., Viol. odor., Acid. nitr., Plat., Ambra, Ars., Bry., Sil., Pzuls., Sep., Magn. m., etc. NERVOUs TEMPERAMENT. (Defined by fine thin hair, thin skin, small, attenuated muscles, paleness of countenance and often indifferent or delicate health. Predominant activity of the brain and entire nervous system; suddenness and mutability of decision and judgment; 64 LIST OF MEDICINES. quickness in muscular motion.) Acon., Coffea, Bry., Cham., Nux v., Sep., Plat., Lach., Ac. nitr., Cocc., Ambr., Ars., China., Zinc., Cup., Ign., Phosph., etc. CONSTITUTION OR HABIT OF BODY, CACHECTIC: Ars., Sulph., Calc., China, Merc., Ac. nitr., Phosph., Sil., Natr. m., Carb. v., Arnm., etc. - - DEBILITATED OR EXHAUSTED: Ars., Sulph., Calc., Phosph., Phosph. ac., Ars., Carb. v., Nux v., China, Lach., Merc., Natr. m., Staph., Ac. nit,, Sep., Veratr., Sil., Ant. c., Kali, Am., Can., etc. - - DRY: Bry., Nux v., Ac. nitr., Ambra, China, etc. ---- - PLETHORIC, CORPULENT, Leuco-phlegmatic: Acon., Bella., Calc., Am., Baryt. c., Ant., Sulph., Puls., Hell., Merc., Sep., etc. LEAN HABIT OF BODY: Nux v., Sil., Lach., Ac. nitr., China, Ambra, Bry, etc. DISPOSITION, CHOLERIC: Bry., Nux v., Cham., Cocc., Acon., Sulph., China, etc. - -- HYPOCHONDRIACAL: Nux v.,Sulph., Staph., Veratr., Aurum, China, Con., Stann., Phosph., Grat., Mosch., Puls., Asa., Bella., Cham.,.Magn. m., Hell., Plumb., Mez., Val., Zinc., etc. -- MELANCHOLY: Acon., Ign., Natr. m., Lach., Ars., Nux v., Bry., China, Sulph., Mlerc., Graph., Calc., Staph., Aur., Lye., Plat., Puls., Veratr., Sil., Sep., Ac. nitr., Stram., Calc., Con., Chel., etc. - -- MILD (quiet, easy): Puls., Ign., Ambra, Cic., Mag. arct., Stann., Sulph., Calad., Lye., Sil., etc. - - PHLEGMATIC (inactive, inanimate, indolent): Caps., Cocc., Puls., Ac. phos., Sep., Anac., Ars., Hell., Bella., Scill., Sil., Sulph., Zinc., Ac. mur., Natr. m., Cyc., Euph., etc. - - SENSITIVE: Ign., Cap., Phosph., etc. As we very frequently meet with mixed forms of temperament, such as a combination of the sanguine and lymphatic, the nervous and lymphatic, and the nervous and bilious, forming the sanguinelymphatic, the nervo-sanguine and the nervo-bilious temperaments, the remedies which correspond to the two pure varieties which form the compound one ought to be selected where possible, or those which correspond best to the more prominent development of temperament, when a medicament cannot be found which is equally well adapted to the two different temperaments forming the mixed variety. We must, of course, be guided by the entire morbid picture in making a selection from amongst the 'medicaments which are most applicable to particular temperaments. HOMOEOPATHIC PRACTICE OF PHYSIC. IT has been repeatedly found that some remedies act very beneficially when administered after the previous employment of certain others. The subjoined list affords a few such examples, and may prove useful in the treatment of particular cases: the remedy to be selected must be in accordance with the symptoms. Acmui~r NITR. Cale., Petr., Puls., Sulph., are often used with success after Acidum nitri. ACIDmu Pos. China, Zach., Rhus, Verat., are sometimes suitable after Acidum phos. AcIDUM SULPH. IPuls. is sometimes useful after Acid. sulph. ACONITE. Ar., Ars., Bella., Bryon., Cann., Ipec., Spong., Sulph., &c., will frequently be found of use after Aconite. ALUMINA. Bryon. is often of great use after Alumina, when it is indicated. ANT. CRUDUM. Puls. and Mfere. sometimes answer well after Antimony. ARNICA. Acon., Ipec., Rhus., Sulph. ac., are sometimes suitable after Arnica. AESENICuM. China, Ipec., Nux vom., Sulph., Veratr., will sometimes be found beneficial after Arsenic. BELLADONNA. China, Ipec., Dulc., Hepar, lach., Rhus, Seneg., Strain., Valer., are sometimes the most appropriate medicines after Belladonna. BRYONIA. Alum. and Rhus will sometimes be found suitable after Bryonia. CALcAREA CARBONICA. Lycopodium, Nitr. ac., Phos., and Silicea, will be found most useful after Calcarea. CARBO VEGETABILIS. Arsen., Kali, Merc., will often be found suitable after Ccrbo vegetabilis. 5 66 LIST OF MEDICINES. CINCiONA (or China). Arsen., Bella., Puls., Veratr., are sometimes suitable after Cinchona. CUPrUM. Calc. and Veratr. are sometimes of service after Cuprum. HEPAR SULPT. Bella., fere., Nitr. ac., Sjpong., Silicea, are sometimes suitable after fepar sulph. IPECACiUANHA. ATm., Ars., Chin., Cocc., Ign., Nux, are sometimes suitable after Ipecacuanka. LACHESIS. Alum., Ars., Bell., Carb. v., Con., Dule., lMere., Nux mom., Phos. acid., are sometimes useful after -achesis. LYCOPODIUM. Graph., ledum, Phos., Puls., Silic., are sometimes serviceable after Iycopodium. MERCURIUS. After Mercurius, Bell., Du p., Hepar, Lach., Nitr. acid., ]~ep., Sulph., are sometimes suitable. Nux VOMICA. Bryon., Puls., and Sulph., will frequently be found efficacious after Nux vomica. Ouium. After Opium, Calce., Petr., Puls., will sometimes be found of use. PHOSPHORUS. Per., Rhs, and Sulph., will be found suitable after Phosphorus. PULSATILLA. Asa., Bryon., Nitr. ac., and Sepia, are sometimes suitable after Pulsatilla. RHUS TOXICODENDRON. Am. c., Ars., Bryon., lcal., Con., Phos., Phos. ac., Puls., and Sulph., are sometimes useful after Rhus tox. SEPIA. After Sepia, Uarbo v., Puls., are sometimes suitable. SILICEA. After Silicec, H epar, Lach., Lyco., Sepia, are sometimes of service. SPONGIA. Hepatr suph. is sometimes suitable after Spongia -for instance in croup. SULPHUR. ACOn., Bell., Calce.,O Cu3r., ere., Nitr. ac., Puls., Rhus, Sepia, Sil., are sometimes suitable after Sulphur. TARTARuS EMETICUS. After Tartar. emet., Bar. c., Ipec., Puls., Sp., are sometimes useful. YERATRUM. After Veratrum, Ars., Am., Chin., Cupr., Ipec., are sometimes suitable. SYNOPSIS OF THE RULES OF DIET. UNDER HOM(EOPATHIC TREATMENT. ALIMENTS ALLOWED. Soup or broth made from the lean of beef, veal, mutton, or chicken: to which may be added, well boiled sago, tapioca, vermicelli, rice; semolina, or maccaroni, young peas, carrots, pearl barley, or other farinaceous materials, seasoned merely with a little salt. M-eats. Beef, mutton, (poultry rarely,) pigeons, larks, rabbits, (venison, and game in general, may in most cases be partaken of in moderation, but never when high,) plainly cooked, and roasted, broiled, or stewed in its own juice, in preference to boiled. (Ham or neat's tongue rarely.) Fish. Soles, whiting, smelts, trout, and flounders, perch, and such like, boiled in preference to fried; when cooked in the latter manner, the white must alone be partaken of, and the outer or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, artichokes, parsnips, carrots, turnips, French-beans, sea-cale, vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, or with milk, where required, instead of butter. Eggs lightly dressed; all kinds of light bread, not newbaked; and biscuit, free from soda, potash, and the like ingredients. Light puddings, such as those made from vermicelli, semolina, fecula of potato, sago, arrow-root, bread, rice; simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. Fuiit. Baked, stewed, or preserved apples and pears; also gooseberries, raspberries, grapes, or any other wholesome fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. 68 RULES FOR DIET. Beverage. Water, milk, cocoa, chocolate (unspiced), arrowroot or gruel (made thin), toast-water, barley-water, milk and water, sugar and water, rice-water. Salt should be used in moderation. ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. M2eats. Pork, bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat and salted meat. Fish. Crab, lobster, oysters, and shell-fish in general; and almost all other fish not specified in Aliments allowed. Vegetables. Cucumber, celery, onions, greens, cabbage, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Pastry of all kinds, whether boiled, baked, or fried. Spices, Arom)atics, and Artificial Sauces of all kinds; as also the ordinary condiments, mustard and vinegar. Cheese. Chesnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned in Aliments allowed, under Fruit. (See also article REGIMEN.) The above regulations are subject to considerable modifications in particular cases, both as regards the articles allowed, and those which are prohibited. Regularity in the hours of meals should be observed; and too long fasting, as well as too great a quantity of food at one time, should be avoided. PART I. ON THE SYMPTOMS, CHARACTER, DISTINCTION, AND TREATMENT OF DISEASES. FEVERS. Febres. GENERAL CONSIDERATION OF FEVER. CAUSES, TREATMENT) AND DIET TO BE OBSERVED. PERHAPS no form of disease has more occupied the attention of pathologists, or given rise to a greater number of theories than Fever. Many authors consider fever and inflammation as synonymous terms, others as mere modifications of the same pathological state of the system. The investigation is certainly one possessing peculiar interest; but, fortunately, in the homceopathic system, no theory can in the slightest degree affect the practice, since, in the treatment of this class of disease, the external phenomena present sufficient indications for the selection of the proper remedies. Acute diseases have always been considered as the true touchstone of every system of therapeutics. Homoeopathy has been submitted to the test, and the results have at once proved the bold assertion of its founder, that its principle is a law of nature,-the minute doses act in these cases with a promptness and certainty scarcely to be credited, except by those who have either witnessed or experienced their power: under this system, the disease is brought to a salutary crisis, before any great expenditure of vital energy has taken place; and, from this circumstance, combined with the absence of debilitating measures, the period of convalescence is greatly shortened, and in many instances, scarcely perceptible, the patient being, as it were, at once restored from a state of disease to one of perfect health. Although I shall avoid entering into any of the theories respecting fever and inflammation, I cannot but render the 70 FEVERS. tribute of my admiration to the gifted men who have devoted so much of their time and energies to the elucidation of this difficult point, since every new pathological discovery serves to throw light upon the specific action of medicinal substances. Practically speaking, when we find a medicine produce a change of health resembling that present in fevers, we know that in such fevers it is curative; still it would be a satisfaction to be enabled to trace the connection more closely, and to show the perfect affinity between medicinal and morbid action. Ihere is no doubt, that, if a perfect theory of fever be ever given to the world, it will be found in perfect accordance with the homceopathic law. In all forms of acute disease fever is present; in fever, properly so called, there is generally functional disturbance, accelerated action of the vascular, with the participation of the nervous system, and a tendency to increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever also possesses the property of passing from one species into another. Thus inflammatory fever may, by severe antiphlogistic measures, be altered into a low typhus; or, on the other hand, a simple fever, by injudicious treatment, may be changed into an inflammatory one; and that again assume the intermittent form; also, one attack may present all these different phases. Fevers, terminating fortunately, and running a regular course, may be divided into five stages: the accession, increase, crisis, decrease, and convalescence. When the result is fatal, it may arise from a metastasis, the exhaustion of the vital energy of the patient, or the disorganization of some important part. The belief in critical daysis of very ancient origin, though there is some difference in the calculations of physicians upon this point: some counting from the day the shiverings declare the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in quotidian and other forms of ague, such distinctions are of little value, inasmuch as the homceopathic treatment is directed to forwarding the crisis, and thereby materially shortens the duration of the disease. Statistics prove that the average continuation of acute affections FEVERS. 71 is much shorter under the homoeopathic system, than it is where they are treated allopathically, or left to nature; consequently, any calculations based upon other modes of treatment are not to be depended upon, and the best plan for the physician to follow is to watch attentively the disease before him, and apply the remedies his knowledge and experience point out as best calculated to conduct it to a satisfactory issue. A crisis may declare itself by diarrhoea, profuse perspiration, hemorrhage, or increase or alteration of other secretions, or by the appearance of an eruption, after which, if salutary, the skin becomes moist and resumes its functions, and the pulse returns to its usual standard. Fevers have been differently classified by various medical writers. The arrangement we shall adopt is as follows: simple irritative fever, inflammatory fever, typhus, putrid, and gastric or bilious fevers, inltermittent fevers, and then eruptive fevers, such as scarlatina, measles, &c. Although this mode of classification is adopted for the sake of convenience, the author has no intention of generalizing disease: every febrile attack presents peculiar features, and it is to be treated as an individual affection, and according to the nature of the symptoms presenting themselves, not by a blind adherence to the nomenclature of disease. CAUSES OF FEVER. It cannot be denied that there exists in certain individuals, a particular predisposition to acute diseases, and, as before remarked in the introduction, the sanguine, nervous, and bilious temperaments possess this susceptibility in a far more marked degree than the phlegmatic. The exciting causes are numerous. Miasms, epidemic influences, contagion, powerful mental emotions, derangement of some important organ, external lesions, excess or errors in diet, heat or cold, or alterations of temperature, exposure to cold, or damp, repercussed eruptions-in fact, anything that causes derangement of the equilibrium of the system may produce fever. GENERAL TREATMENT IN FEVER, AND DIET. The great essentials in the treatment of fever are: Perfect rest, mental and bodily. 72 FEVERS. Pure air and a cool apartment; the temperature of the patient's room should never exceed 55 degrees. Feather-beds should be discarded and mattresses substituted, when practicable, and the bed-clothes be light but sufficient. Nature herself generally prescribes the regimen to be observed by taking - away appetite, while the thirst present, as an eminent medical writer has well observed, may be considered as her voice calling for fluid. Water is the best diluent; no solid food, broth, or even gruel, and the like, should be permitted in cases where the inflammation runs excessively high; and the utmost caution is to be observed in allowing gruel or weak broths during the decrease: an error in this respect often causes irreparable mischief, and it is always safer to err a little on the side of abstinence than on that of indulgence. Toast-water, or weak barley- or rice-water, sweetened with a little sugar or raspberry or strawberry syrup, or orangade, may be allowed when the fever is somewhat abated, though then we must still carefully avoid incurring the risk of a relapse, by giving any aliment likely to tax, in however slight a degree, the digestive powers. Fruits, such as those which have been enumerated in the Rules for Diet (see page 67), are very generally allowable in most forms of fever, unattended with diarrhoea. Drinks ought, for the most part, to be given, in preference, frequently and in small quantities, than in large draughts. SIMPLE OR EPHEMERAL FEVER. Febris simplex. The disease seldom presents any distinct character, and generally runs its course in twenty-four hours; as, however, it frequently forms the initiative of other more serious disorders, it deserves attention. Before attacks of* scarlatina, measles, small-pox, &c., it is generally present, although occasionally showing itself as a distinct affection. DIAGNOSIS. Shivering followed by heat, restlessness, thirst, accelerated pulse, general uneasiness and lassitude, terminated by profuse perspiration. In allopathic practice, unless the immediate cause of the INFLAMMATORY FEVER. 73 affection can be traced,-for instance, indigestion,--the treatment is occasionally hazardous; for, if the simple fever be merely the commencement of an attack of severe inflammation, the allopathic physician incurs either the risk of increasing it by using stimulants, under the idea of its being a precursor of typhus; or, acting upon the opinion of its being a forerunner of inflammation, of weakening the constitution by antiphlogistic methods, if it should unfortunately run on to the former. In this case, the safer plan was to wait quietly the development of the affection, in order to see if it would terminate in a crisis, or take upon it a more virulent form, and then deal with it accordingly. TREATMENT. Throughout this work the disease will be found treated of, both when arising from indigestion or cold, and when appearing as the precursor of other affections; but when it is encountered along with the symptoms already detailed, and cannot be traced to any particular exciting cause, and particularly when hot dry skin is present, Aconite should be prescribed, which, if it be simple fever properly so called, will speedily dissipate all the symptoms; and, if it be the forerunner of any more severe disorder, either at once check its further progress or materially modify its malignancy. The former is more peculiarly the case with purely inflammatory attacks: the latter holds good as far as relates to typhus, exanthematic diseases, and some other affections, which run a regular course. INFLAMMATORY FEVER. SYNOCHAL FEVEE. Febris inflammatoria simplex. Synocha. Febris synochalis. DIAGNOSIS. Rigors (generally considerable), followed by burning heat; pulse strong, hard, and greatly accelerated; dryness of the skin, mouth, lips and tongue; the latter generally of a bright red, in some cases lightly coated with white; thirst; urine red and scanty; constipation; respiration hurried, in accordance with the pulse; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regularity to a crisis, which shows itself in profuse perspirations, critical urine, diarrhcea or hemorrhage, principally 74 FEVERS. epistaxis. The period mentioned is its ordinary average of duration, but under homceopathic treatment, the perfect crisis is considerably hastened without the long convalescence entailed by the usual antiphlogistic means. It is peculiarly apt, if not carefully treated, to change into typhus, or, by metastasis, to fix upon some important organ. CAUSES. Sudden chill, or check of perspiration, exposure to damp or wet, dry easterly winds, violent mental emotion, high living, external injury or lesion, local inflammation, and slight febrile attacks mismanaged. Individuals, of what is denominated a plethoric habit, are particularly subject to this disease; it generally attacks between the ages of 15 and 30 years. Under the diagnosis we have given the pathognomonic symptoms of synocha; we, however, find it complicated, in the majority of cases, with more or less cerebral disturbance, which we shall consider more in detail under INFLAMMATION OF THE BRAIN OR ITS TISSUES. TREATMILENT. Although, throughout this work, the author purposes to confine himself to pointing out the remedies most valuable in disease, without entering into any disquisition upon their efficacy, or the principle of their employment, yet he cannot refrain, in this instance, from briefly noticing a medicament, which has so successfully superseded all the antiphlogistic measures of the old school, subduing, as it does, the inflaml~ation, without lowering the vital energy. No one, who compares the pathogenetic symptoms of AcoNITE given in the /Lateria Miedicai Pura of Hahnemann, and carries in mind the principle of its application, can forbear being struck with the close resemblance which they present to those of pure inflammatory disease; and by this powerful auxiliary, the author has no hesitation in declaring, that disease of the said description is brought so fully under the control of the physician, as to be in a great measure divested of its malignancy, and in no case is the superiority of homceopathy more strongly evidenced. When, therefore, the symptoms above mentioned are present, we may at once prescribe Aconite as follows:Aq Tinct. Acon. 3, gtt. iij. Aq. pur. 3 iij. M. INFLAMMATORY FEVER. 75 DOSE. 3 ss every three to six hours, according to the intensity of the fever. The pulse should be carefully watched, and also the appearance first of simple moisture of the skin, and subsequently of copious sweating, which generally takes place after the first or second dose of Aconite. The intervals between the doses must be lengthened as soon as this favorable crisis sets in. A slight degree of delirium is friequently present in this affection, chiefly at night, which-unless it threatens to run on to inflammation of the brain, in which case Belladonna must be had recourse to-Aconite of itself is sufficient to subdue. When, however, during the course of the affection, other symptoms, besides those mentioned, develop themselves, we may find it necessary to have recourse to different remedies, such as Belladonna, Bryonia, &c. BELLADONNA is especially useful after the previous employment of Aconitum; but it may be prescribed at the commencement of the attack in all cases when the cerebral system seems prominently affected, and there is great heat in the head, with violent cephalalgia, particularly in the forehead, and redness of the face; distension of the arteries of the neck and temples; nocturnal sleepiness, with furious delirium; eyes red, shining and fiery; general internal and external heat; burning thirst and agonizing restlessness. If Tinct. Bellad. 6, gtt. ij. Aque pure, 3 ij. DOSE. 3 ss every four hours, until amelioration supervenes, or we observe unequivocal symptoms of medicinal aggravation; in which latter case we must cease to prescribe altogether, until the reaction has taken place; and in the former, lengthen the intervals of repetition, as the improvement advances.* BRYONIA. When the orgasm is chiefly concentrated in the thoracic viscera, or when there is gastric complication, and the fever inclines to degenerate into synochus. This medicament is accordingly indicated when, in addition to the usual symptoms of inflammatory fever already given, we find a * See remarks on medicinal aggravation, in the Introduction. 76 FEVERS. heavy stupefying headache, with a sensation as if the head would burst at the temples, much aggravated by movement, vertigo and giddiness on rising up or moving; 1burning heat of the head and face, with redness and swelling of the latter; delirium; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting; constipation; aching or shooting pains in the limbs, short cough, oppression at the chest, and laborious breathing. kc Tinct. Bryon. 3, gtt. iij. Aq. pure, 3 iij. DOSE. 3 ss every six or eight hours; few cases are so particularly urgent as to require more frequent administration of this remedy; indeed, when the virulence of the disease has been subdued, a single dose is generally found sufficient, and no further exhibitions should take place, as long as the patient manifestly continues improving. CANTHARIS has been recommended in irritative fever bearing a close resemblance to pure synocha, and especially when the following symptoms become developed: the fever is very intense during the night, and is accompanied by burning heat of skin, strong accelerated pulse, general redness of the surface, dryness of the mouth, and violent thirst. Further, when pains are complained of in the right side of the body, attended with great anxiety and raving. Chamomilla is useful in pseudo-synochal fever, with burning heat and bright redness of the cheeks, tremulous, anxious, palpitation of the heart, extreme irritability of temper, and over sensibility of the senses, alternate heats and chills, and, sometimes, spasmodic attacks, &c. Chamomilla is peculiarly applicable when the above symptoms have been excited by a fit of passion or vexation. A dose or two of Aconite is, however, generally requisite, in the first place, when the derangement has been excited by the aforesaid cause. When inflammatory fever seems to arise from a primary inflammation of some important organ, such as the Head, Lungs, Liver, or Stomach and Bowels, the treatment will be found under the head of INFLAMMA-TION of the function most evidently the seat of the disorder. NERVOUS FEVER. ý7 It is sometimes the result of severe lesion, in which case the patient is to be treated as prescribed under EXTERNAL INJURIES. NERVOUS FEVER. SLOW FEVER. Febris nervosa. Typhus. It is sometimes extremely difficult, particularly when the disease arises from some local affection of the more important viscera, to discriminate, at the commencement, between a nervous and inflammatory attack, so as to give a decided diagnosis. However, in such cases the marked advantage of the homceopathic system is again shown; for, by exhibiting medicines in accordance with the symptoms that declare themselves, we run no risk either of weakening the vital energies, should we err in our diagnosis, and treat it on its first appearance as an inflammatory attack,-or of stimulating the inflammation by what is commonly denominated an anti-nervous treatment, should the precursory symptoms lead us to consider it typhus, and it afterwards assume the inflammatory form. DIAGNOSIS. Typhus rarely sets in with such marked symptoms as announce the approach of inflammatory fever; instead of severe chills or shiverings, we first find a complaint of general uneasiness, a sensation of chilliness, occasionally followed by a greater or less degree of heat. The patient either complains but little, or of pains in his head, chest, and abdomen, and frequently an unusual degree of drowsiness is present, arising from a comatose state of the brain-there is also occasionally a slight dyspncea-after various alternations of cold and heat, the former sensation predominates in the feelings of the patient, while to those around him he appears hot; the extremities, however, on examination, are found cold. Different characters of pulse present themselves; sometimes it is full and soft, at others accelerated, frequently about the natural standard or below it, or quick and weak, but not strong and hard as in inflammatory fever: the frequent difference between the action of the pulse and heart is worthy of notice, the former may be so weak as scarcely to be perceptible, and the action of the latter strong; the pulse also may 78 FEVERS. be hurried and the respiration natural. As the disease progresses, the tongue, at first moist, becomes thickly coated, dry, glazed, and tremulous; there is faintness, cephalalgia, giddiness, and vertigo: the delirium, at first slight, and manifesting itself only at night, becomes unintermitted, and is characterized rather by wandering and low muttering, than fury and violence: we may also meet with spasms and convulsions. All these symptoms, if the disease be allowed to gain ground, increase in malignancy, the evacuations become involuntary, the weakness and lassitude excessive, and the patient sinks down to the bottom of the bed-an evidence of complete prostration of strength, while all endeavors to rouse him are fruitless, and he is perfectly blind to all around. Tenderness of the abdomen, or pain in the region of the coecum, is also frequently met with. Some only of the above symptoms may be present, or the fever may be complicated with others: when only a few of the less virulent symptoms declare themselves, it is called mild typhus; when complicated with considerable disturbance of the vascular system, great heat, and quick hard pulse, inflammatory typhus: a distinction is also found in the type, as in continuous and intermittent typhus; in the accidental circumstances or exciting causes present, as for instance in the gastric and catarrhal complications, which, although generally treated as gastric or catarrhal fevers, with typhoid symptoms, may be considered as modifications of this affection; this difference in arrangement can, however, make none in practice, as we must be guided by the symptoms that present themselves in selecting our remedies. The CONGESTIvE FEVER Of some authors may be considered as a variety of typhus, in which, from the balance of the circulation being destroyed, the blood is determined to some particular organ, the external heat of the body diminished, and the pulse becomes slow and oppressed. The symptoms vary according to the organs attacked. It may be remarked that in most forms of this malady, the course is extremely irregular -the precursory symptoms may precede the disease only a few days or several weeks, and its duration is also uncertain. Death may take place from exhaustion of the vital energies, paralysis of the whole system, or of the brain, apoplexy, dis NERVOUS FEVER. 79 organization of some of the nobler viscera, or a change to the putrid form. CAUSES. Densely populated neighbourhoods, where a number of individuals are crowded into small apartments, and the air rendered impure by exhalations from decomposed animal and vegetable matter, stagnant water, and a want of circulation, are the very hotbeds of typhus; a deficiency and improper quality of food are often added to the above, and are of themselves sufficient to produce it: other causes are, over-exertion, either of body or mind, or excesses of any kind, the prevalence of cold, damp weather, mental emotions, and contagion. In fact, anything tending to depress the vital energies may be productive of typhus; it may consequently arise after inflammatory fever treated by bloodletting or other severe antiphlogistic measures, or even by the reaction of the organism, or an imperfect crisis after the same affection. The prognosis in typhus is to be formed by the type of the fever, the regularity of its course, the local complications, the greater or lesser intensity of the symptoms, and the tendency to a dissolved state of the fluids;-continued delirium and stupor; carpologia, subsultus tendinum, impeded speech and deglutition, tremulous or paralytic state of the tongue; a fetid exhalation from the body; excessively offensive, dark, dysenteric stools; effusions of blood under the skin, or the early appearance of miliary eruption; involuntary evacuation of faeces and urine; hemorrhages and hiccough are highly unfavorable signs. On the other hand, the absence of stupor and delirium, or abatement of febrile heat and thirst, returning strength of pulse, a gentle transpiration over the whole body, loose bilious stools, gradual clearing of the previously turbid urine, or moderate cloudiness in place of the former clear or colorless urine, and deposition of a lateritious sediment, are to be held as favorable indications. Typhus fever generally begins to subside in this and other temperate or cold climates about the fourteenth or sixteenth day, but is frequently protracted to a much longer period. In warm climates, again, the fever commonly terminates in six or eight days. 80 FEVERS. The following remedies have been found the best adapted to the different forms of typhus: Acon., Bella., Bryon., Rhus, Nux, Acid. m., lycop., Hyoscy., Stram., Oham., Natrum m.-in nervous fever, characterized by erythismus (FEBRIS NERVOSA VEESATILIS). Bellal, Rhus, Arsenic., Bryon., Op., Hyosc., Stramn., China, Cocc., Nux v., Yeratr., Arn., Nitr. sp.-in FEBEIS NERVOSA STUPIDA, or slow typhus. Acon., Bella., Hyoscy., Bry., Lach., Op., Stram., Rhus, Acid. phos2ph., Cupr. ac.-in TYPHUS CEREBRALIS. Bryon., Rhus, or Acon., lerc., Cliam., NXux, Veratr., Bella., Hyoscy., Arsenic., China, Sulph., and Senega-in PNEUMO-TYPHUS, TYPHUS PULMONALIS. Ipecac., Puls., Cham., Bryon., Nux, Ignat., Cocc., Am., China, Digit.,-in TYPHUS BILIOSUS S. TYPHUS GASTRICUS. Rhus, Bryon., or Arsenic., Merc., China, Carb. v., Phosph., Canth., Puls., Sulph., Calc., Acid. nitr., Nux mosch.-in TYPHus ABDOMINALIS, Typhus gravior (malignant, putrid, or petechial fever). During the period of incubation the development of the disease may sometimes be prevented, or the attack rendered much milder by the employment of Bryonia or Rhus, or both of these remedies in alternation (see the indications given further on). In the INFLAMMATORY period Bryonia is one of the most important remedies, but it will not unfrequently be found necessary to select one or more of the following in this stage: Acon., Bella., COham., Hyoscy., Nux v., Lycopod., Stram. In the period of DEBILITY, ]hus is almost always of a greater or less degree ofutility, and is often alone sufficient to effect such a favorable change as to render it a comparatively easy task to conduct the fever to a successful issue. The other remedies, which are often required at the debile stage, are, Arsenicum, Carbo vegetabilis, Acidum muriaticum, Mercurius, and Cinchona; or, Acid. phosph., Lach., Arn., Nux mosch., and Sulph. In ILEO-TYPHUS, with ulcerations, Carbo v., Rihus, Acid. nitr., Phosphor., and Lycop. are the most deserving of attention. NERVOUS FEVER. 81 Ca/rb. v. is occasionally of service in cases which seem utterly hopeless; the pulse, from being almost imperceptible, becoming stronger, and the sinking energies rallying in such a manner, after the employment of this remedy, that the patient is readily placed out of danger by the aid of one or more of the medicaments above enumerated, and particularly such as Rh8us, China, Arsenic., &c. At the commencement of typhoid fever, where gastric symptoms set in, such as headache, giddiness, nausea, vomiting, watery, yellow, or greenish, slimy evacuations; particularly when attended with slight chills, alternately with heat, or considerable shivering with slight heat, or marked heat with but little shivering, we may administer IPECACUANHA. Or Pulsatilla may be selected at this stage of the disorder, when there is frequent shivering, bitter taste, whitish tongue, loss of appetite, nausea, vomiting of mucus, slimy evacuations, febrile heat, intermingled with chills, and particularly when the above symptoms occur in mild, temperate, or phlegmatic subjects, with extreme depression of spirits, and tearfulness; in a more advanced stage of the disease, with slight delirium, tears and lamentations, alternating with somnolency, Pulsatilla is still of considerable service. Acid. l/posphoricum is sometimes required after Pulsatilla. DIGITALIS is indicated when febris nervosa, or rather typhus biliosus is ushered in by yellow, jaundiced hue of the skin; violent, bilious vomiting, spasmodic pains in the stomach; sensibility of the left hypochondriun4 on pressure; frequent desire to make water, particularly at night, with scanty, bilious urine; burning heat of the head and face; anxiety of mind, and dread of soame imaginary impending misfortune; urination painful and difficult, or entirely suppressed. Nux'VOMICA. Gastric or bilious symptoms, constipation, with frequent inclination and ineffectual efforts to evacuate. Nux vomica is further indicated when the spasms, which not unfrequently accompany this disease, are confined to the stomach and intestines, particularly the rectum--a frequent cause of the above-mentioned constipation; painful and difficult emission of urine; painful pressure, and tension in the epigastrium and hypochondria; sensation as if the limbs were bruised; general nervous excitability, with great nocturnal 6 82 FEVERS. restlessness and slight delirium; weakness, and exacerbation of the symptoms in the morning. Temperament, sanguine or bilious; disposition, irritable and impatient. When the disorder assumes the asthenic form of abdominal typhus, or when the inflammatory diathesis is more lymphatic than arterial, from the occurrence of the disease in venouslymphatic subjects, with pale or yellowish appearance of the face, severe headache, or sensation as if a tight band were across the forehead; thickly coated tongue; bitter or foul taste; little thirst; sensibility of the scrobiculus or umbilical region to the touch, and distension of the abdomen; evacuations copious, watery, flocculent, and even bloody, sometimes attended with tenesmus; at first, dry burning skin, followed by profuse debilitating sweats; depressed pulse, and great prostration; extreme restlessness and anxiety with constant tossing about in bed; disturbed unrefreshing sleep, with anxious dreams-MiECURIUs will be found a most efficient medicine. CINCHONA. This remedy is frequently of service in the first stage, or when there is paleness of the face, lancinating, rending, aching, or pressive headache, cloudiness of vision, buzzing or roaring in the ears; dulness of hearing; yellow or white coating on the tongue, dryness of the mouth, insipid, clammy, or bitter taste; inclination to vomit; sensibility and distension of the abdomen; thin, yellow, watery motions, occasionally intermixed with undigested substances; urine scanty, pale or dark colored, and cloudy; oppression at the chest; dragging shooting pains in the limbs; anxiety, sleeplessness, and general coldness and shivering. In an advanced stage of the disease, moreover, China is occasionally of considerable value, especially when the attack has become lengthened and tedious, and the following symptoms have set in: nocturnal sweats, obstinate diarrhoea, but with clean tongue, and absence of abdominal pain,-followed by Sulphur should the sweats not yield; or by Acidum sulph., if the sweating be very profuse when lying still and diminished by movement. When inflammatory symptoms declare themselves at the commencement, Aconite and Belladonna are the best remedies; but when the disease becomes more developed, and still retains the inflammatory character, Bryonia and Rhus will NERVOUS FEVER. 83 generally be found more useful. For the employment of Aconite, we have given the characteristic indications under Inflammatory Fever, and in all cases where these decided symptoms are present it is imperatively called for, and should be administered as there prescribed. The following symptoms indicate BELLDONNA: Alternate heat and chills, or general heat externally and internally, with redness, burning heat, and bloated appearance of the face, or alternations of coldness and paleness, and heat and redness of the face, violent throbbing of the carotids; redness, sparkling, and protrusion of the eyes, with dilatation of the pupils, extreme sensibility to light, and strabismus; singing or noises in the ears to a greater or less degree; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run away; violent, shooting pains in the forehead, or dull heavy pain, causing the patient to put his hand frequently to his head; sopor; furious delirium or loss of consciousness; delirium and carpologia, or spasmodic or convulsive attacks; parched lips, soreness of the corners of the mouth, redness and dryness of the tongue, which is also sometimes foul, and covered with yellow fur; skin, hot and dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids, nausea, pressure at the pit of stomach; meteorismus; constipation, or watery motions; scanty and red or amber-colored urine; rapid respiration; pulse full and accelerated, or quick, hard, and wiry; parotid glands inflamed and tumid. STRAMONIM may be given when, in addition to the above symptoms, we find twitching of the muscles of the face, subsultus, strabismus, trembling of the extremities, tremulous motion of the tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulations, and risus sardonicus. HYOSCYAMus, with similar symptoms, and moreover twitching of the tendons, strong, full pulse, fulness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium; frequent, but ineffectual urging to urinate. We shall now proceed to the consideration of two medicines, 84 FEVERS. Rhus and Bryonia, whose value in typhus, in the form in which it appeared in Germany in 1813, was proved by Hahnemann's treatment of 183 patients, not one of whom died, while thousands perished under the means employed by the professors of the old system of medicine. The two medicines above mentioned possess many striking points of similarity, but also many of difference; they may, on some occasions, be administered alternately, with great advantage. For their individual employment the indications are as follow: BRYONIA. More particularly when the disorder assumes the character of a Febris nervosa versatalis, or Typhus cerebralis with violent stupefying headache, as from a blow, and pain across the forehead, and at the temples, as if the head would burst; frequent raising of the hands to the head. Aggravation of these sensations by movement-continuous violent delirium with excessive febrile heats; foul, thickly-coated, yellow tongue, or dry cracked tongue, with parched mouth,:and great thirst, and vesicles on the mouth or tongue, furred lips; nausea, inclination to vomit, or vomiting of mucous and bilious matter; tenderness of the scrobiculus when touched; general heat of the whole body, dryness of the skin, redness of the face, and profuse perspiration during the fever; sensibility of the epigastric regions; distended abdomen, oppression at the chest, and frequent sighing and moaning, indicative of threatening miliaria (alba); constipation, or relaxed stools; urine of a deep orange color or bright yellow, with yellow sediment; sensation as of a plug in the throat; stitches in the side; drowsiness or disposition to sleep during the day; sleeplessness, fugitive heat, and excessive restlessness, or continued drowsiness or coma, with startings and unpleasant dreams; painful shooting and aching in the limbs, aggravated by movement; trembling of the hands; pulse quick, soft, frequent, or irregular, small and intermitting; miliaria, petechise; irritability, irascibility, despair of recovery. (Crocus has in some instances been found of unequivocal service in alternation with Bryonia.) In the period of incubation, Bryonia and Rhus are, as has already been remarked, frequently of great service, either in arresting the fever at its onset, or of giving it a milder character throughout its future NERVOUS FEVER. 85 course. The indications for Bryonia in this stage are chiefly as follows: after a slight cold the patient complains of aching pains over the whole body, which admit of no relief from a change of posture; there is severe throbbing, bursting frontal headache, aggravated by opening or turning the eyes; the scalp is tender to the touch, and the head burning hot, yet the forehead is nevertheless frequently bathed with a cold sweat; the sitting or the recumbent posture is rendered compulsory, by the prevalence of debility, languor and heaviness of the limbs, and there is an aversion to cold air; the nights are disturbed, more especially in the forepart of the night, by ebullition or congestion of blood, heat and anxiety; the patient sighs and moans during sleep, and is often aroused by agonizing or frightful dreams, which continue to haunt him even whilst awake. Symptoms of deranged digestion are also prominently developed, as bitter taste, yellow, furred, dry tongue, disgust at food, nausea, and inclination to vomit, pressure, or weight and pricking in the scrobiculus cordis, with sensation of distension in the hypochondria, costiveness.* IRHUS TOXICODENDRON. This medicine is more peculiarly suitable to the debile form or stage, the Febris nervosa stupida (Bryonia being more applicable to the inflammatory), but will frequently be found serviceable in all the stages of the disease, particularly when there is diarrhca, congestion to the head, oppression at the chest, and great weakness. The headache is generally of a stupefying nature, with a feeling as if from a bruise, but not so severe as that of Bryonia; the tongue presents nearly the same character, less nausea and inclination to vomit exists; violent pain is felt at the epigastrium, especially when touched. Constipation as in Bryonia, but more particularly, copious yellowish, or loose, sanguineous evacuations, with severe cutting pains in the abdomen; the symptoms of general heat, and those of the face resemble those given under Bryonia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark colored, or at first clear, and afterwards turbid; the symptoms of the ears the same; sleep also the same; difficult deglutition of solids, as if from contraction of the throat and cesophagus; * See HARTMANN'S Acute and Chronic Diseases. 86 FEVERS. general trembling, debility and prostration, almost amounting to paralytic weakness of the different limbs: shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected: pulse quick and small, or weak and slow; in the morale we may notice, excessive anguish, anxiety, extreme lowness of spirits, and disposition to weep. In TYPHus ABDOMINALIS, characterised by continued heat and dryness of the skin, violent' delirium; oppression at the heart, with sighing and moaning; pains in the limbs; extreme debility; tongue and lips dry, or covered with a brown or blackish tenacious fur; red, burning cheeks, subsultus tendinum; carpologia; coma somnolentum, with muttering and stertor; weak, accelerated pulse; anxious expression of countenance; sleep disturbed, or prevented by the frequent recurrence of sudden starts; eyes inflamed, watery, and insensible; features collapsed; breath highly offensive; involuntary evacuation of feces and urine; coldness of the extremities; sinking energies; petechie; miliaria-Rhus is, moreover, a most efficient medicament. During the period of incubation, or the premonitory stage of typhus (particularly of FEBRIS NERVOSA STUPIDA), it is also of great value. Its employment is called for here when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with diarrhoea, accompanied by colic, and complains of chilliness even when seated close by the fire; further, when aching pains (or pains as if arising from the effects of contusions) are experienced in particular parts of the body, or when a painful sensation is experienced as if the flesh had been torn from the bones; the tongue is furred white, and there is giddiness, inclination to vomit, or actual vomiting of mucus; the patient is tormented by numbness, creeping and tingling in the parts of the body on which he lies, together with lancinations, drawing pains, and stiffness in the nape of the neck and in the back; rigidity and feeling of paralysis in the extremities; all the symptoms are, generally speaking, exacerbated during rest and at night. Again, in the period of convalescence, it is a remedy of considerable importance, especially when the progress towards recovery proceeds slowly, the pulse retaining a febrile charac NERVOUS FEVER,. 87 ter, the appetite, although improved, being capricious, the bowels prone to become relaxed, and the chest not yet exempt from feelings of oppression.* In many cases it will be found useful to give Bryonia and Rhus in alternation, at intervals of from three to six hours. CAMPHORA frequently proves useful after Rhus (according to the experience of some of the Continental homoeopathists); it is indicated especially when the symptoms are chiefly as follows: heat of the head, with confusion of ideas; or violent delirium; giddiness; throbbing headache; burning heat in the forehead; cold and clammy skin; continuous coldness of the hands and feet; debilitating and clammy sweat; tendency to diarrhoea; scanty, cloudy urine, which deposits a thick sediment; great weakness, and feeble, scarcely perceptible pulse. Dose. A drop of the tincture every quarter of an hour until symptoms of amendment supervene, and a change of prescription is called for. CoccuLus is often serviceable after the previous employment of Rhus or Camphora, especially when the great debility continues, and the patient complains of giddiness and headache; or when there is a tendency to syncope, or paralysis of the limbs, and when there are prominent symptoms of gastric disturbance. Arnica is also of some importance in febris nervosa stupida; with coma somnolentum, or delirium and carpologia; or when the patient lies in a state of unconsciousness, as if he had been stunned by a concussion of the brain. ARSENICUM. This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, sometimes restoring the patient when almost beyond the reach of hope, and renovating the vital spark. The chief indications for its employment are: extreme prostration of strength, falling of the lower jaw, open mouth, dull and glassy eyes, bitter taste, inclination to vomit, pressure and aching at the scrobiculus cordis, pain in the coecal region, bursting headache, giddiness, violent or low muttering delirium, sopor, tympanitis, burning thirst, dry hot skin, giddiness, parched, cracked, sometimes blackish-looking, clammy * See HARTMANN'S Acute and Chronic Diseases. 88 FEVERS. tongue, and colliquative diarrhoea, pulse scarcely perceptible and intermittent. YERATRUM is occasionally useful after or in alternation with Ars., when the inferior extremities become cold and covered with cold sweat. CARBO VEGETABILIS is another remedy which often proves of utility in these desperate cases; it is indicated where we find drowsiness with rattling respiration, face pinched, sunken, and deathlike, pupils insensible to light, pulse scarcely perceptible, and the vital power rapidly sinking, cold perspiration on the face and extremities, involuntary and offensive evacuations, deep red urine, with a cloud floating in it or rising towards the surface. In Ileo-typhus, with symptoms of incipient ulceration, or with signs of so-called putrescency, and tendency to metastases, Carb. v. is, moreover, a most serviceable renjedy: and in the second stage of malignant typhus, or typhus abdominalis, it may be employed with decided advantage when the symptoms are as follows: Burning, lancinating pains in the epigastrium and deep in the abdomen, which become renewed after partaking of nourishment of any kind, and are accompanied by great anguish, excessive flatulency, and the evacuation of burning, light-colored, fetid, watery, sanguineous stools with tenesmus; desire for salt food, and for coffee, but aversion to meat,-the patient, however, generally dreads to satisfy any inclination which he may have for food, on account of the above-mentioned sufferings which such indulgence entails;-anxiety and burning heat of skin, arising from congestions to the head and chest; agglutination of the eyelids during the night; deafness and tinnitus aurium, as also bleeding from the nose and obstruction of the latter from the formation of incrustations; eruption around the nose, and the brown or blackish-looking cracked lips - the legs are drawn up during sleep, which is restless and disturbed by frequent waking. AcIDUM PHOSPHOmICUM. When at the very commencement of the disease, we find great exhaustion and prostration, with wandering even when awake; or in almost hopeless cases, this medicine may be administered either alone, or still better, in alternation with ]Rhus, when the patient is always found lying on the back in a comatose state, and either gives no NERVOUS FEVER. 89 reply when talked to, or if he does, it is in an incoherent manner; constant loquacious delirium, or low muttering; carpologia, fixed look; seeming efforts to escape from some alarming object; black incrustations on the lips; dry, hot skin, continual copious watery diarrhoea; the motions are generally passed involuntarily; sanguineous evacuations; frequent, weak, and occasionally an intermitting pulse. Should the debilitating sanguineous evacuations continue, Acid. nitricum should be administered, or Cantharides, if strangury also be present. Acidum nitricum, in addition to'being useful against hemorrhage, is also efficacious where there is sensibility of the abdomen, with diarrhoea and slimy, acrid, greenish-colored stools; tenesmus, aphthTe, intestinal ulcerations; sensibility of certain parts of the abdomen on pressure; shooting pains in the rectmnm; tenesmus, greenish slimy diarrhoea; scalding micturition; tendency to collapse. SULPHUR has been found useful when Bryonia, izRus, or Acidum phosphoricum has been fruitlessly administered; but particularly when the following symptoms were encountered: pale and collapsed countenance, burning, itching eruptions on the lips, dryness of the mouth; foul, dry tongue; bitter taste; slimy or bilious vomiting; tenderness of the epigastrium, and pain as from excoriation in the umbilical region, increased on pressure; borborygmus; frequent, watery, flocculent or yellow evacuations; cloudy urine, depositing a reddish sediment; miliaria, miliaria purulenta; epistaxis; stitches in the chest, oppressed breathing; dry cough, worse towards evening and at night; sleeplessness, or whining during sleep; dry heat during the day, with moderately quick pulse, and profuse sweating at night. OPIUM. (Febris nervosa stupida.) Great drowsiness, or coma with stertorous breathing, open mouth, half-closed eyes, or fixed look, slight delirium or muttering; CARPOLOGIA; the patient is in a continual state of sopor, from which it is extremely difficult to rouse him, and is scarcely aroused, ere he relapses into his former state; dry offensive stools, which, together with the urine, are passed involuntarily. NITRI. SPIR. In desperate cases of febris nerv. stup., with complete apathy or insensibility, and fixed, expressionless, or haggard eyes, dry, brown, or blackish lips; sopor, with low 90 FEVERS. muttering delirium. As soon as signs of improvement set in from the employment of this remedy, it will in general be found requisite to follow up the treatment by prescribing some one or other of the remedies mentioned above, such as Rhus, Acid.phosph., Nux, Bella, &c. CALCAREA C. may sometimes be administered advantageously, alternately with Belladonna, Arsenic., or Jhus, according to the symptoms; it is, further, occasionally a most efficient remedy in cases in which debilitating diarrhoea or epistaxis will not yield to such remedies as Ac. phosph., hus, Cinchona, etc.; when the nasal hemorrhage fails to be arrested by Calcarea, Heepar sulphuris is generally the most appropriate remedy to follow up with, provided all the symptoms of the disease are not better embraced by Pulsatilla, Belladonna, Jhus, or Sulphur: lastly, Calc. c. may be exhibited with advantage where there are symptoms of impending miliaria, jerkings, or twitchings in the limbs, particularly in children, tendency to meningitis, delirium, etc. LYcOPODnmI is often a valuable remedy after Cale. in the second stage of typhus, when miliaria is slowly and scantily developed, and there is sopor with muttering delirium; confounding of words; stammering; subsultus tendinum; carpologia; meteorismus, with constipation; affections of the bladder; or, when there are shiverings alternating with heat; circumscribed redness of the cheeks; debilitating sweats; excessive debility; complete hanging of the lower jaw; halfclosed eyes; slow respiration; or, state of excitement without heat or congestion in the head or face; redness of the tongue; constipation; burning urine; tranquil and resigned state of mind, or surliness and malevolence, especially on waking. LACHESIS is spoken of as being likely to prove serviceable in typhoid fever, attended with vertigo on rising or sitting up; muttering delirium; hanging of the lower jaw; vacant expression of countenance; sunken features; bitter taste; yellowish tongue, with bright red margins; cracked tongue; smooth dry tongue; or furred, white slimy tongue; heaviness of the tongue, with difflculty of protruding it, and inarticulate speech; seeming paralysis of the eyelids; lethargic sleep, and tendency to lie in the prone position; thirst, with disinclination to drink; brownish-red, copious urine. NERVOUS FEVER. 91 SECALE CORNUTUM is, in like manner with Natrum m. and Heleborus, recommended by many honceopathists who have had frequent opportunities of treating nervous fevers, particularly in cases occurring in the wake of other diseases; but is more especially appropriate where the symptoms developed clearly proceed from irritation of the spinal nerves, with wandering, fugitive, spasmodic pains extending from the dorsum and sacrum into different parts of the body; the spasms which affect the face become subsequently chronic; whilst those that have their seat in the hands and feet partake of a tonic character. This remedy is further indicated by dry heat of skin, insatiable thirst, accelerated pulse, great restlessness and sleeplessness; excessive languor; aversion to food. Should the spasmodic affections readily yield to the employment of Secale, but the febrile symptoms continue, some other remedy appropriate thereto must be prescribed. PuOSPHORus is of great service where we find great dryness of the tongue, heat of skin, small, hard, quick pulse, painless diarrhcea, with excessive borborygmus; or when the disease becomes, as it were, concentrated in the lungs, and there is consequently congestion, with extremely laborious breathing and excessive anxiety, dulness on percussion, mucous rAle, stitches during respiration; cough, with copious expectoration of mucus mixed with blood, or even offensive pus; more benefit may be looked for from this than from any other remedy. Phosphorus is also serviceable when, notwithstanding the pneumonic concentration, there is, moreover, sensibility and rumbling in the cocal region, or when there is continued heat of skin, with small hard accelerated pulse, throbbing of the carotids, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sudden cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive heat, and aching of the whole body. In addition to these symptoms, there is burning sensation in the abdomen and anus, with frequent semi-fluid stools streaked with blood; giddiness, confusion, and throbbing pains in the head; deafness, frequent discharge of blood on blowing the nose, and heat in the face; tongue and lips dry and cracked; bitter taste; copious evacuation of urine, which deposits a whitish or 92 FEVERS. reddish sediment: venereal orgasm; delirium; obstupefaction. ACIDUM I MUIATICUM. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness in the mouth. NATRUTM MURIATICUM is recommended in nervous fevers with great debility, insatiable thirst, dryness of the tongue, and loss of consciousness, and particularly when they follow in the course of antecedent debilitating diseases. HELLEBORUS has also been found of very great utility in febris nervosa, occurring after other febrile affections, such as scarlatina, rubeola, febris gastrica, febris verminosa, and cholera, with pain as from contusion, combined with tumefaction, in the integuments of the head; disposition to somnolency, with confusion of ideas and extreme restlessness; dark, cloudy urine; heaviness, or feeling of stiffness and powerlessness in the limbs; depression of spirits, and obtuseness of faculties. In prescribing the above remedies, it will generally be found necessary to order the dose to be repeated every three or four hours, but as soon as an amendment sets in, or even if the symptoms become stationary, the medicine should be discontinued for a time, and only resumed (or changed, if called for by the invasion of new symptoms requiring a different remedy) when the slightest signs of a relapse or an alteration for the worse can be detected. Against the following sequelce:-DECUBITUS, compresses with diluted alcohol, or a very weak lotion of Arnica, may be employed at the commencement; but when there is violent inflammation, Belladonna, sometimes in alternation with Sulphur, should be had recburse to: when sphacelus supervenes, Carb. v. internally and externally, or Arsen. or Cinchona; where the bones are implicated Silicea, and when granulation is retarded-Sulphur and Cinchona will generally prove the most useful medicaments. METASTATIC ABSCESS: Bella., and Hepar sulph. FURUNCULI: Arnica, Bella., and Sulph., or Iycopod., or Silicea. Frequent tendency to DIARRMHEA: China. Obstinate night-sweats, sometimes with dry noc NERVOUS FEVER. 93 turnal cough, Sulph. (EDEMA OF THE FEET: Bryonia, Lycopod., Puls., China, Sulph., according to the concomitant symptoms. Intestinal ulcerations: Acid. nitr., Arsenic., Phosph., Carb. v., Sulph., Calc., Puls., Bella. After severe cases of Typhus, a period of debility generally supervenes, of greater or less duration, according to the violence of the attack. In such instances the invigorating effects of pure air are for the most part preferable to all other roborants; the patient ought, therefore, under favorable circumstances, to get out of doors as soon as possible. In some cases, however, a dose or two of Cinchona may prove serviceable, particularly if the patient has suffered much from diarrhoea during the course of the disease. In others, Valeriana, Cocculus, Nux v., or Veratrum, may be better indicated. Ferrum c. in repeated doses, is often more efficacious than China, where the pulse continues very weak and frequent after the cessation of profuse hemorrhage, particularly in the case of chlorotic females, or those who have previously suffered from chlorosis. Again, when the fever has completely subsided, as also the diarrhoea, and there remains only great debility with slow, small, feeble pulse, with profuse sweating towards evening, Ruta and Sulph., in alternation, are of great utility. When debilitating sweats supervene, Cinchona should be administered, followed by Sulphur if required..Magnes. m. is useful when, in nervous subjects, general aching pains remain behind, with great weariness and weakness of the limbs, and lowness of spirits; disturbed nights; giddiness; feeling of weight and confusion in the head. Should symptoms of deranged digestion, with headache, palpitation of the heart, &c., remain after the fever has been subdued, Nux vomica, Pulsatilla, and Spigelia will be found most serviceable, according to the temperament of the individual, and the symptoms present. (See article INDIGESTION.) The other medicaments mentioned under the head referred to, may also be advantageously consulted. DIET. In a disease that presents so many varieties, it is difficult to give any rules upon this head, applicable to all cases. When a marked inflammatory character is present, the same abstinence should be enjoined as already noted under Fevers; and in all cases, either during the progress of the 94 FEVERS. disease or the period of convalescence, the greatest possible care should be taken to avoid tasking the digestive functions; the diet should be light and simple, and the patient never allowed to indulge the appetite to its full extent. PUTRID FEVER, PESTILENTIAL FEVER, OR MALIGNANT TYPHUS. Typhus putridus. Typhus abdominalis. We have already alluded to this form of the disease under Typhus, particularly in the indications given for the employment of Arsenicum, Carbo vegetabilis, ihus, Merc., &c., but consider it of sufficient importance for separate remark. This fever sometimes rages as an epidemy, but it more frequently appears in the wake of nervous fever, or the latter degenerates into the malignant type in consequence of improper general treatment, uncleanliness, or the impurity of the air by which the unfortunate patient is surrounded. Indeed, almost any fever may terminate in malignant typhus under the favoring circumstances just quoted. DIAGNOSIs. The symptoms of Nervous Fever already given, running on to the colliquative state; extreme debility, pulse exceedingly small and weak, so as to be scarcely perceptible; a peculiar sensation of burning pungent heat, communicating itself to the hand, when placed upon the body of the patient, heavy cadaverous smell of the whole body, putrid odor of the breath, perspiration, and secretions in general; profuse oily and clammy sweats; involuntary evacuations; colliquative or sanguineous diarrhoea; dark or bloody urine, epistaxis, petechise, and other marked tendencies to organic dissolution. The patient is always found lying on his back, and continually shrinks down to the foot of the bed, a sign of utter helplessness and prostration. TREATMENT. In the premonitory stage of epidemic Typhus putridus, the most appropriate remedies are those which we have enumerated under Typhus gastricus et biliosus, and at the commencement of Nervous fever (which see); but when the disease has reached the second stage, Arsenicum, Carb. v., Mere., Acid. phosph., Acid. mur., Cantharis, Rhus, &c. ARSENICUM corresponds closely to the symptoms, and is, therefore, our principal remedy when the disease TYPHUS FEVER. 95 assumes this malignant form, particularly when we find involuntary and sanguineous evacuations and tenesmus. Carbo vegetabilis may be advantageously alternated with it, when the symptoms, already given under Typhus for the exhibition of that medicine, are present; Mercurius is called for where there is great tenesmus, and when the discharge of blood is principally alvine, followed by Acid. phosph., Acid. nitr., or Cantharis, should sanguineous diarrhoea continue. (See NERvous FEVER.) CINCHONA will frequently be found useful, when the more dangerous symptoms have been in a great measure subjugated, but at the same time great weakness remains from the loss of humors; it is also useful, when the little nutriment the patient may have partaken of passes off undigested. In those cases where Arsenicum and Carbo vegetabilis fail to produce any amendment,,the employment of the Mother Tincture of Rhus (Dosis. Gtt. j. ter quaterne, vel. scepius quotidie) has, in a number of instances, been found most efficacious.* CONTAGIOUS TYPHUS, CAMP FEVER, JAIL FEVER, PETECHIAL FEVER. Typhus Contagiosus. DIAGNOSIS. The symptoms of nervous or putrid fever caused by infection or contagion. TREATMENT. The same as already given under Febris nervosa, but especially Bryon., Rhus, Ars., Secale, &c. We may here add another remedy of much value in this form of the disease, namely, Opium, indicated by coma-coma somnolentum, especially,-stertorous breathing, mouth partly open, eyes open or partially closed, loss of speech, rigidity of the limbs, smallness or intermission of the pulse, meteorismus, involuntary evacuations, or constipation. When, in addition to the above mentioned paralytic affec* Many of the remedies, along with the indications for their employment, which have been given in the preceding chapter, but more particularly the following: Ipecac., Bella., Hyoscy., Op., Nux, Camph., &c., will also be found equally appropriate in particular cases, or in certain cases of so-called putridfever-the attention of the practitioner is therefore particularly called to them in such circumstances. 96 FEVERS. tion, we find jerkings in individual limbs, we should have recourse to Hyoscyamus or Stramonium, choosing the remedy which more closely approximates to the symptoms we have given for their individual use, under Febris nervosa. ACCESSORY TREATMIENT. PROPHYLAXES, ETC. We need hardly insist upon, what every practitioner knows to be an essential auxiliary in the treatment of this affection, a constant supply of fresh and continually renewed air. PROPHYLAXES, during the prevalence of Typhus. Cool pure air, thorough ventilation, the avoidance of dark or dismal-looking apartments, into which the genial daylight does not freely penetrate; and the removal of all causes generating the disease, such as stopped sewers, all collections of decaying vegetable and animal matter; a plain wholesome diet, with moderation in the use of fermented liquors or wine, and total abstinence from spirits; the refraining from late hours, intense study, and excessive mental or corporal exertion; exercise in open situations, with proper precautions against exposure to cold or damp; and, finally, the preserving a healthy tone of mind and cheerful temper. The absurd practice of keeping the bowels constantly open by means of aperient medicines, and the use of sudorifics, cannot be too strongly reprobated; both these practices weaken the system and predispose it to the disease. Standing between a fire or open window and the bed of the patient is to be avoided, as unnecessarily increasing the risk of taking the infection. The safest plan for the physician to pursue, in epidemic or endemic typhus, or any other epidemy, &c.. is to form an aggregate of the symptoms by carefully collating those of individual sufferers, so as to present a perfect image of the existent malady, and to choose his remedies accordingly, which should be administered directly on the premonitory symptoms declaring themselves, without waiting for the further development of the disease. It may be remarked that Bryonia and Rhus cover a great number of the symptoms of typhus, as met with in this country; when, therefore, the point just mentioned has been ascertained, they may be given alternately, and will often either TYPHUS FEVER. 97 check the malady at its outset, or materially modify its virulence-in some cases, one of these remedies is of itself suffi cient, according to the leading symptoms of the reigning epidemic; in a great variety of instances, ABSENICUTI may prove a valuable' prophylaxis; but at the same time, the indications we have already given of the several medicaments, should be carefully consulted, as the same rule holds good for them all. Febris lenta nervosa. Lingering nervous fever is characterized by a predominance of fever chills and coldness over heat, little or no sweats, or only fugitive sweats; pulse variable, but generally small and quiet. The fever commonly becomes increased in the morning, or while the patient is fasting, and is attended with great depression of spirits. After a meal it generally subsides, and leaves the patient in a more cheerful mood. Headache, spasmodic sufferings, and general uneasiness are frequent attendants on this form of fever. The causes of the disease are generally attributable to those influences which exercise a debilitating effect upon the nervous system, as over-indulgence in venery, or self-abuse; the excessive loss of blood, either by artificial or natural means; protracted blenorrhcea; the weakening effects of nervous and other fevers; severe and prolonged mental and corporal exertion; care; grief, &c. The fever developes itself slowly and gradually, and continues for months without giving rise to any inflammatory appearances. The treatment must be regulated by the cause, and the nature of the symptoms. When the former is unknown, we must direct our attention carefully and minutely to the symptoms, and select a remedy in accordance therewith. When vexation, care, or debility from venereal excess, has given rise to the disease, Acid. pkosph. will rarely fail to effect a greater or less degree of improvement. The alternate employment of Arsenicum and Acid.phospk. has proved useful in some cases. When deep and concealed grief has been the exciting cause, Ignatia will, if administered early, generally succeed in arresting the disease, and will be found more or less useful in cases of long standing, proceeding from the aforesaid cause. Cinchona will prove very useful, when constitutional *7 98 FEVERS. debility, arising from the excessive loss of blood, or from prolonged self-abuse (onanism), has developed the fever. (Acid. phosph., Nvx, Sudph., Calc., may be required after China.) In cases resulting from debilitating acute diseases, Veratrum, China, Hepar, Silic., or Acid. phosph., Calc., Lachesis, and Natrum m., will usually answer best. In other cases, Ipecac., Camph., Helleb., Coccul., Merc., Plumb., Lycop., Can., Cup., Stann., may be called for INTERMITTENT FEVERS, AGUE. Febres Intermittentes. We have now to enter upon a class of fevers, differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, and the uncertainty of their duration. DIAGNOSIS. A chill or cold fit, followed by heat, and terminating by perspiration, more or less profuse; these three stages constitute a paroxysm; after which, for a certain period (the Apyrexia), the patient is generally free from suffering: These periods are generally of definite duration;-if the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian,-offorty-eight, a Tertian,-of seventy-two, a Quartan; even longer intervals have been observed between the attacks, hence the Octanse of some writers, -if two paroxysms take place within each period, the ague is said to be doubled, as a double Quotidian, or Tertian. These fevers are sometimes found existing in the simple form above noted, and at others complicated with other forms of disease, as in intermittent, catarrhal or gastric fevers. They are exceedingly indefinite in duration, and frequently assume a chronic form. An individual, once attacked with ague, is frequently liable to a return in after-life, if the disease has not been radically cured at the commencement; nay, more, any attacks of disease he may be hereafter subjected to, are peculiarly apt to assume the intermittent form. Nervous or inflammatory fever may change into an intermittent, or the latter take upon itself, if it continue, the INTERMITTENT FEVER. 99 character of either of the two former, or become remittent; this frequently happens in hot climates. Ague is rarely dangerous in this country, except when of long continuance, by the weakness it occasions and the injury, it inflicts upon the constitution; it may, however, lead to obstructions and indurations of the more important viscera, particularly of the liver and spleen, or induce dropsical affections. But in hot climates, or in low marshy countries, this disease is exceedingly fatal; and on dissection, the brain and its tissues, the mucous coat of the stomach and bowels, the lungs, and peritoneum have been found affected; in such instances, when the disease gains ground, the patient loses strength and becomes emaciated, every fresh paroxym entails an increase of suffering, and the perspiration fails to relieve; he complains of a sense of weight in the hypochondria, particularly the right, with griping pain in the bowels, flatulent distention of the abdomen, diarrhoea, or constipation, and constantthirst; or of headache, cough, and dyspncea; the tongue is furred, and dry at the tip; the skin hot, harsh, and dry; the urine scanty, the abdomen tumid, the extremities become dropsical, and sleep is restless or broken. Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important function, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifications of the symptoms will be found more in detail, under the medicaments, when we enter into the therapeutic treatment. Premonitory Symptoms. Sense of languor, or general uneasiness; yawning, headache, stupor, pains in the limbs or dorsal region, the toes and fingers becoming numb, and the nails blue. Cold Stage (Congestive Stage). Coldness of the extremities, with a feeling as of a stream of cold water running down the back, and extending itself to the chest and abdomen; general prostration of strength, insupportable coldness, external and internal tremors, chattering of the teeth, respiration 100 FEVERS. labored and hurried, with inability to draw a full inspiration, and oppression at the chest. The head is variously affected, sometimes with headache, at others with coma, stupor, or delirium; the pains noticed in the premonitory symptoms are generally present, and, in some instances, the patient complains of pain all over: the tongue is moist, the eyes are heavy and sunken, the features pinched, and the lips and cheeks livid: the rigors sometimes run on to convulsions. The pulse is weak and oppressed, sometimes slow, at others quick, and frequently intermitting, and often, from the severity of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is generally above the natural standard, while the patient complains of cold. Sometimes the patient feels only a slight degree of cold, without tremors, but accompanied with symptoms of functional derangement, and in a few hours the hot fit declares itself. The duration of the cold stage is from an hour to four hours; and it runs into the hot without any marked interval. The Hot Stage presents all the characteristics of a modified inflammatory attack, with hot, dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, region of the spleen, liver, &c.; there is also occasionally a degree of cerebral disturbance, or even delirium. The general duration of the hot fit is from four to twelve hours, when it terminates in the sweating stage; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent,-a not uncommon issue of this disease in warm climates. Sweating Stage. After the hot fit has continued a longer or shorter period, profuse perspirati6n sets in, commencing in the forehead and extremities, and quickly diffusing itself over the whole body; as soon as it makes its appearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. CAUSES. Marshy districts are noted as being the hot-beds of this malady; a continuance of fish or farinaceous diet is also apt to produce it; it may, moreover, arise from taking INTERMITTENT FEVER. 101 cold, indigestion, internal obstructions, peculiar constitutional tendency, or local irritation. The medicines should generally be administered in the apyrexia or interval between the paroxysms, but when the intervals are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside. In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. The following remedies have been found most appropriate in ordinary cases. Against MARSH FEVERS the principal remedies are, Cinchona, Arsenicum, and Ipecacuana; but the following are also useful in particular cases: Carb. v., mus, Veratrum, Natr. m., Fer., Arnica, and in some severe and very obstinate cases, Cimex lectul. Against intermittents which prevail in spring or summer, and in warm climates: Bella., Ipecac., Veratr., Caps., Arn., Zach., Calc., (inc., Slph., Bryon., Garb. v., et a., Puls., Digit., &c. Those in which COLD predominates require chiefly the following remedies: Veratr., Ipecac., Puls., Diad., Sabad., Piosph., Carbo v., Bry., Capsicum, Staph.; those with prevailing HEAT: Vux, CocC., Ign., SulmA., Ars., Acon., Bella., Bryon., Ipecac., Sabad., Valer., Verar., Silic.; and those in which sweating predominates: Cocc., Caps., China, iferc., Ars., Bryon., Nux, Samb. Intermittents which consist in SHIVERINGS, HEAT, and SWEATING (or a cold, a hot, and a sweating stage), are most frequently to be cured by Ipecac., Nux v., Ars., China, Veratr., Bella., Bryon., Caps., Cham., Puls., Rhus, &c. In those which consist in SHIVERINGS and HEAT, the principal medicines are, firstly, when the heat precedes: NVux, Caps., Calc.; secondly, when the shivering precedes: Acon., Arn., Bryon., Ccps., Carb. v., Ign.., Ipe Cic. in., Natrum m., Nux.., Puls., Ahus, Sabad., ulph., Veratr.; thirdly, when the shivering and heat precede or follow in alternation: Bella., Calc., Lycopod., Merc., Natrum m., Nux v., Sabad., Sil., Spig., Szulph., Veratr.; and fourthly, when they occur simul 102 FEVERS. taneously: Acon., Arsenic., Bella., Chain., gnatia, Ipecac., Lyc., Nux, BRheum, Rhus, Sabad., Sulph. In those which consist of HEAT and SWEATING, the most important medicaments are, when the heat is accompanied by sweating: Bella., Bryon., Caps., Chami., Cin., Hep., Ign., Merc., Nux V., Op., Puls., Rhus, Sabad.; and when the sweating sets in after the heat: Ars., China, Cin., Hep., Ign., Ipec., Puls., Bhus, Veratr. Fevers which consist only in RIGOns and SWEATING call for Lycopodium, Pulsatilla, and Sulphur principally, if the shivering and sweating are simultaneous; and Caps., Carb. V., Zycop., Natr. mi., Rhus, Sabad., Thuj., Veratr., if the sweating follows the shivering. When there is thirst before the attack: China, Ar., Puls.; -during the COLD STAGE: Ipecac., Bela., China, CarTo, Phosph., Sabadilla, Bryon., Cham., Cina, Ign., Caps., R2hus, Ars., Veratr.;-after the COLD STAGE: Sdbad., Puls., Ars., China;-after the HOT STAGE, China;-during the HOT STAGE, Chain., Puls., Rhus, Veratr., Nux v.; and when there is ADYPSIA during the HOT STAGE: Puls., Ars., Veratr., China, Nux i., Ipecac., Carb. v., Ignatia, Rhus, Sabad., are the principal remedies. In intermittent fevers, attended with somnolency during the paroxysms, Opium, Nux vomica, Tartarus emeticus, and Cocculus; or, in some instances, Bella., Hyosc., Stramon., are amongst the most important remedies. In those with apoplectic and paralytic symptoms during the paroxysm, Nux V., Cocculus, Opium, Aconitun, and, perhaps, also Arsenic. or Coffea, are chiefly indicated. Those with syncope during the paroxysms, Yeratrum album, and possibly also, Ipecac., Puls., Sulph., Sep., Lyc., Graph., &c. With respect to the TYPE of the fever: Pulsatilla, Ipecacuanaa, NVux vomica, Caps., Diadem., Calc., Sabad., may be instanced as being particularly useful in SIMPLE QUOTIDIAN fevers. Ant., Calc., Caps., Chain., Dros., Lyc., MJez., Staph., in TERTIAN; and Arsen., Acon., Lyc., Nux m., Sabad., in those of a QUARTAN type. Against DOUBLE QUOTIDIANS: China, Bella., Graph., Stram., Puls. And against DOUBLE TERTIANS: NUWX u., Arsenic., Rhus, have, principally, been recommended. INTERMITTENT FEVER. 103 Intermittent fevers which recur every year have, for the most part, been treated most successfully by means of Nux v., Arsenic., Rhus, Sulph., Lyc., Calc., Sep., &c. In reference to the period of the day at which the ague-fit generally comes on, Am., Cham., Sabad., Staph., Calc., have repeatedly cured those which appear in the morning (matutinalfevers); Ign., Sabad., Staph., Carb. v., Am., Lyc., Sep., Merc., against those which set in towards evening; and Carb. v., Cham., imerc., those which make their appearance at night (nocturnalfevers). But as has already been observed, the entire morbid picture must be taken into consideration in the selection of the remedies, and not merely a single peculiarity. Remedies which have proved useful in quartans or tertians, will, nevertheless, be found efficacious in other types, if they correspond accurately to the characteristic accompanying symptoms. The following medicaments are especially useful in intermittents presenting the train of symptoms enumerated: Cinchona, Arsenicum, Ipecacuanha, Nux vomica, Pulsatilla, Antimonium crudum, Bryonia, Veratrum album, Cocculus, Sabadilla, Ignatia, and Carbo vegetabilis, Ant. crud., Bella., Caps., Canth., Ign., Lach., Puls., Sep., Digit., Natr. m., Lyc., &c. CINCHONA. This well-known, but too frequently abused remedy, is undoubtedly of great efficacy in those fevers which owe their origin to the influence of marsh miasm, and are peculiarly prevalent at particular seasons of the year. It may be given when the fever commences with a sense of languor or general uneasiness of the heart, anxiety, headache, sneezing, great thirst, bulimy, or nausea, and pain in the bowels. It is also indicated when the fever has set in by adypsia during the cold stage-but thirst is experienced AFTER the heat, and during the sweating, or thirst between the hot and the cold stage. It is contra-indicated when thirst exists during the hot stage. Turgidity of the veins, with heat in the head, and natural warmth or increased heat of the body, with or without increased heat of the surface. Or, again, determination of blood to the head, commonly with redness and heat in the face, frequently with chilliness of all the other parts of the body, and even external coldness, or only a feeling of internal 104 FEVERS. heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indications for the employment of this medicament. In many cases, Cinchona, although not capable of effecting a radical cure, is yet of great utility as a palliative: it should, under such circumstances, be exhibited immediately before the cold stage. (Arsenicum, Carbo v., Veratr., Arnica, Sulph., Pulsatilla, or Calcarea, are often required to complete the cure after the previous employment of Cinchona.) ARSENICUM is one of the most important remedies in intermittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously,-or when we find cold shuddering alternately with heat, or a sensation of cold internally with heat, or an imperfect development of the paroxysms; or burning heat, as if molten lead were coursing through the veins, communicating an unpleasant sensation of heat (calor mordax) to the hand, when placed upon the body of the patient; great restlessness; excessive, almost insatiable thirst, obliging the sufferer to drink constantly, although but a little at a time; depression, markedprostration of strength and anxiety; nausea, desire to vomit, retching, and even vomiting; severe and burning pains in the stomach, and insupportable pains all over the body, especially in the limbs. One marked characteristic of Arsenicum is, that all the sufferings of the patient, pains in the limbs, &c., increase in intensity during the paroxysms, and others develop themselves; another is its marked periodicity, usually either Tertian or Quartan, and the rigors generally setting in towards evening. It is therefore called for in these cases, where we meet with a well-marked periodicity of imperfectly developed paroxysms, with some or any of the symptoms above mentioned. A few globules of this medicament, given during the apyrexia, will be generally found a sufficient dose; however, in some cases, when the vital energies of the patient seem too weak to rally, and the cold fit continues, two drops of the tincture may be added to an ounce of water, and a dessert-spoonful given every four or two hours, or every quarter of an hour, according to the exigency of the case. Such cases are INTERMITTENT FEVER. 105 happily rare in this country, but we have thought it advisable to touch upon the means to be employed when they do occur; in such instances Yeratrum (which see) is also occasionally useful. IPECACUANHA. This remedy has been found more or less useful in most cases of marsh fever, and although not always competent to effect the entire removal of the complaint, yet, when administered at the commencement, it is often of considerable benefit, and in many instances, when judiciously selected, is alone sufficient to perform a cure. Striking benefit has frequently been derived from its employment with Nux v., by giving three to four doses of Ipecac., at equal intervals during the apyrexia; then Nux v., one dose, in the succeeding apyrexia. Either of these remedies is sometimes alone sufficient to shorten the duration of the disease; the indications for IPECACUANHA are as follows: much shivering with but little heat or vice versa; increase of the shivering by external warmth; oppression at the precordial region; adypsia, or at least, little thirst; dryness of the mouth, nausea, vomiting, and other symptoms of deranged digestion. For Nux vOMICA: Excessive weakness at the commencement of the fever; the horripilation mixed with or immediately followed by heat; warmth of the cheeks, with internal chilliness; feeling of heat in the face, with horripilation in the remaining parts of the body; heat in the head with coldness of the body; burning pain in the eyes; or, giddiness, with feeling in the head as if from intoxication, desire to lie down, with trembling of the limbs, syncope, or a sensation of paralytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet, difficulty of breathing, palpitation of the heart, anxiety, irascibility, fear of death, and even violent delirium. (Febris intermittens apoplectica so called); gastric derangements, such as anorexia; dislike to bread; bitter and sour eructations, tension of the abdomen, or spasm of the abdominal muscles, and constipation; burning itching miliary eruption, and burning itching sensations over the whole body. During thefever: coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration; occasionally 106 FEVERS. stitches in the side, shooting pains in the abdomen, aching in back and limbs, and dragging pain in abdomen during the rigors. During the hot fit particularly:-headache, buzzing in the ears, heat in the head, or face, with redness of the cheeks and thirst. Bryonia, Verat., Puls., Cocc., Bella., also deserve attention in intermittent fevers accompanied by constipation. PULSATILLA, like the two remedies last mentioned, and also Antimonium crudum, Bryonia, and Ignatia, is an excellent remedy in agues complicated with gastric or bilious symptoms, whenever the slightest dyspeptic attack brings on a relapse. Its more peculiar indications are: vomiting of mucus at the commencement of the cold stage; adypsia, all through the fever,-or thirst, only during the hot fit; simultaneous heat and shivering-aggravated in the afternoon or towards evening; shivering when uncovered; anxiety and oppression of the chest during the shivering. During the hot stage: redness and swelling of the face, or redness of the cheeks only, and perspiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indications for its employment. ANTIMONIUM CRUDUM. The indications for this remedy closely resemble those of Pulsatilla, but it is particularly called for when the perspiration breaks out simultaneously with the accesses of heat, and then suddenly disappears, leaving the skin dry and hot. It may be exhibited in the same manner as Pulsatilla. CINA is of great efficacy in quotidian agues, which are ushered in by vomiting of ingesta, followed by bulimy; as also when the cold stage is attended with thirst. BRYONIA is indicated by headache and vertigo, with dry heat preceding the attacks of shivering; by the predominance of cold or shivering, with redness of the cheeks, heat in the head, and headache; or marked heat followed by shivering; by stitches in the side, excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting and constipation. VERATRUM ALBUM is indicated by the predominance of external coldness, with heat internally, cold clammy perspiration, especially on the forehead, or general coldness of the INTERMITTENT FEVER. 107 body; or by shivering, followed by heat and perspiration, and then relapsing into shivering; coldness, great thirst, deepcolored urine, diarrhoea with griping, or constipation, sometimes nausea or vomiting and vertigo, and pains in the dorsal and lumbar regions. Tart. e2net. has also been recommended in such cases, and especially when the nervous system becomes prominently affected, as indicated by sopor, insensibility, with coldness of the extremities, 'rigidity of the whole body,, or twitchings of the muscles of the face and limbs, and almost imperceptible pulse. BELLADONNA. Severe headache, with giddiness, or heat and redness of the face, pulsation of the carotids, and excessive exacerbation of pain from meditation; partial shivering and shuddering, with heat in other parts; great heat, with slight shivering; or violent shivering with moderate heat; adypsia, or, on the contrary, intense thirst; extreme susceptibility, tearfulness, or depression of spirits, and desire for death, particularly when the sufferings are at their height. CoccuLUs may be employed when, in addition to the usual symptoms of Ague, we find, during the apyrexia, symptoms of spasmodic affections, particularly of the stomach and abdomen, such as cramp-like pains at the epigastrium, or constrictive 'pinching, or tearing, burning, colic-like pains in the hypogastrium. SABADILLA has been found useful in cases where the attacks return always at the same hour, with chills of short duration, then thirst followed by heat; also, where thirst is present just at the close of the cold stage, and in such affections as consist entirely of chills. IGNATIA is indicated when, with heat of some parts of the body, there is coldness, chill, and shuddering of others; also where the heat is only external. Its best characteristic is, when the chills are easily relieved by external warmth, and attended with thirst. OPIUMn has chiefly been recommended infebris intermittens soporosa, with stertor, convulsive movements in the limbs and suppressed evacuations. Tartarus emeticus may, however, be found more generally appropriate in cases of this description. NVux., Cocc., Bella., fHyosc., Stramon., and Cham., are likewise worthy of attention here. 108 FEVERS. NATRUM M. Ague fits commencing with headache, general aching pains; predominant or prolonged shivering; great thirst during the hot fit, and nearly to the same extent during the cold stage; also dryness of the mouth and tongue; tenderness of the scrobiculus to the touch; bitter taste and loss of appetite; debility, sallow complexion; soreness of the corners of the mouth (sequele of the abuse of Cinchona bark, or of Quinine). CARBO VEGETABILIS is particularly indicated, when throbbing at the temples, aching in the teeth and in the bones of the extremities, and the coldness of the feet precede the paroyysm; when thirst is present only during the shivering; and there are rheumatic pains in the teeth or limbs before or during the attack, or nausea, giddiness, and redness of the face during the hot fit; further, when an intense burning pain, occupying the right frontal protuberance and the orbit, accompanies the fever. CAPSICUM. Excessive thirst during the cold stage; predominating cold, followed by burning heat; accumulation of mucus in the mouth and throat, or vomiting of mucus; diarrhoea; slimy and burning stools; headache, restlessness, sensibility to noise; ill-humor, anxiety, and giddiness, which iicrease during the cold stage; aching pains in the back and limbs; painful swellings of the spleen (after the abuse of China). When the hot fit continues long without perspiration supervening, and the intermittent fever threatens to become remittent or inflammatory, we must have immediate recourse to ACONITE, of which we may give two globules, and if no relief follows in three or four hours, add six globules to an ounce of water, and administer a dessert-spoonful every hour until perspiration sets in, or the pulse is reduced. In intermittent fevers of various types, which become developed after a thorough wetting, RHUS TOXICODENDRON is of great use; and in those which are accompanied by very copious and sour, or otherwise offensive smelling sweat, with palpitation of the heart; mixed heat and shivering, anguish and thirst during the hot stage, Mercurius does good. Agues which have become altered in character, and rendered much complicated by the abuse of Cinchona in large and long-continued doses, are in general very difficult to cure. The follow INTERMITTENT FEVER. 109 ing remedies have been employed with more or less success in such cases: Belladonna, Ipecac., Yeratr., Arsenic., Arnica, Bryonia, Caps., Pulsatilla, Natr. m., Stuph., Sep., 3alc., Carb. v., Merc., Cina, Nux, Lach., Hell., Fer. Against oedema of the feet and hydrops abdominis, arising from a similar cause, Bry., Helleb., Arsen., Acid. hydr., may be found of great service. Inveterate intermittents, occurring in bad habits of body, are most likely to be relieved by such medicaments as the following: Sulph., Calc., Lycopod., Sepia, Calc. sulph., Carbo v., Hepar s., irnex lent., Natr. mn., Mez., etc. The preceding are the medicines that have been found useful in ordinary cases of this affection; but, as it is frequently found complicated with other complaints, it has only been found practicable to give a general statement of the course to be pursued when the disease occurs in its more simple forms, and merely to allude to the others-there being scarcely a disease known, that may not assume the intermittent type, as there is scarcely a proved medicine that does not also partake of the same character. All the author has endeavored to do, in the preceding pages, is to give a clear idea of the treatment of ague, commonly so called, as frequently met with; as he feels it would be vain to attempt to enter upon the many various forms and appearances which this malady presents. Besides the above-mentioned medicines, the following have been used with great success: Chinin. sulph., Eupator., Lobelia, Podophyllum. RAPHANIA. M-iorbus cerealis, Consulsio cerealis. Eclampsia typhoides. The term Raphania has been given to this disease from its being said to be produced by eating a species of radish. A residence in damp, ill-ventilated dwellings, combined with insufficient, indigestible, or otherwise unwholesome food, seems, however to be the general predisposing cause. Most authors have divided it into two forms, the acute and chronic. The acute variety is of the severest and most dangerous character, and though not so frequently ushered in by pre 110 FEVERS. monitory symptoms as the chronic form, is yet occasionally preceded by indications of considerable gastric and nervous disturbance, such as, moist, foul tongue, insipid nauseous taste, eructation, inclination to vomit, spasm of the stomach, vomiting of dark or blackish brown-colored bile; confusion in the head, giddiness, tremor, and slight creeping sensations (formication) of the limbs, etc. The disease itself commences with cold chills and lassitude, headache, and praecordial anxiety. These symptoms are succeeded by burning heat, intense, almost insatiable thirst, violent fever, delirium, feeling of suffocation, frequently attended with spasmodic palpitation of the heart, convulsions of various kinds, which latterly terminate in frightful tonic spasms. The cutaneous transpiration is either suppressed or the skin is covered with a cold clammy sweat, and the countenance wears an expression somewhat similar to that in febris nervosa stupida. After a few days the nervous state assumes a putrid type, the vital powers begin to sink, the spirits become extremely depressed, the face pale, the features distorted, the hearing obtuse, and stupor with fits of fainting supervene. At length the pulse becomes almost imperceptible, purple exanthemata break out, or rigidity of all the joints, or tabes, succeeds; and finally, dry gangrene sometimes sets in, affecting either the fingers and toes alone, or entire limbs. The chronic variety is chiefly distinguished from the acute, by its marked exacerbations, paroxysms, remissions, and longer duration. It is, moreover, oftener introduced by premonitory symptoms, which generally partake of the following character: general languor, a distressing feeling of chilliness in the abdomen, back, and extremities; anxiety, headache, disturbed sleep, frightful dreams, rending, aching pains in the joints, and sensation of crawling in the extremities. Along with these, there are various signs of gastric derangement, such as eructation, pyrosis, nausea, vomiting of viscous mucus, gastrodynia, etc. When the paroxysm itself comes on, the creeping and painful sensations in the extremities increase in severity. Spasmodic contractions in various parts take place at the same time, the fingers being bent backwards, the eyes convulsed, and the pupils contracted; the patient is seized with tremor, contorts the limbs in different directions, RAPHANIA. 111 stammers in his speech, and speaks feebly and incomprehensibly. Constipation is an occasional concomitant symptom, as also colic, hiccough, asthmatic sufferings, and even epistaxis and hemoptysis. In other cases diarrhoea with discharge of worms, and vomiting take place. When the attack is of a protracted nature, the clonic become converted into tonic spasms. The duration of the paroxysm varies from one to several hours. The recurrences take place at least once a day, and commonly end in a fit of copious sweating followed by sleep, and subsequent insensibility of the affected limbs. The patients are not wholly exempt from abnormal conditions during the remissions, experiencing great languor, numbness of the extremities, especially of the fingers and toes. The skin becomes bluish, corrugated, and deprived of its sensibility; or colliquative sweats, petechia, and the other morbid states enumerated under the acute variety, succeed and put a period to the mournful scene. THERAPEUTICS. Hahnemann was the first to recommend the employment of Solanum nigrum in this serious malady, and the opinion which he formed of its specific property, both in the acute and chronic forms of the malady, was amply confirmed by the successful result of subsequent trials. Secale cornutum has also been favorably spoken of by some writers. The following remedies have, moreover, been mentioned as likely to prove useful in particular cases: Belladonna, Rhus, Hyoscyamus, Stramonium, Aconitum, Arsenicum, Ignatia, Cina, Cuprum aceticum, Cinchona. BELLADONNA, when there is burning, heat of the skin, excessive thirst, trembling of the limbs, slight convulsions, contracted, immovable pupils, mnscae volitantes. Rhus, when the nervous appearances form a prominent feature of the disease, and the symptoms approximate to those of a febris nervosa stupida. Hyoscyamus and Stramonium correspond better than the foregoing to the convulsions, the former particularly to those which come on in the earlier stage of the disorder, and the latter to those of a more violent character, such as occur at a later period, and in the severer forms of the affection. ARSENICUM may be of service in chronic cases attended with 112 FEVERS. anxious and oppressive respiration, spasmodic palpitation of the heart, quick, nervous, small, and occasionally intermittent pulse, foul, brown-coated tongue, extreme prostration of strength. Ignatia amara is well adapted to, and has proved useful in some of the milder chronic forms of the complaint,* more especially when the convulsive movements resembled those which are met with in St. Vitus's dance. Cina,spasmodic sufferings chiefly confined to the addomen, vomiting, with discharge of worms. Cuprum aceticum afforded signal service in a species of Raphania chronica, in which the convulsions increased in intensity at every succeeding paroxysm.t THE PLAGUE. Pestis. Pestis bubonico. TypAus pestilentialis. The term Plague is employed to designate a malignant disease which frequently prevails on the coast of the Levant, and which appeared in this country about 200 years ago. It is characterized by highly contagious typhus fever, buboes and carbuncles which have a strong tendency, to take on a gangrenous character, petechike, hemorrhage, colliquative diarrhoea, and prostration of strength. Most authors who have written on the subject consider the plague to be a pestilential contagion, which is propagated almost solely by contact, either with a diseased person, or with porous substances, such as wool and woollen cloths, which have absorbed and retained the specific poison; but it would seem that it occasionally prevails also as an epidemic disease. No certain statements have yet been made as to how long an individual who has been affected with the disease is capable of communicating it to others, nor how long the contagion may adhere to a non-susceptible person without developing the disease in the said party, and may yet be communicated, and the malady produced in habits more susceptible to its influence. It has, however, been observed, that the disease generally appears so soon as the fourth or fifth day after infection. Sometimes premonitory symptoms, in the form of slight * See HARTMANN'S Acute and Chronic Diseases, translated by Charles J. Hempel, M.D., in 4 vols. f Ibid. THE PLAGUE. 11l headache, and some degree of languor, are experienced by the patient, for many days previous to the outbreak of the disease; but it more frequently happens that great depression of strength, anxiety, palpitation of the heart, fainting, giddiness, violent headache, delirium, and stupor, together with a weak and irregular pulse, very soon supervene. Nausea, and vomiting of a dark bilious substance are shortly superadded; and, as the disease proceeds on its course, buboes form in the axillary, parotid, cervical, maxillary, and inguinal glands; carbuncles also arise, or petechie make their appearance; or hemorrhages and a colliquative diarrhoea ensue. The disease is always regarded as serious and pregnant with danger when it presents itself in a severe form. Much appears to depend upon the particular character of the epidemy. When accompanied by buboes, it is commonly less fatal than when unattended by these inflammations. The invasion of healthy suppuration in the buboes is always held as critical, and conducive to -recovery. The breaking out of a gentle perspiration has also been known to prove critical. Petechie, hemorrhages, colliquative diarrhoea, and a tendency to gangrenous degeneration of the carbuncles of buboes, have hitherto been regarded as positive indications of a fatal termination. THERAPEUTICS. We are not aware of any detailed homceopathic writings on the treatment of plague, and presume that no homceopathic practitioner has as yet had an opportunity of treating the disease. We have every reason to believe, however, that this frightful malady will in time be found perfectly tractable under homoeopathic treatment, and thereby bereft of much of the terror which its invasion inspires in those parts where it so frequently and so destructively rages. The following remedies may be named as likely to prove more or less useful: Arsenicum, Lachesis, Cinchona; Carbo v. et a., Veratrum, Rhus toxicodendron, Merc., Acidum nitr., Kreosotum, and Silicea. The leading indications for these remedies against the typhoid fever, will be found in the chapter on Nervous fever, to which, therefore, we beg to refer our readers. ARSENICUM, in addition to being appropriate to the fever, is, 8 114 FEVERS. moreover, either alone or in alternation with Veratrum, well adapted to the excessively irritable state of the stomach, with rejection of everything that is partaken of, or vomiting of blackish bilious matter, the great prostration, and the colliquative diarrhcea, which so frequently accompany the disease. It is, further, well calculated to be of essential service in warding off a tendency to gangrenous degeneration when carbuncles arise, and may even prevent a fatal issue when gangrene has already commenced. In the latter case, Lachesis and Cinchona are also capable of being of some service, and may, perhaps, be advantageously given in rapid alternation with Arsenicum. When buboes form, and threaten to become indurated, although they do not assume a livid appearance, after the employment of Arsenicum, Veratrum, or any of the other remedies which may have been called for by the typhoid fever, such as Rhus, Cinchona, or Zachesis,-Mercurius may be useful, particularly when the parotid glands are affected, and the region of the liver is much distended. Acidum nitricum, Carbo v., or Silicea may be required after Mlere. When the integuments over the buboes present a purple or livid aspect, or when the buboes suppurate and discharge, but instead of showing a disposition to heal, exhibit a gangrenous tendency,-Silicea may possibly succeed in bringing about a healthy action; but Lachesis, Arsenicum, and China may claim a preference even here, provided they are better indicated by the entire morbid picture. When petechi~e break out, Arsenicum and Rhus will deserve the.most attention. When there is colliquative diarrhoea, Arsen., Veratr., and China. When debilitating, sanguineous, alvine evacuations take place, Acid. nitr., Rhus, Arsenicum, China, and KTreosotum. And when excessive epistaxis results, Cinchona and Jihus; or perhaps Sulph., Calc., or Heyar s. It is probable that Acid. hydrojod., Acid.phosph., Phosph., Bryon., Bella., Hyosc., Lycopod., Spirit nitr., &c., may also be worthy of notice in the treatment of plague. REMITTENT FEVER. 115 REMITTENT FEVER. YELLOW FEVER. Febrisflava. iTyphus icterodes. This fever is a disease of warm climates, and has obtained the name of yellow fever from the hue which the skin of those affected by it very frequently acquires. The more constant symptoms of the disease are: violent vomiting, first of bilious and subsequently of brownish black matter, which is also passed by stool; great anxiety and prostration, intense fever. Remarkable remissions take place in the course of the fever, succeeded in a few hours by exacerbations. The outbreak of the malady is generally preceded by sudden debility and restlessness, which are soon followed by headache, giddiness, faintness, and slight chilliness, to which are added prnecordial oppression, want of appetite, and deranged digestion. In other cases, the seizure is sudden and unattended with premonitory symptoms, and the course of the disease exceedingly rapid, and a fatal termination not unfrequent within thirtysix hours from the accession of the attack. The more usual form which the disease takes is, however, as follows: Immediately after the fit of chilliness and horror, violent reaction sets in, announced by a high degree of fever, with great heat of skin, strong throbbing of all the arteries of the body, and determination of blood to the head. The respiration is hurried and often laborious, attended with deep sighing and gasping for air. The face is flushed, the eyes heavy, sensitive to light, and affected with burning pains; the tongue white, furred, and sometimes red, but soon becomes parched and dark-colored, and tinged with yellow after the vomitings come on; the thirst is excessive. A burning pain is sometimes experienced in the scrobiculus; an excessive sensibility to the touch in the right hypochondrium; and the stomach, irritable from the first, is rendered so much so as the disease advances, that everything which is taken into it is almost immediately rejected, along with a quantity of bilious matter. Severe darting pains traverse the head, the small of the back, and even extend down the thighs. The pulse is subject to variations, being in some cases quick and strong, in others quick, low and irregular; in plethoric individuals, who have not been long exposed to the relaxing effects of the warm climate, it is ac 116 FEVERS. celerated, full, and bounding, for some hours after the development of the reaction; the urine is suppressed, or scanty and offensive; the stools have likewise a most disagreeable fetor; the patient is excessively restless, tormented with spasms in the abdomen and legs, and tosses about with anguish. These symptoms constitute the first or inflammatory stage of the fever, and may continue from twenty-four to sixty hours and upwards, according to the severity or mildness of the attack. The second stage commences with the abatement of several of the preceding symptoms, and the increase or substitution of others. The skin and eyes present a yellow tinge; the head is confused, or delirium supervenes, and the eyes look glassy. The fits of vomiting are more violent, and the matter ejected becomes thicker and darker; the patient occasionally drops asleep, but instantly awakes in a fright, and sometimes he springs out of bed in a state of furious delirium, but instantly sinks to the ground in a state of tremor and exhaustion; the pulse flags, but is sometimes soft, at others high; the tongue is generally parched, harsh, and discolored, but sometimes moist and covered with a dark fur; there is frequent hiccough, and the skin is soft and clammy. The duration of this stage is also variable; rarely if ever longer than fortyeight hours, sometimes only twelve. The first and second stages terminate by a remission of the more alarming symptoms, and a hope of recovery is entertained, but it is too often doomed to disappointment by insidious degeneration of the disease into the third stage, in which the pulse sinks, becomes irregular and intermittent, yet sometimes increases in frequency; the vomiting becomes incessant, and is attended with great straining and noise, from the violent belching of flatus; the matter vomited is grumous, resembling coffee-grounds, and is named the black vomit. The breathing becomes more labored; the tongue black, or shrunk dry and red; the eyes hollow and sunk, and the features shortened. A gradual aggravation of the symptoms then ensues, attended with startings or twitchings of the tendons, the limbs become deadly cold, and the hiccough distressingly constant. llemorrhage, or oozing of blood takes place from different parts of the body; the urine is deep-colored, the stools black or sanguineous; the abdomen often tense and tympanitic; vibices make their HECTIC FEVER. 117 appearance, and death slowly or suddenly terminates the scene. THERAPEUTICS. From the scantiness of the information which is at present to be gleaned from homoeopathic authors respecting the treatment of the disease, we are, in the absence of any personal experience, precluded from giving even a brief sketch of the characteristic indications for the employment of the appropriate remedies. Under such circumstances we can but simply offer a list of those medicaments which will, in all probability, be found of the greatest value in remittent fevers. They are chiefly as follows:-- Aconitum and Bella., (in the inflammatory stage,) NVux v., Bryonia, Pulsatilla, Digitalis, Crotalus, China, Lachesis, Rhus, Arsenicum, VTeratrum, Carbo v., (the three last-named particularly in the third stage, but also in the second, in malignant cases,) and perhaps also Arnica, Armon. m., Sulph., and especially Guaco. When the disease partakes of the character of a highly congestive or malignant typhus, which it would appear to be prone to do when it occurs in situations where the marsh miasm is unusually concentrated, or where its effects are aggravated by the depressing influences of unhealthy locality, damp, ill-ventilated, crowded dwellings, together with deficient or unwholesome nutriment, the same medicaments that we have given in the chapter on Nervous Fever (which see) may be resorted to. (See also art. Cholera, where, as well as in that on Nervous Fever, a few of the leading indications for Ars., Veratr., Carb. v., in some of the forms of this disease, will be met with.) HECTIC FEVER. Febris hectica. Hectic fever, properly so called, may be defined to be febrile symptoms occurring in the course of, and depending on the existence of some internal or local chronic disease. It usually commences slowly and insidiously, the only symptoms which present themselves, for some months, being lassitude after a short walk, or any trivial corporeal exertion, failure of appetite, and emaciation. Subsequently, the debility becomes excessive; the blood forsakes*the skin, which accord 118 FEVERS. ingly looks pale, except the cheeks, which display what has been denominated the hectic flusl; the appetite, impaired from the first, grows more and more fastidious, and the stomach becomes extremely irritable, frequently rejecting all the aliment introduced, the pulse quick and weak, the artery giving from ninety to a hundred and twenty strokes in a minute, even at the incipient stage of the fever, and sweating takes place spontaneously at night in bed, but is, moreover, at all times readily excited by any exertion. Diarrhoea sets in during the course of the disease in a large number of cases, and the discharge from the bowels is always exceedingly offensive. The breathing is anxious, the patient commonly very restless, and often complains of pains bearing a resemblance to those of rheumatism. The disease is subject to exacerbations, and from the circumstance that each paroxysm begins with chilliness, followed by reaction, which is soon succeeded in turn by copious perspirations, it has been mistaken for intermittent fever; but the history of the case, together with the appearance of the patient, the greater irregularity of the different stages, and the almost unremitting quickness of the pulse, sufficiently distinguish the hectic fever. THERAPEUTICS. As hectic fever rests upon a morbid state of some portion or structure of the body, the treatment must be directed to the cure, or, if incurable, the removal, where practicable, of the part diseased. It frequently happens, however, that the source of all the mischief is involved in impenetrable obscurity, and we are compelled to attack the disorder solely as it is manifested by its symptoms. Here, as in many other similar instances, it is, that the homceopathist possesses such unequivocal advantage over the allopathist; for, by dint of a faithful collation of every symptom, from the most important to the apparently most trivial, he is generally enabled (where the affection is not already beyond the reach of art), by assiduously consulting his -Materia Medica, and comparing the pathogenetic symptoms therein detailed with those of the disease, to select a remedy specific to the case. It is of unquestionable advantage to the homceopathist, however, to pay due regard to the actual cause of the disease where that is discoverable, as by so doing he will materially facilitate his search after the appropriate remedy. HECTIC FEVER. 119 The following remedies have repeatedly proved efficacious, and in other instances been strongly recommended in hectic fevers. First, in hectic fevers, with internal or local affections, such as chronic inflammations,-particularly of the mucous membrane of the stomach and bowels,-extensive suppurations, etc.: Phosphorus, Acid. phosph., Sulphur, Cale., Acid. nitr., Lachesis, Merc., Arsenicum, China, Bella., Puls., Sanguin. canad., Cham., Ipecac., Colocynth, Secale c., Ant., Scilla, Nux v., Hepar s., Silicea, Lycopodium. Second, against those arising from excessive depletion from loss of blood, immoderate indulgence in venery, &c.: China, Acid. phosph., Nux v., Sulphur, Calc., Staph., Lachesis, Cin., Artemisia absinthium, Carb. v., Con., Arnica, Anacard., Natrum m., Cocculus, Merc., Sepia, Nux moschata. Third, those proceeding from the effects of severe acute diseases, such as typhoid fevers, cholera, scarlatina, measles, &c.: Cocculus, Belladonna, Hyoscyamnus, Helleborus n., and Acid. phosph.; or, Pulsatilla, Sulphur, Arsenicum, Veratrum, Ohina, &c., Fourth, those which have been developed by depressing emotions: Acid. phosph., Staphysagria; or, 4gnatia, Lachesis, Mere., and Hyoscyamus, Arsenicum, or Graphites. In so-called nervous hectic fevers (slow nervous fevers): Arsenicum, China, Merc., Cocculus, Nux., Phosph. ac., Staph., and Veratrum have chiefly been recommended. And in hectic fevers,ý proceeding from dyscrasia, such as scrofula, &c., or from disease of the brain, liver, or lungs, or else from the suppression of habitual discharges, normal or morbid, see the treatment pointed out for these affections in their respective chapters. The following characteristic indications for a few of the leading remedies may here be given, but in all where the symptoms are multifarious, or where no real cause for the disease can be traced, reference must be made to the Materia Medica. Pospionus, when we encounter colliquative diarrhea; colliquative, clammy, nocturnal; chilliness and shivering towards evening, succeeded by dry heat; emaciation; extreme lassitude; shortness of and laborious respiration. SILICEA, which is often very efficacious after Phosphorus, and sometimes in alternation with Phosphorus, Sulphur, and Calcarea, is especially called for where there is great 120 FEVERS. weakness, particularly of the joints; paleness of the surface, emaciation; anorexia; short, anxious respiration, febrile heat towards evening, or in the morning. SULPHUR. Dryness and paleness of the skin during the day, when at rest, with night sweats or perspiration towards morning or after any exertion; hectic flushes on the cheeks (especially the left cheek) and feverish heat in the evening; thirst; dry, or relaxed and slimy motions; palpitation of the heart; short, oppressed respiration. CALOAREA. Dryness and flabbiness of the skin; great emaciation and debility; constant heat of the skin with little thirst; or frequent flushes of heat, with anxiety and palpitation of the heart; or continued chilliness, but particularly in the evening, with redness of the cheeks; apathy; extreme dejection after speaking; perspiration after the slightest exertion, or spontaneously during the night; anorexia, weak and sluggish digestion; great anxiety and uneasiness respecting the state of the health. ARSENICUM. Excessive emaciation, with great debility; dry, burning heat of skin; thirst, with inclination to drink frequently, but in small quantities at a time; palpitation of the heart; restless, unrefreshing sleep, frequently disturbed by sudden jerks and starts; constant desire for the reclining posture; anorexia, with impaired digestion; vomiting of all food; irritability of temper, and fastidiousness. CINCHONA. Dryness and laxness of the cutaneous surface; sunken cheeks; paleness of the face; dryness and looseness of the skin; but tendency to perspire after the most trivial exertion, and spontaneous sweating at night; anorexia, with desire for delicacies only, or excessive hunger and voracity, with weakness of digestion, indicated by uneasiness, distension of the abdomen, and other derangements after partaking of food, diarrhoea, sometimes with ingesta; sleeplessness, or restless unrefreshing sleep, with anxious dreams; great apathy, ill-humour. CoccULUs. Great debility, with tendency to break out into perspiration after the slightest exertion, attended by dejection and trembling; frequent flushes of heat, especially at the cheeks; dryness of the mouth and tongue; anorexia; nausea after eating, and at other times; oppression at the chest, with MUCOUS FEVER. 121 ebullition of the blood, and anxious respiration; sleep disturbed by disagreeable dreams and frequent sudden starts; extreme depression of spirits; mildness of temper. (Pulsatilla, Sulphur, and Calcarea are sometimes required after, or in alternation with Cocculus.) IPECACUANHA is, occasionally, of considerable utility in alternation with Arsenicum, or Nux v., or as an intermediate remedy during the employment of other remedies, when the following symptoms predominate: anorexia, with desire for dainties exclusively; nausea after every meal, and sometimes vomiting of the contents of the stomach; dry heat, particularly in the evening, accompanied with thirst; great restlessness, burning in the palms of the hands, and nocturnal sweats; apathy; indifference; shortness of breath after the slightest exertion. NKux VOMICA. Want of appetite, with bitter or sour eructations after a meal, or vomiting of ingesta great debility; perspiration excited by any slight exertion, or coming on spontaneously early in the morning; paleness or sallowness of the face; partial heat; coldness and shivering, with pains in the back and loins; constipation; or constipation alternately with diarrhoea; desire for the recumbent posture; dread of the open air: ill-humor. The diet should be light and of easy digestion; and regular hours, with gentle exercise, ought to be enjoined. MUCOUS FEVER. Febris pituitosa. Febris mucosa. This is a form of continued fever which chiefly attacks persons of lymphatic temperament; is characterized by irritation of the gastro-enteric mucous membrane, with excessive secretion of mucous from this, and sometimes from the other mucous membranes. The premonitory symptoms, which, for the most part, precede the attack for a considerable period, consist in loss of appetite, insipid taste, or even complete loss of taste, moist, slimy, white furred tongue, nausea, fulness in the epigastric region, irregular stools, paleness of face, languor, &c. These symptoms rarely create any serious feelings, uneasiness or anxiety, particularly as the patient has occasional intermissions of somewhat improved health. As the 122 FEVERS. disorder progresses, vomiting of a tasteless white mucus supervenes, the stomach becomes deranged and distressingly distended after the smallest quantity of food; the tongue, which was previously uniformly white, and coated with mucus, is now free of mucus at the tip and margins, and of a somewhat dark red color, which indicates the tendency to typhoid degeneration. Sometimes, however, the tongue remains white though it becomes dry, throughout the entire course of the disease, especially towards evening: the taste is disagreeable, the mouth and fauces are besmeared with mucus, and in the morning the patient hawks up and even vomits a white tenacious mucus. Costiveness or constipation is generally present; though when the affection extends, the bowels are opened several times a day, accompanied with borborygmus and griping, the stools consisting of white, bilious, stringy mucus mixed with ingesta, and sometimes fragments of worms; the urine is straw-colored and turbid, and deposits a mucous sediment. The fever is at first marked with remissions, but these subsequently become imperceptible; the pulse is rather soft and weak, seldom frequent; thirst and sweat generally moderate; there is considerable prostration of strength; drowsiness, pressive aching frontal pains, restless nights, dull lustreless eyes and an indifferent, indolent, morose disposition are almost always in existence. The duration of the disease varies considerably. In favorable cases it runs its course in fourteen days. SRecovery is generally preceded by the breaking out of a gentle sweat; or a profuse discharge of straw-coloured urine, which deposits a thick sediment; or it is ushered in by a gentle sleep. When the disease terminates fatally, it is either from the formation of aphtha which extend over the mucous lining of the alimentary canal and bronchial tubes, and become gangrenous, or in consequence of the repercussion, or non-appearance of miliaria, or through paralysis of the abdominal nervous system, with meteorismus, involuntary putrid-smelling stools, and small, weak, and trembling pulse; or from superadded paralysis of the brain. THERAPEUTICS.-In the treatment of this disorder it is of great importance to check it by means of appropriate remedies at the commencement of the attack, before the complete development of the fever, as by so doing we are thereby fre MUCOUS FEVEIR. 123 quently enabled to arrest it with facility; whereas, when the disease is allowed to attain a more advanced stage it assumes a most obstinate character, and is with difficulty conducted to a happy termination. The principal remedies which have been recommended in the first or premonitory stage (status pituitosus) are Pulsatilla, Nux vomica, Ipecacuanha (the leading indications for which, will be found under DERANGEMENT OF THE STOMACH and DYSPEPSIA, which see,)-Ammonium muriaticum, Miercurius, Dulcamara, Ignatia, Staphysagria. AMMONIUM M. is chiefly indicated by the following symptoms: tongue coated with whitish mucus, incessant clearing of the throat in order to rid it of an accumulation of tenacious mucus; disagreeable taste, with flow of limpid fluid into the mouth, nausea, aversion to food, eructation, risings of a sourishbitter watery fluid, sensation of vacuity and hunger in the stomach, uneasiness or qualmishness, and warmth or heat in the stomach, evacuation of tenacious slimy stools, &c. DULCAMARA is particularly recommended when the attack has been excited by exposure to cold, and the disorder is manifested by insipid or soapy taste, great thirst, dryness of the tongue, increased secretion of saliva, disinclination for food, dirty white coating on the tongue. IGNATIA frequently proves of much efficacy at the commencement of the disorder, when the feelings of the patient vary considerably; when there is great disinclination to exertion and desire to retain the recumbent posture; when there is headache, with a feeling of weight and pressure in the sinciput, pain in the scrobiculus, and alternate paleness and redness of the face; dry, cracked, or chapped lips, white tongue, insipid or disagreeable taste, disgust at food and drink, and bitter regurgitations; further, when there are frequent, white, slimy stools accompanied by sudden general flushes of heat, with small, accelerated pulse. MEERcOIUS is one of the most important medicaments in the treatment of this disease, both in its incipient and in its more developed form. It corresponds especially when, along with increasing loss of appetite, the tongue is coated with a white fur, and covered with mucus; the act of swallowing is accompanied by a painful feeling of dryness in the throat and gullet, the taste putrid, and the breath offensive; further, when there 124 FEVERS. is nausea, with tearing burning pains in the temples, pressive aching or weight and tension in the scrobiculus, stomach, and region of the liver; risings into the mouth consisting of an acrid fluid; cloudy slimy urine, with deposition of sediment; irregular alvine evacuations, with frequent inclination for stool; pale, earthy, yellow face; great debility; inanimate, indolent disposition. The characteristic indications are, thick, dirty, slimy coating on the tongue; insipid, pap-like, soapy taste; longing for highly seasoned food; sensation of dryness in the mouth and throat; aphthoe, sluggish stools, or constipation; or relaxed, slimy, very offensive alvine evacuations; extreme mental and physical depression. STAPHYSAGRIA.-This remedy has been found of great utility in the height of disease; but it may, like Ignatia, also prove of service in the first stage, more particularly when mental emotion has given rise to disease. (See Ignatia and Staphysagria under art. MENTAL EMoTIONS.) As already remarked, however, it is chiefly in the advanced stage of mucous fever, and even when it has degenerated into a nervous or putrid type, that this remedy is especially serviceable. SENEGA has chiefly been recommended against the following symptoms: slight rigors and heat, accompanied by pulsating headache; oppressed and anxious respiration, shooting pains in the chest, general aching of the body, and considerable thirst, with accelerated pulse; accumulation of tenacious mucus in the throat, and constant efforts to expel it. Senega is, like Pulsatilla and Capsicum, peculiarly adapted to persons of phlegmatic temperament, and soft, flabby muscular system. In fully-developed mucous fever DIGITALIS is a valuable remedy, especially with extreme depression of the vital powers, slow, languid pulse, great prostration of strength, pressure and fulness in the pit of the stomach, incessant nausea, and frequent fits of vomiting, thirst, diarrhoea, frontal headache, especially over the orbits, short, disturbed sleep. In cases which become protracted, but without assuming a serious character, with predominant plethora venosa abdominalis, SEPIA is deserving of attention, Lycopodium, Naatrum, Kali c., Magnesia c., and Calcarea are also well adapted to those cases which take an obstinate character. Arnica, Spigelia, Dulcamara, Cina, Valeriana, on the other hand, have been MUCOUS FEVER. 125 spoken of as most suitable to those forms of mucous fever, which, after a longer or shorter interval of improvement, relapse into their previous state. If signs of invermination accompany the disorder, the principal remedies to be had recourse to are, ierc., Oina, CicZta, Spigelia, Sulph., Sil., Nux v., Digital., IHyos., Valerian., Stram., Stann., &c. When the fever assumes a torpid character, and nervous symptoms make their appearance, Bryonia, Rhus, Belladonna, Veratrum, or Phosphorus are commonly the most appropriate remedies. BRYONIA is indicated by violent congestion to the head, dry burning heat of skin, dry lips, dry red tongue, pressure in the scrobiculus, constipation, slight delirium, &c. Rhus is indicated by a similar train of symptoms, but with great depression and extreme feebleness of pulse. BELLADONNA is to be preferred, if signs of cerebral irritation predominate, the pulse is quick and hard, the skin dry and hot, and the tongue parched. PHosPHORus is called for when the increased secretion of mucus extends over the bronchial tubes as well as the entire alimentary canal, and is accompanied by expectoration of mucus, rattling in the chest, and diarrhoea; further, when the patient lies motionless, with the mouth open, the lips and tongue being at the same time dry, cracked, and blackish; lastly, when there is oppressed respiration, delirium, and carpologia, VERATRUM will often be found useful in the torpid form of mucous fever, with tinnitus aurium, dulness of hearing, and delirium. In the event of threatening miliaria, announced by a peculiar sighing respiration, IPECACUANHA is chiefly recommended. And when the miliary eruption has made its appearance, or has been driven in, ARSENICUM is the remedy on which we must place our chief reliance; the usual symptoms in such a case are, sopor, cold sweat, sordes on the lips and teeth, offensive breath, dry, tremulous tongue, insatiable thirst, meteorismus, involuntary stools and urine, oppressive respiration, stertorus breathing, small, tremulous, much accelerated pulse, nocturnal delirium. (Acid. phosph. and Carbo v. are also deserving of attention here.) Arsenicum is further indicated when aphthoe form, and are either of a simple kind or disposed to become gangrenous, and extend throughout the entire alimentary tube. MERCURIus, as has already been observed, is well 126 FEVERS. adapted to cases attended with the development of aphthle, nocturnal exacerbations of fever, offensive breath, and sometimes swelling of the parotis. ACID. NITRICUM may frequently be employed with advantage after MVercurius.-Acid. sulphuricum and Mezereum may also be found applicable to some cases with the formation of aphthe. When mortification seems inevitable, China, Carbo v., Baryta c., and Acid. muriaticum, are, in addition to Arsenicum, the remedies which are mainly to be depended on. (See Febris nervosa.) The diet must, both in the first stage of the fever, and in that of convalescence, be light and of easy digestion, chiefly fluid, and only in small quantities at a time; plenty of cold water should be drank, or rice or barley-water, to which, during the period of convalescence, it has been found advantageous to add a little wine. GASTRIC FEVER. BILIOUS FEVER. Febris gastrica biliosa. This is a form of fever in which, as its name implies, the digestive organs are chiefly affected; it has some degree of affinity with typhus, but is distinguished from the latter by the absence of nervous symptoms, although, when it assumes a torpid character, these are occasionally developed,-by the absence of the pressive aching pains in the occiput; and by the absence of disturbance or derangement in the senses of sight and hearing; further, that the pain in the cecum, which is so constant a symptom in typhus, is not a feature of this disease. The following are the principal symptoms of gastric fever; sensation of fulness and weight in the epigastrium; flatulent distension of the epigastric region, with inclination to vomit; eructations of offensive flatus, and sometimes vomiting of ingesta and tenacious mucus mixed with bile; thickly furred, dirty yellow tongue; abdomen soft; bowels costive; but in the advanced stage of the disease the evacuations are often very offensive, and contain portions of undigested food; frontal headache; languor; sickly and distressed expression of countenance, with yellow discoloration of the albuginea; more or less chilliness, succeeded by heat and dryness of skin; GASTRIC FEVER. 127 pulse quick but soft, sometimes intermitting or irregular, particularly the latter; urine thick, cloudy, and dark colored. When bilious symptoms are predominant (Febris biliosa), all the symptoms commonly appear in an aggravated form; the heat of the skin is very considerable, the restlessness and thirst excessive (the patient expressing a constant desire for acid drinks). The epigastrium is, as in gastric fever, much distended with flatus, but, in addition to this symptom, the following are more or less marked: the tongue is colored at first with a pale yellow fur, which gradually assumes a deeper or brownish color; the taste and eructations are bitter, and the substance vomited consists of a greenish, bilious matter; the bowels are either confined or relaxed, presenting in the latter case a yellow, green, or brown color; the face exhibits an earthy, somewhat jaundiced aspect; sometimes there is also a greater or less degree of sensibility, hardness, tension, burning in the hepatic region; the urine is dark brown, bilious; the pulse full, accelerated, intermitting or double. THERAPEUTICS.-The following remedies are those which are most required in simple gastric fever: Pulsatilla, Nux vomica, Ipecacuanka; Antimon. c., Bryon., Cham., China, Cocc., Tart. RAus.; Sulph., Arsen., Veratrum, Colocyn., Acid. phosph. The principal indications for the selection of these will be found in the chapters on DERANGEMENT OF DIGESTION and DYSPEPSIA, which see. When mental emotions have given rise to the disorder, Chamomilla, Bryonia, Colocynth, and Acid. phosph., are the most appropriate remedies. Chamomilla and Bryonia particularly, if in consequence of a fit of passion; Colocynth, from indignation, or mortification. Staphysagria is sometimes preferable to Colocynth, when vexation is combined with indignation. Acid. phosph., if grief, care, or anxiety have been the chief exciting causes. (SEE MENTAL EMOTIONS.) In Bilious fever the most important remedies are, Acbn., Cham., Puls., Nux v., China, Cocculus, Digit., Bella.; Arsenic., Colocynth, Mercurius, Staph., Colch., Tacraxac., Ignatia, Asar. (See DERANGEMENT OF DIGESTION, DYSPEPSIA, HEPATITIS, and also MENTAL EMOTIONS, when the disorder has been developed by such influences.) When gastric or bilious fevers partake of a somewhat 128 FEVERS. inflammatory character, Bella., Bryon., or Ciam. will generally be required sooner or later in the disease. When the fever degenerates into a nervous character: Bryonia, Rhus, Cocculus, Veratrum, Bella., or Arsenic., Carbo v., China, Hyos., Ipecac., Puls., Nux v., &c., will especially be called for in in the majority of cases. (See NERvoUs and PUTRID FEVERS.) ERUPTIVE FEVERS. Under this head we intend to treat of those diseases which possess the common property of febrile symptoms, preceding an eruption which is present during a part of their course, such eruption varying, in character, according to the nature of the affection. In this class are comprised, scarlet fever, measles, smallpox, chickenpox, miliary fever, and nettle-rash. SCARLET FEVER. This disease, in its simple generic character, consists of a contagious fever, with swelling of the face and a scarlet appearance of the skin-(hence its name)-which is of a bright raspberry color, or of a hue resembling a boiled lobster, smooth and glossy, upon which the finger, being pressed, leaves a white imprint which almost immediately disappears. In the present day we seldom meet with it in this simple form, but more frequently complicated with severe or ulcerated sore throat, delirium, congestive or violent inflammatory symptoms, and often with more or less deviation from the characteristic efflorescence above described. DIAGNOSIS. Fever, with extreme quickness of pulse; a feeling of soreness or pain in the throat; and, in one or more days, the appearance of an eruption, of the color above mentioned, in large, indefinitely marked patches, gradually growing paler towards their margins, and often overspreading entire limbs with a uniform scarlet color; the efflorescence disappears in five or six days, when the skin disquamates, and comes off in large pieces. SCARLET FEVER. 129 We sometimes find scarlet fever with scarcely any or even no external redness, but at the same time marked angina and bright redness of the tongue; in such cases, the disease, instead of showing itself on the skin, has fixed upon the mucous membrane; and even the angina and redness of the tongue present in most cases of this disease, may be considered indicative of an internal scarlatina. Scarlatina was formerly confounded with measles, from the resemblance which the two eruptions bear to each other, at their commencement; but they are easily distinguishable, even without taking into consideration the peculiar appearance of the slkin above mentioned-characteristic of the disease,by the eruption, in scarlet fever, generally developing itself in from twenty-four to forty-eight hours after the commencement of the fever, whereas that of measles rarely sets in before the third or fifth day; the absence of catarrhal symptoms, such as, cough, sneezing, lachrymation, the usual precursors of measles, constitutes another mark of difference. The greatly accelerated pulse, which denotes the approach of scarlatina, is also never met with, to the same extent, in any other disease. THERAPEUTICS.-In those cases, in which this disease appears in its simple form, the skin presenting the characteristic hue, with a smooth and glossy surface (Sccrlatina levigata s.plana), Belladonna is a specific remedy. Even in the severer forms of scarlatina, when the throat is considerably affected (Scarlatina anginosa) and' high fever or congestive symptoms set in, and which, if not properly treated, or if they occur in a bad habit of body, may assume the malignant type (Scarlatina maligna), attended with ulcerated sore throat, extension of the inflammation to the air-passages, delirium, spasm, &c., Belladonna is a valuable remedy. In scarlatina anginosa, the fever and sore throat increase with the eruption, in mild cases, and cease with its decline, but, in the more severe, continue; it is when the disease appears principally to attack the head, throat, thoracic, or abdominal viscera, that it becomes dangerous.* The eruption frequently does not appear before the third day, and then only in isolated patches. * When scarlatina anginosa is complicated with bronchitis, phrenitis, or enteritis, the remedies mentioned under these different heads must be had recourse to. 9 130 ERUPTIVE FEVERS. BELLADONNA should be administered, as soon as the throat and tongue become affected with dryness and burning, and there is a desire, but complete inability, to swallow even drinks or saliva; with sense of suffocation; further, when the throat is of a bright red color, having its surface excoriated, or covered with white specks, or stringy mucus, or presenting the appearance of thrush; the tonsils swollen, and the tongue of a bright fiery red hue, sometimes interspersed with dark red patches at a later period in the disease; also when delirium 'exists. If the disease have taken a favorable turn, we may allow the Belladonna to continue its action; but if, after the second,or third repetition of Belladonna, the inflammation and swelling increase instead of diminish, as is frequently the case in strumous constitutions, or if we clearly -perceive an appearance of ulceration commencing, with increase of mucus, we must have immediate recourse to Mercurius.* If, on the other hand, the ulcers present a livid appearance about the edges, and emit an offensive odor, or, when there is excessive thirst, with great dryness of the mouth, and extreme prostration of strength, we must have recourse to Arsenicum, in preference to l2lercurius; and if this medicine prove inadequate to complete the cure, we should follow it with NVux vomica. (Vide ULCERATED SORE THROAT.) NVux v. is, moreover, of considerable efficacy, when a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the fauces, which adheres so tenaciously, that it is with difficulty expelled, and, sometimes, even threatens suffocation. (Pulsatilla is also useful in such cases. See SORE THROAT.) When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite in the same * The exudations of various colors, or aphthous crusts, as they have been termed, which appear on the tonsils, anterior pillars of the velum palati and the fauces, in scarlatina anginosa, are often mistaken for ulcers and eschars. They are, however, readily discovered, on attentive examination, to consist of a thick viscid fluid, or floculi or concretions of gray, yellowish, white, or blackish-looking matter, differing from coagulable lymph by being softer. They are easily removed, and the parts which they covered present no trace of ulceration or loss of substance. Mercurius is the most useful remedy here, but Acid. nitricum, Lachesis, &c., are sometimes required. See SORE THROAT. SCARLET FEVER. 131 manner as already given under INFLAAMATORY FEVER, which see. When the quickness of pulse and other inflammatory febrile symptoms are subdued, and the affection of the throat again appears prominent, we may return to Belladonna, especially if the skin retain the peculiar scarlatina hue. OPIUM may follow the administration of Belladonna, when there is burning heat of the skin, drowsiness, stupor, stertorous breathing, open mouth, eyes half closed, restlessness with vomiting, or convulsions. We may here remark, that Dr. Schmidt of Vienna states that he has found CUPRUM ACETICUM particularly efficacious, in a peculiar affection of the brain, that frequently declares itself in cases of repercussed exanthemata, and which, if not speedily checked, may terminate in paralysis of that organ. Dr. Schmidt is of opinion, that when the eruption, during efflorescence, is suddenly repercussed, the result of which is frequently fatal, Cuprum aceticum may be almost considered specifi; or, at least, the medicament, which, with the greatest degree of certainty, can save the patient; if, in this condition, death should happen, it is in consequence of paralysis of the brain. Symptoms indicating its employment: " Quick, small, weak, irregular pulse; temperature of the skin considerably reduced, in more severe cases, chilly, and covered with perspiration. Affections of the nervous system are never absent; to this belong convulsive movements of various parts of the body, distortion of the eyes, face, mouth, head, &c., spasmodic affection of the chest, sometimes even eclampsia; as well as great restlessness, frequent change of position, sopor, delirium, &c." It displays its efficacy in reproducing the eruption, when the cerebral affection disappears, and the disease runs its usual course." * The remarks made on this medicine are taken from the translation of Dr. Schmidt's paper on the subject, in the 'British Journal of Homoeopathy,' No. III, page 233, to which the reader desirous of further information is referred. The following is Dr. Schmidt's formula: one grain of the Cuprum aceticum triturated with one hundred, one hundred and fifty, or two hundred grains of sugar of milk, previously triturated so as to feel as fine as flour; the process should occupy from twenty to thirty minutes. Of this preparation take from three to four grains, dissolve in a tumbler of 132 ERUPTIVE FEVERS. PULSATILLA is indicated, when derangement of the stomach and digestive organs is a prominent symptom, the face pale, red, or bloated also constipation-or looseness, especially at night,-occasionally with pains in the bowels, and shivering; disposition fretful and sensitive, or melancholy. When the eruption is very intense, and extends over the entire frame, and particularly when the patient affected is of the scrofulous diathesis, Sulphur, in repeated doses, has been strongly recommended. Aconitum, as intermediate remedy after Sulph., when great restlessness and dry heat of skin prevail. After the employment of Sulph. and Aconit. other remedies, such as Puls., Calc., Arsenic., &c., may be called for. We frequently find this affection in a complicated form, distinguishable from pure scarlet fever by the absence of the peculiar hue of the skin, of which we have spoken at the commencement, and by the pressure of the finger leaving no white imprint. This, so widely different type of the disorder, will be found treated of, in the succeeding chapter, under the denomination of Pupura miliaris or Scarlatina miliaris. The accession of laryngitis is one of the most serious and fatal complications which is liable to be encountered in scarlet fever. The remedies on which we must place the greatest reliance, as soon as we have detected this dangerous state of matters, are: Aconite, Spongia, Ilepar s., Lachesis, Merc., Ars., Carbo, &c. (See LARYNGITIS.) In strumous habits, or in instances where the disease has been allopathically treated from the commencement, many troublesome sequelse are frequently left. And we may remark that, even after the desquamatory process is completed, the whole of the danger is not altogether passed, any exposure to cold, or infringement of dietetic rules, being likely to entail unpleasant and even dangerous consequences. CHAMOMILLA may be employed with advantage, either alone, or alternately with Belladonna, against excoriation of the face, &c. AURuJM. Against the offensive and'purulent discharge from the nose, with soreness and swelling of the interior. pure water, and administer in tablespoonfuls, every quarter of an hour, half hour, one, or two houra.according to the violence of the disease. SCARLET FEVER. 133 MERCURIUS VIVUS is a good remedy against soreness of the nose and face, with swelling of the submaxillary glands; followed by Hepar sulphuris, Silicea, Sulphur, and Calcarea, if necessary. Against the following symptoms Belladonna is extremely efficacious: puffiness of the face, swelling of the hands and feet, lingering fever in the evening, glandular enlargements, chaps about the mouth, severe headaches, stammering, &c.; and may frequently be advantageously alternated with the medicines just mentioned. Dropsical swelling of the whole body is not an unfrequent sequela, sometimes requiring a most careful and discriminating treatment. The following remedies will generally be found the best adapted to the successful treatment of the same: Helleborus, Arsenicum, Bryonica, Rhcs; of these IIelleb. is, generally, the most appropriate when the whole body has become suddenly anasarcous: Rhus, when the inferior extremities are more especially affected, and Arsenicum, when Helleborus does not speedily produce a favorable impression. Bryonia has been recommended as the best remedy when the dropsical infiltration is detected early, and the effused fluid is small in quantity. In obstinate cases, Arnica, Bella., Phosphoric acid, Digitalis, Bcaryta m., Sulph., Lycopod. Against Otitis, or Otorrhoea: Belladonna, Hepar sulphuris, or Pulsatilla are the best remedies; and in the case of Boils, Arnica, followed by Bryonia and Sulphur, when necessary; and for deafness, Belladonna, Pulsatilla, Dulcamara, Sulphur are to be chiefly recommended. It may here be added, that Ammonium carbonicum, Arsenicum, Secale cornutum, and Acidum phosphoricum, have been found very useful in scarlatina, when it assumes the typhoid form; and Arsenicum in frequently repeated doses,-or Acidum nitricum, Aconitum, Lycopodium, and Belladonna, alternately, a dose of each remedy being given every hour, or oftener if necessary, for several successive hours, to rouse the vital force to new efforts,-in the severe and dangerous sore throat which accompanies malignant scarlatina, the amygdale being swollen into hard tumors, often as large as apples, attended with snorting and difficult breathing, enlargement of 134: ERUPTIVE FEVERS. the neighboring glands, remitting pulse, and sopor.* Against Parotitis:.Iercurius, Carbo v., Calcarea c., and Kali c., will generally be found the most important remedies. Belladonna is valuable as a preservative against pure scarlatina, when epidemic, and, moreover, greatly assists in modifying the character of the disease, in such individuals as do not wholly escape its attacks. t Should the disease continue to rage, the treatment may, in some instances, be renewed. If, however, the ruling epidemic be scarlatina in an unusual or complicated form, the remedies employed as preservatives must be such as possess pathogenetic properties, corresponding to the entire morbid picture of the disease. Aconitum and Belladonna in alternation, (allowing twelve to twenty-four hours to elapse after the administration of Aconitum before Belladonna is given, and from two to four days after Belladonna, before Aconitum is repeated, and so on,) have been employed successfully in epidemics not possessing the clear scarlatina hue, with a smooth and glossy surface. While taking Belladonna or Aconitum the patient must adhere strictly to the homceopathic diet, particularly avoiding wine and acids. We must, in administering prophylaxes, carefully watch their efects and if a medicinal action set in discontinue immediately. DIET. During the course of this malady, the greatest * Brit. Jour. of Horn. No. xii. Vide also ULCERATED SORE THROAT. f There are various methods of employing Belladonna as a prophylaxis. We have repeatedly used the following prescriptions with advantage: 1c Tinct. Bellad. 3, gtt. vj. Aq. destil. 3 vj. Dose. To robust children of ten years of age a dessert-spoonful twice a day; to those of abQut five years of age a teaspoonful daily; and to those of and below three years, a teaspoonful every third day. Or, in the case of delicate children, or those who are very sensitive to the action of the homceopathic medicines: I~ Bellad. 30, glob. 3. Aq. destil. 3j. Dose. A teaspoonful every third, or only every fifth day, when there is inactivity of the skin, with great susceptibility to the medicinal effects. A little pure alcohol may be added to the water when the weather is very warm, or when it is required to keep the prophylactic liquid for a longer period than usual. A fortnight to three weeks' use of the Belladonna is generally sufficient to obviate any risk of infection. SCARLET FEVER. 135 possible attention must be paid to this point. In the more severe accesses of fever, no other nourishment must be given than toast-water, or weak barley-water; and even after the fever has abated, every care must be taken, and a return be gradually made to a more nourishing diet, as negligence in this respect may be productive of the most serious consequences. In mild attacks the patient may be allowed gruel or weak broths. SCARLET RASH. Purpur Rubra s. Miliaris Hahcnemanni. Scarlatina miliaris, miliformis, papulosa. Miliaria purpurea. This affection is, by many authors, regarded as a mere modification of the exanthema we have treated of in the preceding chapter (scarlatina pura, scarlatina levigata seu plana). It is easily distinguishable from pure scarlet fever, by the dark redness of the efflorescence, by the slight pressure of the finger leaving no white imprint, and by the small granular elevations, the cause of the dark red hue, which are felt, on passing the hand over the affected cutaneous surface. Some parts of the skin are perfectly free from the miliary papulke, and consequently present a brighter hue than those which are studded with them. In confluent scarlatina miliaris, or that in which, on some parts of the cutaneous surface, several papule run into one another, the affection has received, from the appearance which the eruption then assumes, the term of scarlatina phlyctoenosa, vesicularis pustulosa. This eruptive fever does not run a defined and regular course, like other exanthematic fevers. The efflorescence often disappears suddenly, and is then productive of extreme danger, frequently terminating in a fatal result. The extent of the efflorescence does not necessarily add to the danger, as the latter is often greatest when the efflorescence is scarcely perceptible. Sweat is only met with on the surfaces affected with the eruption, and it is, consequently, only when the eruption covers the whole body, that the sweat is general. Those who have been once affected with the disorder, are 136 ERUPTIVE FEVERS. by no means exempt from future attacks. Soreness of the throat is chiefly encountered when the eruption is altogether wanting, but it is also frequently met with before the outbreak of the rash, becoming trivial during the full bloom, and, again, very severe on the disappearance of the same. This disease requires a totally different treatment from scarlatina levigata (scarlatina pura, scarlatina simple), and Belladonna, the specific remedy in the latter, will, in this case, neither be found to be a preventive nor an indispensably curative medicine, but simply an auxiliary in some complicated cases. AcoNITUM. When the disorder occurs in an idiopathic form, there are few exceptions, in which any other remedy than Aconite is required, for the entire removal of the disorder. Sometimes it is found necessary to administer a dose of Cofea, a few hours after the first or second dose of Aconite, when the patient complains of severe pain in the head, trunk, or extremities, and is extremely restless, fretful, agitated, and disposed to shed tears, and then, again, to return to Aconite after a similar interval: and so oB.4 alternately, until the cure is completed; which, under favorable circumstances, is speedily accomplished by means of these remedies." When, however, this eruptive fever occurs in complication with smallpox, or measles, or when it breaks out in unfavorable seasons, during the prevalence of one or more of the said exanthemata, it generally becomes a much more serious disorder, and requires the aid of other remedies, in addition to the above mentioned. Among these, Ipecacuanha, Pulsatilla, Bryonia, Dulcamarac, Belladonna, Arsenicurn Ph.osphorus, and -huss are the most important, preceded by, and, where necessary, alternated with Aconite, when signs of inflammatory fever, or the following symptoms present themselves:-Slight, general fever chills, with rapidly alternating redness and paleness of the face; quick full pulse; slight confusion of ideas, increasing to a mild degree of delirium at night, combined with dryness of the mouth and lips, and thirst; eyes somewhat inflamed; oppression at the chest, short cough, sometimes attended with reddish sputa, and followed by a shooting pain * Sulphur may be substituted for Coffea, in cases where the fever continues to run high, notwithstanding the employment of Aconitum. SCARLATINA MILIARIS. 137T under the ribs; occasional vomiting; angina pharyngea. In all such cases, a dose or two of Aconite, at intervals of four hours, will be found of considerable service, if not sufficient to put a check to the further progress of the affection. IPECACUANHA. In many instances, either at the commencement of the attack, before the appearance of the eruption, or during its full development, but particularly the former, this is a most efficient remedy. It is indicated when there is a sensation of distressing tightness of the chest, with laborious breathing, and heightening of the febrile action towards evening; with symptoms of nausea, or even vomiting; extreme restlessness and agitation; deep sighing or moaning; disposition to tearfulness, or whining in children; diarrhoea, or colic. When the oppression of the chest and excessive restlessness have been removed by Ipecacuanha, but considerable nausea or frequent fits of vomiting remain, these symptoms will, generally, soon yield to Pulsatilla. BRYONIA is frequently more efficacious than either Coffea or Ipecacuanha, in relieving the extreme anxiety, restlessness, deep sighing or moaning, which so generally attend this affection; it should, therefore, be had recourse to in all cases in which these remedies fail to afford speedy relief. In some rare cases, even Bryonia is not sufficient, and it is then found necessary to administer Cinchona, followed by Phosphorus. Bryonia is further indicated, when the accompanying fever partakes of a nervous character, attended with delirium and other symptoms mentioned under Bryonia, in the article on Nervous fever-which see. The excessive and continual urging to urinate, which sometimes sets in, in the course of the disease, is often very readily subdued by Bryonia or by Conium. BELLADONNA. When the disorder is met with during the prevalence of Scarlatina pura (as also when symptoms, more or less characteristic of the latter affection, make their appearance in the course of scarlatina miliaris), this remedy is a most efficient auxiliary; it is, moreover, a most important remedy, when symptoms of cerebral disturbance exhibit themselves; or when the patient complains of his throat, which, on being examined, is found to be in a state of phlegmonous inflammation. iercurius may follow Belladonna, when the tonsils become 138 ERUPTIVE FEVERS. much inflamed and tumefied, or ulceration supervenes; in the latter instance, however, Arsenicum or Acid. nitricum may become necessary under particular circumstances. (Vide SCARLATINA, SORE THROAT, and SCARLATINA MALIGNA.) PHOSPHORUS. This remedy is very useful in cases in which there are symptoms of congestion in the chest, with extreme anxiety and oppression, and also, when there is considerable cerebral irritability, characterized by over-excitability of the senses; further, when the patient appears extremely listless and apathetic, and complains of burning sensations in isolated parts, rendering a frequent change of posture necessary. Phosphorus is often of great utility after Bryonia or Belladonna. DULCAMARA. When severe aching or gnawing (rheumatic) pains are complained of in the back or extremities, either in the course of the disease, or at its termination, Dulcamara is useful. ARSENICUM may be had recourse to in an advanced stage of the complaint, if the vital power seems rapidly sinking, and the organs, which perform the act of deglutition, are, as it were, paralysed, so that the patient is incapacitated from swallowing; or when, from a metastasis to the throat, the latter has become so rapidly and seriously affected, as to have assumed a gangrenous aspect.* (See ULCERATED SORE THROAT.) [" Arsenic. is also a most important agent for the relief of various forms of DEOPSY that succeed scarlet fever, such as Hydrothorax, Ascites' and Anasarca."-ED.] [" CAPsICUM, if there be extreme redness of the face, alternating with paleness, or a mottled face; swollen and cracked lips; burning blisters on the mouth and on the tongue; slimy saliva in the mouth; violent sore throat; painful swallowing and a sensation of fulness and tightness in the throat; a sensation of contraction or spasm in the throat; painful pressure and contraction in the curtain of the palate on swallowing, with paroxysmal and agonising pains in the ganglions of the neck; also, tickling and roughness in the throat, with sneezing, hoarseness, and hacking cough, and a final accumulation of tough mucus in the nose and throat."-ED.] * Compare these symptoms with those described under Calcarea carbonica at the end of this chapter. SCARLATINA MILIARIS. 139 [" MURIAT. Ac. is an important remedy in malignant scarlet fever, if there be dark red flushings of the cheeks, lividity of the neck, and dull redness of the eyes; irregular and faint eflorescence which changes to a dark red color, often intermixed with petechiae; ulcerations of the tonsils and adjoining parts, with sloughs; fcetid breath; acrid discharges from the nose, with soreness, chaps and blisters about the nose and lips."-ED.] When the disease, in cases of a bad type, puts on a nervous,* or even a putrid character, with extreme offensiveness of all the excretions, and hemorrhage from the nose, mouth, &c., the medicines, already mentioned under fevers of the said description (which see p. 32), must be employed. Cuprum aceticum and Kreosote have been found useful in some of these, almost hopeless, but fortunately somewhat rare cases; the former particularly, when the efflorescence repeatedly appears and disappears suddenly in the course of the disease. To show, however, how very essential it is to make a careful selection of the remedy, in the strictest possible accordance with the law similia similibus, instead of blindly pursuing the path of routine, and prescribing remedies solely in consequence of their having been found useful in other epidemies of the same name, we add the following account of a severe epidemy which was described by Dr. Elbe, of Dresden, in the 'Allg. Hom. Zeitung,' No. 15, 2lster Band: " The scarlet-fever epidemy of 1845, which raged not only in Dresden and its environs, but also in many other remote * Rhus and Sulphur may also be mentioned as having been found useful in this disorder; the former, when the exanthema had degenerated into a species of vesicular erysipelas, attended with lethargy, great thirst and strangury; and the latter, in cases where Belladonna had failed to effect all that could be expected. Antimonium tartaricum may prove of considerable service in the vesicular or pustular form of the exanthema. Against the convulsions which precede the evolution of scarlet rash, or the efflorescence of scarlet fever, as well as confluent smallpox, Tart. emet. is also indicated. In the event of repercussion of the eruption, Bryonia, Phosphorus, Sulphur and Cuprum aceticum have been recommended as the most useful. Opium proves very useful when the following symptoms present themselves: burning heat of skin, extreme agitation and anxiety, vomiting, diarrhoea, or obstinate constipation, convulsions, and excessive drowsiness. 140 ERUPTIVE FEVERS. parts of Germany, was unquestionably of a more violent character than has appeared for a long time. There were but few families that entirely escaped its ravages, and the number that fell victims to it was very large. It is well known, that in many families as many as from three to four children died of it; in one case, indeed, seven children out of a family of eight; and from this great mortality a conclusion may be drawn of the violence and malignity of the fever. It will perhaps not be wholly superfluous to remark, that a rubeoloid epidemy, but which was not exactly of a malignant character, prevailed here in 1844. After it had passed over, the scarlet fever appeared in the spring of 1845, sporadic, but of slight character, and continued thus till August; in the said month, however, the epidemy assumed a malignant character, which may perhaps, in a great measure, be ascribed to the excessive heat we had in July (frequently 32~ Reaum. in the shade). So much is certain, that a great number of children died from that time forward of scarlet fever, although there were also slight cases which occurred during the course of the epidemy, which were readily cured by Acon. and Belladonna, or recovered by the unaided efforts of nature. This, however, happens in all epidemics, and as nothing of interest is to be elicited from it, either as regards pathology or therapeutics, I shall pass these over, and confine myself to pointing out the characteristics of the more malignant cases, and to mentioning those remedies which proved specific thereto. The exanthema itself appeared in many cases very suddenly, without any precursors; in others, a fever preceded the eruption for several days, which possessed, however, in the absence of all local disturbance, no determined character. The only circumstance worthy of notice being, that the skin was usually more dry, and of higher temperature, than it commonly is in fevers, and that Aeon. had no effect. In some cases, headache, hemorrhage from the nose, sore threat, vomiting, and diarrhoea showed themselves as precursors. Neither the nature of the precursory symptoms, nor the character of the exanthema justified the prognostication that the disease would take a malignant course; cases turned out dangerous, with a scanty, as well as with an abundant efflorescence, and vice versa. This alone I observed, that those cases were more SCARLATINA MILIARIS. 141 dangerous, in which the single patches were confluent and more elevated than usual; frequently also these larger patches had not the proper scarlet red, but more of violet color. The violence of the angina was, likewise, a certain criterion of a malignant case; on the other hand, the intensity of the fever (although even some cases, where almost no fever existed, suddenly terminated with death), with an asthenic character, which appeared usually with the first eruptions, sometimes also with the following, was an almost infallible prognostic; the skin was at the same time burning hot, partly dry, partly covered with colliquative sweat; the pulse small, weak, and very quick (130 to above 160); the face bloated; the tongue mostly dry, at first furred yellow, afterwards brown; the tip red, and the papills swollen; the lips dry, and brown, as in typhus; the teeth often covered with a viscid brown mucus; thirst usually excessive; the difficulty in the performance of the act of deglutition was not always uniformly great; in some cases it proceeded from the swelling of the tonsils, in others, the cause appeared to be an inflammation of the throat, and again, in others, it manifested itself only during the febrile exacerbations, which mostly took place in the evening; strangury was not unfrequently an unfavorable symptom; the urine which was voided, often emitted an ammoniacal or putrid smell, and was as clear as water. So far, the more malignant cases were analogous, but from here they can, as regards the affected organs, the brain or lungs, be divided into two classes. The affection of the brain was, as usual, accompanied by violent delirium, periodical or continuous unconsciousness, involuntary evacuations of the urine and faeces, which latter were mostly of a light color; the skin, which had previously been hot, became cool, the pulse thready, the efflorescence scanty and violet-colored; death followed from paralysis of the brain. The affection of the chest betrayed itself nQt only by short, but also by difficult and laborious breatlm~hg, by mucous rattling in the bronchi, and sometimes also by an efflux of pus from the nostrils. In this variety, also, involuntary evacuations took place latterly; the excretions were in almost all cases clayey, as in icterus in adults, but the urine clear, like water. Delirium was, moreover, not wholly absent, but certainly not so violent as in the affections 142 ERUPTIVE FEVERS. of the brain; the disease terminated with paralysis of the lungs. I have drawn the distinction between the two forms thus prominently, from the circumstance, that it was of importance in conducting their respective treatment. In most cases, death ensued on the third, but often not before the fifth day, and in rarer instances, already on the first day of the disease. I may transitorily mention that many other symptoms, such as convulsions, &c., made their appearance towards the close of the disease, but all the danger was usually over when once the period of desquamation had commenced. The epidemy continued with almost unabated intensity till February, 1846, when it suddenly assumed a milder character, and then gradually disappeared. The sequelhe of the disease consisted chiefly in hydrops anasarca, ascites, hydrocephalus, glandular swellings, and abscesses, which always yielded readily to the usual remedies. Before I enter upon the treatment, I must add, that I by no means found the prophylactic power of Belladonna so very generally confirmed. I had, it is true, cases, where children, to whom I gave Belladonna as a palliative, escaped the scarlet fever, even when it was in the family; but I as often found that others were attacked by the fever although they had taken Belladbnna for many weeks, and that notwithstanding the long continued use of the same, the subsequent disease was not in the least mitigated by it.* Of the treatment of the milder cases I shall say nothing here, since, as mentioned above, Aconitum and Belladonna perfectly sufficed. That these remedies, however, had no effect, and could have none, in the more malignant cases, may be accounted for by the fact, that in these the fever was not sthenic, or similar to the inflammatory; that the tendency to paralysis was occasioned by pure nervous weakness, i. e., by prostration of the vital power; that Acon. and Belladonna, * Belladonna may only be expected to act as a preservative when it.happens to be specific to the prevailing epidemy. Had the remedies (Calcarea and Zincum) which were subsequently employed with such striking success in the treatment of this epidemy, been used as prophylaxes, there is every reason to surmise that these remedies would not have failed to exert a preventive effect. SCARLATINA MILIARIS. 143 on the other hand, can only prove beneficial against erethic and inflammatory fever, and although unquestionably also against paralysis, they are only so when the latter has orginated in congestion; consequently that their curative power in febrile, congestive, and inflammatory states, rests upon their capability of suppressing abnormally excited vital power, but which must, in cases of the description noticed here, by all means be avoided; on the contrary, we must endeavor to invigorate the already but too much depressed vitality, the lowered condition of which presented so much difficulty in the treatment of the epidemy in question. The remedies employed in typhus, viz., Bryon., Acid. jphosph., Phosphor., Carb. veg., Acid. muriat., Arsen., Rhuzs, and Ammon. carlb., appeared to correspond to the indication just mentioned, as also to all the other symptoms, and yet none of them had any unequivocal beneficial effect, for although single cases took a favorable course, still, the fatal termination was unfortunately the more frequent: it was therefore much to be doubted whether the more rare favorable termination was to be ascribed to these remedies or to nature. Amongst the remedies quoted, hus and Ammon. carb. undoubtedly appear the best suited against scarlet fever. Still Jius has no specific relation to this disease, for, although we certainly know it to be appropriate in erysipelatous phlyctsenous, pustular, scabby, and herpetic forms of eruptions, it is not so in any which are analogous to the efflorescence of scarlatina. Th observation of Dr. Kreussler (Allg. Homceopath. Zeitung, 29. 8), that Rhuzs proved a specific remedy against scarlatina, combined with an intense vascular fever, I did not see confirmed; it is moreover well known that the intense vascular fever abates as soon as the eruption has fully taken place, and before this period it will hardly be possible to mitigate the fever. According to my opinion, a beneficial effect, and that with some certainty, can only be expected from Rhus in scarlet fever, if the latter is complicated with a typhoid state. Ammon. carb., therefore, appeared to hold out the most favorable expectations, especially as it had been already successfully employed by many; this year, however, no advantage followed its employment, and this, no doubt, 144 ERUPTIVE FEVERS. arose from the circumstance that every epidemy possesses its peculiarities, as is shown in that described by SchrSn (Hyg. 21, 1), in which he prescribed Ammon. carb. with great success; for, in the first instance, the frequency of the pulse, in the cases described by Schron, was not above 130, whilst it rose here to 164, consequently a difference of more than 30 pulsations in the minute; secondly, in Schrdn's cases, danger was indicated by the intensity of the redness and the extent of the efflorescence, whilst in our cases this was not of any prognostic moment; and lastly, in Schron's cases, paralysis of the brain usually took place after vomiting, and in cases where the eruption was scanty, whilst it was here mostly unpreceded by any perceptible precursory symptoms, and could only be recognized by its consequences, viz., by the diminished temperature of the skin, by the retrocession of the exanthema, and by involuntary evacuations. Schr6n makes no mention of cases in which the lungs were implicated. These may be considered as the principal distinguishing characteristics of the two epidemies, and may account for the circumstance, that remedies declared as curative by Schron, were of no avail in the epidemy that occurred in this place. All the remedies mentioned having failed, I was compelled to search for others, and I found Calcarea carbonica and Zinecin to be the most suitable according to the entire morbid picture of the disease. We shall, however, proceed first to attempt to compose, from the pathcgenetic symptoms which can be produced by Cale. carb., a form of disease which presents a strong resemblance to the state described above. We find, as the effects of CALC. CAIB.,* WITH REGARD TO THE EXANTHEMA: SYMPTOMS.-293, 394, 415. Red, hot, turgid countenance. 417. Small painless rash on the face. 418. Eruption on the face resembling miliaria. 443. A fine eruption about the neck and chin attended with itching. * See Hahnemann's Materia Medica Pura. Translated by Charles J. Hempel, M.D., in 4 volumes. SCARLATINA MILIARIS. 145 1364. Red streaks on the shin-bone, which consist of miliary vesicles, with violent itching and burning after being rubbed. 1403. Burning in the palms of the hands and soles of the feet. WITH REGARD TO FEVER. 1502. Difficulty in falling asleep in consequence of excessive heat, in a cold room. 1555. Restless dozing, during the night, with excessive heat and confusion in the head, as in fever. 1585. Accelerated pulse. CONCOMITANT SYMPTOMS. a. Affections of the Throat. 512-521. Difficulty of deglutition. 528-29-30. Swelling and inflammation of the palate and tonsils. 525-27. Indicate inflammatory action in the pharynx. b. Trackea and Lungs. 1025. Loud rattling in the windpipe during the act of expiration, as if from an accumulation of mucus in the chest. 1053. Hot breath, with heat in the mouth. 1069-76. Difficulty of breathing. 1109-10. Precordial anxiety. 1023. Mucus in the chest, without cough. c. Cavity of the fouth and intestinal Tube. 531-33. Dry tongue. 564-70. Thirst. 517. The fmces perfectly white. d. Urinary System. 871-74, 76, 78. Strangury. 877. Wetting the bed (involuntary emission of urine). 884. Copious emission of watery urine. 895. Offensive, acrid smell of the urine, which is very clear and pale. 10 146 ERUPTIVE FEVERS. e. Nervous Symptoms. 1505-8, 10, 12. Involuntary exuberance of ideas, with visions during sleep. 1544-46. Indications of delirium. 1561. Decided delirium in the case of a child. 1435-36-79. Weakness, debility. If we take the sum of these symptoms, we shall find that it yields as distinct indications of the applicability of Calcarea c. to the treatment of scarlet fever, (see Scarlatina miliaris,) as may be gleaned from the pathogeny of Belladonna and Ammon. carb., and more so than can be met with in that of any of the other remedies; the angina, the constant attendant on scarlet fever, is also clearly to be recognized. We certainly find here but a small number of febrile symptoms, only a few times " heat during the night, restlessness, and quick pulse;" experience, however, has long proved that Calc. is of great use in rather violent fevers, e. g. in fever accompanying dentition,-the usus in morbis is, therefore, in its favor. It is moreover known that every febrile state will yield, if the rest of the morbid picture, the source of the fever, corresponds with the remedy employed. Thus far we might already expect a curative effect from Calcarea in scarlet fever; but it is chiefly to be recommended in an epidemy of the character of that which is at present under our notice, by its so distinctly marked symptoms of paralysis of the lungs; it possesses also the nervous symptoms, which were never absent in the more malignant cases, and even the feces and the urine, with the peculiar smell of the latter, are of the same nature. There was, therefore, reason to conclude that a beneficial effect might be looked for from the employment of Calcarea; and my expectations were realized in the most striking manner, for of all those children to whom I gave this remedy, I did not lose a single one. At the same time it will be seen from what I have stated, that Calc. is only indicated in that form of the disease, where affections of the chest take place, and where paralysis of the lungs is to be feared. I gave it in the first instance, in these bad cases only, and invariably effected a speedy cure by means of it; afterwards, however, I employed it in all cases without exception, from the commencement of the attack, and SCARLATINA MIILIARIS. 147 the disease under such circumstances always assumed a mild character, at least symptoms of threatening paralysis of the lungs never appeared after its use; the fever, however violent it might be, diminished so rapidly, that on the third day it was hardly perceptible; the development of cerebral symptoms, indicative of threatening paralysis alone, could not be prevented by it, and as soon as these appeared I discontinued the Calc. and proceeded as I shall hereafter describe. I gave Cale. only once every twenty-four hours, and usually gr. j, of the third or fourth trituration. It may probably be asked, why I repeated the medicine so seldom in such precarious cases. But I must confess, that I have seen a decidedly better effect from these rare doses than from more frequent repetitions. Moreover, the curative effect of the Calc. develops itself with considerable quickness, as I often had occasion to observe; for example, I have even succeeded in arresting incipient paralysis of the lungs (a state which decidedly requires the promptest assistance), by one dose of the third trituration; and in a case, which occurred in, a child of one year old, where difficulty of deglutition appeared in the evening, during the febrile exacerbation, to such a degree that suffocation was to be apprehended, relief was so far afforded in the space of a few minutes by Cale. 4, gr. j, that the child was enabled to drink with ease, although the symptoms had existed for upwards of an hour before my arrival. The attack returned for several evenings in succession with equal intensity, but as Calc. was then immediately administered, it never lasted above ten minutes. But great as was the curative power of Calc. in the above-mentioned form of this epidemy, it was inadequate to cope with the other variety, viz. that with threatening paralysis of the brain; here Zincum was indicated, its pathogenetic properties bearing not only a similitude to scarlatina in general, but with the form in question in particular, as the following catalogue will render manifest. ThFe eruption.is indicated by: SYMPTOMS:-276. Efflorescence in the face. 297. Violent itching in the knee, and redness of the same. 921. Itch 148 ERUPTIVE FEVERS. ing between the shoulder-blades, with extensive eruptions. 991. Miliaria at the bend of the left elbow. 1035. Red, small, round spots on the hands and fingers. 1231. Pricking itching of the skin with miliary eruption after rubbing. 1232. Itching miliary eruption in the popliteal space and the joint of the elbow. 1231-35. Small red efflorescence withitching, disappearing after scratching. Fever.-157. Sensation of heat in the head, and redness of the face. 158. Heat in the head, during the evening, with increased temperature of the cheeks. 1266. Whilst in a sitting posture, almost burning heat is felt in single small spots. 1358-68. Fever consisting only of heat. 1357. Describes a febrile paroxysm with trembling of the limbs, which was characteristic in this variety of the epidemy. 1371. Quick pulse, sometimes with a sensation of increased temperature. ANGINA. 370. Pressive pain in both tonsils during deglutition, in the evening and throughout the night. 373. Feeling of contraction in the throat whilst swallowing. 374. Pain in the throat, as if caused by internal swelling. 376. Pain in the throat whilst swallowing, with swelling of the external parts, and of the tonsils. Lungs.-807. Tightness of chest, two successive evenings, with small quick pulse. JMouth, and intestinal canal.-352. Dryness of the tongue. 390-96. MTuch thirst. 391. Dry, cracked lips. 613. Viscid, light yellow stools. 622. Solid, light-colored stools. 627. Thinner and easier stools than ordinary. 1288. In the morning on awaking involuntary discharge of liquid stools. URINARY SYSTEM. 673. Diminished emission of urine of a pale color. 666-68. Strangury. 675. Frequent and somewhat increased emission of urine, varying from the clearness of water to lemon-color. SCARLATINA MILIARIS. 149 677. Frequent but not copious emission of scanty, very light-colored urine. 679. Involuntary emission of urine whilst blowing the nose. NERVOUS SYMPTOMS. a. Delirium. 11. Fear of thieves, or horrible visions whilst waking, as in febrile delirium. 48. Unconnected ideas. 1310-29. Restless sleep with anxious dreams and delirium. b. Indications of Paralysis of the Brain; 49. Diminished faculty of comprehension, and difficulty of collecting the thoughts. 50. Absence of thoughts, and mental torpor. 51. Oblivion of what has transpired during the day. 52. Great forgetfulness. 55. Sensation of weakness in the head. 217. Transfixed, motionless eyes, with absence of mind. Further, with regard to the symptoms combined with suppressed activity of the brain:263-64. Pale countenance; and 1029. Cold hands. Rademacher also mentions, as the primary effect of zinc, " great disposition to sleep, and a state between dreamiAg and sleeping," and employs it for this reason in delirium; he, at the same time, admits its usefulness against sleeplessness in acute diseases of the brain, and considers its principal effect to be on the brain. When we come to compare the ensemble of these symptoms with the first variety of scarlet fever above described, we find a reflection of the whole picture of the disease; we see an eruption not dissimilar to that of scarlet fever, a febrile state, which consists only of dry heat, with a quick pulse and excessive thirst, as also the symptoms of difficult deglutition (not merely those which are spasmodic, but likewise those which arise from swelling of the tonsils). These are the reasons in general that are calculated to determine us to employ Zincum in scarlet fever; but that which chiefly points out the sphere of its operation is its influence upon the brain, with incipient signs of paralysis of that organ, giving 150 ERUPTIVE FEVERS. rise to the following concomitant phenomena: involuntary evacuations of faeces and urine, diminished temperature of the skin, accelerated pulse, trembling or paralytic state of the extremities. On the other hand, with the exception of the single symptom of oppression, we do not meet with any indications of a paralytic affection of the lungs. From what has been stated, it is sufficiently obvious that Zinczum can only be beneficial in those cases which are complicated with affections of the brain; the efficacy of Zinc. in analogous states, e. g., in paralytic states of the medulla spinalis, has been long mknown. I found it necessary to prescribe Zincum in large and frequently repeated doses (gr. 3.-gr. j of the first trituration,-at the commencement every hour, afterwards every two to three hours), from the circumstance that, in consequence of the prostration of activity in the central organ of the nervous system, the organism is neither readily nor lastingly acted upon by external agency. As we have just seen, both forms of the disease possess exactly those symptoms in common, in which Cale. and Zinc. resemble one another, and both differ in those in which Calc. and Zinc. do not coincide. But in order to substantiate theory by practical evidence, may I be allowed to communicate at least two cases of cure by means of these remedies? Oslar Graf, 3 years old, scrofulous, but strong, formerly afflicted for a long time with hydrocephalus chronicus, had, on the 31st of December, been affected with general dry burning heat during the whole day. January 1st he complained, after a sleepless night, of headache and colic, and vomited once; in the course of the morning the scarlet. efflorescence began to appear, and spread over the whole body before the close of the day; the skin was burning hot, the pulse small, weak, and could not be counted; there was also profuse sweat. The child, usually so cheerful, lay still and quiet, with closed eyes, and answered only reluctantly if spoken to; the face was bloated, the thirst excessive, and the patient drank often, but little at a time; in addition to these symptoms, grinding of the teeth and convulsions of the face took place almost every half hour (both symptoms in this case probably arising from the presence of ascarides); delirium subsequently supervened. SCARLATINA MILIARIS, 151 I prescribed, in the forenoon, Cale. 3, gr. j. The child remained in much the same state throughout the day, only, in the afternoon, the heat became diminished, and the gnashing of the teeth less frequent; in the evening, however, both returned, with increased restlessness and delirium. In the night, between January 1st and 2d, the patient slept little, and was very restless, particularly betweeni 12-1, and in the morning he passed the foeces and urine involuntarily; the paroxysms of teeth-gnashing had not returned so frequently, and the child appeared to be in a less soporous state, but was boring rather more with his head into the pillow; the heat. was no longer so excessive; the pulse, towards evening, could at least be counted 152, and was consequently also no longer so small; the efflorescence looked well (another does of Calc. had been given that morning). On January 3d the child was no better, and had passed a rather sleepless and restless night; the gnashing of the teeth was more violent and more frequent; the patient went on boring with the occiput into the pillows; and there was great anxiety, with oppressed respiration, and mucous rattling; the pulse as it was the day preceding. Cole, was repeated, whereupon the attacks ceased entirely during the day, the restlessness subsided, the respiration was no longer so difficult, and in the afternoon the child slept for a short time; in the evening the fever had not increased. During the following night the restlessness was not great, and the sleep continued for half an hour at a time; in the morning, an involuntary alvine evacuation occurred, but there was perfect consciousness, no sopor, no delirium, no difficult respiration, and no mucous rhonchus; the exanithema still looked well. Calc. repeated. In the evening the fever did not increase, the temperature of the skin moderate, and the pulse no longer small, 142. January 5th, the child had passed a quiet night, sitting cheerfully on the bed; no dangerous symptoms were present, the eruption was receding, the temperature of the skin little increased, the pulse 115, no involuntary evacuations, and the child responded perfectly sensibly to all inquiries; no febrile exacerbation ensued in the evening. I accordingly discontinued the medicine, and the disease proceeded on its course, as free from danger as usual under the employment of Calcarea. 152 ERUPTIVE FEVERS. Oskar Wagner, 4 years old, an uncommonly tall, stout, over-fed, flaccid, scrofulous boy, was attacked with several fits of vomiting in the night, between December 20-21. On the following morning the vomiting had ceased, the child was very restless, the surface of the body cool, and the exanthema made its appearance. Cale. carb. 3, gr. j. During the evening much heat, in the night delirium, and two involuntary, but liquid alvine evacuations. On the morning of the 22d very violent fever, the exanthema fully developed and very much raised, the single points or elevations standing together in groups; Cale. repeated. During the day, delirium, great thirst, dry brown lips; the state of the tongue could not be discovered, as the child could not be induced, during its whole illness, to show it; periodical unconsciousness and delirium, the latter continuing during the night with restlessness. Calc. repeated. On the 23d, early in the morning, intense fever with delirium. Cale. repeated. In the evening the child was in a state of complete sopor, pulse collapsed, small, 152; extremities cool,-Zincum 1, gr. j, every 2 hours; the night very restless, much delirium. After midnight the child appearing quiet, the parents discontinued the medicine. This supposed quietude was, however, a bad symptom, for on the morning of the 24th I found the child lying perfectly motionless; the pulse very small, and could not be counted; utter unconsciousness; the extremities icy cold, the rest of the body cool, and the whole cutaneous surface blueish-red, except about the eyes, forehead, and chin, these parts being white; the eruption remaining was but scanty. Zinc. 1, gr. j, every two hours. After the first dose, symptoms of returning consciousness were already perceptible; in the evening the skin was warm, and its blueish-red color had disappeared; the pulse was somewhat strengthened, 150, and there was some degree of sweat; the night passed over pretty favorably, now and then delirium, but also several hours' sleep. On the 25th the child appeared to have recovered more consciousness, he recognised his parents and asked for something to drink. The temperature of the skin was somewhat higher, the pulse no longer weak, 140, and, for the first time, the urine was not emitted involuntarily. Zinc. continued every three hours. The following night he slept perfectly quiet, without delirium; SCARLATINA MILTARBIS. 153 in the morning he was in full possession of his faculties, and wished to play; the temperature of the skin was natural, the pulse strong, 128, and the skin had commenced to exfoliate. Zinc. three times a day. On the 27th the child was well, as far as circumstances could admit, and recovered perfectly without taking any more medicine. The difference between the effects of Calc. and Zinc. in this epidemy, not only as elucidated by the symptoms enumerated in the Materia Medica, but also as established by experience, consists accordingly in the following: Cclc. operates more upon the organs of the chest, Zinc. more upon the brain; Cale. diminishes the immoderate febrile heat and the frequency of the pulse; Zinc. does not affect the frequency of the pulse which is associated with febrile heat, but removes the icy coldness of the skin (the result of depressed vitality), strengthens the small, quick pulse, and reduces it to a normal state of frequency; Calc. is only useful in slight delirium, but very effective in violent angina; Zinc. is as beneficial in violent delirium alternating with sopor, as in paralysis of the brain; Calc. is, on the other hand, preferable in incipient paralysis of the lungs. I must guard myself here against the imputation of any intention to hold Zinc. and Cale. curative in all malignant cases of scarlet fever, by stating that it was only in this epidemy that I found them of such great efficacy, and it is only in similar instances that their beneficial effects may be looked for. I was induced to make these communications, chiefly from the circumstance that I consider it would be attended with great advantage if the different epidemics were carefully described and compared, their distinguishing characteristics pointed out, and the remedies mentioned which had proved most serviceable in each,-as it is mainly by such means that the selection of the specific remedy, at the first outbreak of the disorder, can in future be facilitated, and a number of sacrifices thereby avoided. The remedies required for the occasional sequeloe of scarlatina miliaris are the same as those enumerated at the conclusion of the chapter on Scarlatina. 154 ERUPTIVE FEVERS. MEASLES..Rubeola. This disease generally reigns as an infections epidemic,, and,. for the most part, confines its attack to children, in which cases it is seldom, when properly treated, either severe or dangerous.; when it occurs in adults, it generally assumes a more critical character. It rarely attacks an individual a second time. Measles is not to be so much dreaded for itself, as for the deleterious consequences it, under an improper mode of treatment, frequently entails, or to use the technical term, the dreg it leaves after it, which in many constitutions, develop an inherent disposition to consumption. DIAGNOSIS. Catarrhal symptoms, such as short, dry cough, lachrymation, with redness of the eyes, and a degree of fever, more or less marked, preceding the eruption from three to five days, and generally continuing as long after, or all through the disease. Eruption of a number of small red spots (frequently papular), the skin, in the intervals between them, generally preserving its natural color, and sometimes exhibiting a faint reddish hue. We often find them in the shape of small irregular arcs. They, for the most part, make their first appearance on the face and neck, become confluent, and extend themselves gradually downwards over the rest of the frame. About the sixth or seventh day from the time of sickening, the eruption begins to turn pale on the face, and afterwards on the rest of the body, and, generally, entirely disappears about the ninth day, with a bran-like desquamation of the epidermis, a distinguishing sign of this disease. THERAPEUTICS. ACONITE has been regarded, in some instances, as almost specific against measles, and in its mild form, will frequently be found sufficient, in a few doses, to conquer the disease, or at least materially to shorten its duration. This remedy is particularly indicated, when the fever assumes an inflammatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration; and is more or less useful, throughout the course of the MEASLES. 155 malady, either alone or in alternation with Pulsatilla, or any of the other remedies which may be better indicated, whenever marked febrile or inflammatory action becomes prominent. (Cffea or Hepar are frequently useful after Aconite, when there is a distressing dry cough.) PULSATILLA is also very efficacious, and even specific in this disease, and is frequently indicated at the commencement, from the strong resemblance which some of its pathogenetic properties bear to the catarrh attendant upon measles, together with the characteristic exacerbation of the symptoms towards evening, &c.* This remedy is, moreover, of great utility in bringing out the eruption, when it is longer than usual in making its appearance; but, whilst the fever is high, Aconitumr must be administered, and if the febrile irritation does not diminish after a dose or two of Aconitum, Sulphur may be given, after which, if the fever return with increased force, Aconitum will rarely fail to answer our expectations. When there is great oppression at the chest, before the eruption is evolved, a dose or two of Ipecacuanha is very useful. Pulsatilla is also valuable when any gastric derangement is present, or when the cough, which so generally accompanies the disease, is worse towards evening, or in the night, and is attended with considerable mucous rhonchus, or copious, thick, yellowish or whitish expectoration, sometimes followed by vomiting, or symptoms of approaching suffocation; further, when there is coryza with a thick, yellowish or greenish nasal discharge. (Sulphur is frequently of considerable service after Pulsatilla, particularly in strumous subjects. Where there is dry nocturnal cough, Nux v. will be found useful, especially in dark-complexioned subjects.) BELLADONNA. When the inflammation attacks the throat, presenting many of the throat symptoms we have given for this medicine under Scarlet Fever, attended with great thirst, which the patient is often prevented from indulging by the acute shooting or pricking pain in the throat produced by swallowing; and further, when there is a coarse, dry, barking, * Pulsalilla and Bryonia are two of the most important remedies, when there is prominent bronchitic complication. (See also BRONCHITIS.) 156 ERUPTIVE FEVERS. and somewhat spasmodic cough, worse at night, with mucous rhonchus, great restlessness, and high nervous excitement; also, in those cases of measles, where no eruption declares itself, but simply headache and catarrh, with severe inflammation of the eyes, which present a glassy appearance, are bloodshot, or streaked, and watery; finally, when evident signs of cerebral irritation set in. (Against ulcerations on the cornea,.Mere., followed by Calc. or Hepar s.) BRYONIA is an excellent remedy, when the eruption is faint, or imperfectly developed, and the respiration much oppressed and laborious, attended with aching in the limbs; also, when there is dry cough, and the patient complains of shooting pains in the chest, increased by a full inspiration. This disease has frequently terminated fatally, from the eruption being driven in by sudden exposure to cold or change of temperature; in such cases, BRYONIA, administered as above, is generally found efficacious in re-evolving the eruption, and preventing this disaster; if diarrhoea, with mucous discharge, follow the suppression, PULSATILLA is indicated; if the vomiting, with great oppression at the chest, be the more prominent symptom, IPECACUANHA should be substituted, and followed in turn by Arsenicum, if symptoms of improvement do not speedily show themselves:-In the case of children, Chamomilla is to be preferred to Ipecacuanha, when there is dyspnoea and diarrhoea, with colic and vomiting. When symptoms of cerebral disturbance supervene, Ciurum aceticum (see SCARLATINA), Belladonna and Stramonium or Helleborus niger, Arsenicum, and Sulphur, have proved of the greatest utility;-and in the case of pulmonic inflammation, Phosphorus, Bryonia, or Sulphur, should Aconitum and Pulsatilla not suffice. In those comparatively rare cases in which typhoid symptoms manifest themselves, either during the course of the disease, or at its termination, Bryonia, Arsenicum, and Phosphorus will be found useful, where any chance of recovery remains. (See TYPHUS.) For the treatment of coughs, which sometimes remain after measles, Sulphur, Sepia, Carbo v., Conium. Chamonilla, Drosera, Dulcamara, Ilyoscyamus, Ignatia, Nux v., Belladonna, &c., are very serviceable. (See COUGHS.) Against Laryngitis, Aconitum, Iiepar s., Spungia, Belladonna, Lachesis, Arsenicum, Mercurius, &c. (See LARYNGITIS.) MEASLES. 157 For the diarrhoea, which the disease sometimes leaves behind it, Cinchona, Pulsatilla, Mercurius, and Sulphur, are in general the most appropriate remedies; for their several indications, see DIARRHIEA. For otitis or otorrhoea, Pulsatilla, Carbo v., Sulph., 3lerc., and IHepar sulpluris (chiefly); for parotitis, Arnica, and Phos.; for tenderness of the skin, Mercurius; for miliaria alba (chiefly), Nux v.; and for burning, itching rash, which bleeds after scratching, Arsenicum and Sulphur are severally indicated. As a precautionary measure against the attacks of this disease, when epidemic, we may prescribe a few globules of the third or sixth potency of PULSATILLA, in a little water, followed by ACONITUM, at the same potency, three days after; allow the latter medicine to act for twenty-four hours, and continue the alternation for a fortnight, renewing it, when necessary, at the termination of a week or ten days. This treatment will, frequently, be found sufficient to ward off this disease, or, if it be taken, will generally reduce it to an extremely mild form. DIET. In this respect we may follow the rules given under SCARLET FEVER. SMALLPOX. Variola. This disease is, by pathologists of the present day, divided into two varieties-the distinct, when the pustules on the face are clearly defined, and do not run into one another; and the confluent, when they coalesce and form one continuous whole. When the symptoms are less severe than those properly characteristic of the disease, and the eruption on the face slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vaccinated, a precaution which, although not always a preservative from the attacks of variola, greatly lessens its virulence, and gives a milder character to the complaint, when taken. DIAGNOSIS. The disease is frequently very sudden in its attacks, commencing with chilliness and shivering, followed by febrile symptoms, headache, severe pains in the small of the back and loins, languor, weariness and faintness; 158 ERUPTIVE FEVERS. the patient also complains of oppression of the chest, and acute pain in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Catarrhal symptoms, as sneezing, coughing, wheezing, and frequent difficulty of breathing, often accompany this disease. The eruption first displays itself in the shape of small, hard-pointed, red elevations, which in about three days present a vesicular appearance, surrounded by an inflamed circular margin, and become depressed in the centre as they enlarge. About the sixth or eighth day, the lymph in the pustule becomes converted into pus, and the depression in the centre disappears. When the pustules are very numerous on the face, it generally becomes much swollen, and the eyelids are frequently closed up. On the first day, a small lump, like a millet-seed, may be felt in each of the elevations above noticed, distinguishing this eruption from all other exanthemata. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course; thus, those which first appeared are forming into scabs, or dying off, while the others are suppurating. The general desiccation commonly takes place on or about the eighth or fourteenth day, according as the pustules may happen to be distinct or confluent. When the pustules have attained their full development, they generally burst, in mild cases emitting an opaque lymph, which dries into a crust and falls off, whilst in severe ones, we find a discharge of puriform matter, forming scabs and sores, which leave, on their healing, pet manent marks or pits. Red stains, caused by increased vascular action, always remain for awhile after the eruption; but if no ulceration has taken place, they disappear in process of time. In Confluent Smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease; the pain in fhe pit of the stomach, and difficulty of breathing, are more complained of, and, in children, the eruption is frequently preceded by convulsions and delirium; the latter symptom, indeed, is frequently present with adults during the suppurative or SMALLPOX. 159 secondary fever, which frequently assumes a typhoid character, and sometimes carries off the patient on the eleventh day. All cases in which we have generally a deep-rooted morbid constitutional taint to contend against, require the utmost skill of the experienced practitioner to ward off a fatal result. An extensive erythematous efflorescence of the face or trunk almost invariably precedes the confluent variety of smallpox. Salivation, with soreness of the throat and aphths, or pustules on the tongue and pharynx, frequently declares itself in both forms of this disease, but more particularly in the confluent. Before we ome to the medicines to be administered in the different stages of the disease, we may say a few words upon the general treatment of the patient. Cool and fresh air are our best auxiliaries, the variolous virus being of a nature to react upon the organism, and warmth being calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open window when attacked with convulsions, will generally be found to afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pustules, the room ought to be kept as dark as possible, to aid in preventing the risk of disfigurement, a precaution deducible from common experience, since we find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease. THERAPEUTICS. In the first or febrile stage of the disorder, COFFEA is valuable in allaying the nervous excitability generally present. ACONITE may either follow or precede this medicine when the fever runs high, and visceral congestion threatens. CHAMOMILLA is often of great service at this period, or during the course of the disease in children, when there are dyspnoea and diarrhoea, with colic and vomiting; or when startings or convulsions set in, prior to the appearance of the eruption, and again, during the maturative stage, when the nights of the little patient are much disturbed by a troublesome 160 ERUPTIVE FEVERS. cough. Should Chamomilla afford but slight relief, Belladonna may be administered. When considerable tightness and oppression at the chest, sometimes attended with nausea and vomiting, are experienced before the appearance of the eruption, the alternate use of Ipecacuanha and Antimonium tartaricum affords speedy relief. The latter remedy is, moreover, well indicated when convulsions precede the evolution of variola; and, from the close analogy which the eruption it is capable of producing bears to that of smallpox, may be administered with advantage during the eruptive and maturative stages also, unless some other remedies should be more urgently called for by the nature of the symptoms; the existence of a hollow sounding cough with load nmucous rhonchus, is an additional index for the employment of Antimonium tartaricum. BRYONIA is sometimes useful in assisting the natural course of the eruption; it is also indicated when symptoms of considerable gastric derangement are present, such as bitter taste in the mouth, foulness of the tongue, headache, rheumatic pain in the limbs increased by motion, constipation, and irritability of disposition; also, when there are occasional shooting pains in the chest, especially during inspiration. Ruus is equally serviceable at this stage of the disease, and particularly, when the acute pains in the head, back, and loins are aggravated during a state of rest, and temporarily relieved by movement. BELLADONNA. This remedy may follow Aconite, wlien the latter has been indicated, should symptoms of cerebral disturbance have set in, characterized by flushed countenance, intolerance of the eyes to light, headache, and delirium, great thirst, nausea, and vomiting; or, when there is redness of the tongue at the tip and margins; abdomen tumid and painful, particularly at the epigastrium, with sensibility on pressure; prostration of strength, stupor, &c. For additional indications for the employment of this remedy see INFLAMMATION OF THE BRAIN AND ITS TISSUES. OPIUM is useful when there are symptoms of stupor or strong inclination to somnolence. If Antimonium tartaricum and Ipecacuanca do not succeed in allaying the nausea and vomiting, and the patient com SMALLPOX. 161 plains of excessive thirst and dryness of the mouth, the tonygue being at the same time very foul and dark, and the prostration of strength excessive, we may prescribe ARSENIcuM-(the dose to be repeated every two or three hours, if required, but the remedy must be discontinued as soon as decided benefit has resulted from its action). The last symptom generally occurs after the maturation of the eruption and secondary fever.* PULSATILLA is occasionally of considerable utility in confluent smallpox, when an efflorescence, similar to that of measles, precedes or accompanies the eruption, attended with nausea or vomiting, and aggravation of all the symptoms towards evening. An occasional dose of Stramonium, two globules, is sometimes useful, when some pustules are already formed, in forwarding the eruption, and shortening its duration. During the filling up of the pocks, a secondary or suppurative fever frequently sets in, particularly when the pustules are thick, and evince a disposition to run into the confluent form; when, moreover, there is swelling of the head, inflammation of the eyes, throat, and nose, with salivation, hoarseness, and impeded deglutition; tenderness of the stomach; diarrhoea, with tenesmus, and sometimes sanguineous stools. Having, if this remedy be called for, first attacked the more prominent febrile symptoms, with ACONITE, we should have recourse to Miercurius, 3-6, a few hours afterwards, in repeated doses, until amelioration declares itself. When the fever runs high, in confluent smallpox, and threatens to continue so, as it often does throughout this form of the disease, Aconite must repeatedly be had recourse to, and given in alternation with Sulphur, when not sufficient of itself to mitigate the excessive febrile action. * In some cases, and especially those of a bad type, livid spots, or diffused ecchymoses are observed on the skin, prior to the evolution of the eruption (variolce nigra). Arsenicum is here also of considerable service, particularly when great weakness and languor, thirst, nausea, or vomiting, with pain in the epigastrium, are present. Acidum murialicum, in repeated doses, has been found of important service in cases of a similarly bad type, with typhoid fever, and constant tendency of the patient to sink downwards in the bed. 11 162 ERUPTIVE FEVERS. While the disease is running its course, particularly during the distension of the pustules (should no other remedies be imperatively called for), and also towards the period of their bursting, we may safely administer an occasional dose of YJercuri'us as above, and in the latter case, follow this medicine with a dose or two of SULPHUR, to assist in the desiccation. When rheumatic pains, in the back and extremities, which become worse at night, and are somewhat relieved by movement, are complained of at this period, Rhus may be advantageously alternated with Sulphur.. Rhus is, moreover, extremely serviceable in confluent smallpox, when the fever assumes a typhoid type, attended with the signs denominated putrescent; AMercurius and Arsenicum are also occasionally useful in the latter case, when indicated by the character of the symptoms. (See TYPHus.)* During the period of desiccation, frequent laving of the pustules with tepid water and bran, and gently drying them afterwards, will be sufficient; cleanliness being then the great requisite, combined with a careful attention to diet. REPERCUSSION OF THE ERUPTION. When this has taken place, and symptoms of cerebral disturbance have set in, we may have immediate recourse to Cuprum aceticum, provided Belladonna, Sulphur, Bryonia, or some other remedy be not better indicated. Some physicians, in their treatment of the affection, divide it into two distinct stages; we have, however, contented ourselves, when necessary, with slightly referring to them. Should Laryngitis supervene during the course of smallpox, we must have immediate recourse to Aconite, Hepar s., Spongia, Belladonna, Lachesis, Arsenicum, or.Mercurius, &c. (See LARYNGITIS.) Against the cough, which sometimes results from an attack of smallpox, Belladonna, iJfercurius, and Arsenicurn, are three of the most appropriate remedies in most cases (the particular indications for which will be found in the article on COUGHS, which see); *When Pleurilis or Pneumonia intervene during the progress of the disorder, the remedies mentioned under these different heads must be had recourse to. The invasion and progress of the latter disorder are sometimes so insidious, that, unless the aggregate signs of pneumonic inflammation be narrowly looked for, disorganization of the lung may take place before the existence of such a complication is detected. SMALLPOX, 163 and against asthmatic symptoms, attended with mucous rattling in the chest, Tartarus emeticus should be employed, and followed by Senega, if insufficient to effect a cure. When, in the suppurative stage of confluent smallpox, the pus becomes sanious, and sphacelus is apprehended, Arsenicum and Carbo v. may exert a beneficial effect. Cinchona and Phosphorus have repeatedly been found specific against the Diarrhoea, which occasionally results:and against the Ophthalmia, Conium, Belladonna, ITepar sulpkuris, Euphrasia, Sulphur, Calcarea, Arsenicum, Pulsatilla, Iercurius, Nux vomica, and Bhus toxicodendron, have been found the most useful remedies. MODIFIED SMALLPOX is merely a mild description of the above, and, as we have before said, is the form the disease generally assumes, when it attacks those who have been properly vaccinated. We must regulate our treatment according to the symptoms, being guided in the selection of the remedies by the indications before given.* DIET should be regulated by the virulence of the attack; but, in all instances, the beverages should be cold, as a warm regimen, and neglect of the precautions before mentioned, may convert the mild into the malignant form. After recovery, it is necessary that the patient abstain, for a considerable time, from animal food. It may be remarked that, after an attack of malignant smallpox, the patient's constitution generally requires a thorough renovation,-he should, therefore, be.put under a course of medicine best calculated to attain that result. CHICKEN-POX. Variola spuria, Varicella. DIAGNOSIS. A disease, bearing a considerable resemblance, in its external character, to smallpox, but differing in * I have given in detail the treatment which has been generally adopted by the Homoeopathists, and with great success. But it may here be added that Vaccinine given internally, has obtained much repute, as an impor. tant and eminently successful remedy, in the treatment of variola, the most virulent cases having been reported to have yielded to it, with a promptness and certainty, that would afford another great illustration, if such were needed, of the truth of the homoeopathic law. 164 ERUPTIVE FEVERS. its duration, and symptomatically, being considerably milder, generally requiring no medical assistance, but merely attention to diet, and but rarely becoming dangerous, except when the lungs or brain become involved. The fever, however, occasionally runs high. When this affection attacks an individual during the prevalence of smallpox, which is not unfrequently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with which the eruption declares itself; the pustules (in many instances closely resembling those of the smallpox), being generally fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark. THERAPEUTICS. When much fever is present, we should check it by the administration of ACONITE, repeated from time to time as required, or COFFEA, also occasionally repeated, if there be simply extreme restlessness and anxiety. When cerebral symptoms threaten, BELLADONNA must be given; for the employment of this medicine, see INFLAMMATION OF THE BRAIN. When the complaint is attended with convulsions in children, particularly during dentition (see CONVULSIONS), Antimonium tartaricum may be given to accelerate the eruption. MERCURIUS may be employed when the lymph of the pustules becomes converted into pus, as in the smallpox, and is also beneficial if strangury be present. For the course of treatment to be adopted when the eruption has been driven in, see REPERCUSSION OF THE ERUPTION in SMALLPOX. In anomalous cases, where other symptoms supervene, more closely resembling smallpox, we may refer to the remedies mentioned under that disease. MILIARY FEVER. Miliaria. Miliaria alba. Miliaris sudatoria. Sudor miliaris. DIAGNOSIS. The primary feature of the disease consists of a great number of exceedingly small, round, red pimples, which are soon converted into white vesicles, afterwards become opaque, and end in scurf; they are irregularly scat MILIARY FEVER. 165 tered, of the size of millet-seeds (hence the name of the complaint), and when the hand is passed over the cutaneous surface, a sensation is experienced as if caused by the presence of small grains of sand beneath the cuticle. This affection is sometimes idiopathic, but more frequently associated with fever, and even occasionally accompanies various chronic diseases, in which latter instance, it may generally be considered as an evidence of some internal constitutional taint; it is most frequently met with in women, particularly at the turn of life, and at the period of confinement (arising from the room being kept at too high a temperature-a frequent cause of this malady). This, like other cutaneous affections of the same nature, is generally preceded by febrile symptoms, the eruption appearing on the fifth or sixth day; from the commencement of the fever we frequently find profuse perspiration, with a putrid sour odor; previous to the vesicles evolving themselves, there is a tingling or itching of the skin, occasionally attended with a sensation of burning, together with a numbness of the extremities; the patient complains of dyspnoea or a sense of oppression at the chest, sometimes with short dry cough, and stitches in the side, and not unfrequently, of creeping, tingling, numbness, weight and stiffness in the extremities, or severe or fugitive rheumatic pains in the limbs and teeth. Low spirits, excessive anxiety, extreme restlessness, sighing, tinnitus aurium, violent palpitation of the heart, irrregular pulse, and the emission of clear, colorless urine, are also frequent premonitory indica tions of approaching Miliaria. PROGNOSIS. This must be regulated by the severity of the accompanying symptoms. Death often takes place suddenly, particularly on the shrinking of the vesicles. When the morbid signs decline after the appearance of the eruption, the termination of the disease will commonly be favorable. In malignant forms of the complaint, a fatal issue sometimes takes place within twenty-four or forty-eight hours. The general course of the disease varies from four or five days to three weeks. Convalescence, in severe cases, rarely sets in before the fourth week. THERAPEUTICS. In consequence of the numerous diseases with which miliary fever is complicated, it requires a 166 ERUPTIVE FEVERS. variety of medicaments. When it appears in a simple and apparently idiopathic form, and is attended with anxiety and restlessness, which seem to depend upon an accelerated circulation of the blood, with great internal and external heat, ACONITE is a specific remedy. When the above symptoms seem more particularly to arise from high nervous excitability, Coffea is indicated. BELLADONNA should be administered when the accelerated circulation is attended with considerable determination of blood to the head, and delirium; but Arsenicum is the most appropriate remedy when the eruption is accompanied by excessive anxiety and oppression at the chest. (Veratrum is sometimes useful after or in alternation with Arsenicum.) When the disease is found conjoined with puerperal or other fevers, and is preceded by oppression, lassitude, anxiety, and a sense of weight about the chest, restlessness, sighing, &c., it is generally speedily subdued by IPECACUANHA; when, however, the symptoms, which precede the eruption, are accompanied by constipation, or shooting pains in the chest, Bryonia should be selected. Nux voMICA is useful when aching, gnawing pains are experienced in the epigastric region, attended with eructations, constipation and other signs of gastric derangement. CALCAREA CARBONICA is a most valuable medicament in critical miliary fever, especially against the extreme anxiety which is so frequently manifested, or against the convulsions which sometimes take place in the case of children, and finally as a general remedy to hasten the development of the eruption when it is tardy in making its appearance. CHAMOMILLA (followed, if no alteration takes place, by Tincture of Sulphur) is also useful when the disease occurs in children, brought about by excessive warmth, or even errors in diet, attended with a watery, greenish or yellowish diarrhoea. Puls., Tart. stibiat., Stram., Acid.phosph., Led., Cocc., or Carb. v., may be required in certain cases. When this disease is benign and appears in an idiopathic form, it is rarely so severe as to require a very frequent repetition of the medicines if the accessary treatment, about to be pointed out, be carefully attended to-in most cases, a globule MILIARY FEVER. 167 or two, repeated in from four to twelve hours, according to the intensity of the disease, will be found sufficient, and, in some instances, a single dose will dissipate all the symptoms, or at least so modify them that we may safely trust to nature to perfect the cure-but it is otherwise in the severer or more complicated forms of the malady. (See also SCARLATINA MILIARIS). REMARKS. When it exhibits itself in complication with other affections, Miliaria may be either symptomatic or critical, and the physician should always bear in mind that an improper treatment of other affections may develop it. When symptomatic, it may be recognized by appearing either very early or late in the original affection, which, so far from being relieved by the eruption, is frequently exacerbated by the excitement of the nervous system consequent on its appearance. Even when critical,-in which case, after the eruption has been fully developed, amelioration takes place,-it is still dangerous from its liability to retrocede. When the disease is very prevalent, its outbreak amongst lying-in women may generally be prevented, if proper attention be paid to keeping the patient cool by light covering and the removal of feather beds, and allowing a free supply of pure air. When, however, it appears critical, we must be most careful not to check it, and a moderately warm temperature must be kept up. REPERCUSSION OF THE ERUPTION. When this has taken place we must carefully watch the result, as sometimes nature herself provides for it by an increase of some other secretion, but when symptoms of cerebral disturbance, &c., present themselves, Cuprum aceticum, Calcarea c., or Belladonna, &c., must be had recourse to, according to circumstances. (See articles SCARLET FEVER, and SCARLATINA MILIARIS.) DIET. Same as already given for FEVER, modifying it according to the violence of the symptoms; when repercussion threatens to take place, the patient's beverages should be given moderately warm. NETTLE RASH. Urticaria. DIAGNOSIS. Spots or wheals, flat or prominent, and of a dull white color, like the sting of a nettle, or redder than 168 ERUPTIVE FEVERS. the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and reappearing when exposed to cold, evolved suddenly and continually changing their situation. This eruption is brought to the surface by various causes, not unfrequently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with restlessness, languor, oppression, and want of appetite, derangement of the digestive functions, and fever. When the eruption breaks out the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected. This disease, in almost all cases arising from a constitutional cause, requires for its total eradication a regular course of treatment. THERAPEUTICS. In acute cases, the remedies found most useful are Dulcamrara, Aconite, Nux vomica, Pulsatilla, Antimonium crudum, Belladonna, Hepar sulphuris, Rhus toxicodendron, and Bryonia. DULCAMARA, when the exciting cause has been cold or damp, when the affection occurs in wet weather, or when we find considerable fever with bitter taste in the mouth, foul tongue, diarrhoea, pains in the limbs, and extreme itching, with a burning sensation after scratching. ACONITE, when the febrile symptoms are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present. Nux VOMICA, when there is considerable gastric derangement, with constipation, more especially when arising from wine, stimulants, or indigestible substances; it may, if necessary, follow Aconite in eight or twelve hours after the febrile symptoms are somewhat modified. PULSATILLA deserves a preference, under similar circumstances, when the bowels are relaxed, and the patient is of a quiet disposition and lymphatic temperament, and the attack has apparently been excited by indigestible food. ANTIMONIUM CRUDUM may follow Pulsatilla, should the latter have failed to relieve the affection. BELLADONNA is indicated when the affection is attended with a severe throbbing headache, with redness of the face. NETTLE RASH. 169 HEPAR SULPHURIS has frequently been found useful in urticaria accompanied by cold in the head, and particularly when the coryza was confined to one nostril. RIIs TOXICODENDRON is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection has apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. (See Article on DIET in Introduction.) PRESCRIPTION. In ordinary cases, we. may prescribe 6-12 globules of the sixth dilution in six dessert-spoonfuls of water, and order one to be taken morning and evening, except in the case of Aconite, which may be more frequently repeated, when the febrile symptoms seem to demand it.* In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external applications or lotions; a sudden retropulsion, as before noted under SCARLATINA and SMALLPOX, being frequently attended with fatal consequences. When, however, from improper treatment, we have reason to dread this having taken place, we may generally succeed in re-establishing the eruption, and thereby averting any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symptoms declare themselves, the complaint should be treated as before described under SCARLATINA, &c.,--Reercussion of the eruption, which see. URTICA URENS has been found useful in some cases; and in those of a chronic or extremely obstinate character, Calcarea, Lycopodiumn, Sulphur, Carb. veg., Causticum, Acid. nitric., Conium, Natr. mur., &c.; the last two, particularly, when the eruption is liable to reappear after violent exercise or exertion of any kind; Calcarea, when exposure to cold fresh air produces it, and Acid. nitricum when it arises from the patient going into the open air, after having kept within doors for a day or two. * See the directions for the repetition of the dose in the INTRODUCTION. DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM. TOOTHACHE. Odontalgia. WHEN we find a constant disposition to this distressing malady, on the slightest exposure to cold, without any presumable cause, or what is generally called rheumatic toothache, we are warranted in concluding that some taint lurks in the constitution, and until proper measures are adopted for its eradication, even the remedies most clearly indicated under other circumstances, fail to relieve the patient, or at most but temporarily alleviate his sufferings. Another obstacle to the selection of the proper remedy is the difficulty we find in obtaining from the patient a perfectly clear description of his sensations. We shall, nevertheless, mention a few of the remedies which have proved most efficacious in the relief of toothache, and when the symptoms of the sufferer approximate closely to the indications given for the several medicines, they will in very many cases afford a prompt relief. THERAPEUTICS. Among these, Belladonna, C(hamomilla, Mercurius, Nux vomica, Pulsatilla, Sulph)ur, Carbo vegetabilis, Iiepar sulphuris and Arsenicum, hold a high rank. ADMINISTRATION. The medicine selected may be taken dry, or dissolved in a little water; and if an aggravation of pain is experienced soon after taking the medicine, the dose must not be repeated, as this is generally succeeded by considerable relief; but when the pain threatens to get worse again, the same remedy, may be repeated, provided the symptoms are of a similar description to what they were before taking the remedy; if they have altered, select another medicine. BELLADONNA is particularly indicated when the pains are very severe, of a drawing, tearing, or shooting nature, extending to the face and ears; becoming aggravated in the evening, especially at night, with gnawing or boring pain in the carious teeth, swelling of the gums and cheeks, dryness of the mouth TOOTHACHE. 171i with excessive thirst, with or without salivation: renewal of the pains from intellectual labor, or after eating; aggravation of suffering when masticating; also in the open air; congestion to the head, with heat and redness of the face, also pulsation in the head and cheeks. CHAMOMILLA, when there are severe drawing, jerking, pulsative or shooting pains; heat and redness, especially of one of the cheeks; the pain becomes almost insuferable, especially at night in the warmth of the bed; shooting and pulsative pains in the ear of the affected side: the pains are aggravated by eating or drinking anything hot or cold, but especially the former; great agitation and loss of self-control from pain, or excessive weakness, sometimes amounting to fainting; great irascibility, and disposition to shed tears during the paroxysms. Chamomilla is useful when the toothache has arisen from an abuse of Coffee,* in which case NAux vomica and Pulsatilla are also valuable, when indicated by the symptoms. ihus and Dulcamara frequently answer best after Chamomilla in toothache from cold, when the last-mentioned remedy has not removed the attack. And when the toothache returns after every exposure to cold, Sulphur is, generally, the best remedy, but in some cases, Cinchona. MAERCURIUS is particularly indicated when the pains affect carious teeth, or exist in the roots of the teeth, and consist of tearing, shooting pains, occupying the whole side of the head and face of the part affected, and extending to the ears; loosening of the teeth, and a feeling as if they were too long; the pain becomes almost insupportable towards evening, and especially at night in the woarmth of the bed, and is also aggravated by eating or drinking, particularly after anything cold has been partaken of, and likewise by exposure to cold or damp air; swelling and inflammation of the gums; nocturnal perspiration, peevishness, and inclination to tears; this * Those who are subject to toothache ought to abstain from coffee altogether; as also from very hot or cold drinks, stimulants of every description, sweetmeats and acids; they ought farther to refrain from using medicated tooth-powders, particularly if they wish to derive any benefit from homoeopathic treatment; the toothpick ought to be cautiously used if required, and the mouth well rinsed with tepid water (or about the same temperature as that of the mouth), night and morning, and after each meal. 172 DIGESTIVE SYSTEM. medicine is especially useful in persons who are subject to glandular swellings. Nux voMICA is useful for persons who are habituated to wine, cofee, or other stimulants, or addicted to a sedentary life, or to severe study; of lively or irritable temperament, dark or florid complexion; or whose sufferings are increased by intellectual labor. The pains generally occur in carious teeth, and are of a drawing and jerking or gnawing description, occasionally diffusing themselves to the head and ears, sometimes attended with painful enlargement of the submaxillary glands: gums swollen and painful, accompanied with throbbing and pulsation. The toothache is more liable to come at night or on awaking in the morning, sometimes also after dinner or in the open air. PULSATILLA is peculiarly adapted to persons of a mild or phlegmatic disposition. The pains are digging and gnawing, attended with pricking in the gums, and extending to the face, head, eye, and ear of the side affected; this remedy is particularly efficacious in toothache, when accompanied with earache, or with paleness of the face, when the affection has been excited by taking cold, and when we find shortness and difficulty of breathing; the pains are sometimes of a drawing, tearing, shooting, or jerking description, and occasionally produce a sensation as if the nerve were drawn tight, and then suddenly relaxed; the pain is much aggravated in the evening or after midnight, generally increased by warmth and when the patient is at rest, and mitigated by cold air or cold applications to the mouth. SPIRIT. SULPHURIS. This remedy is particularly valuable in strumous habits, with a tendency to constipation. It is indicated by pain, sometimes attended with swelling of the cheek, and shooting pains in the ears, congestion of the blood to the head, and pulsative headache the pain is of a tearing, jerking, pulsative description, affecting both carious and sound teeth; aggravated in the evening and at night, or by exposure to the open air, also by the application of cold water or by mastication; sensation as if the teeth were loosened, elongated, and set on edge; the gums are swollen, affected with pulsative pains, and bleed easily. BRYONIA is also a useful remedy in this affection, particu TOOTHACHE. 173 larly with persons of a lively, choleric, and obstinate disposition. Its indications are loosening and sensation of elongation of the teeth, especially during or after eating; shooting in the ears, with inclination to lie down, pains aggravated by taking anything hot in the mouth, mitigated by lying on the affected side or exacerbated by the contrary position. CARBO VEGETAILIS is indicated by toothache, with dragging, tearing, or constrictive and throbbing pains, excited by anything hot, cold, or salt; chronic looseness of the teeth; receding, ulcerated, and suppurating gums (particularly after the abuse of mercurial preparations, such as calomel, etc.), bleeding of the teeth and gums, with tendency of the teeth to decay rapidly. HEPAI SULPHIURIS is indicated by dragging, jerking toothache increased by approximating the teeth (clenching), by masticating, or from sitting in a warm room; swelling of the gums, with tenderness on pressure, or abscess in the gums. This medicine is especially useful in cases where hurtful doses of Mercury have previously been taken under allopathic treatment. ARSENICUM, when there is nocturnal pain, which extends into the ear, cheek, bones of the face, and temple; aggravation of the pain by lying on the affected side; amelioration from the warmth of the fire; aching in the teeth so excessive as almost to drive the patient to madness or distraction; sensation of elongation and looseness of the teeth; grinding of the teeth, and bleeding of the gums. Aconite, Belladonna, Chamomilla, Coqfea, and Ignatia, are the most useful in affections of this nature with children. ACONITE, when the pains are difficult of description, or are described as being of a pulsative nature, attended with great agitation, feverish sensation, blood to the head, heat and redness of the face, and when the pains are described as of a pulsative, throbbing nature. COFFEA, against violent pains with great excitability and almost distraction in adults; also when the patient is conscious that the excitement is disproportionate to the pain suffered. For Clamomilla we have already given indications; if it prove insufficient, and the toothache has been caused by a 174 DIGESTIVE SYSTEM. chill, and is attended with diarrhoea, we may substitute DULCAMARA. IGNATIA is suitable for such cases as present similar indications to those of Nux vomica or Pulsatilla, but more particularly applicable to mild or sensitive dispositions, with alternation of high and low spirits. TARTARUS EMETICUS will often be found beneficial in toothache occurring during cold, wet weather,-particularly in women,-with nocturnal exacerbation, or aggravation of the pain when drinking any cold liquid.* ASAFUETIDA may generally be prescribed with advantage when the pain is chiefly of a subdued description, and is intermittent; also when it partakes of a burning or shooting character, and seems to proceed from within outwards. SORE THROAT, OR QUINSY. APHTHOUS SORE THROAT. Agina faucium, Tonsillitis phlegmonoides, Cynanche tonsillaris.-Anginca aphthosa, etc. DIAGNOSIS. Inflammation of the throat, denoted by swelling and red color of the back part of the throat, accompanied with difficulty of swallowing, impeded respiration, alteration of the voice, and fever. In the incipient stage of this affection, there is a sense of constriction about the throat, with a feeling of soreness, and sometimes of obstruction in the act of swallowing the saliva; if it runs its course, the difficulty of swallowing and breathing increases, the tongue swells and becomes foul, the tonsils assume a redder hue, occasionally a number of small yellow eminences appear at the back of the throat, particularly on the tonsils; the patient complains of thirst, and the pulse is high, strong, and frequent; sometimes the cheeks swell and *In rheumatic or arthritic toothache with nocturnal aggravations, or increase of pain on partaking of cold or warm drinks, but with temporary relief on the external application of heat; also in toothache which returns every spring or autumn during the prevalence of easterly winds (and then continues sometimes for several weeks), the pain being occasionally confined to one tooth, which is extremely sensitive to the slightest touch, and often accompanied with acute shootings into the ear, Rhododendron Chrysanthum is a useful remedy, in repeated doses. SORE THROAT, OR QUINSY. 175 become florid, and the eyes inflamed, and in severe cases delirium is not an unfrequent occurrence. As the local affection progresses the majority of the foregoing symptoms become aggravated, and the tonsils tumefied, and suppuration ensues if resolution be not speedily effected. When suppuration takes place, the pain is instantly relieved on the bursting of the abscess; it sometimes happens, however, that scarcely has the patient been relieved from suffering by the latter event, before the state of the other tonsil gives indications that a similar train of symptoms are about to be encountered there. This affection, occasionally dangerous, if not properly treated, even in its simple form, becomes particularly critical when it puts on the putrid type. In such instances, the attendant fever generally assumes a typhoid character; when this takes place, we may always infer a peculiar constitutional tendency. THERAPEUTICS. The following are the principal remedies used in the treatment of quinsy: Aconitum, Belladonna, Mercurius, Carbo v., Acidum nitricum, Lachesis, Pulsatilla, NVux., Arsenicumn, Chamomilla, Ignatia, Dulcamara, Hepar sulphuris, Silicea, Sulphur. When this disorder is, at the commencement, attended with considerable fever, thirst, and dry heat, deep redness of the parts affected, painful and difficult deglutition, pricking sensation in the throat, with aggravation of the symptoms when speaking, we should have recourse to AcoNITUM. The next medicament we shall mention, Belladonna, as may have been observed in the treatment of Scarlatina, Measles, &c., is one of the best remedies we possess against phlegmonous inflammation of the throat, more especially when it occurs in plethoric or lymphatic subjects. The following are the symptoms by which it is particularly indicated: Pain in the throat as if from excoriation, attended with scraping, and a sensation of enlargement, and burning or shooting pains, principally experienced during the act of swallowing; these pains sometimes extend to the ears. Other characteristic indications for this remedy are-a sense of spasmodic constriction or contraction of the throat, with constant and almost uncontrollable desire to swallow the saliva; occasionally there is violent thirst, with dryness of the throat, 176 DIGESTIVE SYSTEM. but a dread of drink from the suffering it occasions. Sometimes a complete inability to drink exists, and the liquid returns by the nostrils. On examination, the throat presents a bright red colour, with swelling of the palate, uvula, and tonsils; there is also an accumulation of slimy whitish mucus in the throat and on the tongue, obliging the patient to spit frequently; swelling of the muscles and glands of the neck, severe headache, chiefly confined to the forehead, sometimes determination of blood to the head, and delirium. (After Belladonna,-Xercurius, lachesis, or Pulsatilla are often suitable.) This remedy frequently succeeds in speedily removing the whole of the above group of symptoms, or, at least, so far subdues them as to enable Mercurius to complete the cure. BRYONIA. Painful sensibility of the throat when touched, and on turning the head; difficult and painful deglutition, as if a hard body were in the throat; shootings, and sensation of excoriation and dryness in the throat which prevents speaking; fever with or without thirst, or shivering and coldness; irascibility and irritability. [Swelling of the back of the throat, the palate and mouth; abundant secretion of saliva; constipation; cold in the head and hoarseness; dry cough and oppressed respiration. Bryonia follows the Aconite advantageously in practice.-R. L., Ed.] [BARYTA, when there are penetrating pains in the throat on empty swallowing; pressure and shooting pains on swallowing aliments; strong swelling suppuration of the palate and tonsils; obstructions to speech and deglutition; sometimes, in the morning, dryness and painful stitches on swallowing; recurring at night; contraction of the throat, with laboured respiration after meals; efforts to belch; scratching in the throat; humid coryza, with dry cough, alternate chills, and flushes of heat. The Baryta renders the greatest service when the Argina lingers, remains stationary, passes over to the chronic state, or resembles scirrhus.--. L., Ed.] MERCuRIus is frequently valuable at the commencement of the disease, and forms one of our best remedial agents; in some cases advantage accrues from the employment of Belladonna in alternation with it. The indications for its selection are: violent shooting in the throat and tonsils, especially SORE THROAT, OR QUINSY. 177 when swallowing,-these pains extend to the ears and glands before the ears, and under the jaw; inflammatory redness and swelling of the affected parts of the throat, burning in the throat, desire to swallow, attended with a sensation of an obstruction existing in the passage; accumulation of thick and tenacious mucus in the throat, difficult deglutition, especially of liquids, which sometimes escape through the nostrils; swelling of the glands, and muscles of the neck, and of the posterior part of the tongue; occasional swelling of the gums; unpleasant taste in the mouth, which is filled with saliva more or less inspissated; throbbing, and formation of matter in the tonsils; (confluent, or small, isolated, round, white specks or vesicles on the tonsils; indolent ulcers in the throat;) (Angina aphthosa); offensive odor from the mouth; aggravation of the symptoms at night, from the act of speaking, and in the evening; chills, and shivering, sometimes alternated with heat; nocturnal sweating. Lachesis, Hepar.sulphuris, Carb. veg., or Acid. nit. are often suitable after Miere. CANTHARIDES, when the throat manifests a burning and grating sensation; when there is redness and tension in the mouth; or pressure terminating in shooting pains on swallowing; or when the patient cannot swallow liquids; has a bitter and sour taste; white tongue; salivation; violent tickling in the larynx; dry cough; sometimes followed by bloody expectoration, and labored painful respiration. Cantharides has proved useful at the conclusion of inflammatory and at the commencement of catarrhal sore throat.-R. L., Ed. LACHESIS. One of the characteristic indications for this remedy is, aggravation of all the symptoms on awaking from sleep, or an increase of the pain in the throat from the slightest external pressure; it is, moreover, an excellent remedy in cases of tonsilitis in which Belladonna or Mercurius have afforded relief, but seems incapable of effecting resolution; and also in aphthous sore thaoat with considerable ulceration, when Mercurius has afforded only partial relief. CARBO VEGETABILIS. This remedy may either follow, or be selected in'preference to Mercurius,-after a previous dose or two of Aconite when necessary,-in Aphthous sore throat characterized by the appearance of small white specks or 12 1T8 DIGESTIVE SYSTEM. pimples (which, if not checked, become confluent and spread beyond the throat) on the enlarged and protuberant tonsils, when the patient complains of severe burning and pricking pain, with great thirst. ACIDUM NITRICUM is indicated when Aconite and Mercurius have been administered in Aphthous sore throat, characterized by superficial ulcerations in the throat, and the small white or gray ulcers refuse to put on a healing appearance a few hours after the use of the latter remedy. Nux VOMICA. This remedy is especially useful when the sore throat appears to arise from, or to be accompanied by, symptoms of deranged digestion, and when a sense of scraping or excoriation exists in the throat, and also when a feeling of contraction is experienced in the upper part of the throat during empty deglutition; secretion of viscid mucus, which can be expectorated only with great difficulty, and sometimes accumulates in such a quantity as to threaten suffocation; or there is swelling and elongation of the uvula, producing a constant desire to swallow; at times only a sensation of swelling, with aching pressive pains; or when cold has been the exciting cause, and the affection is attended with dry cough and headache, chiefly in the morning, and pains under the lower ribs during the cough. This remedy is likewise indicated when there are small offensive ulcers of the throat, or when considerable debility is present. (Vide ULCERATED SORE THROAT. Sulphur is frequently useful after Nux vomica.) PULSATILLA is frequently serviceable after Belladonna when there is an undue secretion of viscid mucus in the fauces;but it is more particularly when the following symptoms are met with that this remedy is called for: gastric derangement, with dark livid redness of the throat and tonsils; a sensation as if the parts affected were much swollen, or a feeling of enlargement in the upper part of the throat, as also of excoriation and scraping, with dryness of the throat without thirst; shooting pains in the throat when not swallowing; aggravation of the symptoms towards evening, attended with shivering; also accumnulation of adhesive mucus in the throat. This remedy is more particularly suitable for females, or for individuals of a mild and phlegmatic temperament. CHAMOMILLA is a remedy particularly useful in sore throat SORE THROAT, OR QUINSY. 179 when it occurs in children, or in nervous or sensitive females who suffer much from trivial ailments, and especially when the disease has been brought about by checkedperspiration,when there are shooting or burning pains, with a sensation of swelling in the throat, deep redness of the parts affected, inability to swallow solid food, especially when lying down; thirst, with dryness and heat of the mouth and throat, or secretion of frothy saliva with burning heat in the throat and gullet; swelling of the tonsils and glands before the ear and under the jaw; cough excited by constant tickling in the throat, attended with hoarseness; fever towards evening; alternate heat and shivering, redness of theface, but especially of the cheek, great excitability and tossing about. IGNATIA is indicated when there is a sensation as of a plug in the throat when NOT performing the act of deglutition, with red and inflammatory swelling of the tonsils or palate; burning pains during the act of deglutition, as if the substance being swallowed were passing over an excoriated surface, or partially obstructed by some foreign body in the throat. Liquids are more difficult to swallow than solids; there are also shooting pains in the cheeks, thence extending to the ears, when not performing the act of deglutition; induration of the tonsils or evolution of small pustules upon them. DULCAMARA is generally a most useful remedy when sore throat, particularly in the form of tonsilitis, has arisen from exposure to wet. It may be followed by Belladonna or Mercurius, should it not wholly remove the affection, and should any of the symptoms given under these medicines present themselves. COFFEA CRUDA. Sometimes useful as an intermediate remedy when many of the symptoms enumerated under Belladonna, with the exception of the external swelling of the throat, are present; and also when there is a sensation as if the uvula were elongated or loaded with mucus, causing a constant inclination to swallow. One of the best indications for its employment in this, as in other diseases, is an over-excitability of the nervous system, characterized by sleeplessness, great restlessness, sensitiveness, disposition to weep, and peculiar impressionability to external agents. When the disease occurs in an aggravated form, or when 180 DIGESTIVE SYSTEM. it has been neglected, and all the parts have become so excessively tumefied that the mouth can scarcely be opened, the breath being at the same time extremely offensive, the tongue foul, and the strength much exhausted, Arsenicum may be given with advantage. (See also the indications for the employment of this remedy in sore throat, which have been already given under SCARLET FEVER, and will also be found under MALIGNANT SORE THROAT.) HEPAR SULPHURIS is valuable in bringing the matter to a head, when resolution cannot be effected, and the quinsy has attained to such a height that its bursting is desirable from the painful sense of suffocation, arising from the tumefied condition of the tonsils. SILICEA. This remedy is, in some instances, of greater efficacy than Ifepar in rapidly forwarding the suppurative process, and causing the ripened abscess to burst. It generally promotes incarnation more effectually than Hepar. MERCUnIUS may follow either of the last-mentioned medicines, after an interval of a few hours, to facilitate the healing. Silicea and, in some cases, Sulphur may be called for after Mercurius. Bryonia and Rhus have been found useful in some forms of sore throat, the former especially when attended with considerable gastric disturbance, and where there was great dryness of the throat, with redness of the soft palate and tonsils, but no swelling;-the latter where there was considerable fever towards evening, hot dry skin, aching and pricking pain during deglutition, lowness of spirits, and excessive anxiety. Bryonia is indicated by sore throat, with difficult deglutition and hoarseness; pain in the throat as from excoriation; excessive dryness of the throat, and pressure in the throat as if caused by a hard angular body; pain and pricking in the throat, which is also experienced on external pressure or on moving the head; accumulation of adhesive mucus in the trachea, temporarily removed by coughing. It is further called for when there is marked gastric disturbance, the tongue covered with a dirty yellow fur, the taste insipid, and the bowels confined; when there was severe frontal headache and very disturbed sleep, with dryness of the throat, redness of the tonsils and palate (velum palati), without ýswelling. Rhus toxicodendron, when the pains seem situated SORE THROAT, OR QUINSY. s181 lower in the gullet, the disposition of the patient anxious, depressed, or disposed to tears; and when Bryonia has not been sufficient tp remove the complaint. Where there is difficulty of swallowing, and, at the same time, a sensation as if a plug or some kind of foreign substance were in the throat,-Lachesis, Nuxw V., and Arsenicum are useful when otherwise indicated. Sulph., Bella., Baryta, Mere., Sep., Ign., Graph., Am. c. and Cocculus are also indicated by this latter symptom. In obstinate cases, such as are occasionally met with in bad constitutions, the healing of the cavity, after the matter has been discharged, goes on very unfavorably, and even fresh abscesses form in succession: Sulphur, Hepar s., and Psoricum, repeated every eight or twelve hours, have chiefly been recommended to subdue these fortunately rare symptoms; Sulphur in ordinary cases, Hepar, when the patient has been previously subjected to an abuse of Mercury under allopathic treatment, and Psoricum when Sulphur has been taken in excess. See Brit. Jour. of Homoeopathy, No. VII. SEPIA is a useful remedy in obstinate cases of angina, with pain in the fauces as if the parts were excoriated, and prickings during the act of deglutition. Relaxed sore throats generally require Vux, Puls., capsic., Gentians cruciana, or Sulph., &c. (See also the other remedies mentioned in the article on dyspepsia, as such sore throats are commonly connected with deranged digestion.) The following remedies may also be mentioned as being useful in angina when the symptoms are as described: YERATRUM ALBUM is indicated by constrictive and suffocating pain in the throat, particularly during deglutition; sensation of contraction in the gullet; sense of roughness and scraping, or of extreme dryness in the throat; intumescence and burning in the gullet, sometimes attended with danger of suffocation. CoccuLus, indicated by great dryness and sensibility of the gullet, causing everything partaken of to seem pungent, acid, or too salt; by constriction or sensation of paralysis in the gullet, and noisy or clucking deglutition. CAPsICUM is often useful in sore throat from cold, when Puls., Cham., Ign., Bry., or Nux v. afford little relief, particularly when a degree of fever continues, with shiverings 182 DIGESTIVE SYSTEM. and thirst, followed by heat; pressive aching pains, accompanied by a sensation of spasmodic constriction in the throat; distressing cough; constant desire for the recumbent posture and for sleep, with dread of the slightest breath of cold air. In gangrenous sore throat, or sphacelated quinsy:-Ars., Lach., Carbo v., Am. c., China, Conium, hus, or Baryta m. are the remedies which are chiefly to be relied on where there is any chance of recovery. (See ULCERATED SORE THROAT.) The DIET of the patient must be regulated acccording to the degree of inflammation present. If required, the throat may be gargled with a little warm water, and when much pain is present, inhalation of the vapour from boiling water will often afford considerable relief, but at the same time it may be observed that all medicinal gargles, blisters, leeches, or other topical applications are rendered unnecessary by proper homceopathic treatment. While we thus free the patient from a considerable degree of annoyance and needless suffering, we, at the same time, by a careful attention to the symptoms, and the exhibition of the proper remedy, effect a speedy cure. In overcoming the predisposition to sore throat, Mercurius, Sepia, Baryta m. and Graphytes have been found useful. The latter two particularly, when sore throat results after every exposure to cold, and is always prone to terminate in suppuration. ULCERATED SORE THROAT. Mialignant Quinsy. Malignant, putrid, or gangrenous Sore Throat.-Angina Maligna, Tonsilitis Maligna, Cynanche Maligna. This serious disease is also known by the name of Scarlatina ialigna, from the eruption with which it is frequently attended. It is usually epidemic, of a highly contagious nature, and generally occurs in damp and sultry autumnal seasons. It sets in with coldness and shivering, succeeded by heat and accompanied with great languor and oppression at the chest; nausea, or vomiting, and sometimes purging; eyes inflamed and watery; deep red color of the cheeks; the nostrils are also more or less inflamed, and secrete a thin acrid dis ULCERATED SORE THROAT. 183 charge, frequently causing soreness or excoriation of the nose and lips; pulse indistinct, or very weak, small, and irregular; tongue white and moist. The deglutition is painful and difficult, and the throat, on being examined early in the disease, is observed to be of a bright red color, and much tumefied; but this state is very -soon altered, and numerous ulcers of various sizes will then show themselves interspersed over the parts, which become covered with a white, grayish brown, or livid coat. In some cases, these ulcerations spread so widely as to extend over the whole fauces into the nostrils, or downwards even to the glottis and gullet, &c., and assume a sloughing appearance as they increase in magnitude. The prostration of strength, considerable from the first, is now excessive: the tongue, lips, and teeth are covered with brown or blackish incrustations, and there is more or less delirium; the breath is extremely fetid, and the patient himself complains of a disagreeable odor. The neck appears swollen and of a livid color, and an efflorescence of a faint scarlet hue, or blotches of a dark or livid red, sometimes intermixed with petechihe, break out on various parts of the body, and usually, though not necessarily, add to the danger,--as many are carried off, particularly children or persons of an advanced age, without any eruption, when the local symptoms are severe and the fever high,-- but the appearance of livid spots or petechioe, and other indications of so-called putrescency, with frequent shivering, weak fluttering or intermittent pulse, sunken countenance, severe purging, extreme prostration, and bleedings from the nose, mouth, &c., must decidedly be regarded as symptoms of imminent danger. When the local symptoms are mild, the danger is rarely great; and even in the severe forms of the disease, when a gentle sweat breaks out about the third or fifth day, when the sloughs throw off in a favorable manner, leaving a clean, florid, healthy-looking bottom, and the respiration becomes more gentle and free, the expression of the face more lively, and the pulse stronger and more equal, a salutary result may be held in expectation. THERAPEUTICS. The subjoined remedies will be found adequate to subdue the various forms which the malady 184 DIGESTIVE SYSTEM. assumes, where any prospect of a cure may reasonably be entertained from the commencement: Aconitum, Belladonna, Miercurius, Acidum nitricum, Pulsatilla, Arsenicum, Lackesis, Nux v., Carbo vegetabilis, Sulphur, &c. The accompanying fever being generally of a low typhoid character, ACONITE is rarely necessary in this complaint; however, there are cases, particularly when the fever runs high from the commencement, in which advantage is found to result from a dose or two of this remedy, followed by BELLADONNA as soon as the patient complains of dryness, with impeded deglutition and a sense of constriction or choking in the throat, which, on examination, is observed to be swollen and to present a florid red appearance. Belladonna is additionally indicated when the fever continues to run high; when the face is bloated and the eyes much inflamed; when the patient is affected with considerable delirium, and is, occasionally, with difficulty to be restrained from leaving the bed, or committing acts of violence; or, further, when the rash, which sometimes breaks out in this disorder, about the third day, presents a scarlet hue, and is smooth and glossy. In cases in which the symptoms are mild, or in which the above-mentioned symptoms have been reduced by means of the remedies quoted, and an increased secretion of mucus supplies the place of the previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting,-a dose or two of PULSATILLA may be administered with good effect. The progress of matters in the throat must, however, be carefully watched, and as soon as the presence of small ulcers, or still better, their incipient formation, can be detected, a dose of MERCURIUS should be prescribed, followed by ACIDUM NITRICUI, when, from the increasing size and painfulness of the ulcers, Mercurius does not promise to arrest their progress or cause them to assume a healthy aspect. In the milder forms of this disease, the two last named remedies will frequently be found sufficient to conduct it to a speedy and successful termination; but in those much more dangerous forms, which the complaint so readily assumes when it rages as an epidemy, and when the patient, at the commencement, is seized with vomiting and purging, attended ULCEREATED SORE THROAT. 185 with such prostration of strength as to render it impossible for him to leave the recumbent posture without feeling faint, and compelled to fall back exhausted by his efforts; when, moreover, the ulcerations spread with alarming rapidity, and early take on a sloughing character. In such cases, the conducting of the disease to a happy issue becomes obviously a much more serious and difficult task. Here the symptoms must generally at once be attacked by administering AuSENIcuM,-sometimes, however, benefit will be found to result from a dose of Pulsatilla beforehand, when there is an excessive degree of bilious vomiting,-but Arsenicum must unhesitatingly be had recourse to when there is that marked prostration of strength so characteristic of this disease, accompanied with nausea or vomiting; or when the ulcers present a livid hue. This important remedy is also indicated in a more advanced stage of the disease, when the ulcerations are covered with dark sloughs, surrounded by a livid margin; the teeth and lips incrusted with sordes; the tongue parched, cracked, blackish, and tremulous; the pulse small and irregular; and there is delirium or constant muttering; with frequent hanging of the lower jaw; laborious respiration; acrid discharge from the nostrils, causing excoriations; the eyes dull and glassy; the skin hot and dry, and the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty; finally, when the prostration of strength is so extreme that the patient seems rapidly sinking, and a rash of a livid color breaks out in blotches, here and there intermingled with petechise. [CONuLM is as energetic as the Arsenic, and has been employed with great success when the diseased parts have suddenly assumed an ash-gray color and a blackish aspect; ulcerations have formed, secreting a fetid matter, without much pain; the strength, and, with it, the natural temperature have suddenly declined; the spirits of the patient become anxious, indifferent, and prostrated; the febrile paroxysm becomes irregular, sometimes consisting of chills and heat, then of burning fever succeeding the chills, and concluding at night in a copious perspiration; whitish eruptions appear on the skin; the face grows pale; features change, with cedema; the tongue becomes covered with a thick coat, swells, is painful, 186 DIGESTIVE SYSTEM. and the speech is difficult; when the stools are diarrhoeic, bloody, and involuntary.-Mfercurius corrosivus is very useful at the commencement of angina. A prominent inflammatory swelling of the throat and tongue, a burning heat from the mouth to the stomach, oppression of the chest, vomiting, and unquenchable thirst, are the principal indications.-R. L., Ed.] LACHESIS will frequently be found'very useful after, and in some cases alternately with, Arsenicum, should the patient complain of great pain in the throat, which is aggravated by the slightest external pressure; or should the sloughs seem indisposed to cast off, and the neck become much swollen and discolored. CONIJM has been recommended when the diseased parts assume an ash-grey color and a dark brown or blackish aspect, paleness and puffiness of the face, swelling of the tongue, inarticulate speech, loose, sanguineous, involuntary stools, depression of strength and spirits, evolution of a whitish eruption on various parts of the body. When the tendency to gangrene continues, and the patient is still affected with considerable prostration of strength, accompanied with debilitating sweats, Cinchwon will often be found of service. Nux vomrica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous, small, foul, offensive ulcers are seen in the mouth and throat,-and may be succeeded by Carb. v., should a copious fetid ichor be discharged from the ulcers, attended with extreme exhaustion, and small, indistinct, or scarcely perceptible pulse. Secale cornutum may sometimes be administered with advantage in alternation with Carb., when the latter appears to afford but temporary benefit. Aius is occasionally useful in extreme cases, particularly if there be great muscular weakness, with trembling of the extremities, especially on movement; sopor, and other symptoms described under this remedy in the chapter on TYPHUS. When, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invigorated, the countenance more animated, and the sloughs are thrown off in a satisfactory manner, yet the ulcers threaten to become indolent; these will, generally, very speedily acquire a clean and florid bottom, and begin to INFLAMMATION OF THE (ESOPHAGUS. 187 cicatrize, on the administration of Acid. nitricum. In other cases the aid of Sulphur and Silicea will be found necessary. For further particulars in the treatment of malignant sore throat, the reader is referred to page 182 of this work (see also SORE THROAT). In conducting the cure, the utmost cleanliness, combined with free ventilation, ought to be strictly observed, for the double purpose of removing all malignant excretions and effluvia,-and thereby putting a check to the ready extension of the contagion,-and providing for the comfort and well-being of the patient. The diet should consist of semolina, sago, gruel, and similar articles of food. Angina Pharyngea. Pharyngitis. Cynanche Pharingea. Inflammation of the membrane that lines the pharynx is generally an attendant on tonsilitis; and, in like manner, when phlegmonous inflammation commences in the pharynx, it, for the most part, extends to the tonsils. In pharyngitis simplex, although there is usually some degree of inflammatory fever, it rarely attains a considerable height, and is, together with the local affection, with facility subdued by means of a dose or two of Aconite. When the inflammation spreads to the tonsils and neighboring parts, the same remedies must be employed which have been enumerated under ToNSILITIS, which see. When the velum palati is particularly implicated, Cofea, Belladonna, JMercurius, or Nux vomica answer best, after Aconitum, where the latter has been called for, but found inadequate to complete the cure. If, on the other hand, the uvula participates chiefly in the pharyngeal inflammation, NVux., Coffea, Bella., Mlerc., Sulphur or Calcarea are, in addition to Aconitum, the more important remedies. When a spasmodic, almost suffocating constriction of the gullet takes place in pharyngitis, and Belladonna, Mercurius, or Zachesis fail, Calcarea c. often affords rapid relief. INFLAMMATION OF THE UESOPHAGUS. (ESOPHAGITIS. Inflammation of the gullet is more frequently met with as a symptomatic disease. It is, accordingly, sometimes encoun 188 DIGESTIVE SYSTEM. tered in strictures, measles, smallpox, and in the case of tumors in the neighborhood of the oesophagus. It does, however, occasionally occur in an idiopathic form, either in consequence of mechanical or chemical irritants, or otherwise. The disease is indicated by the following symptoms: a sense of burning heat is experienced in the cesophagus, either high or low in the tube, according to the seat of the disease, with painful and difficult deglutition. The patient can almost always point out the locality of these, generally circumscribed, sensations; and consequently refers them either to the neck or to the back, between the shoulders and under the sternum. In the treatment of symptomatic cesophagitis, our attention must be directed to the removal of the exciting cause, when this is practicable. In the idiopathic form again, we must be guided, in the selection of our remedies, by the law similia similibus. Amongst the medicines which are capable of producing symptoms analogous to those which characterize the disease: Belladonna, Ifyoscyamus, Cantharis, Arsenicum, Jfercurius, Arnica, Carbo v., etc., are the most important. In some instances it may be found requisite to commence with ACONITUJM, but generally speaking, the attendant fever of the phlogistic character will find a sufficient antidote in BELLADONNo, which remedy is, moreover, better adapted to the collective features of the complaint. HYoscYAMus frequently succeeds -in removing any signs of spasmodic contraction in the gullet when Belladonna is insufficient to remove them; but when the burning heat continues unabated, and deglutition is still performed with great pain, CANTHARIs should be, resorted to. MIERCURIUS is especially useful when symptoms of incipient suppuration make their appearance; ARSENICUM when great prostration of strength sets in, either in the course of the complaint, or at the commencement of the attack, accompanied by intense thirst and sleeplessness. Should only partial relief result from Arsenicum, CARBO v. may be had recourse to. In other instances YERATRUM may be required. In cases arising from mechanical lesion, the early employment of ANICA has been favorably spoken of. The remedy selected in any case will rarely require to be repeated earlier than six to eight hours after the first dose; and subsequently at longer MUMPS. 189 intervals, if the symptoms are found to yield. When the symptoms become more unfavorable after an interval of twenty-four hours from the taking of the first dose, another medicament must be prescribed. MUMPS. Parotitis, Angina Parotidea. DIAGNOSIS. Inflammation with swelling of the parotid and submaixillary glands, sometimes running high, and extending to the throat and tonsils, with danger of suffocation. This complaint generally affects individuals under the age of puberty, and frequently declares itself as an epidemy, during the prevalence of cold damp weather. When properly treated, it is rarely dangerous, but particularly apt, if not carefully attended to, to attack some more important organs by metastasis,-for example, suddenly disappearing in the glands mentioned, and painfully affecting those of the breast, &c.: these metastases may occur either from fresh exposure to cold, or from the application of saturnine, camphorated or other repellent lotions. This complaint is generally ushered in by the ordinary symptoms of mild catarrhal fever, after which the swelling declares itself, sometimes interfering with the motion of the jaw, and by the extension of inflammation to the tonsils, affecting the hearing and impeding inspiration. THERAPEUTICS. MERCURIUS may almost be termed the specific remedy in the idiopathic form of this disease. When lfercurius does not promise to produce much benefit, after a dose or two (which is frequently the case in those who have been formerly salivated by Mercury under allopathic treatment), Carbo vegetabilis should be administered, particularly if the affection be accompanied by a considerable degree of hoarseness. When, through any neglect in taking proper precautions against cold, a metastasis to the brain has taken place, characterized by a sudden disappearance of the swelling of the glands, followed by a loss of consciousness, delirium, or other symptoms of Inflammation of the Brain (which see), we should have immediate recourse to Belladonna, Iyoscyamus, or Ciprum aceticum, etc. 190 DIGESTIVE SYSTEM. Belladonna is moreover indicated when the swelling is red and presents an erysipelatous appearance. If the inflammatory symptoms do not readily yield to Belladonna, Hyoscyamus may be given; and after the latter BRhus, Bryonia, Sulph., Arsenicum, Lachesis, or Silicea, accofding to circumstances. Should, however, the disease in the same manner be transferred to the stomach, CARBO VEGETABILIS is usually a most useful remedy; when it fails to afford all the desired relief, Cocculus may be had recourse to. When the glandular enlargement occurs as a sequela of any of the following disorders, the remedies thereafter mentioned will generally be found the best adapted to effect resolution when practicable: of TYPHUS, Bella., Sulph., Calc. c.; of MTEASLES, Arnica, Bryonia, klus/ of SCARLATINA, Hlrepar 8., Dulo., Baryta, Bella., Jhus, and Arsenicum.--Carb. v., Silicea, Ljycopodium, Hepar, Conium, OClamomilla, Aurum, Sulph., and Calc., in general cases, according to circumstances. During the treatment of this affection, every care should be taken that the patient be kept moderately warm, exposed neither to damp, cold draughts, nor vicissitudes of temperature. INDIGESTION, OR DYSPEPSIA. This disease appears in so many different phases, that we shall simply content ourselves with an enumeration of some of the principal exciting causes, and refer to the symptoms given under the different medicaments for its DIAGNOSIS. The following may be considered the chief of these:Irregularities in diet-such as an over-indulgence in the pleasures of the table, partaking of rich and indigestible food and stimulating soups, excessive use of wine, malt and spirituous liquors, strong tea, coffee, and other stimulants; imperfect mastication of food; irregularity of, or too long fasting between meals; indolent or sedentary habits; exhaustion from intense study; keeping late hours; mental emotions, &c. The foundation of this disorder is frequently laid in early life, by the baneful practice of administering large doses of calomel and other deleterious drugs, for the most trivial as well INDIGESTION, OR DYSPEPSIA. 191 as the more serious derangements of the chylopoietic viscera; and the evil is perpetuated in more mature age, by a continuance of the same absurd and injurious system. THERAPEUTICS. The principal homceopathic remedies for the treatment of this affection are: Nuzx vomica, Sulphur, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha, Ignatia, Carbo vegetabilis, Cinchona, and Hepar sulphuris. Nux VOMICA covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exertion, or long watching, or from the abuse of wine or ardent spirits: the head confused with occasionally afeeling as if resulting from intoxication, and giddiness with sensation of turning and wavering of the brain; headache, unfitting for, and increased by, mental exertion; tearing, drawing or jerking pains in the head or cheeks, and pulsative pains, and a sensation as if a nail were driven into the brain; congestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower part of the white of the. eyes, with a mist before them; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes; short-eightedness; pale or yellowish color, or redness of the face, especially about the mouth and nose; frequent headache, and impaired powers of digestion, with insipidity of food; foul, dry, white or yellowish tongue; thirst, with water-brash, particularly after acids or rich food; accumulation of slimy mucus, or water in the mouth; metallic, salt, sulphureous, herbaceous, mucous, bitter sour, sweetish, or putrid taste, chiefly in the morning, or after meals; bitter eructations, or continued nausea, especially after meals, or even after drinking cold water or milk,-or on going into the open air after a meal, or after partaking of acids; heartburn, hiccough, acidity, flatulence, frequent and violent vomiting of food, mucus, or bile, or ineffectual efforts to vomit; distension and fulness in the epigastrium, with excessive tenderness to the touch; a feeling of tightness of the clothes round the upper part of the waist; cramps in the stomach; constipation; reddish urine, with brick-dust colored 192 DIGESTIVE SYSTEM. sediment; sleep unrefreshing and restless, either from suffering or otherwise, with disagreeable dreams, and drowsiness in the morning. One of the most distinctive indications for the employment of this remedy in preference to the next mentioned, is the temperament, which is restless, irritable, lively, and choleric. A disposition to Hemorrhoids is also a good indication. For PULSATILLA we have nearly the same range of dyspeptic symptoms, with the distinction of its being particularly adapted for females, children, individuals with light' hair, and a marked predisposition to purulent exudations at the edge of the eyelids, or to styes, and for mild or phlegmatic dispositions. Amongst its characteristic indications, we more frequently find a want of thirst than thirst; a repugnance to fat and rich meat, and suffering, after taking pork or pastry; general chilliness, or great difficulty in keeping the hands and feet sufficiently warm; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or difficult and loose, or sluggish evacuations; hypochondriasis, hysteria. BRYONIA: HEADACHE, burning or expansive, particularly after drinking, attended with bewilderment of the head and vertigo; TONGUE dry and red, or covered with a coated, whitish-yellow fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hunger; craving for acid drinks; great thirst; insipid clammy, putrid, sweetish, or bitter taste in the mouth; ACIDITY and FLATULENCE, or bitter risings after every meal, or after partaking ofmilk. HICCOUGH, nausea, water-brash, vomiting offood or bile, particularly at night; tenderness of epigastrium to the touch, sensation of swelling in the pit of the stomach; especially after a meal, or on walking; sensation of burning in' the pit of the stomach, especially when moving. Constipation; temper restless, irascible, and obstinate; also when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the symptoms. The dyspepsia is more apt to manifest itself in summer, or in damp weather, is frequently accompanied with chilliness. (Rhus is often of service when Bryonia produces little or no improvement.) INDIGESTION, OR DYSPEPSIA. 193 CHAMOMILLA: HEADACHE, with sometimes semi-lateral pulling, shooting, and beating in the head; fulness, giddiness, and staggering in the morning when getting up, oppressive heaviness, vertigo, and sensation of a bruise; headache, felt sometimes during sleep, with obscuration of the EYES; and yellow color of the white; TONGUE dry and cracked, with a thick and yellowish coating; mouth dry, with the occasional presence of frothy mucus; excessive thirst and desire for cold drink; bitter taste in the mouth and of food; want of appetite and dislike to food. ACIDITY or sour risings, regurgitation of food, nausea, vomiting of food, mucus, and bile; acute, oppressive pain in the region of the heart, distension at the epigastrium, pit of the stomach, and upper part of the waist, chiefly after eating, and at night attended with inquietude and terror; burning pain in the pit of the stomach, uneasiness and feeling of sinking in the stomach; CRAMPS IN THE STOMACH, especially when traceable to coffee; sometimes constipation, but generally relaxation of the bowels. This remedy is valuable in indigestion, brought on by a fit of passion, or suppressed perspiration. IPECACUANHA: FACE pale and yellowish; tongue sometimes clean, at others coated white or yellow; aversion to food, and particularly to fat, or to rich indigestible food, such as pork, pastry, &c., or' dyspeptic suffering on partaking of such; vomiting of food, drink, mucus, or bile, sometimes after' a meal; retching or easy vomiting, generally attended with coldness of the face and extremities, and sometimes alternating with watery diarrhoea; feeling of emptiness, and flaccidity, and sensation of sinking at the stomach. Headaches, attended with nausea and vomiting; shooting pains, with heaviness and painful pressure on the forehead. Both this medicine and Pulsatilla are valuable remedies for indigestion in children, arising from imperfect mastication or improper food. IGNATIA may sometimes follow Pulsatilla to complete a cure, or even supersede it, when there is a tendency to constipation, and particularly in persons who are subject to sudden alternations from high to low spirits, or vice versa; it is especially indicated when grief has been the inducing cause of dyspepsia, hysteria, and hypochondriasis. In chronic cases, these remedies, as indicated, are chiefly 13 194 DIGESTIVE SYSTEM. valuable in the commencement of treatment, and may require to be followed by other remedies to complete the cure. SULPHRIE, or TINCTURE OF. SULPHUR, will be found especially useful after Pulsatilla and Nuw vomica, in removing any symptoms that may remain. HEPAR SULPHURIS is a valuable remedy in some cases of dyspepsia, but particularly when the patient has previously been taking blue-pill, or any other mercurial preparation for a considerable time. ACIDUM SULPHURICUM: Dyspepsia arising from excessive study, drinking, or other excesses, with the following symptoms: great weakness of digestion; acrid, foul, putrid taste in the mouth, dry tongue, burning and smarting sensation in the throat, sometimes attended with pricking, especially at night, and so troublesome as to prevent sleep (Pyrosis); offensive breath, especially in the morning (apkthce); renewal or aggravation of the symptoms from drinking cold wzater; all cold drinks appear to disagree, unless a little brandy or some other ardent spirit is added to them; accumulation of water; saliva in the mouth; flatulence; bitter risings; vomiting of a limpid fluid, or of food. It may be here remarked that, in cases where 7Nux vomica seems indicated, but the disposition is of a morose or hypochondriacal turn, COCCULUS may be substituted with effect; when, however, the indications for temperament are not sufficiently distinctive, Cocculus, 'Nux vomica, and Pulsatilla, may be advantageously alternated. Finally, CARBO VEGETABILIS will frequently remove any symptoms that may remain after Nux vonmica. CINCHONA is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite with great weakness of digestion, which is more liable to be experienced on partaking of supper; flatulence; bitter taste; languor; hypochondriacal disposition; and particularly when we can trace the affection to debilitating losses of fluids, such as the abstraction or loss of blood, too great a drain upon the resources during lactation, prolonged use of aperient medicines, &c.; also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter. NWATRUM C. may follow NVx v., Bryonia, or Cinchona, INDIGESTION, OR DYSPEPSIA. 195 with advantage, when a degree of weakness of digestion remains. In chronic cases this disorder sometimes takes a critical turn, when vomiting becomes excessive, everything taken is returned from the stomach, the skin is hot and dry, the patient becomes emaciated, and the countenance cadaverous. In serious cases of this description Arsenicum and Lachesis will tend much to invigorate the sinking energies, and even,-with the occasional aid of Lycopodium, Veratrum, Baryta, Phosphorus, Conium, or some one or other of the above-mentioned remedies, where necessary,-eventually effect a cure, provided the inroads of organic lesions have not already placed the unfortunate sufferer beyond the reach of art. (See also Chronic inflammation of the stomach. Cardialgia. Want of appetite. Flatulency, and Derangement of the stomach.) The following are frequent additional pathognomonic signs of deranged digestion, and may, when taken in conjunction with others already described, facilitate the selection of the remedies placed in juxtaposition: TONGUE, swollen: l ach., Merc., Ars., Bella., Kali, Hell.; Calc., China, Silic., Dig., Plumb., Anac., Elect., Con., Thvj., Stram., Sec. TONGUE, with a white fur: Puls., Sulph., Mere., Tart., Amr.; Nux v., Bry., Ant. c., Calc., Sep., Bism., Ign., Ipecac., Dig., Raph., &c. TONGUE, with a yellow fur: Nux, Puls., China, I4ecc., Plumb.;-Cham., Bry., Cocc., Veratr., Bella., Alum, Coloc., China, Siulph., Elect., &c. TONGUE, with a slimy fur: Puls., Sulph., erc., Bella., Acid. phosph.; Lach., Chin., Sulph., Verb., Nux mosch., Cupr. TONGUE, with a brownish fuir: Sulp., Bella., Phosph., Sil.. Verb., Hyos., Sabin., &c. TONGUE, with a grayish fur: Tart. emet., Amb., CCpr. acet., Puls. TONGUE, with a grayish-brown fur (whity-brown): Ambra, Puls., Nux, Bryon., Ipecac., &c. TONGUE, with a greenish fur: Plumbum. - with a blackish fur: Xerc., Chin., Phosh., Laci. - with a dirty fur: Bry., Zye., Olean., Anthrako, 196 DIGESTIVE SYSTEM. TONGUE, with a thick fur: Puls., Mfere., Bella.;-Nucw V., Cham., Sulph. - ivid red at the margins: Bella., Nux v. - with vivid redness of the papillke: Bella., Ammon. - red at the tip: Elect. - ivid redness of the whole tongue: Bella., Bry., Lach., Hyos., Nux v., Cham., Ran. sc., Rhus, Ars., Suph., Veratr., &c. TONGUE, dry: N ux v., Sulph., Veratr., Bella., 2ere., Nux mosch., Cham.;--Lach., Bry., Rhus, Sep., Carb. a., Baryt. m., Plumb., &c. TONGUE, glazedG, shining: Lachesis;-Bella., Sulph., Bry., Ars., Veratr., &c. TONGUE, with elevated paillce: Elect., Crocus, Oleand., Bella., &c., TONGUE, cracked, clefted, or split irtofuTrrows: Nux, Puls., Lach., Bella., China, Plumb., Cham., Veratr., Ars., Baryt., Cic., Ran. sc., Pulh. TONGUE, tremulous Bella., Ars., Bry., Merc., Dig., Dule., Nux, Cocc., Ign., Yeratr., Lach., Rhus. SALIVA, acrid: Iiere., Dulc., Veratr. - alkaline: Galv. - bitter: Ars., Sulph., Thuja. - brownish: Bism. - cool: Asar. SALIVA, frothy: Bry., Plumb., Ran. sc., Sulph., Spig., Eug., Berb., Canth., Phell., Sabad. SALIVA, hot: Daph. - of a mawkish, insipid taste: Bry., Puls., Ipec., Ign., Nux v., Cham., Lyc., China, Cps., Sulph., &c. SALIVA, of a metallic taste: Bism., Ran. b., Zinc., Cocc., Hepar, Agn., Cup., Natr. m., &c. SALIVA, of an offensive, fetid smell: iferc., Dig., jercur. subm. - of a reddish color: Sabin. - of a saline taste: Sulph., Sep., Yeratr., Euph., llerc. sol., Ilyosc., Phosph., Verb. SALIVA, Of a sour taste: Ing., Sulph., Calc.; Cale. phosph., Galv., Alum., Lact., Natr. s., &c. SALIVA, of a sourish-sweet taste: Zinc. oxyd. INDIGESTION, OR DYSPEPSIA. 19T SALIVA, of a sweetish taste: Puls., Plumb., Dig., Sabad.; Alum., Gran., &c. SALIVA, thick: Nux mosch., Bism., Bella., &c. SALIVA, thin, serous: Puls., fagn. m., Kreos., 2Magn. p. aust., Gal., Zobel., Asar., Thea, &c. SALIVA, tenacious: Puls., Nux, lach., Plosph., Staph., Ars., Zinc., &c. SALIVA, of white color: Ran. b., 01. an., Sabin., Spig., &c. GUMS, bleeding of the: NNux v., Carbo v., Sulph., Natr. m., Acid. nitr., Mierc., Phosph., Sil., Staph.; Calc., Graph., Baryt. c., Amrn. c., Alum., iagn. m., Acid. sulph., Sep., Kali c., &c. GUMS, redness of the: Carb. v., Kreos., Nux v., Merc., Kali, Natr. nm., Phell., Ran. sc., Rep., Aur. GUMS, spongy: Nux v., Caps., Natr. m., Carb. a. et v., Bry., Ars., -Merc., Staph., Sulph., Kreos., China. GuMs, swollen: Nux v., NaIt. m., Sulph., lMerc., Caps., Staph., Sep., Baryt., Am. m. et c., China, Ac. nit4, lach., Lye., &c. GUMS, tender: Nutx v., lach., Natr. m., Caps.; Staph., Calc., Agar., Amb., Acid. nitr., Carbo v., Ilepar. GUMS, fetid: Carb. a. et v.; Acid. n., Staph., Hepar, CKina, Natr. m., Merc., Graph. GUMS, shrinking, or separation of the gums from the teeth: Carb. v., /Merc., Sulph., Par., Cist. GUMS, paleness of the: Staph., Plumb., Acid. nitr., Zinc., Oleand., 2errc. TEETH, discoloration, aching, decay of the: Nux v., Puls., Bryon., Cham., Merc., Staph., Lack., Ckina, Sulph., Calc., Plum., Ars., Natr., Veratr., &c. Lips, Vivid redness and spongy state of the: Nux v., Bry., Carbo v. et a., Baryt. c., Bella., Hep., -Lach., Caps., ierc., Sil., Staph., Sulph., Alum., China, Spig., &c. LIPS, blanched, yellowish, and somewhat indurated: Nux V., Sulph., Calc., ]ycop., Ars., Lach., Can., Clem., Silic., Aur., Natr., Alum., Spig. THROAT, sensation of excoriation, roUghness, and dryness: NATux V., Lach., Carb. v. et a., Sulph., Puls., Calc., 2Merc., (ham., Ign., Bryon., Hep., Teuc., Scilla, Staph., &c. THROAT, redness of the, with swelling of the uvula, &c.: 198 DIGESTIVE SYSTEML. NVux V., Bryon., Ign., Chamin., Caps., Puls., Lack., Sulph., Calc., Baryt., China, Sep., Veratr., Cocc. EYES, bleared and suffused: Nux v., Puls., Natr. m., Staph., Graph., Chamn., Calc., lyc., Bism., Ant., Agar., &c. EYES, muscoe volitantes: Nux v., Puls., China, Iyc., Sulph., Sep., Agar., Mere., Coco., &c. EYES, appearance of vapor or mist before the: Puls., Plumb., Sulph., CcLCa., iMerc., Bell., Cyc., Dig., Alum., Ign., Evon., Am. m., Ambra, &c. EYES, sparks, flashes of flame: Nux v., lach., lIycop., Dig., StapA., Cale. c., Zierc., Natr. m., etc. EYELIDS, thickened, gorged, and inflamed at the margins: Nux v., Pzuls., CAaim., Merc., lRep., Bry., Sulph., Euph., Veratr., Lye., Ars., Baryt. c., Staph., Sep., Natr. M., etc. NOSE, dryness of the nostrils: Sulph., Calc., Sep., Graph.; Bryon., Bella., Ign., /Mag. m., Phosph., Rhus, Kali, Sil., etc. NOSE, excessive secretion from the: Ars., lach., 1gn., Lye., Puls., I1ecac., Hlep., Bry., Nux v., Sulph.; Cocc., Carbo v., Alum., Ammon. c., Calce., Mere., etc. NOSE, itching in the nostrils: N'ux v., Puls., (Carbo v., Ign., Ammon. c., Agar., Spig., Tesc., Cin., Sabad., Sulph., Calc., etc. NOSE, imaginary smells: XNux u., Puls., Sulph., Cale., Ars., Graph., Alum., etc. NOSE, deficient sense of smell: Puls., Sep., Sulph., Calc., Alum., Ipecac., Natr. m. NOSE, great acuteness of smell: Sulph., lye., Hep., Colch., Nux v., COham., Calc., Kali c., etc. EAIs, dryness of the (eustachian tube): Graph., Lach., Ac. nitr., Petr., Carb. v., Ars., etc. EARS, acuteness of hearing: lach., Ars., lyc., Bry., Ch0amn., Veratr., Sep., Plumb., Magn., Chin., Sil., etc. EARs, dulness of hearing: Nux, Puls., Sulph., Calc., Carb. V., Lack., Bell., Ars., Veratr., Ant., Anac., Asar., Kali c., fHep., Staph., Bry., lyc., etc. HEAD, frontal headache: Nux v., Puls., Bry., Ign., Natr. m., Chin., Plumb., Sep., Natr. m., Ant., Staph., Plat.. Sulh., etc. (See also Art. Cephalalgia.) FACE, flushes of heat in the: lye., Graph., Cocc., Kali c., Alum., Ambr., Kali m., etc. INDIGESTION, OR DYSPEPSIA. 199 FACE, pimples on the: Nux v., (arb. v. et a., Lach., Salph., Sep., Acid. nitr., Acid. m., Ambr., Alum., Hepar., etc. FACE, eruptions various, on the: Nux v., Rhus, Sulpli., ]Lack., Lycop., Graph., Merc. sol., Sep., Calc., Amrnon. c., Dig., etc. FACE (earthy color of the, and of the skin in general): Nux V., Ars., Liach., lyc., Ign., Ipecac., China, Nat'r. in., lfer., Bry., Silic. FACE, pale: Nax uv., Puls., Garb. v., Lyc., Suaph., Veratr., iMagn. iM., Plumb., China, Sep., lcac., Anac., Dig., Graph., Ign., Am. c., Ambr., Olean., Miere., etc. FACE, red: Bry., Nux, Cocc., Lye., Puls., Plat., Ilep., Ign., Sulph., Cale., lach., etc. FACE, yellowish: Nux v., Pals., Lyc., Natr. m., illagn. in., Carb. v., Graph., Calc., Mere., Bry., Sadph., Sep., etc. SKIN, like parchment: Arsenicum; Lyc., Graph., China, Sep., Ambr., Am. c., Calc., Kali, Natr. c. GIDDINESS: Nux, Puls., Plumb., Natr. m., Op., Bry., Calc., Kali, Natr. in., Jiach., etc. (See also Vertigo.) HEAD, confusion in the: Bry., Nux, Puls., Calec., Sepia, Plumb., Op., Rhod., Zinc., Natr., Plat., Staph., Caps., Graph., Mlagn. m., Calc. ph., Nux mosch., Rhus, Ambr., Arn., &c. UPPER EXTREMITIES, trem0ulousness of the: Bry., Rhus, Veratr., Phosph., Silic., &c. UPPER EXTREMITIES, numbness (torpor); Nux v., Lye., Oham., Croc., Graph., Kali, Sep., Sulph., Verat., Silic., Hagn. m., Ambr., Baryta, &c. UPPER EXTREMITIES, jerTings or spasmodic movements of the: Puls., China, Ign., Lyc., Bry., Cham., Plumb., Cic., Sabad., Bellad., Op., &c. HANDS, tremulousness of the: lach., Sulph., Calec.; Phosph., Zinc., Agar., Cocc., Kali, Tart., Rhus, Sabad., Bis., &c. HANDS, numbness of the hands and fingers: Nux v., Lyc., Puls., 'roc., Carb. a., Coc., Phosph., Lyc., Veratr., Zinc., Calc., Am. c., Baryta c., Sep., Sil., Natr. in., Kali, Zinc., Cham., uSalph., &c. HaNDS, jerkings or spasmodic movements: Ign., Lyc., Bry., Cham., Kali, Cic., Mere., Phosph., Sulph., &c. UPPER EXTREMITIES, tingling, cra0wling or creeping s ens 200 DIGESTIVE SYSTEMf. tions in the: Nux V., Puls., Igm., Caps., Rhod., Suilph., Arn., 3agn., Bella., Sabad., Magn. artif., iaqn.p. aust., &c. HANDS OR FINGERS, tingling, &e., of the: Teratr., Sulph., Rhod., Nat. m., Xagn., Colch., -Lam., Clcd., SiU., Baryta c., Nux, Bry., Bella., Coco., &c. FINGERS, paleness and torpor of the, as if dead: Suiph., Calc., Thuja, Ciel.; Am. c., Am. m., Lye., Hep., Phosph, Acid. phosph., Mere., Acid. m., Acid. n., Ifep., Cic., &C. HANDS OR FINGERS, coldness of the: Nux u., Suiph., Puls., Coce., Ambr., Baryta c., (ham., Natr. n., Phosph., Petr., Kali, Ac. nit., Ran. b., Scilla, Tart., Tnuja, &e. HANDS OR FINGERS, burning heat in: Nux, 1Lach., Lye., Carbo, Stcaph., Phosph., &c. LOWER EXTREMITIES, tremulous&ness of the: NUX, 000c., Puls., Bry., Lye., cale., Carb. v., (kam., Naivor., &c. LOWER EXTREMITIES, numimess of the (torpor): Nu r., Graph., Petr., Ant., Carb. v., Cale., Zye., Alum., Ambr., Uk am., Platina, Plv/mb. KUli, Olean., pkly A., Sep., Silie., Yerat., led., ik uja, &c. LOWER EXTREMITIES, jer1ings or spasmodic movements of the: Ign., Puls., Carb. v., Op., Lye., Kiali, Ipeae., Scilla, Natr. m., Plat., Sep., Ammon. e., Bmryta e., Silie., Suyph., Cie., &c. LOWER EXTREMITIES, torpor and paleness (deadness): Graph. chiefly. LOWER EXTREMITIES, reetping, crawling or tingling in the: Plat., Rhod., Salph., Caps., Borax, Sabad., Gwaiae., Raph., &c. FEET, ereeping, &c., in the: Caps., Suaph., Sep., Amrn., Par., Zinc. ox., Croc., Ammonium, Calec., See., Am. m. FEET, torpor and paleness (deadness) of the: Cale., NxI V., Rhus., lye., Chel., Sec. FEET, feeling of numbness or torpor in the: Nux, Coce., Iach., Plumb., Sep., Kal., Sil., Oland., &c. FEET, feeling of heat in the: PuMls., Staph., Phosph., Elect., Petr., Led., &c. FEET, coldness of the: Sulph., Sep., Sil., Coce., Carbo a., Graph., Kali c., Rhod., Colch., Con., Dig., lach., Lye., Plat., Plumb., Acid. nitr., Natr. m., &c. LOWER EXTREMITIES, tottering, staggering, (trembling) or INDIGESTION, OR DYSPEPSIA. 201 giving way of the legs or knees: Nu x v., Puls., Bry., Plat., Lach, China, Puta, Su/ph., &c. LOWER EXTREMITIES, cramps in the: Nux v., Sulph., Calc., Lyc., Bry., Cham., Acid. nitr., LZach., Carb. v. et a., Baryt. c., Am. c., Ar., Colocy., Can., iMagn. min., &c. LOWER EXTREMITIES, cramnps in the feet: Nux m v., Sulph., Lyc., Carb., Plumb., Staph., Silic., Rhus, N3atr., Ran., Graph., Am. c., Petr., &c. DRoWSINESS, tendency to: Pu/ls., Nue v., Bry., Ant.; cocc., Carb. v., Plumb., Staph., Ign., Am., Chamn., Coloc., Ars., Veratr., Zinc., &c. EMAcIATION: Nux v., Puls., Sulph., Calc., Ars., Veratr., Lye., China, Natr. in., Cham., Ant., Am. c.;-cocc., Carb. V., Fer., Plumb., Graph., iep., Lack., Mere., &c. OBESITY: Calc., Snuph., Baryt. c., Ant. c., Ars., chiefly. ASTHMA: NUX., Carb. v., (aps., Ukam., china, Su/ph., Zinc., Ars., Veratr., chiefly. MORAL SYMPTOMS. HYPOCHONDRIASIS: NUX, PU/8., &SU/ph.. Calc., China, Bellca.;-Cham., Coco., Natr. mn., Staph., Rhus, Zinc., Anac., Ars., Aur., &c. ILL-HUMOnR, irascibility: Nux v., Bryon., Chain., carb. v., Ars., Natr. min., Graph., Teratr., Kali, Suph., Sep., il., Ac. nitr., Lyc., &c. SADNESS, depression, dejection, gloominess: Ign., Puls., Cocc., ILach., Lyc., Natr. min., Sulph., Cac., Plat., Nux v., Veratr., Ars., Graph., Silic., Sep., Ac. sulph., Plumb., Am. Mn., Anac., &c. SUSPICION, mistrust: Pu/s., Nux v., Lach., Baryt. c., Merc., Ac. sulph., Cic., Bella., &c. ANXIETY, inquietude: Nux v., Puls., Bryon., Lack., chamn., China, Carb. v., Sulph., Calc., Lyc., Merc., Plumb., Acid. nitr., Ars., Veratr., Ar., Aur., Sabacd., Cic.;-Alum., Amb., Am. min., Anac., Graph., Plat., Natr. in., Rhus, Sep., Staph., Acid. sulph., Cocc., Baryt. c., &c. FICKLENESS: Ign., Plat., Nabt%. i., Zinc., Cin., Caps., Puls., Sunph., Val., carb. a., Kali, Ars., Nux mosch., &c. HYSTERIA, tendency to: Ign., Puls., Plat., Sep., Nux, Sulph., Galc., &c. ACCESSORY TREATMENT AND DIET. In no class of disorders is it more requisite to adhere strictly to dietetic regulations, 202 DIGESTIVE SYSTEM. than in those which consist of derangement in the digestive system, whether so called functional or organic: the patient should therefore, in such cases, regulate his regimen, as closely as possible, by the rules* laid down at the commencement of this treatise, carefully avoiding, moreover, all such articles as he may find disagree with him even if they appertain to the aliments allowed. He should generally abstain from soups, and everything that has a tendency to distend the stomach, such as taking large quantities of warm liquids; he should not indulge his appetite to its full extent, and carefully avoid late hours, unnecessary exposure, and severe mental exertion or anxiety; he should also take sufficient exercise in the open air, and, as much as possible, keep his mind from dwelling upon his complaint, or on gloomy subjects. WANT OF APPETITE. APEPSIA. ANOREXIA. Want of appetite, being a concomitant symptom of many diseases, is treated accordingly in other parts of this work; but we now propose to look upon it as one of the leading symptoms of indigestion, and in this character deserving a particular notice. In a great variety of cases, amongst others that of dyspepsia, it is usually attributable to an ill-regulated regimen, imperfect mastication of food, the abuse of tonics and other medicines in large doses, sedentary habits, and the neglect of sufficient exercise in the open air. In many instances the removal of the exciting cause will cure this disorder. Sufferers from this inconvenience should * As we have already observed at the conclusion of the said " Rules," there are particular cases in which the regulations given are subject to considerable modifications. Thus, in some severe forms of dyspepsia, it is necessary to allow meat only every other, or every third day, or to prohibit it entirely for a time, and to substitute farinaceous food, or fish, or meat which is of a less stimulating quality, such as chicken. In other forms, particularly where the patient suffers much from flatulence, vegetables must be disallowed. Again, there are cases, but especially those with symptoms of biliousness, or rather excessive secretion of bile, in which milk, eggs, butter, and fat rich food are inapplicable. The use of unfermented bread will frequently be found of more easy digestion than that -which is made by the ordinary process. There are instances, however, in which the former does not agree with dyspeptics. In such cases, bread made by means of the German yeast will often prove of easier digestion. WANT OF APPETITE. 203 carefully avoid creating an artificial appetite, and also partaking of the smallest quantity of food until the previous meal has been assimilated; the habit of taking tea, and even, as the expression is, " making a meal of it," within a couple of hours after removing from the dinner-table, is a frequent cause of apepsia and dyspepsia. Another source is the habit of drinking frequently, or very copiously during meals-thereby attenuating the saliva and gastric juice, and rendering them less fittted for the purpose of digestion. Other causes are the custom of sleeping after dinner, partaking of heavy suppers before retiring to rest, and the indulgence in fermented vinous or spirituous liquors, or in tea or coffee, particularly the latter. An alteration in the hours of meals, and avoiding too long fasts between them, will frequently remove this affection. In other cases, early rising, great attention to diet, abstinence from rich or highly seasoned food, together with the daily use of pure, cold water-drinking a tumblerful an hour or so before breakfast, two to four hours after dinner, and again about the hour of retiring to rest-will suffice to restore the weakened digestive functions to a normal condition. When, however, we cannot trace this disorder to some of the above, or any other probable cause, when every attention to regimen, and even an alteration of diet, according to individual peculiarities or idiosyncrasy, has failed to produce any good effect, we generally find the want of appetite accompanied with other symptoms of derangement in the digestive functions, which may prove useful in aiding us to select a proper remedy to restore the natural tone of the stomach;this will be found among the medicines most useful in DYSPEPSIA and CARDIALGIA: namely, Nux vomica, Chamomilla, Pulsatilla, Cinchona, Ipecacuanha, Antimonium crudum, Bryonia, Arnica, Hepar sulphuris, Zachesis, Sulphur, and Calcarea, &c. Nux VOMICA is the principal remedy when the want of appetite can be traced to late hours, the habitual use of wine and coffee, or to sedentary and studious habits, also when the following symptoms are present: dryness of mouth, tongue coated white, with cracks or slimy mucus in the mouth, 204 DIGESTIVE SYSTEM. agustia, pyrosis, or insipidity of aliments (particularly meat), accumulation of water in the mouth, aversion to food, costiveness or constipation, confusion in the head or giddiness (as if the results of intoxication), amnesia, and difficulty of fixing the mind to a train of application, weight in the occiput, tinnitus aurium, heaviness and aching in the limbs, uneasiness and a feeling of working or dragging of the tendons in the lower extremities, or cramps, restlessness, and irritability of temper-symptoms aggravated in the morning. CHAMOMILLA is frequently found useful after Nux vomica, when, although considerable benefit has been derived, the whole train of symptoms are not removed. The following are its particular indications; restless sleep, sensation of fulness and aching in the head, heat and redness of the face, a degree of fever, tongue thickly coated, yellowish, rough and cracked (anorexia and greenish diarrhoea) and general sensibility of the nervous system. This remedy is especially called for, when a bitter taste in the mouth (or vomiting of bile, or of greenish mucus) ensues after eating. PULSATILLA. This remedy is specific in the affections arising from partaking of over rich or greasy food, for instance, pork or pastry; or of aliments causing fatulence, such as vegetables; or of food, in the preparation of which rancid butter or lard has been used. The more immediate indications are, whitish, cleft or fissured tongue, with bitter, salt, or foul taste in the mouth, sliminess of the mouth, scraping, roughness or acidity at the pharynx, bitter eructations, aversion to warm food or to meat, as well as butter, and all rich food; loss of taste; distension of the abdomen, and particularly a feeling of tension under the false ribs, borborygmus, retarded or difficult defecation, or diarrhoea, drawing-in of the limbs (resembling that presentment in ague) exacerbation of symptoms in the evening, in contradistinction to Nux vomica, which is generally indicated by this occurrence in the morning. This remedy is well adapted to the mild lymphatic temperament, and also when there is a peculiar sensibility, with a dislike to conversation; it is likewise valuable when imperfect mastication is the cause of the affection, as well as in cases where there is a marked aversion to tobacco, even when the patient is accustomed to its use. Moreover, this WANT OF APPETITE. 205 remedy will be frequently found# of benefit in some cases where Chamomilla has only temporarily relieved; but should a considerable degree of nervousness, or even irritability, remain after Pulsatilla, Nux vomica may be had recourse to. CINCHONA is highly efficacious in anorexia occurring during foggy weather, when the air is charged with unwholesome vapors, or in the vicinity of marshy lands. The following are its indications: a sensation of constant satiety, with general indiference to food, and adypsia; tongue cracked, or loaded with yellow or white coating; sensation of sinking and fluttering in the epigastrium (particularly when this symptom can be traced to the effects of tea); eructation after eating; desire for highly-seasoned food, acids, pepper, and other condiments; general weakness, with inclination to assume the recumbent posture, and inability to remain long in one position; uncomfortable feeling of dry heat, or shivering and sensitiveness in the open air; retarded or interrupted sleep; general feeling of uneasiness, with moroseness and peevishness. IPECACUANHA is indicated by the following symptoms: Nausea or vomiting, without foulness of the tongue, with dislike tofood. Tobacco-even to smokers-has a nauseous taste, and causes vomiting. This remedy is also useful when the impaired appetite has arisen from bolting the food, particularly in children, and may be followed by Pulsatilla, when only partial relief has been obtained. ANTIMONIUM CRUDUM will prove a good remedy in cases where a great disposition to nausea and vomiting with foul tongue exists; anorexia, dryness of the mouth with great thirst, particularly during thenight; accumulation of phlegm in the throat, with continual attempts to clear the throat; frequent rising, soon after meals, of the food last partaken of; pain or disagreeable fulness at the epigastrium, frequently with sensibility to external pressure. In cases of recent standing with the above symptoms it is very speedily efficacious: and when relief does not quickly follow, the next mentioned remedy should be had recourse to. BRYONIA in recent derangement of the stomach with anorexia; when we find thirst more during the day than through the night; with a sensation of dryness in the throat, extending 206 DIGESTIVE SYSTEM. down the cesophagus; chilliness; yellozo, dark brown, or whitecoated, cracked tongue, with constipation. ARNICA. This remedy is valuable when the loss of appetite has arisen from sitting up at night; watching at a sick bed; from not having devoted a suffitient number of hours to the period of rest; from intense mental exertion; or from provocation or excitement. When from these causes the nervous system is powerfully affected; tongue coated yellow; taste foul, bitter, or sour, or nauseous, or chalybeate, with offensive smell from the mouth; rising of the food, or eructations of the taste or smell of rotten eggs;* aversion to smoking and desire for acids; sensation of fulness in the scrobiculus after meals, with inclination to vomit; distension of the abdomen, with pinching colic, relieved by doubling up the body, and renewed by drinking the smallest quantity of wine, or passing off and then coming on with inclination to evacuate the bowels; general irritability and impossibility of fixing the mind upon any subject; inclination to remain lying down, as this position relieves a heavy stupefying headache, which the least motion or even conversation increases. HEPAn SULPHURIS is useful in chronic cases of want of appetite, with indigestion from the slightest cause, notwithstanding the most careful observance of diet. It is indicated by desire for high-seasoned dishes, acids, and wine; nausea, even inclination to vomit, particularly in the morning; and constipation, frequently with colic. This remedy is one of our chief antidotes to Mercurius, and consequently one best adapted to those affections of the stomach which have arisen from the longcontinued use of calomel or other mercurial preparations. LACHESIS is a valuable remedy to follow Hepar sulphuris in obstinate cases, particularly when long-continued constipation is complained of, and the symptoms have always been aggravated by acid drinks, &c.; in the latter case Arsenicum is also useful, and may sometimes precede or follow Lachesis with advantage. In addition to the two last-mentioned remedies, we may * (Tartarus emet., Sulphur, Valerian, Sepia, Stannum, also cover the latter symptom): the practitioner will therefore do well to bear the said remedies in mind, when this particular symptom is a prominent one, and does not yield to Arnica. DERANGEMENT OF THE STOMACH, ETC. 207 observe, that in the same class of cases, Belladonna, 2Mercurius. Sulphur, and Calcarea may be used with considerable advantage, when the former remedies have afforded only partial relief. ACIDUM SULPHURICUM is a useful remedy in cases of impaired appetite, with weakness of digestion, arising from habitual excess in the use of ardent spirits, or from debilitating loss of fluids, such as blood, or in consequence of excessive study,with the following symptoms: acrid or putrid taste, dry tongue, burning and smarting sensation -in the gullet resembling heartburn; offensive breath, especially in the morning; aphthae; disagreeable sensation of pricking in the throat, frequently occurring during the night, and disturbing sleep. In other cases the practitioner or student may consult the subjoined remedies in the Materia Miedica with advantage, either as applicable to the treatment of this affection, or to that of dyspepsia and cardialgia; Sepia, Colchicum, Ferrum, Silicea, Ruta, Ammon c., Jhus, Aurum, Baryta c., Acid. nitr., Kali c., Natr. m. and c., Graphites, Hyoscyamus, Ignatia, Staphysagria, Kreosotum, Petroleum, Anacardium, Drosera, N. mosch., Capsicum. (See also DYSPEPSIA and CARDIALGIA.) DERANGEMENT OF THE STOMACH, ERUCTATIONS, &C. Under this head we intend treating of a disorder which may arise in individuals of a generally unimpaired digestion -the characteristics of eructations will assist to indicate the remedy for persons subject to this unpleasant affection. The ordinary causes of this derangement are; hurried, imperfect mastication; overloading the stomach; fat, greasy, indigestible, or tainted food, flatulent vegetables, ices, stimulants, &c. THERAPEUTICS. When the symptoms of approaching stomachic derangement declare themselves immediately, or a few hours after a repast, a little strong black coffee is frequently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclination to vomit be present, we should assist Nature by tickling the fauces with a feather, and giving tepid water to drink until the stomach has completely evacuated its contents. 208 DIGESTIVE SYSTEM. Should, however, on the following morning, symptoms of deranged digestion continue, such as nausea, inclination to vomit, or vomiting, and disagreeable or offensive eructations, we should administer ANTIMONIUM CRUDUMI,-one of our most useful remedies in this affection, and which rarely fails to afford at least some relief. It is also peculiarly indicated when the affection has arisen from drinking sour or impure wine; or, when, in addition to the symptoms of disordered stomach, a degree offever returns every second day. IPECACUANHA. When a rash has been thrown out, from the effects of a disordered stomach, attended with anxiety, oppressed breathing, and sickness, this remedy will, in most cases, effect speedy relief;-but should the difficulty of breathing, or a degree of nausea, or other uneasiness continue, BRYONIA should be employed. (Tartarus emeticus is sometimes more efficacious than either Ipecac. or Bryonia, when there is great drowsiness, with constant nausea and frequent vomiting: relaxed, brownish, yellow motions.) BRYONIA. In addition to the usefulness of this remedy in the foregoing instance, it is also very serviceable when the following symptoms are present: bitter eructations:fever, alternately with coldness and shivering; or redness of the face, heat in the head, and thirst with coldness and shivering; also where diarrhoea or constipation and peevishness, or excessive irritability are present. (In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief.) ARSENICUM is appropriate when there are acrid and bitter eructations with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or cholic, and griping in the hypogastrium, and particularly when these derangements have arisen from the effects of an ice which had been partaken of when warm, or from fruit, stale vegetables, or acids. It may, in many cases, be advantageously followed by Carbo vegetabilis, which see. Nux voMICA is indicated by offensive or acrid eructations, constipation, and confused headache, particularly when arising from previous intoxication, or even slight over-indulgence in wine or other stimulants; when possible, it should be taken DERANGEMENT OF THE STOMACH, ETC. 209 the same night, as taken in the morning, although eventually relieving, it frequently causes an aggravation for a few hours. (In derangement of the stomach with heartburn, flatulence, more or less nausea and headache, &c., in consequence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration.) ARNICA, deranged stomach, accompanied by eructations resembling rotten eggs.* PULSATILLA is, next to Antimonium crudum, the most important remedy in recent cases of deranged digestion, with eructations of ingesta, tongue foul and covered with mucus; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derangement. This remedy is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid wine, &c. (Arsenicum may follow Pulsatilla, if the latter do not effectually relieve.) ACONITE. When the affection owes its origin to partaking of sour beer, vinegar, or other acids, particularly when we find oppressive pain in the stomach, great heat in the head, nausea, or actual vomiting of mucus, or even of blood. HEPAR SULPHURIS. When the digestion is naturally weak, and sour vomiting, attended with burning in the throat, colic, and diarrhoea, is liable to ensue from the slightest error of diet, and particularly when anything of an acid quality has been partaken of. (Lachesis is often of great service here in alternation with Hepar sulphuris, at intervals of a week of so.) When a fit of passion has produced an attack of indigestion, Chamomilla rarely fails to relieve. Bryonia is, however, to be preferred when chilliness and shivering accompany the symptoms of gastric derangement. (See MENTAL EMOTIONS.) CARBO VEGETABILIS, although last mentioned, is not one of the least valuable remedies in this affection, and is often found particularly useful after Pulsatilla, Arsenicum, or Nux vomica, in removing any symptdms that may remain; it is, moreover, particularly useful where great susceptibility to the influence * See also note, page 210. 14 210 DIGESTIVE SYSTEM. of the atmosphere, particularly to cold, exists at the same time; or in sufferings arising from abuse of wine, ices, or salt; further, in derangement of the stomach, arising from having partaken of game or fish which has been too long kept, or meat that has been recooked whilst in a state of fermentation, which is liable to occur in warm weather; in the latter instances Carbo v. is to be preferred to any other medicine, and will rarely fail to afford relief; but if any disagreeable symptoms remain, Cinchona may be administered in a little water; and followed, if required, by Pulsatilla in the same manner. Finally, this remedy (Carbo v.) is peculiarly valuable in obstinate and chronic cases of deranged digestion when annoyance or inconvenience is felt after every' meal, even amounting to nausea and vomiting, attended with excessive flatulency, and where the pit of the stomach is tender on pressure.* FLATULENCY. Flatulentia. Flatus. Tympanitis intestinalis. This affection, together with the sufferings it entails, is generally found in individuals of weak digestion, and many also suffer from it immediately on taking cold in the abdomen or feet; it is also, as well known, a common result of errors in diet, and the too frequent indulgence in vegetables and fiuits. In corpulent individuals the sufferings arising from this complaint, such as difficulty of breathing, palpitation of the heart, trembling of the limbs, confusion of the head, and swelling of the face, especially in hypochondriacal subjects are most distressing. However, with proper attention to regimen, and suitable medical treatment, it is rarely very difficult to remove. As an accompaniment of deranged digestion, it has already been noticed under DYSPEPSIA. The most useful preservatives against the complaint are avoiding cold, exposure in cold damp weather, very cold drinks, or distending the stomach with a large quantity of warm fluid, particularly strong tea or coffee; each patient should also study * A small quantity of finely-powdered charcoal, in a little good French brandy, will be found an equally efficacious mode of administering this remedy as a corrective against derangement of the stomach produced by having partaken of tainted meat or fish. FLATULENCY. 211 his own digestion, and carefully refrain from partaking of any species of aliment which experience has proved to produce flatulency. Sedentary habits also should be avoided, and a proper portion of the day devoted to exercise in the open air. THERAPEUTICS. In the treatment of this affection the following medicines are most frequently called for: Cinchona, Arsenicum, Nux vomica, Pulsatilla, Carbo vegetabilis, Colchicum, Belladonna, Colocynth, and Spirit sulphuris. Of these Nux vomica and Pulsatilla are perhaps the most frequently required. CINCHONA. When the affection can be traced to the effects of habitual indulgence in tea or warm drinks, an hour or two after a hearty meal, by which the process of digestion has been interrupted; or to debility, loss of humors from venesection, or the continued use of purgatives; or to deranged digestion arising from flatulent food, with painful tension and distension of the abdomen; or when, on the occasional expulsion of flatus, a sensation of tension is felt in the umbilical region; or, finally, where coldness or shuddering is experienced after drinking. ARSENICUM, where the last-mentioned symptom has not been, relieved by the foregoing medicine. Nux voMIcA. In cases where the flatulence is attended with sensation of pressure at the pit of the stomach, causing dyspncea and a feeling as if the clothing were too tight,, or a sensation of pressure as from a stone, and particularly when the affection arises from an habitual use of coffee, or from sedentary habits. PULSATILLA, when the affection has arisen from having eaten of rich or greasy food, after which a copious draught of water has been partaken of, and the abdomen is tumid and accompanied by a pain as from a bruise, with borborygmus. Carbo vegetabilis is one of the most important remedies after the foregoing, in chronic cases, especially when the inconvenience arises after partaking of the smallest morsel of food. COLCHICUM, when from a considerable accumulation of flatus the abdomen is extremely distended, or, as it might be expressed, inflated and sounds like a drum on being struck with the hand (Tympanitis intestinalis)-without any marked pain, but with heat and difficulty of respiration. This remedy 212 DIGESTIVE SYSTEM. is generally peculiarly efficacious when the derangement is attributable to vegetable food; or to the effects of exposure to a cold, damp atmosphere. BELLADONNA. In cases of flatulent obstruction, in which the transverse section of the colon is the particular seat of the accumulated flatus, and becomes protruded like a pad, this remedy should be employed; it may be followed by Colocynth when the relief obtained is only temporary, or when, from the manner in which the patient traces the,course of his uncomfortable feelings, there is every reason to conclude that the flatulent distension and obstruction occupy the entire extent of the colon. When the flatulence occurs very frequently, in fact, where a marked predisposition to it exists, we must have recourse to SPIRIT SULPHURIS. Although we have pointed out the remedies best suited to the cases of this affection most ordinarily met with, and have also treated of the same subject under DYSPEPSIA and COLIC, to which the reader is referred, we still think it advisable to add a few medicines which bear particularly upon this disorder, and are deserving of attention. They are: Lycopodium, Cocculus, Natrum, Natrum muriaticum, Zincum foliatum, Magnetis Polus Arctus, Agnus castus, Ferrum, Graphites. SPASM OF THE STOMACH. GASTRODYNIA, CAIDIALGIA, GASTRALGIA. DIAGNOSIS. Contractive and spasmodic or gnawing pains at the epigastrium, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities: the patient is sometimes relieved by emission of ascending flatus, and when complicated with pyrosis, by a discharge of a quantity of limpid fluid; occasionally headache and constipation are present. In some cases the pain is very slight, but there is always more or less, and a degree of anxiety, with nausea, often increased by taking food. The disease originates in an abnormal state of the nerves of the stomach, and is frequently accompanied by a disease of the liver, spleen, or pancreas, or even by scirrhus of the stomach or duodenum, in its advanced stages. It is a frequent attendant on gout; and very rarely occura SPASM OF THE STOMACH. 213 before the age of puberty. The paroxysms last for a longer or shorter time, according to the violence of the affection, and return in many instances periodically, and may be brought on by partaking of improper articles of diet, or in severe cases by any solid food whatever. The chief articles to be avoided by an individual suffering from this malady are-crude, uncooked vegetable substances (such as salads), also cheese, new bread, sweetmeats, cherries, nuts, olives, and roasted chesnuts; and stimulants of all kinds, whether strong tea, coffee, alcoholic or fermented drinks. The exciting causes are: long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, worms, and in some instances, perhaps, exposure to cold or damp weather. It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly discharge, or from any interruption of its usual course; in such instances it is frequently accompanied with hysteria, syncope, and may pass on to vomiting of blood. Notwithstanding the general intractable nature of this affection, it has been treated with marked success by the method about to be pointed out. THERAPEUTICS. Nux VOMICA is one of the principal, and, in a large number of cases, the most appropriate remedy against spasms of the stomach, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or an excessive indulgence in spirituous liquors; it is, moreover, of essential service in many cases which have arisen after the suppression of chronic or hemorrhoidal discharges, or when the party affected is liable to fits of hysteria or hypochondriasis; the following are the immediate symptoms which call for the administration of this medicine: Constipation, pressure, squeezing, or spasm in the stomach, accompanied with a sensation as if the clothes were too tight at the waist, or as if flatus were pent up in the hypochondria. This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of cofee; in addition to which, a feeling of depression or constriction is experienced at the chestrwhich, in many cases, extends to between 214 DIGESTIVE SYSTEM. the shoulders and the lower part of the back. Frequently, also, we find nausea, accumulation of clear water in the mouth, or risings of sour bitter fluids, attended with a sensation of burning in the throat and gullet (pyrosis); sour or putrid taste in the mouth, vomiting of ingesta, flatulent distension of, the bowels, constipation, aching in the forehead, palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of passion, or become aggravated in the morning, or when the patient is occasionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Should Nux vomica merely afford temporary benefit, followed by renewed aggravation, and in cases where the disorder returns again after it has been for a time suppressed by Nux, we should first repeat that remedy; and if it then fail to afford relief, CARBO VEGETABILIS will generally be found to answer our purpose; if not, SPIRIT SULPHURIS may then be had recourse to, particularly where the affection is traceable to the suppression of some chronic eruption. This last-named medicine, as well as Pulsatilla and Sepia, the value of which in such cases we shall notice under their several heads, is particularly useful in gastrodynia in females, arising from derangements of the menstrual functions. In other cases, where no improvement results from the exhibition of Nux vomica, the following should be consulted: Chamomilla, Belladonna, Cocculus, Ipecacuanha, Pulsatilla, Sepia, Ignatia amara, Cinchona, Staphysagria, Stannum, Bryonia, Platina, Senega, Ratanhia, and Arnica montana. Should any one of these seem strongly indicated from the first, we must not hesitate to employ it in preference to those we have already noticed above. CHAMOMILLA. For the employment of this remedy the principal indications are: pressure as if from a stone in the pit of the stomach; or painfulpressure at the prcecordial region, as if the heart would be crushed, flatulent distention at the same part, as also of the hypochondria and abdomen, with shortness of breath, anxiety, and throbbing headache; mitigation of the above symptoms on partaking of cofee,-a distinguishing mark between the indications of this remedy and SPASM OF THE STOMACH. 215 those of YNux vomica;-on the other hand (as in the case of the latter), it is also indicated when the symptoms, as described, are liable to be brought on by a fit of passion. COLOCYNTH is sometimes more efficacious than Cham. in the latter case, and especially when the fit of passion is accompanied by indignation. In obstinate cases, where Chamomilla fails, notwithstanding the apparent similarity of the symptoms, BELLADONNA ought to be substituted for it; also when we meet with gnawing pressure, or spasmodic tension in the pit of the stomach, relieved on bending backwards and holding in the breath; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of consciousness. Carbo v. may, however, be preferred to Belladonna, when the most prominent symptom remaining consists of a sense of aching and pressure at the pit of the stomach and the proecordial region, causing a feeling as if the heart were about to be crushed. (See Chamomilla.) *CoccULUs, in many cases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and constrictive pains over the entire abdomen, with flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. IPECACUANHA is useful in cases of this affection, when the paroxysms are accompanied by nausea, vomiting, dull, darting pains in the pit of the stomach, and sensation of excessive uneasiness in the same region. PULSATILLA. In cases with shooting pains in the stomach, which are aggravated by movement, and particularly by making a false step. Pulsatilla is also one of the most appropriate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeezing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposition thereto. Tendency to hysteria or hypochondriasis. This remedy, as well as Sulphur and Sepia, is called for in cases of this affection, arising from suppressed menstruation. When Pulsatilla does not afford much relief, 216 DIGESTIVE SYSTEM. the desired result is often attainable through the agency of Ignatia. SEPIA is an efficacious medicine in gastrodynia arising from suppressed or difficult menstruation, and may in general cases advantageously follow Pulsatilla; it is indicated when, as in the cases of Nux v. and Pulsatilla, most of the sufferings arise after a meal, when there is pressure in the stomach as from a stone, and a burning pain is experienced in the epigastrium and scrobiculus. By restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the cardialgia and hysteria consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms. IGNATIA AMARA is indicated under nearly the same circumstances as Pulsatilla, with the exception of the state of the bowels, Ignatia being more appropriate to cases attended with costiveness, and where the inclination to vomit is absent, or when the affection has been caused by grief, anxiety, exhaustion by long abstinence, &c., or occurs in very hysterical or hypochondriacal individuals. (See also the remedies mentioned at the end of the chapter.) CINCHONA is of great service in most cases of spasms of the stomach with general weakness arising from loss of humors, the result of blood-letting, or repeated hemorrhages, abuse of emetics or aperients, too long-continued suckling, &c.; and is further indicated by great weakness of digestion, distension and uncomfortable weight, pressure, or pains in the stomach after eating, so that the patient feels much easier when fasting; these latter symptoms are the more immediate indications for the employment of this medicine. (Nux v. and Carbo v. may follow Cinchona, should the latter not remove all the symptoms.) STAPIYSAGRIA. This is useful in some cases of this complaint, and is particularly applicable when there is acute pressive tension and squeezing about the pit of the stomach, which sometimes obstructs the breathing, but which is relieved by bending the bodyforward. When, however, the pain partakes of a marked tensive character, and extends to the region of the navel, accompanied by sensibility of the region of the SPASM OF THE STOMACH. 217 stomach on external pressure, shortness of breath, anxiety and nausea, STANNUM will be found more appropriate. BRYONIA. This medicine is more particularly adapted to the milder cases of cardialgia, with painful pressure, or a feeling of disagreeable fulness in the stomach after a meal, which occasionally becomes converted into a feeling of constriction, cutting, or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more clearly indicated when the symptoms are generally accompanied by severe headache or painful compression in various parts of the head, and particularly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree; increase of the sufferings by movement; habitual costiveness. PLATINA. Spasms of the Stomach in females, occurring particularly at the monthly period (Chamomilla, Pulsatilla, Nux v. and Cocculus are equally efficacious at such periods when the symptoms are as indicated under these remedies,) and especially when the menses are, at the same time, generally very copious, and of too long duration. SENEGA will be found efficacious in cases characterized by painful pressure and burning in the stomach, especially at night. RATANHIA. Spasm of the stomach, or painful constrictive pain, relieved by eructation, with loss of appetite, hiccough, distension of the abdomen, costivensss, and frequent micturition. ARNICA MONTANA, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found specific. It is, however, also an excellent remedy when there is a sense of pressure as from a stone, or of fulness in the stomach and scrobiculus, constrictive pain in the stomach and in the prcecordial region, shooting pain in the pit of the stomach, with painful pressure or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. BISMUTH,-Cardialgia, with tenderness on pressure at the pit of the stomach in hysterical females. This remedy is, further, often of great service in some of the most obstinate cases, particularly when there is a sensation of great weight or pressure, with indescribable pain and uneasiness in the stomach. 218 DIGESTIVE SYSTEM. ARSENICUM. Periodic pains in the stomach, chiefly consisting of a burning character, and attended with acrid, sour eructations, vomiting of ingesta, or of mucus, sometimes even of blood; anorexia, extreme debility, emaciation. LYCOPODIUM. Squeezing or compressive pains proceeding from each extremity of the stomach, with flatulent distension; want of appetite, pains in the back and loins (constipation); exacerbation of the symptoms in the open air, after a meal, or in the morning; cardialgia in lymphatic females, with too copious catamenia. LACHESIS. Spasms of the stomach, particularly in persons addicted to excessive indulgence in wine or ardent spirits, relieved by partaking of food; tongue covered with a dark brown fur, or glazed, red, and cracked, or swollen; flatulence, constipation; tremulousness, numbness, and paralytic weakness of the extremities. SULPHUR is frequently an indispensable remedy in chronic cases, attended with heartburn; aggravation of the pains after a meal; constipation, hemorrhoids. CALCAREA. In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, especially after the previous employment of Nux v., Lachesis, and Sulphur. It is further a valuable remedy in the cases of plethoric females subject to nasal hemorrhage, or to excessively copious menstruation; and is generally indicated when the paroxysms of pain come on usually at night, or after a meal; in which latter instance vomiting sometimes results, or nausea and acidity, with painful sensibility on pressure at the epigastric region. Constipation, hemorrhoids, or chronic looseness of the bowels, are additional general indications for the employment of this remedy. These are the principal remedies to be employed in ordinary cases of Cardialgia; but, in some cases, one or more of the following medicines may be called for: Sanguinaria canadensis, Bismuth, Carbo v., Graph., Gratiola, 3Mlagn., Nitr. spir., Sil., Stann., Staph., Stront., Am. c., Cup., Daph., Kali, Euphorb., Kreos., Natr., Natr. m., Nux m., Asafotida, Digitalis. In Cardialgia occurring in hysterical or hypochondriacal subjects, Ign., NSux v., Calc., Grat., Cocc., HEARTBURN. 219 Stann., Bism., Digitalis, etc., form the more important medicaments. The DIET ought to be extremely simple, and easy of digestion; and everything which is known by experience to bring an attack should be eschewed. Fat, oil, butter, cheese, etc., are often hurtful, and should therefore be avoided. See also DYSPEPSIA, of which this malady is but a modification. HEARTBURN. BLACK WATER. WATER-BRASH. PYROSIS. This is not an affection of that organ which its name would imply, but a painful or uneasy sensation of heat or acrimony about the pit of the stomach, sometimes extending upwards. It is frequently accompanied with anxiety, nausea, and vomiting; or a violent gnawing spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. The remedies required for the treatment of the disorder are the same as those mentioned under Dyspepsia, Flatulence, and Spasm of the Stomach, according to the symptoms: of which Nux V., Puls., Sulphur, Acid. sulphuricum, Carbo v., Cinchona, or Calcarea, will be found the most appropriate in ordinary cases. (See the aforesaid derangements for particular indications.) VOMITING OF BLOOD. ILEMATEMESIS. DIAGNOSIS. Blood evacuated by vomiting, sometimes pure (generally venous), of a dark color, but sometimes of a bright red; it is occasionally mixed with bile, food, &c.; the quantity varies; blood is also not unfrequently discharged in coagula by stool. PREMONITORY SYMPTOMS. Weight, pressure, fulness or tensive pain or spasm in the hypogastric or hypochondriacal regions; griping and cholic; burning heat in the region of the stomach; anxiety, particularly on partaking of food or drink, or on pressure at the stomach; saltish taste in the mouth; impaired appetite and nausea; giddiness; syncope, cold perspiration; sometimes also an intermittent pulsation is perceptible at the scrobiculus. 220 DIGESTIVE SYSTEM. Some only of the preceding symptoms may be present previous to the attack, and others, during its course when very severe, or frequently renewed. We often find wild delirium or wandering accompanied with spasms, and a gradually increasing weakness and remission of pulse with frequent syncope. The most frequent causes of this affection are the sudden suppression of any sanguineous discharge, and the consequent determination of blood to the stomach; it is, therefore, apt to declare itself after a stoppage of the hemorrhoidal flux, and is a very common affection in females, from the suppression or cessation of the catamenia; in which case (as before remarked under that affection), it is frequently preceded by CARDIALGIA. Other causes are scirrhus of the stomach, internal lesions or injury of that organ from swallowing sharp substances, or from worms; poisons, drastic purgatives, or emetic drugs, external contusion, obstruction of important viscera, or a change in the constituent principles of the blood itself; the direct cause is the bursting of some of the vessels of the stomach. The dangers arising from the use of powerful astringents are, inflammation or subsequent induration of the stomach, or putrid gastric fever. When this affection occurs in females from non-appearance or suppression of the monthly discharge, or from its final cessation, see articles CHLOnOSIS, AMENORRH(EA, CESSATIO MENSIUM; when it arises from worms, see IELMINTHIASIS; from poisonous substances, see PoisoNs; and when it originates in diseases of the spleen, consult SPLENITIS. We may now proceed to the consideration of the remedies above alluded to. ACONITUM. When the premonitory symptoms above given, declare themselves, and particularly when a considerable degree of fever precedes the attack. Nux vOMICA. In a decidedly plethoric constitution with a marked (venous) stomachic or abdominal congestion, and tendency to constipation, particularly when arising from suppression of hemorrhoids, or of the menstrual flux, or from indulgence in vinous, spirituous, or fermented liquors; this remedy is still further indicated by irritability of temper. PULSATILLA. The value of this remedy is noticed in the VOMITING OF BLOOD. 221 diseases of females above mentioned; it is also, in many cases, found more suitable than Nux vomica for males, when of lymphatic temperament and mild disposition. Some of the best indications for this medicine will be found under DYSPEPSIA, CARDIALGIA, and DERANGEMENT OF THE STOMACH. CINCHONA. When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debilitating losses, is clearly indicated; it should also be chosen when the patient has had a severe attack of hoematemesis, which has ceased of itself, but still left great weakness. ARNICA. One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a sanguine temperament, and choleric disposition. It is further indicated, when the patient complains of pains resembling the results of a contusion, in all the extremeties. SPIRIT SULPHURIS is useful in strumous habits, or when the affection has arisen from suppressed hemorrhoids; its value also in cases of abnormal menstruation will be pointed out in the proper place. The following remedies also deserve a careful study: Phosphorus, Belladonna, Arsenicum, Lycopodium (which may be ranked next to Nux v. in cases arising from abdominal congestion), Hyoscyamus, (which, with Belladonna, is particularly useful in cases attended with spasmodic action), Lycopodium, Arsenicum, Phosphorus, and Secale cornutum (in Schirrus), together with Carbo vegetabilis, Millefolium, Cantharides, Oalcarea carbonica, Natrum nmuriaticum, and Zincum, under peculiar circumstances, and as tending to eradicate the predisposition to such affections. The application of dry cupping-glasses to the abdomen and under the ribs, or of a cloth which has been dipped in cold water, to the lower region of the abdomen, sometimes forms a useful auxiliary in arresting the hemorrhage. See also Hemorrhage from the Lungs, under HIEMOPTYSIS. DIET. The rules already given under CARDIALGIA should be observed, but with still greater strictness; no solid food must be partaken of; all drinks should be cold; animal jellies, preparations of milk, light puddings, and broths, merely 222 DIGESTIVE SYSTEM. tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose; immediately after an attack, no food should be given for some hours, and then very cautiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. COSTIVENESS, CONSTIPATION, OBSTIPATION. Constipatio, Obstipatio, Obstructio, Alvi. We have now to treat of an affection which so frequently baffles the -skill of the practitioners of the old school; their leading cause of failure being their ignorance of, or inattention to, the great curative principle, and consequent proceeding upon a system opposed to the operations of Nature. This complaint is generally sympathetic with some other derangement of the organism, and, consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the Constizpation, most closely approaching to an idiopathic form, is the practice of flying to aperient medicines on the slightest appearance of costiveness, under the absurd idea that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they continually administer physic to their children, without the slighest apparent call for it, and thus they lay the foundation of dyspepsia and other visceral derangements in after-life. AMany a slight case of costiveness which, if left to nature, would have disappeared of itself, leaving no ill consequences, has, by an ill-judged administration of aperients, been converted into obstinate and habitual constipation, embittering existence, and predisposing the constitution to a variety of diseases in after-life. To prevent misconception upon this point, it should be clearly understood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, we happily possess remedies calculated to restore the general balance of the system; and, in obstinate cases, do not content ourselves with simply alleviating the symptoms, but mainly direct our attention to the permanent removal of the affection. CONSTIPATION. 223 Many of the principal causes of this disorder, besides that mentioned, are the same as those particularised under INDIGESTION OR DYSPEPSIA. THERAPEUTICS. In trivial cases it will be found sufficient to pay proper attention to diet, to avoid too dry or indigestible food, to masticate properly, to partake of meat only once a day, and to take sufficient exercise in the open air.* Should this course not have the desired effect, we must choose one or more of the following remedies: namely, Opium, Alumina, Bryonia, Nux vomica, Pulsatilla, Platina, Natrum muriaticum, Plumbum metallicum et carbonicum, Sulphur, Calcarea c., Lachesis, Veratrum, Lycopodium, Sepia, Veratrum, Silicea, Zincum, etc. OPIuM is chiefly to be selected in recent cases, when constipation is not habitual; but is also, like NVux v., and other remedies, serviceable in cases of a more chronic character, occurring in vigorous, plethoric, well-nourished subjects, and arising from inactivity in the intestinal canal or from sedentary habits. In old people, it is generally more useful than Bryonia and Lachesis, when diarrhoea alternates with the constipation, although these and other remedies, such as Antim., Phosph., and Ruta, must be borne in mind and administered when called for by the nature of the symptoms. The more immediate indications for Opium are: want of power to relieve the bowels, with a feeling of constriction in ano; pulsation and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, determination of blood to the head, with redness of the face, and headache.t * See also the concluding remarks of this chapter. f Opium is strongly recommended by Dr. Perry, as the best palliative remedy in constipation arising from pressure on the rectum, such as that which is occasioned by the gravid uterus, abdominal tumors, swelling of the ovarium, fibrous swelling of the uterus, and, in consequence of which, the fecal matter frequently accumulates in excessive quantities in the rectum, and can only be expelled after great effort, accompanied by severe pain. In weak, nervous, emaciated females, in whom the monthly discharge is always too copious, or in cases where the constipation has arisen from affections of the stomach or liver, Opium is contra-indicted. M. Perry recommends the administration of Opium by olfaction, in preference to the ordinary method, and that as follows:-At the period of the day at which the 224 DIGESTIVE SYSTEM. ALUMINA. Constipation from an apparent absence of peristaltic motion; fieces hard, dry, broken, evacuated with considerable exertion of the abdominal muscles and forcing, and sometimes streaked with blood; constipation from travelling. BRYONIA is especially useful in constipation occurring in warm weather, and in persons of dark complexion and an irritable or obstinate disposition, with a tendency to be easily chilled, and subject to rheumatism; it is further indicated when constipation arises from disordered stomach, and is attended with determination of blood to. the head, and headache. Nux VOMICA: This remedy is particularly useful when constipation results from too heavy a meal, indigestible food, and stimulating liquids; or when the confined state of the bowels has resulted from prolonged diarrhoea or frequent purgings. In the latter instances Opium may often be advantageously alternated with Nux v. In chronic cases arising from longcontinued indulgence in vinous, fermented, or spirituous drinks, or coffee, or from sedentary habits or excessive study, Nux is one of the most effectual medicaments. It is peculiarly,adapted to persons of irascible and lively temper, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a feeling of general oppression or heaviness; frequent and ineffectual efforts to relieve the bowels, attended with a sensation of stricture, and sometimes frequent, painful and difficult emission of urine. It is further, as remarked under DYSPEPSIA, particularly indicated for individuals subject to hemorrhoids. PULSATILLA has nearly the same indications as Nux vomica, patient used formerly to have the bowels relieved, or, otherwise, as soon as a slight ineffectual inclination for stool is experienced, he desires the patient to smell a solution of Opium (a few globules dissolved in a small phial containing a mixture of spiritus and aqu. destill.) several times, and to repeat the process after an interval of half an hour, and again, as before, on the day following, if no satisfactory action result from the first trial. He frequently found, that on the first occasion, only a more decided inclination to go to stool wxvs the sequel, whereupon, after a repetition of the olfactus, the desired effect took place. In some very obstinate cases, he ordered a simple enema to be employed, after several previous trials of Opium, in the foregoing method, and succeeded in this manner in instances when neither Opium, nor the enema alone, was capable of affording the desired relief. -Journal de la Mid. Homceop., tom. i, chap. 1. CONSTIPATION. 225 - with the characteristic distinction of temperament before noted under Dyspepsia. In recent cases, it is particularly indicated when the obstruction has arisen from indigestion brought about by a rich or greasy food, and when it is accompanied by moroseness and shivering. PLATINA is a useful remedy when constipation has been brought about by travelling, when Opium has failed, or especially when the act of expulsion is attended with great straining. PLUMBUM METALLICUM, or CARBONICUM. Obstinate constipation, with ineffectual efforts; painful retraction and constipation of the anus; or evacuation of tenacious, hard, bulletshaped foeces. (See Obstipation.) NATRu M MURIATICUM. This remedy will sometimes be found efficacious when many others have failed to relieve, particularly in chronic and extremely obstinate cases. SULPHUR is one of the best remedies in the relief of habitual costiveness, constipation, particularly when hemorrhoids are present, or a disposition to them exists; or frequent inclination to go to stool, but without the desired result. YERATRUM. Constipation, chiefly from inactivity of the rectum, with heat and dryness of the skin, determination of blood to the head and lateral headache. (Alumina is also of great efficacy in constipation from torpidity of the rectum -see Constipation from inertia recti.). LACHESIS. In obstinate constipation, this medicine may be given with effect after Nux v., to those who habitually take wine rather freely, or who experience flatulent distension after meals and ineffectual efforts to eructate. SEPIA may frequently be taken with advantage in chronic constipation after Nux and Sulphur; and is, moreover, particularly well adapted for females in whom there is an irregnlarity or obstruction of the menstrual flux; it is also indicated by constipation in individuals subject to rheumatism, as well as by hard, conglomerate bullet-shaped fieces. (See Obstipation.) SILICEA is often useful when constipation is accompanied with colic, impaired appetite and thirst; the stools hard, knotty, and passed with great difficulty; and the patient troubled with tenesmus. (Conium is occasionally useful in. completing the cure after Silicea.) 15 226 DIGESTIVE SYSTEM. LYCOPODIUM. Chronic constipation with ebullition and determination of blood to the head: colic, flatulence, sense of weight in the lower part of the bowels. In Obstipation with indurated foeces, formed into hard balls (scybala), Plumb., Magn. m., Sep., Ruta, Verb., and sometimes Nux v., Op., Veratr., Sulph., &c., are useful; but in obstinate and complicated forms of this affection, the treatment requires considerable experience, in addition to a thorough knowledge of the Mcateria edica. In all cases of constipation of an obstinate or chronic nature, recourse may occasionally be had to an enema of tepid water, as a temporary mode of relief, until the medicine has effected the desired result. The drinking of a tumblerful or more of cold water, thrice a day, fasting, dashing cold water against the abdomen, and then applying brisk friction by means of a coarse towel, combined with early rising and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering, or defeat the object we have in view, by exhausting instead of giving tone to the energies of the patient), will be found useful auxiliaries in promoting a regular action of the bowels. The diet ought to be regulated according to the state of the primary digestive organs (see Dyspepsia, rules for diet in), and highly seasoned food, or that which contains much fibrous or ligneous matter, such as radishes, cabbages, turnips, green fruits, &c., avoided. When constipation occurs in alternation with diarrhoea, Nux v., Lachesis, Rhus, Antimonium,?uta, Bryonia, Opium, and Phosphorus have been found useful. In constipation from inertia recti, or from atony of the intestinal canal, Sepia, Veratrum, Aurum muriaticum, Alumina, Natrum m., and Padus avium have been recommended as the best general remedies; but when the indications for the selection of any of the remedies we have given in the preceding part of this article manifest themselves, we must not hesitate to prescribe accordingly. For constipation in aged persons, the following medicaments are generally the most efficacious: Opium, Aurum m., Natrum m., and Padus avium (Padus prudus), or Veratrum, Bryonia, Lachesis, Baryta c., Juta, &c. In that which is prone to occur when travelling: Platina, Opium or Alumina, Calcarea, Cocculus, Conium, Graphites, HEMORRHOIDS. 227 Gratiola, Arsenicum, Kali, Baryta c., Agaricus m., or Ammon. &c., may also be called for in particular cases. When frequent purgings or protracted diarrhoea have given rise to constipation, Nux v. and Opium sometimes in alternation, or China, Aurum m., Natr. m., Pad. prud., Lachesis, Antim., Ruta, usually answer best. Againstvconstipation from exposure to the VAPOR OF LEAD: Opium, Alumina, Platina, aa, in general cases, the most important remedies. That from Congestion or fulness of the vessels of the head; Aconit., Belladonna, and, still better, Opium, N Vux v., Pulsatilla, Sulphur, Calcarea, Lycopodium, &c. (See Determination to the head.) And against that from Duodenitis (chronic): Jux v., Pulsatilla, Sulphur, lachesis, Veratrum, and, sometimes, JMercurius, Digitalis, Kali, Sepia, Ars., Silicea, Ammon. c. (See also HEPATITIS, DYSPEPSIA, and SPAsMODIC STRICTURE OF THE RECTUM.) PILES. HEMORRHOIDS. DIAGNOSIS. Varices, or effusion of blood in the cellular tissue of the rectum, either within or without the anus (internal or external piles); or protrusion and filling of one or more of the inner folds of the same intestine, and with or without bleeding (open or blind piles), preceded or accompanied by pains in the back, sacrum, and abdomen; sensation of itching, pricking, tickling, burning, or pressing at the rectum, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary functions. The predisposing cause of the disease is a constitutional taint; whilst among the exciting causes are habitual costiveness, severe exertion on horseback, prolapsus, use of drastic medicines, stimulating diet, the use of vinous, alcoholic, and fermented drinks, or coffee, the suppression of long continued discharges, sedentary habits, &c. During the treatment of this affection it is of the utmost importance to attend strictly to the homoeopathic rules for diet. Strong or heating drinks, such as wines, cofee, strong tea, and stimulating or highly-seasoned food of all kinds are 228 DIGESTIVE SYSTEM. particularly to be avoided. Sedentary habits and the use of soft cushions or chairs materially tend to aggravate the affection. The painful practice among surgeons of removing the hemorrhoidal excrescences by means of the knife or ligature is much to be deprecated; for, independent of the danger not unfrequently attending the operation, it may occasion serious consequences by metastasis of the congestion to some of the noble viscera; in a great number of cases, moreover, it wholly fails, and the disease returns, sometimes even in an aggravated form. THERAPEUTICS. The medicines most used in this affection are Aconitum, NVux vomica, Sulphur, Zycopodium, Arsenicuam, Belladonna, Hiepar sulphuris, Pulsatillac, Platina, Ignatia, Antimonium crudum, Colocynth, also Ipecacuanha, Calcarea, and Cinchona. ACONITE, although not specific'in its curative action, is useful in allaying pain, when considerable and distressing inflammation exists, and may in such cases precede the administration of each of the following medicines, which are among the principal remedial agents in this disease. Nux voMIcA, as we have before had occasion to remark, is a most valuable remedy in this affection, and is equally efficacious against both descriptions of piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulating liquids, and also for females during pregnancy; when the hemorrhoids are atterided with shooting, burning or itching pains; colic; shooting and jerking pain, as if from bruises in the loins, rendering it difficult to rise or walk in an erect position; and when they are accompanied by constipation and sometimes painful and difficult urination, and the other symptoms described under INDIGESTION or DYSPEPSIA. SULPHUR may follow the administration of Nux vomica; and an alternation, at intervals of a week or ten days, of these remedies frequently effects a cure in cases of long standing. ARSENICUM. Hemorrhoids accompanied by burning and shooting pains, heat, and agitation, sometimes with prostration of strength. BELLADONNA, moist hemorrhoids, with an insufferable pain in the sacral region, as if the back would break or be rent asunder; difficulty in voiding urine. HEMORRHOIDS. 229 HEPAR SULPHURIS may follow Belladonna, should that medicine fail to, or only partially, relieve these symptoms. RHUS TOXICODENDRON, when the violent pain, mentioned under Belladonna, still continues severe, this medicament may be selected in preference to Hepar, particularly if the pain be relieved by motion. CAPSICUM, when a burning sensation exists, attended with considerable itching and diarrhoea. PULSATILLA, discharge of blood and mucus during stool, sometimes accompanied by painful smarting, and sensation of excoriation in the hemorrhoids, pains in the back, pallid countenance, and disposition to fainting; difficulty in passing water. PLATINA, when there is frequent inclination to go to stool, followed by a very scanty and difficult evacuation, succeeded by general shuddering and a feeling of weakness in the abdomen; frequent creeping, itching, and piercing at the anus, particularly in the evening; griping in the lower intestine, discharge of blood during stool, and at other times. LYcOPODIUI is a most important remedy in chronic hemorrhoidal affections, particularly when there is congestion to the head, with giddiness and headache, flatulent distension of the abdomen, constipation, severe burning, itching, and pricking pains in ano, with painful protrusion of the hemorrhoids, and sometimes prolapsus ani after a motion; acrid discharge from the hemorrhoids; and prurient eruption round the anus. IGNATIA is indicated by itching and creeping, and also sensation of constriction and excoriation in the anus, and pricking or darting pain extending deep into the lower intestine; discharge of blood or of bloody mucus, rumbling noise in the abdomen, and protrusion of the lower intestine accompanied by acute pain. ANTIMONIUA CRUDUM, discharge of mucus and of blood at every stool, followed by severe colic and pain in the hemorrhoids, with throbbing, itching, and burning at the anus, and discharge of viscous acrid moisture, particularly at night; frequent determination of blood to the head, with bleeding at the nose; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulence, and constipation. 230 DIGESTIVE SYSTEM. COLOCYNTH. In cases of hemorrhoids, attended with excessive, almost insupportable colic, this is an efficient remedy. When the discharge of blood from piles amounts to hemorrhage, a dose or two of Aconitum may be given in the first place, followed by Ipecacuanha, if improvement do not speedily follow; again, if Ipecacucaha does not arrest or diminish the discharge in a few minutes, Szlphur should be prescribed, and followed in turn by Aconitum: but if, notwithstanding the employment of these remedies, the hemorrhage does not cease, Belladonna should be given, and then Calcarea. (See Hering's Domestic Physician.) CINCHONA is valuable either as an immediate remedy to support the patient, when there has been much loss of blood, or afterwards against prolonged debility. These are the principal medicaments to be employed in the treatment of ordinary cases of hemorrhoids; and when judiciously selected, will be certain to afford the desired relief, provided the patient is careful to adhere strictly to the rules laid down in the introductory remarks upon this affection. In severe cases of long standing, much patience and perseverance are required before the disease can be permanently removed. Against hemorrhoids with mucous discharge (blennorrhcea intestini recti), 2Mercurius, Ifelleborus niger, Colchicum, and 8pigelia are valuable medicines. STRICTURE OF THE RECTUM. Stricture of the rectum is divided, by some authors, into two kinds, viz,, the spasmodic and permanent. The first appellation being given to that form of the complaint which sometimes arises in consequence of the existence of hemorr, hoids, or from constipation, the prolonged use of drastic purges, etc., and in which the patient is affected with the following symptoms: costiveness, with considerable pain in the anus, particularly after a stool; the fieces are small in diameter, and present a twisted appearance. On passing the finger into the rectum, the lower sphincter is felt spasmodically constricted. The disease is, moreover, often complicated with a small but painfully sensitive ulcer of the mucous membrane, or with rhagades, or irregular fissures or cracks. The second variety, the permanent stricture, or stricture proper, consists STRICTURE OF THE RECTUIM. 231 in a thickening and induration of the mucous and muscular textures, and probably also of the interposing cellular tissue. In this form of the disease, the fseces are flattened and diminished in volume, and the patient encounters much difficulty in expelling them; the pain about the anus is distressingly severe, and does not remit, as in spasmodic stricture. When the finger is introduced into the rectum, the gut will, in most cases, be found contracted two or three inches from the anus; but in some cases the seat of the stricture is considerably higher. As permanent stricture of the anus is by far the most serious and obstinate form of the complaint, we shall offer the following additional particulars connected with it. The disease comes on very insidiously, and occurs in both sexes and at all ages, but in adults more frequently than in children. The patient, at the commencement, meets with some difficulty in evacuating the contents of the rectum, and is under the necessity of exerting considerable expulsive force. These symptoms gradually increase in severity, and are sometimes accompanied by others, which resemble those of ileus; the pain becomes extremely violent, and the freces are not only accompanied by a discharge of mucus, but also of blood and purulent matter, from the accession of inflammation in the contracted portion of the intestine. If the disease be not checked, the cellular tissue around the rectum becomes implicated iu the inflammatory process, and putrid abscesses form which burst in various spots in the vicinity of the anus, and the patient sinks. In some cases, the patient is carried off with symptoms resembling those of strangulated hernia, from the blocking up of the stricture by indurated fieces. In the advanced stage of the disease, most patients become hectic, but frequently linger on for several years. THERAPEUTICS. In spasmodic stricture, or preternatural contraction of the sphincter ani, the homceopathic treatment is, in recent cases, at once gentle, simple, and peculiarly efficacious: and even in long-standing inveterate cases, their employment is generally attended with successful results, when the patient can be prevailed upon to pursue the treatment long enough. The following are amongst the more frequently applicable remedies in ordinary cases of the disorder. Nux v., Opium, 232 DIGESTIVE SYSTEM. Jachesis, Plumb. c., Sepia, Natrum m., Mang., Mags., Staph., Calc., Coloc., Ang., Thuja. Where the patient is habitually of a costive habit, or the faeces are dry and hard, as is commonly the case in this affection, these remedies will prove equally opportune. And where hemorrhoids appear to have given rise to, or at all events accompany and aggravate the disorder, the same medicines, together with Sulphur, Colocynth, Calcarea, etc., form the principal remedial agents. In hysterical females, Ignatia, Sepia, Nux., Lachesis, and Natr. mn., Cale., Staph., N. moso., deserve a preference. The indications which are given for choosing the abovementioned remedies under the chapters of Constipation and Hemorrhoids, as also under that of Dyspepsia, when deranged digestion accompanies the complaint, will assist us in making a selection of the remedy or remedies best adapted to particular cases. Although we are opposed to the employment of a bougie for the purpose of dilating the anus in spasmodic stricture, still we are willing to allow that there are some cases in which the introduction of a suppository of tallow, at night, (a portion of a mould candle for instance,) may prove serviceable. Cases that are complicated with rhagades require the employment of such remedies as Graphites, Agnus, Sulphur, Calcacrea, Phus, or, Ifepacr, Mezereon, Alumina, Mercurius, Lycopodiunm, Sarsaparilla; but one or more of the medicaments enumerated, at the commencement of this article, will commonly be called for in the course of treatment. When the complication of a small, and excessively painful ulcer exists: Lachesis, Arsenicumn, Lycopod. And, sometimes, Sulphur, Silicea, and Calcarea are chiefly requisite. The homoeopathic treatment of permanent stricture likewise possesses many advantages over that of the ordinary method, particularly when, in the latter, the employment of bougies is rendered unsafe or inapplicable by the distance of the obstruction from the anus, or by an insuperable degree of irritability of the bowel. At the commencement of the disease, when the patient experiences much difficulty in expelling the fieces, and almost constantly complains of more or less pain about the anus, the same remedies are required as those we have mentioned as STRICTURE OF THE RECTUM.2. 233 appropriate in recent cases of spasmodic stricture. In the majority of instances, and especially in the male subject, Nux v., answers best to begin with, the more so, if the patient has been addicted to a rather free mode of living, or been given to sedentary habits and suffers from constipation, hemorrhoids, &c., in consequence. After the employment of Nu v., we shall generally find it requisite to have recourse to Sepia, Sulphur, and Calcarea at proper intervals. (See rules for the repetition of the dose, etc., in the Introduction.) At a more advanced stage of the complaint, where inflammation has taken place in the constricted portion of the bowel, and the pain has become intense, and is attended with a discharge of blood and even of purulent-looking matter, we have often obtained very satisfactory results from the use of a dose or two of Aconitum followed by Sulphur in repeated doses. After deriving all the apparent benefit from Sulph. which it seemed capable of accomplishing, we have prescribed Nux v., Ignatia, or Iachesis, according to circumstances, with decided benefit; the former was selected in preference where the indications or peculiarities were present which we have already given above,-Ignatia where the patient was affected with shuddering after each evacuation, and the last-named remedy, where the pain in the anus was accompanied by throbbing. Pulsatilla we have substituted with advantage for NAx v., as an intermediate remedy, in individuals of phlegmatic temperament; but have always found it necessary to follow up the administration of this, or any of the three preceding remedies, with Sep., Sulph., Calc., Silic., &c. There are a variety of other medicines which may be required in preference, or subsequent to any of the foregoing, in particular cases, and in different stages of the disease. Amongst these, we may quote the following, as deserving of especial attention: Staph~ys., Grcaph., Lycop., Clem., iiagn.. mn., NNatr. mn., Plumb. c., Alum., e., 3fez., Dulc., Coloc., Plat., JR1od., Hep,. s., Phiosph., Thu,., etc. In cases where the bougie may be thought necessary, but where great pain is produced by its introduction, the alternate use of Aconitum? and Arnica may remove the irritation. When the feces accumulate above the obstruction and give rise to additional irritation by over-distending the rectum, Opium should be prescribed, and 234: DIGESTIVE SYSTEM. succeeded by Nux v., if no effect take place after an interval of a few hours.* But when symptoms resembling strangulated hernia have made their appearance, in consequence of a blocking up of the stricture by a collection of hardened faeces, it may be advisable to attempt to introduce an elastic gum catheter through the stricture, for the purpose of throwing up an injection of tepid soap and water, and then tepid water and a couple or so of tablespoonfuls of sweet oil, previously to having recourse to aforesaid medicines; and if the enema fail to empty the bowel of its contents, we must avail ourselves of the remedies mentioned, or any of the others for which we have given special indications in the article on Hernia. In advanced cases of stricture, with ulceration of the mucous membrane, and the formation of abscesses, a cure may yet be attainable through the instrumentality of Silicea, Phosphorus, Sulph., Calc., Lycop., Mere., or Hepar s., etc. ABSCESSES IN ANO. - FISTULA IN ANO. The formation of matter in the vicinity of the anus is often preceded by a shivering fit. In some cases, the first marked symptom of derangement consists in a swelling of a part of the buttocks in the vicinity of the anus, which presents a somewhat extensive circumscribed hardness, and soon becomes very red in the centre, or assumes the form of phlegmonous inflammation, accompanied by a quick, full pulse, with great dryness and heat of skin. In other instances, the suppurative process is ushered in by an attack of widely ramified erysipelatous inflammiation, unattended by any circumscribed hardness, and exhibiting the disease in a more superficial character; the quantity of matter secreted being at the same time small, but the cellular tissue sloughy to a greater or less degree. On some occasions, the affection commences somewhat in the appearance of a carbuncle; the skin displays a livid or dusky red aspect, the matter is unhealthy and small in quantity, and the cellular membrane is in a grangrenous state. Finally, it may be observed, that the abscess sometimes * Plumbum c. may, perhaps, be better indicated than Nux v. in certain cases. ABSCESS IN ANO. 235 begins as a hardening of the cutaneous surface, near the anus, exempt from pain and discoloration; the induration softening and suppurating very gradually. The pulse is, incipiently, full, and hard; but as the disease progresses, it speedily becomes low, or feeble, unequal and irregular; the strength sinks rapidly; and the spirits are excessively dejected. The abscess may point in the buttock, either remote from the anus or in its immediate vicinity; or in the perineum. The matter may make its exit from one orifice or from several. Most frequently there is either only an external opening, or both an external and an internal one, which communicates with the interior of the rectum; but in other instances there is merely an internal aperture. Hence, abscess, or rather fistula in ano, has been divided into three kinds: viz., the blind external; the complete; and the blind internal. When a fistula in ano, or sinus by the side of the rectum, is fairly established, the following symptoms present themselves: The patient experiences pain in expelling the feeces, and is not unfrequently effected with strangury, prolapsus ani, tenesmus, hemorrhoids, diarrhoea, or obstinate costiveness; there is a discharge of thin sanies from the anus, or from a small fistulous opening in its immediate vicinity, according to the variety of the fistula; and the surrounding integuments are generally red and indurated. THERAPEUTICS. The homceopathic treatment of fistula in ano is, in many instances, eminently preferable to the surgical. It is the duty of a surgeon, however expert he may be as an operator, to spare the knife on every occasion, and in every disease, when he can do so without detriment to the case, and especially when there are other, and equally efficacious means either of terminating or of materially alleviating the sufferings of his patient. The disease in question, in addition to being frequently capable of a cure through the instrumentality of medicine, is, moreover, in some cases, so complicated, that the performance of the surgical operation for laying open the fistula, will fail in effecting a cure, or if it succeed, the affection will either return again at some future period, or its healing up will be followed by a more rapid advance and unequivocal development of the existing collateral disease. We particularly allude to complications with dis 236 DIGESTIVE SYSTEM. orders of the liver, lungs, or with stricture of the rectum, schirrus, &c., or to cases where the complaint occurs in persons of a very bad habit of body, and whose organism is in a greater or less degree of general derangement. In the early stage of abscess about the anus, if the patient be of a full, plethoric habit, the pain violent, and the inflammation of a phlegmionous character, a few doses of Aconitum are requisite. A simple emollient poultice may then be applied to the part, and the suppurative process forwarded by repeated doses of the third trituration of Silicea, or of Ilepar s. and Silicea in alternation. Should the abscess not burst, during the employment of one or both of these remedies, which will rarely be the case, however, it may be opened mechanically, when the skin has become much attenuated. When the inflammation is erysipelatous, and spreads extensively, Bella. and JRAus may be prescribed alternately in the first instance, but as soon as a degree of fluctuation, however trivial, can be felt, or when shivering sets in, Silicea, which is one of the most important remedies in established fistula in ano, must be given in repeated doses. Should an opening not form, soon after the exhibition of Silicea, and the cellular membrane be found in a sloughy state, an aperture should be made for the discharge of the matter. If the skin presents a livid appearance, and the fistula commences with the features of a carbuncle, Lachesis and Silicea must be exhibited in alternation at the comecemcement; but if a healthy action do not early display itself, a f'ree incision may be made in the part, and ArsenicuZm and Oinchona had recourse to, in alternation, if the patient's strength and spirits become much depressed. A little wine may also be allowed, where required, as is sometimes the case, even under the invigorating or tonic action of the homceopathic remedies, and that particularly in elderly subjects, or in those who have been long habituated to the use of stimulants, or have had their constitutions impaired by intemperance. After the bursting of the abscess and discharge of its contents, the approximation and union of the sides of the cavity may be left to nature; but when incarnation appears to proceed slowly or imperfectly, her efforts must be assisted by the internal exhibition of Jifercurius, Sulphur, and Silic., or of _Merc., Hepar, and COdc. ABSCESS IN ANO. 237 When the rectum has become involved or a true fistula has resulted, either through neglect or otherwise, our first object ought to be to attempt to heal it by the employment of medicine. Even in cases of long standing, and particularly, as already stated, where any other disease is found to exist, or where the general health is in a much impaired state, the employment of appropriate homoeopathic medicines must be resorted to before the surgical operation is thought of. In recent cases where the fistula has not been under homoeopathic treatment from the beginning of the attack, a dose or two of Mercurius may be given, and then Silicea and Sulphur to forward granulation. Should these not be sufficient to effect a cure, or should the case have been under homceopathic treatment from the commencement, and Silicea have been employed to promote the ripening and bursting of the abscess, we may have recourse to Pulsatilla, Sulphur, and Calcarea, in alternation, if the employment of only one of these be found inadequate to effect a cure or surmount the complicated features of the case. Hfepar may sometimes be required after Miercurius where the fistula is extensive, and Phosphorus after Silicea where there is considerable constitutional disturbance, or where there is complication with disease of the lungs. In cases which have been maltreated, or which have been long in existence and utterly neglected, the medicines with which the cure may be attempted are the same as we have already mentioned; but Silic, Sulphur, and Calcarea may be named as those on which we may chiefly rely, where any chance of success remains. It may be added that, when the liver is implicated, or the digestion much impaired, either through habits of intemperance or otherwise, Nux v., Pulsatilla, Mfercurius, and Lachesis will form valuable intermediate remedies, provided Silphur, Silicea, and Calcarea prove insufficient to overcome that additional derangement. (See HEPATITIS and DYSPEPSIA.) Where hemorrhoids exist, Sulphur is almost indispensable (see also art. HEVMORRHOIDS); and where the disease is associated with schirrus or carcinoma, Silicea, Sulphur, or Mere., Lack., Con., Arsenicum, and Lycopodium, are the remedies that are most likely to afford any chance of a cure. In complications with stricture, Nx, Sulph., Calc., &c., claim attention. (See STRICTURE.) 238 DIGESTIVE SYSTEM. PROCTALGIA. Proctalgia, or severe pain in the anus, is liable to attack certain individuals after every exposure to cold; but it more commonly occurs as symptomatic of some other affection, such as piles, prurigo, schirrus, or the existence of a small ulcer, which often forms on the posterior wall of the rectum, opposite to the extremity of the os coccygis. The suffering in the latter, or symptomatic forms of the complaint, is solely experienced, or is at all events materially aggravated during and after the expulsion of freces; and the act of defecation is frequently attended with copious hemorrhage. THERAPEUTICS. When the disorder takes place in consequence of exposure to cold, or occurs apparently as a purely idiopathic affection, it will often yield to the employment of Kali c. In other cases, especially when the pain is excessively acute, a dose of Aconitum will be found useful, followed, if required, by the continuation of the pain in an undiminished ratio, after an interval of a few hours, by Nax v., or by Ignatia if the pain is increased after a stool, or is attended with shivering or shuddering. The following medicaments may be named as likely to prove efficacious in some instances: Conium, Natrum m., Sulph., Sepia, or Carb. v., &c. In the symptomatic forms of the disease, the remedies must be selected according to the nature of the primary complaint. Thus, in the case of hemorrhoids, Aconitum, Belladonna, Nux v., Puls., Sulph., &c., are principally required. (See HEMORRHOIDs.) In that of prurigo, Sulph., Sep., Ac. nitr., Mferc., Thuja, Calc., &c. In schirrus or cancer, Con., Arsenic., Lachesis, Xere., Sulph., Silicea. And in that arising from the formation of a small, excessively sensitive, ulcer in the lower and posterior part of the rectum, Iache.sis, Lycopod., Sulphur, especially when there is obstinate constipation; and Arsenicum, Silicea, or Calcarea, when the bowels are in a normal state, or the former remedies are insufficient to effect a cure. PROTRUSION OF THE INTESTINE. PROLAPSUS ANI. By this term is understood the protrusion of a portion of the mucous membrane of the lower intestine; it is of much COLIC. 239 more frequent occurrence in children than adults, and takes place during straining when at stool, or when urinating. The reduction of the protruded portion of intestine is easily effected by gentle pressure with the thumb, or thumb and fore-finger, which have previously been dipped in oil. THERAPEUTICS. The principal remedies for removing the tendency to this affection are, Ignatia, Nux vomica, Mercurius, and Sulphur. IGNATIA is particularly efficacious when the disorder occurs in persons of mild and sensitive temperament, and is attended with constipation. Nux vonMIcA is indicated for persons of irritable or lively disposition, and addicted to high and stimulating diet, with a tendency to hemorrhoids and constipation. MERCURIUS is particularly suited for children, in whom the disease is attended with hardness and swelling of the abdomen, and great tenesmus. SULPHUR is one of the best remedies for the permanent removal of the disease. Calcarea, Iycopodium and Sepia may be found necessary in some obstinate cases, after Sulph. In other cases: Plumbum, Arsenicum, lfezereum, Natrum m., Colchium, Ruta, Theridion, and MJcagnes artiicialis have been found efficacious. COLIC. ENTERALGIA. DIAGNOSIS. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with painful distension of the abdomen, spasmodic contraction, and sometimes vomiting and costiveness, or diarrhoea. The general exciting causes of this complaint are, acid fruits and indigestible substances; cold from wet feet, drinking cold beverages when heated, constipation, worms, &c. It is frequently also a concomitant symptom of some other derangement, but occurs equally often as a primary disease. We shall here content ourselves with giving the symptoms under the medicines, without entering upon the different varieties of this affection. One of the distinctive characteristics between this malady and internal inflammation, is the pain being somewhat relieved by pressure. 240 DIGESTIVE SYSTEM. THERAPEUTICS. In general cases the selection of the remedy is considerably facilitated by directing our attention to the cause of the affection. Thus, when the pain is evidently induced by a morbid accumulation of flatus (flatulent colic), one or more of the following remedies will be required: Nux V., Puls., Chin., Cocc., Carb. v., Cham., Bella., Sulphur; or Lycop., Colch., Natr. m., Coloc., Grcah., Fer., Veratr., Acid. nitr., ]iMagnet. arct., N. mosch., Agn., Phosph., Zinc. When the attack proceeds from a spasmodic contraction in a portion of the intestinal tube (Ileus): Opium, Plumbum;or, when inflammation has supervened, or given rise to this form of the complaint: Nux v., Bella., Lachesis, Mierc. (See ENTERITIS.) For colic resulting from hemorrhoids (IHemorrhoidal colic): Nux V., Puls., Lach., Coloc., Carb. v., Sulphur. (See HEMORRHOIDS.) For that arising from the presence of worms in the alimentary canal: Cina, Cicuta, Spigelia, iMerc.; or, Fer., Ruta, Sabad., Nux mosch, etc. (See INVERMINATION.) For spasmodic colic: Bella., Hyosc., Cham., Coloc., Cocc., Nux V., Puls., Cupr., Lach., Sulph., etc. For that which has been occasioned by indigestible food: Puls., Antim. c., Nux V., Bella.; or, Bryon., Carbo v., Arsenic., China, Coffea, iHepar sulph. For colic which has been excited by a moral cause, such as a fit of passion, or indignation: Cihamomilla, Colocynth, and, sometimes, Sulphur. When external violence, such as a blow, strain in the abdomen, or in the loins, has given rise to the attack: Bhzus, Bryonia, Arm., or, Carbo v., Calc., Lach. Against Lead colic, Devonshire colic, Dry bellyache (colica pictonum), Opium, Belladonna, and, secondly, Alumina or Platina, are the most efficacious remedies. (See also Leadparalysis, Art. Palsy.) For colic arising from a chill, Nux v., Cham., Merc., Coloc., China, are the most serviceable. For that from exposure to cold, damp weather, Pulsatilla; and that from a thorough wetting, Rhus. In hysterical colic, Ignatia, Cocculus, Mosch., Magn. m., Nux V., Puls., Ipecac., Bella., Bryod., Stramon., are the most useful. COLIC. 241 And in that which occurs in females during the catamenia (menstrual colic); Cocculus, Nux vomica, Belladonna, Pulsatilla, Cofea; and Carbo v., Secale, Sulphur, Zincum, etc. (See DYSMENORRHEA.) Nux VOMICA is especially indicated, either in flatulent or hemorrhoidal colic, or colic arising from a chill, when there is a sensation of fulness and tightness at the upper part of the abdomen; with acute pressive and forcing-down sensation, compelling the sufferer to bend double; violent cutting pains in the hypogastrium; confused headache, with occasional loss of consciousness; short and difficult respiration; flatulence, aggravation of the pains on the slightest motion, generally disappearing when at rest; violent pains in the loins, and sensation of internal heat and obstruction; constipation, coldness and numbness in the hands and feet during the paroxysm. It is a very useful remedy at the monthly period in- females, when we find weight or violent deep-seated aching pain in the abdomen, and aching in the sacral region; dragging pains extending to the thigh; aching and creeping sensation in the same part when sitting; painful pressure towards the rectum. PULSATILLA is often of peculiar efficacy in colic occurring in females, either during the catamenia or at other times, when coming on periodically in the evening during cold, damp weather, and accompanied by tightness and distension of the abdomen and epigastrium; pulsation in the pit of the stomach, aggravation of the suffering when at rest or in the evening, attended with shivering, which increases with the pains, and is mitigated by motion; severe bruising pains in the loins, especially when rising up; also when the affection has arisen from overloading the stomach, or from rich greasy food, with inclination to vomit, flatulence, diarrhcea, paleness of the face, livid circle round the eyes, and headache; or in hemorrhoidal colic, with fulness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness. CHAMOMILLA,-bilious colic; colic in females during the menstrual flux. The followifg are the principal indications: sensation as if the intestines were gathered into a ball, and as if the abdomen were empty, with tearing and drawing pains, attended with excessive anxiety and restlessness; distension under the lower ribs and in the pit of the stomach; incarce16 242 DIGESTIVE SYSTEM. rated flatus, sometimes nausea, or vomiting of a bitter or bilious fluid, bitter vomiting, followed by desire to relieve the bowels, and bilious diarrhoea; livid circles round the eyes, alternate paleness and redness of the face; the pains come on particularly at night, at other times early in the morning, or after a meal. This remedy, as before stated, is particularly adapted for children of irritable temperaments, and is extremely serviceable in all cases in which a fit of passion has been the exciting cause of the sufferings. It is also useful when colic has arisen from cold in the feet or checked perspiration. Although in instances quoted, Chamomilla is of itself generally sufficient, it has been sometimes found useful to precede it by a dose of Aconite. (Colocynth is often useful after Chamomilla, when the latter has produced only partial relief.) BELLADONNA,-flatulent colic, when there is distension of the transverse section of the great intestine, attended with colic-like pain which is relieved by pressure on the part; also severe dragging pains, from above downwards, as if the whole of the intestines would be forced downwards from their containing cavity; menstrual colic, with spasmodic constriction in the abdomen, and a burning pain lower down or in the small of the back; violent griping in the hypogastrium. The symptoms are frequently attended with a liquid or puriform species of diarrhoea, and swelling of the veins of the head; and the pains are aggravated by movement, or are sometimes so violent as almost to deprive the patient of reason. CoccuLus is indicated (especially in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains in the lower part of the abdomen; great flatulence, fulness, and distension of the entire abdomen, with nausea and difficulty of breathing; also when there is a sensation of emptiness, tearing and burning pains in the intestines, sometimes with squeezing, tearing and dragging pains, excessive anguish and nervous excitement, and constipation. COLOCYNTH. In the majority of violent and obstinate cases, we find this a valuable remedy; it is indicated when the pains are excessively violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives; sometimes there is a sensation of clawing and pinch COLIC. 248 ing, and tenderness of the abdomen, with a pain as from a blow; or distension of the abdomen; at other times a sense of emptiness is experienced, with cramps and shivering, or tearing pains in the legs; during the continuance of the attack, we find excessive restlessness, agitation, and tossing about from the violence of the pain: when the pains come on, they continue without any apparent intermission; after their disappearance, a bruised sensation remains, and the sufferer feels as if the intestines were held together by thin threads, likely to break from the slightest motion. Both this remedy and Ohamomilla are particularly efficacious in the so-called bilious colic, being indicated by the diarrhoea and bilious vomiting attending it, and also in cases where passion has been the exciting cause. Colocynth is more particularly useful in the case of adults, or where the fit of anger is attended with indignation. SULPHUR may follow either Ciamomilla or Colocynth in cases of bilious colic, where only partial relief has been obtained; or, in flatulent colic, may be taken after Nux v., Carbo v., Cocculus, or Ckamomilla; and in hemorrhoidal colic after Nux v. or Carbo v. ARSENICUM in colic, arising from disordered stomach, witnausea, vomiting; diarrhoea, with green or yellow evacuations, violent gripings, headache, paleness of the face, and blue marks round the eyes; accession of the pains, particularly during the night, or after eating or drinking. COFFEA is valuable when we have to prescribe for colic with excessive pains, attended with great agitation, anxiety, and tossing about, grinding of the teeth, convulsions, threatening suffocation, oppressive despair, acidity, and coldness of the body and extremities. It is also useful in some kinds of menstrual colic, denoted by a sensation as if the abdomen were being rent asunder; or by fulness and pressure in the abdomen, and violent spasms, which extend to the chest. It is also indicated by cutting pains in the intestines as if divided by a knife, and when the pains are so violent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. BRYONIA, colic with constipation, tension in the abdomen, and flow of saliva like salivation. In cases of colic, arising 244 DIGESTIVE SYSTEM. suddenly from indigestible food, a cup of black coffee, without milk or sugar, will frequently afford relief, by causing the stomach to free itself from the cause of annoyance; i. e. in patients, who have not used that article as an ordinary beverage. When the complaint arises from CONSTIPATION, Silicea is sometimes called for, at others Conium. See CONSTIPATION. (See also articles, Dyspepsia, Gastrodynia, Flatulency, Hepatitis, Nephritis.) DETERMINATION OF BLOOD TO THE ABDOMEN. Congestio viscerum abdominis. Congestio ad abdomen. This derangement is characterized by a disagreeable or painful sensation of weight, heat, and burning, with hardness and tension in the lower portion of the abdomen. Nux voMICA is one of the most frequent sources of relief in those who lead a sedentary life, or are much addicted to overindulgence in the pleasures of the table, and particularly when the following symptoms are complained of: hardness, tension, and fixed pain in the abdomen, sense of great weakness or prostration, rendering it difficult or almost impossible to walk about; constipation, with pain in the loins, spirits oppressed and irritable. SULPHUR will frequently be found serviceable in completing the cure after the above, or it may be selected in preference in cases of long standing, when we meet with the following indications: dull pains, and disagreeable sensation of distension in the abdomen, constipation, tendency to obstinate hemorrhoidal attacks, extreme dejection. CARBO VEGETABILIS may be selected when the symptoms are accompanied with excessive flatulency, and will frequently be found of great service in some obstinate cases when alternated with the two preceding remedies. ARSENICUM will also be found useful, especially when there is a disposition to diarrhoea with extreme weakness: orCAPSICUM, when these symptoms occur in individuals of a lymphatic temperament. SEPIA is often of much utility in the case of females, particularly when the symptoms are analogous to those described under Sulphur. LOOSENESS OF THE BOWELS. 245 In particular cases the following will also be found useful: Pulsatilla, Belladonna, Jiercurius, Bryonia, Lycopodium, Chamomilla, Rhus toxicodendron, Veratrum. (See also DYSPEPSIA and HEMORRHOIDS.) Daily exercise in the open air, together with a careful attention to regimen, must be observed by those who are afflicted with this affection. LOOSENESS OF THE BOWELS. DIARRHIEA. DIAGNOSIS. Fluid discharges from the intestines in increased quantity. This affection is simply an increase of the peristaltic action of the intestinal canal, and is so well known under its different forms, that I shall simply allude to the principal exciting causes, and then proceed to the treatment. The exciting causes are acid indigestible food, a check of perspiration, sudden changes of temperature, the prolonged use of powerful purgatives, which, although still more frequently the cause of constipation, nevertheless, by producing irritation of the intestinal canal, also predispose to attacks of this derangement, worms, &c. Sometimes diarrhoea is a salutary crisis, as remarked under Fevers; here again the homoeopathic treatment assists Nature, and, while it abridges the duration of the affection,-and thereby obviates future debility,-does not rashly check its course. THERAPEUTICS. We shall, in the first place, give a synopsis of the medicaments, and the different forms of diarrhcea in which they are especially applicable, and then proceed to describe the leading indications for those remedies which are most frequently required in general cases. In DIARRnHEA BILIOSA,-Pulsatilla, NVzx., Bryon)., Cham., Ipecac., Antim. c., chiefly; or, Arsenic., Coloc., China, Veratr., Acon., Bella., Digitalis, Tarax., Asar., Colch., Ign., Acid phosph. In DIARRiHEA MUCOSA s. PITUITOSA: PWul., Coloc., Mere. chiefly; and Petrol., Acid. phosph., or Phosph. in inveterate cases. Or again, Nux v., Secale c., Dulc., Ammon. m., Ignat., Staph., Senega, Bry., Rheum, Cham., Digit., Cina, Bella., Acid. sulph., Arsenic., Sep., China, Rhus, Spig., Mez. In DIARRHCEA STERCORALIS: Puls., Ipecac., Ant. c., 2vu, Bry., Cham., 246 DIGESTIVE SYSTEM. Tart. em., Arsen., Ac. phosph. Sulph., chiefly; or Coloc., Coccul., China, Merc., Dig., Bella., Veratr., &c. DIARRIHEA SEROSA: Arsenic., Cham., China, Puls., Nux, Rhus, Lach., Calc., Sec., Fer., Iyosc., chiefly; or Phosph., Petr., Sulph., &c. LIENTERIA: Cinchona, Ferrum; or Arsenic., Bry., Nrux v., Ph., Acid.phosph., Lach., &c. When an attack of diarrhoea has been occasioned by a CHILL: Cham., Dulc., Bry., Bella., Merc., Yeratr., or Nux mosch.; in some cases, Puls., China, Natr., Nux, Sulph., are the most appropriate remedies. When arising from a chill, during spring, summer, or autumn: Ars., Dulc., Bry., or M1ere. When from COLD DRINKS: Ars., Bry., Puls., Carb. v., Nux mosch. If a sudden mental emotion has given rise to the attack,-Coffea, Opium, Veratr., Antim., Acon., or Puls., are the most useful when it has consisted of a sudden fright or an unexpected joy,-Ignatia or Acid. phosph. when of a depressing character, such as grief; Cham., Coloc., or Bry., when a fit of passion or the effects of contradiction have brought on the complaint. For diarrhoea arising from EXCESSIVE INDULGENCE IN INTOXICATING LIQUORS, Nux v. and Carbo v. are commonly the most useful. That which is liable to ensue after partaking of milk, Bry., Sulph., Lycop., Sep., Natr. And that which takes place after eating fruit, or after the use of acids, Ars., Zach., or Puls., chiefly. Against the diarrhoea which sometimes occurs as a sequela of MEASLES, SCARLATINA, SMALLPOX, &c., Arsenic., Puls., M2erc., Ac. phosph., or Sulph., are commonly of the greatest efficacy. That which is encountered in STRUMOrS HABITS, Calc., Sulph., Silic., Zye., Sep., Dulc.; or Arsenic., China, and Baryta c. That in PHTHISICAL PERSONS: Fer., China, Phosph., Calc. That in individuals of DEBILITATED or exhausted constitutions: Secale c., China, Fer., Acid. phosph., Phosph., Nux mosch. And that in the aged, Antim., Secale, Bry., Phosph. When diarrhoea is unattended with pain, Ferrum is the most useful remedy in general cases, but China and Secale c. are often useful; the latter especially when the tongue is coated with mucus, the taste clammy or pap-like, and there is much borborygmus. When accompanied by colic (DIAR LOOSENESS OF THE BOWELS. 247 RHIIEA TORMINOSA): Gale., Ars., iere., Cham., Puls., Bry., Rhus, ]Rheum, Sulph., Acid. nitr., Hepar s., &c. When attended with TENESMUS, Mer.c, Lach., Hepar, Rhus, Nux v..; or Arsenic., Rheum, Caps., Sulph., &c. With VOMITrIG; Ars., Ipecac., Veratr.; or Oham., Coloc., Dulc., Fer. (See also CHOLERA.) With PROSTRATION OF STRENGTH (colliquative diarrhcea): Arsenic., Veratr., Cin., Ipecac.; or Secale c., Phosph., Acid. phosph., NVux., Sep. In chronic or inveterate diarrhcea, Phosph., Acid. phosph., Petrol., Sulph., Calc., China, Fer., Acid. nitr., Graph., Ilepar, ]hus, Lach., Acid. sulph., are the most important medicaments. And in cases in which there is constantly a relaxed state of the bowels or tendency to have several stools daily, Phosph., Sulph., Calc., Acid. nitr., Sep., _Kreos., Graph., or Natr. m. The principal remedies in ordinary cases are, Dulcamara, Bryonia, Cinchona, Ferrum aceticum, OChamomilla, Rheum, Mercurius, Pulsatilla, Nux vomica, Ipecacuanha, Arsenicum, Antimonium crudum, Rhus toxicodendron, Opium, Sulphur, Calcarea, Acidum phosphoricum, Phosphorus, &c. DULCAMARA is often the most appropriate remedy in diarrhoea, occurring in summer from cold, especially from wet feet or exposure to rain. Particular indications for its exhibition are the diarrhoea being attended m ith colic, or cutting pain, chiefly in the region of the navel; the evacuations being liquid, slimy and yellow, or greenish, generally coming on at night, and sometimes attended with nausea, or even vomiting; want of appetite and great thirst, paleness of the countenance and lassitude. BRYONA should be given in cases of diarrhoea arising from the before-mentioned causes, and attended with many of the symptoms noted under Dulcamara, when that medicine has failed to afford the required relief in six or eight hours, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and the stools are passed almost involuntarily, and certain portions undigested; also when looseness is experienced after partaking of milk. In diarriea occurring during hot weather, when we cannot trace the causes to any errors of diet, requiring other remedies, this 248 DIGESTIVE SYSTEM. medicine is further indicated, and particularly so in the following instances: diarrhoea from checked perspiration, or being overheated-cold drinks-a chill from remaining in any cold exposed situation, or in draughts-or from biting, easterly winds. When this affection has been produced by passion, particularly in individuals of a bilious temperament, Bryonia is again a most useful remedy. (Chamomilla is equally efficacious here, and deserves a preference in the case of children.) It may also be remarked, that the diarrhoea arising from drinking impure water when heated, has frequently found relief in this medicine. When the water is strongly impregnated with vegetable substances, it may be advantageously followed by Cinchona, Pulsatilla, or by Arsenicum, according to the symptoms (see these remedies). (Antimonium is sometimes required to complete the cure after the previous employment of Bryonia.) CINCHONA:-Looseness in consequence of indigestion, particularly if occasioned by partaking of fruit or flatulent food, such as vegetables; stools very profuse, sometimes attended with but little pain, frequently occurring immediately after partaking of food, or especially during the night, watery, and brownish, and sometimes containing portions of undigested food. CINCHONA is, in some instances, further indicated when considerable spasmodic or griping pain is present, accompanied by flatulence, want of appetite, thirst, and great weakness; and is also valuable after improper treatment or protracted cases of this affection, when considerable debility remains. FERRMU ACETICUM may be advantageously given in alternation with Cinchona at intervals of twelve, hours, when the evacuations are partly composed of undigested food (see also Arsen., Mere., Bryonia, Phosph., Zachesis,) and pass without pain; or this remedy may be administered alone, when the diarrhoea is unattended with pain, and there are paleness of the face, weakness of the eyes, pains in the back and anus, with great weakness of digestion. CHAMOMILLA is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration; it is further particularly indi LOOSENESS OF THE BOWELS. 249 cated when the evacuations are watery, bilious, green, yellow, or slimy, or of a fetor resembling rotten eggs, and accompanied by fulness at the pit of the stomach, severe colic or spasm, pain in the abdomen, distension and hardness of the abdomen, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting, and flatulence (in infants), with restlessness, screaming, and drawing up of the limbs towards the stomach. Sulphur is frequently useful in completing the cure when the pains have been removed by Chamomilla. RHEUM, when the symptoms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a very sour smell; paleness of the face is also an indication for this medicine. (See DIARRCEA IN CHILDREN.) MIERCURIUS, when the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated; also when there is painful tenesmus before, during, and after stool, frequently followed by protrusion of the lower intestine; severe cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, shuddering, great lassitude, and disposition to syncope; sour-smelling stools; diarrhoea with ingesta. PULSATILLA is one of the best remedies in simple looseness, or diarrhcea, arising from errors of diet, such as indulgence in acids, fruits, or rich indigestible food, attended with foul tongue and other dyspeptic symptoms. (See INDIGESTION.) Another remarkable indication for this remedy is one evacuation differing from another in color. IPECACUANHA:-Looseness arising from indigestion, particularly if caused by imperfect mastication, attended with nausea and vomiting; paleness of the face (see also Arsen.), weakness, and desire to retain the recumbent posture (in the case of children). When Ipecacuanha does not appear to afford much relief, Pulsatilla ought to be had recourse to, in the space of from twelve to twenty-four hours, after the last dose of Ipecacuanha. Nux voMIcA:-Scanty stools, consisting of slime and blood, attended with straining and great weakness, flatulency, and violent cutting pains in the region of the navel. For some of 250 DIGESTIVE SYSTEM. the occasional accompanying symptoms the reader is referred to the indications given under this remedy, in INDIGESTION. ARSENICUM:-Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, &c. the characteristic symptoms for its employment are, watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, emaciation, and great weakness; and when the affection is more liable to come on at night, or after eating or drinking.-( Vide the further indications for this important remedy in Part III, under BOWEL COMPLAINTS IN CHILDREN.)* ANTIMONIUM CRUDUM is a good remedy in cases arising from disordered stomach, with white tongue, loss of appetite, eructations and nausea; also when the symptoms given under Bryonia (which see) continue after the administration of that medicine. RHUS TOXICODENDRON:-Lumpy or pap-like diarrhoea, coming on only at night, and preceded by colic, which disappears after each evacuation. OrIUM is efficacious in diarrhoea arising from fright, or from cold, and may be followed, if required, by Dulcamara in the latter case. For other indications, vide MENTAL EMoTIONS. LACHESIS:-Diarrhoea from acid drinks,' or sour unripe fruits, with severe griping; diarrhoea with ingesta; diarrhoea during damp weather. SULPHUR is a most valuable remedy in diarrhoea, particularly when the affection is worst during the night, or when it occurs in strumous habits. In adults predisposed to hemorrhoids, or in children, when the diarrhoea is attended with excoriation and papular eruptions, it is particularly efficacious; also in very obstinate cases, and where the slightest cold brings on a relapse or an attack; or when milk disagrees and causes a looseness. CALCAREA may be had recourse to after Sulpkhr. AcmIDM PHOSPHORICUM:-In obstinate cases, with portions * When Arsenicum does not answer our expectations, Veratrum should be substituted; the latter remedy is, moreover, for the most part to be preferred, when the disease appears to have arisen from atmospheric causes. DYSENTERY. 251 of undigested food in the evacuations; or occasional involuntary evacuations. PHOSPHORUS:-In chronic, painless diarrhoea, with gradual prostration of strength; diarrhoea with ingesta. When diarrhoea occurs only or chiefly during the night, Arsenicum, Cham., China, Puls., Merc., Rhus, Sulph., Dulc., or Bryonia, are the most appropriate remedies; and when it occurs alternately with constipation, NVux., Lach., Antim. c., Rhus, Ruta, or Tartarus emet. Lastly, when diarrhoea has been produced by the abuse of medicinal agents in allopathic practice, the following are the most serviceable: Repar s., or Acid. nitr., China, or Carbo, when from the abuse of MERCURIAL PREPARATIONS. Puls., or Rheum, when from the employment of Magnesia. And Puls, OCam., M3erc.; or Coloc., and Nux v., when from Rhus. DIET. Acids or acidulous wines, beer, coffee, strong tea, and fruits, whether raw or cooked, should be carefully avoided. Solid food should likewise be proscribed, as tending,to keep up the intestinal irritation; and gruel, fresh milk, broths, and light mucilaginous food substituted. In protracted cases, attended with debility, but no symptoms of inflammation or ulceration, generous, easily digestible food, and sometimes a little wine, or wine and water, must not be withheld. DYSENTERY. DYSENTERIA. FEBRIS DYSENTERICA. DIAGNOSIS. Constant urgency to evacuate the bowels, tenesmus, violent pains in the abdomen, a greater or less degree of fever, particularly towards evening, and stools of mucus or blood, or both. It may appear suddenly, but is frequently preceded some time by loss of appetite, costiveness, flatulency, nausea or slight vomiting, with chills followed by heat of skin and accelerated pulse, then dull abdominal pains and increased evacuations; after a time no fieces are discharged, but white mucus (dysenteria alba) which may afterwards change to blood (dysenteria rubra); stools, particularly when fever is present, very frequent and fetid. If not checked in time, the disease may terminate in ulceration or gangrene, or the patient may sink from exhaustion. 252 DIGESTIVE SYSTEM. The prognosis becomes very unfavorable when the pains, which have previously been extremely severe, suddenly cease, the extremities become cold, the pulse small and intermittent, the stools putrid and involuntary. This affection is very frequently complicated with pains resembling those of rheumatism (Dysenteria rheumatico-catarrhalis), which will be noticed under the different remedies, as an additional indication for their employment. The exciting causes are, checked perspiration, particularly in warm weather, or an exposure to the cool atmosphere of an autumnal evening after the pores have been opened by active exercise, or exertion during the day; low or marshy situations, local irritations, such asworms, scybala, &c., and suppression of hemorrhoids, metastases, and sometimes, in infants, difficult dentition. THERAPEUTICS. The principal remedies in dysentery are Aconitum, Belladonna, COamomilla, Pulsatilla, Ipecacuanha, Colocynth, Mercurius corrosivus, Mere. vivus, Arsenicum album, Carbo vegetabilis, Nux vomica, Capsicum, Cinchona, Kreos., Aloe, Ihus, Sulphiur Staph., Tart., Sep., &c. Of these Acon., Bella., and Nux or Merc. are the most appropriate in DYSENTERIA INFLAMMATORIA. Aeon., Cham., Rhus or Puls. in DYSENTERIA RHEUMATICO-CATARRHALIS. Aconitum, Merc. corros., Colocynth, Colch., Puls., or Veratrum in DYSENTERIA BILIOSA. Pus., Ipecac., iMerc., Dulc., but more especially Colchicum and Mtere. corros.; and in some cases, Acid. sulph., Hepar s., Aloe, Canth., Caps., Carbo v., Ahus, Staphys., Acid. nitr., P umb., in DYSENTERIA PITUITOSA S. ALBA. Arsenic., Nux, Carbo u., Petrol., Kreosot., Acid. sulph. et nitr., in DYSENTERIA PUTRIDA. On consulting the chapters on Enteritis, Febris gastrica, biliosa etmucosa, Diarrhoca, Cholera, and Dyspepsia, many of the general indications for the most of these remedies will be found detailed, and considerable assistance in the selection of the remedies thereby afforded. The following are, however, some of the characteristic indications for some of those medicaments which are most frequently called for in dysentery: ACONITUM. This remedy is peculiarly adapted to cases attended with synochal fever, and in young and plethoric patients is generally required at the commencement or in the DYSENTERY. 253 course of the disease. It is indicated by full and hard pulse; severe pains, generally in one spot; abdomen tense and painful when touched, denoting the commencement of inflammation (dysenteria inflammatoria); and is also valuable when we find pains resembling rheumatism in different parts of the body, with shivering, or excessive heat and thirst. Prescription as in INFLAMMATORY FEVER, which see. CHAMOMILLA should be prescribed if, after the administration of Aconite, we still find violent heat and thirst, rheumatic pains in the head, and constant agitation and tossing. This remedy is also useful when the disease seems to have taken for its proximate cause the formation of gastric impurities in the primse vie; or when it has arisen from exposure to a cool atmosphere when in a state of perspiration. When we find foul tongue, with clammy, bitter taste in the mouth, and bilious stools, before tenesmus declare itself. This remedy is evidently indicated as most useful in the first or diarrhceal stage of the complaint; it may be followed by Pulsatilla, when the symptoms given under that remedy present themselves. J Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. ij. M. Dose. 3 ss every six hours, until the improvement takes place, or indications for some other remedy present themselves. PULSATILLA, when the gastric symptoms noted under Chamomilla are present, but the stools consist entirely of mucus, striated with blood. (Dysenteria pituitos.) fr Tinct. Puls. 6, gtt. iij. Aq. pur. 3 ij. M. Dose. 3 ss every six hours. (See "Rules for the repetition of the dose."-Introduction.) The three remedies above-mentioned are also valuable in dysentery arising from cold, or what is commonly denominated rheumatic catarrhal dysentery. IPECACUANHA. This remedy is serviceable when the dysenteric affection seems fairly established; when the stools consist of slimy matter containing white flocks, followed by evacuations of sanguinolent mucus. 1ý Ipecac. 3, gtt. iij. Aq. pur. 3 ij. M. Dose. As above. 254 DIGESTIVE SYSTEM. COLOCYNTH. In cases attended with violent colic and excessive distension of the abdomen; shivering with chills, apparently extending from the abdomen over the whole body; excessive agitation and restlessness; tongue coated white; slimy, and sometimes bloody evacuations; it is sometimes found useful after Ipecacuanha or.Mercurius. 1F Tinct. Coloc. 6, gtt. viij. Aq. pur. 3 iv. M. Dose. 3 ss every hour, or every three to six hours, according to the seventy of the symptoms, until amendment supervenes, when the intervals between the doses may be lengthened. MERCURIUS CORROSIVUS may be considered to be one of the most important of all the homoeopathic remedies in dysentery; but it is more especially in cases with the following train of symptoms that it is characteristically indicated: in the red dysentery or BLOODY FLUX, when we find severe tenesmus or straining, with evacuation merely of a little mucus, sometimes succeeded or accompanied by the protrusion of a portion of the intestine, and increased discharge of pure blood, or of putrid, corrosive, greenish, yellowish, or frothy mucus, intermixed with blood, and sometimes followed by the evacuation of small hard substances (scybala) after much straining; burning in ano; severe griping and lancinating pain before, during, and even after the motions; increased desire to go to stool after each evacuation. 1c Mere. corros. 3, gr. ij. Pulv. saccn. lact. gr. viij. Misce intime, et in chart. sequales viij distribue, quarum sumat unam tertiis vel quartis horis, p. r. n.-(See" Rules for the repetition of the dose."-Introduction.) In cases with the above symptoms MJercurius corrosivus may be considered a specific: it will, at all events, prove so efficacious a remedy, that any remaining symptoms can, in general, be removed, with facility, either by means of Colocynth, Acidum phosphoricum, or Acidum nitricum (the two latter especially, in the event of a continuance of the sanguineous stools), or any of the other remedies which may seem more appropriate, according to the indications for their employment as given in this chapter. (The directions for the dose are already given above.) DYSENTERY. 255 BRYoNIA is frequently called for in those cases in which it has been found necessary to administer Aconite at the commencement of the disease; but is more particularly indicated, when the attack has occurred, during the heat of summer, from the effects of a chill, and is attended with typhoid fever of the inflammatory form; with loose evacuations of a brownish color and putrid odor, occasionally containing lumps of coagulated mucus, resembling undigested substances, or small hard lumps or balls (scybalous faecal matter), with griping during, and burning in ano after, the act of evacuating, and aching pains in the limbs, aggravated by movement. When the disease has attained an advanced stage, and the accompanying fever is of a low typhoid type, the patient being much exhausted and distressed with severe rheumatic or aching pains in the loins and extremities, when reclining or sitting still, and the stools of a slimy, frothy, white, gelatinous, or sanguineous nature, passed involuntarily at night in bed, ius not unfrequently gives a favorable turn to the disorder. Dose of Bryonia or Rhus. Three drops of the third dilution to two ounces of water, a dessert-spoonful every two to four hours, until a favorable alteration is effected. ARSENICUM.-Dysentery of epidemic or contagious origin, with fever of a typhoid or putrid type (Dysenteria putrida); dysentery arising from exposure to noxious exhalations in marshy situations, &c. This remedy may, however, be selected in all cases, from whatever cause arising, when great weakness and even prostration exists from the commencement, with burning pain in relieving the bowels, thirst and aggravations of the sufferings after drinking, or, on the contrary, adipsia;-also when the disease threatens to assume the ulcerative or gangrenous form-characterized by previous severe pains, particularly burning, which suddenly cease; hypocratic expression of countenance; rapid sinking of the vital energies; pulse small and intermittent; coldness of the extremities; highly offensive, putrid, and cadaverous-smelling evacuations, both of faeces and urine; unconscious passing of stools; offensive breath, and petechie in different parts of the body. 256 DIGESTIVE SYSTEM. 1* Tinct. Arsen. alb. 6, gtt. iv. Aq. pur. 3 iij. Dose. A dessert-spoonful every two, three, or six hours, according to the urgency of the case, carefully watching the effects, and shortening or lengthening the intervals accordingly. CARBO VEGETABILIS is a most useful remedy in those desperate cases where the breath is cold, the pulse almost imperceptible, and the patient complains of severe burning pains. Its indications closely resemble those of Arsenicum, with the exception of the thirst, and the aggravation caused by drinking. It may be given with benefit when that remedy has failed, or only partially relieved, and in this, as in other affections, many instances might be cited where a judicious alternation of these two remedies has effected benefit-neither of them having been, singly, adequate to the exigency of the case. Form of prescription, same as Arsenicum. Nux VOMICA. When Arsenicum has diminished the severity of the symptoms and warded off the impending danger, but we find that the foeces still retain a highly putrid odor.; also at any period during the course of the disease, when the following symptoms are present:-Frequent and scanty evacuations of mucus or sanguineous mucus, and occasionally small, compact, hard freces (scybala), attended with violent cutting or griping pains in the region of the navel, borborygmus, pains in the loins, tenesmus, burning or sensation of excoriation in the anus, and sometimes protrusion of the intestine; great heat and excessive thirst. CINCHoNA is a good medicine when the disease has an endemic character, occurring in marshy countries, and in many cases where a state of putridity remains in the foeces after the administration of the remedies above mentioned. Form of prescription for Vux and China, same as that given for Pulsatilla. CANTHARIDES:-Sanguineous stools, mixed with whitish mucus or solid substances likefalse membranes; strangury * SColchicum autumnale is preferrable to Cantharides when the symptoms,described, but more particularly when the stools consist almost exclusively of mucus, unmixed with blood (dysenteria alba, pituitosa), and DYSENTERY. 257 1ý Tinct. Canth. 6. gtt. iv. Aq. pur. 3 iij. M. Dose. 3 ss every four or six hours. SULPIUR:-When the more marked symptoms are ameliorated by the use of the foregoing remedies, but the dysentery still continues obstinate, and especially when the disease occurs in subjects, who have previously been long affected with hemorrhoids; or when it has from time to time been subdued, and afterwards returned with'greater or less violence; or even when the apparently best selected remedial agents have failed to check its course. It will frequently be found most efficacious in all these cases, since, whenever they occur, we may suspect some latent constitutional cause is baffling our efforts. In the first instance, denoted by the removal of the more prominent symptoms, the affection is terminated; in the second, the predisposition to a return of the attack is obviated; and in the third, the constitutional taint alluded to being controlled, the organism becomes susceptible to the specific action of the other medicaments. 1 Tinct. Sulph. 6. gtt. iii. Aq. pur. 3 iij. M. Dose. 3 ss at first every twelve hours, until an effect is produced, then discontinued for a time and allowed to act. In conclusion, we must not omit to add that, when the disease is of long standing, and has become (so to speak) habitual, a cure is often effected by means of PhosphLorus. Rules of Conduct and Diet. In this affection, it is of great importance to keep up a moderate degree of warmth around the abdomen, which is best obtained by flannel, worn outside the linen. During the course of treatment barely sufficient nutriment to keep up the strength of the patient should be allowed; and the more severe the inflammatory symptoms, the more strict must be the abstinence. No solids should on any account be given; but the diet should consist principally of mucilaginous or demulcent fluids, such as thin barley-water, and gruel; in comparatively mild cases, white of egg in sugar and water, when pain is experienced in the sigmoid flexure of the colon, and the disorder rages as an epidemy during the autumnal season. 17 258 DIGESTIVE SYSTEM. weak chicken-broth or beef-tea, may be allowed. Even after convalescence, this course of diet should be for a short time observed, fruit and vegetables eschewed (especially when the disease is raging in an epidemic form), and a return to the usual diet gradually brought about. Wine and alcohol are absolute poisons in this affection. Having thus given the general mode of treatment for this disease, which is ordinarily so fatal, we may remark that, in a great majority of cases, the homoeopathic method checks it at its commencement, without allowing it to assume the more serious forms portrayed in the instructions for its treatment, but, on the contrary, causing it to pass off, leaving the patient in sound health; whilst in the most violent cases, where it has already made head, and seems approaching a fatal termination, this may almost be said to be the only system which offers a chance of salvation to the sufferer; and in strumous constitutions, (where, under the old mode of procedure, the results were commonly so unfortunate,) it generally mitigates the violence of the symptoms, and safely conducts the patient through his perils. Suppressed Dysentery. When the dysenteric evacuations have been suddenly checked by allopathic means, and a violent inflammatory or spasmodic action declares itself, distinguished by severe pains, anxiety, dyspnoea, nausea, and empty retchings, or distension and tenderness of the abdomen; suppression both of faeces and urine; coldness of the face, tongue, and extremities; breath also cold; with spasms of various kinds in different parts of the body, which are renewed by any exertion, either of speech or movement,-the following remedies will be found useful. AcoNITUM. Against any inflammatory symptoms that may present themselves. CUPRUM ACETICUM, when spasms or cold sweats predominate. BELLADONNA, against inflammatory colic, or if symptoms of abdominal inflammation set in, (see article ENTERITIS, and also CoLIC,) and administer accordingly. COLOCYNTH, violent colic and distension of the abdomen (see COLIC). VERATRUM ALBUM, coldness of the body and extremities, and retching. CHOLERA. 259 CARBO VEGETABILIS, in extreme cases, with scarcely perceptible pulse, and cold breath. The use of clysters of warm water has, in many instances, been found serviceable in promoting an evacuation of the bowels, and bringing back the suppressed discharge. When the patient has escaped the serious consequences above noticed, chronic complaints are often the result of Suppressed Dysentery: the most frequent being Dropsy, Paralysis, and Rheumatism. CHOLERA. By the term Cholera Morbus was formerly understood a disease attended with nausea, griping, purging, and vomiting, generally prevalent towards our summer months, and at the season when fruit abounds. But it has now become a generic term, under which are included two varieties-the Cholera Morbus, properly so called, and the Asiatic Cholera. DIAGNOSIS. The first-named, sometimes called the Sporadic Cholera, generally commences with a sudden feeling of nausea and griping, followed by purging and vomiting; in severe cases, accompanied with coldness of the body, particularly the extremities, anxious and hurried breathings, excessive thirst, a feeling of cramp in the legs, sometimes in the arms, with spasmodic contractions of the abdominal muscles, shrinking of the features, and a hollow expression about the eyes; pulse weak, sometimes scarcely perceptible; thin, watery, and fetid, or bilious evacuations, sometimes with dark bilious vomiting, anxiety, and tenesmus. CAUSES. The most frequent are worms, gall-stones, unwholesome indigestible food; fruits, or crude vegetables, alterations in temperature, moist or marshy situations, damp weather, wet feet, suppressed perspiration from sudden exposure to cold, cold drinks when overheated, dentition, or parturition. THERAPEUTICS. In the treatment of Cholera, in its sporadic form, (i. e.when the disease arises from occasional causes, such as cold, fatigue, &c.,) the following remedies will be found the most efficacious:--Chamomilla, Ipecacuanica, Veratrum album, Arsenicum album, Cinclona, and Pulsatilla. CIAMOMILLA is almost specific in the premonitory stage, par 260 DIGESTIVE SYSTEM. ticularly when the complaint has been excited by a chill, or a ft of passion, or great dread of being attacked during the prevalence of the disease. The following are the symptoms which particularly indicate its employment: acute colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish; bilious diarrhoea, cramps in the calves of the legs; yellow furred tongue, and sometimes vomiting of acid matter. (Pulsatilla is preferable to Chamomilla, when the attack has been brought on by partaking of rich, indigestible food, and when the stools are more of a mucous character. Colocynth, again, is more appropriate in some cases arising from a moral cause, more especially a fit of anger or mortification, attended with indignation.) Chamomilla, etc., may be prescribed as follows: ~c Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. 3 ij. M. Dosis. Coch. maj. j, tertia vel sexta quaq. hor. pro re nata. (Vide Rules for the repetition of the dose, in the Introduction.) IPPECACUANHA may be administered after the above, should the attacks of vomiting become more prominent; or it may be selected from the commencement, should vomiting predominate, or at least assume as marked a character in the complaint as the diarrhoea. Other indications are--sensation of weakness, or softness (flaccidity) in the epigastrium, coldness in the face and limbs, sense of shivering in the abdomen; slight cramps in the calves of the legs, and in the fingers and toes..ux v. has been found of great value after Ipecac., when the vomiting yielded to the employment of that remedy, but symptoms of Cardialgia remained, such as weight in the epigastric region, anxiety, pain in the abdominal viscera, frequent small evacuations, and tenesmus, frontal headaches, horripilation with predominating internal chills. Form of prescription, same as CHAMOMILLA. VERATRUM ALBUM, should the disease increase notwithstanding the employment of the preceding remedy, and assume the following characteristics: violent vomiting with severe diarrhcea, excessive weakness, and cramps in the calves of the legs; eyes hollow or sunken, countenance pale, and expressive of CHOLERA. 261 acute sufering and intense anguish; coldness of the breath and tongue; excruciating pain in the region of the navel, tenderness of the abdomen when touched; dragging pains and cramps in the fingers, shrivelled appearance of the skin on the palms of the hands. (This is one of the best remedies in both varieties of this disease. 1c* Tinct. Veratr. 6, gtt. iij. Aq. pur. 5 iij. Dosis. Coch. medioc. j. omni bihorio, omni hor., omn. quadr. hor., vel. smpius p. r. n. (See Rules for the repetition of the dose, in the Introduction.) ARSENICUIM is useful, when this malady assumes a severe character from the beginning, but is more particularly indicated when the disease is attended with rapid prostration of strength, insatiable thirst, excessive anxiety, loss of articulation, with fear of approaching death, burning sensation in the region of the stomach, almost constant discharge from the bowels, or renewal of the discharge, as often as the desire for drink is gratified; suppression of urine or scanty micturition, followed by a burning sensation; violent and painful vomiting, tongue and lips dry, cracked, blueish or black; hollow cheeks, pointed nose; pulse almost imperceptible, or small, weak, intermittent, and trembling; severe spasms in the fingers and toes; clammy perspiration. Form of prescription the same as that given for Veratr. The dose to be repeated every half hour, every hour or every two hours, according to the severity of the symptoms; the intervals to be lengthened as soon as signs of amendment set in. CINCHONA is chiefly most useful against the weakness which remains after cholera, but is also serviceable, occasionally, during the course of the disease, particularly when there are vomiting of ingesta, and frequent watery and brownish evacnations, containing particles of undigested food; also when there is oppression at the chest, with eructations, which afford temporary relief; severe pressure in the abdomen, especially after partaking of the smallest portion of food; great exhaustion, sometimes amounting to fainting. This remedy is, moreover, indicated when the disease has been excited by indigestible substances, such as unripe fruit, &c., or by inhabiting a marshy situation: 262 DIGESTIVE SYSTEM. l Tinct. Cinch. 3, gtt. 3 iij. Aq. pur. 3 ij. M. Dose. 5 ss every six or twelve hours, according to circumstances, until amelioration results. PULSATILLA, in mild cases, with mucous diarrhoea and dyspeptic symptoms. It is also useful when the disease has been excited by the use of indigestible articles of diet. (Vide DIARRH(EA and INDIGESTION.) lc Tinct. Puls. 6, gtt. ij. Aq. pur. 3 ij. M. Dose. A dessert-spoonful every six or eight hours, until amendment takes place. ASIATIC CHOLERA. MALIGNANT CHOLERA. (Cholera asiatica, epidemics, spasmodica.) It generally commences with vertigo, headache and singing in the ears, a sensation of flatulence in the stomach, or griping pains, and a feeling of weight and oppression in the region of the heart. In some, though not all cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue color, but, in almost every instance, the frame loses its power df generating heat, the pulse and pulsation of the heart are almost unfelt, and the circulation of the blood becomes stagnant. Patients, who have escaped through the second stage, are frequently carried off by a typhoid fever in the third. We quote the following accounts of malignant cholera, as it has appeared in India, in the north of Europe,* and in this country,t as giving a sufficiently full and vivid description of the symptoms of the malady in its different stages. " The attack of the disease in extreme cases is so sudden, that, from a state of apparent good health, or with the feeling only of trifling ailment, an individual sustains as rapid a loss of bodily power as if he were suddenly struck down, or placed under the immediate effects of some poison; the countenance assuming a death-like appearance, the skin becoming cold, and giving to the hand (as expressed by some observers) the sensation of coldness and moisture which is perceived on touching a frog; by others represented as the coldness of the * Hooper's Med. Dict., page 380. f Mackintosh's Practice of Physic, p. 337. CHOLERA. 263 skin of a person already dead. The pulse is either feeble, intermitting, fluttering, or lost; a livid circle is observed round the eyelids; the eyes are sunk in their sockets; the tongue is cold, and either clean or covered with a slight white fur; and, in many instances, even the breath is cold. In cases of this severity, the vomiting and purging characteristic of the disease do not commonly take place so early as in milder attacks, but seem to be delayed until the almost overpowered functions of the body make a slight effort at reaction. It is worthy of remark, that, unless death takes place in these extreme cases within a few hours, some effort of the animal power is made to rally the constitution; and this point is insisted upon here, because it will direct the mind of practitioners to the particular moment when bleeding, and certain other parts of practice, recommended in the Indian Reports, can be enforced in this country with probable success. Vomiting soon succeeds; first of some of the usual contents of the stomach, next of a turbid fluid, like whey, white of egg, water-gruel, or rice-water; described, perhaps, more accurately as a serous fluid, containing flocculi of coagulated albumen. The lower bowels seem to let go their contents; what happens to be lodged in the rectum is passed more or less in its natural state: the next discharges are similar to those thrown up from the stomach, and are passed with violence, as if squirted with a syringe. The same similitude may be applied to the vomiting. Spasms, beginning at the toes and fingers, soon follow, and extend, by degrees, to the larger muscles of the legs and arms, and to those of the abdomen. These vary in intensity, but are sometimes so violent as to put on the appearance of tetanus. " In some severe cases the vomiting is slight, in others considerable; and the purging and vomiting precede each other without any known rule; but whichever may be the precursor, a severe burning heat is felt at the proecordia: there is an invincible desire for cold liquids, particularly water; and, although the skin and tongue are cold to the touch, and the pulse nearly lost, or altogether imperceptible, the. patient complains of intense heat, and has an almost insuperable aversion to any application of it to the skin. The spasms increase,. sometimes spreading gradually, sometimes suddenly, to the 264 DIGESTIVE SYSTEM. abdomen, as high as the scrobiculus cordis. The next severe symptoms are, an intolerable sense of weight and constriction felt upon the chest, accompanied with anxious breathing, the spasms continuing at the same time; a leaden or blueish appearance of the countenance, the tongue, fingers, and toes assuming the same color; the palms of the hands and soles of the feet becoming shrivelled; the fingers and toes giving the appearance of having been corrugated by long immersion in hot water. There is, throughout, a suppression of the secretion of urine, of the secretions of the mouth and nose: no bile is seen in the evacuations; and it may be generally observed, that all the functions employed in carrying on life are suspended, or alarmingly weakened, except that of the brain, -which appears, in these extreme cases, to suffer little, the intellectual powers usually remaining perfect to the last moment of existence. At length a calm succeeds,-and death. The last period is commonly marked by a subsidence of the severe symptoms, without improvement of the pulse or return of natural heat; but, occasionally, it terminates in convulsive spasm. Within an hour or two from the commencement of such a seizure, and sometimes sooner, the pulse may be imperceptible at the wrist, or in the temporal arteries. If it be discoverable, it will usually be found beating from eighty to a hundred strokes in a minute; this, however, is not invariable, the pulse being not unfrequently quicker. The powers of the constitution often yield to such an attack at the end of four hours; and seldom sustain it longer than eight. " In the less rapid and more ordinary form, sickness at the stomach, slight vomiting, or perhaps two or three loose evacuations of the bowels, which do not attract much attention, mark the commencement of the attack; a sense of burning heat soon felt at the praecordia excites suspicion of the disease; an increased purging and vomiting of the peculiar liquid gives certain indication of its presence, if this has not been previously declared by the prostration of strength, and an expression of the countenance not often exhibited, except when death is to be expected within a few hours. The symptoms before described, follow each other in similar but slower succession; the spasms of the extremities increase with the vomiting and purging, and particularly in propor CHOLERA. 265 tion to the constriction of the thorax; and this form of the disease, which creeps on at first insidiously, and is in its progress more slow, by giving a greater opportunity for assistance, is, if treated early, more tractable; but if neglected, equally fatal with the more sudden seizures. Such cases last from twelve to thirty-six hours. "The principal difference consists in the diffusion of the symptoms through a greater space of time; a misfortune, it is true, to the patient, if the disease prove ultimately fatal, but advantageous, by affording an interval for the natural powers of the constitution to rally themselves, and for the proper employment of the resources of the medical art. But there is another remarkable distinction well worthy of attention. It has been observed before, that in the more rapid cases, the intellectual faculties suffer but little; and it may be added here, that the disturbance of them is not delirium, but rather a confusion and hesitation of mind resembling slight intoxication. In those of longer duration, if the individuals, either by the natural vigor of their constitution or medical assitance, sustain the shock beyond the period of seventy-two hours, suffusion of the tunica conjunctiva often takes place, not mufrequently delirium, and even coma. "It is remarked, that those who survive seventy-two hours, generally recover-but there are exceptions to this; for although, according to the Reports of the Medical Practitioners in the Presidencies of Bombay and Madras, the recovery from this seizure commonly terminates the disease; or, as is stated in the latter, the sequelhe are those dependent upon some previous ailment of the individual; yet the Bengal Report details a series of subsequent symptoms resembling those of low nervous fever, which, when they proved fatal, usually terminated within eleven days from the commencement of the seizure called Cholera. To complete the outline, an account of these symptoms, extracted from the Bengal Report, will be presently given; and we may observe, that they correspond accurately with the description given by Dr. Keir of the second stage of the disease, as it appeared at Moscow from the beginning of the month of October to the earlier part of the month of March. But we will previously point out the manner in which the recovery from this seizure commonly 266 DIGESTIVE SYSTEM. takes place. The first symptoms are, the abatement of the spasms and difficulty of breathing, a return of heat to the surface of the body, and a restoration of the pulse; these, however, are equivocal, from being often only temporary; and the prognostic from them is very uncertain unless they follow a progressive march of amendment: sleep and warm perspiration attending it are of more importance and more certain signs of recovery. The return of the secretion and evacuation of urine is reckoned one of the most favorable signs: the next is, the passage of bile by the bowels; and if this be freely established, and accompanied with an improvement of the pulse and of the temperature of the skin, the patient is soon placed in a state of security from the attack: but it will appear, from the following extract from the Bengal Report, that upon this recovery he has often a serious stage of disease to encounter; the description of which is given in the words of the author. Before, however, we proceed to this, we must remark, that the seizure, when not fatal, has three modes of termination: one in immediate convalescence, accompanied only with great weakness;-a second, in which large evacuations of vitiated bile are passed for several days, sometimes attended with blood, and with peculiar pains in the bowels, particularly in the rectum. The third is of a febrile nature, of which the following account is supplied from the information given in the Bengal Report, viz.: "'The fever, which almost invariably attended this second stage of the disease,... partook much of the nature of the common bilious attacks of these latitudes. There was a hot, dry skin, a foul, deeply-furred tongue, parched mouth, thirst, sick stomach, restlessness, watchfLlness, and quick variable pulse, sometimes with delirium and stupor, and other marked affections of the brain.- Generally, when the disorder proved fatal in this stage, the tongue, from being cream-colored, became brown, and sometimes black, hard, and more deeply furred; the teeth and lips were covered with sordes, the state of the skin varied, chills alternating with heats, the pulse became extremely quick, weak, and tremulous, hiccough, catching of the breath, great restlessness and deep moaning succeeded, and the patient soon sunk incoherent and insensible under the debilitating effects of low nervous fever, and fre CHOLERA. 267 quent dark, tarry alvine discharges.' It is to be observed, that the able author of the Bengal Report doubts whether these symptoms can be considered as 'forming any integrant or necessary part of the disorder itself,' or whether they belonged to the bilious seizures of the climate. Subsequent experience of the disease has removed this doubt by showing that the febrile stage of cholera has been much more frequent in other climates than in India. "The cholera morbus of the north of Europe, to which the Russian peasants have given the name of ' chornaia bolezn,' or blackc illness, like most other diseases, is accompanied by a set of symptoms which may be termed preliminary; by another set which strongly mark the disease in its first, cold, or collapsed stage; and by a third set, which characterize the second stage, that of reaction, heat, and fever. "Preliminary Symptoms.-We have had but few opportunities of witnessing the presence of all these symptoms, some of which precede the complete seizure by so short an interval, that the utmost diligence is scarcely sufficient to bring the patient and the physician together, after their occurrence, before the disease is fully formed. Diarrhoea, at first feculent, with slight cramps in the legs, nausea, pain or heat about the pit of the stomach, malaise, give the longest warning. Indeed, purging, or ordinary diarrhoea, has been frequently known to continue for one, two, or more days, unaccompanied by any other remarkable symptom, until the patient is suddenly struck blue, and nearly lifeless. Often the symptoms just mentioned are arrested by timely judicious treatment, and the disease completely averted. When violent vertigo, sick stomach, nervous agitation, intermittent, slow, or small pulse, cramps beginning at the tips of the fingers and toes, and rapidly approaching the trunk, give the first warning, then there is scarcely an interval. "First Stage.-Vomiting or purging, or both these evacuations, of a liquid like rice-water, or whey, or barley-water, come on; the features become sharp and contracted; the eye sinks; the look is expressive of terror, wildness, and, as it were, a consciousness on the part of the sufferer, that the hand of death is upon him. The lips, the face, the neck, the hands, feet, and even the thighs, arms, and whole surface 268 DIGESTIVE SYSTEM. assume a leaden, blue, purple, black, or deep brown tint, according to the complexion of the individual, varying in shade with the intensity of the attack. The fingers and toes are reduced at least a third in thickness; the skin and soft parts covering them are wrinkled, shrivelled, and folded; the nails put on a blueish pearl white. The larger superficial veins are marked by flat lines of a deeper black; the pulse is either small as a thread, and scarcely vibrating, or else totally extinct. The skin is deadly cold, and often damp, the tongue always moist, often white and loaded, but flabby and chilled like a bit of dead flesh. The voice is gone; the respiration quick, irregular, and imperfectly performed. Inspiration appears to be effected by an immense effort of the chest, whilst the alce nasi (in the most hopeless cases and towards the close), instead of expanding, collapse, and stop the ingress of the air. Expiration is quick and convulsive. The patient asks only for water, speaks in a plaintive whisper (the 'vox cholerica'), and only by a word at a time, from not being able to retain air enough in his lungs for a sentence. He tosses incessantly from side to side, and complains of intolerable weight and anguish around his heart. He struggles for breath; and often lays his hand on his stomach and chest, to point out the seat of his agony. The integuments of the belly are sometimes raised into high irregular folds, whilst the belly itself is violently drawn in, the diaphragm upwards and inwards towards the chest. Sometimes there are tetanic spasms of the legs, thighs, and loins; but we have not seen general tetanus, nor even trismus. There is occasionally a low suffering whine. The secretion of urine is always totally suspended; nor have we observed tears shed under these circumstances. Vomiting and purging, which are far from being the most important or dangerous symptoms, and which in a very great number of cases of the present epidemic have not been profuse, generally cease, or are arrested by medicine early in the attack. Frictions remove the blue color for a time from the part rubbed, but in other parts, particularly the face, the livor becomes every moment more intense and more general. The lips and cheeks sometimes puff out and flap in expiration, with white froth between them, as in apoplexy. If blood be obtained in this state, it is black, flows by drops, is thick, and CHOLERA. 269 feels to the finger colder than natural. Towards the close of this scene the respiration becomes very slow; there is a quivering among the tendons of the wrist. The mind remains entire. The patient is first unable to swallow, then becomes insensible; there never is, however, any rattle in the throat, and he dies quietly, after a long convulsive sob or two. " The above is a faint description of the very worst kind of case dying in the cold stage, in from six to twenty-four hours after the setting-in of the bad symptoms. We have seen many such cases just carried to the hospital from their homes or their barracks. In by far the greater number vomiting had ceased; in some, however, it was still going, and invariably of the true, serous kind. Nany confessed that they had concealed a diarrhoea for a day or two. Others had been suddenly seized, generally very early in the morning. " From the aggravated state which we have just described, but very few indeed recover; particularly if that state have been present evenforfour hours before treatment has commenced. A thread of pulse, however small, is almost always felt at the wrist, where recovery from the blue or cold stage is to be expected. Singular enough to say, hiccough, coming on in the intermediate moments between the threatening of death and the beginning of reaction, is a favorable sign; and generally announces the return of the circulation. " In less severe cases, the pulse is not wholly extinguished, though much reduced in volume; the respiration is less embarrassed; the oppression and anguish at the chest are not so overwhelming, although the vomiting, the purging, and the cramps, may have been more intense. The coldness and change of color of the surface; the peculiar alteration of the voice; a greater or less degree of coldness of the tongue; the character of the liquids evacuated, have been invariably well marked in all the degrees of violence of attack which we have hitherto witnessed, in this epidemic. In no case or stage of this disease have we observed shivering, nor have we heard, after inquiry, of more than one case in which this febrile symptom took place. " FJeveir, or hot stage.-After the blue, cold period has lasted from twelve to twenty-four, seldom to forty-eight hours or upwards, the pulse and external heat begin gradually to re 270 DIGESTIVE SYSTEM. turn; headache is complained of, with noise in the ears: the tongue becomes more loaded, redder at the top and edges, and also dryer. High-colored urine is passed with pain, and in small quantities; the pupil is often dilated; soreness is felt on pressure over the liver, stomach and belly; bleeding by the lancet or leeches is required; ice to the head gives great relief. In short, the patient is now laboring under a continued fever, not to be distinguished from ordinary fever. A profuse, critical perspiration may come on, from the second or third day, and leave the sufferer convalescent, but much more frequently the quickness of pulse and heat of skin continue; the tongue becomes brown and parched; the eyes are suffused and drowsy; there is a dull flush, with stupor and heaviness about the countenance much resembling typhus; dark sordes collect about the lips and teeth; sometimes the patient is pale, squalid, and low, with the pulse and heat below natural: but with the typhous stupor, delirium supervenes; and death takes place from the fourth to the eighth day, or even later, in the very individual, too, whom the most assiduous attention had barely saved in the first or cold stage. To give a notion of the importance and danger of the cholera fever, a most intelligent physician, Dr. Reimer, of the Merchants' Hospital, informs us, that of twenty cases treated under his own eye, who fell victims to the disease, seven died in the cold stage, and thirteen in the consecutive fever. "This singular malady is only cognizable, with certainty, during its blue or cold period. After reaction has been established, it cannot be distinguished from an ordinary continued fever, except by the shortness and fatality of its course. The greenish, or dark, and highly bilious discharges, produced in the hot stage, by calomel, are not sufficiently diagnostic; and it is curious, that the persons employed about these typhoid cases, when they are attacked, are never seized with ordinary fever, but with the genuine, cold, blue cholera. Nothing therefore, is more certain, than that persons may come to the coast of England, apparently laboring under common, feverish indisposition, who really and truly are cases of cholera in the second stage." CHOLERA. 271 ChOLERA. 271 "Phenomena of Asiatic Cholera as it appeared in this country. "The disease consists of three stages. The first stage may be called premonitory; the second, the stage of collapse; the third, that of consecutive fever. "The first stage is characterized by symptoms of indigestion, flatulent disturbance in the abdomen, praecordial weight or oppression, slight nausea, acidity, griping pains, diarrhoea, vertigo, some degree of headache, or tinnitus. These symptoms, even when accompanied by spasms, are too often either disregarded or concealed, till the second stage is far advanced. It is most unfortunate, that this reluctance to confess the early part of the indisposition should so frequently exist in all classes of society, but particularly among the poor, because few of the more severe maladies to which flesh is heir are so remediable as cholera in the first stage, and not one more hopeless after the lapse of a few short hours. "It is stated by the Russian physicians, that at Orenberg, Moscow, and other places, scarcely a person escaped, during the season when cholera prevailed, without some disorder of the stomach and bowels, indicated by nausea, vomiting, and oppression at prsecordia, indigestion, pain in the belly, and looseness of bowels. Many instances of disorder of the stomach and bowels prevailed during the epidemic season, and for some weeks before there was a well marked case of cholera in Edinburgh. " Second stage.-The duration of the premonitory or first stage is various; sometimes the unpleasant symptoms suddenly cease, and the patients recover quickly; but this happy issue is comparatively rare, when proper remedies are not used; and in some few cases, from the peculiarity of constitution of the patient, remedies seem to have little effect in arresting the progress of the disease, even when applied in this early stage. The stools, which were at first feculent and bilious, now become characteristic of the true Asiatic cholera. They have the appearance of very thin gruel, or rice-water; sometimes they are watery, limpid, with small flakes of curdy-looking matter intermixed; at -other times, they present an appearance of water in which fresh beef had been macerated. The 272 DIGESTIVE SYSTEM. usual feculent smell has vanished, instead of which the stools have a peculiar odor, which struck me to resemble that produced by macerating fish in water; a similar odor is generally observed from the surface of the body. More rarely, the stools look like the lees of port wine; and it was remarked, that almost none recovered who passed 'port-wine stools;' I recollect at present one recovery only in which there was this appearance. The desire to go to stool is irresistible and instantaneous; tenesmus is great in some cases, sometimes preceded or accompanied by a sense of heat or griping. The stools are generally very copious,-sometimes, however, scanty; often accompanied by loud discharges of flatus from the bowels. Along with the bowel-complaint, there are burning keat in the region of the stomach, and vomiting of large quantities of a similar fluid from the stomach. The abdomen feels doughy. The thirst is intense, and there exists an urgent desire to drink cold water. The mind, for the most part, remains comparatively entire, but the vertigo and tinnitus increase. Cramps are general attendants,--sometimes confined to the fingers and toes; at other times they affect the muscles of the extremities, and often those of the trunk of the body, more particularly of the abdomen. The urine is generally suppressed early in the disease. The voice is whispering, the person being unable to speak in any other tone. The respiration, although weak, is often nearly natural in other respects, even at times when the pulse is scarcely perceptible at the wrist; occasionally, however, the breathing is hurried and oppressed, sometimes laborious. The pulse becomes weak and rapid early in the disease, even when the action of the heart is comparatively strong and tumultuous; but frequently both the pulse and action of the heart are feeble. As the disease goes on, both become more and more weak; the pulse is only now and then felt like a 'flutter,' and often ceases to be perceptible at the wrist for some hours before death. The tongue is cold and shrunk. It is quite painful to a bystander to watch the restlessness and impatience of the sufferers, who are constantly in a state of jactitation, more particularly when restrained, and when heat is applied. Indeed, they seem to have a horror at, and to suffer pain from, warm applications. The temperature of the body, but more particularly of the extremities, diminishes early in CHOLERA. 273 the disease, and goes on sinking. It is often impossible to raise the temperature of the body during life, but the moment death takes place, and for two or three hours afterwards, the body becomes warm,-even the icy coldness of the extremities gives place to a genial warmth. The color of the hands and feet become changed, more particularly the nails assume a blue appearance; the face often is similarly affected; occasionally the whole surface presents a blue color, and consequently, the second stage has been sometimes termed 'the blue stage;' but it is an error to suppose that the blueness is invariable, or that it is an attendant only on the worst forms of the complaint,-the patient who had this appearance more strongly marked than any other, was the one who made the most rapid and the most complete recovery. Blood, drawn from an artery or vein during this stage, flows with difficulty, is of a dark color, does not coagulate, or separate any serum. It remains in a semi-fluid state, and has the appearance which the ancients called 'dissolved blood.' The surface of the body is covered, for the most part, with a cold exudation, the features and eyeballs shrink, and death closes the scene,-sometimes very unexpectedly, at others the body seems to be long dead, while the functions of the brain are still going on, and comparatively entire. "Sometimes the prostration of strength is extreme; but it is my belief, that muscular debility is no part of the disease, till far advanced in the second, or collapsed stage. I have been surprised at the efforts made by patients when they were thought to be near death.... The appearance of muscular debility is occasioned by the vertigo, which renders the gait unsteady and tottering, as well as by the dread of motion producing cramps. " Many exceptions might be made to this account of the symptoms in these two stages. Sometimes no premonitory symptoms can be traced. I know of one case where the person appeared to have died under the effects of the first attack of cramps; he was known to have labored under slight bowel complaint for several days, but he did not confine himself, and was lying without any complaint on a sofa; he was dressed, and engaged reading. A noise was heard, and he was soon after found on the floor on his face, dead, with the book 18 274 DIGESTIVE SYSTEM. clenched in his hand, and his muscles rigid. I have seen several cases where the urine was not entirely suppressed, and others in which the stools were feculent and bilious up to the moment of death. But those cases are to be regarded as exceptions to the rule, which they do not contravene. The symptoms in this disease, as in all others, must suffer modifications from peculiarity of constitution, previous condition of health, and habits of the patient affected. " The symptoms which present the most unerring characteristics of Asiatic cholera are diarrhoea, and other symptoms of disordered stomach and bowels, in the first or premonitory stage. I believe previous diarrhcea may be discovered in at least four out of six cases, and probably exists in all, if the history of each were perfect. Thus, in the city of Albany, U.S., diarrhoea occurred in 282 out of 336 cases; in the remaining 54, it could not be ascertained whether this symptom had or had not existed. In the stage of collapse, there are the whispering voice, great restlessness, characteristic discharge upwards and downwards, cramps, suppression of urine, excessive thirst, weak faltering pulse, weak rtspiration, coldness of extremities, shrivelled hands and feet, bedewed with a cold exudation. The general blueness, when it exists, is also quite peculiar to cholera. It is remarkable how quickly an extremely collapsed state of the features takes place. The patients appear to dread hot applications. The blood-vessels, on such parts of the body as, the temples, where they are comparatively superficial and easily seen, are observed to be full of blood of a very dark color; even the serpentine branches of the temporal artery can be traced in this manner, and the motion of the blood is very slow. " Third 8tage.-A large proportion of patients died in the second stage; there were few immediate recoveries from collapse, without undergoing the danger and miseries of a consecutive fever, which is now to be described. I shall never forget the joy expressed by all who were watching the first case of cholera in which death did not take place in the stage of collapse. This feeling was increased as the watery diarrhoea, vomiting, and cramps diminished, and at last ceased, and as reaction became more evident and permanent. Nor shall I attempt to describe the subsequent disappointment, as CHOLERA. 275 bad symptoms arose one after another, to convince us that the patient, although he had made an escape from one set of dangers, was still surrounded by another, which experience speedily proved to us were extremely formidable. " The symptoms that denoted an escape from the horrors of the second stage, were, diminution in the number and quantity of the evacuations, both from the bowels and stomach; cessation of restlessness, thirst, and cramps; increase of the.temperature of the body, and strength of the pulse; an expression of animation in the countenance; and a disposition to sleep. Sometimes the stools speedily lost the characteristic watery appearance, and became feculent; but this change was generally gradual. Sometimes the secretion of urine took place early after the reaction was established, but this favorable circumstance rarely occurred so soon. In some cases, after everything appeared to be going on well, the vomiting and purging suddenly returned, the pulse became weak and quick, and the patient rapidly died. "The phenomena of the third stage presented every appearance of fever; sometimes of that form denominated in this country ' Typhus,' and in several cases a similitude was easily traced to the last stage of Yellow Fever. In fact, the general opinion that was, and still is maintained, that cholera is nothing but a fever, with violent irritability of stomach and bowels, suppression of the secretions of bile and urine, with a cold stage, appeared to derive eupport from the resemblance to the phenomena of intermittent fever. But it will soon be in my power to show how erroneous this opinion really is, when the pathology of cholera shall be treated of. " After the complete development of reaction, patients for a time appear to be doing very well, not teased with violent tenesmus and vomiting, nor disturbed with intense thirst and violent cramps. The restlessness has ceased, and they seem, to be enjoying tranquility. But this state is generally to beregarded as a calm which is too soon to be followed by a storm. The subsequent symptoms vary much in different cases, depending on the previous state of health and habits of, the patient, and his peculiarities of constitution, as well as on the phenomena of the previous stage, and the treatment pursued. 276 DIGESTIVE SYSTEM. "These symptoms were, lethargy or coma, which were frequent; delirium; convulsions; paralysis; rigidity of the flexor muscles of the extremities; distressing nausea; bilious vomiting, and thirst; dyspncea, or hurried respiration; cough, expectoration; palpitation and irregular action of the heart, and more or less heat of skin; bilious diarrhoea; port-wine stools; tenesmus; and pain or tenderness, increased on pressure, in some part of the abdomen. Of all these symptoms, convulsions were the most rare. The others existed variously, combined and modified. " Causes of Cholera.-The undivided opinion of medical men who saw the disease in India is, that in the East it is not contagious. After the appearance of cholera in Russia and Poland, however, a belief became prevalent that the disease had been modified by climate, and the habits of the people in Europe; that it had more resemblance to a fever, and was highly contagious. There were few medical men who were not influenced by this specious statement; and I confess that my mind was at one time so strongly impressed with the belief in the contagious nature of the disease, that for the first five or six weeks after its appearance in Edinburgh, when I retired to bed at night, I scarcely expected to find myself alive in the morning. But my fears were at last dispelled, and my opinion is, that if it be contagious, it is not so in any very great degree. The following are the grounds on which this opinion is formed. It was intimated to me, by authority, that as the disease was so contagious, every possible precaution must be taken to prevent its extension, and that few bodies could be allowed to be opened, as the contagion was more virilent and searching after than before death. But from the moment my mind was made up to accept the appointment, I resolved that fear should not be allowed either to interfere with my attendance on the sick, or to hinder my investigations after death. Accordingly, in attending the first case of cholera in the hospital, I remained in the ward all night, and became so much exhausted, that I fell asleep in the bed next the dying person, and slept for above an hour, at a time when my animal spirits were low, and my physical strength diminished by the fatigues of the previous day. Subsequently, I have more than once accidentally fallen asleep on a bed on CHOLERA. 277 which some unfortunate had died, and in a ward in which there were several dying persons at the time. None of the house surgeons, the number being between 20 and 30, who were seldom out of the wards, had the disease, although their bodies must have been ready to receive the contagion, if fatigue of body, anxiety of mind, and want of sleep ever predisposed any person to take a disease. Two male nurses had cholera. One was a sober man, and although he had the warning diarrhoea, he neglected himself, but had the disease slightly. The other was a complete tippler; he had a slight bowel complaint, which he concealed, and by way of curing, obtained leave to go home to see his family; he got drunk, and was brought to the hospital with cholera, but never became collapsed. Several female nurses were also attacked; but that is no wonder, for, independent of the fatigue they underwent, they were drunkards, and bad characters in other respects; and were actually in the habit of drinking the spirits and wine served out to their patients. Two of these characters, after much fatigue and a hard course of drinking, went to bed one night quite drunk; they were both speedily seized with cholera-one died. But there is no proof of the influence of contagion in these cases. In truth, no case has ever been advanced in proof of the contagious nature of cholera, that cannot be explained on other and more satisfactory principles. Is it because four children, with father and mother, in one family, have had cholera, and because communication can be proved between them and an infected house, by means of a bundle of dirty clothes, or a web of linen, or actual personal contact, that we are rashly to attribute the whole to contagion? The same story may perhaps be told in a different way. The father is a dissipated good-for-nothing man, who spends almost all his wages on whiskey; he deprives his family of the means of procuring suitable nourishment; the poor mother has pawned her last blanket, to purchase a few potatoes for her starving children, who have all had loose bowels for several days or weeks. The explanation is easy to show the strong predisposing cause-insufficient clothing, deficiency of food, &c. What answer can be made to this fact, that I have seen several mothers suckle their children when they themselves were dying of cholera, and in one 278 DIGESTIVE SYSTEM. instance I found an infant sucking its dead mother's breast,and yet not one of them had a symptom of cholera, at least for months afterwards?... From the economical arrangements of the Board of Health, and the' difficulty of procuring a proper apartment, the dead-room, where these examinations were conducted, was a miserable place about eight feet square; generally six or eight persons were present, sometimes more; and in an inner apartment, about ten feet square, there sometimes lay six dead bodies. Not one of those who frequented this den of death, and who had their hands imbrued in the secretions of the dead for six hours out of the twenty-four, were affected with cholera, although their hands were irritated and punctured daily! "It cannot be denied that some mysterious influence was operating at the period cholera prevailed, by whatever name it may be called,-that it selected its own victims-exercised its poisonous qualities in one district, town, or hamlet, more than in another-changed the scene of its ravages suddenly and capriciously, and made its progress from place to place, by strange detours, avoiding many populous situations, in the direct tract of human intercourse..... "Were any persons more prone to contract cholera than others? This is an important question, and it is rare that a point in medical investigation can be so satisfactorily answered. All who had any important visceral disease, or tendency to bowel complaint from slight causes, and drunkards, were the persons generally attacked. It is no doubt certain, that in each locality where cholera prevailed, some instances may be quoted to the contrary; but these are very few indeed, and are to be regarded as exceptions to the general rule. Nothing could be more unsatisfactory than the accounts we received of the previous health and habits of patients; very frequently we found them to be quite the opposite of what had been stated; but when we opened the bodies, in the careful and minute manner in which the dissections were conducted, we had the best evidence that few subjects were even tolerably sound. "Persons advanced in age had, in the epidemic that I saw, a bad chance of recovery. Females seemed to be more liable to the disease than males. Almost every woman we opened, CHOLERA. 279 under a certain age, had the catamenia; and we found a great number of diseases, of various kinds, of the uterus, ovaries, tubes, and broad ligaments." THERAPEUTICS. We now proceed to mention the remedies which have been successfully prescribed by those homoeopathists who have treated the disease in all its forms. When the premonitory symptoms of this disease, as above noted, exhibit themselves, its complete development is frequently prevented by the administration of the SATURATED SOLUTION OF CAMPHOR. D OSE. One or two drops of the above, every five minutes, in a teaspoonful of cold water, until a cessation or amelioration of the symptoms takes place, when the intervals between the doses may be lengthened at first to every two, and then to every four or six hours. In many cases also we may succeed in checking the disease at its commencement by the remedies already mentioned under Sporadic Cholera. But when Cholera sets in in all its frightful forms, we should have immediate recourse to VERATRUM, a remedy which all who have had an opportunity of trying have eulogized. Ic Tinct. Veratr. 3, gtt. viij. Aq. pur. 9 iv. Dose. A dessert-spoonful every hour, every half hour, or even every quarter of an hour, according to the severity of the symptoms. But should no improvement set in after several doses, and the cramps change to spasms and convulsions, with spasmodic constriction of the chest, which obstructs respiration,-CuPRUM (third trituration, or sixth dilution) must be had recourse to, in the manner as prescribed for Veratrum: and if Cuprum be productive of only partial melioration, Veratrum may be administered in alternation with it. When symptoms of trismus and tetanus supervene, Ounaphora has been recommended as preferable to Cuprum. ARSENICUM should be selected in preference to, or given alternately with, Veratrum, when an intense burning sensation is experienced in the stomach and bowels, with extreme prostration of strength, great thirst, &c. (Vide the indications for both these remedies, pages 260 and 261.) 280 DIGESTIVE SYSTEM. CARBO VEGETABILIS (sixth dilution) may often be given with advantage when the patient is reduced to. a state of almost complete asphyxia with scarcelyperceptible pulse; or when, on the cessation of vomiting, diarrhcea, and cramps or convulsions, congestion to the head and chest ensues, with oppressed breathing, coldness of the breath, redness or lividity of the face (which is covered with clammy sweat), and lethargy. It has been found useful in some instances to exhibit a dose or two of Acid. hiydrocyanicum, about an hour before the employment of Carbo v. Should the pulse become stronger under the action of Carbo v., but the pain, vomiting, cramps, &c., return, Veratrum must again be had recourse to. (Carbo v., like Cicuta, and perhaps Stramon., is, properly speaking, not so appropriate during the disease itself, as against the sequelhe, especially those of a nervous type.) IPECACUANHA and Nux v. have been found efficacious before or after Yeratrum, or any of the other medicaments, when the symptoms assumed the character mentioned at page 178. (The Russian homceopathic practitioners found Ipecac. of peculiar efficacy.) PHosPHORus (followed by AcIDUM PHOSPHORICUM, should great clamminess of the tongue supervene) is particularly useful in cases of diarricea, which are so liable to occur during the prevalence of cholera, and which, if neglected, are but too prone to pass on rapidly to confirmed cholera. (Camphora, Secale corn., and Mercurius may also be required in cholerine. The Russian practitioners found Mercurius often useful in cholera proper. See also art. I)IARRICEA, as any of the remedies mentioned there may be resorted to in preference to the medicaments just named, if better indicated.) Dose. Tinct. Phosph. 3 gtt. j, quarta vel sexta quaque hora. (Vide rules for the repetition of the dose in the Introduction.) PHOSPHORUS is also useful in the event of congestion in the chest during the course of the disease; and is, moreover, one of the most serviceable remedies against the obstinate diarrhoea which sometimes remains after an attack. TARTARUS EMETICUS. Amongst the physiological effects of this medicament, we find, those spasmodic movements, or jerking and twitching of the muscles; the trembling of the CHOLERA. 281 limbs, prostration of strength, or weakness to fainting; tremulous or imperceptible pulse; peculiar paleness of the face; hoarseness; cramps in the calves of the legs; and especially the symptoms of gastric derangement that are so frequently met with in some forms of the disease. When the stools still consist of feculent matter, as is the case in cholera biliosa, or at the commencement of cholera indica, or also at the termination of the same, where the functions of the abdominal viscera are not yet restored to a normal state, Tartarus is, at all events, well deserving of attention. (See Hartmann's Therapie, or Acute and Chronic diseases, p. 198.) CIcUTA VIROSA is considered an appropriate remedy, when there are spasms in the pectoral muscles, continuous vomiting, and little diarrhoea; when the eyes are turned upwards, and the patient is in a soporific state. It is particularly in neglected cases, and consequently more in the sequelce of cholera than in the disease itself, that this remedy is more generally indicated. Stramonium may likewise be useful in similar cases. In conclusion it may be added, that a few doses of CANTHARIS will be found useful when there is great irritation and pain in the bladder; Rhus, Bryonia, Acid. phosphor., Bella., f yoscy., Stram., Carb. v., Op., &c., when TYPIUS FEVER results (vide Typhus); Belladonna (followed, if required, by Opium and liachesis), when there is CONGESTION OF THE BRAIN; Aconite, Phosphorus, Bryonia, Belladonna, &c., in addition to Phosphorus, should CONGESTION IN THE CHEST S1 -pervene; and Aconite, followed by Nux v., Bryonia, or ifercurius, &c., when the stomach and intestines become the seat of congestion. (Vide Congestion to the Abdomen.) SECALE CORNUTUM is very useful in cases of colorless diarrhowa, with pains in the extremities remaining on the cessation of the vomiting, but is also valuable after Veratrum and Cuprum, when the cramps or convulsions do not yield to these remedies. Cinchona is useful against the general debility, and Sulphur and Phosphorus are two of the most important remedies against irritation or weakness in the alimentary canal, characterised by frequent attacks of or nearly continual looseness occurring after cholera. The foregoing, then, are 282 DIGESTIVE SYSTEM. the principal remedies employed by homceopathists in cholera, and when the treatment is had recourse to from the commencement, the disease generally yields without difficulty, rarely passing even into the second stage, and scarcely ever into the third. When patients affected with cholera sought the aid of a homceopathic practitioner, after having been previously treated allopathically, it was found essential to give Camphora in repeated doses, in the first place, partly for the purpose of rousing the reactive power, and partly to neutralize the effects of the allopathic medicines. The best preservatives against infection are Veratrum, Cuprum, and Camphor; an occasional dose of the preparation mentioned under the latter medicine, at page 279, has frequently been found sufficient to ward off an attack; it is, however, more particularly during the first stage of the disease itself, under whatever form it sets in, that the greatest reliance is to be placed on this remedy. Yeratrum and Cuprum are the prophylaxes which have been employed with the greatest success. Many homceopathic practitioners recommend Veratrum alone, but the alternate prescription has perhaps been more generally preferred. They may be prescribed as follows: 1c Veratr. alb. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q. s. Misce intime, et divide in partes aequales quatuor. Signal, 3, 5, 7. 1* Cupr. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q. s. Misce intime et divide ut supra. Sign 2, 4, 6, 8. N.B.-A powder to be taken in numerical order, every fourth day. Some practitioners, again, would prefer prescribing as follows: fc Veratr. alb. 6, gtt. iij. Spirit. vin. rectif. 3j. Aq. destil. 3 iij. *c Cupr. 9, gtt. iij. Spirit. v. rectif. 3j. Aq. destil. 3 iij. N.B.-The mixtures to be taken alternately; the dose to consist of a table-spoonful night and morning, every third day. Or thus: CHOLERA. 283 1* Veratr. alb. 3, gtt. j. Pulv. sacch. lact. q. s. F. pulv. tales sex. Sign 1, 3,, 7. 1* Cupr. 3, gr. vj. Divide in chart. sequales sex. Sign 2, 4, 6, 8. N.B.-A powder to be taken in the order numbered every third day. The same rules should be observed, whilst these preservatives are being taken, as those we have notified in the article on SCARLATINA. The patient at the same time avoiding excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all strongly predisposing causes to attacks of this malady. When the disease happens to break out, notwithstanding these precautions, it is almost invariably in a mild form. During the prevalence of cholera the clothing should be sufficient to preserve the body at an equable temperature, and care should be taken to avoid chills or checked perspiration, or cold and wet feet: those who have habitually considerable perspiration in the feet should change their stockings at least once daily; a flannel bandage worn round the abdomen is also a useful precaution, and should not be hastily laid aside, even when the danger seems to have passed away; constant exercise should likewise be taken, during the day, in the open air. Adherence to the homoeopathic rules is a sufficient dietetic guide, but too sudden a change of diet is not advisable; raw vegetables and cold fruits, for example melons, should be carefully abstained from, and even the more wholesome varieties and all cooked vegetables should be used in extreme moderation; pure beer and non-acid wines are unobjectionable for individuals not attacked, and accustomed to their daily use, with the same limitation. It may appear almost supererogatory to observe that purity of air and thorough ventilation are highly necessary. ACCESSORY TREATMENT. The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means, and bottles of hot water applied to the feet, if necessary. The observance of this rule greatly facilitates the action of the medicine employed; anything which might disturb the equanimity of the sufferer, such as noise or con 284 - DIGESTIVE SYSTEM. tradiction, should be carefully avoided, and his spirits should be sustained as much as possible. Cold water is the best drink, but the patient should not be allowed to take too much at a time; the occasional administration of a small piece of ice, if possible, or of iced water in teaspoonfuls, is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines. During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his appetite. But if the appetite remain for a long time afterwards in an impaired state, the employment of such remedies as Arsenic., Nux v., Puls., JlRus, Veratr., Cyclamen, or Acid. nitr., will, according to the peculiarities of the individual cases, prove of considerable service. REMARKS. When this disease is raging as an epidemy, we not unfrequently find individuals suffering under many symptoms bearing a marked resemblance to those of cholera, but with constipation instead of diarrhea, and retching in place of vomiting; this affection being closely analogous to Suppressed Dysentery, the reader will find its appropriate treatment under that head, article DYSENTERY. CHOLERINE. This affection being merely diarrhea, occurring during the prevalence of cholera, without any of the more severe symptoms of that disease, the reader is referred to that article for its treatment. LIVER COMTPLAINT. This disease is divided into the Acute and Chronic: the latter generally goes by the name of Liver Complaint, although a careful diagnosis will often discover that the real disease is in the stomach and intestines; however, in many cases the liver itself becomes materially implicated, and in itself deserves considerable attention. When the disease has been for a long time unchecked, and the inflammation becomes deeply seated in the substance of the liver, an abscess frequently forms, bursting either externally or internally; in the latter case often proving critical, or bringing on hectic fever. INFLAMMATION OF THE LIVER. 285 ACUTE INFLAMMATION OF THE LIVER. HEPATITIS. This disease is much more common in tropical climes than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the powerful rays of the sun by day, are among its principal exciting causes; but it may also arise from violent mental emotions, the use of stimulating or alcoholic drinks, suddenly suppressed evacuations, strong emetics or purgatives, the abuse of mercury, gallstones, external lesions, or injury of the brain. DIAGNOSIS. This differs according to the seat of the inflammation. When it occurs on the outer surface or convex side, the symptoms closely resemble those of pleuritis; there is generally a violent pain in the right hypochondrium, sometimes resembling stitches, at others burning-shooting to the sternum, the right scapula and point of the shoulder, and even affecting the right foot,-sensation of numbness or tingling in the arm of the same side, the pain increased by inspiration; a short dry cough, and the symptoms of inflammatory fever; bowels irregular, generally constipated, and stools, in the majority of cases, of an unnatural color. In this form the patient can only lie on the left side. When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient complains rather of a sensation of pressure than actual pain, but the whole biliary system is much more affected. The eyes and countenance become yellow, and sometimes complete jaundice declares itself; the urine is orange-colored, the evacuations mostly hard, and generally of a whitish or gray color. We also find bitter taste in the mouth, vomiting, and considerable distress. The patient can only lie on the right side. Inflammatory fever is met with in this variety likewise. In both forms, the right hypochondrium, on examination, will usually be found hot, tumefied, and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form; it may also end in suppuration externally, or internally by a communication either with the lungs or intestinal canal, or by a vomica in the substance of the organ itself, or it may terminate in indurations or other alterations of structure, in gangrene, or in the formation of adhesions. 286 DIGESTIVE SYSTEM. The disease may terminate by resolution, critical metastases, hemorrhoids, diarrhoea, epistaxis, or cutaneous, particularly erysipelatous, eruptions. THERAPEUTICS. The following remedies are those which are most frequently required in the generality of cases:Aconitum, Belladonna Mercurius, Lachesis, Bryonia alba, Chamomilla, Nux vomica, Pulsatilla and Sulphur. ACONITE is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is violent inflammatory fever, attended with insupportable shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish. BELLADONNA* may be advantageously employed after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present themselves: oppressive pains in the region of the liver, which extend to the chest and shoulders, distension of the pit of the stomach, sometimes extending across the epigastrium, producing a sensation of tension, with difficult and anxious respiration; determination of blood to the head, with cloudiness and giddiness, sometimes causing faintness; great thirst, tossing about at night and sleeplessness. (Temperament, sanguine lymphatic.) When Belladonna fails to remove the whole of these symptoms, we frequently find that MVERCURIUS will have the desired effect; this medicament is too well known as an allopathic remedy in the cure of this disease, and the consequences produced by its abuse are frequently so great, as to render the disease almost incurable. It is generally administered by allopathic practitioners, even when not indicated, until its marked pathogenetic symptoms declare themselves, and consequently the patient, in addition to the original malady, has frequently * Dr. Bosch found the alternate employment of Belladonna and Bryonia very efficacious in acute inflammation of the liver; when the liver remained tumid and painful after the removal of the fever, Phosphorus and Bryonia; and when fulness, weight, dull pain, with dyspepsia and icterus, Carbo v. and Bryon.; or, when the said fulness and weight were unaccompanied by pain, but the patient complained of a feeling of weight in the scrobiculus with frequent eructation, constipation, clayey stools, extreme languor, and jaundice, Carbo v. and Nux in alternation.-Hygea, XX Bd. 5 Heft. INFLAMMATION OF THE LIVER. 287 to contend with a medicinal disease. The following are some of the principal indications for its employment. Considerable fulness or tumefaction in the region of the liver, with pricking, burning, or oppressive pains, not allowing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected; pains in the shoulders; bitter taste in the mouth, want of appetite, thirst, and protracted shivering, sometimes followed by sweating, but without relief, with pale yellow color of the skin and eyes; also in more advanced stages of the complaint, when there is induration of the liver, or when we have reason to suspect the formation of matter. (Arsenicumn, Hepar s., or Silicea, are equally, if not more, deserving of attention in the latter case.) If the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there will be additional reason for selecting Ailercurius. LACHESIS. In subacute cases, or in those in which Belladonna or Jlfercurius have merely afforded partial relief, Lachesis is often of great service. It may also be administered with advantage, alternately with the said remedies, in obstinate cases occurring in drunkards. BRYONIA, when the pains in the region of the liver are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing, or respiration, and especially during inspiration; or much exacerbated by movement; also when the symptoms are attended with violent spasmodic oppression of the chest; rapid and anxious respiration; bitter taste in the mouth, tongue coated yellow; and constipation. Bryonia, like Chamomilla, is particularly useful in cases which have been excited by mental emotion, such as a violent paroxysm of anger, and is well adapted to persons of nervous or bilious temperament, and of choleric disposition. CHAMOMILLA, in slight cases, or simple irritability of the liver with pressive, aching pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs, yellow color of the skin, pains not aggravated by motion, &c.; tongue foul and yellow, bitter taste in the mouth; paroxysms of great anxiety. OCamomilla is almost a specific, when the above symptoms have been brought on by a fit of passion. 288 DIGESTIVE SYSTEM. Nux VOMICA is particularly indicated, when the pains are shooting and pulsative, and attended with excessive tenderness, at the region of the liver, to the touch, pressure in the epigastrium and under the ribs, with shortness of breath, and constipation: also when enlargement and induration occur; and in the chronic form, when there are marked symptoms of gastric derangement. Temperament sanguine or bilious; disposition choleric. (Vide Nux vomica, art. INDIGESTION.) ARSENICUM:-Distension of the right hypochondrium, with severe burning pains and sensibility to the touch, burning heat of skin, accelerated pulse, intense thirst, anxiety, vomiting of a dark-colored, grumous fluid. PULSATILLA. Sensation of tension in the region of the liver, and pressure or dull pain in the epigastric region; oppression at the chest, bitter taste, yellow tongue, nausea; loose, greenish and slimy stools; excessive anxiety, especially towards evening or during the night. (Temperament lymphatic; disposition mild.) SULPHUR is valuable to follow Nux v. or Pulsatilla when either the one or the other, although apparently indicated, does not speedily declare a decided action, or when the disease continues, although in a diminished degree; it is particularly efficacious after Nux vomica, to combat the sequeloe of the disease. RIhus, Lycopodium, and Kali c. may be required in some forms of Hepatitis. The two latter have, together with Sulphur, Silicea, and Hepar, been especially recommended in the abscess of the liver. DIET. The same as under FEVERS, modified according to the violence of the disease. LIVER COMPLAINT, OR CHRONIC INFLAMMATION OF THE LIVER. Hepatitis OCronica. In this form of the disease we find many of the symptoms which attend the acute variety, but in a modified degree; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls'off in flesh, and loses strength; and there is, not unfrequently, an occasional cough with expectoration; sometimes considerable perceptible enlargement of the liver, either continuous or returning periodically, with a number of dyspeptic symptoms; high-colored JAUNDICE. 289 or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms; the pulse, except during these attacks, generally quick but regular. Nux voMICA, BRYONIA, ARSENICUMA, and SULPHUR are remedies of great value in this as well as the acute form of liver complaint. It frequently, however, requires a careful discriminative treatment, and all the acumen of the experienced practitioner to conduct the affection to a happy issue. For the indications for the above medicaments, see ACUTE INFLAMMATION OF THE LIVER. CARDUUS MARIANUS. This remedy is indicated by most of the symptoms which have been described under Bryonia and Nux v. in the preceding chapter, but it is more particularly called for, when there is bitter taste, with dull pain or occasional shooting or pricking in the right hypochondrium, increased by inspiration; yellow hue of the skin; short dry cough, or cough with expectoration of mucus streaked with blood; and slight feverishness. Aurum, Ilepar s., Lycopodiumn, j3agn. m., Natrum, Silic., Cinchona, Alumina, Calcarea, Digitalis, Laurocerasus, Berberis vulgaris, Sepia, Carbo v., Natrum m., Tali c., Plumbum c., Acid. nitr., Magnesia, Cuprum m., etc., have also been found useful in chronic disease of the liver. JAUNDICE. ICTERUS. DIAGNOSIS. Yellow color, varying in shade from a pale saffron to a dark brown yellow, appearing first in the eyes, then extending over the surface of the whole body; hard whitish fieces; orange-colored urine; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver. In severe cases, even the perspiration will impart a,yellow hue to the patient's linen. The disease frequently declares itself without being plainly referable to any exciting cause; the principal causes, however, are affections of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics, or drastic purgatives, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. Among the predisposing causes may be enumerated a too 19 290 DIGESTIVE SYSTEM. sedentary or irregular mode of life, indulgence in spirituous liquors, and the frequent use of aperients. It may be remarked that the malady frequently assumes the intermittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences, for example, dropsy, hectic fever, or general atrophy. THERAPEUTICS. MEROURIUS and CINCHONA are two of the best remedies in the treatment of the disorder, particularly the former; but, in cases where the patient has suffered from the abuse of that mineral, a preference may, in most cases, be given to Cinchona, especially when the disease appears to have arisen from partaking of indigestible substances, or where it assumes an intermittent form. In cases which have been excited by a fit of passion,-as we have before noted, no unfrequent cause-we should have recourse to CHAMOMILLA; but Nux voMIcA is to be preferred, when, in addition to this, the bowels are confined, or alternately confined and relaxed. Nux vomica is also indicated, when sedentary habits, over-study, or indulgence in spirituous liquors, appear to be the predisposing, or partly the exciting causes. PULSATILLA. Lassitude, great weakness and anxiety, especially towards evening; obtuse pressure, but sometimes also pricking or shooting pain, in the region of the liver, extending occasionally upwards, towards the right shoulder; whitish stools. DIGITALIS is a most important remedy in many cases of this disease; the following are the principal indications for its employment: nausea, retching, or vomiting, tongue clean or coated white; pressure at the pit of the stomach and region of the liver; sluggish state of the bowels, with white, gray, or clay-colored evacuations; alternate heats and chills. (Icterus Spasmod. s. Spast.) AunRm is frequently an excellent remedy in obstinate cases, after Pulsatilla, when the disorder occurs in young females. Should the Jaundice be accompanied with symptoms of inflammation, and pain and pressure in the hepatic region, INFLAMMATION OF THE SPLEEN. 291 see ACUTE INFLAMMATION OF THE LIVER; it may, however, be again observed in this place, that in the majority of such cases, Aconite, followed, if needful, by Belladonna, Miercurius, or Chamomilla, as best indicated, will be found of essential service. In inveterate icterus, the alternation of Sulphur, Hepar sulphuris, Lachesis, and Acid. nitricum has been found successful; but as these cases frequently arise from obstructions, atony, or a spasmodic or irritable state of the liver and duodenum, they require considerable skill and discrimination in their treatment. The diet should be light and unstimulating; veal or chicken-broth, with bread (unfermented); roast apples, also mild vegetables, such as vegetable marrow, stewed lettuce, and French beans. Bacon, butter, eggs, milk, wine, spirits, and malt liquors in general must be strictly avoided. The drink should be chiefly confined to water. INFLAMMATION OF THE SPLEEN. SPLENITIS. DIAGNOSIS. Sharp pressing or shooting pains in the region of the spleen, with, in most cases, a high degree of fever, general derangement, and sometimes enlargement and tumefaction; and, when very severe, hematemesis. It is a rare disease in this country, but sometimes declares itself in hot seasons, when it is not unfrequently mistaken for other affections. It may, however, arise in individuals of delicate constitutions, or in children, when exposed to the influence of marsh miasms, particularly when to that cause has been added insufficient clothing, want of exercise or proper nutriment, and long-continued mental disquietude. The value of Cinchona in this malady, and the power it displays of developing an affection closely similar to it, affords one of many exemplifications of the truth of the homceopathic law. From our very imperfect knowledge of the physiology of this viscus and its relation to the other organs, this disease, except when it presents itself in the tangible form above mentioned, is extremely difficult to diagnose. Its best characteristics are tenderness or sensibility on pressure in the splenic region, with general debility, paleness of the complexion, 292 DIGESTIVE SYSTEM. bloodless appearance of the conjunctiva, languid circulation, and tendency of the extremities to become cold. THERAPEUTICS. The chief remedies in this affection are Cinchona and Arsenicum, which are useful not only in its treatment, but against the tendency to dropsy, which not unfrequently developes itself in connection with this complaint; an aggravation, however, which can but rarely occur, where the proceedings of the practitioner are guided by the homceopathic law, inasmuch as the very remedies employed to combat the disease itself are the surest preventives against such a result. The other medicines most frequently required are Aconitum, Arnica montana, Nux vomica, and Bryonia alba. AcoNITUA. Against the fever generally present, if the disease be severe. CINCHONA, when the inflammatory symptoms have abated, or if no fever of any moment exists at the commencement, particularly if the disease owes its origin to marsh miasm, or if the accompanying fever presents an intermittent type, in which case it should be administered during the Apyrexia; moreover, if impaired appetite and general derangement be present;-see this medicine under APEPSIA. Also, if the patient have been weakened by hematemesis or diarrhoea;see these articles. When the abuse of this medicine has given rise to disease of the spleen, benefit will often be derived from the employment of Arsenic., Carbo v., Puls., Veratr., and Suzph. ARSENICUM is useful where the disease resembles or is complicated with ague (see Cinchona and this remedy under art. INTERMITTENT FEVEn); and further, when the patient complains of a violent burning pain in the region of the spleen, and a constant pulsation at the scrobiculus, attended with great anxiety; also vomiting of a dark, grumous, fluid, watery, or sanguineous diarrhoea, and burning at the anus; excessive weakness, and cedema of the feet. In some cases it has been found advantageous to alternate these two remedies, by giving a dose of Cinchona morning and evening, allowing an action of one, two, or three days, according to circumstances, and then exhibiting the other in the same manner. ARNICA is indicated by pressive pain in the left hypochon INFLAMMATION OF THE STOMACH. 293 drium, causing dyspnoea, and when the vomiting of blood is excessive. (When external violence has given rise to the disorder, Arnica is especially called for. Bhus may also be useful under similar circumstances, particularly when severe corporal exertion has produced the disease.) Nux voMIcA is chiefly indicated by the symptoms of deranged digestion, constipation, &c., which remain after the more threatening symptoms are removed. BRYONIA is found useful in milder cases; where an aching, shooting pain is felt in the region of the spleen, which is much aggravated by the slightest movement; or when the patient complains of a constant stitch in the side, or the left hypochondriac region, and general gastric derangement, with constipation. The preceding are the remedies, which have been found most useful in the treatment of the disease, in the acute form. Chronic enlargement and indurations of the spleen require a long and judicious course of treatment for removal, or even amelioration. We shall, therefore, simply direct the attention of the reader to those remedies which have proved most successful in these instances-namely, Sulphur, Calcarea carbonica, and Baryta carbonica (particularly when the mesenteric glands have become affected), and further, Zycopodium, Carbo vegetabilis, Plumbum, Ferrum, Mezereum, Platina, and Stannum. INFLAMMATION OF THE STOMACH. GASTRITIS. As some difference of opinion exists among medical authors as to the application of this term, it may be as well to state clearly the disease intended to be treated of in this place. By gastritis is here meant, inflammation of the mucous membrane of the stomach, which frequently involves the submucous tissue, and sometimes the muscular coat. DIAGNOSIS. Burning, pricking, or shooting pain in the gastric region, increased by pressure, inspiration, or the passage of food; swelling, considerable heat, and tension over the whole stomachic region, sometimes with pulsation; great thirst, nausea, and vomiting, increased or brought on by the smallest quantity of food or drink; sometimes with hydrophobic symptoms (hydrophobia symptomatica); soreness of the 2941 DIGESTIVE SYSTEM. throat, with inflammation of the fauces; hiccough, sobbing, great restlessness, anxiety, and prostration of strength; coldness of the extremities; tongue generally red at the tip and round the edges, foul, rough at the centre and round the root; frequently also syncope, violent spasms, convulsions, even tetanus; small, sometimes scarcely perceptible, and remittent pulse; sunken features, with expression of anxiety; and, generally, constipation, but frequently diarrhoea, or alternations of these two states. Death may ensue-either from gangrene, in which case the pains suddenly cease, the coldness of the extremities increases, and the pulse becomes scarcely perceptible, and remittent; or from paralysis of the nervous system, during the attacks of the spasms or syncope. When this disease has been neglected or improperly treated, and the patient has the good fortune to escape with life, it inay pass into chronic inflammation, schirrus, or ulceration of the stomach. SCAUSES. The most frequent are partaking of cold drinks or iced water when heated or during hot weather; the admission of acid or poisonous substances into the stomach; lesion from having swallowed any rough-pointed body, external injury, ardent spirits, suddenly checked secretions or evacuations, abuse of emetics, and, finally, metastases. THERAPEUTICS. The remedies which have been found the most useful in the homoeopathic treatment of Gastritis, are Aconitum napellus, Belladonna, Ipecacuanha, Nux vomica, Antimonium crudum, Pulsatilla, Bryonia, anunculus bulbosus, Euphorbium, Cantharis, Hyoscyamus, Arsenicurn. ACONITE is requisite in those cases in which synochal fever is developed, and must be repeated until relief is obtained, or an alteration in the symptoms calls for the selection of another remedy. BELLADONNA may follow Aconite, if the active febrile symptoms become relieved, but do not wholly subside under the employment of Aconite, and when there is vivid redness of the tongue at the tip and margins, inflammation of the fauces, and hydrophobia symptomatica. IPECACUANIA is useful when the vomiting is excessive, the epigastric region considerably distended, and the patient af INFLAMMATION OF THE STOMACH. 295 fected with great anxiety, restlessness, and difficulty of breathing. ANTIMONIUM CRUDUM may follow this remedy, or be given in preference thereto, if the tongue be much loaded. BRYONIA may be administered after any of the foregoing remedies, should they have afforded only partial relief, and particularly if the disorder has been excited by a chill from having partaken of cold drinks when overheated. Nux VOMICA is one of the most important remedies in the gastritis mucosa of drunkards, with low fever, nausea, and vomiting, in the morning or after the simplest food; weight, fulness, and pain in the epigastric region, and tremulousness of the hands. It is, moreover, one of the most useful medicaments, when this disease occurs, as a metastasis from suppressed hemorrhoids, and has also been found efficacious after the previous administration of Aconitum, Bryonia, Ipecacuanha, and Arsenicum, when the disorder has been caused by a chill from drinking iced water when overheated. Lac1hesis and Arsenicum may, in some instances, be advantageously administered in alternation with Nux v., in the idiopathic gastritis mucosa of drunkards. Opium may also be included with advantage here. PULSATILLA has been recommended in the subacute form of gastritis, arising from the sudden suppression of some secretion, such as the menstrual flux, &c.; and also in cases proceeding from a chill in the stomach from ice, particularly after the previous employment of Ipecacuanha or Arsenicum. Ranunculus bulbosus, Euphorbium, and Cantharis have been recommended in the more violent forms of the disease, especially when the burning pain, so commonly attendant on this disease, is well marked. When, however, in addition to the last mentioned symptom, there is excessive prostration of strength; thirst, with violent vomiting immediately after drinking; small, quick, and occasionally intermittent pulse; anxiety, restlessness, and apparent sinking of the vital energies-ARsENICUM must at once be had recourse to, whether the disease has arisen from a chill in the stomach or any other cause,-excepting, of course, poisoning by that mineral, in which case the treatment to be followed will be found under the head of PoIsoNs. The alternate administration of Aconitum with Arsenicum has been found useful in some cases. 296 DIGESTIVE SYSTEM. in others, Veratrum and Arsenicum: the former, at an earlier stage of the disorder, with accompanying inflammatory fever; and the latter, where the extremities have become cold, the pulse small, features sunk and expressive of great anxiety; with hiccough, thirst, vomiting on partaking of the smallest morsel of food, solid or liquid, extreme debility, and othtr symptoms mentioned in the diagnosis. When the pain suddenly ceases, or when the burning pain continues, and the tongue becomes covered with a thick yellow coating, the pulse weak, irregular, or intermitting, and purulent matter is occasionally ejected,-Arsenicum is again one of the few remedies by means of which we may yet hope to arrest the progress of the disease. Sulphur, Cocculus, and Carb. v. have also been recommended in the last stage of gastritis. In certain cases the attention of the practitioner may be directed to the following remedies. IHYoscYAMUS,-Stupor, or confusion of ideas with incoherent speech; convulsions, hydrophobia symptomatica. Lachesis, Stramonium, and Cantharis may likewise prove useful in cases in which the latter symptom is present,-see HYDROPHOBIA. Finally, Colocynth, Mercurius vivus, Sulphur, and COamomilla may be mentioned, as likely to prove serviceable auxiliary remedies in some instances; and Arnica should be resorted to, if the attack can be traced to lesion of the stomach from any rough or pointed substance having been swallowed, or if it has arisen from extern'al injury. When the disease has passed into the chronic form, Natrum m., Lachesis, and NVux v. may be administered in alternation with great advantage; and followed, if required, by Lycopodium, Colchicum, Sulphur, and Phosphorus, &c. Arsenic., Sep., Plumb., Platina, Kali c., Natrum m., Cale. c., Magn. c., and Rhus may also be named as likely to be required in some old standing cases.* Vide also CAnDIALGIA (which chronic gastritis nearly resembles), and DYSPEPSIA. * The alternate employrnent of Sulphur and Carbo v. has been recommended in chronic inflammation of the stomach with the following symptoms: Burning constrictive pains, with sensibility to the touch, fulness and tension of the epigastric region, acidity, and frequent vomiting of watery fluid, or even of ingesta, great debility and sensation of paralysis in the extremities; should indurations (not schirrous) have formed (symptomsperiodic, pressive aching pains, extending from the stomach to the spine, INFLAMIMATION OF THE BOWELS. 297 INFLAMMATION OF THE BOWELS. ENTERITIS. DIAGNOSIS. This disease is comparatively of rare occurrence in the idiopathic form, and appears much more frequently as a symptomatic affection, particularly in the course of certain fevers-such as low Nervous or Typhoid Fever, Scarlet Fever,.Measles, &c.; and also in all diseases attended with hectic fever. It much more frequently occurs in the subacute or chronic, than in the acute form. In the acute form of the disease, involving the submucous tissue and peritoneal coat, as well as the mucous membrane, the symptoms are usually as follows: intense burning or pungent pain, generally in one spot of the abdomen, especially in the region of the navel, increased by the slightest pressure and by movement, with tightness, heat, and tympanitic distension of the abdomen; sobbing, anxiety, and violent thirst, with aggravation of suffering from cold drinks; obstinate constipation; violent vomiting, first of slime and bile, and sometimes even of excrements (Ileus miserere); small and contracted pulse, inflammatory fever, flatulence, and frequently obstruction of urine. In the subacute form of the disease, or in simple enteritis mucosa, the pain is often very slightly felt, in comparison with that which accompanies inflammation of the peritoneal coat, and generally consists of a diffused soreness over the abdomen, which is commonly, though not always,, increased on pressure; but indigestible food or cold drinks almost invariably cause an aggravation of pain. The tongue is often very red, smooth and glossy; and, generally speaking, there is more or less redness at the tip and margins, however foul the centre may be. We also find loss of appetite, and indigestion, with nausea and vomiting, more or less prominent, according to the portion of the intestinal tube affected; being greater the nearer the seat of the inflammation is to the stomach. When the inferior parts are implicated (indicated commonly increased after partaking of the most simple food, and accompanied by anxiety, oppressed breathing and obstinate constipation, and sometimes vomiting of mucus), which are often to be felt at the region of the pylorus, Spia and Aurum should be given in alternation.-Hygea, Zeitschrift besonders fir rationell-specifische Heilkunst, XX Band, 1 Heft. 298 DIGESTIVE SYSTEM. by pain or soreness in the iliac regions and in the course of the colon), there is usually diarrhcea, the stools being frequently slimy and mixed with blood, in severe cases consisting of pure blood, particularly when the rectum is involved, in which case there is, moreover, considerable straining. The pulse is quick, the thirst sometimes excessive, with a greatei or less degree of fever and extreme languor. Unless resolution take place, it may terminate in induration of the intestines-laying the foundation of chronic constipation, hydrops, suppuration, or gangrene. The signs of approaching gangrene, or of its having set in, are the same as in gastritis, with the difference of situation. Among its exciting causes are, cold in the feet and abdomen, suppressed discharges, cathartics, worms, metastases, parturition, indigestible or highly stimulating food, prolonged use of acids, sour wine, or beer, &c. The state of the atmosphere appears to have some share in producing it, from the circumstance that the disorder sometimes prevails almost as an epidemy. THERAPEUTICS. Arsenicumn and, where required, Yerat rum are the principal remedies in the first-described variety of this disease, as well as in the severest forms of gastritis, to which, indeed, it bears a strong resemblance; but the treatment must necessarily be commenced with Aconite when the accompanying fever is intense, and the skin hot and parched. For the selection and administration of the two former remedies, see GASTRITIS. OPIUM and PLUMBUM are the principal remedies against Ileus miserere, when that derangement arises from spasmodic congestion or strangulation of the intestines; but when it is connected with inflammatory action, or has resulted therefrom, Aconitum and Sulphur are more appropriate. Lachesis, Meirc., Bella., &c., may, however, be better indicated by the existing symptoms, in some cases. (See also HERNIA.) In the subacute form of the complaint, a few doses of Aconite are often serviceable; but as soon as the marked inflammatory symptoms have been subdued, one or more of the following remedies must be selected to complete the cure: Belladonna, Jiercurius, Acid. nitricum, Bryonia, Colocynth, INFLAMMATION OF THE BOWELS. 299 COamomilla, Nux v., Pulsatilla, China, Opium, Cantharis, Colchicum,?zhus, Phosphorus, Sulph., Silic. BELLADONNA. Tongue red and smooth, or coated white or yellowish brown in the centre, with intense redness of the tip and margins, and inflammatory redness of the papillae; skin hot and dry, intense thirst, hot, flushed face, giddiness with occasional delirium, especially at night; sensation of soreness or of excoriation either in the umbilical and ccecal regions or over the entire abdomen, with tenderness on pressure, and sometimes considerable distension, particularly in the region of the arch or transverse section of the colon. (Lachesis is sometimes of great service after Belladonna.) LACHESIS is a most important remedy in enteritis, with burning, aching, cutting pain, oppressed respiration, tense, distended abdomen, with sensibility on pressure over the affected part, and obstinate coustipation. (Belladonna may sometimes be returned to with advantage after Lachesis; but if any of the other remedies, such as Bryonia, Nux, or Sulphur, &c., seem better indicated, they should unhesitatingly be had recourse to.) Nux VOMICA. Redness of the margins of the tongue, with yellow or whitish coating in the centre; sensation of soreness, with burning heat in the abdomen;. loss of appetite; indigestion, with vomiting after partaking of food, and aggravation of the abdominal pain after drinking; flatulence, constipation, or constipation and looseness alternately; scanty watery stools, or stools consisting of a small quantity of mucus, sometimes tinged with blood, and attended with straining. This remedy is especially useful when the above symptoms have been caused by the sudden suppression of a hemorrhoidal flux, or from indigestible food, &c. Sulphur is frequently of great service after the previous employment of Nux. MERCURIUS is a most important remedy in this disease, even in the most serious cases, and especially after Aconite and Belladonna, or even Arsenicum, should that remedy have been called for. The following are its principal indications: tongue very foul, coated white or dark brown, sometimes dry, but more frequently covered with thick mucus; excessive thirst; abdomen hard, tense, distended, and very tender to the touch; copious, watery, bilious, and highly offensive stools, 300 DIGESTIVE SYSTEM. but more frequently there is constant urging to stool, followed, after severe straining, by the evacuation of a small quantity of mucus tinged with blood; or at other times, of pure blood in considerable quantity; extreme prostration of strength, chilliness and shivering, with tendency to sweating at night, which, however, brings little or no relief. (Mercurius may sometimes be beneficially alternated with Belladonna, or with Lachesis in more advanced cases.) ACIDUM NITRICUM. The indications for this remedy are much the same as those described under the foregoing; it is therefore sometimes of great service in completing the cure when Mlercurius has effected considerable improvement but seems inadequate to give further relief. It is an invaluable medicine in chronic cases, attended with abdominal tenderness and tenesmus, and especially when the disorder occurs in individuals who have been previously subjected to an abuse of Mercury under allopathic treatment. BRYONIA. After the previous employment of Aconite, Bryonia is occasionally a very useful remedy here, particularly when the patient complains of severe headache, with constipation, and acute pain in the abdomen, aggravated by movement, and after meals; it is also indicated when, after Aconite, there remain dark redness of the tongue, or whitish or yellow coated tongue, with parched mouth, and considerable thirst; loose, offensive evacuations, particularly after partaking of food or drink; nausea and vomiting after eating. PULSATILLA. When the acute inflammatory symptoms of enteritis, arising from the sudden suppression of some habitual discharge, as the catamenia, or the hemorrhoidal flux, or occurring as a sequela of measles, have been subdued by Aconite, and the following symptoms remain: tongue loaded with a thick white, grayish, or yellow coating; adipsia, or, on the contrary, excessive thirst, deranged digestion, loss of appetite, with nausea and vomiting after partaking of a little nutriment; sensibility of the abdomen on pressure, or on every movement; flatulence. COLOCYNTJH. In cases where the large intestines are the seat of inflammation, attended with tympanitic distension of the abdomen, and soreness and sensibility to the touch; tormina and diarrhoea, with increase of pain, followed by INFLAMMATION OF THE BOWELS. 301 urgent desire to go to stool, after eating or drinking; nausea, or vomiting of bilious matter; frequent discharge of flatus. CHAMOMILLA is peculiarly well adapted to the treatment of the disorder in the form it is sometimes met with in children, or in highly nervous and excitable females, who are extremely sensitive to pain and complain loudly from trivial suffering; it is indicated, moreover, by a sensation of soreness in the abdomen, as if arising from internal excoriation or ulceration, accompanied with painful tenderness on slight pressure, and slimy, whitish, watery, or greenish or yellowish diarrhoea, of an offensive odor. CINCHONA is frequently useful after Aconite or any of the foregoing remedies; when there is a tympanitic distension of the abdomen; diarrhoea, aggravated after a meal, with portions of undigested food in the evacuations; thirst, extreme weakness of digestion, and great debility. CANTHARIS. In very serious cases, with discharge of pure blood at stool, and strangury; or in an advanced stage of the disorder, with evacuations of mucus and solid substances, like shreds of membrane, this remedy will frequently be found of considerable service. CCLCHICUM will also be found useful, occasionally, in advanced stages of the disorder, with tympanitic distension of the abdomen, diarrhoea, the stools consisting of white or transparent gelatinous mucus, or of blood mixed with substances resembling false membrane. RHUS. When eruptions break out about the mouth, and there is redness of the tongue, with pain as if from soreness or ulceration in the abdomen, and tenderness on pressure; watery, slimy, frothy, or sanguineous stools; low fever, with nocturnal delirium. ]hus is chiefly useful in symptomatic enteritis, such as frequently occurs in low Nervous Fever, which see. When ulceratioi, with purulent evacuations and nocturnal sweats, sets in, Arsenicum, Nux V., Sulph., Phosp h., Acid. nitr., or Carb. v., rarely fail to relieve, and may even effect a cure when the mischief is not too extensive. The chronic stage of the complaint, which is chiefly characterized by fixed pain, fulness, or uneasiness and oppression in the lower part of the abdomen, increased after meals or after cold drinks; appetite impaired or capricious; thirst, 302 DIGESTIVE SYSTEM. particularly after dinner or at night; bowels constantly relaxed, or affected by constipation alternately with diarrhoea; fetid and discolored evacuations; skin hot, harsh, and of an unhealthy hue; pulse rather quick; tongue loaded, but red at the tip and margins,-or redness of the entire tongue, with large and elevated papillae, especially at the root; emaciation, weakness and languor. 'Here the foregoing remedies required the acute and sub-acute varieties, but more particularly Belladonna, Nux v., Bryonia, and -Rhus, together with Acidum nitricumr Phosphorus, Sulphur, Silicea, Arsenicum, &c., will in most instances be found the most serviceable. AcmIDU NITRICUM is particularly indicated when there is thirst, attended with pains in the bowels or other uneasiness after drinking; impaired appetite, tenderness of the abdomen, fetid diarrhoea and tenesmus; greenish stools, with ingesta, skin dry and harsh during the day, sometimes with nocturnal sweats. PHosPHonus. Soreness in the abdomen, withl tenderness on pressure, and distressing tension after meals; obstinate diarrhoea, or constipation and diarrhoea alternately; stools containing ingesta; pulse rather quick and hard; weakness and emaciation. SULPHUR. This remedy is one of the most useful in enteritis, arising from the suppression of some accustomed discharge, such as the hemorrhoidal, &c.; as also in cases arising from the driving inward of a tetter, or sudden healing up of an ulcer. It is also indicated when we find the tongue red or loaded; thirst; pain, as from excoriation, in the abdomen, with tenderness on pressure; or fulness and uneasiness in the abdomen, increased by cold drinks or after meals; diminished or fastidious appetite, with aversion to meat; fetid diarrhoea, frequently containing ingesta; constipation, or constipation alternately with diarrhcea, flatulence; skin yellow, or otherwise unhealthy-looking, or dry and peeling, but often covered with perspiration at night, or towards morning; pulse quick and hard; emaciation, with considerable debility. SILICEA. When the disorder has been excited by the sudden suppression of the perspiration of the feet, or the sudden healing up of a chronic ulcer, Silicea is one of the most important remedies. The following symptoms are some of the INFLAMMATION OF THE PERITONEUM. 303 more immediate indications for its selection; dryness of the mouth, loaded tongue, great thirst, with diminished appetite, and sometimes disgust at meat, or cooked and hot food, with desire for cold food and drinks; abdomen hard, hot and tense, and painful to the touch; constipation, or extremely fetid watery stools; borborygmus, especially on movement; skin dry and parched during the day, and covered with sweat towards morning; pulse quick and hard. ARSENICUM has already been noticed as the principal remedy in acute cases of a violent character; it is, moreover, a remedy of considerable service in some of the chronic varieties of enteritis, characterized by a feeling of soreness or of burning heat in the abdomen, attended with nausea, want of appetite, and great thirst; increase of pain after cold drink; borborygmus; diarrhoea, sometimes with ingesta; fetid, discolored stools; skin parched, hard, and of a yellowish, unhealthylooking hue; emaciation, with extreme debility. Lachesis, Lycopodium, Kali nitricum, Natrurn muriaticum, Secale cornutum, Hepar sulphuris, Sepia, Calcarea, Graphites, and Carbo vegetabilis, may also be of considerable service in some cases. When we have reason to suspect worms as the cause of this affection, the patient must be treated accordingly. See INVERMINATION. DIET. In acute cases of inflammation, either of the stomach or bowels, the regimen must be placed under the same restrictions as described at page 69 (see Fever); and in subacute and chronic cases the food should be very light, and given in small quantities; raw fruit, green vegetables, and sometimes potatoes, must be strictly prohibited; and the drink should consist solely of toast-water, barley-water, or the like. INFLAMMATION OF THE PERITONEUM. PERITONITIS. DIAGNOSIS. Painful tension and tumefaction of the abdomen, with a sensibility to the touch even more acute than in Enteritis, so much so, that the patient cannot bear the pressure even of a sheet upon the abdomen; frequently constipation or ischuria, and the symptoms of enteritis. CAUSES. General causes of inflammation, and, moreover, 304 DIGESTIVE SYSTEM. external injury, parturition," chill of the abdomen, and metastases. THERAPEUTICS. In the first place it will generally be found beneficial to administer three or four doses of ACONITUM, exhibited at intervals of time varying according to the exigency of the case, until the fever and inflammation lower; this remedy has been found, in many cases, sufficient of itself to remove the affection, and in all it materially modifies its violence. When the cause is external lesion, we should prescribe AuNICA, and at the same time apply bandages wetted with a diluted tincture of the medicine, as recommended under EXTERNAL INJURIES in cases of contusion. (Acon. followed, if requisite, by Belladonna, is, nevertheless, indispensable, as soon as inflammatory fever, with excessive local tenderness, supervenes.) Sometimes vomiting and other symptoms, closely resembling those of enteritis, are present; at other times, merely the marked sensibility of the abdomen and tumefaction, with gastric derangement; but as, physiologically considered, these symptoms arise from the intensity and extent of the inflammation, and the sympathy of the other organs, our chief care must be to lower the inflammation, which having been in a great measure effected by the first-mentioned remedy, we shall find considerable benefit from the employment of Nux vomica and.fercurius in combating any remaining symptoms: Nux VOMIcA, where there is painful sensibility, and distension of the abdomen, with a tendency to the predominance of gastric symptoms and ischuria. MERCURIUS is more particularly suited to the advanced stages of the disease, with weak, quick pulse, nocturnal sweats, and great weakness. When the inflammation extends to the pleura, and the breathing becomes affected, with acute shooting pain, we should have recourse to BRYONIA, in the same manner as directed for Aconite. (See also PLEURITIS.) When the peritoneal coat of the upper portion of the alimentary tube or of the stomach itself becomes affected, evinced by an increase in the intensity of the disease, the INVERMIINATION. 305 pain extending higher-vomiting, generally a rare symptom, becoming severe and continual-collapse of the features, small pulse, and a rapid sinking of the vital energies, we should have recourse to ARSENIcOUM. In cases where there are evidences of the brain being affected, Beltadonna may be had recourse to. (See PHRENITIS.) In other instances Cantharides, Lach., COamomilla, Bryonia, RhuS, Lycopodium, Colocynth, &c., may be found necessary.* (See also GASTmITIs and ENTERITIS, as the indications for many of the remedies mentioned under that head will, in many instances, prove useful in the selection of the appropriate medicament in inflammation of the peritoneal coat.) INVERMINATION. WORMS. HELMINTHIASIS. FEBRIS RELMINTHIACA. The existence of worms in the intestinal canal, in the majority of cases evidently arises from a peculiar constitutional taint, inducing a certain diseased state of the mucous. or lining membrane, and thereby giving rise to the formation of these parasites; and, although no period of life is wholly exempt from their presence, infants and children appear to be much more subject to the affection than adults, on account of the predominance of nutrition in early youth. Weakness of the digestive functions, accumulation of mucus in the intestines, an ill-regulated diet, and a degree of moisture in the atmosphere, favor their generation. The three species most generally met with in the human subject are, the thread, or maw-worm (Ascaris vermiczularis, Oxyuris), the long round worm (Lumbricus, Ascaris lumbricoides), and the tTnia or tape-worm; of the latter there are two varieties-the solitary tape-worm (Tcenia solium), Tcenia osculis mnarginalibus), composed of long and slender articulations, which has been known to exceed the length of thirty feet; and the broad tape-worm (Tcenia osculis supemficialibus, Bot/hriocephaluIs latus), which varies from three to ten feet, seldom comes away entire, but in joints, which are consider* In Peritonitis puerperalis: Aconitum, Ipecacuanha, Bryonia, Arsenicum, Veratrum, Chamomilla and Pulsatilla are the remedies which have chiefly been used; but some of the others which have been mentioned in the treatment of ENTERITIS may be found serviceable in particular cases. 20 306 DIGESTIVE SYSTEM. ably broader and thicker than those of the variety first mentioned. The presence of worms, unless when passed, is not always easy of detection, since subacute inflammation of the mucous membrane from other causes will frequently present nearly the same range of symptoms; but here (as in the treatment of most diseases) Homoeopathy presents two manifest advantages over the old system. In the first place, if acting upon the certainty of the existence of worms, we administer a remedy specific to the affection; in the next, when we are uncertain as to the true character of the complaint, and select a medicament distinctly indicated by the united symptoms, this medicament will be found applicable to the affection, from whatever cause it arises; whilst a careful observance of the known pathogenetic powers of the remedies selected will materially assist us in tracing the disease to its proper source. DIAGNOSIS. Worms, and especially ascarides, frequently exist in the intestines without occasioning any disturbance, and their presence is only known by their being observed in the evacuated faces; but when the alimentary tube becomes irritated by them, a number of symptoms are developed, of which the following are the principal: Pallor and sickly appearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils; headache or vertigo; irregularity of appetite, or great voracity; fetidity of breath; acrid eructations; occasional nausea and vomiting; foul tongue: tensive fulness of abdomen, with a sensation of gnawing and burning at particular parts of the intestines; hard and tumid belly; great thirst; discharge of mucus from the rectum, bladder (and vagina); heat and itching at the anus: slight febrile symptoms, or remittent fever, and nocturnal wakefulness, with low spirits or irritability of temper, and gradual emaciation; we also usually notice an inflammatory redness of the nostrils, with great disposition to picking or boring at the nose, especially in children, with sudden screaming when waking, and grinding of teeth. In addition to the above general symptoms of this affection, we frequently meet with severe colic-like pains, with tenesmus and slimy and bloody evacuations; dysury; strangury, involuntary flow of saliva, especially when asleep; convulsions in INVERMmINATION. 307 children, and epileptic attacks, combined with cerebral affections, in adults; inflammation of the bowels. The pain is periodic, and occurs particularly in the morning, and whilst fasting; melioration generally after eating. The quality of the food exercises considerable influence over the pains; milk, sugar, and other sweets, pungent, salted food, ham, cheese, raw fruit, etc., often produce aggravation. In tcenia, in addition to the above, we find a crawling, scraping or groping, and twisting sensation, extending from the left side of the abdomen towards the epigastrium, and even as far up as the cesophagus; or a sensation as of something rising into the left side of the throat, and then falling back; the feeling of a cold ball on either side, with an undulatory motion; a sense of sugillation in the abdomen; creeping torpor and numbness in the fingers and toes. The principal exciting causes of worms are, insufficient and unwholesome food (excess of vegetable, and deficiency of animal diet), uncleanliness, impure air, with residence in a damp, dark, ill-ventilated dwelling. The leuco-phlegmatic habit appears to engender a predisposition to their formation; and females are oftener affected than males. As already observed, the alimentary tube may be infested with worms without any other indication of their existence being developed beyond the fact of their occasional evacuation at s6ool. But the reverse is more frequently the case, and in addition to the anxiety and alarm which are so often created in the minds of parents by the distressing nature of many of the symptoms, in severe cases a further and more serious cause for apprehension is given rise to, when other diseases above noticed, such as chronic inflammation of the mucous membrane (sometimes followed by perforation), mucous fever, epilepsy, or hectic fever, become associated with invermination. The progress of the disease is generally slow, and there is a constant proneness to relapses. The prognosis is generally favorable, particularly in the case of ascarides. It is less so in that of tape-worm, chiefly on account of the greater duration of the disease, and its more uncertain cure. When the 308 DIGESTIVE SYSTEM. colon and rectum are the seat of the disorder, the cure is more easily accomplished than when the stomach and small intestines are affected. When the nervous symptoms, so-called, such as sopor, spasms, dilated pupils, vomiting, are present, the case is liable to be confounded with hydrocephalus; but in the latter the abdomen is flat or retracted, whereas in helminthiasis it is soft and distended; the head in hydrocephalus is hot, and the symptoms succeed each other in a regular course, whereas here they are very changeable, periodic, and inconstant. (See Hartmann's Acute Diseases, p. 175.) THERAPEUTICS. Aconitun, Ignatia amara, Sulp.hur, Calcarec carbonica, Chinca, Ferrum metallicum, ilarum ver., Cinc, Nux vomica, lMercuriucs, Valericna, Spigelia, Belladonna, Sabadilla, Silicea, Cicuta virosa, Filix mas, &c. Of these, Aconitum, Ferrum, Ignatia, iMerc., Nux v., YValer.,.Ifarunm er., Cinac, and Sulph. tinct. are generally the most appropriate against Ascarides. Cina, Nux v., China, Bella., _Merc., Spigelia, &c., against Lumbrici. And Graph., Calc., Sabadl., and Fragaria vesca (Dr. Gross); or Sulph., iMerc., and Calc. (Dr. C. Hering); as also Garbo an. et veg., ~ali c., Miagnes. m., Natr., Phosph., Petrol., Plat., Tereb., Filix mas, Punica granat., Stannum, against tape-worm. ACONITUM. When considerable febrile irritation exists, with restlessness at night, fever and irritability of temper, continual itching and burning at the anus, and at times a sense of crawling in the throat. In many cases IGNATIA AMARA will be found the most appropriate medicine after Aconite, particularly if spasmodic twitchings take place in one of the extremities or in individual muscles, intolerable itching, and pain as from excoriation in the anus and rectum. (See Cina.) VALERIANA may be substituted when the insupportable nocturnal itching causes spasmodic muscular twitching and sleeplessness. FERRUMI METALLICUM is of much service when there is frequent vomiting and accumulation of watery fluid in the mouth. MERCURIUS. When, in addition to many of the ordinary symptoms of worms, there is especially a constant inclination to go to stool, and diarrhoea with tenesmus; distension and INVERMINATION. 309 hardness of the abdomen (umbilical region); increased secretion of saliva. SULPHUR, in case the annoyance still continues after the lapse of two or three days. This remedy is, however, sometimes indicated from the commencement, and is in some cases alone sufficient to effect a radical cure. It is especially called for in lymphatic, leuco-phlegmatic habits, with tendency to frequent attacks of coryza and other mucous discharges; bitter, slimy taste, aversion to meat; irresistible longing for sugar; alternations of loss of appetite and voracity; frequent regurgitation of ingesta, together with pyrosis, hiccough, vomiting, and borborygmus; also when the before-mentioned itching and feeling of soreness in the anus and rectum are extremely distressing. CALCAREA is, if anything, still better calculated than Sulphur to eradicate the tendency to worms. It is peculiarly well adapted to children of lymphatic constitution, with disposition to blenorrhoea; cold in the head and diarrhcea; feeble debilitated frame; defective nutrition; face pale and hollow, or puffy, and of diminished temperature; weakness of the ancles; complications with scrofula and rickets; chronic derangement of the digestive functions. SILICEA is often of essential service after Sulph7ur or Clccarea, when the symptoms are generally much exacerbated at the first quarter, or at the period of full moon, as is very frequently the case in helminthiasis. Some of the other medicaments, such as Mercurius, NuVux e., or Pulsatilla, Ipecacuanha, Antimonium, may be required after a few doses of Sulph/ur or Calcarea, when indicated by the turn the symptoms may take; moreover the beneficial action of Sulphuer or Calcarea is often materially assisted by the intermediate use of one or more of the aforesaid remedies. An interval of from six to ten days, and sometimes upwards, must generally be allowed to elapse between the different remedies, in chronic cases. This course of treatment, persevered in for a short time, has often proved successful in most obstinate cases, by purifying the constitution, and restoring the mucous membrane to a healthy state. When excessive irritation is present, and does not appear to diminish readily under the action of the pre 310 DIGESTIVE SYSTEM. ceding remedies, we may give a drop of the tincture of Urtica urens, in a little water, or on a piece of loaf sugar, every night or morning for several successive days, and should this not relieve the annoyance, we may administer an enema of a dessert-spoonful of salt to a pint of water, of which from two to six fluid ounces, according to age, may be injected; if this produces a relaxed state of the bowels a mixture of vinegar and water, in the proportion of one fourth part of the former, may be used. (See Hering's Domestic Physician.) After this palliative course of treatment, the course above mentioned may again be adopted, should it appear necessary. CINA. This is an eminently useful medicine in the case of worms, and is generally indicated where the following symptoms are met with: frequent boring at the nose, obstruction of the nose, great perverseness of temper, bashfulness, heat and irritation, constant inquietude and restlessness, with, in children, a desire for things which are rejected when offered; fits of crying when touched, paleness of face, with livid circle round the eyes; constant craving for food, even after a meal; griping, distension, heat, and hardness in the abdomen, with discharge of thread and round-worms, costiveness, constipation, or loose evacuations; fever chills towards evening, hard quick pulse; little sleep, or restlessness, tossing about, startings, talking or calling out suddenly during sleep; transitory paroxysms of delirium; heaviness of the limbs; changing of color, the face being at one time pale and cold, at another red and hot; pupils dilated, tongue covered with tenacious mucus; disagreeable eructations, vomiting; itching in the anus, and crawling out of thread-worms, involuntary micturition, and white, turbid urine; occasional convulsive movements in the limbs; weakness and lassitude. This medicine is particularly indicated in COLIC produced by worms. Nux VOMICA is a valuable adjunct in cases of worms, with considerable derangement of the digestive functions, irritability of temper, and constipation; or excessive distension and sensibility of the abdomen and epigastric region; feeling of heat in the abdomen; inclination to vomit; exacerbation of symptoms early in the morning. (See also DYSPEPSIA, GASTRIC or Mucous FEVER.) MERCURIUS. When we find diarrhoea, distension of the INVERMINATION. 311 abdomen, and hardness in the umbilical region, with increased secretion of saliva. CHINA is appropriate when the symptoms are generally exacerbated at night, particularly the abdominal sufferings; or, when pressive aching pains are experienced below the umbilical region after every meal, and are attended with distension of the abdomen, pyrosis, pains in the epigastrium, and retching; also, when in addition to the foregoing, there is an over-excitability of the nervous system, with spasmodic twitchings of the muscles in various parts, tremulousness and debility. (Valeriana and Veratrum are also deserving of attention here.) SPIGELIA in cases, with colic, voracity, diarrhcea, and chilliness; or nausea in the morning, accompanied by a sensation as if something were ascending from the stomach into the throat; smarting in the nostrils, paleness of face, palpitation and anxiety; exacerbation of symptoms, particularly after dinner. BELLADONNA is best adapted to cases with cerebral disturbance; great nervous excitement; nocturnal delirium, with startings during sleep; tendency to be startled or frightened by the most trivial cause; also colic, headache, thirst, quick pulse, hot dry skin. Should these symptoms not yield to Belladonna, recourse must be had to Lachesis or to Silicea, if the febrile symptoms continue, and the patient be of a scrofulous diathesis. CICUTA vmIosA. Severe worm-colic, with febrile irritation and convulsions. (Bella., Ignatia, Ifyoscyamus, are also valuable in the event of convulsions. See that article.) The treatment of teenia, although similar to the above, has some modifications. In most cases Aconitum may be prescribed, followed by Cina, after which considerable relief is often experienced; subsequently FILIX MAS, a drop of the concentrated tincture, night and morning for four or five days.* * Dr. Wahle, of Rome, considers the Filix mas a specific remedy in teenia, when anything sweet invariably disagrees with the patient, or rather with the worm. He has repeatedly found only a few doses of this medicine sufficient to remove all the symptoms and sufferings arising from tape-worm, when the aforesaid peculiarity formed a marked symptom; and that every 312 DIGESTIVE SYSTEM. PUNICA GRANATUM has been employed with much success by Drs. Lobethal and T. O. Miiller. The latter gives the following symptoms as the principal indications for this remedy: convulsive movements, catalepsy and epilepsy, syncope, emaciation with voracious appetite, sudden starting from sleep, hallucinations, hypochondriasis, vertigo, confusion in the head, dilated pupils, yellow color of the face, grinding of the teeth, accumulation of water in the mouth, capricious appetite, eructations of watery fluid, vomiting, sensation as if something were rising up in the stomach, distended abdomen, colic, palpitation of the heart, &c. (Hyg., Bd. x, pp. 137-93.) In chronic cases, the following treatment has proved successful: Nux vomica, Mercurius, Sulphur and Calcarea. Dose, four globules of each remedy in rotation in two doses, two globules at night and two in the morning,-an interval of from six to ten days to be observed between the different remedies. When any improvement takes place after the administration of any one of these remedies in particular, it will be well to repeat that medicine at the stated intervals, as long as it appears to do good, instead of going on to the next remedy in rotation. In addition to these medicines, the following, as already observed, are more or less useful in tenia; Ccrbo an. et veg., Kali, li1agnes. m., Petrol., Plat., Tereb., Natrum muriaticum, Lycopodium, Sabadilla, Fragaria, Graphites, Baryta, Stannum, Phosphorus, as the one or the other may appear the best suited to the case. In the selection of these or other remedies, we must be guided by the entire group of symptoms. In many cases of tape-worm, a cure has been performed, and the parasite discharged, when the slightest suspicion had not been entertained that the sufferings ofthe patient arose from such a source,-by administering a remedy in strict accordance with the symptoms complained of by the patient. When the symptoms are few, or not well marked, we may derive considerable assistance by paying attention to such particulars as-the disposition and temperament of the patient; the periods of the day trace of the worm disappeared after the employment of the remedy, if the patient paid strict attention to diet-carefully avoiding indigestible food for the space of a few months. (Neues Arch., Dritter Band, Erstes Heft, p. 3.) BLENOFBIEEA. 313 when the sufferings make their appearance or become exacerbated; the part of the body affected (right or left side); the partialities or peculiar dislikes of the patient; the agreeing or disagreeing of different kinds of food or drinks, &c. REGIMEN. The food ought to be wholesome and nutritious; and consist chiefly of meat, such as roast or boiled beef or mutton, sometimes chicken, and occasionally a light pudding; fruits or vegetables must be prohibited, as also milk, pastry, and sweetmeats; and the utmost care should be taken to prevent children from eating raw herbs, roots, &c., which they are so prone to pick up in their rambles when not looked after. Plenty of exercise in the open air is of essential service, and must on no account be neglected. BLENORRIICEA. This epithet is given to an increased secretion or discharge from any of the mucous surfaces. We purpose to restrict ourselves here to the consideration of the affection as it occurs in the stomach and bowels. BLENORRH(EA VENTRICULI. This form of the complaint is chiefly characterized by loss of appetite, insipid, clammy, nauseating, sweetish taste in the mouth, furred, or white and thickly-coated tongue and fauces, flatulence, absence of thirst, constipation, or slimy stools, pale, cloudy, and slimy urine. In addition to these symptoms, a sensation of coldness, with pressure and aching, or gnawing, throbbing, and spasmodic tension is experienced in the epigastrium, frequently attended with an oppressive feeling of sinking and emptiness in the stomach while fasting, and distressing fulness or weight after meals, the sleep is restless or disturbed by frightful dreams, or night-mare; the natural temperature of the body diminished, the countenance pale, and the physical powers much depressed. Accumulation of fluid in the mouth, nausea, and vomiting frequently take place early in the morning or after dinner, and occasionally at other times. Sometimes there is merely an adhesive, tasteless, rarely acidulous, inodorous mucous ejected by the act of vomiting. The prolonged use of imperfectly azotized and indigestible food, sedentary habits, the presence of worms in the alimentary canal, damp, ill-ven 314 DIGESTIVE SYSTEM. tilated dwellings, or other debilitating influences-such as excessive evacuations of blood, immoderate excess in the use of ardent liquors, depressing passions, and a lymphatic temperament are the general predisposing or exciting causes of blenorrhcea in general. A moist, relaxing, and changeable state of the atmosphere, errors in diet, mental emotions of all kinds, materially aggravate the symptoms, and are readily productive of pituitous fever (febris pituitosa, febris mucosa). THERAPEUTICS. Ipecacuanka is one of the most important remedies in the early stage of the disorder, and is in most instances the best with which to commence the treatment. It must be given in repeated doses, until it has produced all the amendment that it seems capable of producing, after which another remedy must be selected in accordance with the remaining symptoms. Against these, we shall generally find either Nux vomica, Arsenicum album, Pulsatilla, Veratrum album, Tartarus emeticus, or ] heum palmatum, etc., the most appropriate. Nux v. is particularly indicated when spasmodic sufferings in the stomach, with accumulation of watery fluid in the mouth, acid taste, vomiting of sour-smelling and tasting mucus, and constipation, sometimes in alternation with slimy stools, form the most prominent features of the case; and especially when these symptoms occur in individuals given to sedentary habits, or to habitual over-indulgence in spirituous, vinous, or malt liquors. Arsenicum may be frequently prescribed with advantage after, or alternately with, Nuux v. where there is an extreme degree of debility, and burning heat in the throat, or stomach, etc. When the last named symptoms occur in lymphatic subjects, and especially females, Capsicum may be preferred to Arsenicumn. PULSATILLA is productive of considerable alleviation where the pituitous state is accompanied by continued shivering, frequent slimy evacuations, and vomiting of mucus, and occurs in debilitated, irritable, and relaxed constitutions, but more particularly in chlorotic females. Sulphur may follow Pulsatilla with advantage when the latter is insufficient to remedy the state of matters. (See CILORosIS.) In cases of an inveterate character, attended with repeated and painful attacks of vomiting not only of mucus, but also BLENORRHCEA. 315 of bile, from the violence of the act of vomiting, YERATRUM rarely fails to afford prompt relief. TTARARUS EMETICUS is sometimes useful after, or alternately with Ipecacuanha, when in addition to the frequent recurrences of vomiting, there is also a constant tendency to slimy diarrhoea. Rheum may be given with advantage where there is much abdominal flatulence, tension at the pit of the stomach and epigastrium, insipid, slimy taste, disposition to diarrhcea; with brown-colored stools mixed with mucus. GRATIOLA has been chiefly recommended as being of considerable efficacy in rebellious or chronic cases where the foregoing remedies have only effected a degree of melioration. Along with Gratiola, the following may be mentioned as being useful in the treatment of inveterate cases: Sulphur, Carbo vegetabilis, Veratrum album, Oalcarea carbonica, Hepar sulphuris, lachesis, Lycopodium, Natrum muriaticum, Stanum, Acidum nitricum, Plumbum, 3iagnes., Assafostida, Bovista, and occasionally Squilla, Cinchona, Ferrum, etc. When the affection arises from worms, Cina, Spigelia, Ferrum, Valerian, and Mercurius, etc., are the principal remedies. (See INVERMINATION.) BLENORREHEA INTESTINORUMI is chiefly characterized by a distressing tension and constrictive sensations in the abdomen, accompanied with flatulent distension, spasms, and obtuse griping pains. Sometimes the bowels are sluggish, or there is obstinate constipation complained of; and the motions that are passed are either intermixed with more or less mucus, or are formed exclusively of masses of thick, tenacious mucus. At other times the bowels are relaxed, the evacuations consisting of large quantities of watery or biliouslooking mucus, passed in rapid succession, and preceded by griping pains. The remedies required here are nearly the same as those given in the foregoing variety of the disorder. When diarrhoea is present, Pulsatilla, Rheum, Arsenicum, Phosphorus, M ercurius, Cinchona, or Ferrum will commonly be found the most appropriate, the latter two particularly when the prolonged use of laxatives or other debilitating losses has been the predisposing cause of the malady. When the bowels are inactive, but the motions coated or mixed with considerable quantities of mucus, or consist en 316 DIGESTIVE SYSTEM. tirely of slimy substances,-Nux vomica, Sulphur, Sepia, Stannum, Alumina, Iachesis, etc., are usually the most suitable. BLENORRIHCEA RECTI. (fzcemorrhioides mucosce.) This variety of the disorder is most frequently met with in the male subject, and particularly in those of a debilitated habit. It may occur in the idiopathic form, but is often purely hemorrhoidal, and in such cases partakes wholly of the characteristic features of hemorrhoids. On other occasions the complaint appears in connection with blind piles. Frequently again it either immediately precedes a fit of bleeding piles, or exhibits itself in alternation therewith. The mucous discharge takes place for the most part periodically, generally subsequent or anterior to an evacuation, but occasionally at other times, and involuntarily. It is usually attended with more or less tenesmus, spasmodic and burning pains in the rectum. The discharge for several days is either watery or viscid, sometimes streaked or mixed with blood, and, though small in quantity, commonly continues for several days. This form of blenorrhcea is not unfrequently preceded by indigestion, flatulence, colic, spasms in the stomach, bowels, and abdominal muscles, local intestinal constrictions, pains in the hips and sacrum, spasm of the bladder, scanty urine, itching in the glans. These symptoms increase in intensity as the period for the flow of mucus approaches, but as soon as it makes its appearance they commence to subside in a similar ratio. The exciting causes of blenorrhcea recti, as well as blenorrhoea intestinorum, of which the former is but a variety, are nearly the same as those we have given under Blenorrhoea Ventriculi, to which may be added the debilitating effects or the transposition (Blenorrhwc metastatica) of catarrhal, venereal, or rheumatic, gouty and other more purely dyscratic diseases. THERAPEUTICS. Helleborus niger, Colclicum autumnale, Mercurius, Spigelia, Capsicum, Putlsatilla, NVuw vomica, Carbo vegetabilis, and Sulpl)ur, will in the majority of cases prove of the greatest efficacy. HELLEBORUS is extremely serviceable when the stools consist of mucus, generally in solid pieces, and without any ad BLENORRHCEA. 317 mixture of proper fecal matter. COLCHIcuM is equally serviceable under such circumstances; but particularly when the motions are preceded by severe griping, in which event it may be exhibited in preference to fellebore. Where the presence of worms in the alimentary canal, or the existence of hemorrhoids form the exciting cause of the malady, IMERcuRIus is one of the most important medicaments, especially when at the same time the evacuations consist of mucus intermingled with degenerate fecal matter, during the expulsion of which, violent colic and tenesmus are experienced. SPIGELIA is useful under nearly similar conditions; it may consequently be had recourse to with advantage in many instances where jfercurius affords only partial relief. CAPSICUM is an excellent remedy when the disorder occurs in lymphatic subjects, and is connected or not with hemorrhoidal disease; the motions copious, somewhat frequent, and accompanied with distressing burning pain in the rectum and anus. PULSATILLA may follow, or be given in alternation with Capsicum, when the pains are in a great measure removed, but the stools unaltered in character. Nux v. will be found of essential service in meagre, debilitated subjects, of sanguine or bilious temperament, addicted to sedentary or intemperate habits. CARBO v. may be prescribed with benefit after Nux when there is excessive flatulence, or burning pains in the lower intestine, especially after stool. When we have obtained from the action of Nux v. and Carb. v. all the improvement that they are evidently capable of effecting, we may follow up the treatment by the administration of SULPHUR, by means of which a cure will often be obtained in cases.of the most obstinate character. Lachesis, Rhus toxicodendron, Ignatia, Antimonium crudum, and Borax, etc., have also been recommended as being capable of affording considerable assistance in the treatment of this variety of blenorrhoea. 318 RESPIRATORY SYSTEM. DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. CATARRH, OR COMMON COLD. CATARRIHAL FEVER. THIS term is given to an affection which consists of a mild degree of inflammation of the lining membrane of the nostrils and windpipe, and occasionally also of the ramifications of the latter, induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere, with insufficient clothing, particularly as regards children. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings: there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses it is termed A COLD IN THE HEAD; of which latter affection, as well as HOARSENESS and COUGH, we shall treat separately. THERAPEUTICS. In many instances catarrh is carried off, or runs to a salutary termination in a day or two. This desirable result is frequently obtained by having timely recourse to the simple proceeding of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm water, at the temperature of about 98-100 degrees of Fahrenheit, is also a useful auxiliary mode of restoring perspiration, but the patient should go to bed immediately afterwards. Very robust persons who are accustomed to be in the open air in all weathers, but who have caught cold after having overheated themselves, will frequently, prevent any bad effects by drinking one or two glasses of cold water on going to bed; when, however, they have learned by experience that little benefit is to be derived therefrom, a few globules of Carb. v. or Silicea should be taken instead. A moderate degree of abstinence should at the same time be observed; veal or chicken broth, bread, sago, or semolina pudding, being substituted for the ordinary diet. The drink may consist of water-gruel, barley-water or toast-water. All strong liquors must be abstained from. The following are the principal medicines to be employed COMMON COLD. 319 in the majority of cases, when called for: Aconitum, Bryonia, Camjphora, Nux vomica, Chamomilla, Coffea cruda, Belladonna, China, Dulcamara, Arnica montana, 2ercurius, Acidum phosphoricum, Sulphur, Calcarea, Ipecacuanka, Arsenicum, Silicea. Nux VOMICA, when the symptoms of common cold declare themselves, will often check the attack. It is especially indicated by the following symptoms: Tickling or scratching irritation in the larynx, dry cough, particularly in the morning, and sometimes during the day, rarely during the night; occasionally a small quantity of adhesive mucus is with difficulty expectorated after a fit of coughing; and the paroxysms are frequently attended with a painful sensation in the umbilical region, as if arising from the effects of a bruise or blow. This remedy is further of great utility in catarrhal fever with disposition to chilliness, or wandering fever chills, worse during movement, coming on, and gradually increasing, in the after part of the day, and alternating with flushes of heat. Warmth and absolute rest mitigate these symptoms. When convenient, it is preferable that this remedy should be taken towards evening. CHAMOMILLA. In the treatment of children this medicine is generally more efficacious than Nux vomica in arresting the attack. It is (like Belladonna, Bryonia, China, Dulcamara, iSulphur, and Silicea) extremely valuable in restoring the suppressed perspiration, and removing the following symptoms: colic, with pains in the head, ears, and teeth, thirst, illhumor, and impatience; or dry heat of skin with chilliness (in any part of the body which may happen to be uncovered for a short time), or on lifting up the bed-clothes; burning heat in one part (as for instance one cheek) and chilliness in another; severe, dry cough, especially at night, excited by tickling in the larynx. COFFEA CRUDA. This remedy is indicated where there is excessive sensibility, fretfulness, and sleeplessness, with general pains, especially in young persons. BELLADONNA, when there is a throbbing, bursting headache, attended with determination of blood to the head, and increase of the pain from movement or exposure to cold air. CINCHONA. Aching pains in the shoulder-blades, and in 320 20ESPIRATORY SYSTETM. the extremities, increased by the slightest pressure on the affected parts, with great restlessness, and constant desire to change the position of the limbs. DULCAMARA, when the pain is more of a passive or dull, aching description, and felt only in particular parts of the head, with humming in the ears, and obtuseness of hearing; catarrhal fever with hoarseness, dry, rough cough, or cough with copious mucous expectoration, severe coryza, great heat, dryness, and burning of the skin; pains in the limbs, increased when at rest, and attended with a feeling of coldness, stiffness, and numbness; or when an offensive perspiration breaks out after an attack of cold; and when the affection has been brought on by suppressed perspiration, from exposure to a cold and humid atmosphere. DRosERA. Painful or bruised-like pains, and paralytic weakness in the extremities; frequent rigors, with coldness of the hands and heat in the face; hoarseness, and cough excited by roughness and scraping in the throat, aggravated by talking. ARNICA MONTANA, when aching pains, or pains as if arising from a bruise, are felt in the linmbs after exposure to cold, causing excessive restlessness and a constant disposition to change the position of the affected parts, and increase of pain from the slightest touch or movement. MERCURIUS, when the lining membrane of the eyelids, nostrils and bronchi, is highly irritated, and gives rise to copious lachrymation, coryza and cough, with profuse expectoration; headache, or feeling of tightness and fulness in the head, with pulsation extending to the nose; general heats predominate over the chills. When the pains in the limbs and joints are accompanied with profuse sweating, which affords no relief; this remedy may be followed by Dulcam.ara should the sweat continue, and be of an offensive odor, or by Emuphrasia, if the lachrymation and coryza remain unmitigated. CONIUM MACULATUM is of great service in catarrhal fever with internal heat, much thirst, and great debility, scraping or scratching, itching and creeping sensations in the throat, which produce a dry, almost incessant cough. The patient dreads the slightest noise or whisper; passes a restless night, the sleep being unrefreshing, and disturbed by anxious dreams; urine cloudy and whitish. COMMON COLD. 321 AOIDUM PHOSPHORICUM, aching pains, relieved by movement. SILICEA, pains in the limbs, colic and general derangement arising from suppressed perspiration, particularly in those who are subject to sweating at the feet. SULPHUR, in cases of swelling of the knee, or of the joints of the hand and fingers, from taking cold. It may, in many such cases, be followed by Calcarea carbonica in a week or ten days. MEZEREUM. Alternate heats and chills (the febrile heat occurring chiefly in bed, and the chills when out of bed); extreme sensibility to cold air, acrid coryza, burning irritation in the larynx and trachea, which provokes cough, attended with difficult mucous expectoration. LYCOPODIUM. Inveterate catarrh, with lemon-colored, often bitter-tasting, mucous sputa; tearing, throbbing, frontal headache, aggravated in the afternoon or evening. (Goullon, Arch. XX, 3-54.) IPECACUANHA. Jausea and inclination to vomit, or Dyspncea, almost amounting to suffocation, arising from having taken cold, followed byARSENICUM, should no amelioration declare itself in six or eight hours. (See also the indications for this remedy in the article on COUGH and INFLUENZA.) HEPAR S. is indicated by many of the symptoms which call for Mere., Ezphr., and Nux. It is moreover of service, where the respiratory organs are solely or particularly affected, the cough loose and attended with mucous rattling in the chest; pain in the larynx while coughing, and a feeling of weakness of chest which renders talking oppressive. PULSATILLA. Useful in cold in the head, with loss of the senses of taste and of smelling in consequence of a chill,followed or preceded by Belladonna, should there be an uncomfortable sensation of heat in the eyes and head, and heat and smarting in the nose: or by Nux v., should there be complete stuffing or dryness of the nose. (See CORYZA and COUGH.) iHus TOXICODENDRON. General indisposition from exposure to a thorough wetting, when in a state of perspiration: followed by BRYONIA in a few hours, if no improvement is experienced. 21 322 RESPIRATORY SYSTEM. SEPIA. Catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating with heat; nocturnal spasmodic cough, with shortness of breath and inclination to vomit, coryza, occipital headache. AcoNITUM is one of the principal remedies in febrile attacks, provoked by c'old, and particularly from exposure to a dry, cold wind, or to a draught, with hot, dry skin, or general shivering chills, alternating with burning heat of the surface, great thirst, especially towards evening, sensation of dryness, and roughness or scraping, slight burning, and excoriation in the region of the larynx, or even throughout the whole of the chest, which gives rise to an incessant, short, dry, hollow cough (more of a hoarse or rough description at night); restless sleep, disturbed by confusing dreams, or crowding of fantastic ideas, when not by the cough. BRYoNIA may follow Aconitum, or it may be selected in preference at the commencement of the attack, when there is an excessively dry, hollow cough, accompanied by tenderness of the larynx on pressure, inclination to vomit, and pain in the chest, as if it would be torn asunder, severe headache, aching pains in the limbs, increased by the slightest movement, violent coryza, thirst and coldness of the right half of the body. CAMPHORA. Incipient catarrh, coming on after getting the feet wet, is frequently cut short by smelling spirits of camphor. When there is usually weariness, heaviness, and general uneasiness, attended with shivering, and dryness or coldness of the skin, and symptoms of approaching fever, one or two drops, every ten minutes, for two or three times, will generally succeed in preventing the development of an attack, either of common catarrhal fever, or influenza. The remedies for any other effects, arising from cold, will be found under the different heads, such as SORE THROAT, DIARRHCEA, COUGH, IIOARSENESS, &C. Some individuals, particularly among those of the fair sex, are tormented with an extreme degree of susceptibility to cold; the best corrective of which is, to rub the throat, chest, and indeed the whole body every morning with a wet towel, until a glow of heat is produced,-drying one part before another is commenced,-also to acquire a habit of going out every day, provided there is no inherent predisposition to pulmonary con COMMON COLD. 323 sumption; all extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. When these means are not sufficient to remove the tendency to suffer from the slightest exposure to cold, the practitioner will find Silicea, Carb. v., and (alcarea, administered at intervals of firom two to three weeks, of considerable power in removing this constitutional delicacy. In other cases, one or more of the following remedies must be had recourse to:--Bryon'ia, Belladonna, Dulcamara, Nux v., China, Ifercurius, ]hus~ Chamomilla, Arsenicum, Lachesis, Rhododendron, according to the character of the sufferings, which are experienced after each exposure to the influence of the atmosphere. INFLAMMATION OF THE LARYNX. LARYNGITIS. This disease consists in a suppurative inflammation, having its seat in the lining membrane of the larynx, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally forms a part; but occasionally the inflammation is exclusively restricted to the larynx; and it is a frequent cause of a fatal termination in scarlet fever and small-pox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passages) rather than a violent and involuntary cough,-and by the character of the sputa, which consists of a thick tenacious mucus rather than a coagulable and membranaceous-looking exudation. The invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes hoarse and inarticulate, whilst a painful sense of constriction is experienced in the throat; the breathing is laborious and shrill during inspiration; the larynx extremely sensitive to the touch, so that the slightest pressure against it, either externally by the hand, or internally from the performance of the act of deglutition, is productive of the most distressing spasms, which threaten death firom suffocation. The heat of skin is great, the pulse rapid and hard, the thirst considerable, but incapable of being satisfied from the suffering that is occasioned by the attempt. On examining the throat, the fauces are often found to present a red, inflamed, and turgid appear 324 RESPIRATORY SYSTEM. ance; in some cases the epiglottis is involved, and the motions of the tongue thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen and sometimes livid; the eyes protruded as in threatened strangulation, and life is speedily cut short by asphyxia. The disease, if not arrested, occasionally runs its course in a few hours to a day or two at the farthest. THERAPEUTICS. We have stated that the symptoms of laryngitis bear a close analogy to those of croup; and experience has proved that the same remedies, which are so eminently successful in the treatment of that affection, are equally efficacious here. The principal of these are: Aconitum, Spongia, Hlepar sulpJuris, Lachesis, Belladonna, Phosphorus. In some cases of a less formidable nature, COamomilla,.Mcrcurius, or Drosera rotundifolia may prove serviceable. AcoNITuM must be immediately exhibited when the signs of inflammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of the febrile movement; on the consummation of which, or as soon as the breathing becomes shrill, and the pain and sensibility of the larynx more decided, with increase of hoarseness and difficulty of articulation,-SPONGIA must be administered, and will, for the most part, be found of great efficacy in forwarding the curative process. When we have satisfied ourselves that we have obtained from the action of Spongia all the benefit which it is capable of effecting, we may then prescribe HEPAR s., which will generally be found sufficient to complete the cure, or at all events to place the patient out of danger, and thereby enable us to make a careful selection of the remedy required to combat the remaining symptoms. (Hfepar may be selected in preference to Sjpongia, if the fever and burning heat of the skin continue, notwithstanding the previous employment of a dose or two of Aconite.) In some instances it will be found necessary to return to Aconite again, or to exhibit Aconite, tIepar s., and Spongia in alternation, but the remedy from which we have derived the most marked benefit, when the more prominent features of the malady did not yield to, or were only palliated by, the use of Aconite, Spongia, or IIepar, is LACHESIS, the pathogenetic properties of which correspond very accurately to the symptoms of the HOARSENESS. 325 malady, particularly the extreme sensibility of the larynx, and the pain and difficulty experienced in performing the act of deglutition. From BELLADONNA we have likewise derived very appreciable service, especially when there was considerable heat of skin, much thirst, but complete inability to satisfy its cravings from the spasms which the attempt occasioned: further, when, on looking into the throat, it is found to present an inflamed and swollen appearance. Should Belladonna have previously been employed, as would naturally be the case if the disease made its access during, or immediately after, an attack of Scarlatina pura, the substitution of IIyoscyamus for Belladonna may be found advantageous. PHOSPHORUS may prove useful against remaining hoarseness with more or less pain and frequent expectoration of viscid mucus. Or OCcrbo v. when the hoarseness is accompanied by a burning and scraping sensation in the larynx, and some degree of cough or hawking up of phlegm of a less viscid nature than in the preceding instance. (See also the aricles on HOARSENESS, CHRONIC LARYNGITIS and CROUP.) HOARSENESS. RAUCITAS. Hoarseness, or roughness of the voice, arises from some abnormal condition of the larynx or trachea. In the majority of cases the seat of the affection is in the mucous lining of the larynx, which is extremely liable to be affected by the common causes of catarrh; hence it is a frequent accompaniment of the latter disorder. The remedies, mentioned under CATARRH and COUGI, are generally found the most useful in this complaint. Amongst these, in cases of recent origin, the following deserve particular notice: namely, Pulsatilla, Afercurius, Nux vomica, Capsicum, Rhus toxicodendron, Sambucus nigra, Chamomilla, Carbo vegetabilis, Drosera, Sulphur, and Hepar sulphuris. The indications for the employment of these medicines are as follow: PULSATILLA. Almost complete aphonia, particularly when accompanied with loose cough, or thick yellow coryza. MERcURIUS. This remedy will often be found useful in removing any symptoms remaining after the above, but it is 326 RESPIRATORY SYSTEM. to be preferred should the hoarseness, from the commencement, be attended with thin coryza,* and when a sensation of burning or tickling is complained of, in the larynx, with the characteristic indication of Mercurius, namely, a disposition to 2rofuse sweating, especially at night. Nux VOMICA. Hoarseness, accompanied by a dry fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. CAPSICUM. Hoarseness, and dry obstruction in the nose, attended with an unpleasant sensation of crawling and tickling in the nose; a severe cough, worse towards evening; and pains in other parts of the body, such as the head and abdomen. It is better suited than Nux vomica for individuals of a lymphatic temperament. RHUS TOXICODENDRON. Hoarseness, accompanied by sensation of excoriation in the chest; oppressed breathing, with frequent and violent sneezing, unaccompanied by coryza, but occasionally by a great discharge of mucus from the nose, during the attacks of sternutation. SAMBUCUS NIGRA. Hoarseness, with deep, hollow cough; oppression at the chest; frequent yawning; restlessness, and thirst. CHAMOMILLA. Hoarseness, with accumulation of mucus in the throat; cough worse at night, continuing even during sleep, and frequently with a degree of fever towards evening, and great irritability of temper. This remedy is frequently specific in cases of children. DROSERA. Hoarseness, with very low, or deep and hollow voice. CARBO VEGETABILIS. Chronic hoarseness, worse in the morning and towards'evening, with aggravation after talking. SULPHUR. Hoarseness, attended with roughness and scraping in the throat; and of great value in obstinate cases, where the voice is low, and nearly extinct, particularly in cold damp weather. (Sulphur is especially useful after Puls.) HEPAR SULPHURIS is a most useful remedy in chronic hoarseness, particularly in individuals who have taken large quanti* Sulph., Calcarea, and Silicea are of great service in obstinate hoarseness attended with coryza. COLD IN THE HEAD. 327 ties of mercurial preparations; otherwise Ammonium Carbonicum is of equal efficacy. (See CORYZA, CATARRH, and COUGH.) When we find individuals in whom this affection occurs frequently at different seasons, or on the slightest exposure to cold or damp, we may naturally infer that there is a constitutional predisposition to chronic laryngitis, a malady requiring the most careful and judicious treatment, as, if neglected, it may eventually end in CHRONIC LARYNGITIS. (Phthisis laryngea.) This is a comparatively rare disease, and, when present, is generally attended with a degree of ulceration. The following are its principal symptoms: pain in the larynx, and round the glottis; pain and difficulty in swallowing; hoarseness, and difficulty of respiration; frequent attacks of severe cough, with scanty, and occasionally sanious expectoration; it sometimes ends in hectic fever, which carries the patient off. The medicines, to which we would particularly direct the attention of the practitioner in the treatment of this malady, are Hepar suly~uris, Lachesis, Phosphwrus, Carbo vegetabilis, Acidum nitricumn Calcarea carbonica, Arsenicum, Spongia, Sanguinaria canadensis-(this remedy proved of singular efficacy, after the previous employment of Sulphur, in chronic laryngitis with the following symptoms: sensation of swelling, and pain as if arising from excoriation, in the larynx, during empty deglutition; expectoration of whitish, saline-tasting mucus; hectic fever ')-and Argentum fol. (The latter has been found very efficacious in affections of the larynx occurring in public speakers, with a sensation at a small spot in the fore part of the larynx, as if a foreign substance were sticking there, and giving rise to a feeling of coldness and some degree of pressure, with frequent inclination to cough, but no abatement of the irritation in the larynx after coughing.)f The patient should adhere rigidly to dietetic rules, avoid unnecessary exposure, and enter as little as possible into conversation. TRACHEITIS. For the treatment of this disorder, see CEOUP.. * Neues Archiv, Zweiter Band, Zweites Heft, p. 148. f Neues Archiv, III. Band, 1. Heft, p. 99. 328 RESPIRATORY SYSTEM. COLD IN THE HEAD. CORYZA. This affection is a very general attendant upon common catarrh. THERAPEUTICS. When it is the leading symptom, or exists independently of those already mentioned, the best medicines for expediting its removal are:-.Nux vomica, Euphrasia, Pulsatilla, Chamomilla, Mercurius, Hepar sulpjhuris, Belladonna, Ammonium, Natrum, and Arsenicum, Zachesis, Silicea, &c. Nux VOMICA. Dry obstruction, especially during the night only, with pressive heaviness in the forehead, and confusion in the head; heat in the face, increasing towards evening. If these sensations occur in combination with other catarrhal symptoms, see the indications already given for the exhibition of this remedy under the several heads of CATARRH, HOARSENESS, and COUGH. This direction equally applies to the other medicaments here quoted. LYOPODIUM will often be found efficacious after Nux v., in obstinate cases of stuffing of the nose, particularly at night, rendering it necessary to sleep with the mouth open, which causes a disagreeable dryness without much thirst, attended with confusion in the head and burning pain in the forehead. This remedy is frequently more or less useful in colds in the head of all kinds. PULSATILLA. The discharge thick, fetid, greenish yellow, or mixed with clots of blood; loss of taste and smell, headaches, sneezing, chill, especially towards evening; disposition to weep, lowness of spirits, heaviness or confusion of the head in a warm room. CHAMOMILLA. When the affection has arisen from checked perspiration, and there is an acrid discharge from the nose, causing redness of the nostrils, and excoriation or soreness under the nose; chapped lips; shivering, with thirst. MERCURIUS. Dryness of the nose, with obstruction; profuse discharge, producing excoriation,.swelling, or redness of the nose, pains in the head and face. This is a valuable remedy in the generality of ordinary cases of cold in the head, particularly when the complaint is, as it were, epidemic.* * When the secretion from the nose is excessive, and there is, at the COLD IN THE HEAD. 329 HEPAR SULPHURIS. Chiefly when only one nostril is affected, or when there is headache which is aggravated by the slightest movement; or when the complaint is renewed on each exposure to cold air; further, in most cases in which Mercurius, though apparently indicated, has produced little or no improvement. BELLADONNA may follow the above, after an interval of a few hours, if the headache continue unabated. When the sense of smelling is variously affected, being at one time too acute, and another too dull, there will be additional reason for resorting to this remedy. AMMONIUM. Stuffed nose, especially at night; swelling and painful sensibility of the nostrils; dryness of the nose. NATRUM. Cold in the head, renewed by the slightest chill, or exposure to a current of air; obstruction of the nose every second day. LACHESIS. Swelling and soreness of the nose and nostrils, with copious watery secretion. ARSENICUM. Obstruction of the nose, with, at the same time, discharge of thin, acrid, excoriating mucus, and burning heat in the nostrils, &c. Suffering relieved by heat; pain in the back, feeling of general debility, or prostration of strength. Dulcamara is useful when fresh obstructions arise from every trivial exposure to the air. Ipecacuanha may be had recourse to after Arsenicum, if the latter has only partially relieved. AMMON. CARB. Cold in the head with copious discharge, particularly of an acrimonious, burning, watery fluid; hoarseness, tickling, suffocating cough, with alternate heats and chills. GRAPHITES, and also SILICEA, are useful in all cases which are of frequent recurrence, and always of a most obstinate character. CAMPHOR. In the premonitory stage of the complaint, with shivering and headache, the attack may frequently be checked by a drop or two of spirits of weak camphor administered, &c. same time, confusion in the head, with redness and soreness of the eyes and eyelids, and copious acrid or scalding lachrymation, Euphrasia should be prescribed. 330 RESPIRATORY SYSTEM. Sulphur, Calcarea, Silicea, Natrum, and Pulsatilla are the best remedies for removing extreme susceptibility to colds in the head.* Against the effects of a suddenly suppressed catarrh, the following are the most important remedies: Aconite against headache, followed by Pulsatilla, and then Cinchona, if the secretion does not return; difficulty of breathing,-Ipecacuanka, followed, if required, by Bryonic and Sulphur. In other cases Nux v., Arsenicum, or Cina, may be required to remove the sequele resulting from the suppression. (See also HOARSENESS, COUGHI, and other affections of the organs of respiration.) COUGH. TUSSIS. DIAGNOSIS. Forced and audible expiration without fever; or a symptom in acute diseases,-such as fever, pneumonia, or phthisis; either dry or accompanied with expectoration. Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a precursor of phthisis it is too often neglected. It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes; or be merely sympathetic or the consequence of derangements of other important viscera. We purpose here to treat more particularly of idiopathic, mucous or moist and dry cough. THERAPEUTICS. The following are the medicines most useful in this affection: Aconitumn, Dulcamara, Belladonna, Hyoscyamus, Nux vomica, Pulsatilla, Ammonium carbonicum, Ammonium muriaticum, Camomilla, Hepar sulphuris, Ignatia, Ipecacuanha, Jlercurius, Carbo vegetabilis, Capsicum, Bryonia, Rhus toxicodendron, Arsenicum album, Drosera, Silicea, lachesis, Causticum, Sulphur, Calcarea * In other cases, this desirable result may be attained by the administration of Mercurius, Hepar s., and Belladonna, on each successive attack (when the symptoms resemble those which have been described under these remedies)-and failing these, Silicea, Sulphur, and Calcarea: the other remedies also, mentioned above as useful in removing this susceptibility, must sometimes be had recourse to. The state of the digestive functions ought, at the same time, to be attended to; and if found to be in a disordered state, such remedies as Nux v., Pulsatilla, Bryonia, &c., must, in addition to Sulph., Silic., Calc., be had recourse to. (See DYSPEPSIA.) COUGH. 331 carbonica, Euphrasia, Sepia, Stannum, Verbascum, Arnica montana, Squilla, &c. ACONITUM. Violent short cough, with quick, hard pulse and feverish heat: pricking in the chest when coughing, or during inspiration. (See ACUTE BRONCHITIS.) DULCAMARA. The following are indications for the selection of this remedy: moist or loose cough, with copious expectoration after exposure to wet; or cough with hoarseness and copious secretion of mucus in the bronchial tubes, sometimes accompanied by expectoration of bright-colored blood during the night; barking, shaking cough, increased or excited by taking a deep breath. (Compare with Rhus.) BELLADONNA. Short, dry, barking (spasmodic, catarrhal or nervous) cough at night in bed, and also during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the larynx, or as if dust had been inhaled; spasmodic cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough with rattling of mucus in the chest, pricking in the sternum or in the hypochondria, and expectoration of thick white mucus, coming on especially after meals; lancinating pains in the abdomen; hoarseness, redness of the face, headache, sneezing after coughing, and pain in the nape of the neck.* Nux voMIcA. This is a valuable remedy in many cases either of a catarrhal or nervous character, and is particularly eficacious where there is a dry hoarse, fatiguing, and sometimes spasmodic cough, which occurs in an aggravated form in the morning, and occasionally also towards evening, and attacks more or less during the day, but relaxes again at night, when, however, it is occasionally supplanted by oppression at the chest, on lying down or on awaking during the night, accompanied with a feeling of heat, and dryness in the mouth; if there be any expectoration, it consists merely of a little mucus, which is detached with great difficulty. The cough is * Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy, when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed; also, when there is mucus rattling in the throat. In dry, spasmodic cough, increased at night, Conium is a valuable remedy. 332 RESPIRATORY SYSTEM. generally excited by a disagreeable tickling or scraping, with a feeling of roughness and rawness in the throat, sometimes attended with HOARSENESS and feeling of roughness in the chest, but more frequently with severe headache, or pain as if from a blow or bruise in the epigastrium and hypochondria: it is frequently aggravated after meals, or by movement, not unfrequently also by reading or meditation, and is occasionally followed by vomiting. PULSATILLA. Severe shaking, catarrhal or nervous spasmodic cough, worse towards evening and at night, frequently followed by vomiting; sensation of sufocation, as if from the vapor of sulphur; increase of cough when in the recumbent posture; cough which is at first dry, then followed by copious expectoration of yellowish or whitish mucus, sometimes of a salt or bitter taste; or expectoration of mucus streaked with blood; wheezing, or rattling of mucus in the chest; the paroxysms of coughing are frequently accompanied with soreness, in the abdomen, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and sometimes followed by a sensation as if the stomach became inverted from the violence of the cough; involuntary emission of urine when coughing; loose cough, with aching in the chest, hoarseness, cold in the head; excited by sensation of scraping or of erosion in the throat; shivering. CHAMOMILLA. Dry cough, excited by continued tickling or irritation in the larynx and chest, and increased by talking; the cough is most troublesome during the night, but also occurs during the day, particularly in the morning and towards evening; accumulation of tenacious mucus in the throat; wheezing in the chest; cough during sleep, sometimes accompanied with paroxysms, as of threatening suffocation; cough with scanty expectoration of tenacious bitter mucus. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the symptoms above described, or with hoarseness, cold in the head, dryness in the throat and thirst; great fretfulness; fever towards evening; paroxysms of coughing after crying, or after a fit of passion. BRYONIA. Catarrhal cough occurring in winter during the prevalence of frost and cold easterly winds, with aggravation COUGH. 333 of the fits of coughing on coming from the open air into a warm room. The following are the general indications for its employment. Dry cough, excited by constant irritation in the throat, or as if caused by vapor in the larynx and windpipe, with greatly accelerated respiration, as if it were impossible to obtain sufficient air; spasmodic, suffocating cough, after partaking of food or drinks, and also after midnight; cough with prickings in the chest, and violent bursting headache, especially at the temples, also with prickings in the pit of the stomach, or in the side; further, in loose cough with yellowish expectoration or slight spitting of blood, this remedy will frequently be found of great service; and likewise in dry nervous cough. RHus TOXICODENDRON. Short, dry cough, worse towards evening, and before midnight, excited by tickling in the chest, attended with hoarseness, or a feeling of roughness or rawness in the throat, congestion in the chest, a sensation of suffocating constriction, anxiety and shortness of breath; cough on waking in the morning, or short cough with bitter taste in the mouth, on lying down at night and on waking in the morning, with expectoration of viscid mucus, sometimes followed by vomiting. Cough with expectoration of bright blood, with sensation of insipidity or exhaustion in the chest, or shooting pains in the chest and sides. IPECACUANIHA. Catarrhal, nervous, or spasmodic cough, particularly at night, attended with painful shocks in the head and stomach, and followed by nausea, retching, and vomiting; or dry cough, arising from tickling in the throat; or severye, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable, when they appear to be threatened with suffocation from the accumulation of mucus, or where the paroxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. (Cale. is often useful after Ipec.) IM/ERCURIUS. Catarrhal cough, with hoarseness, or watery coryza, or accompanied by diarrhcea; or dry cough, excited by irritation in the throat, or the upper part of the chest, which becomes particularly troublesome towards evening, and 3341 RESPIRATORY SYSTEM. at night; sometimes with slight prickings in the chest when coughing or sneezing; excited or increased by talking; cough in children with discharge of blood from the nose, which coagulates as it flows, vomiturition, and headache; dry spasmodic cough, with retching after the paroxysms, and expectoration of blood. CARBO VEGETABILIS. Hollow cough excited by irritation, or a troublesome sensation of crawling in the throat and attended with burning pain and sensation as if from excoriation in the chest; catarrhal or nervous spasmodic cough, frequently followed by inclination to vomit or vomiting, occurring in paroxysms throughout the day; cough with hoarseness, especially towards evening, or morning and evening, increased by speaking. Chronic cough with expectoration of greenish mucus, or even of yellowish pus-or with expectoration of blood and burning sensations in the chest (a characteristic indication for this remedy as well as Arsenicum). CAPsIcuM. This remedy is frequently very efficacious in cases of cough occurring in individuals of the lymphatic temperament. It is particularly indicated when the paroxysms are more severe towards evening and at night, frequently attended with unsettled pains in various parts of the body, and bursting headache; also painful pressure and aching in the throat and ears; cough with offensive breath, and disagreeable taste in the mouth. HEPAR SULPHURIs. Obstinate cases of violent dry, hoarse cough, sometimes attended with a dread of suffocation, and ending in lachrymation. The attacks are frequently excited or aggravated on any part of the body being exposed or becoming cold from the bedclothes slipping off, and are generally worse at night; also dry deep cough excited by a feeling of tightness in the chest, or by talking, stooping, or ascending stairs; hoarseness. IGNATIA. Shaking spasmodic cough, or short hacking cough, as if arising from the presence of dust or feather-down in the throat, which becomes aggravated the longer the paroxysm of coughing continues; dry tickling cough with coryza, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after eating, or on lying duwn at night, or on rising in the COUGIH. 335 morning, and when the patient is of a mild and placid temper, or subject to alternations of high and low spirits. ARSENICUM. Cough, with oppression at the chest, and tenacious mucus in the larynx and chest; cough excited by a sensation of dryness and burning in the larynx. Dry cough chiefly in the evening after lying down, often with dificult respiration and fear of sufocation (sufocative catarrh, catarrhal asthma), as if arising from inhaling the vapor of sulph/ur; dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as soon as the open air is encountered; thin acrid coryza; sneezing; periodic dry cough-nocturnal cough with general burning heat; cough with expectoration of sanguineous mucus; pulmonary catarrh in old people, attended with tenacious mucous sputa, which is extremely difficult to eject, and causes rattling in the chest, oppressed respiration, and frequently symptoms of impending suffocation, or paralysis of the lungs. (Ipecac., Tartarus emet., and Baryta c., are sometimes required after, or in alternation with, Arsenicum.) AMMoNIUM CARBONICUM. Dry, tickling, sufocating cough, especially in the morning, sometimes with fever, occurring during the prevalence of a cold, stormy, bleak, state of the atmosphere, and attended with a sensation of heat or burning behind the sternum, resembling that which is occasioned by drinking spirits; hoarseness; cold in the head, with copious discharge of acrid watery fluid. AMMONIUM o MURIATICUM. This remedy is sometimes serviceable after the former, when the 'cough sounds looser, yet is unattended with expectoration. DROSERA. In many cases of chronic cough with hoarseness; or deep hollow cough, with pain in the chest and under the ribs, alleviated by pressing the hand on the side, excited or aggravated by laughing; cough on lying down in the evening and during the night. Matutinal cough, with bitter and nauseous expectoration; dry, spasmodic cough, aggravated at night, or towards evening, and frequently followed by vomiting of ingesta, or bleeding from the nose and mouth. SILICEA. Cough with oppressed breathing on lying on the back, or cough attended with tightness and oppression at the chest, as if something stopped the respiration while speaking, 336 RESPIRATORY SYSTEM. or coughing. Fatiguing, or deep hollow cough, day and night, aggravated by movement or speaking, and sometimes attended with aching and pain, as if from a bruise, in the chest; cough with copious expectoration of transparent mucus, or pus, sometimes streaked with blood; cough with asthmatic breathing and emaciation, with dread of suffocation at night; cough irritated or excited by a sensation as if a hair were on the tongue. LACIESIS. Fatiguing cough, excited by dryness or continual tickling in the larynx or chest; or by pain or tickling in the pit of the stomach or the epigastrium; also by the slightest pressure on the exterior of the throat; cough excited by talking, laughing, or reading aloud, or anything which may tend to increase the dryness or irritation in the throat; short, dry, suffocating cough, as if caused by the presence of a crumb of bread sticking in the throat, with ineffectual efforts to expectorate. Cough on rising from the recumbent posture, or attacks of cough always after sleeping, or on lying down to sleep; or cough during the day, and at night during the sleep, so that the patient is unconscious of it; continual hoarseness, with a sensation as if something were in the throat which could not be detached. SULPHUR. In some cases of chronic cough, and particularly in dry cough, which disturbs the patient at night as well as during the day; the cough is frequently excited after partaking of food, or during deep inspiration, and is generally attended with a sensation of spasmodic constriction in the chest, sometimes followed by inclination to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest; headache', pains in the chest, abdomen, loins, and hips; also cough, with expectoration of thick, WHITISH or yellowish mucus, or of a greenish yellow, fetid mucus, or pus, of a saltish or sweetish taste; feverish cough with spitting of blood. CALCAREA CARBONICA. Dry cough, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there were a feather down in the throat; also loose cough, with rattling of mucus in the chest, and expectoration of offensive thick, yellow mucus; anxiety. EuIPHUASIA. Cough, with violent coryza and lachrymca COUGH. 337 tion; diurnal cough, with difficult expectoration of mucus; or matutinal cough, with copious expectoration, and oppressed breathing. SEPIA. Cough, with copious expectoration of mucus of a saltish taste, of a yellow or greenish color; also dry spasmodic cough, particularly at night, or on first lying down, attended, in children, with crying, fits of threatening suffocation, nausea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taiht, such as the scrofulous, scorbutic, &c.; and in chronic coughs, with thick, yellowish, greenish, or even puriform expectoration, with a putrid taste, it is also a valuable remedy. STANNUM. Cough, with copious greenish yellow sputa, of a sweetish or saltish taste, attended with great weakness and disposition to sweats; soreness at the chest as from internal excoriation; feeling of weakness or sinking in the chest, as if it were empty, particularly after expectorating, or even after speaking; or dry shaking cough, worse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of ingesta. LYCOPODIUM is very efficacious in obstinate coughs which are worst at night, and are attended with expectoration of tenacious mucus, and sometimes vomiting; paleness of the face, emaciation, precordial pains and oppression, flatulence, ill-humor. CINCHONA. Paroxysms of cough as if excited by the vapor of sulphur, with whistling or rattling in the throat from mucus; expectoration difficult, consisting of clear, tenacious mucus, sometimes streaked with blood; pains in the shoulders, or prickings in the chest and windpipe; cough, sometimes with bilious vomitings; cough after hemoptysis. VERBASCUM. This remedy is frequently of great service in children, though less frequently so than Chamomilla. Indications: dry, hoarse cough, worse towards evening and at night, occurring during sleep. IODIUM. Cough in plethoric children, with copious accumulation of mucus in the bronchi, and ineffectual efforts to expectorate. PHoSPHORUS. Dry cough excited by tickling irritation in the throat or chest, or by laughing, talking, or drinking, or by 22 338 RESPIRATORY SYSTEM. cold air, and accompanied with pricking in the larynx; hoarseness, or pains in the chest as if from excoriation; cough with hoarseness, fever, and depression of spirits, sometimes with apprehensions of death; dry sounding cough, followed by expectoration of viscous or sanguineous mucus. ARNICA is of great value in coughs attended with bleeding from the nose and mouth; headache, pricking in the chest (pleurodynia), rheumatic pains in the loins and extremities, and soreness or pain, as from a bruise in the chest and abdomen. STAPHYSAGRIA. Cough attended with pain under the sternum as if arising from excoriation or ulceration; expectoration of yellow, purulent-looking mucus; sometimes spitting of blood, and involuntary discharge of urine; exacerbations at night. ARGENTUM FOLIATUM. Cough excited by laughing; or cough attended with a feeling of rawness or soreness in the throat, and sometimes with accumulations of viscid mucus on the palate, which causes a disagreeable scratching or scraping sensation. SQUILLA. In short, dry cough, excited by a full inspiration, or chronic cough, or catarrh with copious secretion of whitish, viscous mucus, which is alternately expectorated with ease and difficulty, this remedy is useful. SPONGIA. In acute inflammation of the bronchial membrane, this remedy is often of essential service (see Bronchitis), but it is of equal utility in the chronic variety when the following symptoms prevail: cough with expectoration of mucopurulent sputa, emaciation, redness and deformity of points of the fingers, lividity and incurvation of the nails, hectic fever. These are the principal remedies to be had recourse to in this disorder; but in complicated cases, we may have to call in the aid of other medicaments. When the symptoms take on an inflammatory character, the treatment recommended in acute bronchitis will generally be found applicable. In obstinate nervous or stomach or duodenal coughs, which frequently occur in highly irritable, nervous, and hysterical habits, or in women during the last months of pregnancy, and which are generally dry, or attended with scanty and difficult expectora COUTGH. 339 tion, consisting of a little clear mucus, are to be relieved by the remedies mentioned under DYSPEPSIA. Change of air is often beneficial in such cases. For cough arising from WoRms, see the remedies mentioned under that head; or from teething, see DENTITION. Finally, the following summary of a few characteristic indications may prove useful in selecting the appropriate remedy. Cough, increased or excited by cold air: Lachesis, Arsenicum, Phosphorus. Cough, excited by a feeling of dryness in the chest: Lachesis, Pulsatilla, Mercurius. Cough provoked by a tickling sensation in the throat: Nux v., Merc., Cham., Arnica, Bryonia, Phosph., Sep., Sulph., Lycop., Kali, Dros., Puls., &c. (See also the other indications, given above for most of these medicines.) From tickling in the pit of the throat: Cham., Bella., Silicea. Cough from a sensation as of a feather in the throat: Calc., Ignat., Amm. c. From a sensation as if from dust in the throat: Bella., Teuc., Ferr. magnet. Cough from a sensatimn of scraping, or a feeling of roughness or rawness in the throat: Nux v., Puls. Cough from a feeling of dryness in the throat: Puls., Zach., Carbo a., Mang., Petr. Cough excited by a tickling in the chest: Veratrum, Phosphorus, Cham., lach., Puls. Ammon. c., Sep., Stann., &c. From a burning sensation in the chest: Phosph., Euphorb., &c. From accumulation of mucus in the chest: Stannum, Arsenicum, Ipecac., Tart., Kreos., &c. From roughness or scraping in the chest: Puls., Acid. phosph., Grat., Nitr. Cough, particularly when in the recumbent posture: Arsenicum, Lachesis, HTyoscyamus, Puls., Sulph., Nux v., Mere., HIepar, Con. Cough when lying on the back: Phosph., Nuw, &c. When on the right side: Am. m., Stann. On the left: Ipecac., Par., &c. Cough which comes on chiefly after eating: Nux v., Bryon., Tartarus, Cham., Bella., Sulph., Amm. m., China, Digit., Fer., &c. Cough after drinking: Arsen., Zach., Bryon., Acon., Dros., Iepar, Lye., Phosph. After eating and drinking: Bryon. Cough on exerting the intellectual faculties: NVux v. AMagnes artif &c. Cough, especially in the morning: Puls., Nux, Laches., Calc., Euphr., Sep., Stann., Sulph., Rhus, &c. Cough, chiefly at night: Bella., Puls., Nux v., Ars., lach., Merc., Sulph., Tart., Veratr., Verb., Cham., Hyose., Phosph., 340 RESPIRATORY SYSTEM. Con., Sep., Silic., Rhus, Staph., &c. Midnight (towards): Bella., Mfagnes. arct. During the day, exclusively or principally: Calc., Laches., Nux v., Phosph., Stann., Amm. c., Alum., Euphr., Nitr., Rhus, &c. Day and night: Bella., Nux, Puls., Dulc., Stann., Sulph., Silic., Lycop., Natr. m., Ignatia, Euphorb., Bismuth, Spong., &c. Cough excited or aggravated by laughing: Phosph., Stann., China, Argent., Dros. Cough during sleep: Lach., Cham., Verb., Bella., Calc., Arn., Mere., &c. Cough excited by speaking: Merc., Phosph., Cham., Lach., China, Sili., Stann., Sulph., Caust., Anac., &c. Cough which comes on periodically (every second or third day): Nux v., Ars., Lach. Cough when reading aloud: Phosph., Magnes., Staph., &c. When singing: Stann., Dros., &c. Cough exacerbated or excited by movement: Nux v., Lachesis, Arsenicum, Bella., China, Ferr., Silic. Cough on entering a heated room: Bryon., Natr., Veratr. Cough on touching the larynx: Lachesis, Spongia, Hepar. On pressing against the pit of the stomach: Calad. Dry cough: Acon., Nux, Bella., Cham., Bryon., Laches.,.Merc., Lye., Phosph., Hepar, Ign., Sulph., Spongia, Natr. m., &c., &c. Cough with expectoration: Dulc., Puls., Stann., Tart., Sepia, Sulph., Calc., Kali, Euph., Caustic.,.Merc.,-Bryon., Carb. v., Lye., Phosph., Bella., Squill., Staph., Natr. m., Acid. nitr., &c., &c. Cough with difficult expectoration: Lachesis, Aur., Staph., Sulph., Sep., Kali, Zinc., Euph., Arn., Caust. Cough with easy expectoration: Dule., Stann., Alum., Veratr., Kreos. Cough with offensive, expectoration: Sanguinaria canad., Kreosotum, Carb. v., Sulph., Calc.,-Guai., Sep., Natr., Arsen., Stann. With expectoration of mucus: Bella., Dule., Puls., Bryonia, Am. c., Lachesis, Squilla, Hepar, Carb. v., Phosph., Merc., Stann., Sep., Sulph., Tart., Sil., Thuja, &c. With purulent expectoration: Sulph., Sil., Staph., Cale., Phosph., Acid phosph., Guaiac., Acid. nitr., Kali, Lycop., Carb., v. et a., Plumb., Stann., Dros., China, Sep., &c. With expectoration of a bitter taste: Puls.,-Ars., Oham., Dros. With expectoration of a putrid taste: Carb. v., Kreos., Sep., Stann., Con., Puls., Ferr., Cupr. With expectoration of a saline taste: Lycopod., Natr., Sep.,-Phosph., Stann., Sulph.,-Ambra, Miagnes., Samb. Of a sour taste: Lachesis. Of a sweetish taste: COUGH. 341 Stann., Phosph., Sulph., Calc., Kreos., Samb. Cough with greenish sputa: Stann., Sulph., Thuja, Cann., Lyc., Sep., Phosph., Carb. v. et an., &c. With grayish sputa: Lycopod., Dros., Thija. With frothy sputa: Lack., Ars., Daph., Op., &c. Cough with thick sputa: Puls., Sulph., Stann., Calc., Plhosph., Am. m., Argent., Bella., Kreos., Ruta, Op. Cough with transparent sputa: Ars., Silic., Ferr., Sen., Nux v. With viscid, tenacious, sputa: Phosph., Senega, Lackes., Nux, Puls., Stann., Staph., Gann., Par.,-Spong., Arsen., Gham., China, Ferr. With serous or watery sputa: Arg., Mfagnes., Stann., Daph. Cough with whitish sputa: Sulph., Puls., Am. m., Arg., Amnbr., Acon., China, Cupr., Ac. phosph., Kreos. Cough with yellowish sputa: Sulph., Calc., Puls., Staph., Thuja, Con.,--Lycop, Stan., Sep., Acid. nit., Acid. phosph., Carbo v., Kreos., Daph., Spong., Dros., Ang., Eug., Magnes., Mang., Garbo v., Arsen., Biryon, Ruta, &c. Cough with expectoration of mucus mixed or streaked with blood: Acon., Phosph., Bryon, Arn., lach., China, Ferr., Natr. m., Sab., Silic., Daph., Eug., Euph., Laur., Jod., Op., Zinc., &c. Deep cough: Hepar, Veratr., Verb.,-Arsen., Lach., Angust., Sil., Samb. Hollow cough: Veratr., Spong., Verb., Carbo v., Tart.,-Phosph., Sil., Ktreos., Caust., Euph., Sep., Mere., Op., Samb., St"ah., Spig. Hoarse cough: Hep., iferc., VYerb.,- Carb. v., Cham., Kreos., Nux v., Natr., Natr. m., Yerat., Cina. Shaking cough: Ipecac., Bella., Iyoscy., Puls., Sulph., Anac., Lachesis, Ars., Ign., 1ycop., Merc., Sep., Caust., Ac. nitr., Rihus, Sil., China, Ant., Sen., Mfagnes. arct. Spasmodic cough: Bella., Hyos., Ipec., Cuvpr., Drosera, Veratr., Nux. V., Puls., Sulph., Ilepar, Gina, Mere., Garbo v., Bryon.-Acon., Ambra, Gale., China, Con., Dig., Ferr., Ign., lod., Kali, Kreos., lact., Sep., iMagn., Magn. m., Natr. m., Nitr. ac., Plumb., Sil., Mags., Iags. are. Short cough: Bella., Cof., Lach., Laur., Natr. in., Nux v., Squilla,-Acon., Alumn., Anac., Arg., Asa., Ign., lNitr. ac., Chamn., Petr., Plat., Rhus, SBabad., Sulph. ac. Suffocating cough: Ipecac., Arsenic., Tart., Samb., Ifep., Lach., Dros., Ghamn., Bryon., China, Spigel., Sulph.,-Con., Ind., Led., Op., Natrum m., Petr., Phell., Tab., Mags. arc. Cough attended with pain in the abdomen during the paroxysms: Ars., Bella., Coloc., Con., Nux, Phosph., Stann., Sulph., Ver. Cough with 342 RESPIRATORY SYSTEM. pain, as if from a blow or bruise in the chest: Ar., Ferr., Veratr., Zinc. In the hypochondria: Nurx. Cough with burning in the chest: Carb. v., Ant., Caustic., Seneg., lod., iagn., Spong., Zinc. With coldness in the chest (after coughing): Zinc. With constriction in the chest (while coughing): Ars., Lach., Sulph. With pain, as from excoriation or soreness in the chest: Carb. v., Puls., Phosph., Stann., Caust., Am. c., Sulph.,-Nux v., Zach., Acid. nitr., Calc.,.Magn. m., Magn. s., Merc., Natr. s., Nitr. ac., Sep., Sil.~ Spig., Spong., Zinc., &c. Cough with rattling (mucus) in the chest: Ipec., Tart., Natr. m., Bella.,-Puls., Sep., Arg., &c. Cough with shooting pains in the chest: Acon., Bryon., Phosph., Nitr., Squil., Sulph.,-Bella., Lach., Merc., Ac. nitr., Kali, Puls., Nair. m., Sep., Con., Dros., &c. Cough with pain as if the chest would burst; Bryon., iere., Zinc., &c. Cough with pain in the chest as if arising from ulceration: Staph., Bat., &c. Cough followed by eructations, or regurgitation of ingesta: Ac. sulph. Cough attended with pain in the eyes: Lach. Cough accompanied by sensations of shocks or concussions in the head: Ipecac., Lach., Natr. m., Rhus. Cough with pain in the head: Nux v., Bryon., Sulph., Calc., Arnica, Ipecac., Bella., Con., Merc., Phosph., Carb. v. Rhus, Lycopod., Alum., Ambr.,.Natr. m., Nitr., Nitr. ac., Squil., Sabad. With pain as if the head would split: Nux v., Bryon., Sulph., Pkosph. Natr. m., Caps. With pains in the hips: Sulphur, Causticum, Bella. With pains in the hypochondria: Nux v., Drosera, Bryonia, Lycopod., Lachesis, An., Arsenic., Bryon., Lachesis, Am. m., Helleb. With pain in the loins: Merc., Sulph., Am. c., Acid. nitr. With pain in the nape of the neck: Bella., Alum. With pain in the occiput: Mere. Ferr. Cough preceded by pain in the stomach: Bella. Cough with pain in the stomach (epigastric region): Bryon., Laches., Arsen., Am. c., Phosph., Thuja. Cough accompanied by a sensation as if the stomach turned round during the paroxysms: Pulsatilla. Cough with scraping or a feeling of roughness in the larynx: Kreos., Natr. s. With pains in the throat: Nux v., IHep., Phosph., Capss., Magn. s., China, Carb. a. Cough with lancinating pains in the throat: Nux v., i erc., Kali, Acid. nitr. With involuntary emission of urine: Pals., uSaph., Kreos., Nartr. m., Ant., Staph., Siuilla, HOOPING COUGH. 343 Zinc. (See the additional indications which have been given under some of the foregoing remedies, at the commencement of this chapter; as also those which are mentioned in the articles on Bronchitis, Croup and Hoarseness.) Unmedicated jujubes, sugar-candy, or gum arabic may be allowed occasionally, to moisten the throat or mouth, in cases of dry irritating coughs. HOOPING-COUGH. TUSSIS CONVULSIVA. PERTUSSIS. This is anlost peculiarly a disease of childhood, and one which few individuals escape during that period; it generally appears as an epidemy; and is, by the majority of physiologists, acknowledged to be communicable by contagion; we seldom find an instance of a person suffering a second time from its attacks. Over many the affection passes lightly, but in the majority of cases it proves a distressing, and in some a fatal malady, baffling especially all the ill-directed efforts of the allopathic physician to conduct it to a favorable termination. Under thie old practice, not only was a great deal of valuable time frequently lost in endeavoring to subdue inflammation by antiphlogistic measures, but the patient's vital energies were weakened, and rendered less capable of contending with the disease, when it assumed the spasmodic type. Now, however, on the contrary, we have it in our power, by the administration of remedies specific to the affection, sometimes to check the inflammation at its outset, subdue the distressing attendant symptoms, and almost invariably to shorten the duration of the complaint, without allowing it to leave after it any of those evil consequences, such as debility and emaciation, which oblige the patient to endure a tedious and protracted period of convalescence. DIAGNOSIS. Paroxysms of violent and convulsive expirations, in rapid succession, interrupted by long whistling inspirations, and in young subjects a loud shrill whoop, terminated by the expectoration of a quantity of mucus, or a fit of vomiting, after which the attack ceases for some time. If the case is severe, the features swell and become livid; blood escapes from the nose and mouth, and even from the ears. A complete cessation of respiration with threatening suffoca 344 RESPIRATORY SYSTEM. tion takes place in the more violent paroxysms, as if from spasm of the lungs. The attacks return every three or four hours, and oftener in severe cases; the least excitement brings them on; they are more frequent and violent at night. Respiration is free during the intervals, and the patient in every respect healthy, although suffering from weakness. Pathologists generally consider this disease under three stages; the distinction between the second and third is, however, not often very clearly marked. The first or febrile stage commences with the symptoms of an ordinary catarrh, attended with slight fever, which gradually increases, the breathing becomes more difficult, and is accompanied with irritative cough and pains in the chest. In the second or convulsive stage* the febrile activity disappears, and the characteristic cough and other symptoms of the disease develop themselves. In the third or nervous stage there are longer intermissions between the paroxysms, but increased weakness from the duration of the cough. THERAPEUTICS. In the incipient, febrile, irritative, or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those we have already pointed out in the treatment of common Cough, and must be selected according to the indications there given, and administered in the same manner, unless otherwise specified. By a careful selection of these remedies it is frequently possible to check the disorder in the first stage. Accordingly, the most suitable medicaments for this purpose are Dulcamara, Pulsatilla, Mercurius, Belladonna, Hepar sulphuris, Chamomilla, Nux vomica, Arnica, Ipecacuanha, Aconite, Bryonia and Phosphorus. DULCAMARA. When the attack has apparently been excited by exposure to wet (a thorough wetting); the cough loose, with copious and easy expectoration. PULSATILLA. Cough loose, and accompanied with lachrymation, weakness of the eyes, sneezing, thick discolored coryza and slight hoarseness, and inclination to vomit after coughing; occasional diarrhoea, especially at night. * The congestive and nervous of some authors. HOOPING COUGH. 345 MERCURIUS. HIloarseness, watery coryza, with soreness of the nostrils; dry fatiguing cough, generally occurring in two successive fits. IBELLADONNA is one of the most important remedies in the catarrhal stage of hooping-cough, when there is dry, hollow, or harsh and barking nocturnal cough, or which becomes materially aggravated at night. This medicine is also particularly well adapted to the angina or sore throat, which is not an unfrequent concomitant at the commencement of the affection. HEPAR SULPHURIS. Cough worse at night, but looser than that indicating Belladonna. This medicine is also useful in forwarding the secretory process. CHAMOMILLA. Dry hoarse cough, or cough with difficult expectoration of tenacious mucus, followed by a feeling of soreness at the part from which the mucus seems to have been detached. The paroxysms of coughing aie excited by an almost incessant irritation of the larynx, and in the upper part of the chest. Nux vOMICA is of great service when the cough approaches the second stage. It is indicated by the following symptoms: dry, fatiguing cough, attended "with vomiting, and occurring particularly from about midnight until morning, the paroxysms so protracted and violent as to produce apparent danger of suffocation, with blueness of the face, and occasionally bleeding from the mouth and nose. (ARNICA is better adapted to this latter symptom, when it occurs with a copious discharge of blood.) IPECACUANHA is, like the former, of great value when the cough is attended with danger of suffocation, and each inspiration appears to excite a fresh fit of coughing. It is further indicated when the fits are attended with spasmodic stiffness of the body, and blueness of the face, great anxiety, and accumulation of mucus in the chest. ACONITE may be had recourse to from time to time, when marked febrile or inflammatory symptoms are present, it being carefully borne in mind that the action of this medicine is of short duration, and may be followed in a few hours by any other of the remedies which appear more particularly indicated. Bryonia and Phosphorus are chiefly called for, 346 RESPIRATORY SYSTEM. when the cough threatens to become associated with inflammatory action in the lungs, &c. Second or Convulsive Stage. THERAPEUTICS. Drosera, Veratrum album, Cuprum aceticum, Arnica, Ferrum metallicum, and Conium maculatum. DROSERA is one of the principal remedies in the treatment of the disease, when it has reached this stage; and in cases where the constitution has not been enfeebled by the transmission of hereditary weakness or other causes, it will speedily declare its beneficial effects, and materially shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are: violent paroxysms of cough, occurring in such rapid succession as to threaten suffocation, and attended with the characteristic shrill sound during inspiration, and sometimes fever; after each fit of coughing, vomiting of food, or of stringy mucus; relief on moving about. VERATRUM ALBUM is indicated when the child has become reduced in strength and emaciated; or when it suffers from cold sweats, particularly on the forehead, with excessive thirst, involuntary emission of urine, vomiting, and other symptoms common to this stage; also pain in the chest and inguinal region; fever.* When the vomiting, as also the cough, become more distressing at night than at any other time, Conium may follow Veratrum, if the latter fails to relieve this peculiarity. CUPRUM ACETICUM. This remedy is found most useful in the nervous stage, particularly when convulsions with loss of consciousness ensue after each paroxysm. Also when we find vomiting after the attacks, and rattling of mucus in the chest, and wheezing at all times. In almost all cases a marked benefit has followed the employment of this remedy; sometimes it has been found sufficient of itself to cut short the * Carbo vegetabilis is frequently useful in bringing this stage of the affection to an early and successful termination, after the previous use of Veratrum or Drosera, or both of these important remedies; particularly when, notwithstanding the decrease of cough, the tendency to vomit still remains. (See also Ferrum.) CROUP. 347 disease, and in others, has so far modified it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked effect, and completed the cure.* ARNICA is serviceable as an intercurrent medicine when the epistaxis or hemorrhage from the mouth is considerable; and also against the affection itself, when each paroxysm is succeeded by crying. (Heepar s. is also useful when the latter symptom followed a hoarse dry cough.) FERRUM METALLICUM is often very efficacious as an intermediate remedy, when there is, invariably, vomiting of food on coughing soon after a meal. CONIUM. When the paroxysms occur particularly at night, and with great severity, and are generally followed by vomiting of mucus or of ingesta (Veratr. and Tartarus emet. are also useful when the vomiting is liable to take place during the night). Third or Nervous Stage. THERAPEUTICS. The same medicines as have already been given, according to the indications that present themselves. On the suppression of all the more serious symptoms, the remedies which have been recommended in the first stage, are also useful in removing any catarrhal cough which may remain behind. Change of air is likewise beneficial.t DIET. The diet must be light and of easy digestion; bread-pudding, semolina, and other light puddings of this description, provided the fever be not high, in which case, weak gruel, barley-water, and the like, must alone be partaken of; when the more serious symptoms have been subdued, or in all mild cases, we may give a little chicken-broth, or beef-tea, -and so on, gradually increasing the amount of nutriment, as the disease declines. The drinks should consist of toast-water or barley-water. * Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of coughing, particularly in children affected with worms. SJ In neglected or obstinate cases occurring in delicate constitutions, Sulphuris tinctura and Sepia have been found useful. See also the remedies for coughs of a bad character under the head of COUGH. 348 RESPIRATORY SYSTEM. CROUIP. Angina membranacea. Angina perniciosa. Cynanchie laryngea. Oynanche tracheitis, s. trachealis, &c. DIAGNOSIS. Short, difficult, and hoarse respiration, accompanied by a shrill whistling, squeaking, harsh, rattling, or metallic sound, with cough of the same character; the patient throws the head back; fever, and sometimes comatose state of the brain. This well-known disease is one that. requires the promptest treatment, to avert the danger. From the moment we are assured of the nature of the complaint, recourse must be had to the remedy most clearly indicated by the assemblage of the symptoms, so that not an instant be lost in arresting its further progress, since, if not skilfully kept in check, it sometimes runs to a fatal termination within twenty-four hours; although in the generality of cases, when such an event does take place, it happens about the fourth or fifth day. Croup consists of a peculiar inflammation of the lining membrane of the windpipe, causing the secretion of a thick viscid substance, generally opaque, of about the consistency of the boiled white of an egg, which adheres to the interior of the windpipe, and takes the form of the parts it covers; when this, generally denominated the false membrane, has been allowed to form, the case becomes extremely critical. That croup arises from inherent constitutional taint is evident, from the fact of some families having a peculiar tendency to this disorder. It particularly affects early childhood. The principal exciting causes seem to be exposure to cold or damp, and derangement of the digestive functions, from a too nutritious or heating diet, too much animal food, c r stimulants, such as wine or coffee. It seldom attacks adults, though we occasionally see exceptions to this rule, and is not unfrequently found in complication with other affections both of the lungs and windpipe. The attack generally commences with the symptoms of a common catarrh, such as cough, sneezing, and hoarseness, with a greater or less degree of fever; in a day or two the cough changes its character and becomes shrill and squeaking, or deep, hoarse, or sonorous, attended with a ringing sound CROUP. 349 during speaking and respiration, as if the air were passing through a metallic tube: as the disease progresses, the cough becomes more shrill, and when long continued, resembles the crowing of a young cock. There is seldom much expectoration, and when any matter comes up in coughing, it has a stringy appearance, resembling portions of a membrane. After inflammation has set in, considerable fever and restlessness continue, occasionally varying in intensity, but never wholly remitting; the countenance expresses great anxiety, and alternates from a red to a livid hue; the paroxysms are followed by a profuse and clammy perspiration of the whole body, more particularly of the head and face. When danger threatens, the pulse is hard, frequent, and occasionally intermittent; the breathing, particularly during inspiration, difficult and audible; the features become livid, and almost purple from the sense of suffocation; the head is thrown back; the cough assumes a veiled and husky tone; the voice sinks to a whisper; the eye has a dull, glassy, or dilated appearance, and the whole system seems in a state of utter 1 rostration. TH ERAPEUTICS. The medicines which, for the most part, will be found most appropriate to meet the incipient catarrhal symptoms, and thereby prevent, in many cases, the development of croup, are Chamomilla, Bryonia, and Aconitum (see Cough for indications): but those upon which the greatest reliance is to be placed in the treatment of the disease itself, are Aconite, Iepar sulphuris, Spongia, and I achesis. ACONITE is called for during the inflammatory period of this dangerous disease, when attended with great febrile burning heat, thirst, short dry cough, and hurried, laborious breathing. It may be exhibited as below specified, until these symptoms begin to abate. 1f Tinct. Aeon. 3, gtt. ij. Aq. pur. 3 ij. Dose. A teaspoonful every half hour to six hours, according to the violence of the fever. HEPAR SULPHURIS. Either when the febrile symptoms are partially subdued by Aconitum, the skin having become 350 RESPIRATORY SYSTEM. moist or covered with a profuse sweat, the cough more loose and the breathing freer, but there remains a dry, harsh, deep, hollow cough, with a weak, hoarse voice, and more or less difficulty of breathing; or when, from the commencement, the cough, so peculiar to croup, has already set in, and is accompanied by a constant mucous rattling in the respiratory organs, during which the patient is incessantly but ineffectually occupied in endeavoring to obtain relief by expectoration; or'frequently grasps at his throat and tosses back the head; when, moreover, there is a considerable degree of fever and restlessness, together with a burning hot skin, and excessively quick and laborious respiration.* 1c Hepar Sulph. Cale. 3, gr. j. Aq pur. 3j. M. Dose. A teaspoonful every two to six hours, or oftener (even every half or quarter of an hour) if required. So soon, however, as the medicine begins to make a favorable impression, the doses must be given at much longer intervals until the recovery is complete. SPONGIA is chiefly used after Aconitum or Hepar, when the skin has become moist, the breathing somewhat easier, but still very labored, loud, grating, and wheezing, the patient appearing to carry on the process of respiration more readily with the head thrown backwards, yet, it is even then occasionally threatened with suffocation; further when the cough is hoarse, ringing, hollow and squeaking. Ic Spong. tost. 3, gr. j. Aq pur. 3j. M, Dose. A teaspoonful every quarter or every half hour, or only every three to six hours, according to the intensity of the symptoms and the effects produced by each dose. PHOSPHORUs has been recommended in cases where Hepar might fail to relieve the symptoms we have enumerated under * This remedy is of itself sufficient, in many instances, to arrest the progress of the disease, if administered as soon as the incipient symptoms of the attack are observed; but Aconite, Hepar sulphuris, and Spongia, generally in alternation, become necessary when the affection is more developed.-GRoss. CROUP. 351 that remedy; or when Acon. and Spong., as well as Ilepar have been merely productive of temporary benefit. LACHESIS. In very serious and obstinate cases, to which there is short dry cough with hoarseness; great sensitiveness of the larynx and trachea to the touch, the slightest pressure afecting almost to sufocation; voice very low and hollow, with a sound like that of a person speaking through the nose; fainting; nausea; swooning; loss of sense; rigidity offrame; great prostration of strength, especially towards evening. t Laches. 6, glob. vj. Aq. pur. 3 j. Dose. A tea-spoonful every half-hour, hour, or two hours, according to the intensity of the symptoms, and their abatement. After having subdued these threatening symptoms by the administration of the last-mentioned remedy, we may, if the disease is not wholly vanquished, again fall back upon Ifepar sulphuris, or Spongia, according to the indications given for those remedies. There are other remedies which may afford valuable assistance in the treatment of complicated attacks; but in truth it may be said, that in- the majority of cases, Aconitum, Hepar sulphuris and Spongia, administered alternately, when individually inadequate, are sufficient to effect a cure in a few hours. It need scarcely be stated, however, that it will be imperative to discontinue the administration of these remedies when improvement does not soon become apparent during their employment, or to select others from the commencement, if, from the symptoms and character of the case, they distinctly seem to merit a preference. It may consequently be added, that Tartarus emeticus has been found valuable after Phosphorus, in some apparently hopeless cases with threatening paralysis of the lungs; Arsenicum, Sambucus, and Moschus in complications with Asthma Malaria; and lodium, either alone or in repeated doses, or alternately with Aconite, has been much recommended in obstinate cases, particularly when occurring in plethoric subjects. Kali, Sulph., Kali hydriod., Bella., Bryon., Cham., Can., Mosch., Sanguinaria canad., Cup., Dros., Mere., 352 RESPIRATORY SYSTEM. Veratr., etc., may be found useful in particular cases, either of croup or of affections of the air-passages, bearing a close analogy thereto.* liepar sulphuris, Phosphorus and Lycopodium have been found useful in eradicating a susceptibility to this affection. (See also LARYNGITIS, RAUCITAS, and BRONCHITIS.) INFLUENZA. DIAGNOSIS. Catarrh appearing in an epidemic form, attended, in addition to the symptoms described at the commencement of the article on COMMON COLD, with extreme oppression and prostration of strength; sleepiness, followed by shuddering and general chilliness; rheumatic pains, or pains as if caused by contusions, in the back and limbs; intense frontal headache, sometimes extending to the bones of the face, with pressive aching pains in the other parts of the head, giddiness, earache; slight redness of the eyes, with painful weight or heaviness, and sensibility to light; coryza, or obstruction of the nose; dry, shaking cough, which produces distressing fatigue in the chest; dryness of the throat, and, subsequently, dry, burning heat of the skin, loss of appetite, nausea, together with soreness of the throat and some degree of hoarseness; and, in some cases, swelling of the parotid glands, or offensive sweats. THERAPEUTICS. The principal medicines in ordinary cases are Camphora, Aconitum, llMercurius, Arsenicum, Phosphorus, Belladonna, Pulsatilla. CAMPHORA. One or two drops of weak spirits of Camfphor when taken at the commencement of the attack, and repeated until the chilliness or shivering begins to subside, will frequently check the further progress of the disease. In a more advanced stage of the affection, with (laborious) asthmatic breathing, accumulation of mucus in the bronchi and cold, dry skin, Camphora is further of considerable service. AcoNITUM. - When the disorder assumes an inflammatory character, with quickness of pulse, dry hot skin, and short, harsh, shaking cough. * From some provings and experiments which were made with Bromium, it would appear to be a medicine which bids fair to be of great value in croup. (Vide Arch., II. Bd., 2. Heft; as also Noack and Trinck's A. M. L.) INFLUENZA. 353 Nux vOMICA. This remedy has repeatedly proved of great efficacy in influenza or grippe, after the previous employment of Aconite, when the inflammatory action predominated in the chest; or when the symptoms complained of were chiefly as follows: obstruction of the nose, hoarse hollow cough, excited by tickling in the throat, and attended with severe headache, confusion in the head, giddiness, want of appetite, or sickness, thirst, pain as from a bruise in the hypochondria, aching pain in the lower part of the back, constipation, pain in the chest as if from excoriation. MERCURIUS. Dry or fluent coryza; pains in the head, face, teeth, and chest; sore throat; swelling of the parotids; violent shaking cough, at first dry, but subsequently moist, the paroxysms being commonly excited by irritation in the throat and chest; shivering or heat with profuse perspiration; aching in the bones and slimy bilious diarrhoea, attended with tenesmus. This remedy has also proved of great efficacy when symptoms of pleurisy with copious, iunmitigating perspiration, supervened; as also when the liver became implicated in the general derangement, the pains in that organ partaking more of an obtuse than an acute description. ARSENICUM. The following are the characteristic indications for the employment of this important remedy; heaviness and rheumatic pain in the head; profuse watery and corrosive discharge from the nose, causing a disagreeable burning sensation in the nostrils; violent sneezing; shiverings and shudderings, with severe pains in the limbs; oppression of the chest; difficulty of breathing; thirst; anxiety; restlessness; GREAT PROSTRATION OF STRENGTH, with aggravation of sufferings at night, or after a meal; inflammation of the eyes, with sensibility to light. These symptoms may be attended with a deep, dry, fatiguing cough, exacerbated in the evening, at night, or after drinking, or sensations of dryness and burning, with mucus in the throat, which is difficult to detach. If this remedy be not sufficient to remove the disorder, we may have recourse to the following medicines: Camphora, Aconitumn, Nux vomica, Mercurius, Phosphorus, Belladonna, Pulsatilla. PHosPHORus has frequently been found exceedingly useful when there was excessive irritation in the larynx and bronchi, 23 354 RESPIRATORY SYSTEM. bordering on inflammation, with alteration of the voice, and pain during articulation. BRYONIA has often proved of great service in relieving the violent, pressive, aching, bursting, frontal headache, and cough with easily loosened mucous sputa. It has further been found of great efficacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration; also when vomiting was liable to take place after coughing, or when the cough produced pain in the upper part of the abdomen, and caused a pain as if arising from the effects of a blow beneath the short ribs. (See Nux, which accords with B3RYONIA in the latter case.) BELLADONNA. Dry spasmodic cough, aggravated towards night; sore throat, excessive, almost insupportable, headache, increased by talking, moving, or bright light; fixed look; confusion of ideas on closing the eyes. CARBO V. has been found useful in old people, sometimes in alternation with Bryonia, when the chest was considerably affected, the breathing oppressive, the extremities cold, with threatening paralysis of the lungs. PULSATILLA. Loose cough day and night, exacerbated by lying down, thick offensive coryza, tendency to relaxation in the bowels, loss of appetite, foul tongue, disagreeable or insipid taste in the mouth. EHus. In cases arising after exposure to a thorough wetting, and accompanied by great anxiety, frequent involuntary fetching of a deep inspiration, corporeal restlessness with incessant changing of posture, this remedy is indicated. Distressing, dry cough, or cough with difficulty in expectorating the sputum which has been detached, the paroxysms of which were always followed by yawning, has frequently been cured by Opium, after many other remedies had failed to relieve. SULPHURIS TINCT. has repeatedly proved useful when, at the termination of the disorder, dull pricking pains are experienced in the chest on taking a deep breath, or after a severe fit of coughing; also when there is oppressed respiration as if arising from a heavy weight resting on the chest. SENEGA. Tickling irritation and continual burning in the larynx or throat, with loud mucous rAle, and fear of suffocation DETERMINATION OF BLOOD TO THE CHEST. 355 on lying down. Stannum in neglected or protracted cases, with easy but excessive expectoration of mucus, and great weakness. Cinchona may advantageously follow the last remedy when the expectoration has diminished, or when the fits of coughing are excited by a rattling under the sternum as if arising from an accumulation of mucus. Finally: ARNICA may be administered with advantage in some cases, particularly when pricking pains are experienced in the chest during inspiration (pseudo-pleurisy) with aching pains over the whole body, headache, and hemorrhage from the nose; Ipecacuanha after Arsenicum or any of the other prescribed remedies, when there is vomiting or violent retching during or after each fit of coughing; Hyoscyamus, and in some cases Belladonna, against distressing spasmodic cough remaining after the acute symptoms of influenza have been subdued; or Conium, when the cough continued almost incessantly during the night until relieved by vomiting a quantity of frothy mucus; Ferrum aceticum, cough after eating, with vomiting of the ingesta; fKali hydriod., cough, with wheezing and rattling in the chest; and expectoration of a gray colored, saline or sweetish tasted sputum. Stannum and Carbo v., in alternation, frequently served to prevent the development of phthisis, where there was a predisposition to that disease before the invasion of influenza; and Arsenicum and Jachesis have been emnployed with much success against sequelae in the form of obstinate inflammation of the eye and ulceration of the cornea. (See also article CoUGH.) DETERMINATION OF BLOOD TO THE CHEST. Congestio ad Pectus. DIAGNOSIS. Sensation of great fulness, throbbing, weight, or pressure in the chest and palpitation of the heart, attended with anxiety, short, sighing respiration, and dyspncea. We find that the predisposition to affections of the chest and lungs is greater during the period preceding puberty, and for some years after, than at any other epoch of man's existence. As remarked in the Diseases of Children, in infancy and during very early childhood, from the disproportion between the cerebral system and other portions of the economy, the 356 RESPIRATORY SYSTEM. diseases which the physician has chiefly to combat are those arising from over-excitement of the nervous organization. In maturer years the tendency to abdominal congestion generally develops itself. This is easily explained by entering into the physiology of these different periods of human life; but as my object is rather the treatment of disease than the elucidation of these interesting points, I shall here content myself with briefly alluding to them. There is no doubt, as already remarked, that a particular period of human life is peculiarly liable to chest affections, and, among others, to this disorder, which is but too frequently the precursor of other more serious maladies. Some constitutions, however, especially those in which an hereditary phthisical taint exists, exhibit a marked predisposition to pectoral congestion. Amongst the most frequent causes of this predisposition being called into dangerous activity are, exposure to extremes of heat or cold; stimulants, such as alcoholic, vinous, or fermented beverages, or coffee; the abuse of narcotic drugs; violent exercise, such as running, dancing, &c., or over-exertion even of the voice in speaking or singing; a sudden check of perspiration; cold or damp feet; sedentary habits; metastases; repercussed cutaneous eruptions; or suppression of customary discharges, such as the catamenial and hemorrhoidal flux. THERAPEUTICS. Aconitumn, Nux vomica, jIpecacuanha, Belladonna, Aurum foliatum, MVercurius, Pulsatilla, Spongia, Cinchona, Sulphur are the best remedies in general cases. AcoNrrusT is especially indicated, when there is violent oppression with great heat and thirst, palpitation of the heart, great anxiety, and shaking cough. It will be found particularly valuable for plethoric females of sedentary habits, who suffer considerably from congestion before and during the catamenia. In such cases it may be advantageously followed by Mercurius, to prevent a relapse (in others by Belladonna). Nux VOMIcA. When the affection has been developed by sedentary habits or by habitual indulgence in the stimulants already alluded to, or from hemorrhoidal metastasis or sup_ression: in which cases this remedy is frequently sufficient to effect a radical cure. DETERMINATION OF BLOOD TO THE CHEST. 357 IPECACUANHA will frequently complete the cure when Nux vomica has not removed the whole of the symptoms. In other cases Sulphur will answer better after the previous employment of Nux. (See SULPH.), BELLADONNA. Oppression and throbbing at the chest, with shortness of breath and strong palpitation of the heart, extending into the head; short cough, chiefly at night; internal heat; and considerable thirst. AURUM. Extreme oppression of the chest, as if suffocation impended, sometimes with loss of consciousness and livid hue of countenance; palpitation of the heart; and excessive anguish. MERCURIUS, as already remarked, is valuable after Aconitum, on certain occasions (see that remedy); and also when there is burning heat and oppression at the chest, and frequent desire to take a deep inspiration; or, cough with expectoration streaked with blood, and palpitation of the heart. PULSATILLA. Ebullition of blood in the chest with external heat; constriction in the chest with impeded respiration; palpitation of the heart; anxiety and aggravation of the symptoms towards evening; also when pectoral congestion has arisen in phlegmatic subjects from hemorrhoidal suppression, or in females from stoppage of the menstrual flux. SPONGIA TOSTA. When the symptoms are provoked by the slightest exertion or even movement, and are attended with anguish, sensation of threatened suffocation, nausea, prostration, and fainting. BRYONIA. Burning heat in the chest, with a sensation of tightness, dyspncea, and anxiety; palpitation of the heart, occasional prickings in the chest during inspiration. CINCHONA, when we can trace the affection to debilitating losses, with palpitation of the heart and oppressed breathing. SULPHUR. Ebullition of blood, weight, fulness, and pressure in the chest, aggravated by coughing, palpitation of the heart, dyspncea, chiefly on lying down at night; it is also most serviceable in suppressed hemorrhoids, after Nux vomica or Pulsatilla, and after the latter remedy in checked catamenia. PHOSPHORUS. In some obstinate cases this remedy is often successful in affording speedy relief, particularly when, in addition to the more usual symptoms, shooting or pricking 358 RESPIRATORY SYSTEM. pains are frequently experienced on laughing, speaking, or walking quickly; palpitation of the heart, anxiety, sensation of heat extending*from the chest into the throat. Some one or more of the preceding remedies, if judiciously selected, and timely administered, will generally check the disease, and prevent it assuming a more dangerous form; as, for example, running into hemoptysis, phthisis, pneumonia, carditis, &c. The following, among others, have also been found useful in peculiar cases: Rhus toxicodendron, Sepia, Natrum muriaticum, Phosphorus, Carbo vegetabilis, Acidum nitricum, Ammoniacum carbonicum, and Ferrium metallicum. INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. COLD ON THE CHEST. PULMONARY CATARRH. Bronchitis. This disease consists of a greater or less degree of inflammation of the mucous membrane of the bronchi, and is divided into acute and chronic. Of the former it is intended more particularly to treat. The disorder is of frequent occurrence, both as an idiopathic affection, and as a concomitant of measles, scarlatina, smallpox, hooping-cough, &c. SYMPTOMS OF ACUTE BRONCHITIS. Chilliness, succeeded by fever; hoarseness, difficulty of respiration; severe, frequent and distressing cough, at first dry or with scanty expectoration of frothy or viscid mucus, which subsequently becomes copious and occasionally streaked with blood; excessively laborious respiration, attended with a feeling of constriction and oppression of the chest, which sometimes increases to such a degree as to threaten suffocation; general weakness, foul tongue, and loss of appetite; paleness of the lips, cadaverous and anxious countenance, loud wheezing, and on applying the ear to the chest, a louder sound is heard than the natural respiration, either rattling, whistling, or droning, or harsh and broken, according to the advance of the disease.* In the cases which terminate favorably, the first symptom of improvement which sets in, is a greater freedom of breath* Sibilant and sonorous rhonchi, in the early stage, and mucous or bubbling rhonchus when the secretion becomes increased, indicate both the nature and extent of the disease. BRONCHITIS. 359 ing, with remission of the fever, and an alteration in the expectoration, which becomes thicker, whiter, and diminished in quantity. But when the disease takes an unfavorable turn, the difficulty of breathing increases; a state of excessive debility and collapse supervenes; the face becomes livid, the body covered with a cold and clammy sweat; the mucus accumulates rapidly in the bronchial tubes, and the cough, which has become feeble through the exhausted and sinking energies of the patient, is insufficient for its ejection; aeration of the blood in the cells of the lungs is prevented; cerebral symptoms declare' themselves from impeded circulation, or the effect of unarterialized blood circulating in the brain, and the patient is carried off in a state of asphyxia. In many cases of acute bronchitis, although a degree of oppression at the chest be present, no particular pain, heat of skin, or fever may exist; this is a most insidious form of the disease, and one in which the complaint is but too frequently neglected until beyond the power of the physician's art: it occurs most frequently in children who may apparently be only troubled with a slight wheezing, of which scarcely any notice is taken or any medical aid called in, until suddenly suffocation threatens, or some organic lesion is produced, so that an affection which probably might have been easily subdued at the commencement, is now beyond control. The frequency of the disease in infancy and early life deserves a particular notice. It generally begins, as in adults, with the symptoms of a common catarrh; the breathing becomes quick and oppressed, and from the increased action of the diaphragm, the abdomen is rendered prominent; both the shoulders and nostrils are in continual motion, but the wheezing is often more marked than the difficulty of respiration, and on applying the ear to the chest a mucous rattle is heard over almost every part; expectoration sometimes temporarily relieves, and occasionally the mucus is expelled from the air-passages by vomiting; the countenance is pale and anxious, and somewhat livid:-these symptoms are interrupted and relieved by occasional remissions, during which the child generally appears drowsy; but they return with additional severity, and if not checked, an accession of extreme dyspnoea ensues, and death takes place from suffoca 360 RESPIRATORY SYSTEM. tion. When sore throat is also present, coughing produces considerable pain, and the child for that reason frequently endeavors to suppress it. There is also impaired appetite with thirst, although when the disease has advanced, it is found difficult to take a long draught, from its impeding respiration: this is very observable with children at the breast, who, after eagerly seizing the nipple, will bite it, and discontinue sucking, cry, and throw back the head, and even after vomiting up the phlegm, continue for some time in thatf position. In some cases, from'the character of the voice and cough, bronchitis has been mistaken for croup. The tubes of one lobe, or of one lung only, may be affected, but frequently those of both lungs are attacked by the disease. The exacerbation of suffering at night is a very remarkable symptom in this complaint. The causes are the same as those of common catarrh. THERAPEUTICS. The remedies which are the most appropriate in ordinary cases of this affection are: Aconitum, Bryonia alba, Pulsatilla, Spongia, Belladonna, Nux vomica, Lachesis, Phosphorus, fMercurius, Cannabis, &c. ACONITUM is the remedy upon which we must place our chief reliance in the inflammatory stage of the disease, and throughout its course whenever high febrile action sets in. Its more marked indications are hot, dry skin, with strong, hard, and accelerated pulse; hoarseness, with roughness of the voice; short, dry, and frequent cough, excited by tickling in the throat and chest; obstructed respiration, sibilant or sonorous rhonchus, anxiety, restlessness, headache, and thirst, with occasionally scanty expectoration of viscid mucus. 1c Tinct. Acon. 3, gtt. iij. Aq. pur. 3 iij. M. Dose. To adults a table-spoonful, to children a teaspoonful every three to six hours, according to the urgency of the case, until relief be obtained, after which we may either lengthen the intervals, or select some other remedy more appropriate to the remaining symptoms. It will sometimes be found necessary, as above remarked, to return to this remedy during the course of the disease, particularly during the nocturnal febrile exacerbations. BRONCHITIS. 361 Should the skin not become moist, the respiration easier, and the cough looser after the second or third dose of Aconitum, BRYONIA will, in most cases, be required (see BRYONIA). But it rarely happens that Acoh., when at all indicated, does not produce a favorable effect, even after the first dose. As soon as a decided melioration has been effected, the repetition of the dose must be restricted to intervals of eight to twelve hours, or even longer; or another medicine must be selected if Acon. be found inadequate to complete the cure. (See PULSATILLA.) BRYONIA is of great service in a large number of cases of bronchitis, at the commencement of the attack. We should therefore not hesitate to prescribe it immediately when we meet with laborious, rapid, and anxious breathing, with constant inclination to take a deep inspiration; hoarseness; headache; dry cough, attended with a burning.pricking pain extending from the throat to the middle of the sternum; or cough with scanty and difficult expectoration of viscid sputa, in some instances streaked with blood; sibilant rhonchus; dryness of the mouth and lips, excessive thirst. When, moreover, the respiration is' impeded by shootings in the chest, and the affection threatens to become complicated with pleurisy, this remedy is still more particularly called for. (IIEPAR s. is sometimes required after Bryon. in bronchitis, particularly when the latter remedy produces only temporary relief.) Form of prescription same as Aconite. SPONGIA is often of great service after the previous administration of Aconite, when there still remains a considerable degree of inflammation in the bronchial tubes, especially the larger, with sibilant or sonbrous rhzonchus; and also, at a more advanced stage of the disease, when the mucous rhon chus is distinctly audible; with hollow, dry cough day and night, but worse toward evening; or cough with scanty, viscid, ropy expectoration; heat in the chest, burning, tickling irritation in the larynx, quick, anxious, laborious respiration; inability to breathe unless the head is thrown backwards; hoarseness. (HEPAR s. is sometimes useful after Spongia, especially when the mucous rhonchus is predominant, the skin hot and dry, and the efforts to expectorate ineffectual.) 362 RESPIRATORY SYSTEM. BELLADONNA. This remedy is useful when there is severe headache, materially aggravated by coughing; oppression of the chest, and constriction, as if bound, with loud, wheezing, and rattling of mucus in the bronchi; short, anxious, and rapid respiration; dry, fatiguing cough, especially at night, which is endeavored to be suppressed on account of the pains it creates; heat of the skin and thirst; soreness of the throat. Belladonna is often exceedingly efficacious in children, particularly in those insidious cases which commence with a slight wheezing, and then suddenly become..aggravated to such a degree as to threaten suffocation; the heat of skin being at the same time considerable, and the pulse excessively rapid, and sometimes even intermittent. Sulphur is, in some instances, required to establish the cure after Bella. Form of prescription the same as Aconite, but the repetition of the dose at intervals of eight or twelve hours. Nux VOMICA. Dyspnoea, with excessive tightness of the chest, particularly at night; hoarseness; dry cough, worse towards morning, attended with pain as if caused by a blow or bruise, in the epigastric or hypochondriac regions; cough, with difficult and scanty expectoration of viscid mucus; dryness of the mouth and lips, thirst, constipation, peevishness. Prescription, the same as directed under Belladonna. LACHESIS. Oppression at the chest, with short and hurried respiration, anxiety, and dejection; mucous rdle; dry, fatiguing cough, sometimes followed by the expectoration of a little tenacious or frothy mucus, after much effort, occasionally streaked with blood; hoarseness. Prescription as directed under Belladonna. PHOSPHORUS. This important remedy is frequently of great utility in bronchitis when the more inflammatory symptoms have been subdued by Aconite, but the respiration continues much oppressed, accompanied with great anxiety, and heat in the chest; dry cough, excited by tickling in the throat or chest, aggravated by talking or laughing, and followed by expectoration of stringy mucus of a saltish taste. Further, when the disease has been neglected, or when, from the phenomena which present themselves at the commencement, we have reason to dread complication, or an extension of the inflammation to the substance of the lungs, which we gene BRONCHITIS. 363 rally recognise by the invasion of crepitation, rusty sputa, &c., there will be additional reason for employing Phosphorus. (See PNEUMONIA.) PULSATILLA. This remedy is often required in the second stage to complete the cure, after the previous exhibition of Aconitun, when the acute inflammatory symptoms have been subdued, and the expectoration has become thicker and more copious. It may, however, be.prescribed before or after any of the medicaments we have named, especially when the disease occurs in persons of mild disposition, or of lymphatic constitution, and the symptoms are as follows: Respiration short, accelerated, and impeded, attended with rattling of mucus, heat in the chest, and anxiety; hoarseness; shaking cough, worse towards evening, at night, or in the morning, accompanied with considerable expectoration of tenacious, or thick, yellowish mucus, sometimes mixed with blood; coryza with copious discharge of thick, discolored mucus. Prescription and dose the same. as mentioned under Belladonna. SEPIA may be selected in preference to Pulsatilla, when the expectoration is very copious, though somewhat difficult, and of a salt taste; exacerbation of cough in the morning and towards evening, (If the sputa be still profuse, but more easily detached and ejected, greenish, and less saline, or of a sweetish taste, Stannum may follow Sepia.) LYCOPODIUM. When the cough is materially worse at night, and attended with thirst and quickness of pulse, but moist skin or tendency to sweat; the sputa yellowish gray, and of a saltish taste; oppression at the chest. MERcuRIus. This remedy may occasionally be found useful when the symptoms of bronchitis are accompanied by excessive perspiration; when the cough is fatiguing, worse in the evening, and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder respiration than ordinary; hoarseness; coryza with watery, acrid discharge; swelling of nose. Dulcamara is occasionally serviceable after fercurius, when there is a continuance of night sweats of an offensive odor. CHAMOMILLA is often a most useful remedy in cases of 364: RESPIRATORY SYSTEM. children, after the previous exhibition of Aconite, when a slight degree of whistling or sonorous rhonchus still remains; dry cough worse at night, occurring even during sleep. For further indications, see this remedy under the head of COUGH. IPECACUANHA is also very valuable as a remedy for children, but generally at a more advanced stage of the disorder, with mucous rhonchus in the chest, and when on coughing they are almost suffocated by the excessive secretion of mucus, and become livid in the face; shortness of breath, and perspiration on the forehead after each fit of coughing. Dose. One globule of the sixth dilution, in a teaspoonful of water, every two to six hours, until improvement results. (See the " Rules for the administration of the remedies," given in the Introduction.) There are other remedies which have been found of great value in the treatment of this affection, such as Tartarus emeticus, Arsenicum, Sulphur, &c. TARTARUS EMETICUS is chiefly found useful in those extreme cases where the smaller tubes are clogged with mucus, and suffocation threatens; when the cough suddenly ceases either from weakness or other causes. Dose. A grain, of the second or third trituration, in four dessert-spoonfuls of water, one dessert-spoonful to adults and a tea spoonful to children every quarter, every half, every hour, or every three or four hours, according to the severity of the symptoms, or the effects produced. ARSENICUM is occasionally of the utmost service in those unfavorable cases in which the pulse becomes very quick, feeble, and irregular, and the patient is reduced to a state of extreme debility and collapse. Dose. One or two drops of the sixth dilution to an ounce of water, a tea-spoonful to be given from time to time, as required.* SULPHUR is frequently useful in winding up a cure, and preventing the disease running on to the chronic form, or * See the "Rules for the administration of the remedies," given in the Introduction. BRONCHITIS. 365 when the expectoration has increased in quantity and become whitish and less viscid. It may be added that Ifepar sulphuris, Ammonium carbonicum, Cannabis, Bromium,* &c., may also be found useful in some particular cases, and that Belladonna, Lachesis, and perhaps also Opium, in addition to Tart. em., may prove serviceable against the symptoms of stupor which are so liable to set in in severe attacks of this disorder. Where there is a peculiar tendency to inflammation or cold on the chest, whenever an easterly wind prevails, Aconitum and Belladonna have been recommended as two of the most useful remedies by means of which this predisposition is to be overcome. (Gross, Allg. IHom. Zeit. No. 12, 19ter Bd.) DIET. In the severe forms of bronchitis, the diet to be observed should be the same as that mentioned under Fever; but when the febrile and inflammatory symptoms have been co mpletely removed, the patient should gradually return to a more nutritious diet, even though a considerable degree of cough and expectoration remain. In the slighter forms of the complaint, spare diet, confinement to the house, in short, the simple measures laid down for the treatment of common colds in another part of this work, will frequently check or at 11 events materially shorten the attack. See also article COUGH, in which further indications will be found for the selection of the remedies. CHRONIC BRONCHITIS. Bryonchitis chronica. This complaint may be the result of the acute affection, or it may arise as a gradual and insidious inflammation of the mucous membrane of the bronchial tubes, or proceed from the inhalation of dust or other minute particles carried into the lungs; it may also be coeval with diseases of the heart, or declare itself after erruptive fevers. It differs from acute bronchitis chiefly in the greater mildness and longer duration of its symptoms, the continuance of which varies from several weeks or months to many years. It affects elderly persons more frequently than the young, but is of course liable to occur at all ages as the result of an acute attack (although * The provings of this medicine are given in the "Neues Arch." Zweiter Band, Drittes Heft. 366 RESPIRATORY SYSTEM. such a circumstance is comparatively of rare occurrence under proper homceopathic treatment), the sequel of measles, &c. A comparative exemption from cough is frequently experienced during summer; but in winter, or in inclement springs, the patient is tormented with harassing cough, and copious viscid expectoration, especially in the morning, which in the severer forms of the disorder is peculiarly distressing. The expectorated matter in the chronic affection is of a different nature from that in the acute, being of a thicker consistence, and of a greenish or yellowishtwhite color; it is not unfrequently muco-purulent, and sometimes decidedly purulent, and occasionally streaked with blood, particularly in obstinate, inveterate cases. There is generally more or less dyspnoea, with acceleration of pulse after slight corporeal exertion; but in other respects the health may be good, and continue so. In the more trying forms of the disorder, an aggravated state of all the symptoms enumerated is met with; moreover, where the sputa is of a purulent nature, hectic fever, extreme emaciation, nocturnal sweats, and occasional attacks of diarrhoea are frequent adjuncts: the latter symptoms are sometimes liable to cause the disease to be mistaken for tubercular consumption; but in the majority of cases, auscultation and percussion, together with a careful attention to the symptoms and the history of the case, enable us to form an accurate diagnosis between them. In chronic bronchitis, the resonance of the chest is, on percussion, little if at all diminished. On applying the ear or stethoscope to the chest, the respiratory murmur is found to vary much in intensity, but is never permanently absent in any part of the chest, and is frequently even puerile. The mucous rhonchus, in most of its diversified forms, is heard in various parts of the chest at different times, and occasionally the whistling and sonorous rattles are discernible. When the dilatation of the bronchial tubes is considerable, as is not unfrequently the case in this affection, a loud bronchophony is heard, which is with difficulty, if at all, to be distinguished from pectoriloquy, and a rale, closely resembling the cavernous, is apparent in the vicinity of the dilated tube. The sound on percussion will, however, generally enable us to form a distinction; the dulness of tone being not so great INFLAMMATION OF THE LUNGS. 367 over a dilated tube, as it is in the vicinity of a vomica; the difference of the situation of the cavity in the two cases, is also a useful discriminating guide; dilated bronchi being, as is well known, most frequently detected in the scapular, mammary, and lateral regions, and vomicoe in the subclavian and axillary regions.* However, as before said, we must, in all doubtful cases, combine the history of the attack, the constitution of the patient, the progress of emaciation, &c., with the symptoms to be heard by the ear after repeated examinations, ere we come to a definite conclusion as to the exact nature of the complaint, where that is of material consequence; but as regards the prognosis, chronic bronchitis, with purulent expectoration, dilated tubes and hectic fever, has been truly considered to be nearly as formidable and serious a malady as phthisis itself, and hence ultimate recovery almost as doubtful. As this is a disease which requires a long and judicious treatment for its removal, I shall merely confine myself to the enumeration of the remedies hitherto found most useful in cases of this nature. These are Sulphur, Calcarea carbonica, Oarbo vegetabilis, Pulsatilla, Hepar szuphuris, Phosphorus, Stannum, Sepia, Lycopodium, Kali c., Natrum carbonicum, Natrumn muriaticum, -Baryta c., Lachesis, Causticum, Arsenicum, Silicea, Staphysagria, Acidum nitricum, and Conium maculatum. See, however, the article COUGH, where indications for the selection of most of the above remedies will be met with. INFLAMMATION OF THE LUNGS. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmonitis. This disorder consists in an inflammation of the parenchyma of the lungs. DIAGNOSIS. Rigor followed by heat; dyspncea; respiration short and hurried; cough short, continuous, and distressing; dry at the commencement, afterwards attended with scanty expectoration of viscid, lumpy, and extremely tenacious or glutinous mucus of various shades of color, but * A peculiar fetor of the sputa is deemed by M. Louis as a characteristic indication of a dilated state of the tubes. 368 RESPIRATORY SYSTEM. generally of a dingy, brick-red, or rusty hue,* when the proportion of coloring matter is greater. The cough is invariably excited or aggravated by every deep inspiration, or on every attempt to speak; the speech is interrupted, or there is a pause after every articulation; the respiration is abdominal; a dull pain is occasionally felt in the chest, but more frequently rather a tightness than pain; the pulse is variable, sometimes not beyond the normal standard, but more generally full, strong, and quick at the commencement, or, when the inflammation runs high, hard, wiry, and greatly accelerated; the tongue parched and dark-colored. The fever is usually of the inflammatory type, but is sometimes typhoid. The patient, particularly in severe attacks, lies upon his back. In the first staget of many cases, when not marked by complication with bronchitis, on application of the stethoscope, or the ear to the chest, the crepitous rdle may be heard; but the sound on percussion may appear to be only slightly impaired. As the inflammation gains ground, and the substance of the lung becomes altered in structure (second stage, or that of hepatization), bronchial or tubular respiration is perceptible, with louder respiratory murmur than natural, in the sound parts of the lung, particularly in severe attacks; also bronchophony may be present, and the tone elicited by percussion (excepting when the inflammation is restricted to a small central spot in the parenchymatous substance) more or less dull according to the seat of the structural derangement, but rarely so complete or extensive as in pleuritis with copious liquid effusion. In the third, or suppurative stage of the disorder, the sound on percussion becomes more dull, the tubular respiration and vocal resonance commonly disappear (a gurgling mucous rale is occasionally substituted, denoting the existence of a fluid in the larger bronchi), and the expectoration * This rusty or sanguinolent hue is intinmitely combined, not in streaks. It appears usually about the second or third day, and is a characteristic indication of the presence of the disease in question; at the same time it must be borne in mind, that its absence is by no means a certain criterion of the non-existence of inflam nation of the lungs. - That of simple inflammatory injection or engorgement. INFLAMMATION OF THE LUNGS. 369 becomes muco-purnlent or converted into a brown serous fluid. Slight shiverings generally attend the invasion of suppuration, and the pain, or sense of fulness or tightness, becomes abated; the patient is, moreover, commonly enabled to lie on the side which was affected, without much inconvenience. If the disease be not checked in the second stage, the face becomes patched with red, and sometimes livid, and is of considerable extent, the vessels of the neck swollen and turgid, the pulse weak and irregular, and the patient is deprived of life by the obstruction which is offered to the circulation in the lungs. In the third stage, the pulse becomes weak and thready, and the strength commonly sinks rapidly; but a fatal result is often averted by proper homceopathic treatment. When an abscess forms in the solidified lung, a cavernous or gurgling rhoncus will be heard, as the air passes through the pus; and pectoriloquy with cavernous respiration will supervene,-when the cavity has been emptied of the fluid by expectoration. Such are the general symptoms of pure pneumonia, but in severe cases it is often found combined with pleurisy, in which case the pains of the chest are intense, and mostly of an acute shooting character. Another and still more frequent complication is formed with bronchitis. When pneumonia terminates by resolution, some striking evacuation frequently attends it, such as a very free and abundant expectoration of thick white or yellow matter, often slightly streaked with blood; or a profuse and general sweat; diarrhcea; a profuse discharge of urine, with a copious sediment; or an attack of epistaxis. If no hepatization have taken place, the crepitous rale, at first audible, becomes gradually less perceptible, and the natural respiration is heard, till at last the former wholly disappears; if the lung have already partly solidified, but the disease is approaching a cure, the crepitous rale is first heard, then gradually yields to the natural respiration; in fact, the disease, so to speak, runs its course back again. THERAPEUTICS. Aconitum, Bryonia alba, Phosphorus, Tartarus emeticus, Tinctura sulphuris, Rhus toxico, dendron, Belladonna, &c. 24 370 RESPIRATORY SYSTEM. ACONITE. In the stage of simple inflammatory congestion, with severe inflammatory fever, whether or not accompanied or followed by severe shooting pains in the chest, this remedy is unquestionably of great service. Form of prescription the same as in Inflammatory Fever. BRYONIA is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by that medicine. But Belladonn~ia is generally required before Bryonia, when the fever returns after having been apparently subdued by Aconitum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest continue (particularly when the pain experienced seems more at the sternum), the sputa tinged with blood, and difficult to expectorate, the cheeks flushed, lips and tongue dry and parched, the skin hot, and the thirst incessant. In young plethoric subjects, Aconitum and Belladonna may be given, in rapid alternation, with the most satisfactory results during the first or congestive stage. In such cases indeed the further progress of the disease is not unfrequently arrested, or at all events such a degree of improvement is effected, that any remaining symptoms, such as some degree of oppression, expectoration of viscid sputa, with little or no dulness of percussion or other signs of hepatization, readily yield to the employment of Bryonia. Bryonia may, however, be prescribed at the commencement, when the following indications present themselves:-cough, attended with expectoration of viscid or tenacious mucus, of a brick-dust color, oppression at the chest accompanied by acute shooting pain, or rheumatic pains in the pleura, and pectoral muscles, or in the extremities, with increase of pain on movement; foul tongue, constipation, and other signs of gastric derangement. A complication with pleurisy (pneumopleuritis), indicated by increased dulness on percussion, and in some instances a double-sounding voice, central bronchial * When Aconitum does not effect the desired amendment, Belladonna is generally of greater service than Bryonia in pulmonic inflammation. Again, if Aconitum produces only a slight degree of improvement when prescribed at the third or sixth dilution, the employment of a higher attenuation, such as the twelfth or twenty-fourth, is often followed by the happiest success. I consider Aconitum, Belladonna, and Phosphorus to be the most important remedies in pneumonia.-Rummell, Alig. Hom. Zeit. No. 21. 32ster Bd. INFLAMMATION OF THE LUNGS. 371 respiration, and bronchophony, is often an additional reason for the selection of this remedy. (See also PLEURITIS.) 1* Tinct. Bryon. alb. 3, gtt. iij. Aq. pur. 3 iij. Dose. A dessert-spoonful every four, six or eight hours, according to the severity of the case.* PHosPrIonus.t This remedy has been lately almost exclusively employed by Dr. Fleischmann, of Vienna, in almost every stage of pneumonia, under whatever form it may present itself, and with the most marked success, even when extreme hepatization has taken place. Although the homoeopathic treatment hitherto adopted with Aconitum, Bryonia, Mlerc., Sulpk., &c., has proved eminently successful, yet this remedy, which seems to have such a specific influence over this serious disease, deserves a more extensive trial: at the same time we cannot too strongly reprobate the impropriety of blindly selecting this remedy, when others, such as Bryonia, Tartarus, Sulphur, &c., may, on a careful comparison of the symptoms, be found better indicated; or of persevering in its employment, in cases where no signs of improvement have set in, after we have allowed a sufficiency of time to elapse to admit of the manifestation of its favorable action. I1 Tinct. Phosph. 3, gtt. vj. Aq. destil. 3 ij. Dose. One dessert-spoonful every four hours, lengthening the intervals according to the effects produced. TARTArUS EMETICUS 8. STIBIATUS has been chiefly recommended as valuable in promoting resolution after hepatization has taken place (which is indicated by the greater or less degree of dulness on percussion, the bronchial or tubular respiration, and the peculiar pectoral sounds given by the voice). Oppression at the chest, laborious respiration, no expectoration, or expectoration of mucus (untinged with blood) chiefly during the night; or, mucus rattling in the * Vide "Rules for the repetition of the dose," in the Introduction. f I have cured some of the most desperate cases of pneumonia by means of Phosphorus, although prescribed only in the form of globules, but always at low potencies, (3-6.)-Rummell, Allg. Hom. Zeit. No. 21. 32ster Band. 372 RESPIRATORY SYSTEM. chest, with temporary diminution of the obstructed respiration after expectorating the sputa detached by the cough, appear to be the principal general indications for the selection of Tartarus emeticus.* I~ Tart. stibiat. 3, gr. iv. Aq. dest. 3 iij. Dose. A dessert-spoonful three times a day. TINCTURA SULPHURIs may deserve a preference to the lastmentioned remedy in similar cases, when they occur in strumous habits, also where hepatization has advanced to some extent, and where Phosphorus, or other remedies, may have only effected a degree of improvement; also where there is complication with pleurisy, and obstinate constipation. 1c Tinct. Sulph. 3, gtt. iij. Aq. dest. 3 ij. Dose. A dessert-spoonful every six to twelve hours, according to circumstances; if amendment ensues, the medicine should be allowed to continue its action undisturbed, as long as the improvement continues. Bromium and Nitrum, particularly the former, promise to be of as much importance as Phosphorus in so-called complicated cases of pneumonia, and where there is incipient hepatization.t In obstinate or chronic cases, with weak, thread-like pulse and clammy sweats, Zachesis and Zycopodium have been found very useful after, or in alternation with, Sulphur, Kali n., &c. Carb. v. and Am. m. have also been suggested as * Bosch, in his remarks on the treatment of pneumonia, states, that although the fever may have abated under the employment of Acon., Bella., or Bryon., whenever the oppression at the chest and anxiety continue or increase, the pulse at the same time becoming small, soft, and irregular, and auscultation clearly indicating the establishment of hepatization, he resorts to Tartarus slibiatus, and with such striking success, as cannot be surpassed by any remedy, not even by Phosphorus. The latter he always considered called for when solidification had madetome progress, and was accompanied by signs of incipient paralysis of the lungs; symptoms which are prone to threaten even in the first stage of pneumonia, when the disease occurs in old people, especially those who are subject to asthma, or have been affected with chronic mucous (pituitous) coughs.-Hygea, XX Band, 4 Heft. t Neues Arch., Zw. Bd., Drit. Heft, p. 113. INFLAMMATION OF THE LUNGS. 373 likely to be of service in some cases of the foregoing description. The preceding are the principal remedies used in the majority of cases of this disease; but the following have likewise been found excellent auxiliaries in some instances, and merit attention:Acidum nitricum has been of service in some cases, where, after Aconite, a cessation of pain has taken place with increase of fever. Squilla has been recommended as useful in forwarding the crisis: further, in pneumonia accompanied with gastric symptoms, and where the expectoration is copious, or in cases which had previously been treated by venesection, and China has not proved sufficient to rouse the sinking energies of the patient. Mercurius, when the fever has been lowered by the employment of Aconite, but pain and difficulty of breathing remain, or copious nocturnal sweats exhaust the patient's strength, and the pulse is small and quick; also where there is prominent bronchitic complication. In the latter instance, Capsicum, Nux v., Pulsatilla, and Bryonia, have also proved efficacious: Capsicum particularly in the case of phlegmatic subjects; Nux v., alternately with Phosphorus, especially in the case of drunkards; and Pulsatilla in chlorotic females. The indications for Bryonia have already been given. Cannabis has also been found useful in this frequent complication, and, moreover, in one or two cases where there was disease of the heart and large vessels, with greenish vomiting and delirium.t Arnica-against effusion into the air-passages, with local congestions and hemoptysis, (pulmonary hemorrhage or apoplexy of the lungs.) L'hus toxicodendron may be found serviceable in the congestive stage of pneumonia, when we meet with extreme restlessness, anxiety, palpitation of the heart, and excessive redness of the face. But should diarrhoea supervene, accompaf Cannabis is sometimes useful in pneumonia, when the oppression and dyspnoea is greater than the other symptoms, such as the state of the pulse, etc., would lead us to anticipate.-Rummell. 374 RESPIRATORY SYSTEM. nied by clammy sweats and great frequency of pulse, Arsenicum will generally be required. Sanguinaria canadensis. This important medicament is considered by Constantine Hering as likely to prove a valuable remedy in certain cases of pneumonia. Cantharides seems calculated to prove serviceable in pneumo-pleuritis. When the inflammatory symptoms have been subdued, but the expectoration presents a muco-purulent appearance, and there is great prostration with nocturnal sweats, Lycopodium has been found very efficacious. When the disease has gone on to the third stage, announced by attacks of shivering succeeded by heat, and other signs of suppurative fever, together with the physical changes already mentioned,-Sulphur, Lycopodium, and Kali c., form, along with others, such as Merc., Hepar, China, &c., the principal remedies by means of which we may entertain some hope of averting a fatal issue. Lachesis has proved beneficial, sometimes in alternation with Arsenicum and Cinchona, in those almost desperate cases which threaten to turn to gangrene of the lungs (with fetid breath and sputa). Phosphorus, Kali, and Lycopodium are efficacious remedies in pneumonia occurring in phthisical subjects. When there exists a tendency to suffer from inflammatory injection in the chest, whenever an easterly wind prevails, Aconitum and Belladonna (Bryonia?) have been recommended as prophylactic remedies. The state of the digestive functions ought, at the same time, to be attended to. But when this predisposition arises in consequence of an attack of pneumonia, which had degenerated into the chronic form, and left certain portions of the lung in an indurated state, with more or less bronchial voice and breath-sounds at the seat of the previous inflammation, such remedies as Sulph., Zachesis, Phosph., and Lycopod. must be resorted to. Ere we conclude this chapter, we trust we shall be excused for introducing the following somewhat diffuse but important remarks of Dr. C. Miiller,* on the employment of Tartarus emeticus and Phosphorus in pneumonia, as also some extracts * Tartarus emeticus und Phosphorus in Lungenentzindungen, von Dr. Cl. Miiller. Allg. Horn. Zeit., No. 4-5. 30 Bd. INFLAMMATION OF THE LUNGS. 375 from the observations of Dr. H. G. Schneider* and Dr. Watzket on the treatment of pneumonic inflammation. "The information to be gleaned from homoeopathic authors, as to the efficacy of Tartarus emeticus in pulmonary affections, is nearly as follows: Dr. Wurm (Hygea, xii, 1, p. 41) recommends it in pleuritis complicated with bronchitis, when the expectoration is difficult. Dr. Buchner (Hygea, xv, p. 509) recommends its employment in pneumonia when the fever and the typical signs have, for the most part, disappeared, but the patient is affected with constant rattling in the chest, and expectorates large confluent masses; the expectoration being, at the same time, difficult, the respiration oppressive, the chest affected with a burning sensation extending to the throat, and gastric symptoms predominating. An anonymous writer (Hom. Archiv, xix, 2, p. 31) considers Tartarus emeticus the only specific remedy in Pneumonia gastrica, and in the second stage of pure pneumonia. Dr. Bosch (Hygea, xx, 4, p. 304) gives several detailed cures of pneumonia by means of emetic tartar, and intimates that he has always found it useful when, on the abatement of the symptoms of inflammatory fever, the oppression at the chest and the anxiety increased, the pulse became small, soft, and frequently unequal, and the physical signs afford distinct indications of hepatization (dull stroke sound, and crepitation or bronchial respiration). Dr. Kurtz (Hygea, v, 2, p. 141) holds Tart. emet. to be a really specific remedy only in the stage of hepatization. The following pathogenetic effects of Tart. emet. denote its action on the bronchi, lungs, and pleura: much coughing, and sneezing violent, tickling in the air-passages, which provokes cough; loose night cough; mucous rhoncus; cough after a meal, with vomiting of the contents of the stomach; gasping for breath at the commencement of every paroxysm of coughing; burning sensation under the sternum; continuous violent rheumatic pain in the (left) side of the thorax; fits of soreness in the chest, attended with hopeless despair; sensation as if the chest were lined with velvet; short, labo * Ibid. No. 1. 21 Bd. SIbid. No. 7. 21 Bd. 376 RESPIRATORY SYSTEM. rious breathing, rendering it necessary to sit up in bed,-relieved after coughing and expectorating; nocturnal paroxysms of orthopnoea; irregular or unequal, intermittent respiration during sleep; less frequent inspiration; interrupted or oppressed breathing, with dysphagia; unusual oppression at the chest. The symptoms which have been attained from animals that have been poisoned by Tartarus emeticus are as follows: lungs congested and distinctly inflamed, and in a state of splenization, in some parts even in that of hepatization, of a violet color, and deprived of crepitation. (Magendie-arising from the injection of 6-8 grs. into a vein. Orvil. Toxicologia, Bd. 1, p. 460); lungs materially altered, of an orangeyellow or violet-blue color, increpitating, gorged with dark blood, and of dense texture; inflammation of the bronchial tubes, and, to a greater extent, of the lungs also. (Schrbpfer, in Christison's 'Treatise on Poisons,' p. 503, from 1 scr. injected into the trachea of a dog.) The lungs of those of the human species who have been poisoned by Tart. emet., exhibit black discoloration in several parts. That emetic tartar exerts a specific action on the bronchi, pleura, and lungs, and that the alterations which it is capable of producing on these parts correspond to those which are commonly and intrinsically met with in inflammatory affections of these organs, there cannot be the slightest shade of doubt; the more precise indications for its application are, however, less determined. The majority of physicians (allopathic) understood the multifarious recommendations of Tart. emet. in the sense that it was immaterial in what description of inflammation in the chest it was employed, provided only the affection was either pneumonia or pleuritis; the solitary question on which they were not united was, whether blood should be abstracted or not in the first instance. The result of this summary mode of proceeding was naturally very variable; and it accordingly happened that, whilst one party spoke in the most enthusiastic terms of praise, another gave a depreciatory opinion; others, again, felt that the sphere of its efficacy must be somewhat narrowed, and therefore recommended Tart. emet. in those instances of pectoral inflammation in which it was uncertain whether to bleed or not. (Bersius, Miguel, and others.) A INFLAMMATION OF THE LUNGS. 377 similar discrepancy of opinion arose as to the time and stage of the disease in which the remedy was more appropriate; some employed it at the very commencement of the disorder, others, particularly in pleuritis, only when effusion had taken place, making the Tart. emet. a sort of resolvent and substitute for the ordinary mercurial friction. As already shown, the homncopathic physicians have, upon the whole, employed Tart. ermet. but rarely in thoracic inflammations, and that more apparently from the circumstance that they conceived they possessed sufficient resources in their other remedies, or because they attached but little credit to recommendations emanating from allopathic practitioners, rather than that any want of confidence in the remedy had arisen from established trials. No homceopathist, however, ever expected to find in Tart. emet. a never-failing specific in pulmonic inflammation. It therefore remains for us, from the physiological effects of this remedy, and the experience which has been derived from clinical observation, to consider more narrowly those symptoms which, when encountered in pulmonic inflammation, justify us, according to homceopathic principles, in selecting Tartar. emetic. as an appropriate remedy. In the first place, then, as regards the painful sensations which Tart. emet. is capable of exciting in the chest, we find only a single symptom: violent fixed rheumatic pain in the (left) side of the thorax. Now, we know that in pneumonia the pain is commonly either very trivial or altogether absent, from the circumstance that the parenchymatous substance of the lungs is but little qualified to give rise to painful sensations. With the serous covering of the lungs, however, it is far otherwise; for if the pleura be affected, and particularly when inflamed, acute pain is always present, but this pain is almost constantly of a shooting or cutting description (as is for the most part the case in all serous membranes), and consequently not continual or incessant, but intermitting, excited by movement, breathing, &c. As the above-mentioned pain is, strictly speaking, the only one that is proper to Tart. emet., it therefore follows that its applicability in pleuritis, at least in the first two stages of that complaint, is untenable. Concerning the phrase "rheumatic pain," there is some difficulty in finding a positive definition: if employed to 378 RESPIRATORY SYSTEM. designate the changing or erratic nature of the pain, it contradicts the succeeding term "fixed;" if, on the other hand, the expression is received in the sense in which, in popular language, it is commonly employed in reference to pains arising from exposure to cold, such a signification ought not to find a place in a scientific (homeopathic) work; most probably, therefore, it is intended to be implied that the pain has its seat in the pectoral muscles, inasmuch as rheumatic affections are especially seated in fibrous structures. Consequently, although Peschier regarded pricking or darting pains in the chest as an especial indication for Tart. emet. in pleurisy, his opinion would seem to be unjustifiable, since the aforesaid pains counter-indicate the employment of this remedy. The paucity of painful pectoral symptoms speak much more in favor of the application of Tart. emet. in pneumonioa. The following three symptoms ought to be taken into consideration here: sensation as if the chest were lined with velvet; soreness or pain as from excoriation in the chest, occurring in paroxysms; burning sensations behind the sternum, evidently arising from affections of the mucous lining of the bronchi, and their ramifications; they therefore denote the existence of common catarrh, or of the catarrhal affection which always accompanies inflammation of the lungs, and do not correspond to pleurisy, from the circumstance that catarrhal symptoms of abnormal respiration are strongly marked: short, oppressed breathing, rendering it necessary for the patient to sit up in bed; frequent fits of unequal, intermittent respiration during sleep; extreme pectoral oppression; dyspncea, compelling the patient to sit up, meliorated after coughing and expectorating; nocturnal attacks of orthopncea; respiratory disturbance with dysphagia. When we compare these numerous symptoms with those which the few which were previously mentioned as appertaining to Tart. emet., it will be seen that they predominate so much over the latter, as to be evidently of much greater' importance, and correspond particularly with those of pneumonia, for in that affection, as is well known, the oppression and disturbance to the respiratory functions hold a prominent place, and the remaining symptoms are of a less decided character. The symptoms referring to the expectoration are INFLAMMATION OF THE LUNGS. 379 of a less satisfactory nature; the cough is certainly chiefly loose, and even accompanied with mucous rhoncus, but with regard to the character of the sputa, a point of considerable moment in inflammation of the lungs, we have not the slightest notification. But although this deficiency of observation is much to be regretted, we yet may reasonably conclude that sanguineous sputa can hardly have been met with either during the provings of Tartarus, or in cases of poisoning therefrom, otherwise so important a symptom would most assuredly have been recorded. The following two symptoms may also be said to be of considerable importance: gasping for breath at the commencement of every fit of coughing; and dyspnoea, diminished after coughing and expectorating; since this dependence of the oppression on the accumulation of mucus in the bronchi, and its disappearance and cessation for some time after expectorating, is in like manner to be observed in certain forms of pneumonia, viz., after the act of coughing, or merely by expectoration, the bronchial ramifications which intercept the hepatized portion of lung may be cleared of the fluids or the hard substances which have been secreted, or the communication between the bronchi and the trachea, which had been obstructed by mucus, may be restored by the aforesaid means; which fact can in some measure be accounted for, by the sudden decrease of the oppression subsequent to expectorating, and also by the circumstance that bronchophony, the bronchial respiration, the simultaneous rattling rhonci, sibilus, etc., previously absent, often follow a paroxysm of coughing. (Vide Scoda, p. 251.) Had any doubt remained as to the specific relation of Tartarus to the lungs and pulmonic inflammations, it would have been unconditionally removed by the results which have been obtained from post-mortem examinations after cases of poisoning. The phenomena there met with having exhibited the greatest possible similarity to those which are found after pulmonic inflammation. The symptoms indicated unequivocally that stage of pneumonia in which the lung, or a portion of the same, after previous simple engorgement with blood (engouement), has become more solid, compact, heavy, and no longer possessed crepitation; which condition has been 880:RESPIRATORY SYSTEM. named that of the red hepatization by most authors, and ramollissement rouge by Andral. Taking everything into consideration therefore, we shall find that the following are the indications for Tartarus emeticus: it is particularly applicable in pneumonia, and especially in the so-called second stage, when little or no pain, but an extreme degree of oppression and obstructed respiration, is encountered; when there is a loose cough, attended with mucous rattling and considerable expectoration, followed by melioration of the pectoral oppression; when the sputa contains very little or no blood, and consists chiefly of mucous masses; and when percussion and auscultation demonstrate that a portion of the lung no longer contains air, and is consequently hepatized. With reference to the said physical signs, the following particulars may be determined: percussion will elicit a dull sound over a greater or lesser extent of surface, with increased resistance,-b-ut it may also yield a hollow or tubulous tone (viz., when the subjacent portion of lung is hepatized throughout); the parts of the chest immediately adjacent to this spot, may emit a tympanitic sound, (when, as is often the case, the portions of the lung bordering on that which is hepatized, are emphysematouns,) or, like the remaining extent of the lung, the usual normal sound. Should the hepatized portion be very small in circumference and diameter, the percussion-sound would again be normal, but this is naturally of rare occurrence. Auscultation, over the spot where the stroke-sound was dull, will afford more or less distinct bronchophony (when, namely, the hepatized portion is sufficiently large to embrace one of the larger bronchial ramifications, and the latter is not filled with fluid, or a dense exudation, or a coagulum of blood, and the communication with the trachea thereby intercepted), and, further, bronchial respiration and consonant rattling, or one or the other. The presence of bronchophony does not, however, necessarily imply the existence of bronchial respiration or consonant sibilus, or rhonci, and vice versa, bronchophony is not always heard when bronchial respiration is present; these signs are sometimes only perceptible after the act of expectoration, as has been stated above. At those parts of the thorax where the lung is not hepatized, auscultation will detect weak, vesicular, or INFLAMMATION OF THE LUNGS. 381 puerile respiration, or indefinite respiration, and various kinds of rhonci. It must yet be observed, that the cited physical signs remain the same in the third stage of pneumonia, the so-called gray hepatization, hepatisation grise, ramollisement gris (in which Tart. emet. is inapplicable, at least the symptoms do not indicate it): but this conversion of the effused lymph in the hepatized lung into purulent matter will not be readily mistaken or confounded, because the accompanying group of characteristic general symptoms would lead sooner to the selection of Phosph., Ars., RAus, Zachesis, &c., than to Tart. emet., which has either none, or but a limited number of the said symptoms. It now remains to be ascertained whether, in addition to the symptoms which have already been notified, there are any peculiar general indications for the employment of Tart. emet. According to the usual opinions, derived from theory and practice, it is in pneumonia, attended with gastric or bilious derangement, the so-called pneumonia biliosa (erysipelas pulmonum), that emetic tartar is particularly appropriate. The characteristic marks which distinguish the said form of pneumonia from the common species are, the light bilious discoloration of the skin, and especially of the albuginea, aloe, nasi, and corners of the mouth; further, the coating of the tongue, merging from light yellow into a brownish color, the bitter taste, nausea, or vomiting, the brownishyellow bilious urine (the blood drawn by venesection is also stated to exhibit instantaneously a saffron-yellow color under the test of nitric acid). Along with the foregoing, a lancinating pain is commonly experienced under the right false ribs, or pain and distension are complained of in the scrobiculus, with frequent eructation and hiccough; moreover, a peculiar pressive, severe piercing pain is centred in the forehead, which sometimes gives place towards evening to violent delirium; frothy mucous of a saffron-yellow or greenish hue, rarely combined with blood, is ejected after the fits of coughing, which are often accompanied by vomiting. Among the pathogenetic symptoms of Tart. emet. will certainly be found the majority, but not the whole, of those above given. The yellow color of the skin, for instance, as also the brownish-yellow coating of the tongue and the bitter taste, are 382 RESPIRATORY SYSTEM. wanting; it must be admitted, however, that even in pneumonia biliosa, the bilious aspect of the skin is only occasionally a well-marked symptom. On the other hand, the distension and sensibility of the epigastrium and hypochondria, together with the eructations, hiccough, and vomiting, the dark reddish-brown colored, cloudy urine, the pressive frontal headache, and the cough with vomiting, are well determined symptoms of Emet. tart.; concerning the sputa, as has already been observed, we are in the possession of no positive testimony. It therefore follows that Tartarus (as also Senega, Mferc., or Nux v.) may without doubt be deemed a useful remedy in pneumonia associated with so-called bilious and gastric states; but to maintain that it alone corresponds to pneumonia with such complications is unjustifiable. PHOSPHORUS. The experience of homceopathists as to the efficacy of Phosphorus in inflammations of the respiratory organs, is more extensive; the observations detailed thereon, in various journals and essays, are so numerous that we shall here quote merely a selection of the most appropriate and authentic amongst them. Dr. Wurm (Hygea, xii, 1, p. 38, and ix, 1, p. 55) recommends it in pleuritis and pneumonia, in connexion with tuberculosis pulmonum; as also in complications of pleuritis with pneumonia or bronchitis. Dr. G. Schmidt expresses himself in accordance with the foregoing. (Hygea, iv, p. 68.) Dr. Griesselich (Hygea, xiii, 6, p. 528) cured a case of pleuro-pneumonia by Phosphorus which had continued to gain ground notwithstanding the employment of Acon., Bryonia, Mosch., and Arnica, when, in consequence of the existence of muttering delirium and carpologia, paroxysms of threatening suffocation, extremely laborious respiration, critical debility, small, quick pulse, paralysis of the lungs was momentarily to be dreaded; in the right lung there was no longer any respiratory murmur, but loud rubbing sound was distinctly audible. Very shortly after the administration of Phosphorus expectoration set in, and the breathing became freer, so that after twenty-four hours' incipient slight respiratory murmur, pectoriloquy, segophony became audible, and recovery followed soon afterwards. Dr. Buchner (Hygea, xv, 6, p. 507) recommends Phos2po INFLAMMATION OF THE LUNGS. 383 rus where great prostration, paleness of face, dimness of the eyes, powerless, dry cough, particularly at night, are encountered; further, when the following state of matters is met with: difficult expectoration from exhaustion, burning, darting, rattling in the chest, danger of paralysis of the lungs, complication with bronchitis, imperfect crisis from depressed physical power. Dr. Horner (Archiv, xx, 1, p. 118) found Phosphorus curative in an extremely severe case of peripneumony, in which, after the employment of Aconitum and Bryonia, exhausting epistaxis, subsultus tendinum, delirium furibundum and involuntary stools had supervened. Schellhammer (Archiv, xx, 3, p. 120) found benefit still to arise from the employment of Phosphorus in neglected pulmonic inflammations, where there was coldness of the breath, cold, clammy sweats, tremulous scarcely perceptible pulse, rusty, with difficulty expectorated sputa, extreme anxiety, facies hippocratica, and frequently such absolute dulness of tone on percussion, that it seemed as if a wall were struck instead of the chest. Dr. Eichhorn (Hygea, xix, 1, p. 31) found Phosphorus particularly to be approved of, when incipient hepatization, in pure and (so-called) asthenic pneumonia, is indicated, in addition to the known physical signs, by the livid, sharp face, cold sweats, small, quick, and hard pulse, frequent cough, with frothy or brown (sometimes gelatinous-looking) sputa, &c.; and also in those cases of typhus, where, notwithstanding the pneumonic concentration, sensibility to the touch, and borborygmus in the ccecal region, as well as diarrhcea, are present. Dr. Schneider (A. IH. Zeitung, 21 Bd., p. 4) saw greater benefit from Phosphorus in 1839-40 than from any other remedy; in general he also found this remedy indicated, where Acon., Bryon., erc. had not rendered the expected relief before the pneumonic crisis; and in neglected cases with rattling rhoncus in the bronchi, difficult purulent-looking, copious sputa, and great debility. Dr. Watzke (A. H. Zeitung, 21 Bd., p. 109) states Phosphorus to be appropriate in the second stage of primary pneumonic croup; further, in pneumonia complicated with pleuritic exudation, or with bronchitis. 384: RESPIRATORY SYSTEM. The most decided defender of Phosphorus in pneumonia is Dr. Fleischmann; in the year 1840 he employed it (Hyg., xiv., 4, p. 358) exclusively with success in 51 cases of inflammation of the lungs, and found it equally useful in nearly every stage of the disease; the same striking results ensued in the following year (Hyg., xviii, 5, p. 468). The physical signs were almost constantly as follows: dulness of sound on percussion, bronchial respiration, frequently attended with crepitation or rattling. Descriptions of cures performed by means of Phosphorus in severe, partly so-termed, nervous pulmonic inflammations, have also been given by Dr. A. Noack (A. H. Zeitung, 21 Band, p. 321); Dr. Bethmann (Annalen, 14 Band, 3 Stuck, p. 459); Dr. Hartlaub (Annalen, 4 Band, 4 Stiick, p. 459). The known pathogenetic symptoms which Phosphorus exerts upon the organs of respiration are about as follow: shooting and violent stitches in various parts of the thorax, right and left side, sometimes with burning at rest and during movement, especially while sitting and during respiration; pain in the chest, particularly during inspiration, itching in the interior of the chest with dry cough. Oppression at the chest; precordial anxiety, with obstructed respiration, and throbbing in the right side of the chest; great oppression and shortness of breath; tightness of chest as if caused by a band; tension and dryness in the chest; constrictive pressure in the upper part of the thorax; loud rattling respiration;. dry, hollow cough, without subsequent expectoration; hacking cough, with a suffocating sensation in the chest, and some mucous expectoration; cough, with expectoration of transparent mucus, accompanied by tensive and subsequently pricking pain in the chest; straining cough, with white, viscid sputa, which is difficult to loosen or detach; streaks of blood in the mucous sputa; muco-purulent sputa; expectoration of blood with mucus during a short, slight cough; pricking pain in the scrobiculus cordis while coughing, rendering it necessary to support the part with the hand. The symptoms which have been obtained from the dissection of dogs, which had been poisoned by Phosphorus, are as follows: " A few minutes after the introduction of a solu PNEUMONIA. 385 tion of Phosphorus in oil into the jugular vein, the dog emitted, at each respiration, a voluminous white vapor, which contained a considerable quantity of phosphoric acid, and died soon afterwards; on dissection, the vessels of the lungs exhibited a state of obstruction (hepatization)." (Magendie, Experiences pour servir a l'histoire de la transpiration pulmonaire, 1811, p. 19.) In like manner Orfila observed: " The dog soon began to pant and breathe with extreme difficulty, and vomited a large quantity of a bloody serous-loolking substance. At the sectio cadaveris, the lungs presented several blue patches of a dense and less crepitating texture than in the normal state; in the remainder of their extent they were of a rose color. In another dog the lungs were found red and congested, and did not crepitate." (Orfil. Toxicol. Gen6r., Bd. I, p. 56.) In cases of poisoning in the human subject, the inferior lobes were of firm consistence, and gorged with venous blood. (Oesterreich. Med. Wochenschrift, 1843, No. 39.) The above-mentioned symptoms of Phosphorus are characteristics, and distinctly correspond to the appearances which are commonly observed in certain inflammations of the lungs. The sensations of pain which Phosphorus is capable of producing, consists, for the most part, of stitches and shootings, which are more particularly excited or increased by respiration, coughing, and movement. Identical symptoms are met with in pleuro-pneumony, the pain, which is almost constantly of a shooting or darting description, being, in the said disease, all but exclusively experienced during a deep inspiration, or the act of coughing. The symptoms of tightness of chest and dyspncea form a prominent feature in the pathogenesy of P/osphorus, but they undergo no mitigation from the acts of coughing and expectorating, as is the case with Tart. emet.; on the contrary, each paroxysm of coughing is productive of increased difficulty of breathing. The cough is either perfectly dry and hollow, or it is loose, yet straining, fatiguing, and generally productive of severe pain; the sputa consists of white, transparent, tenacious mucus, or of mucus intermingled with blood, or it is purulent. The results obtained from the cases of poisoning, and post-mortem examinations, are very similar to those detailed under Tart. emet., i. e. the lung, or a portion of 25 386 RESPIRATORY SYSTEM. the same, was firmer, more solid and impermeable, and consequently in a state of so-called hepatization. If, from the foregoing, we now attempt to determine the kinds of pneumonia, the time and stage in which Phosphorus is appropriate, it is requisite in the first place to point out those pulmonic inflammations, where (in contradistinction to Tart. emet.) the shooting pectoral pains, as well as the dyspncea and the respiratory disturbances, are especially excited and aggravated by coughing and respiration,-and these are the so-called pleuro-pneumonic inflammations in which the pleura is pretty extensively (for perhaps in no case of pneumonia does it wholly escape) implicated, and more particularly in the second stage when mucus or sanguineous mucus is expectorated, and the physical signs are the same as those mentioned under Tart. emet., viz. dull stroke-sound and bronchophony or bronchial respiration, and perhaps consonant rAles. So far, therefore, it would seem that Phosphorus corresponds somewhat closely with Tart. emet. in its sphere of action, differing only from the latter in certain isolated instances. But there yet remains a group of symptoms under the head of Phosphorus which have not yet been taken into consideration, and in reference to which, the sphere of action of Phosphorus is altered and considerably extended, viz. those general appearances, which, without inducing any peculiar change in the local and physical symptoms, sometimes connect themselves with pneumonic inflammations, and have by the older physicians been denominated nervous. These "nervous" appearances develop themselves probably only when the pulmonic inflammation enters, unchecked, into the third stage, that of the gray hepatization (hepatisation grise, ramollisement gris) with threatening paralysis of the lungs; and perhaps also in the first stage of those inflammations which occasionally occupy the lungs in typhus. When pneumonia is verging on the third stage, the purulent infiltration of the parenchyma, the following symptoms chiefly declare themselves: mental depression, slight delirium, with carphologia and subsultus tendinum, rapid prostration of strength, cold, clammy sweats, small, feeble, frequent pulse, dim eyes, sunken features, dry lips and tongue, short, laborious breathing, oppression and anxiety, tedious cough and expectoration, PNEUMONIA. 387 frequently loose and involuntary stools. The physical symptoms, as already stated, remain the same as in the second stage, excepting that the sound, on percussion, becomes perfectly dull and deprived of resonance over a larger surface, and the respiratory murmur, at that spot, inaudible, or extremely faint. The expectoration either ceases altogether, or consists of a purulent mucus, or a brown serous liquid. Nearly the whole of these symptoms are also to be found amongst the pathogenetic properties of Phosphorus; and more particularly the delirium with carphologia, the sunken, hippocratic visage, with deep-set eyes, dryness of the lips and tongue without thirst, the short and anxious respiration, with slight, tedious cough and expectoration, the purulent sputa, clammy sweat, with coldness of the face, small, quick pulse. Hereunto must be added the numerous, and, in great part, authentic clinical observations, which almost unanimously recommend Phosphorus in the so-called slow, asthenic, nervous, pneumonic inflammations,-corroborated, moreover, by the testimony of Dr. Fleischmann, whose position, as the physician to an hospital, gives additional weight to his evidence. It consequently follows that Phosphorus, according to homoeopathic principles, must prove valuable at the commencement of the third stage, with so-called nervous symptoms and threatening paralysis of the lungs, as well as in the second stage. On comparing, therefore, its sphere of action with that of emetictartar, it will be seen, in addition to the distinctive marks already given, that the field embraced by Phosphorus is greater than that of Tart. emet., and that the former may be advantageously employed in pneumonic inflammations of a more advanced stage than where there could be the slightest prospect of obtaining a favorable result from the administration of the. latter. But that Phosphorus should still be capable of effecting a cure, when extensive purulent infiltration of the parenchymatous substance of the lungs has taken place, is as little to be expected as the attainment of so desirable an event by means of any other remedy. Dr. Schneider (Klinische Aphorismen. Allg. Hom. Zeit. No. 1, 21ster Band) writes:1. For the last eight years-i. e. from the time that I com 388 RESPIRATORY SYSTEM. menced to substitute the specific or homceopathic for the antiphlogistic method, I have usually seen pneumonia last only four to five days, and terminate on the fifth, inclusive, at most on the seventh, inclusive, by profuse sweats and hypostatic urine. 2. I seldom met with epistaxis in pneumonia,-although artificial bleedings had not been employed, and I never (which may certainly depend upon the stadium) saw this or any other hemorrhage appear critically. I have, moreover, never observed critical diarrhoeas in pneumonia. 3. If, in addition to critical sweats and urine, the evolution of a scabby eruption about the mouth appeared to be necessary to ensure the termination of the inflammation, the decrease of the disease proceeded somewhat slower, and that more especially when the urine was at the same time of a light color. 4. If critical sweats made their appearance on the fourth or fifth day, without effecting a decrease of the pneumony, and they were, moreover, accompanied by anxiety and restlessness, with increased oppression, cough, and pain during the act of coughing, the eruption of a critical miliaria was to be expected. 5. A miliary eruption (consisting of small whitish vesicles on a red ground) was always sufficient (when the inflammation could not otherwise be removed) to terminate the pneumony within nine days. In the meanwhile the sweats diminished, and the miliaria soon afterwards scaled off. 6. In one case, where the patient had wantonly exposed herself to cold on the fifth day of the disease," about the termination of the crisis bona (by sweat, hypostatic urine, and eruption about the mouth), relapse took place, accompanied by great anxiety, restlessness, and sleeplessness, excessive oppression and tightness of the chest, and very difficult, painful cough, which indicated a termination (on the ninth day, reckoned from the first appearance of the disease) in a miliary eruption. * The patient, a woman of very violent, impatient temper, being tired of the sweating, and feeling herself otherwise well, left the bed and seated herself in the passage, in a current of air, coming from two opposite open doors. PNEUMONIA. 389 7. On the decline of the pneumonic inflammation, the oppression at the chest, and the obstructed inspiration, as also the pricking pain whilst making a moderate inspiration, and the frequent pulse, were generally the first symptoms that were alleviated; at the same time the rust-colored sputa became more and more light-colored (subsequently dirty-white and globular), the cough gradually easier and the expeectoration less troublesome; somewhat later, the stitches during coughing disappeared, and lastly the cough itself, after having (in the form of a normal cough) removed the last trace of the disease. 8. For the last eight years I have invariably seen pneumonia simplex, when treated homoeopathically (provided the treatment commenced as early as the third day of the existence of the disease), terminate favorably, and always more regularly and speedily than during the ten preceding years, when the treatment was conducted according to the principles of the old school. 9. During the last eight years I have lost eight patients, of neglected* and badly-treated pneumonia: two women of the age of 60; two men of the same age; one man of 40, one man of 30, and two children. The person of the age of 30 was already in a dying state when I arrived. On the other hand, I have saved, during the same space of time, six other patients similarly affected: four men in the third stage of the disease, one boy of 12, and one girl of 13 years, both were in a hectic state, &c., and had already commenced to expectorate large quantities of purulent matter, of an offensive, pungent smell. 10. Two cases of pneumony occurring in previously diseased lungs terminated fatally,-the one on the seventh day suddenly, in consequence of the bursting of a vomica,t the other on the sixth day, through paralysis of the lungs.4 Some other cases, in phthisis exulcerata, terminated favorably. * By neglected pneumonia, I mean a case in which the period of the first normal crisis has passed unfavorably. f The patient had, several years before, been severely contused by being pressed by his horse against a tree, and subsequently suffered from frequent attacks of pneumonia, accompanied by very copious expectoration.: The patient, a woman, had suffered two years before she was attacked 390 RESPIRATORY SYSTEM. With the exception of those mentioned under ix and x, I have never met with a fatal case of pneumonia during the last eight years. 11. I generally prescribed Aconitugn for only one day at the utmost in pneumonia; I only continued it the day following if the fever was still very violent; and in that case I gave it alternately with the other appropriate remedy. 12. If the patient came under my treatment only on the third day of the existence of pneumonia, I immediately gave Aconit. alternately with the other medicine indicated. 13. If the vascular irritation was very great at the beginning of the pneumony, and accompanied by determination of blood to the head, or also by talking in the sleep, I gave Aconite and Belladonna alternately. 14. The second remedy which I employed in pneumony was generally BBryonia; I soon discovered, however, that this medicament operated much better when given alternately with some other which was appropriate to the genus morborum, or the individuality of the patient, or also the causa occasionalis of the pneumony, with Belladonna or JMercury (most frequently with the latter), or with Nulv v., (e. g. with drunkards) or with Arnica or Rhus (after external causes). 15. In 1839 and 1840, about the time when ganglionic typhus prevailed, Phosphorus proved more effective than any other remedy in pneumonia. During the prevalence of scarlet fevers and anginoe, Belladonna deserves particular attention; and during that of influenza, Mercury. 16. I usually employed 2/iercurius with good effect with that otherwise indicated remedy, if a critical eruption about the mouth was to be foreseen. 17. When a critical eruption about the mouth was foreseen, the employment of -Mercurius in alternation with the remedy otherwise indicated, was attended with good results. If all remedies above-mentioned did not effect the desired amendment before the crisis of the pneumonia, I usually found, after with this fatal (asthenic) pneumonia, from complaints of the chest; and during the latter months she had experienced increasing tightness about the chest, attended with cough and expectoration, and very perceptible emaciation and diminution of strength. I saw her for the first time on the third day of the disease. The expectoration was nearly black. PNEUMONIA. 391 a renewed examination, Phosphorus or Sulph. indicated, more rarely ihus, or Sepia, or Squilla, and still more so, some other remedy. 18. On appearance of great anguish and restlessness, and oppression in the chest (4), &c., before the evolution of miliaria, I found either Arsen. or Veratr., or Hyoscyam. indicated, and effective. 19. In neglected pneumony, with rattling noise in the bronchi, difficult, purulent and copious expectoration, great weakness, &c., I have found Belladonna, Arsen., Phosphor., and Lycop., very beneficial. 20. In neglected pneumony, with copious, very offensive, purulent expectoration (9), I found especially Sepia, Conium, Carb., Silic. and China effective. 21. Latterly, I commonly prescribed Aconitum, Bryon., and Bellad. in the 1-I dilution, and the other medicines in the 4-II, as follows: gtt. iv.-gtt. viij in 3 iv. of water, 1 table-spoonful to be taken every 1-2 hours. Dr. Wartzke* states that"The honceopathic or specific treatment of pneumonia presents very considerable advantages-although more in reference to the direct and indirect consequences, and period of convalescence, than with regard to the course of the disease. In our hands, as a general rule, more or less distinct indications of critical symptoms make their appearance on the fifth day; on the seventh, the perfect crisis takes place, and on the fourteenth day the patient is enabled to attend to his usual occupations. Aconitum has been too unconditionally and generally recommended and employed against pneumonia. We only expect direct benefit from it in active hypersemia, and incipient splenization. Bryonia we employ only in those forms of pneumonia which are sympathetically founded on pleuritic inflammation with predominating plastic-serous exudations. In the first stage of pneumony in robust individuals, with existing consensual irritation of the brain, as also in pulmonic inflammations in general, resulting from severe and continuous * Allg. Horn. Zeit. No. 7. l2ster Band. 392 RESPIRATORY SYSTEM. exertion, or from mechanical lesion, the best remedies are Arnica, Rhus, and Conium. Belladonna is indicated when pneumonia is accompanied by an acute exanthema, with violent cerebral symptoms and general turgor venosus. In pneumonia occurring in females laboring under primary or secondary chlorosis, or associated with chronic, neglected, or acute bronchial catarrh, measles, or smallpox, Pulsatilla will not easily be excelled by any other remedy. In the second stage of primary pneumonic croup we would call attention, besides to the well-known and successfully employed Phosphor. and Antimonium, to Bismuth magesterium, and Arg. nitr.: in addition to the well-known and successfully employed Phosphorus and Antimon. tart. Arg. nitr. promises to be more especially of service against lobular hepatization occurring as a sequela. In the stage of purulent or serous infiltration Bromium is, next to Sulphur, Senega and Carbo v. the most worthy of attention. In irregular reactions, insufficient crisis in asthenic, torpid inflammations of the lungs, which frequently take place in consequence of bleedings, China, Camphor, 01. tereb., and AMoschus, are often beneficial even in apparently hopeless cases. Opium, Nux vomica, Hyoscyamus, Lachesis, Conium, Coeculus, Stram., do not appear to have any primary and direct effect upon the lungs; they are indicated in secondary pneumonic processes, in pneumo-typhus, in delirium tremens complicated with inflammations of the lungs, and in various forms of so-called nervous pneumony. In pneumonia catarrhalis, or in pneumony occurring in lymphatic, flaccid, fat habits, Senega is indicated; in pneumonia complicated with bronchitis, Senega, Mercury, Phospor., Brom., Nux mosch.; in that with hepatitis (pneumonia biliosa?), Senega, Mercury, Nux vomica, and in pneumonia interstitialis-aur. clor. Pneumonic states, which originate from tubercles in the lungs, are sometimes to be cured by means of Mercury, lod., Sulphur, Spongia, and Ol.jecoris aselli. In the pneumonia of old persons, Arsenicum is the principal SPURIOUS PERIPNEUMONY. 393 remedy; in that arising from repercussed eruptions, Arsenicum and Salphur; in complications with endocarditis, Arsenicum, Camphora, l Mercurius, Bromium; and in those with pleuritic exudations Arsenicum, C(amphora, Phosphorus, Scilla, and Acidum muriaticum are the most impoitant medicaments." DIET. It is scarcely necessary to remark that during the inflammatory period of pneumonia, an almost total abstinence must be observed: even during convalescence there is caution required, and care must be taken not to allow the patient to over-indulge his returning appetite, as any error in this respect may entail troublesome consequences. The drinks may consist of water, toast-water, and sometimes whey, rice- or barley-water, sweetened with a little sugar if desired. PERIPNEUMONIA NOTHAS. OCCULTA. CATARRHUS BRONCHIORUM, Spurious Peripneumony. This affection, which is usually most insidious in its approach, is more frequently met with in old than in young or middle-aged subjects, and is liable to terminate in paralysis of the lungs. Sometimes the attack is preceded by a feeling of general prostration; or comes on like an attack of common cold, with cough and alternate heats and chills. The cough is generally loose from the commencement; the sputa, white, yellow, slimy and generally blood-streaked. There is great weight or oppression at the chest, with quick laborious breathing; pain only when taking a deep inspiration, and generally in a small circumscribed spot. All these symptoms are usually aggravated by anything which calls for an increased play of the lungs, such as talking or laughing loudly, ascending stairs, &c., lying upon either side, particularly in the more severe attacks, becomes oppressive, so that the decubitus is generally on the back. Pulse soft but quick, the cheeks slightly flushed; the skin moist and damp, and sometimes there is nocturnal sweating which affords no relief; towards morning the febrile action subsides a little, and the patient feels somewhat easier. The voice is low and weak, occasionally dying away to a whisper. In the treatment of this affection a dose or two of Aconite may be given when the 394 RESPIRATORY SYSTEM. fever runs rather high, but Mercurius is more frequently called for even at the very commencement, and particularly when there is nocturnal sweating, and moist or clammy skin during the day; after the employment of fercurius, Belladonna will generally be found useful, and especially when a short dry cough remains, attended with spasmodic constriction in the chest which impedes respiration and causes an oppressive sensation of suffocation. If Belladonna does not complete the cure, and the cough is accompanied with sibilant or wheezing respiration, a dose of Aconite may be given, followed, after an interval of a few hours, by Chamomila. Nux vomica is serviceable when there is dry cough, or cough with difficult expectoration of a little slimy mucus, and excessive tension and oppression in the chest. In those cases in which AMercurius affords little relief, and the breathing continues quick and laborious, and the countenance is expressive of great anxiety, Ipecacuanha in repeated doses is frequently followed by satisfactory results; but should the extremities become cold, and the sensation of constriction in the chest, with extreme anxiety, increase, Veratrum should be prescribed; on the other hand, if the paroxysms of threatening suffocation become more and more distressing, and the patient appears sinking from exhaustion, ARSENICUM must claim a preference, and will often succeed in restoring the expiring energies of the patient when the case has assumed an almost hopeless appearance. (Tartarus emet. may be substituted for or administered alternately with Arsenic., when there is an excessive accumulation of mucus in the bronchial tubes. It may be added that Arnica has been found useful in some instances, in the early stage of the disorder, when the pleura costalis and the intercostal muscles seemed to be the principal seats of pain, which was rendered more acute by pressing the fingers against or drawing them along the spaces between the ribs; or when a bruised or beaten pain was experienced in the chest, and the cough not very troublesome, but attended with blood-streaked slimy sputa. Pulsatilla has been employed with advantage after Arnica, as soon as the expectoration became more considerable, attended with melioration of the pectoral symptoms. Pulsatilla and Sulphur are two of the best TYPHOID PNEUMONIA. 395 remedies to prevent the disease from assuming the chronic form, when the more acute symptoms have become subdued. (See also BRONCHITIS PNEUMONIA VERA, and PLEURITIS, and select any of the remedies given under these different heads, if the symptoms, general or physical, call for them.) TYPHOID OR CONGESTIVE PNEUMONIA. In this variety of pneumonia the local symptoms are usually very obscure, and the accompanying fever is of the typhoid kind, the pulse quick and very -weak, the skin harsh, dry, or clammy, tongue brown and parched, and the urine of greatly diminished quantity and high colored. In some cases the following physical signs can be detected: dullness on percussion, and absence of respiratory murmur in the lower and back parts of the chest, and occasionally bronchophony and bronchial respiration when the central or middle portion of the lung is the part affected. The remedies which have been used with the most advantage in typhoid pneumonia, are Opium, Arnica, Yeratrum, Arsenicum, Phosphorus, &c. OPIUM. This remedy is generally the most appropriate as soon as the disease.becomes clearly defined, and may be repeated once or twice, after which, if no change be effected, Arnica should be employed. If no improvement result from the foregoing remedies, Yeratrum may be administered, particularly when there is clammy sweat on the forehead, with coldness of the extremities and great weakness, and the respiration unequal, laborious, and rattling. ARSENIcUM may follow Yeratrum if the prostration and rattling respiration increase, the pulse become irregular, and the tongue dark brown or black: the alternate administration of these two remedies every half hour, to every hour or two hours, according to the urgency of the symptoms, is frequently attended with the best results; in other cases, Veratrum, Ipecacuanha, and Arsenicum answer better. But when only temporary improvement results, a few globules of Sulphur may be administered; and then again Veratrum, and Arsenicum or Veratrum, Ipecacuanha, and Arsenicum alternately, or any one of these remedies alone from which 396 RESPIRATORY SYSTEM. any marked degree of improvement may previously have been observed to arise. Bryonia, Rhus, Senega, and Phosphorus will be found useful in certain cases. Some of the leading indications for the employment of the two former will be found under the head of NERVOUS FEvER (which see). Senega is chiefly- serviceable when the lungs are loaded with mucus. Phosphorus when we find great debility, black incrustations on the lips, rapid and laborious breathing, and bronchial respiration. Belladonna will commonly be found serviceable when temporary blindness is complained of, and Natrum m. when the prostration of strength increases, notwithstanding the administration of Arsenicum, which is generally so valuable in such cases. When galling or excoriation has ensued from lying in bed, Cinchona and Arsenicum must be administered alternately; in milder cases, Arnica in the form of lotion (one part in ten) will frequently remove this evil. INFLAMMATION OF THE PLEURA. PLEURISY. Pleuritis. DIAGNOSIS. Severe cutting, lancinating pain in the side, confined to one circumscribed spot, interfering with breathing and acutely increased by taking a deep inspiration, or by coughing; difficult and anxious respiration, but not so oppressed as in pneumonia and bronchitis; quick hard pulse; hot skin, particularly over the chest, or the seat of the disease, (short dry cough;) parched tongue; scanty and high-colored urine; and occasional cerebral symptoms; position in bed, usually dorsal; and if the effusion be free and partial, a change to the sound side creates great uneasiness. The prognosis must be formed according to the severity and character of the symptoms. If the heat and other febrile indications gradually subside, and if the performance of the act of respiration becomes more free and less painful, and a copious and free expectoration ensues,* an early recovery may be expected; but * Care should be taken not to allow this profuse expectoration to go on too long, which it is sometimes prone to do in certain constitutions, otherwise it might degenerate into a chronic affection. Its suppression, when called for, may be effected by means of such remedies as Pulsatilla, Dulc., Stann., Sulph., Ipecac., Seneg., Scilla, Bryon., Sep., Lach., Calc., &c. INFLAMMATION OF THE PLEURA. 397 if the fever and inflammation have been intense, and the pain should suddenly terminate, followed by sinking of the pulse and a change of countenance, danger is to be apprehended. Pleurisy seems to consist in a peculiar inflammation in the pleura, with a disposition to effusion or to the secretion of plastic lymph; and it may run its whole course without any of the symptoms above given, declaring themselves. At the commencement of the disease there is diminution of motion and respiratory murmur from pain (subsequently these abnormal signs arise from efusion), and a rubbing sound is not unfrequently heard, generally about the centre of the chest, accompanying the pectoral movements. Soon after the onset of the inflammation, in the greater number of cases, exudation ensues, and, if not encysted, accumulates at the lowest parts of the chest. When, in such instances, the quantity exuded is considerable, and the lung is not restrained by adhesions, that organ will be floated upwards to some extent, and a dull stroke-sound elicited from the parts beneath it, whilst the upper parts will be found unusually resonant. As the fluid accumulates and ascends in the chest, the antecedent clearness of stroke-sound becomes impaired, as is more especially obvious on gentle percussion,-the breathsound diminished, and respiration more impeded. When these latter abnormal symptoms are met with as high as the middle regions of the thorax, the vocal resonance there,. and particularly anteriorly, becomes preternaturally distinct, and is changed to a small, sharp and tremulous note, resembling the bleating of a goat, and hence termed oegophony; posteriorly the resonance partakes somewhat more of the character of bronchophony from the greater calibre of the tubes at the root of the lung. /Egophony, and all sound of the voice, cease at the affected side of the chest, as the liquid effusion increases, except at those portions where the lung may have been adherent, or at the space within an inch or two of the spine; percussion now gives an extremely dull sound, from the lung being deprived of and rendered impermeable to air by compression, and the respiratory murmur is no longer audible, or only heard in the interscapular and subclavicular regions, particularly the former. 398 RESPIRATORY SYSTEM. In those cases in which the effusion is very considerable. enlargement of the afected side takes place. This enlargement is generally discernible only during expiration at first, but as the exudation increases, the difference can readily be detected during the entire performance of respiration. In attenuated subjects, the intercostal spaces will also be observed to have become prominent, instead of presenting their natural depression. But should absorption be effected after such an enlargement, the state of matters is reversed, and the side which was previously enlarged becomes abnormally contracted-the result of atmospheric pressure, and unantagonized muscular action. Displacement of organs adjoining the seat of the effusion, such as the heart, liver,.and mediastinum, is also an occasional result of extensive effusion. On examining the sound side of the chest, in addition to the negative proofs of the absence of disease, an excess of the usual normal signs will also be perceived, indicated by an accelerated and deeper action, together with a greatly increased degree of respiratory murmur, resembling that of children, and hence denominated puerile. The signs of improvement and approaching recovery are marked by a diminution of pain, fever, dyspncea, and enlargement of the side; and by a return of the respiratory murmur, together with an increasing clearness of sound on percussion. When the result is fatal, death occasionally supervenes very rapidly from the compression of both lungs; but, in most cases, this event is more gradual, and arises from atrophy of the lungs, as also affections of the heart, with consequent dropsy, caused by the efforts required to propel the blood through the compressed lung. In all cases of pleurisy, the whole of the above-detailed symptoms are not to be deemed constant, or even certain diagnostic signs. The absence of marked dulness on percussion is not a conclusive test that effusion has not taken place. The greater or less degree of clearness of tone appears to depend upon the condition of the lung under effusion, and the elasticity of the parietes that cover it. If the quantity of the effusion be very considerable, and the lung deprived of its air by com INFLAMMATION OF THE PLEURA. 399 pression, the sound on percussion is necessarily almost uniformly dull; but when the exudation is inconsiderable, and the compression is not sufficient to deprive the lung of its air, the stroke-sound will be found to consist more of a tympanitic, and frequently even a louder tone, than that of the normal expanded lung. Subsequently, however, if the pressure be unrestrained, the lung will be deprived of its air, and the part formerly so resonant will then yield a dull sound. The auscultatory phenomena are, in like manner, naturally liable to be materially modified by circumstances. Much depends on the extent of the exudation, and also on the state of the lung on which it rests. If the lung still contain air, both voice and respiratory sound will be found indistinct or inaudible. If, from the extent of the effusion, or from the long continuance of the disorder, the portion of lung be entirely emptied of air, weak bronchophony and bronchial respiration will be discernible; but when the amount of effusion is very great, possibly filling the whole cavity of the pleura, no sound whatever will be heard.* On the other hand, when the quantity effused is inconsiderable, the normal sounds frequently remain unchanged. Again, the physical signs are liable to be further modified by old and close adhesions of the lung to the walls of the chest, resulting from previous disease, which renders the lung adherent to the walls of the chest. The upper lobes are the most subject to these adhesions; and in such cases the free portion of the lung is pressed upwards by the subjacent effusion, against the superior part of the thorax. And although the lung may yet admit air, still, from the degree of compression to which its vesicular structure is subjected, both breath- and stroke-sound will be bronchial, and loud bronchophony will pervade the upper part of the affected side. The lower part of the chest, from whence the lung has been separated, or raised upwards by the effusion, will necessarily emit decided dulness on percussion. Finally, it may be added that cegophony, although a frequent phenomenon in pleuritis, has no necessary connexion with the presence of liquid in the pleural sac, and is consequently not to be held as an essential link in the chain of evidence for determining the existence of this disease. * British Journal of Homoeopathy, vol. i., p. 42. 400 RESPIRATORY SYSTEM. The same remarks will, in a great measure, apply to the intercepted vibration of the voice, usually felt by the hand when placed against the chest,-for this, although a very useful and early corroborative indication of the accumulation of fluid in the cavity of the pleura, is yet liable to some exceptions both positive and negative. The rubbing sound already referred to is an important sign; it is not so audible at the commencement of the attack as it is at a later period when the effusion becomes more consistent, and then it is rarely absent. Pain is, with few exceptions, an invariable concomitant on pleurisy, still if it be unaccompanied by the confirmatory evidence of other important symptoms, it must not be implicitly relied on, as it may arise from a totally different cause than an inflammatory oondition of the pleura. But when taken in combination with other signs, its presence and intensity have been found of great use in estimating the amount as well as the quality of the effusion; for it has been ascertained that the greater the quantity of plastic lymph it contains the greater will be the pain.' Great rapidity of effusion is also a frequent, though not an infallible source of extreme pain. The greater or minor degree of dyspnoea depends on the quantity and rapidity of the effusion, as well as on the condition of the lungs; when both sides of the chest are the seat of the effusion, the oppression is usually excessive. The fever is in like manner modified by the nature and extent of the exudation, being generally slight, or altogether absent, when the quantity is trivial; slow, and not unfrequently intermittent, when more extensive but of a serous character; and highly inflammatory, when much plastic lymph is contained in the effusion.t From what has been stated, it will be seen that most of the so-called characteristics of pleurisy cannot, individually considered, be taken as conclusive indications of the existence of that disease. The collective physical signs, however, in the majority of cases, are far from equivocal, and are mainly to be depended on in forming the diagnosis. Cough is not an accompaniment of simple pleurisy, so that when this symptom is present there is either bronchitic or * Brit. Homoeop. Journ., vol. i, p. 44. f Ibid. INFLAMMATION OF THE PLEURA. 401 or pneumonic complication, or the case may be one of hemorrhagic pleuritis. THERAPEUTICS. The chief remedies are Aconitum napellus, Bryonia alba, Sulphur, Belladonna. Mercurius, Arsenicum, Arnica montana, Hepar sulphuris, Phosphorus, Lycopodium clavatum, Carbo vegetabilis et animalis, Cinchona oficinalis, Digitalis purpurea, Kali carbonicum, Ipecacuanha, Helleborus niger, Sabadilla, Scilla maritima. ACONITUM is an indispensable remedy in allaying inflammatory fever when attendant on pleurisy; and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It rarely fails to produce a favorable impression in from six to eight hours; should it not do so in that space of time, another remedy must be selected. In most instances Bryonia will be the most appropriate, but we must not hesitate to select Sulphur in preference, if called for, or indeed any other remedy that may seem more strikingly indicated. 1q Tinct. Acon. 3, gtt. vj. Aq. pur. 3 iij. Dose. A dessert-spoonful every two to six hours.* BRYONIA ALBA should, in general cases, follow Aconitum when the fever has been somewhat allayed by that remedy. It is more particularly indicated, either in simple or complicated pleurisy, when the following symptoms are encountered at an early stage of the disease; aching, burning, but more especially acute shooting or cutting pains in the chest, much increased during inspiration or on movement; dry cough, or dry sounding cough, followed by expectoration of dirty, yellow-colored mucus, streaked or tinged with blood, and attended with great aggravation of pain; oppressed and anxious respiration; palpitation of the heart; dry, cracked, brown, or yellow coated. tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter, bilious-looking fluid; aching or painful pressure at the scrobiculus and hypochondria; intense thirst, especially at night; constipation; head confused and heavy; giddiness on sitting up in bed; * Vide Rules for the repetition of the dose in the Introduction. 26 402 RESPIRATORY SYSTEM. aching and shooting pains in the head, or pain as if the head would burst, particularly at the temples, with exacerbation on coughing, or moving; fiery, or blueish redness, and puffiness of the face; restless, disturbed sleep; frequent startings; nocturnal delirium, with alternations of comatose sleep; burning heat of skin; occasionally, partial, clammy perspiration; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent, and weak; aching in the limbs. Lastly, when in connection with any of the above, the following symptoms are met with: dulness on percussion, with puerile respiration; cough on lying on the side, or impossibility of lying otherwise than on the back,-Bryonia will rarely fail to render undeniable service, and can indeed with difficulty be dispensed with. (See the symptoms mentioned under this remedy in the chapter on PNEUMONIA.) 1c Tinct. Bryon. alb., 3, gtt. vj. Aq. pur. 3 iij. Dose. A dessert-spoonful every three to six hours. SULPHUR may with advantage follow Bryonia when the pain mentioned has been removed by that medicine, but the inflammation is not wholly subdued, and often completes the cure. It is also of value when the fever continues after the administration of Aconite, and may be administered without the previous employment of Aconitum, when, although the fever is not violent, we have reason to suspect recent effusion of plastic lymph. Again, when the affection has already been of some days' duration, and is complicated with pneumonia, it is our chief stay in preventing solidification, or effecting resolution where that has already commenced, and may therefore generally be selected in preference to Bryonia, in such cases, unless the latter be otherwise strongly indicated, in which event a dose or two of that medicine, previous to the employment of Sulphur, will be found serviceable. 1c Tinct. Sulph. 6, gtt. vj. Aq. pur. 3 iij. Dose. A dessert-spoonful every six hours; or, in very severe cases, every two hours. These three are the most important remedies in the greater INFLAMMATION OF THE PLEURA. 403 number of cases of pleuritis, and are frequently* found sufficient to effect a speedy cure. There are often occasions, however, in which it will be found necessary to select one or more of the following remedies: Belladonna, Mfercurius, Arnica, Arsenicum, TIlepacr s., Phosphorus, Carbo v., China, Lycopodium, Digitalis, &c. BELLADONNA has been recommended in cases where the fever returns, and pain and dyspnea continue notwithstanding the employment of Aconite: tc Tinct. Bellad. 6, gtt.-iij. Aq. pur. 3 ij. Dose. A dessert-spoonful every six hours. MERCURIUS has been found very useful in cases where the fever has been subdued, but pain and dyspncea have not been relieved.by Aconite, and the patient's strength is becoming exhausted by copious nocturnal sweats: f1 Merc. v. 6, gtt. iij. Aq. pur. 3 ij. Dose. Same as Belladonna. ARNICA MONTANA, principally when pleuritis has been caused by external injury; but also in other cases when the more inflammatory symptoms have been subdued by Aconite, &c.; and pain in the chest, with oppressed respiration, only remains; it is also useful to promote absorption when considerable effusion has taken place: lc Tinct. Am. Mont. 3, gtt. iij. Aq. pur. 3 ij. Dose. A dessert-spoonful every three or four hours, until the pain begins to yield, and the breathing becomes freer, when the intervals between the doses must be lengthened, or the medicine discontinued, and only resumed should the improvement proceed tardily; but if pain return, Aconitum must again be resorted to, after which Belladonna is often of great efficacy. In other cases, Bryonia or Sulphur will be seen to be more appropriate, and must be selected accordingly. AnSENICuM is the remedy on which we mainly depend in those serious cases where serous effusion to a very great extent has taken place, and where the respiration is painfully im 404: RESPIRATORY SYSTEM. peded and asthmatic, attended with extreme prostration of strength. Sc Arsenic. alb. 6, gtt. iij. Aq. pur. 3 iij. Dose. A dessert-spoonful every two hours, until a beneficial effect is produced. HEPAR SULPHURIS has been particularly recommended when the effusion is plastic, and the disease is of some duration (chronic plastic pleurisy), or where, even at the commencement, there appears-from the pain, fever and dyspnoea, continuing with but slightly diminished severity after Aconite,every probability that the case will prove extremely obstinate.and tenacious. Complication with pericarditis or bronchitis 'is an additional indication for the employment of Heparunder the above circumstances. (Lachesis, Digitalis, Arsenicum and Belladonna are also deserving of attention when there is pericarditic complication.) Rc Pulv. Hep. 3, gr. vj. Dose. As much as will lie on the point of a penknife, every two to six hours, according to circumstances. PHOSPHORUS. From what has been said of this remedy in,Pneumonia, it will readily be conjectured to be useful in cases of complication of pleuritis therewith, as indeed it has repeatedly proved. In complications with bronchitis, and in that form of pleuritis which so frequently shows itself in phthisis pulmonalis, it has further been found of essential service. (Vide PNEUMONIA and BRONCHITIS.) l Tinct. Phosph. 3, gtt. vi. Aq. destil. 3 iij. Dose. A dessert-spoonful every three or four hours, or oftener if necessary, until the respiration becomes easier. CARRO VEGETABILIS is a good remedy when pleuritis is complicated with chronic bronchitis; or at an advanced stage of the disorder, when the patient is much emaciated and hectic at night, presenting in short the usual symptoms of threatening purulent degeneration. It is also peculiarly useful against asthmatic sufferings resulting from an attack of pleurisy, in chronic cases. Dose. Same as Arsenicum, except in the latter instance, when it must be given at longer intervals. ITFLAMMATION OF THE PLEURA. 405 CINCHoNA is chiefly useful after severe depletion, to restore the energies of the patient. LYcoPomuDM will be found serviceable in similar cases to those in which both Arsenicum and Carb. vegetabilis (or animalis) have been found applicable, also where there are considerable dropsical swellings And obstinate constipation. DIGITALIS has proved useful in many cases of serous pleurisy with slow fever, small weak pulse, accelerated by the slightest movement; and coldness of the extremities, with internal heat.* In conclusion, Kali carbonicun may be instanced as serviceable in pleuritis occurring in tuberculous subjects; and Ipecacuanka as a useful palliative against dyspncea and convulsive cough in complications with bronchitis. Helleborus niger has been recommended in some cases of serous, and Scilla in plastic pleurisy, but they, as well as Colchicum, Lachesis, and some others which need not be mentioned here, require the test of further experience to corroborate even the little that has been adduced in their favor in the treatment of pleuritis.t When, either through neglect or otherwise, pleuritis has terminated in purulent degeneration, and become chronic, Arsenicum, Carbo, Lycopodium, Hepar s., and Kali carbonicum, are the principal remedies from which the greatest assistance can be obtained where the cure is at all practicable. (See also HYDROTHORAX.) Pains in the chest arising from adhesions or from thickening of the pleura, after an attack of pleuritis, are often relieved by RJanunculus bulbcsus, Euphorb., Mez., Nitr., Thuja, may also be found serviceable. In chronic pleurisy, Su.phur, Sepia, Kali c., Ammon. c., Lycopodium, and Xezereum, may prove useful. DIET. The same rules are to be observed as in Pneumonia. * British Journal of Homceopathy, No. 1, p. 53. f Rhus toxicodendron has been strongly recommended in serous pleurisy. When low, typhoid symptoms become apparent, this remedy will deserve an additional claim on our attention. Typhoid appearances, and important complications of any kind, a bad habit of body, or indications of a purulent, sanious, or hemorrhagic effusion, are all to be held as unfavorable signs. 406 0RESPIRATORY SYSTEM. SPURIOUS OR BASTARD PLEURISY. Pleurodynia, Pseudo-Pleuritis, Pleuritis Muscularis. By these terms is here meant that painful affection usually referred to the intercostal muscles, which is productive of many of the symptoms described under true pleurisy, and is consequently liable to be mistaken for that disease, particularly when attended with febrile excitement, as is frequently the case in hysterical females. The history of the commencement of the affection, together with the aid of auscultation and percussion, enables us to draw a correct distinction between the two diseases. When, therefore, we have satisfied ourselves from the normal condition of the auscultatory phenomena, &c., that the case we have to deal with is one of pseudo-pleurisy, we must select a remedy from amongst the following: Arnica montana, Bryonia, Nwux., Pulsatilla, Ranunculus bulbosus, Sabadilla. In the majority of cases, Arnica is the principal remedy, and is occasionally sufficient to effect a speedy cure after a single dose. In other instances, however, the disorder does not yield so readily, and consequently one or more of the other remedies enumerated must be had recourse to. BRYONIA. When the pain is of an acute darting description, as if fromr a sharp instrument running into the side, and is at times almost insupportable during inspiration, or even the slightest movement of the body, and when the patient is of a nervous or bilious temperament. PULSATILLA. This remedy is frequently very useful in alternation with Arnica; it is more particularly indicated when the pain is occasionally of afugitive character, moving from one part of the chest to another, becoming increased towards evening, and sometimes experienced more during expiration than inspiration. Temperament phlegmatic. Nux vOMICA. Shooting pains in the hypochondria, increased by the respiratory movements of the chest; especially when the affection occurs in hypochondriacal subjects, or in those who are addicted to indulgence in vinous or spirituous drinks. Temperament bilious or sanguine. It is, moreover, one of the best remedies in this complaint; DIAPHIRAGMITIS. 407 the characteristic indications are as follows, and show a marked resemblance to the symptoms which are so frequently met with in, and are in some respects peculiar to, pseudopleurisy: stitch in the side, or shootings, with painful sensibility of the external parts of the chest, but particularly of the intercostal spaces, aggravated by any movement, and especially by taking a deep inspiration, yawning, or stretching. RANUNCULUS BULBOSUS. The value of this medicine in pains resulting from adhesions of the pleura, has already been alluded to. (Vide PLEURITIS.) In acute pains in the chest of every description of a purely nervous character, depending upon an abnormally exalted sensibility of the pleura, this remedy is one of primary importance. SABADILLA has also been recommended as a useful medicine in pseudo-pleuritis. ADMINISTRATION OF THE REMEDIES. In some cases a single dose of one or two globules is sufficient to effect a cure, in others it will be found necessary to repeat the dose every six, twelve, or twenty-four hours, according to the severity of the attack, until relief is obtained. DIAPHRAGMITIS. Inflammation confined to the muscular structure of the diaphragm is considered to be of extremely rare occurrence, the disorder in almost every case appearing in combination with inflammation of the pleural or peritoneal covering; in either of which investing membranes; moreover, the disease, for the most part, seems primarily to commence, and only subsequently to extend itself to the-connecting cellular tissue and muscular or tendinous substance of the diaphragm. Whether the disease arises in the upper or lower surface or covering, the symptoms are closely analogous. If the inflammation be extensive, the pain is extremely violent, spreading from the lower ribs to the dorsal vertebrae, and accompanied with intense fever. The upper part of the abdomen, and particularly the scrobiculus cordis, is usually hot, very sensitive to the touch, and retracted, but often distended, tense, and accompanied with throbbing and deep-seated burning. There is often at first low muttering delirium, but as the 408 RESPIRATORY SYSTEM. fever increases it becomes more violent; simulating phrenitis, from the circumstance, as has been supposed, of the irritation which is communicated to the phrenic nerve. Owing to the interruption which is caused to the functions of the diaphragm the respiration is always impeded, and a dry, extremely distressing cough is commonly present, especially when the upper or pleural surface of the diaphragm is the principal seat of the inflammation. Along with the foregoing symptoms there is frequently obstructed deglutition, severe hiccup or vomiting, extreme anxiety and restlessness, twitchings, or spasmodic retractions of the angles of the mouth (risus sardonicus). The exacerbations on movement or on attempting to take a deep breath are excessive, and the only position in which the patient experiences any degree of amelioration is when sitting up with the body inclined forwards. The affection may terminate in resolution, or in the effusion of fluid either into the cavity of the pleura or peritoneum, or the patient may speedily sink under the intensity of the fever. THERAPEUTICS. When the fever runs high and is of the synochal type it is necessary to exhibit Aconitum in repeated doses; but when the accompanying fever partakes of the character of synochus, Bryonia is to be preferred, and may, in most cases of the said description, be prescribed at the very commencement of the attack. If the scrobiculus and the region of the false or lower ribs be swollen, and pressure increase the short and distressingly interrupted breathing, as also the pulsating burning pain, which extends from the stated points backwards towards the spine; moreover, when there is a dry, fatiguing cough, or violent vomiting and convulsions, great agitation and constant moaning, Chamomilla is the best remedy. But should there be great tightness, as if caused by the constriction of a cord drawn around the chest, with dry, short cough, anxiety, and constipation,.Nux vomica is the most appropriate remedial agent. Cannabis, Pulsatilla, Cocculus have been recommended as being useful where the symptoms of inflammation continue to occupy a prominent place; and Hyoscyamus, Veratrum album, Arsenicum, Stramonium, and Ipecacuanka, where a nervous condition predominates. SPITTING OF BLOOD. 409 When diaphragmitis exists in connection with pleuritis, Bryonia is one of the most important remedies; as also when it is symptomatic of pneumonia, peritonitis, splenitis, and hepatitis, particularly when the pains are aggravated by the slightest movement and are attended with violent fever, small, quick, hard pulse, delirium, extreme agitation, cough. Nux v. is equally useful when the disease occurs as symptomatic of the above-named disorders, provided the symptoms encountered are analogous to those we have given as characteristic indications for its selection. (See also PLEURITIS, PNEUMONIA, PERITONITIS, SPLENITIS, and HEPATITIS.) Diaphragmitis arising from antecedent gout or rheumatism, is the most dangerous and fatal form in which the affection is met. The remedies chiefly to be relied on under such serious circumstances are the same as the foregoing. SPITTING OF BLOOD. HEMORRHAGE FROM THE LUNGS. Sputum Cruentum. IIcemorrkagia Pulmonum. Hcemoptysis. DIAGNOSIS. Expectoration of blood by coughing, in greater or less quantity, attended by symptoms more or less severe. This disease displays itself in three varieties: first, by an effusion of blood from the mucous lining of the bronchial tubes; secondly, by congestion of the lungs, with engorgement of the parenchyma from effusions; and thirdly, by the rupture of a blood-vessel in the tubercular cavity of the lungs, during the course of phthisis pulmonalis. It is, however, proposed to deal generally with the subject, and to point out the different remedies found useful in the treatment, according to the symptoms present. We must be careful not to confound this disease with affections of the mouth or gums, or the occurrence of blood from the nose escaping through the posterior nares, and being returned by the mouth. When the blood proceeds from the chest, it is almost invariably attended with a sensation as if it came from a deep-seated source, is warm, generally tastes sweet, and there is frequently a simultaneous burning and painful sensation in the thorax. When the attack is preceded by well-known premonitory symptoms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing wind instruments, violent 410 RESPIRATORY SYSTEM. exercise of the arms, running, ascending stairs, or, in short, anything calculated to increase the respiratory action, or otherwise fatigue the chest. When spitting of blood occurs in a robust and healthy person of sound constitution, it is not very dangerous, but when it attacks slender and delicate persons of weak lax fibre, it is more serious and delicate of removal. It is, however, chiefly when the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, that the case may be considered dangerous. The disease may present itself without any marked pains or difficulty of breathing, and pass off with no return of the attack; or be preceded by dry cough, oppression, or tightness at the chest, shivering, coldness of the extremities, great lassitude, and high pulse,-and be accompanied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance,-cease, and then return in a few hours, and be followed by difficulty of respiration and cough; in still more serious cases, when a marked tendency to phthisis exists, anxiety, oppression at the chest and febrile symptoms are more severe, pure blood is coughed up, and the paroxysms frequently return. The rupture of a blood-vessel is a rare occurrence, although it sometimes occurs in phthisis. When, however, a blood-vessel of any consequence, included in a tuberculous excavation, does give way, the result is generally fatal. CAUSES. Indulgence in spirituous beverages, overheating the body by immoderate exertion, or too great external heat; blowing wind instruments; contusion of the chest or back; falls; lesion of the lungs; breathing a vitiated atmosphere, or vapors charged with acrid substances; colds or coughs; violent m ental emotions; diseased state of the lungs, whether from pneumonia or phthisis; a general strumous habit; suppressed menstrual, hemorrhoidal, or other discharges; or repercussed cutaneous eruptions. THERAPEUTICS. In by far the greater number of cases, the discharge of spitting of blood soon ceases of its own accord; the most important object, therefore, is to seek to cure the complaint when the hemorrhage has ceased, and thereby prevent its return, or check the development of organic disease of the lungs. The principal homceopathic remedies SPITITNG OF BLOOD. 411 are: Pulsatilla, Nux vomica, Bryonia, Sulphur, Arnica montana, Aconitum, Ipecacuaniza, Acidumn szulphuricum, Arsenicum, Opium, Cinchona, Carbo, Ferrum metallicumn, RAus, Phos2porzus and Sepia. These are not only calculated to arrest the hemorrhage, but also to prevent a relapse, where that is practicable. PULSATILLA. In cases of females, arising from suppression of the monthly discharge, or, in either sex, of a hemorrhoidal flux (particularly when the individual is of leucophlegmatic temperament), and also in other instances, with the following symptoms: expectoration of dark coagulated blood, attended with shivering, especially towards evening, or at night, and great anxiety; pain in the lower part of the chest; feeling of flacidity in the epigastrium, and weakness. (IIcemoptysis vicaria.) When, in females, the menses do not return, notwithstanding the employment of Pulsatilla,-Cocculus,.Sepia, Sulphur, or any other remedy better adapted to the entire case, should be selected. (Vide CHLOROSIS, AMENORRHIEA, or CATAMENIA, SUPPRESSION OF.) BRYONIA is a good remedy in cases where the expectorated blood is excited by a tickling cough, and is often in a coagulated state; and where there is oppression at the chest, with frequent necessity to take a deep inspiration; anxiety and irascibility. Nux voMiIcA is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. (Hemnoptysis vicaria.) It is further indicated by dry cough, which causes headache, with excessive tickling in the chest and exacerbation of the symptoms towards morning. When Nuzx v. does not afford speedy relief, Sulphur will generally be found to succeed; but should any other remedy appear to be more appropriate, it should unhesitatingly be selected in preference. iRHus. When the blood expectorated is of a bright red, the mind much agitated, and the patient irritable and rendered worse after the slightest vexation or contradiction. ARNuIA MONTANA. Principally in cases arising from external lesion, such as a severe blow in the chest, or from lifting a 412 RESPIRATORY SYSTEM. heavy weight, or any other exertion, even blowing wind instruments; but also in almost all cases where the stethoscope detects effusion of blood into the parenchyma, attended with a sensation of constriction and burning in the chest, pain as from contusion in the scapular and dorsal regions, and dyspnoea. Moreover, profuse expectoration of dark-colored blood or coagula, brought up without much exertion, or bright frothy blood, mixed with mucus and clots; sensation of tickling behind the sternum; general heat, great weakness and syncope. (Aconite is sometimes necessary before, or alternately with, Arnica, &c.) ACIDUMi SULPHURICUM is frequently of service after Arnica when the cough continues, and brings on fresh bleeding. In severe cases attended with manifest danger: Aconitum, Ipecacuanka, Arsenicum, Opium, Cinchona, and.freosotum are the most useful, and must as usual be selected according to the prevailing symptoms. When one of these is insufficient to check the hemorrhage entirely, another must be chosen to meet the remaining symptoms. ACONITUr is often found exceedingly serviceable in warding off an attack, by the great power it possesses in controlling the circulation, and is indicated, previous to the paroxysm, by the premonitory symptoms of shivering, with accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burning and fulness in the same region; paleness and expression of anxiety in the face; great anguish and anxiety, aggravated by lying down; or during the attack when the expectoration is profuse, coming on in gushes, and excited by a slight dry cough. (Hemoptysis plethorica). IPECACUANHA. When a taste of blood remains in the mouth a few hours after the employment of Aconite has been commenced, when there is frequent tussiculation, with nausea, weakness and expectoration streaked with blood. ARSENICUM. When the anxiety, anguish, and palpitation of the heart increase, notwithstanding the administration of Aconite; and when, in addition, we find extreme restlessness and general dry burning heat. The employment of this remedy alternately with Ipecacuanha has been found to succeed in many instances, when SPITTING OF BLOOD. 413 neither of them separately has been found sufficient to conquer the disease; an occasional dose of Naux vomica should be prescribed as soon as the hemorrhage has in a great measure been checked, to such individuals as have been in the habit of indulging in spirituous, vinous, or fermented liquors, or coffee. Should hemorrhage return after a temporary cessation, Sulph2ur may be given, followed in turn, if required, by Arnica. OPIUM. Heat, dyspncea, with sensation of burning heat at the region of the heart; coldness, particularly of the extremities; tremor in the arms; dry hollow cough, with expectoration of blood and frothy mucus, and sometimes also weakness of the voice; drowsiness, with sudden starts; aggravation of cough after swallowing. It will be found useful in the most serious cases, particularly to persons addicted to spiritzuous liquors; in the latter case it may be useful to follow up the treatment with Vux vomica. CINCHoNA, as already mentioned in several places in this work, is one of our best remedies in restoring the vital energies of the patient after considerable loss of fluids, whether of blood or other secretions; it is therefore particularly efficacious after a severe attack of this affection, but is also indicated during its course, when the spitting of blood takes place after a violent cough, or when there is a continual taste of blood in the mouth, or when we find shivering alternately with accesses of heat, frequent and short-lived perspirations; tremor, and confusion of vision, with a sensation of vacuity or lightness in the head, weakness and desire to remain constantly recumbent. FERRUM METALLTOUM may be used with advantage after Cinchona in severe cases, or may be preferred if the expectoration follows a slight cough, and is scanty, but consists of pure bright red blood, attended with pain between the scapuloe, with inability to remain long in a sitting posture; the patient feels the concomitant symptoms relieved by movement, but is speedily fatigued, especially by conversation. It may, in some cases, be advantageously alternated with Cinchona, Carbo v., Arnica, and Arsenicum,-in others, Salphur may be required to complete the cure in some cases. SULPHUR. This remedy is frequently useful in winding up 414 RESPIRATORY SYSTEM. the treatment after the employment of other medicines; and it is also particularly- suitable for individuals disposed to hemorrhoidal affections, in derangement of the menstrual flux, or hemoptysis arising from suppressed cutaneous eruptions, such as scabies, &c. (ficemoptysis vicaria, &c.) Naux v. and Arsenicum may occasionally be advantageously given in alternation with Sulphiur at intervals of five to ten days, particularly when the disease occurs in drunkards. LKREOSOTUM has been found of great efficacy in cases where the patient has had a succession of severe attacks, and the blood is thrown off in large quantities; also when the patient complains of a feeling of burning heat in the chest, or a pain as if from a bruise, together with oppression in the chest and frequent desire to take a deep inspiration. After hemoptysis has disappeared (besides having to guard against a relapse, in which, as above stated, Sudlpur is our chief auxiliary), we have to take every precaution lest inflammation arise in the part primarily affected, or the disease degenerate into PHTHISIS, which objects will sometimes be best attained by the administration of Phoýsporus, in combination with a strict observance of an antiphlogistic regimen, and the other rules ahout to be given for the conduct of patients suffering from this affection. Phosp2 orus, it may be added, is, in conjunction with Aconitum, one of our chief remedies in hemorrhages from the lungs during the course of phthisis. Sepia is also useful in this affection occurring in PHTHISIS, but when it is rather to be looked upon as one of the general symptoms, than as forming a disease of itself; by its power over the economy of the uterus, it is also of great service in cases of hemoptysis, arising from derangements connected with that organ. (IHeemoptysis phthisica et vicarica.) The following remedies may also be noted as worthy the attention of the practitioner in peculiar cases: Kreosotum,. Belladonna, Acid. nitricum, Bryonia, Carbo vegetabilis, Iyoscyamus, Ignatia, Dulcamara, Cocculus, Crocus, Conium maculatumn, achesis, Acidum sulphuricum, Ledurz palustre, Lycopodium, MIillefolium, Szlicea, Staphysagria, and Cuprum metallicum, &c. DIET, &c. The rules given under HIýMATEMESIS ought to PULMONARY CONSUMPTION. 415 be observed as regards regimen; both mind and body should be kept perfectly quiet; the patient should speak as little as possible, and be kept in a semi-recumbent posture, or, if his strength allow, sit upright. PULMONARY CONSUMPTION. PLthisis Pulmonalis. One of the earliest symptoms of tuberculous phthisis is a short cough, which is either dry or accompanied by the expectoration of a frothy mucus, and is generally slight at the commencement, but more or less constant. Shortness of breath, proceeding from obstruction, caused by the granular and diffused indurations, is another early symptom of consumption. It is, at first, experienced only during exertion, but subsequently comes on after every fit of coughing, or on lying on the one or the other side, and is much increased by the slightest movement. Symptoms of gastric derangement are frequently present, with redness of the tongue, or white furred centre, with inflamed and projecting papilloe, and vivid red tip and margins; the patient falls off in flesh, becomes indolent, dejected, and overpowered with languor. A feeling of soreness is often complained of behind the sternum, or under the clavicles, particularly after any fatigue, or after a fit of coughing, and sometimes on exposure to cold air. The pulse is often normal in the first stage of the disease, but soon becomes full, hard, and accelerated. Fever of an intermittent character soon makes its appearance; it declares itself most towards night, remits from about two in the morning until the following day at noon, when it returns in a slighter degree, and continues until about five in the afternoon, and is then followed by another remission. This hectic fever is, in the first instance, chiefly manifested by flushing of the face (which is often most apparent after a meal), and heat in the palms of the hands and soles of the feet; but, as the disease advances, night sweats supervene, which leave the patient in a state of great exhaustion in the morning. As the expectoration increases it becomes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in consequence of the obstruction offered to 416 RESPIRATORY SYSTEM. the blood-vessels, by the indurations or granulations already alluded to. As the disease advances and passes into the second stage, or that in which the dark red or grayish indurations are converted into crude yellow tubercles, the respiration becomes more difficult, the emaciation and debility go on increasing, the cough is rendered more severe and troublesome, particularly at night, and the fever, though of shorter duration, is attended. with more profuse sweating, and the pulse loses tone. The expectoration becomes, at the same time, more free and copious, particularly towards morning, and is less thin and transparent. During the febrile exacerbations, or after meals, or at times of excitement, a circumscribed red patch still appears on each cheek, but at other times the color of the cheek is faded, and the countenance wears a dejected expression. In the third (or suppurative and ulcerative) stage of the disorder the tubercles become soft, and are expectorated at first in the form of curd or cheese-like particles, and subsequently mixed up with pus, ihucus, shreds of lymph, blood, and occasionally, though rarely, portions of pulmonary tissue. The bowels, from having been more inclined to be costive at the commencement of the disease, are now more prone to be relaxed, so that attacks of diarrhoea often recur frequently, and, by alternating with colliquative sweats, induce an excessive degree of weakness and prostration. In this, the last stage of the disease, the patient becomes reduced to a skeleton; the face is thinned, the cheek-bones prominent, the eyes look hollow, the hair falls off, the nails are livid and incurvated, and the feet cedematous; but, notwithstanding all this, the countenance presents a degree of clearness, and the eyes a lustre that are rarely, if ever, met with in other maladies; moreover, the state of mind is generally so serene:,and hopeful, that the patient seems often quite unconscious of his dangerous condition, and speaks and acts as if in full anticipation of a speedy recovery. The senses commonly remain entire and collected to the end of the disorder, but in some cases delirium precedes death and continues until life is extinct. The usual duration of phthisis pulmonalis is from eight or nine months to a year and a half; but circumstances tend much to vary the length of the disease; and there is a rapidly fatal form CONSUMPTION. 417 which runs its course in from two to three months, sometimes indeed only in one. When the malady makes slow progress, the patient is affected with cough, weakness, and emaciation, chiefly in winter and spring, and in many respects restored to comparative health in summer; but is always extremely susceptible to cold, and commonly complains of breathlessness on the slightest exertion. In this state the patient continues for a considerable time, sometimes even for several years, until at length the symptoms of confirmed consumption are developed by the invasion of an inflammatory attack proceeding from cold or some other irritating cause.* When we take the general symptoms in conjunction with the physical signs, the diagnosis of phthisis pulmonalis is, in general, unattended with difficulty. It is true, that in the early stage, when the miliary indurations are equally diffused or scattered through both lungs, they do not give rise to any marked diminution or change in the respiratory murmur, or in the resonance of the thorax on percussion. But it much more frequently happens that the indurations, even in the early stage, accumulate in clusters, particularly about the apices of the lungs, and usually more on one side than the other. The sound, on percussion, will therefore generally be found dull at the clavicle (more commonly the left) and the subelavicular region; the breath-sound during expiration will, at the same time, be unusually audible, and the voice will transmit a diffused resonance or preternatural clearness. When the spaces immediately beneath the clavicles give no signs of disease or discrepancy of sound, the regions below, at the sides, and at the back, should be examined (between the scapula in the case of children, in particular). A slight flattening is sometimes observable under the clavicles. On comparing the movements of the two sides of the chest, when the patient breathes deeply, a difference in their individual mobility will frequently be perceived. When the disease has attained the suppurative stage, and the tubercles have consequently become soft, or entirely liquid, a clicking or bub* Hoarseness is often an early accompanying symptom of phthisis. Laryngeal phthisis, with thickening and ulceration of the lining membrane of the larynx, independently of its own serious character as a disease, is moreover very frequently complicated with tubercular formations in the lungs. 27 418 RESPIRATORY SYSTEM. bling sound will be heard either under one of the clavicles or above the spine of one of the scapulhe. As the evacuation of the softened matter of the vomica progresses, a more continued gurgling, or the so-called cavernous rhoncus, will then be heard. Again, when the vomica or abscess has become completely softened and evacuated by ulceration into the bronchial tubes, a cavity is left, over the seat of which, cavernous respiration, and, when the patient speaks, the phenomenon designated pectoriloquy, are encountered. THERAPEUTICS. It would require a separate treatise to do justice to the treatment of this deplorable disease, by giving, or attempting to give, a full and minute description of the characteristic indications for the medicines which are appropriate to the various forms of the different stages of the disorder. We must, therefore, content ourselves here, by presenting our readers with a brief notice of the principal remedies which are employed in homoeopathic practice against the inflammatory, suppurative, and ulcerative stage of tubercular consumption. In the first stage of the malady, when the tubercles are in a crude, unsoftened state, or when they are inflamed and commencing to soften, the remedies by means of which the malady may be retarded, if not arrested, and, with due collateral precautions, kept harmless for years, are chiefly Aconitum, Bryonia, Belladonna, ]Lachesis, Ilear, Spongia, Phosphorus, Dulcamara, Pzulsatilla, Arsenicum, Nux v., Hyoscyamus, Silicea, Calcarea c., Oarbo v., Acidum nitricum, and Sulphur. These must be selected according to the aggregate symptoms of the case under treatment. Their leading indications may be gleaned from the chapters on COUGH, PLEURITIS, PNEUMONIA, and HEMOPTYSIS. In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are: Acidum nitricum, Silicea, Kali c., Sulphur, Calcarea, Natrum m., _Mercurius, Lachesis, Phosphorus, Lycopodium, Ccarbo v., Sambucus, Hepar sulphuris, Spongia, Cinchona, Ferrum, Conium, Zincum, Ammon. c., Laurocerasus, Graphites, Nitrum, lodium, Drosera, Plumbum, etc. In the third, or ulcerative stage, the same remedies as the foregoing, together with Guiacum, Sepia, Stannum, Staphy CONSUMPTION. 419 sagria, Acidum phosphoricum, Sanguinaria canadensis, are those by means of which the symptoms may be materially mitigated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in the chapter on CouGi. When the colliquative sweats are peculiarly distressing, Sanmbucus, Stannum, Cinchona, Phosphorus, Arsenicum, Carbo v. et a., Silicea, Mercurius, Nitrum, Lachesis, Sulphur, and Zycopodium are the medicines which are of the greatest service. The remaining morbid symptoms must regulate their selection. When colliquative diarrhoea predominates: China, Ferrum, Arsenicum, Phosphorus, Acid. phosphoricum, and Sepia are the most useful. (See DIARRH(EA.) In phthisis resulting from imperfectly treated pulmonic inflammation, or from excessive pulmonary hemorrhage, and occurring in habits which are not of the consumptive diathesis, the remedies which are best calculated, under favorable circumstances, to effect a cure are: Lachesis, Lycopodium, Sulphur, JMercurius, and Ledum. But, in some cases, one or more of the other medicaments noticed under tubercular consumption, may be better indicated. (See also PNEUMONIA.) In pituitous phthisis, or blenorrhma of the lungs, the most effective medicines are Stannum, Dulcamara, Pulsatilla, Sulphur, Sepia; and Calcarea, Lycopodium, Cinchona, Phosphorus, Silicea, Arsenicum, Zincum, Capaiva, &c. While conducting the treatment of consumption, the state of the digestive functions, and in females the condition of the uterine system likewise, must be strictly attended to. This is, however, a superfluous precaution to the homoeophatic practitioner, as he is ever careful to pay due regard to every symptom, not only in this, but in every other disease. Should none of the remedies above quoted correspond to the derangements alluded to in particular cases, although they may be otherwise indicated, an intercurrent remedy may be selected from amongst those we have mentioned in the articles on DYSPEPSIA, CHLOROSIS, &c. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies. In conclusion, it must be remarked that as the irritation which is so repeatedly created in the lungs by the vicissitudes 420 IESPIRATOIY SYSTEM. of climate, so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means be taken to avoid that pernicious influence. It has been much in vogue with many medical men to recommend warm climates or well-sheltered situations, even although the atmosphere might be of a humid and relaxing nature. But we confess that we are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry and not of very variable temperature. Much, however, depends upon the peculiarity of the case, the air, as well as the food, which may be well adapted to one patient, being often perfectly inappropriate and therefore injurious to another. ASTHMA. This affection is characterised by the following phenomena: difficulty of breathing, recurring in paroxysms, attended with a sensation of suffocating constriction in the chest, cough, and wheezing. The paroxysm is frequently preceded by a sense of coldness, languor, headache, heaviness over the eyes, sickness or flatulence, and a sense of oppression in the chest. During the attack, the patient feels much worse in the recumbent posture, and consequently sits up, requests the door or window to be thrown open, to admit more air into his apartment, and uses every effort to dilate and empty the lungs. He also experiences great restlessness, making frequent attempts to force something out of the air-passages, which he thinks impedes the breathing, by coughing. The face is pale or livid, and wears an anxious expression. The extremities, and even the nose and ears, are frequently cold, and the face and chest are covered with cold perspiration; the heart palpitates; the pulse is variable, being quick and full, or small and quick, or weak and irregular; often intermitting. These symptoms continue with a greater or less degree of violence for some hours or even days, until expectoration takes place, which affords relief as it increases in quantity. A remission also sometimes takes place soon after an accession of copious perspiration or a profuse discharge of urine. The disease is more freouently met with at an'advanced than at an early stage of ASTHMA. 421 life, and oftener in men than women. The attacks occasionally come on in the afternoon, or on retiring to rest, but much more frequently during the night, and in the midst of a sound sleep, from which the patient is suddenly awoke by a sense of suffocation. The recurrence, as well as the duration, of the attacks is very various. One attack generally leads to another, and the paroxysms commonly become more and more frequent and distressing; still if no organic disease result, patients who are subject to returns in considerable frequency, sometimes survive to an advanced age. But this is unfortunately not often the case, for unless the disease be arrested, the repeated obstruction and disturbance which is offered to the respiration and circulation, seldom fails, in the majority of cases, to induce organic lesions either of the heart or large vessels, or of the lungs, with the usual concomitants of water in the chest or abdomen. The quantity of expectoration is small, and even entirely absent in some cases of asthma, whilst in others it is exceedingly copious; and hence, the disease has been divided into dry and humid asthma. In the former (Asthma siccum), the attack is usually sudden, violent, and of short duration; the cough slight; the expectoration scanty, appearing only towards the termination of the fit, and in some instances entirely wanting. In the latter (Asthma humidum), the paroxysm is gradual and protracted; the cough severe; the expectoration supervenes early, is at first scanty and glutinous, and afterwards copious and productive of great relief. THERAPEUTICS. In nervous or convulsive asthma (Asthma siccum), the remedies which have been employed with the most satisfactory results are: Arsenicum, Cuprum, Ipecacuanka.-Nux v., Bryonia, Pulsatilla.- Opium, Tartarus, Sambucus.-Aconitum, Belladonna, Phosphorus.Sulphur, Lachesis, Sambucus.-Ferrum, Veratrum, Mloschus, Stannum, Hyoscyamus, Stramonium, Chamomilla, Carbo v., Aurum, Lycopodium, Acidum nitr., Ignatia, Kali, Ambra,.Mercurius, Silicea, Calcarea, Dulcamara, Coffea, obelia inflata, &c. In moist, humid, pituitous asthma (asthma humidum): Pulsatilla, Dulcamara, Stannum.-Sulphur, Sepia, Tartarus, Cuprum, Sambucus.-Ipecacuanka, Belladonna, Bryonia.-Ferrum, Calcarea, lachesis, Graphites, 422 RESPIRATORY SYSTEM. China, Silicea, Hepar, Baryta c., Conium, Camphora, Zincum, 1Mercurius. In flatulent asthma: Nux v., Cinchona, Carbo v., Lycopodium, Chamomilla, Phosphorus, Sulphur, Opium, Zincum, &c. In spasmodic asthma, pulmonary spasm (cramps in the chest): Cuprum, N-ux v., Bryonia, Belladonna, Hyoscyamus, Arsenicum, lachesis, Stramonium, Cocculus, N.ux m., Sambucus, Tartarus, Zincum, Sulphur, Kali, Causticum, Sepia, Stannum, Lycopodium, &c. Asthma arising from exposure to irritating vapors, such as copper or arsenic (asthma vaporosum): Ipecacuanha, Mercuirius, Hepar s.--camphora, Cuprum, or Arsenicumn. From the vapor of sulphur: Pulsatilla chiefly; and when caused by the continued inhalation of stone-dust, and other irritating particles: Szuphur, Oalcarea, Silicea, Hepar, have principally been recommended, and in some cases, also, the following: Arsenicum, Belladonna, Nu x v., Phosphorus, Ipecacuanha, and Cinchona. Where the repercussion or retropulsion of an eruption, or the suppression of an habitual discharge has been the occasional cause (asthma metastacum): Sulphur, Carbo v., Arsenicaum, Bryonia, and Phosphorus are the most appropriate remedies in the majority of cases. If the affection is attributable to suppressed catarrh: Arsenicum, Ipecacuanha, Nux v., &c. Where a chill has given rise to an attack of asthmatical breathing: Ipecacuanha and Arsenicum; or, Dulcamara, Aconitum, Belladonna, Bryonia, Chamomilla. And when mental disturbance has brought on a paroxysm of dyspncea: Aconitum, Chamomilla, Ignatia, Cofea, Nux v., Pulsathlla, Yeratrum. When congestion of blood in the chest forms the occasional cause of dyspncea, see that article. When the disorder occurs as a sequela of bronchitis, see BRONCHITIS. The remedies which are best calculated to afford relief during a paroxysm of asthma are, Ipecacuanha, followed, if it produces but little benefit, by Arsenicum. In other cases Cuprum, Mfoschus, Opium, Tartarus and Sambucus; or Nux v., Bryonia, Chamomilla, Belladonna, Cinchona, Neux moschata, or Pulsatilla will prove more useful. And those which have principally been recommended to eradicate the tendency to suffer from continual recurrences of the disorderwhere that is practicable from the absence of serious organic ASTHMA. 423 disease, &c.-are as follows: Sulphur, Calcarea, Arsenicum, Nux v., Antimonium,-Stannum, Sepia, Silicea, Cuprum, Iachesis, Carbo v.,-Lycopodium, Causticum, Graphites, Acidum nitricum, Phosphorus, Ammonium c., Ferrum, Zincurm, Tussilago. In ordinary cases the subjoined remedies will be found serviceable, when the leading symptoms are in accordance with those which are described. IPECACUANHA. During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in children or adults. It is more especially indicated when the patient is awoke from a sound sleep, with a suffocating sensation of constriction in the windpipe, with quick laborious breathing and gasping for breath; wheezing and mucous rattling in the chest; short dry cough; paleness and coldness of the face, sometimes alternately with heat and redness; coldness of the feet; anxiety and dread of suffocation; feeling as if dust were inhaled during the act of respiration, and caused by the suffocating sensation in the chest; spasmodic rigidity of the body, and livid hue of the face. After a dose or two of Ipecac., it is occasionally requisite to have recourse to Arsenicum to afford further relief. In other instances Nucx. or Bryonia will be found better adapted to remove the remaining symptoms. ARSENICUM is chiefly called for (either in acute or chronic asthma) when, during the attack, the respiration appears to become more and more laborious, and is attended with extreme agitation, moaning, and jactitation; great exhaustion and anguish, as if at the point of death, with cold perspiration. In confirmed asthmatics, it forms a most important remedy, when the breathing is liable to become much oppressed when walking rather quickly, or when going up a hill, or ascending stairs; and when, particularly in the case of old people, even the effort of laughing, or the exertion of getting into bed brings on a fit of dyspncea. Arsenicum, as well as Ipecacuanha, is further indicated when the paroxysms of asthma are most liable to occur on retiring to rest, or before midnight, the patient being disturbed from sleep by a sense of spasmodic constriction in the chest and larynx, which is soon followed by laborious, panting, and whistling respiration, with gasping for breath. These symptoms are 424 RESPIRATORY SYSTEM. occasionally relieved by remissions, but the attack is prone to recur on using the slightest exertion: for the most part, however, the paroxysm continues with more or less intensity until relieved by the accession of a fit of coughing, with expectoration of viscid mucus, filled with vesicles. Arsenicum, though principally called for in cases in which the attacks come on at night, is also useful when they are liable to be excited during the day, on exposure to a cold bracing air, or on going out during the prevalence of disagreeable, damp, or stormy weather. Likewise when changes of temperature, and tight or very warm clothing, are frequent sources of fits of dyspncea. Sensation of burning heat in the chest during the fit of asthma, is an additional indication for Arsenicum. (Acid. hydrocy. or Kali Aydro. may sometimes be had recourse to with decided advantage when Arsenicum fails to give much relief.) BRYONIA. This medicine, as already mentioned, is frequently useful after the previous employment of Ipecacuanha. The indications are chiefly: obstructed respiration at night or towards morning, with frequent cough, pains in the hypochondria, and inability to recline on the right side, and not without inconvenience on the left, so that the patient is constrained to lie on the back; frequent coughing, with expectoration at first frothy, and subsequently thick and glutinous, and frequently attended with retching or vomiting; aggravation of the dyspnoea from talking, or from the slightest movement; frequent efforts to obtain sufficient air by deep inspirations, accompanied with moaning, palpitation of the heart, and great anxiety. The attacks are often attended by shootings in the chest on taking a full inspiration, also on coughing, or after any movement of the arms or trunk. At other times there is colic, eructations of the taste of the food partaken of, irritability of temper, and disposition to find fault with everything. (Bryonia and NJux v. are often administered with great advantage in alternation.) Nux VoMICA. Nocturnal attacks of suffocating tightness, especially at the lower part of the chest, preceded by disagreeable or anxious dreams; also when the paroxysms are prone to occur in the morning, or after a meal, and are attended with anxiety, aching and pressive pains in the ASTHMA. 425 precordial region, as also in the hypochondria; feeling of distention in the abdomen and epigastrium; flatulence; tension, pressure, and aching in the chest; palpitation of the heart; short hacking cough, with difficult expectoration; inability to bear the slightest pressure from the clothing, particularly around the chest and waist; the clothes seem to fit tightly, and increase the difficulty of breathing, whilst in reality they are quite the reverse; dyspnoea when walking and conversing in the open air, especially if the temperature be somewhat cold; dyspncea after trivial corporeal exertion of any kind. Melioration of the asthmatic sufferings when reclining on the back, or on changing from one posture to another, such as sitting up, and then lying down again, or turning from one side to the other. Disposition irritable and passionate. PULSATILLA. Oppressed, rapid, and laborious breathing from a feeling of spasmodic constriction in the chest, especially at the inferior portions,; or suffocating feeling in the windpipe, as if caused by the vapor of sulphur: tension, and sensation of fulness, pressure and aching, attended with mucous rattling in the chest; short fits of coughing in rapid succession, and appearing to threaten suffocation; or cough with copious expectoration of mucus. The attacks usually coming on at night, or in the evening when in a horizontal posture; extreme anguish, palpitation of the heart, and sometimes lancinating pains in the chest during the paroxysms. Pulsatilla is generally more suitable for hysterical females, or individuals of a mild, timid, sensitive, or fretful disposition. In dyspncea, with mucous rattling, and cough, occurring in children from taking cold, it is likewise a most useful remedy. TARTARUS EMETICUS. Dyspncea with suffocating cough and anxious oppression at the precordia, arising from an excessive secretion of mucus in the bronchi; this remedy is frequently of great service, either in aged persons or in children. OPIUM. Obstructed breathing, either from congestion or from pulmonary spasms, with suffocating cough and livid hue of the face; loud mucous rattling in the chest, with 426 RESPIRATORY SYSTEM. extreme anguish from dread of suffocation; dyspnoea during sleep resembling nightmare (incubus). CHINA. Paroxysms of asthma at night, as if caused by an accumulation of mucus in the windpipe; wheezing in the chest during inspiration; difficult expectoration of thick transparent mucus; oppression at the chest, palpitation of the heart, and inability to breathe, unless the head and shoulders are propped up with pillows; great weakness, and tendency to copious sweating at the slightest exertion, or when too warmly clothed. SAMBucUs. Rapid and laborious respiration, with loud wheezing; oppression at the chest as if from a weight, attended with anguish and dread of sufocation, and sometimes swelling and livid hue of the face and hands, general heat, tremor, inability to talk much above a whisper; suffocating cough; aggravation of the symptoms in the recumbent posture. In the case of children this remedy is often of great service, when, in consequence of a chill, they are seized with spasm in the chest, and awake from sleep with a start, and exhibit many of the symptoms detailed. (See SPASMS IN THE CHEST.) MOSCHUS. Acute asthma occurring in hysterical females, or in children from exposure to cold; sense of spasmodic constriction in the larynx and bronchi; or oppression at the chest with paroxysms of suffocating feelings, as if caused by the inhalation of the vapor of sulphur, commencing with a fit of coughing and succeeded by distressing oppressive constriction, sometimes to such a degree as almost to drive the patient to exasperation and distraction. BELLADONNA. Difficulty of breathing, particularly when occurring in females of an irritable habit, and subject to spasms, with tension in the chest, and lancinating pain behind the sternum; dry cough at night, with moaning respiration, which is sometimes deep andfull, and at others short and rapid, with gasping for breath and great efforts to dilate the chest to the utmost to obtain a sufficient supply of air; sensation of constriction in the larynx, and feeling as if suffocation would ensue on putting the hand to the larynx, or on turning the neck; paroxysms of asthma, with loss of consciousness, &c. LACHESIs is often useful when only partial relief has been effected by the action of Belladonna. ASTHMA. 427 VERATRUJM. In violent attacks of acute spasmodic asthma, with symptoms of threatening suffocation, cold perspiration, coldness of the nose, ears, and lower extremities, this remedy will often afford relief when Cinchona, Ipecacuanha, and Arsenicum have failed to do so. DULCAMARA. In moist asthma (Asthma humidum) this medicine is one of the most useful remedies, particularly when the attacks are liable to be excited by a cold and damp state of the atmosphere. In severe dyspnoea, with loose sounding cough, rattling of phlegm in the chest, and copious expectoration, arising from exposure to wet, it is likewise a valuable remedy. STANNUM. Hfumid asthma, with wheezing and obstructed respiration, particularly at night, or on preparing for bed; but also when the paroxysms come on during the day, and render it necessary to loosen the clothing. The attacks are attended with oppression at the chest, and mucous rattling; cough, with copious expectoration of viscid or grumous, or transparent and watery, or yellowish mucus of a sweetish or saline taste. Phosphorus, Sulphur, Calcarea, Sepia, and lycopodium, are also of much value in humid asthma, and of great service in some of the most obstinate cases. In chronic asthma, a dose of the medicine required may be taken at intervals of from four to eight days or so; but in acute cases, or when the remedy is prescribed during the paroxysm, the dose may be repeated at intervals of from half an hour to two hours and upwards, according to the severity of the case. When the medicine first prescribed affords no relief after from two to three repetitions, another must be selected, preference being given to that remedy which corresponds the nearest to the existing symptoms. DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM. DETERMINATION OF BLOOD TO THE HEAD. Congestio ad Caput. THIS is an affection to which many individuals who lead a sedentary life are subject: intense mental application and habitual indulgence in the use of spirituous liquors, or other stimulating liquids, such as coffee, &c., are also its frequent exciting causes, particularly in those who inherit a predisposition to the order. DIAGNOSIS. Fulness of the vessels of the head and neck, the pulsation of which the patient experiences through the entire frame; heat, redness, and turgidity, or pallor and puffiness of the face, with anxious expression of countenance; repeated attacks of giddiness, particularly after sleeping, or sitting in a warm, confined apartment, or on exposure to the rays of the sun when exercising in the open air; headache, generally above the orbits, and in the forehead, increased by stooping or coughing; dimness of vision; buzzing in the ears; tightness around the throat; oppressed breathing; furred, red-pointed, or enlarged and very red-looking tongue; dyspepsia, constipation, disturbed, unrefreshing sleep; drowsiness during the day. THERAPEUTICS. Aconitum napellus, Nux vomica, Belladonna, Opium, Cofea, Chamomilla, Ignatia, Arnica, Mercurius, Pulsatilla, Dulcamara, Cinchona, Sanguinaria canadensis, &c. AcONITUir. This is the principal remedy to commence with in all recent cases, and is alone sufficient speedily to remove the affection, particularly in children, when fright and anger combined have been the exciting causes. Nux voMIcA. As has already been repeatedly observed, this remedy is exceedingly efficacious in complaints arising from sedentary habits, intense study, or that much more culpable habit, the excessive indulgence in spirituous or vinous liquors, &c.; it is accordingly one of the most useful remedies in determination of blood to the head, induced by such causes; DETERMINATION OF BLOOD TO THE HEAD. 429 it is also very serviceable in cases arising from a violent fit of passion, and is more particularly indicated when we meet with the following symptoms: distension of the veins, with violent pulsation in the head; heat and redness, or paleness, or sickly hue of the face; attacks of giddines, violent headache, particularly in the forehead and over the orbits, aggravated by reflecting, or by any attempts at mental application, also by stooping or coughing; disturbed sleep; nervous excitability, and disposition to be angry at trifles; constipation. Calcarea will frequently be found of signal benefit after Nux V., in obstinate cases occurring in persons addicted to indulgence in spirituous liquors. BELLADONNA. After a previous administration of Aconite, when necessary, this is one of our most important remedies in the treatment of congestion to the head. Indications: great distension of the vessels of the head, attended with severe jerking burning pains in one half of the head, aggravated by the slightest movement or the least noise; fiery redness and bloatedness of the face, redness and protrusion of the eyes, sparks before them, and sometimes dimness of vision; darkness before the eyes (obscurity); diplopia; buzzing in the ears.; bright redness of the throat; attacks of fainting; somnolency. OPIUM is of speedy service in cases arising from fright but it is, moreover, a remedy of extreme value in the most serious cases of congestion, either arising suddenly from the effects of a draught of cold or iced water, especially when heated, or from other causes, with the following symptoms: vertigo, heaviness of the head, humming in the ears, dulness of hearing, stupor; also when the attack is occasioned by constipation, or the effects of a debauch, with pressure in the forehead from within outwards, with redness and bloatedness of the face, great depression, fugitive heat; violent thirst; dryness of the mouth; acid regurgitations, nausea or vomiting. COFFEA. In cases arising from excessive joy, this remedy will be found to exert a salutary influence. Symptoms: excessive and uncontrollable liveliness; great heaviness of the head, or aggravation of the sensations when speaking; sleeplessness. 430 NERVOUS SYSTEM. CHAMOMILLA. Congestion caused by vexation, or a fit of passion, particularly in children, is speedily relieved by this remedy. IGNATIA, when induced.by stifled vexation, or harrowing concentrated grief. ARNICA. In cases arising from external violence, such as severe falls or contusions, followed by stupefaction, vertigo, sensation of pressure or coldness over a small circumscribed space; tendency to close the eyes; disposition to be frightened, and vomiting,-the external and internal administration of Arnica, when timely had recourse to, will frequently be found specific. This remedy is, however, equally useful in other cases with the following symptoms: heat in the head, with coldness of other parts of the body; sensation of obtuse pressure on the brain; painful burning or throbbing in the cranium; humming in the ears; vertigo, with confused vision, especially on assuming the erect posture after sitting for some time. MERCURIUS. Congestion, with sensation of fulness, or, as if the head were compressed by a band; nocturnal aggravation with darting, piercing, tearing, or burning pains; disposition to sweating. After Arnica, Belladonna, or Opium,.Mercurius is frequently found serviceable in completing the cure. PULSATILLA. This remedy, as will be found stated in the proper place, is well adapted to many cases of congestion occurring in young girls at the critical age, or to all cases occurring in cold, lymphatic temperaments with the following symptoms: distressing semi-lateral pain in the head, particularly of a pressive character, or if the pain in the head commences at the occiput, and extends to the root of the nose, or invertedly. Amelioration of the symptoms from exercise, or from pressing or binding the head; exacerbation while sitting; sense of weight in the head; vertigo; face pale and wan-like, or red and bloated; inclination to weep; anxiety; coldness, or shivering. LYCOPODIUM is a valuable remedy in some obstinate cases of congestion attended with giddiness, ebullition, flatulence, anxiety, and habitual constipation. DULCAMARA. Congestion, attended with continual buzzing DETERMINATION OF BLOOD TO THE HEAD. 431 in the ears, dulness of hearing, and particularly when the affection has arisen from getting the feet wet, or from a chill in cold, damp weather. SANGUINARIA CANADENSIS. Distension of the vessels, heaviness of the head, with fulness and aching, as if the head would burst; pressure behind the orbits. The pains are chiefly complained of in the forehead, sinciput, and right side of the head. CINCHONA. Congestion occurring after repeated bloodlettings, or hemorrhage in general, is generally relieved by this remedy. After the completed action of Cinchona, a dose or two of Sulphur and Calcarea carbonica, at intervals of about a week, will materially tend to strengthen the impaired constitution, when Cinchona is not of itself sufficient to effect that desirable object. Nux v., Veratrum, and Valerian, are also valuable remedies in particular cases arising from debilitating losses. Attention may also be directed to the following remedies: RAus toxicodendron, Bryonia alba, Cicuta virosa, Ieepar sul)phuris, Silicea; the two latter, together with Sulphur and Calcarea, are more particularly adapted to the treatment of chronic cases. (See also DYSPEPSIA and APOPLEXY.) In those cases where patients have habituated themselves to the periodical abstractions of blood, as a temporary mode of relief, the employment of Aconitum and Belladonna, in alternation, commonly suffices to obviate the necessity of having recourse to such a culpable practice. Occasionally, it will be found requisite to select other remedies, such as N'ux v., Suph., China, &c., in addition, or in preference to, Aconitum and Belladonna. In cases of giddiness simply, or when that is the prevailing symptom, the following remedies are amongst the most useful: MERCURIUS, when the giddiness comes on only in the evening, especially on assuming the erect posture; or in the morning on getting out of bed; and is attended with nausea, dimness of sight, heat, anxiety, and desire to lie down. Nux voMICA,-giddiness during mental application, or after a meal, or when in the recumbent posture, particularly in nervous or bilious subjects; and in cases where sedentary habits INFLAMMATION OF THE BRAIN. 433 CoNImu. Violent giddiness, with dread of falling to one side when looking backwards. Giddiness arising from disordered stomach, with nausea or vomiting: Aconitum, followed by Antimoniumn crudum, and subsequently Pulsatilla, if necessary from a continuance of the symptoms in a greater or less degree. DIET. The homoeopathic regimen already given in the introduction should be rigidly adhered to, and stimulants of all kinds carefully avoided; moreover, early rising, and daily exercise in the open air should not be.neglected; the use of the flesh-brush in the evening is also of some service. INLFAMMATION OF THE BRAIN AND ITS TISSUES. BRAIN FEVER. Phrenitis. Encephalitis. DIAGNOSIS. Coma, or constant delirium, or both, with signs of determination of blood to the head; fulness and redness of the face and eyes; breathing of the carotid and temporal arteries; occasional attempts to grasp the head. When it is caused by inflammation of the tissues, the pain is more acute than that arising from inflammation of the substance of the brain. Paralysis also more frequently accompanies the latter form. In inflammation of the brain or its membranes, the symptoms are exceedingly diversified; the extent and duration of the disease, the age, the sex, and constitution of the patient, all combine to give to the affection a variety, of character. Much assistance may be derived, in ascertaining whether the brain is affected or not, from examining the eyes and general expression of the countenance. The pupils in the first stages are commonly found more or less contracted, but as the disease advances, they often become dilated. Occasionally the attack is preceded by premonitory symptoms, such as congestion of blood to the head, attended with sensations of weight or stupefying, pressive, constrictive, and sometimes shooting pains in the head. In some instances slight feverish symptoms are complained of, with ringing in the ears for about the space of a week; giddiness, and a sense of weight on the crown of the head; pulse rather quick, and the heat of the skin somewhat increased at night, attended with restlessness 28 434 NERVOUS SYSTEM. and a difficulty of lying long in one position; moreover, the patient is observed to be irritable and annoyed at trifles; anomalies in the mental powers may next be observed, such as obstupefaction, drowsiness, with slight delirium; or a high degree of excitement, in which the patient is affected by the slightest noise, and the eyes have a brilliant and animated expression, or are bloodshot, with fiery redness of the face, violent delirium (delirium ferox). According to the seat of the inflammation, or the constitution of the patient, the accompanying fever is of greater or less intensity; the pulse is very variable in the course of the same day; it may be regular, intermitting, quick and weak, or very slow and strong. A very slow or very quick pulse generally indicates danger. The patient frequently complains of heat in the head, whereas the extremities are cold. When there is stupor, or a tendency to it, the eyes look heavy and void of all expression; vomiting sometimes takes place, and proves very intractable; the stupor becomes more profound, convulsions appear, and death sooner or later ensues. The peculiar and delicate structure of the brain and its membranes in children, renders them much more susceptible of the attacks of this serious disease, and great attention ought to be paid to the following symptoms: heaviness and tendency of the head to gravitate backwards, attended with pain (of which latter circumstance we are sometimes made aware, in very young children, by the little sufferer frequently raising its hands to the head); alternation of temper; intolerance of light; nausea, occasionally followed by vomiting; tendency to costiveness; drowsiness; wakefulness, or starting during sleep. Secondly, continuous boring of the head against the pillow; a high state of excitement, in which the slightest noise or ray of light throws the child into a fit of screaming, or a state of discontentment; heavy sleep; great heat in the head; redness and swelling of the face, with perceptible throbbing in the vessels of the head and neck; great agitation with continued tossing about, especially at night; eyes red, sparkling, convulsed, or fixed; pupils immoveable, and generally dilated. CAUSES. Anything tending to irritate the brain, such as extremes of heat or cold; the abuse of ardent spirits; external injuries of the head; concussion from falls; mental emo INFLAMMATION OF THE BRAIN. 435 tions, or over-exertion of the faculties; excesses of all kinds; sanguineous congestion; metastases; contagious diseases; repressed eruptions, &c. THERAPEUTICS. We should have immediate recourse to ACONITE at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indications of pure Inflammatory Fever, which is especially liable to be the case in young plethoric subjects. After the employment of Aconite we may have recourse to any of the following remedies as indicated; namely, Belladonna, Hyoscyamus, Opium, Stramonium, and Cuprum aceticum. BELLADONNA. This medicine seems to possess a certain specific influence over inflammation of the brain and its meninges; and is generally the remedy we should select, when the following, amongst other symptoms, present themselves: great heat of the head; redness and bloatedness of the face, with violent pulsation of the carotids; boring of the head in the pillow, and increase of suffering from the slightest noise, with extreme sensibility to light; violent shooting and burning pains in the head; eyes red and sparkling, with protrusion or wild expression; contraction or dilation of the pupils; violent and furious delirium; loss of consciousness; sometimes low muttering; convulsions, occasionally symptomatic hydrophobia; vomiting; involuntary evacuations of foeces and urine. BRYONIA. This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial improvement, and the symptoms indicate a tendency to rapid effusion; in which case also Hfelleborus may follow Bryonia if required. (Vide HYDROCEPHALUS.) HYoscYAMUs is appropriate when there is drowsiness, loss of consciousness, delirium about one's own affairs; inarticulate speech; tongue coated white, with frothy mucus about the lips; dilatation of the pupils; fixedness of vision; skin dry and parched; redness of the face; and picking of the bedclothes with the fingers. OPIUi~. When there is lethargic sleep, with stertorous breathing; half open eyes, and confusion or giddiness after 436 NERVOUS SYSTEM. waking; sanguineous congestion; complete apathy and absence of complaint. STRAMONIUM. When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and tossing about; vision fixed, and the patient frequently appears in a state of dread, and utters cries; redness of the face; feverish heat, with moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Belladonna, with the exceptions of being indicated by the more prominent existence of spasms, and less acuteness of pain in the head. ZINCUM may be employed after, or in alternation with Belladonna, when that remedy produces only a partial degree of amendment. In those extreme cases where symptoms of threatening paralysis of the brain are manifested by the following indications: loss of consciousness; half closed eyes; dilated, insensible pupils; icy coldness of the extremities, or of the entire body; blueness of the hands and feet; impeded respiration; small, weak, scarcely perceptible pulse-Zincum has repeatedly been found effectual in preventing a fatal issue.* Dose. Gr. ss. to gr. j. of the first trituration, every hour, until signs of improvement set in, in which case the intervals between the doses must be lengthened. (See also Hydrocephalus). CUPRUM ACETICUM. The reputed value of this remedy in cases of repercussed exanthemata, and the consequences therefrom arising, have been already noticed under SCARLET FEVER; under which also some of the symptoms indicating its employment are commented upon; it is also called for in a peculiarly sensitive rather than an inflammatory or irritable state of the brain, which not unfrequently appears in children, during the course of catarrhal fever or difficult dentition, of which affection the following are the symptoms: at the commencement, crossness or fretfulness, or apathy and indifference; sleep disturbed and restless. As the disease gains ground, drowsiness, with inability to sleep; incapability of holding the head erect, * Allg. Horn. Zeit. No. 15. 31ster Bd. APOPLEXY. 437 and flushing of the face; dryness of the mouth without increase of thirst; disgust to food, nausea, even vomiting; torpor of the bowels, rarely diarrhcea; shudderings; followed by heat, and occasionally burning, unfrequent perspiration; pulse variable, generally rather accelerated and full; exacerbations of fever (synocha) towards evening and at night; subsultus tendinum, and grinding of the teeth during the exacerbations. Belladonna, Phus, Lachesis, and Mercurius have also proved serviceable in cases arising from repercussed exanthemata. CINA is useful in irritation of the brain in children, apparently arising from helminthiasis. In chronic cases, Sulphur, Ilelleborus niger, Arsenicum, and Lachesis, are the more generally useful. It may be added, that Aconite followed, if required, by Belladonna, Camnphora, or Iachesis, is the most appropriate course of treatment, when the affection has arisen from exposure to the sun (coup de soleil). Aconite, Bryonia, Arsenicum, Hyoscyamus, when result, ing from a violent chill in the head. From suppressed otorrhoea, Sulphur, Pulsatilla. External injury, Arnica, Belladonna, Mercurius. Abuse of ardent spirits, Opium, Zachesis. And-when from intense mental application, Belladonna, &c., according to the symptoms. Antimon. tart. has been recommended as deserving of attention in inflammation of the brain and its membranes. APOPLEXY. APOPLEXTA. DIAGNOSIS. Sudden or gradual loss of consciousness, sensation, and motion, with greater or less disturbance of the pulse and respiration. Few diseases offer a greater number of varieties in form than apoplexy; and there is scarcely a single classification of the many, that eminent medical writers have given to the world, which is not more or less liable to objection. It is also extremely difficult to diagnose clearly between the different varieties, the external symptoms not always bearing a uniform relation to the internal injury; thus, all the indica 438 NERVOUS SYSTEM. tions of serous apoplexy may declare themselves from sanguineous extravasation; and it is not always possible to decide in apoplexy whether effusion or simply congestion of the vessels of the brain has taken place. PREMONITORY SYMPTOMS. Continued inclination to somnolence, heavy profound sleep, with stertorous breathing, incubus, grinding of the teeth, shocks or cramps, a general feeling of heaviness or disinclination to the least exertion; frequent yawning and fatigue after the slightest exercise. A sense of weight and fulness, and pains in different parts of the head, sometimes very deep-seated. Cephalalgia and megrim, or vertigo and fainting; pulsation of the temporal and carotid arteries, with swelling of the veins of the head and forehead; disturbance of the cerebral system, evinced by loss of memory, forgetfulness of words and things, irritability of temper, or mildness and indifference, despondency and weeping; infiltration of the conjunctiva, dimness of vision, specks or motes before the eyes, or flashes of fire or sparks during darkness; acuteness of vision or diplopia, sometimes also the words in a line appear to run into one another; difficulty of opening or closing the eyes; noises, humming, singing, &c. in the ears; dulness of hearing, dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor, sneezing, and slight epistaxis; stammering, and indistinct enunciation; difficulty of deglutition, numbness or torpor, or pricking sensation in the extremities, with occasional partial attacks of paralysis in the face, distorting the features and affecting the utterance, or in some of the muscles of the limbs; pains in the joints; weak or unsteady mode of progression, difficulty of micturition, &c. TREATMENT. Against the preceding, Homceopathy possesses remedies, by whose proper application the practitioner may, if consulted in time, succeed in warding off the attack of this dreaded malady. The following are the medicines most appropriate to the treatment of the foregoing symptoms, and also most generally called for in the treatment of the disease itself: Aconitum, Belladonna, Nux vomica, Iachesis, Opium. ACONITUM. In all cases where there are evident symptoms of plethora, determination of blood to the head, characterized APOPLEXY. 439 by redness and fulness of the face, distension of the veins of the forehead, quick, full pulse, restless and anxiety.* BELLADONNA. Should the symptoms of congestion not speedily yield to Aconite, or should only a partial degree of amelioration have taken place; or further, should the following symptoms present themselves: redness and bloatedness of the face, injection of the conjunctiva, violent beating of the carotid and temporal arteries, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, by the least noise or bright light; or diplopia, and almost all the symptoms relative to the eyes already mentioned; dryness of the nose, with unpleasant smell and epistaxis; difficulty of deglutition; slight attacks of paralysis in the face; paralytic weakness, or heaviness in the limbs. Nux vOMICA is particularly suited to. cases in which the apoplexy threatens individuals of sedentary habits addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or to those who have long been affected with dyspepsia, either bilious or nervous, and have consequently more or less of the rheumatic or gouty diathesis, and also when the following symptoms present themselves: headache, deep seated or frontal, but more especially at the right side, with vertigo, confusion and humming in the ears, nausea, and inclination to vomit; turgescence of the capillaries of the face, or redness only of one cheek; drowsiness, feeling of languor, with gre-it disinclination to exertion, either mental or bodily, cramps of the limbs, especially at night, and weakness in the joints; constipation and dysuria, irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air; bilious, sanguine, or nervous temperament. OPIUM is a most important remedy in almost all severe attacks, but particularly in old people, when we find the * Some homoeopathists persist in employing the lancet here; but we believe there are few instances, if any, in which the use of Aconite, followed, if required, by Belladonna or Opium, and sometimes Nux v., according to the characteristic features of the remaining symptoms and the nature of the case, will fail to act as speedily, and certainly with more beneficial ultimate results. 440 NERVOUS SYSTEM. following symptoms: marked congestion to the head, indicated by stupor, vertigo, heaviness in the head, and violent pressure in the forehead, singing in the ears, and obtuseness of hearing, sleeplessness or agitating dreams, or frequent and almost overpowering drowsiness during the day, redness of the face, and constipation; pulse slow, but full. LAcHESIS is indicated by many of the same symptoms which have been enumerated under Nux v., together with the following distinctive characteristics: frequent abstraction of mind, or vertigo with congestion, pains deep in the brain, or severe aching pains at the left side of the head, and lowness of spirits; face pale and puffy, or turgid and somewhat livid; pulse weak and slow. The moment any of the symptoms before noticed present themselves is the proper time to prevent the attack running on to apoplexy; sometimes the signs are so marked, that we can have but little doubt of the result, unless timely precautions are taken; at other times so slightly as to be almost imperceptible; and at others again, the attack comes on suddenly, without any marked premonitory symptoms whatever. (See also CONGESTIO AD CAPUT.) APOPLEXY. The following are the principal remedies which have hitherto been chiefly recommended, or found most successful, in the treatment of the disease itself:Opium, Nux vomica, Belladonna, Lachesis, Arnica, Pulsatilla, Baryta carbonica, Silicea, Stramonium, Zincum metallicum, Acidum hydrocyanicum, Agaricus, &c. In sanguineous or sthenic apoplexy (generally characterised by bloodshot eyes, redness of the face, full, hard pulse, oppressed and stertorous breathing. The paroxysm more usually comes on without warning,-although sometimes preceded by fulness, weight, and a dull pain in the head, attended with giddiness and drowsiness,-the patient suddenly falling to the ground, and seeming as if in a heavy sleep), Opium, Acon., Bella., N1ux v., Lach., Stram., Ant., Cof., Hyos., Puls., &c., are the principal remedies. In asthenic apoplexy (chiefly defined by pale and sallow, but puffy, bloated countenance; feeble and easily compressible pulse, heavy, laborious respiration. This variety is more commonly ushered in by premonitory symptoms than the APOPLEXY. 441 preceding, such as headache, giddiness, loss of memory, illusions of hearing, inarticulate speech, somnolency, and a disposition to clonic spasms), Ipecac., 3Merc., Dig., Arn., -Baryt. c., Cocc., Con., N1ux v., Puls., Zinc., Bella., Cof., IIyos., Stramo., Cip., &c., are more frequently called for. OPIUM is held as a most important remedy in all cases of apoplexy when the disease has attained considerable height. It is one of the best remedies to commence with, when the attack has arisen from excess in drinking, and the symptoms are as follows: slow, stertorous breathing; red and bloated face; heat of the face and head, which latter is also covered with sweat: insensible and dilated pupils; stupor; tetanic rigidity of the entire frame, or convulsive movements and trembling in the extremities; foaming at the mouth. In elderly persons Opium is, as has already been stated, a remedy of primary importance. Baryta c., as will be hereafter noted, is also valuable in such cases, but chiefly, perhaps, after the previous use of Opium. Digitalis, ilerc. or Con., &c., may, however, be required subsequent to Baryta or Opium, and even in preference to these in some instances, especially when of the serous type. Nux VOMICA has been found of great service in completing the cure after the previous use of the above remedy; but may also be employed at the commencement, when the attack has occurred in an individual of bilious, sanguine or nervous temperament, and of irritable temper, in consequence of overindulgence in vinous or spirituous liquors; or when the attack has resulted during or after a fit of passion, and the patient appears in a state of drowsiness approaching to stupor; the breathing stertorous; eyes dull and glassy; hanging of the lower jaw, with copious secretion of saliva; paralysis, particularly of the inferior extremities (paralysis paraplegica); hemiplegia. LACHESIS is also a valuable remedy in this disease, especially when occurring in habitual drunkards; or in choleric, hypochondriacal persons, or those who are frequently affected with melancholy, and are of a spare habit, or of exhausted constitution, with drowsiness or loss of consciousness; lividity of countenance, convulsive movements or tremor in the extremities; stupor or paralysis, especially of the left side; pulse weak and slow. 442 NERVOUS SYSTEM. ARNICA. Apoplexy after too hearty a meal, with loss of consciousness (drowsiness or stupor); stertorous breathing; moaning or inarticulate muttering; involuntary evacuations; paralysis of the extremities (hemiplegia, left side); pulse strong and full. BELLADONNA. Lethargy, loss of consciousness; the patient lies speechless, with the mouth drawn to one side; convulsive movements of the limbs or facial muscles; hemiplegia, particularly of the right side; dilated immovable pupils; red and bloated face. PULSATILLA. Lethargy, loss of consciousness; bloatedness and blueish-red hue of the face, occurring after a full meal, which has been hurriedly swallowed;* or sudden loss of the power of movement; palpitation of the heart; pulse almost entirely suppressed; respiration stertorous; temperament phlegmatic. BARYTA CARBONICA. This remedy, like Opium, is peculiarly well adapted to the treatment of many of the affections of old people. It has accordingly, like the latter medicine, been found very serviceable, when the serious affection at present under consideration is met with in patients of advanced age, particularly when the following symptoms are encountered: Coma somnolentum, with moaning and muttering, circumscribed redness of the cheeks; mouth drawn to one side; paralysys of the tongue, or of the upper extremities; hemiplegia (right side); confusion of ideas; childish manners. The following remedies may also be pointed out as being worthy of the attention of the homceopathic practitioner: Ignatia, Tart. emet., China, and Cocculus (the two last named particularly in cases which have been brought on by excessive depletion, by loss of blood, &c.); and in the paralysis resulting from apoplexy, Belladonna, Baryta, Carbonica, Nuax vomica, Rhus, Silicea, Lycopodium, Lachesis, Graphites, Carb. V., Olean., Bryonia, Cocculus, Plumbum, Stramonium, Stannum, Sulphur, Calcarea, Zincum metallicum, and Electro-magnetism, particularly when occasional twitchings take place in the limbs. * Ipecacuanha is equally indicated when the attack has arisen from such a cause,.;Di.nay therefore be employed after, or in alternation with PulSatilla d the latter remedy not afford speedy relief. MYELITIS. 443 During the paroxysm of apoplexy the patient ought to be placed in a cool room, with the head raised, or put, in short, in such a position as will least favor determination of blood to the head. The clothes ought to be loosened, especially about the neck; and the feet or legs allowed to hang down. It may also be useful to increase the force of the circulation in the feet and legs by means of friction, or by putting them in warm water. We cannot conclude this article without giving expression to the gratification we feel, in common with the majority of the most eminent of our homoeopathic medical brethren, at the gradually increasing distaste to blood-letting evinced by our allopathic colleagues. Many have renounced the use of the lancet altogether; and others, while they do not wholly discountenance its employment, surround the cases, in which they allow it ought to be had recourse to, with so many restrictions as almost to amount to a prohibition of its use. At all events, we may hope that the time. has already arrived, at least for the more enlightened of our profession, when even those who still adhere to the practice in particular cases, will not rashly prescribe bleeding in all instances of cerebral compression, where, if it be had recourse to before a reaction has set in, it may destroy the patient, either by causing him to sink under it, or by producing effusion, if that has not already taken place, or by increasing it if it has. ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES. Myelitis. Meningitis spinalis. This affection is indicated by pain, more or less severe, in some cases of an intermittent character, either confined to the lumbar, dorsal, or cervical region, or embracing the entire length of the spine. The pain is aggravated by the slightest movement, and an exalted sensibility of various parts of the cutaneous surface is often perceptible from the dread and shrinking, which the patient exhibits at the slightest touch. Sharp pain at the epigastrium, sometimes spreading over the whole of the abdominal region, and increased on pressure; palpitation of the heart, sensation of constriction and weight in the fore-part of the chest, with oppressed respiration; 444 NERVOUS SYSTEM. small, quick, hard pulse, are symptoms which are generally encountered in the course of the disorder. When the inflammation occupies only a part of the cord, the symptoms vary according to its locality. Thus, when the commencement, or the cervical portion is principally affected, strabismus, spasm of the pharynx, trismus with loss of voice, spasm, or other abnormal conditions of the muscles of the neck, chest, and superior extremities, with general clonic convulsions, declare themselves. When the dorsal portion of the cord is the seat of the inflammation, opisthotonos usually results; and when that of the lumbar region is attacked, retention of urine, or paralytic or spasmodic affections of the pelvic viscera generally, are met with. In each of the latter cases, the inferior extremities are commonly either convulsed or paralysed. When the membranes of the cord are principally or solely affected, the sensibility of the surface is said to be always increased, and the spasms more frequently general, and of a tonic character. While in inflammation confined to the substance of the cord, the sensibility is usually lessened, the muscles of the extremities are affected with clonic spasm or paralysis, and only those of the back in a state of tonic contraction. In the former, moreover, the bowels are for the most part constipated-while in the latter, diarrhcea has almost uniformly been found to predominate. Finally, according as the power of motion or the sensibility is abnormally altered, so it may be concluded will the anterior or posterior columns of the spinal cord form the seat of the inflammation. CAUSES. Exposure to cold and damp, and external injuries appear to form the leading exciting causes of this inflammation. CHRONIC INFLAMMATION of the spinal cord and its coverings is generally accompanied with a trivial degree of local pain, and its prominent features chiefly consist in derangement of the functions of the viscera, deprivation or diminution of the sense of feeling, paralysis, cramp, and emaciation. The chronic variety is even more dangerous than the acute. The disease, when confined to the substance of the cord, MYELITIS. 445 may terminate in softening (ramollissement); induration; suppuration; gangrene; in effusions of serum, pus, or blood; or in thickening of their structure, when the membranes have been the seat of the inflammation. THERAPEUTICS. Aconitum must be prescribed in repeated doses, in all cases where the accompanying fever is intense; and on the completion of its beneficial action, recourse must be had to Belladonna, Dulcamara, Arsenicum, Digitalis, Pulsatilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Veratrum-according to the portion of the cord which is evidently attacked. BELLADONNA is the most important remedy when the upper part is the seat of the disorder. If, from the invasion of delirium, &c., there is some reason to apprehend an extension of the inflammation to the brain, this remedy will still be the most appropriate, and, indeed, that on which we must rest our chief hope in so serious a complication of a malady, sufficiently dangerous in its simple form. Hyoscyamus, Stramonium, Bryonia, Zincum (particularly with signs of threatening paralysis of the brain), and in some instances Sulphur may, however, be found necessary and prove useful in warding off a fatal result. (Vide PHRENITIS.) Dulcamara * may follow Aconitum and Belladonna, when the more acute symptoms of myelitis have been removed, and particularly when the disease has been excited by exposure to cold and wet. Arsenicum, Pulsatilla, and Digitalis have been recommended as useful auxiliary remedies, when the thoracic viscera are prominently affected, evidenced by laborious and anxious respiration, palpitation of the heart, &c.; and Veratrum, Nux V., Cocculus and Ignatia, when the abdominal viscera are seized with coldness and spasms. Should opisthotonos result from inflammation of the dorsal division of the cord; Belladonna, RAus, Ignatia, and Opium are chiefly to be recommended. Again, when the inflammation is restricted to the lumbar portion of the cord: Nuxw., Cocculus, Digitalis, and Bryonia; or Pulsatilla, ]Rhus, Veratrum, and Sulphur. In general tonic spasms resulting from * Rhus is perhaps still more appropriate than Dulcamara in such cases. The instances in which the latter remedy has been reported to have acted beneficially are involved in some degree of obscurity. 446 NERVOUS SYSTEM. inflammation of the entire cord, or rather its enveloping membranes,-Belladonna, Lachesis, Hyoscyamus, Opium,.Natrum m., and Ignatia are the remedies from which, in general cases, we may expect to derive the greatest benefit. Arnica, IIyoscyamus, and Opium may claim a preference in myelitis arising from external injury; but we must be guided in our selection by the nature of the symptoms, and not hesitate to have recourse to one or more of the above-mentioned medicines if called for. (Vide HYDROPHOBIA and TETANUS.) In the chronic form of the malady, the medicines from which the most benefit may be looked for, when the disease has not reached an irremediable stage, are, in addition to most of those required in the acute variety,-Sulphur, Silicea, Lackesis, Baryta c., Stannum, &c. PALSY. PARALYSIS. This affection consists in the abolition or diminution of the power of voluntary motion. It usually comes on suddenly, but in some instances it is preceded by numbness, coldness, paleness, and slight convulsive jerking or twitching in the parts affected. The treatment must be regulated according to the originating cause. When it results from apoplexy, see that article. When we find it occurring as a sequel of rheumatism: Arnica, Ferrum, Jeuta, as also Bryonia, Rhus, Lycopodium, Sulphur, Silicec, &c. When in consequence of debility from loss of fluids: China, Ferrum, Baryta c., and Sulphur. From the sudden suppression of an eruption, or of a wonted discharge: Sulphur, Lachesis, &c. And when it is attributable to exposure to the fumes of lead, or the frequent handling of white lead: Opium and Belladonna; or Platina, Alumina, Pulsatilla, and Vux v. (These remedies are equally useful in LEAD COLIC, COLIC of PAINTERS, COLIC of POICTOU, colica saturnina, colica pictonum, colica plumbariorum s. pictorum, colica damnoniorum.) With reference to the parts which are affected with the disorder: Belladonna, Graphites, and Causticum are chiefly recommended in paralysis of the facial muscles. Belladonna, Opium, ITyoscyamus, Stramonium, Lachesis, and Graphites in that of the tongue. Belladonna, NVux v., Cocculus, Lycopodium, Calcarea, Silicea, Opium, Zincum, Ruta, &c., in TETANUS. 447 paralysis of the upper extremities. And in that of the inferior extremities, Cocculus, Nux v., Opium, Sulphcur, Silicea, Stannum, and Oleander principally. Electricity or galvanism (electro-magnetism), in moderation, is frequently of considerable service in facilitating the cure, or, at all events, in promoting improvement in obstinate cases, and particularly when painful jerkings or twitchings frequently take place in the affected parts. TETANUS. SPASMS. This is a disease characterised by a general spastic rigidity of the muscles. Its varieties are TRIsMus, the lock-jaw. OPISTHOTONOS,-which is the most common,-when the body is drawn or bent backwards by the spasmodic contraction of the muscles, sometimes to such a degree that the occiput touches the heels. EMPROSTHOTONOS, when the body is bent forwards; a rare form of the disease. PLEUROSTHOTONOS, in which the body is bent to one side; a still more rare variety. The disorder is chiefly occasioned either by exposure to cold (idiopathic tetanus), or by some irritation of the nerves resulting from local injury, particularly of tendinous parts (traumatic tetanus). It is of much more frequent occurrence in warm than in cold climates. In this and in other climates the amputation of a limb, or the twitching of a nerve by a ligature, are not unfrequent sources of its occurrence. When it takes place in consequence of such a cause, or of any other external lesion, the symptoms generally set in about the eighth day, and sometimes later; but when it supervenes on exposure to cold, they usually declare themselves much earlier. In some cases the attack comes on suddenly, and with extreme violence; but it more generally approaches in a gradual manner: a slight stiffness being at first experienced in the back part of the neck, together with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of deglutition, an oppressive tightness is complained of in the chest, with a pain at the inferior extremity of the sternum, or the scrobiculus cordis, extending into the back; the respiration is impeded; the countenance pale, pulse small, bowels constipated, and urine high colored; a stiffness also takes place in the lower jaw, which ere long increases to such an 448 NERVOUS SYSTEM. extent, and compresses the jaws so closely and firmly that the smallest opening is unattainable, and the patient is now afflicted with what is termed lock-jaw. In some instances the spasmodic contractions proceed no further; in others they return with great frequency and increased severity, and also extend to the arms, the abdominal muscles, the back, and inferior extremities, so as to bend the body forcibly in one or other of the directions before stated. Finally, the arms, lower extremities, head, and trunk become rigidly extended, from an equipoised spasmodic action of the flexor and extensor muscles. The tongue is also seized with spasm, and is, not unfrequently, injured by the teeth becoming clenched together, just as it happens to be convulsively darted out. As the affection advances, the eyes become fixed and immoveable, the whole countenance frightfully distorted and expressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings, generally about the fourth day in acute cases, by one concentrated spasm. In some cases the fatal termination is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abatement, but is generally immediately renewed as soon as the patient makes an effort to speak, drink, or change his posture. THERAPEUTICS. The remedies which have chiefly been used in homoeopathy, in the treatment of this distressing disease, are: Belladonna, Stramonium, Cicuta virosa, Arnica, Opium, Hyoscyamus, Angustura, Rhus, Ignatia, Lackesis, Natrum muriaticum, Mercurius, Aconitum, Sulphur, Veratrum, Phosphorus, Camphor, Staphysagria, and Moschus. BELLADONNA is one of the most important of these, particularly in idiopathic tetanus, properly so called, or in trismus; it has also proved useful in the traumatic variety as well, after the previous employment of Arnica. It is principally indicated when a sensation of constriction is experienced in the throat, with tightness at the chest, grinding of the teeth, spasmodic clenching of the jaws, distortion of the mouth, foaming, obstructed deglutition, and a renewal or exacerbation of the paroxysms on attempting to drink. In some cases of trismus the alternate use of Belladonna and Lachesis, or TETANUS. 449 Belladonna, Angustura, and Cicuta virosa has been found necessary; and of Belladonna, Lachesis, Hyoscyamus, and Stramonium, or Opium, Rhus, and Belladonna, in opisthotonos. ARNICA MONTANA. In cases of traumatic tetanus, which is by far the most fatal variety, this remedy is, in most instances, the most appropriate to commence with, and should be used both internally and externally, in the form of an extremely weak lotion (about a teaspoonful or a drachm to half a pint of water). Should symptoms of improvement not set in in twenty-four to forty-eight hours, Opium and Hyoscyamus must be had recourse to. Any local irritation which may seem to have excited the disease, ought, at the same time, if possible, to be carefully removed. OPIUM has proved extremely useful in some of the severest forms of opisthotonos arising from cold; but, as above stated, it is also valuable in traumatic tetanus. (Likewise in tetanus from fright.) RHUS and IGNATIA have been found very efficacious in severe cases of opisthotonos, in which the body has been bent up in the form of an arch, and on some occasions with the back of the head touching the heels, when the complaint has arisen from terror. IMERCURIU has frequently succeeded in curing inflammatory trismus, with swelling of the angle of the lower jaw, and tension of the muscles of the throat and neck, from cold. These are a few general indications for the employment of the foregoing medicines. The following may also prove serviceable in various forms of tetanus: Aconitum, Sulphur, Veratrum, Phosphorus, Camphora, Staphysagria, Mloschus, Bryonia, N1ux, Platina, Ipecacuanha, Secale cornutum, Cannabis indica, Oantharides, Cicuta virosa, Cina, Jhus toxicodendron, Gratiola, Stannum; but considerable care must necessarily be bestowed on the selection of the proper remedy. When, from the spasmodic clenching of the jaws, it is found impossible to introduce the medicine into the mouth, the effect of olfaction must be tried; it has also been found useful to moisten fhe lips and nostrils with the medicine dissolved or diluted in water; and in some cases, the administration of the remedy in the form of an enema (a few drops to an ounce or 29 450 NERVOUS SYSTEM. two of water) has been found very efficacious. (See also HYDROPHOBIA, HYSTERIA, and MYELITIS.) DELIRIUM TREMENS POTATORUTM. This malady consists of an affection of the brain, and is nearly peculiar to drunkards, hence its name. There are a few instances on record, in which it has arisen from exhaustion caused by excessive depletion; from the effects of lead, and also from the prolonged use of opium. The intemperate use of ardent spirits, vinous or strong malt liquors, is, however, beyond comparison, the exciting cause in by far the major number of instances. The disease generally comes on in drunkards, during the state of prostration which ensues when they have in a great measure given up, or been suddenly deprived of, their accustomed stimulus. The first symptoms of the malady are generally indicated by extreme irritability of temper, weakness of memory, but constant activity of mind, anxiety, and uncontrollable restlessness, with increased muscular mobility. The appetite is often pretty good, but more frequently impaired in consequence of the previous habits, and the tongue is sometimes foul, but moist. Soon after these premonitory signs, vigilance sets in, and little or no sleep can be obtained; or it is unrefreshing and disturbed by frightful dreams, imaginary visions and sounds. Fixed ideas then take firm possession of the patient's mind, such as the supposition that some one is bent upon poisoning him, or doing him some other grievous injury, &c., yet he generally dreads being alone. The speech is frequently stuttering and inarticulate; the countenance quick, wild, and exceedingly variable, according to the prevailing impression on the mind; the face in most cases pale or sallow; the eye rolling, expressive, and restless, and the conjunctiva blanched; the skin damp, or covered with sweat, chilly and relaxed, very rarely above the natural temperature; the hands are commonly tremulous, and muscular twitchings are often observable. As the disease advances, sleep is completely banished; loquacity, with perpetual bustling occupation, becomes incessant; and eventually, when it is fully developed, delirium supervenes. The pulse is soft and compressible, and rarely quick when unruffled by the DELIRIUM TREMENS. 451 struggles or exertions of the patient-for his corporal activity keeps pace with the restlessness of his mind, and it is difficult to confine him to his bed or apartment; at the same time, exhaustion is liable to come on very rapidly after great exertion, and the patient is prone to drop down from fatigue. Occasionally, convulsions take place, but though sometimes serious, they are usually not of a fatal character. The history of the case, together with the distinctive nature of most of the above-described symptoms, enables us to discriminate between this disorder and that of inflammation of the brain or its membranes. THERAPEUTICS. Nux v., Opium (provided, of course, the attack has not been excited by the effects of Opium, or its alkaloid, in large doses), Aconitum, Belladonna, Zachesis, Hyoscyamus, Sulphur, and Calc., form our main remedial agents. Nux v. is particularly useful in the first stage of the disorder, and may frequently be the means of arresting its further progress, when administered at that period. The dose repeated in from six, to twelve, or twenty-four hours, according to the effects produced. But when the disease has become fairly established, and the patient is affected with delirium or convulsions, and we find an aggravated degree of all the symptoms remarked at the commencement of the attack, we must have recourse to Opium, in frequently repeated doses. The curative properties of this drug, in the malady under consideration, do not, as is erroneously supposed by the majority of allopathic practitioners, arise from its property of producing sleep, but from its hormcopathicity or specificity, if I may use the expressions; the pathogenetic effects which it produces being exactly similar to those symptoms which are developed in. the course of the disease as it occurs in drunkards. In some cases, particularly where the patient exhibits extreme irritability of temper, with more or less derangement of the digestive functions, considerable advantage will be attained from the alternate employment of _zux v. and Opium. In some rarer varieties of the affection, which are more liable to occur in young, robust, or plethoric subjects, we 452 NERVOUS SYSTEM. meet with symptoms indicative of active cerebral congestion, which call for the administration of a dose or two of Aconite, followed in a few hours by Belladonna, or by Belladonna and Laclzesis, alternately, if only partial benefit is obtained from the action of Belladonna alone, and the trembling of the hands and arms forms a very prominent symptom. Hyoscyamus may be prescribed in preference to Belladonna, when the patient's insanity is more particularly apparent in the exhibition of excessive and uncalled-for jealousy. In extremely obstinate attacks, Sulphur, Opium,- and Nux v. may be given in alternation, at longer or shorter intervals, according to the greater or less severity of the symptoms. Calcarea is also a remedy of considerable importance in such cases, but more especially when they occur in plethoric or lymphatic habits. Finally,-Stramonium, may be mentioned as likely to be useful when Belladonna, Hyoscyamus, and even Opium fail to do much good, and the spasms or convulsions are very severe. Cofea and Camphiora have also been named as likely to prove serviceable against the vigilance, or the mental and bodily activity above described, when the remedies already enumerated fail to answer the purpose required. But it may safely be averred, that there are few instances in which Nu x. and Opium, when timely administered, will not succeed in subduing the more violent features of the disease; and Sulph., Opium, Nux v., and Calcarea, in removing any inveterate sequeloe. These medicines, together with Arsenicum and Acid. sulp2uricum,* administered at intervals of from four to eight days, have also been recommended as useful in correcting the vice which gives rise to this disease as ordinarily met with.t Delirium * In the morning sickness of drunkards, Acidum sulphuricum is a most useful medicament.-Gr. u. St. h. Arch., 1. 1, 173. - Dr. Hering, of Philadelphia, recommends, in the case of inveterate drunkards, a drop of sulphuric acid in a tumbler of water, early in the morning, every two or three days, until disagreeable symptoms arise; in the event of which he orders the patient to smell camphor frequently. When the drunkard has an unconquerable craving for liquor, he advises his friends or relatives to proceed as follows: " Take pure sulphuric acid, mix it with a large proportion of water so that it may taste only slightly acid, and give the mixture to the patient in everything he eats or drinks, and that as liberally and as frequently as possible, although others should EPILEPSY. 453 tremens, arising from exposure to the vapor of lead, chiefly requires Opium, Belladonna, and Nux v.; and that from poisonous doses of Opium, is mainly to be subdued by Nux v. and Belladonna. EPILEPSY. Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Miorbus herculeus. Morbus comitialis. This is a malady which consists of clonic spasms, or convulsions, with loss of consciousness and voluntary motion, and generally foaming at the mouth. It comes on by fits, and is usually characterised by the suddenness of the attack, although it is occasionally preceded by pain in the head, dimness of vision, flashes or sparks of fire, tinnitus aurium, palpitations, flatulency, and languor; or, by a peculiar feeling, partaking partly of pain, and partly of a sense of cold, commencing in some remote part of the body, as in the toes, abdomen, or fingers, and proceeding gradually upwards towards the heart or head. (Aura epileptica.) During the paroxysm, the muscles of one half of the body are commonly more severely agitated than those on the other, and those concerned in the performance of respiration are always more or less implicated; the eyes are hideously convulsed, and turned in various directions, but at length become fixed, so that the whites occasionally or even constantly have to participate in his meals, &c.; mix it especially in acidulated.sauces or lemonade. If it impairs the digestion, give tea made of bitter herbs, roots or oranges, continuing the sulphuric acid at the same time, but ceasing as soon as the mouth becomes sore. Should obstinate diarrhcea, protracted derangement of the stomnich, vomiting and giddiness result, give Pulsalilla; if bad ulcers form in the mouth, give Mercurius virus. Schreiber's method of attempting to cure the pernicious habit, consists in locking the patient up by himself, allowing him to drink brandy mixed with one third part of water ad libitum, and adding one third part of brandy to every other liquid, and all the food the patient partakes of. Although intoxication may be the result of this procedure, during the first day or two, still the subsequent disgust which takes place (generally about the fifth day) commonly puts a stop to further relish for the intoxicating beverage. Carbo v. has recently been suggested as likely to be of service in some cases of delirium tremens. (Allg. Hom. Zeit. No. 1, 33 Bd.) 454 NERVOUS SYSTEM. of them alone are seen; the fingers are firmly clenched, and the muscles of the jaws are often spasmodically affected, in consequence of which the tongue is sometimes lacerated by being thrust out immediately before the sudden and violent approximation of the teeth; the mouth is frequently filled with phlegm, which is expelled with considerable force in a frothy state. The face is either of a dark-red or livid color, or it is pale, or alternately pale and red, or pale one side and red on the other. The foeces and urine are sometimes passed involuntarily. On. the abatement of the spasms the patient gradually recovers. Sometimes a fit of vomiting terminates the attack. The memory and judgment are generally somewhat impaired for some little time after the fit, and a sensation of languor and exhaustion, or weight and other uncomfortable feelings in the head are complained of. Comparatively few patients are carried off during a fit, but it sometimes happens that one fit succeeds another in rapid succession, or with increasing intensity, until a comatose state ensues, and the patient sinks. Idiocy is an occasional melancholy result of this distressing malady. The prognosis is more or less favorable according to the age of the patient and the species of the epilepsy. When the disease occurs before the age of puberty, or when purely sympathetic, it is generally cureable without much difficulty by means of homceopathic remedies. On the other hand, when it comes on after the age of puberty, is idiopathic, or of hereditary origin, and has been of long duration, the cure is not easily accomplished. It is generally possible, however, even in the most inveterate cases, to lengthen the intervals between the attacks, and to mitigate their violence by means of steady and judicious treatment. THERAPEUTICS. This must be regulated by the character and causes as well as by the symptoms of the malady; the latter guiding us in the selection of one from amongst a class of remedies. When the disease proceeds from plethora with determination of blood to the head, Acon., Bella., Op., Nux V., Puls., Bry., HMere., Ign., Sulph., Veratr., Silic., are the most effective remedies. (See Congestio ad Caput.) When from debility, caused by loss of humors (hemorrhage, venereal excess, masturbation, etc.): China, Phosph., Ac. EPILEPSY. 455 phosph., Vux., Sulph., Calc., Staph., Sil., principally. When from the irritation of worms: Iyos., Bella., Cinc., Cina, Mere., Sulph. (See INVERMINATION.) When from that of teething: Bella., Clam., Cina, Ign., Sulp&h., Calc., Stann. (See DENTITION and CONVULSIONS IN CHILDREN.) When from hysterical affections (Epilepsia uterina): Bella., Plat., Sep., Ign., Sulph., lMosch., Nux, Coco., Veratr., Puls., Aur., Magn., Magn. m., Sec. corn., Stram., ITyos., Ac. hydroc. (See HYSTERIA and METRITIS.) When from the retropulsion of an eruption: Sulph., alc., Sil., Ipecac., Tart., Bry., Lach., Nux v., Stram. From the abuse of intoxicating drinks, or narcotics-as wine, spirits, tobacco, opium, malt liquor (adulterated): Nux v., Zach., Ign., Bell., Ilyos., Cupr., ClOam., Op., Calc., &c. From exposure to the fumes of arsenic and copper: Camph., Cup., Mere., Ipecac., C'hin., Nux v., Yeratr., Ars. To those of mercury, Stramonium chiefly, in the first place. From checked perspiration: COam., Sulph., Acon., Bella., Nux v., Lach., Cic., Sil., Chin., etc. From moral causes, such as fright, fear, etc.: Artemn., Op., Acon., Cham., Hyos., Nlux v., Plat., Cupr. (See MORAL EMOTIONS.) From crudities of the stomach: Ipec., Nux v., Puls., etc. (See DYSPEPSIA and DERANGEMENT OF STOMACH.) And when from an injury of the head (Epilepsia traumatica): Arnica, Acon., Ang., Cic.; and Bella., Rh/us, Sulph. An operation may sometimes be necessary to remove the source of the irritation, particularly when we have reason to apprehend that a spicula or morbid growth of bone is pressing upon the brain. In recent cases of idiopathic epilepsy, either attacking suddenly without manifest cause (Epilepsia cerebralis), or preceded by a peculiar and disagreeable or painful sensation ascending from some part of the body (Epilepsia sympathica), Bella., Hyos., Ignatia, Nux v., Op., Cocculus, etc., are most frequently indicated; and those which are chronic: Sulphur, Calcarea carbonica, Silicea, and Cuprum chiefly; but also, Bell., Zach., Hep., Stann., Stram., Ars., Agar., Camph., Mlere., etc., and likewise the others which have been named as the more appropriate in ordinary cases of recent origin. The following are amongst the leading indications for these remedies: 456 NERVOUS SYSTEM. BELLADONNA. Commencement of the attack with a sensation of crawling and torpor in the upper extremities; jerking of the limbs, especially of the arms, convulsive movements of the mouth, muscles of the face and eyes; congestion in the head, with vertigo, deep redness, heat and bloatedness of the face, or paleness and coldness of the face, with shivering; photophobia; convulsed or fixed eyes; dilated pupil; cramps in the larynx and throat, with obstructed deglutition and danger of szufocation; foam at the mouth; unnoticed emission of freces (and of urine), or loose evacuation of ingesta; oppression on the chest and anxious respiration; renewal of the fits on the slightest contact or the least contradiction; dizziness, or complete loss of consciousness; sleeplessness between the fits, with agitation and tossing, or deep and lethargic sleep, with smiles and grimaces; waking with a start, with cries. Compare with Cham., Hyos., Ign., Op., Stram.) CUPRUM. Commencement of the paroxysm in the fingers or toes, or in the arms; retraction of the thumbs; loss of consciousness and of speech; salivation, sometimes frothy; redness of the face and.eyes; recurrence of the fits every month, and especially at the catamenia. HYOSCYAMUs. Bluish color and bloatedness of the face, foam at the mouth, prominent eyes; convulsive movements of certain limbs, or of the whole body; violent jactitation; retraction of the thumbs; renewal of the fits, on endeavoring to swallow the least drop of liquid; cries; grinding of the teeth; loss of consciousness; unnoticed emission of urine; cerebral congestion; deep and lethargic sleep, with snoring. (See Bell. and Op.) IGNATIA. Convulsive movements of the limbs, eyes, eyelids, muscles of the face and lips; throwing back of the head; retraction of the thumbs; red and bluish face, or redness of one side and paleness of the other, or paleness and redness alternately; frothy salivation; spasms in the throat and larynx, with threatening sufocation and difficult deglutition, loss of consciousness; frequent yawning, or drowsy sleep, great anxiety, and deep sighs between or before the attacks; daily paroxysms. LACHESIS. Loud cries, falling, and loss of consciousness, EPILEPSY. 457 foaming at the mouth, cold feet, eructations, ple face, vertigo, heaviness and pain in the head, palpitatio cordis, distended abdomen, coma somnolentum, nausea, &c. Nux voMIc~. Shrieks, throwing back of the head, trembling or convulsive jerks of the limbs or muscles; renewal of the fits after contradiction or an angry emotion; unnoticed evacuation of'feces and urine; sensation of topor and numbness in the limbs; vomiting, profuse perspiration, constipation, ill-humor and irascibility between the attacks. OriuMr. Occurrence of the fits at night or in the evening; throwing back of the head, or violent movements of the limbs, especially of the arms; loss of consciousness, insensibility, cries; closed fists; threatening suffocation; deep and lethargic sleep after or between the paroxysms. (See Bell., Hyos., Ign.) STRA'MONIUM. Throwing back of the head, or convulsive movements of the limbs, and especially of the upper part of the body and of the abdomen; pale and haggard face, with stupid expression, or redness and bloatedness of the face, loss of consciousness and of sensation, sometimes with cries, &c., renewal of the fits by contact, and also by the sight of bright and brilliant objects. (See Bell.) ARSENIcuM-chiefly when the fits are attended with burning in the stomach, vetebroe, and abdomen. SULPHUR. Chronic epilepsy, often preceded by a sensation as if a mouse, or some other small animal, were running over the muscles, cries, stiffness of the body, fits excited by cool air, or by a current of air. (Bella. is very useful before or after Sulph. in some cases.) LCLCAREA. Especially when the fits occur at night, and in chronic cases. (After Sulph.) SILICEA is chiefly useful in chronic epilepsy. (After Cale.) CAlMPHORA-against epilepsy, with snoring, red and puffed face, coma somnolentum. CICUTA. Paleness, or yellowish color of the face, trismus, distortion of the limbs, cries and frothy salivation, colic, as if caused by worms, &c. CoccuLus-especially in women during the catamenia, or also from a traumatic cause. MERCURIUS. Cries, rigidity of the body, distension of the abdomen, itching in the nose, thirst, and nocturnal attacks. 458 NERVOUS SYSTEM. STANNUM. Jactitation of the limbs, retraction of the thumbs, paleness of the face, backward traction of the head, loss of consciousness, appearance of the fits in the evening. VERATRUM. Loss of sense and movement, distortion of the eyes, and convulsive movements of the eyelids; anguish, discouragement and despair, between the fits. During the epileptic seizure or paroxysms, the patient should be placed in the horizontal posture, and such precautions taken as will obviate any injury which may be sustained by the violence of the convulsive movements. In order to prevent any lesion of the tongue, something ought to be inserted between the teeth. The neckcloth should be removed, the stays loosened, and cold water sprinkled over the face, especially when the breathing is much affected by the spasms of the muscles concerned in respiration. A dose of ACONITE, followed by BELLADONNA if relief be not speedily obtained, is necessary, when the fit occurs in plethoric subjects, and is attended with strongly marked signs of congestion of the vessels of the head and neck. The DIET of epileptic patients ought to be very moderate, simple, and easy of digestion. Stimulants ought to be strictly avoided where there is plethora, with tendency to congestion. Debilitated persons require a somewhat more generous diet that the robust, but in all cases care should be taken never to overload the stomach. Excessive corporal or mental exertion must be abstained from. NERVE-PAIN. FACE-ACHE. FACE-AGUE. Neuralgia.. Neuralgia facialis. Tic douloulreux. Prosopalgia. This distressing malady consists in an excruciating pain, which has its most frequent seat in the branches of the fifth pair of nerves, 'and is accordingly experienced with great acuteness under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face, and frequently into the orbit and cranium. The paroxysms occasionally continue with shorter or longer intervals, for several days or weeks in succession. The disease is, unfortunately, generally of great obstinacy, a nd, in some melancholy instances, utterly incurable. NEURALGIA. 459 When the malady is symptomatic, remedies which are appropriate to the primary disease must be had recourse to. Thus, when from derangement of the digestive functions, Nux vomica, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha or Zycopodium, will usually prove the most serviceable medicines. When arising from or connected with uterine disease: Nux v., Puls., Plat., Chinac, Ignatia, Bella. When connected with, or arising from invermination: Spigelia, Bella., Cinac Graph., Ferr., Stann., Sulph., chiefly. In RHEUMATIc face-ache, or prosopalgia, - Aconitum, Bryonia, Rhus, fMercurius, Phosphorus, Pulsatilla, Mezereum, Sulphur, Nux v., lachesis, &c., are the remedies that have generally proved the most effectual. In ARTHRITIc, Nux v., Rhus, Colocynth, Miercurius, Causticum, etc. In NEURALGIA, with INFLAMMATION OF THE NEURILEMMIA: Acon., Bella., Bryon., principally; or, Merc., Phosph., Staph., Sulph., Arn.; or, Spig., lach., Plat., Veratr., Baryta c., lThuja. FACE-ACHE from the effects of MTercury, chiefly requires the employment of Aurum, Hepar, Bella., Carbo v., Sulphur, China, Mfezereum, &c. That from periostitis in the vicinity of the affected nerves: Acon., Bellca., Puls., JMez., Bry., Ruta, Aurum, Silicea, chiefly; and that which appears to arise from enlargement of a bone: Sulph., Calc., Silic., Aurum, Assa., JMez., Acid. nitr., &c. (See B3ONES, DiSEASES OF THE.) When neuralgia facialis is attended with purulent discharge from the nose, and thickening of the schneiderian membrane, or with obstruction of the larchrymal duct: Aurum, Lach., Petrol., Silic., Ars., l arum verum, &c.; and when nerve-pain has resulted from external injuries, such as accidents or surgical operations, Ar., Acon.,?Rhs, cCalendula, are the medicaments which are chiefly to be relied on. In neuralgia occurring in young, plethoric persons: Aconiturn and Belladonna; or Calc., Phos., Plat., Lach. That in nervous persons: Bella., Zach., Spigel., Plat.; and that in excessively debilitated constitutions: Cinchona and Ferrum. When the sacro-sciatic nerve is the seat of the neuralgia: Aconitum, Chamnomilla, Ignatia, Nux v., Pul 460 NERVOUS SYSTEM. satilla, Colocynth, and Rhus, are, in general, the most efficacious medicines. (See SCIATICA.) Finally, in prosopalgia generally, the following have proved more or less useful: Aconitum, Arnica, Yerbascum, Sulphur, Calcarea, Capsicum, Pulsatilla, Stannumm, u, Thuja, Baryta c., Coffeca, Kali, Camphorc, Electro-magnetismus, &c. In idiopathic neuralgia facialis, or tic douloureux, the remedies which have hitherto been employed in homceopathic practice with the most success are: Belladonna, Platina, Lycopodium, Colocynth, Arsenicum, China, ifezereum, Yeratrum, iMags. arc., Sulphur, &c. BELLADONNA. When the pain chiefly pursues the course of the infra-orbitary nerve, but sometimes also the other branches of the fifth, and is prone to be excited by rubbing the usual seat of the sufferings: darting pains in the cheekbones, nose, jaws, or zygomatic process; or cutting and tensive pains, with stiffness at the nape of the neck, and clenching of the jaws; twitches in the eye-lid, or violent shooting and tearing, and dragging pains in the ball of the eye; jerking pains in the facial muscles, and mouth; heat and redness of the face. The pain is generally preceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insupportable. PLATINA. Feeling of coldness and torpor in the affected side of the face, with severe spasmodic pain, or tensive pressure in the zygomatic process, with a sensation of creeping or crawling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; lachrymation; redness of the face, &c. LYCOPODIUM is often useful when the symptoms are much the same as described under the preceding remedy, with the exception of the torpor and creeping, and particularly when the right side of the face is the part affected. COLOCYNTn. Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the 8lightest touch, and extend to all parts of the head, temples, nose, ears, teeth, &c. ARSENICUM. When there is a tendency to periodicity in the attacks or paroxysms, and the pains partake, more espe NEURALGIA: 461 cially, of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples: the sufferings being occasionally of so severe a description as almost to drive the patient distracted; great anguish; excessive prostration, with desire for the recumbent posture; sensation of coldness in the affected parts; exacerbation during repose, from fatigue, in the evening, when in bed, or after a meal; temporary melioration from external heat. CHINA. When, as in the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibility of the skin, and consequent aggravation from the slightest touch; sensation of torpor and paralytic weakness in the affected part; great loquacity, with ill-humor, paleness of the face, frequently followed by or alternated with redness and transient heat of the face. MAEZEIEUM. Pains which occupy the left zygomatic process, chiefly of a spasmodic stupefying description, and extending to the eye, temple, ear, teeth, neck and shoulder, with exacerbation from partaking of warm food or drink, or on coming into a warm room after being in the open air. VERATRUM. Insupportable pains which almost drive the patient to distraction; excessive weakness even to fainting; general chilliness, exacerbation of suffering on getting warm in bed, or towards morning; temporary relief on moving about. ASSAFCETIDA may generally be prescribed with decided benefit when the pain is chiefly of a dull, subdued description, and occurs intermittingly; but also when it partakes of a burning or shooting character, and proceeds from within outwards. SPIGELIA is frequently a useful palliative remedy in all cases when the pain is excessive; but is more especially required when the pains are of a jerking, tearing character, exacerbated by the slightest touch or by movement of the affected parts; or when they appear to shoot from the centre of the brain to the sides of the head or the ears; further, when the pains partake of a burning and pressive aching character, and have their seat in the zygomatic process; 462 NERVOUS SYSTEM. glossy tumefaction of the affected side of the face; excessive agitation and anguish. In other cases: Lachesis, Phosphorus, Hyoscyamus, MJags. arc., Oleand., Verb., Graph., Eali, Con., ]uta, Anac., Baryta c., Magn. m., Manganum, Merc., Bhus, Ignatia, Arnica, CCasicum, Staphysagria, Cofea, &c., may be found useful. HEADACHE. Cephalalgia. Cephalcea. Cephalalgia arthritica. Cephalalgia nervosa. Hemicrania (imegrim.) Clavus hystericus. Headache is often but symptomatic of disease, and in such cases is only to be cured by the removal of the primary affection. When, therefore, it arises from derangement of the stomach, or dyspepsia, constipation, cold in the head, mental emotions, congestion of blood in the vessels of the head, &c., the remedies most appropriate to the treatment of these different disorders must be had recourse to. An abuse of coffee and tea is a frequent cause of many descriptions of sick and nervous headache, attended with excitement and dyspeptic symptoms, which will frequently disappear of themselves on the disuse of these beverages. If, however, this result should not speedily ensue, for the effects of coffee we may have recourse to Nux v., Puls., Camemilla, or Ignatia, according to the character of the symptoms. Against the effects of tea, Cinchona will generally be found an antidote, followed by Ferrum, if necessary; in other cases, Ipecacuanha, Thuja, or Selinum will be found useful. In the treatment of nervous headaches, hemicrania, or megrim, the following remedies have generally been found the most useful: NVux v., Veratrum, Colocynth, Pulsatilla, Sepia, Ignatia, Bryonia, Rhus, Ipecacuanha, Chamomilla, Cofea, Hepar, China, Cicuta, Belladonna, Arsenicum, Arnica, Acid. nitr., Petroleum, Salphur, Silicea, Platina, Causticum, Graphites, Natrum m., Phosphorus, Zincum, &c. Rheumatic headaches: Aconitum, Chamomilla,.Mercurius, Nux v., Pulsatilla, Lycopodium, Spigelia, Sulphur, Bryonia, Belladonna, China, Ignatia, Phosphorus, &c. (In fugitive rheumatic pains in the head, or pains which are aggravated by movement and at night, and are attended with sensibility to the touch, fits of vomiting, and frequent HEADACHE. 463 sweating, Nux v., followed by Cham. and Puls.) Arthritic: Ipecacuanha, Ignatia, Nux v., Coloc., Bryonia, Belladonna, Sepia, Veratrum, &c. Hysterical: Ignatia, Moschus, Platina, Veratrum, Valeriana, Sepia, Aurum, Acid. nitricum, Magnesia c. et m., Cocculus, Phosphorus, &c. Against headaches occurring in extremely sensitive individuals: Aconitum, Ignatia, Chamomilla, Coffea, Spigelia, Veratrum, Cina, or Ipecacuanha, have usually proved the most appropriate. Headaches arising from the habitual use of coffee are generally curable by means of Naux v., Chamomilla, or Ignatia. From gastric derangement: Pulsatilla, Antimonium crudum, Ipecacuanha, Nux i., Sulphur, Bryonia, Cocculus, Carbo v., or Nux moschata. From constipation: Bryonia, Nux v., Opium, Conium, or Veratrum. And those from long continued excessive mental application: Nuux v., Opium, and Sulphur, chiefly; but also, Lachesis, Pulsatilla, Calcarea, Aurum, Natrum m., Silicea, Zycopodium, &c. If the affection arises from sitting up late, or prolonged watching at the bedside of a sick person: Cocculus, VNux v., or Pulsatilla. When headache is always excited by exposure to a current of air, Aconitum, Belladonna, Colocynth, Nux v., or Cinchona have often been found successful, either in removing the said susceptibility, or in shortening the attacks, and rendering them of a much more bearable character. And when cold, damp, or boisterous weather is generally productive of headache: Bryonia, Nux v., Carbo v.; these last-named medicines, moreover, together with Silicea, are frequently equally useful, if headache is always experienced during hot, sultry weather, the air being overcharged with electricity. Against headaches arising from the effects of mercury in large doses: Carbo v., Pulsatilla, Cinchona; or Hepar sulphuris, Acidum nitricum, Aurum, or Sulphur. Headache after drinking cold or iced water, &c.: Aconitum, Arsenicum, Opium, Belladonna, Pulsatilla, Sulphur, and Natrum. Headaches from congestion: Aconitum, Belladonna, Bryonia, Sanguinaria canadensis, Opium, ]Mercurius, Pulsatilla, Rhus, Nux v., Veratrum, Coofea, Lachesis, Chamomilla, Cocculus, Sulphur, Silicea, &c. Headache from exposure to metallic vapors, Sulphur; and from that of copper especially, Ilepar s. 464 NERVOUS SYSTEM. In general cases, the subjoined remedies will prove useful, and may be selected according to the indications given. BELLADONNA. When headache is periodic, or nearly constant, and the pain is increased by the slightest movement either of the head or body, and particularly on stooping, or by moving the eyes; or when a bright light or the most trivial noise tends to aggravate the pain, which consists of a dull pressure at the vertex, or is of a lancinating description, and occupies either the entire head (cephalea), or merely one side (hemicrania), extending from the occiput into the orbit and root of the nose, and is then described as a violent, screwing, piercing, bursting, or tearing pain, sometimes attended with great heat at the vertex; or the seat of the pain is in the forehead, and is of a dull, aching, or cutting description, attended with a sense of fulness or a feeling as if the brain would be forced through the forehead in stooping. At times these pains become so violently increased as almost to deprive the patient of consciousness whilst they last; or the headache is attended with extreme restlessness, sleeplessness, and delirium; and there is a falling off of the hair, in consequence of the headaches. Platina answers well, in some cases, after Belladonna, when the pain is chiefly lateral, and of the same description; or when there is, at the same time, coldness of one half of the face, &c., with humming or buzzing in the head. 2fercurius and Iepar s., and, in very obstinate cases, Sepia and Silicea, are frequently very useful after Belladonna. 3RYONIA. Aching, piercing, or digging, tearing pain, at a small fixed spot (clavus hystericus); or piercing, aching pain in the forehead daily after a meal, or coming on in the morning, and afterwards becoming lancinating; or pain coming on in the morning, disappearing in the afternoon, and returning again in the evening with great violence, when it is attended with a sensation as if the head were pressed together, particularly at the temples; burning, tearing pain over the entire head; shootings in one side of the head. The pains are increased by movement, and are attended with irascibility, and disposition to chilliness or shivering; they are sometimes relieved or terminated by a fit of vomiting. Nux v. and Rhus often serve to complete the cure of the foregoing symptoms, IHEADACHE. 465 or, at all events, to curtail and remove each attack, after the previous administration of Bryonia. REus. Shooting and rending pains, extending to the ears and root of the nose; burning or pulsative pains; headache after a meal, with desire to assume the recumbent posture, and remain quiet; fulness and weight in the head; renewal of the headache at the slightest contradiction, or on going into the open air: undulation of the brain at every step; or sensation as if water were in the head, or as if the contents of the cranium were in a relaxed or loosened state, and shifted about with every movement of the head; feeling of creeping or crawling in the head. SEPIA. Periodic cephalalgia, aggravated by mental emotion, particularly in hysterical subjects; the pain is either of a lancinating description, and affects the whole head, or is merely seated under the eye, or occupies one half of the head or forehead; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with extreme sensibility of the eyes to the light. Sepia is also very efficacious in cases of chronic hemicrania, with violent piercing or rending pain, intermingled with lancinations so excruciating that the patient is afraid to move, and can only obtain a trivial degree of relief by remaining perfectly quiet with the eyes closed; at other times, the pain is so violent as to cause the patient to scream out, and is attended with heat in the head, or faintness and giddiness, followed by nausea and vomiting. SILICEA is especially useful where a sensation is experienced as if the brain were about to protrude through the forehead or orbits; or pain so severe that the head feels as if it would split; or semilateral, shooting, rending pains, commencing at the temple, and extending to the nose, the upper and lower jaw-bones, and teeth of the same side. When there is a tendency to frequent sweating of the head, or when there is frequently great tenderness of the calp, Silicea is further indicated; as also in cases where the parties affected are subject to the formation of small tubercles on the head. HEPAR SULPHURIS is also a good remedy to follow Belladonna in the treatment of headaches, when only partial relief has been obtained from that medicine, or it may be administered alternately with Silicea in cases where there are painful 30 466 NERVOUS SYSTEM. tubercles on the head. The pains chiefly piercing, generally aggravated at night, and frequently limited to a small fixed spot, with a sensation as if a nail were being driven into the head. Against this latter species of headache (clavus hystericus), Nx vomica, Ignatia, Cofe, aJiMosch., Magn., and Staph. are also most important remedies. Nux VOMICA may be selected when the following symptoms are complained of. Pain commencing with a slight pressure, or a sensation of coldness at the part which is subsequently affected; succeeded by throbbing, and then an intense shooting, piercing, rending, or stunning pain confined to a small space, which can frequently be covered with the point of the finger, and is extremely sensitive to the touch; or the pain causes a sensation as if a nail were driven into the head: at other times, the pain extends over the nose down to the lip, and also to the gums; or, on the other hand, it commences at the eyelid or the orbit, causing constant lachrymation, and extends over the forehead and temples to the ears, back of the head, and nape of the neck; or it is seated in the crown of the head, and produces a sensation as if the head would split, or was being opened, at the coronal suture; or rending, aching pain, affecting only one side of the head, sometimes combined or alternating with shootings; the pain becomes heightened to such a degree occasionally, and more particularly in the morning, as well nigh to drive the patient to des: pair, or deprive him of consciousness; great heaviness of the head, and sensation as if the brain were bruised or lacerated; tenderness of the scalp. The pains are aggravated by movement, such as walking or stooping, or by reflection; also after eating, or on going into the open air, and are frequently attended with considerable giddiness or confusion in the head; the headache is generally attended with extreme irasciiility, and is renewed or aggravated after partaking of coffee, the constant habit of drinkk which is not an unfrequent cause of the complaint; sudden attacks of headache are frequently excited by a fit of passion, a fright, the effects of a chill, or an overloaded stomach. IGNATIA is also an excellent remedy, as already stated, in * Compare: with Belladonna and Arsenicum. HEABDACHE. 467 cases in which the pain is confined to a small space, and causes a sensation as if a nail were driven into the brain; and when there are nausea; dimness of the sight, and sensibility of the eyes to light; paleness of the face, and temporary alleviation from change of posture; aggravation from noise or strong odors, or after partaking of coffee. Ignatia is sometimes serviceable in completing the cure after the previous administration of Nux v. or Pulsatilla. It is especially applicable to nervous, hysterical females of a mild and sensitive disposition. COFFEA. In cases of megrim, brought on by meditation, vexation, or exposure to cold, attended with irritability, sensibility to noise, great anxiety, and chilliness, and a sensation as, if a nail were driven into the brain, or a feeling as if the brain were bruised, occurring in individuals who are extremely impatient under suffering, and are not habituated to the use of coffee, this remedy is frequently a very efficacious one. PULSATILLA. Megrim, characterized by rending or shooting pains, with heaviness of the head, dimness of the sight, sensibility to light; or buzzing or singing in the ears, and ear-ache; nausea, paleness of the face, lowness of spirits; headache, with pain in the nape of the neck; aggravation of the headache, with chilliness towards evening, during repose, or particularly when sitting; melioration in the open air. Disposition mild; temperament phlegmatic. CHINA. Headache worse at night, accompanied with a sensation as if the head would split; or dull, aching, pressive, or boring pains, particularly at the crown of the head, increased by movement, or by the open air: tenderness of the scalp; great sensibility to pain; taciturnity and obstinacy. VYEATHUM. Headache, preceded by coldness and shivering; pain in the head, as if the brain were bruised or lacerated; or lateral, aching, constrictive, and throbbing pains, sometimes attended with a sensation of constriction or tightness in the throat; feeling of coldness at the crown of the head, as if ice were placed upon it; or sensation both of coldness and heat on the exterior of the head, with deep-seated or internal burning heat; headache, with paleness of the face, nausea and vomiting, and preceded by a copious discharge of color 468 NERVOUS SYSTEM. less urine; headache, with pain at the pit of the stomach, or painful stiffness of the neck, headache with extreme weakness and melancholy; painful sensibility of the hair to the touch; chilliness, with general cold perspiration. Arsenicum and Acid. phos. are sometimes useful after Yeratrum. LAcHESIS. Deep-seated pains in the head, or severe aching pain in the occiput, in the sockets of the eye, or above the orbits, with stiffness of the neck, particularly at the nape; heaviness and feeling of expansive pressure, sometimes to such an extent as if the head would burst; tension in the head, as if caused by strings or threads drawn through the occiput towards the eyes; lancinations in different parts of the head; headache every morning on waking, or after dinner, or at every change of weather. MERCURI.US. Rending and burning, or lancinating and piercing pains, generally lateral, sometimes extending to the teeth and neck, with shootings in the ears; tightness round the head; excessive nocturnal aggravation of the headaches, often accompanied by profuse sweating. COLOCYNTH. Nervous headaches, attended with smarting in the eyes; excruciating lateral aching; rending, dragging pains; nausea and yomiting; feeling of compression in the forehead, increased by stooping or lying on the back; headache every afternoon or evening, with great anguish and excessive restlessness, so that it is impossible to remain in the recumbent posture; offensive perspiration; profuse discharge of colorless urine during the headache. CHAIMOMILLA. Headaches occurring in individuals who are extremely impatient under suffering, and exasperated by the slightest pain, or who exhibit symptoms and expressions of suffering apparently uncalled for by the nature of the complaint; the headaches are often confined to one side of the head (hemicrania), and the pains are of a rending, aching, or shooting character, and sometimes extend into the upper and lower jaw; sweating at the head is a frequent concomitant symptom. COamomilla is occasionally very useful after the previous administration of Cofea, when not called for from the commencement. Moreover, hemicrania, attended with extreme excitability, arising from the daily use of black coffee, but HEADAtCHE. 460 which is usually relieved for the time by partaking of a cup of that beverage, will generally be materially relieved, if not cured, by Chiamomilla; sometimes a subsequent dose or two of Nuux is required to complete the cure. SULPHUR. Chronic headache; headaches occurring daily, or every eight days, worse in the morning, or during the night, and attended with heaviness of the head, aching or pressive pains in the forehead, above the eyes (causing the patient to knit the brows, or keep the eyes closed), or over the entire head; incapability of mental exertion from the pains in the head; pains as if the head would split; or rending, shooting, dragging, jerking pains on one side of the head; aggravation of the headaches from meditation, the open air, or movement; extreme tenderness of the scalp to the touch; falling off of the hair. CALCAREA. Chronic headaches, frequently attended with a sensation of extreme coldness, either interiorly or on the scalp; the pains either affect the entire head, or merely the forehead, the side, or the crown of the head, and are chiefly of a stunning, aching, throbbing, or hammering description, cbmpelling the patient to retain the recumbent posture; at times the head feels as if compressed in a vice, or the forehead feels as if it would burst open, particularly when in the open air; headache, with humming noise in the head, confusion of ideas, excited or aggravated by close application to study, or by movement; falling off of the hair. Calcarea is generally very useful after Sulphur; and Silicea, ]Lycopod., and Acid. nitr. after Cale. ARsENICUM. Headaches so intolerable as almost to drive the patient to despair, occurring periodically, and aggravated by partaking of food: the pain sometimes extends to the gums, where it is so excruciating as to render it impossible to fall asleep; tenderness of the scalp to the touch; temporary amelioration of the headaches from the application of cold water. AuIUM. Headaches in hysterical persons, attended with buzzing or other noises in the head; and pain as if the head had been bruised, especially on rising in the morning, or during mental occupation. EUGENIA. Severe one-sided headache (megrim) coming on 470 NERVOUS SYSTEM. in the evening, attended with a sensation of pressure, or forcing outwards behind the eyes, lachrymation, and sometimes nausea and vomiting, which produce exacerbation; aching pains in the entire head (cephalaea) at night, with burning in the eyes, thirst, and copious discharge of urine. BuoMIUm. Headache (weight in the forehead), in the heat of the sun, disappearing in the shade; headache after drinking milk; relieved by resting on the right side with the arms over the head. One remedy is seldom sufficient to effect a cure of cephalalgia of long standing, particularly when of a nervous character; and, indeed, in some cases of this description, it is only possible to effect a degree of melioration. In comparatively recent cases, the medicines may be repeated at intervals, from an hour to six or twelve hours, when the headache is excessively severe; but in those of a more chronic and obstinate nature, in which it is necessary to have recourse to such remedies as Sulphur, Calcarea, Sepia, Coriaria myrtifolia, Silex, &c., considerably longer intervals must be observed between the doses, when our object is to attempt to eradicate the disorder, or destroy the susceptibility to headache from trivial causes. In chronic headaches of various kinds, and particularly in megrim, or where the pain is for the most part confined to the right side of the head, or to the forehead and sinciput, Sanguinaria canadensis promises to be one of the most valuable remedies. It has been employed with great benefit in cases of the following symptoms. Headache, commencing in the morning, relieved by sleep, or disappearing after the night's rest to that of the night following. The pain is chiefly experienced in the right side of the head, but, in some instances, it is transferred from one side to the other during the same or at the succeeding attack. More rarely, the left side alone is affected. The eyes are almost always sympathetically affected; and relief is sought by having the apartment darkened. Nausea is nearly uniformly present; but melioration is seldom derived from, or the attack ever terminated by, a fit of vomiting. Chronic headaches with the aforesaid characteristic symptoms, are frequently mitigated (the attacks shortened, and the intervals between them lengthened), by means of Aconitum, and especially by Bella ANGINA PECTORIS. 471 donna. The relief afforded by these remedies is, however, for the most part, merely temporary; the radical cure being commonly only attainable by the employment of such medicines as Sulphur, Sepia, Sanguinaria canadensis, &c. Dr. Helfrich recommends chiefly Aconitum and Belladonna, at the commencement and during the height of the attack, and Sanguinaria on its decline, in all cases of nervous headaches where there are no particular indications for other remedies.* DISEASES OF THE CIRCULATING SYSTEM. ANGINA PECTORIS. THE pathology of this disease is very obscure. It is frequently associated with organic lesions of the heart and large vessels. Many authors have accordingly attributed such derangements as the cause of this disorder; others have considered it as depending on a species of spasm of the diaphragm and other muscles concerned in the process of respiration, on diseases of the pericardium, ossification of the coronary arteries, and on inflammation of the mediastinum. There are many, again, who are of opinion that it is produced by asthma, by scrofula, or by syphilis,-by general plethora with accumulation of blood in the heart and large vessels, or by disordered action of the cardiac and pneumogastric nerves. The disease seldom at'tacks individuals under forty; it appears to occur more frequently in men than women, and particularly in those who are of a corpulent make, of a rheumatic or gouty diathesis, and are exposed to much mental uneasiness, or are addicted to habits of intemperance. The pain of this distressing malady is always severe, and sometimes excruciating. The paroxysm usually comes on in the following manner: the patient is suddenly seized with an agonizing sensation in the chest, especially about the lower part of the sternum, a little towards the left side; a painful feeling of constriction and suffocation is generally experienced, and if the party affected be walking he is compelled to stop until the attack is over. In the early career of the affection, the parox * Neus Archiv. Zweiter Band, Zweites Heft, p. 150. 472 CIRCULATING SYSTEM. ysms are commonly only brought on by some exertion, such as walking up a hill, but when it has reached a more advanced stage, the most trivial degree of excitement, or mental or corporal exertion, as also an error in diet, such as partaking of some indigestible article of food, is sufficient to excite an attack; and, finally, the incursions come on suddenly and unexpectedly without any manifest cause, even when in bed and during slumber. At the first invasion of angina pectoris the pain is ordinarily confined to the chest; but subsequently it extends to the left shoulder, or to the deltoid muscle, and frequently it affects the entire length of both superior extremities. In the milder forms of the disease the paroxysms terminate in from a few minutes to half an hour; but in those of a severer character it continues for several hours, and in some cases the unfortunate patient is never perfectly free from distressing uneasiness and constriction in the chest. Occasionally the attack goes off as suddenly as it made its onset; while at other times more or less soreness remains about the chest or in other parts for many hours or days. In severe cases the patient is pale, the features haggard and contracted, the eyes sunk, and the countenance bears an expression of extreme anguish; the body is frequently cold, or covered with a cold and clammy sweat; the action of the heart and lungs variously disordered; and although the patient is capable of taking a full inspiration, his respiration is rapid and difficult, and is accompanied with palpitation of the heart, excessive anxiety, and a feeling of approaching dissolution. The pulse is sometimes not much affected, but in the generality of cases it is slow, feeble, oppressed, and intermittent; occasionally, however, it is quick, strong, and irregular, under which circumstances the skin will usually be found warm and the face flushed. There is often considerable derangement of the functions of digestion; and an attack is frequently terminated with a discharge of flatus. THERAPEUTICS. Aconitum, Arsenicum album, and Digitalis purpurea, are the remedies which have chiefly been recommended in the treatment of angina pectoris. AcONITUmA is of considerable service in recent cases, and even in those of a more advanced stage, occurring in strong ANGINA PECTORIS. 473 plethoric subjects, in whom the paroxysms are attended with flushing of the face, some heat of skin, with a full, strong, and throbbing pulse, it is a most valuable palliative when administered at the commencement of each attack. But in order to diminish the frequency of the returns, where there is local congestion, it will be necessary to have recourse to such remedies as Belladonna, Lachesis, Nux vomica, Carbo v., and Sulphur. The three last-named are, moreover, of service when the digestive functions are in a deranged state, and the attacks are attended or succeeded by excessive flatulence. In cases of local congestion combined with debility: Ferrum, Cinchona, Nux v., Acidumphosphoricum, and Sulphur are the most useful. ARSENICUM is one of the most important medicines, and one from which the most complete success has been derived in cases when the sufferings were exceedingly severe, but unattended with any signs of serious organic lesion. The indications by which we are chiefly to be guided in prescribing it are: excessive dyspncea from the slightest movement, but especially on getting into bed, sometimes with renewal of the paroxysm on turning in bed; palpitation of the heart, extreme anguish, and a feeling of impending dissolution; paleness of the face, haggard and contracted features, great debility, with feeble, irregular, or intermittent pulse. (Kali hydrocyanicum or Acid. hydrocyanicum -may be substituted for Arsenic, when the latter does not afford much relief; in other eases Ipecac. and Veratr. may be more useful,-Ipecac. when Ars. or Kali hiydr. fail to produce any amendment,--Veratr. when the paroxysms are accompanied by coldness of the extremities, cold sweats, and slow, depressed, intermittent pulse.) DIGITALIS PUIPUJREA. In more advanced cases, or in those in which the attacks come on suddenly without any assignable reason; also when the intervals between each recurrence appear to decrease in length with the duration of the disorder. In most cases of this dreadful affection, where no serious structural derangement has taken place, the aforesaid remedies are not only of great service in alleviating the sufferings, and in curtailing the frequency of the attacks, but are even capable 474 6IRCULATING SYSTEM. of effecting a cure when timely and appropriately administered. In those unfortunate cases, on the other hand, in which we meet with unequivocal symptoms of concomitant organic disease of a formidable character, although we cannot entertain any hope of correcting the dangerous state of matters, we may yet succeed in affording some relief by means of Arsenicum and Digitalis, together with the following in particular instances: Veratrum, Lactuca virosc, Assafcetida, Sepia, Spigelia, Cannabis, Aurum, Natrum muriaticum, Ignatia, &c. PERICARDITIS. Pericarditis, or inflammation of the serous membrane which lines the pericardium, and is reflected over the heart and the roots of the larger vessels, is a disease which is frequently not well marked in its external characters, at least by no means so much so as an affection so intimately connected with an organ of such importance as the heart would lead us to conceive. The symptoms are exceedingly variable, and sometimes so insidious and deceptive as to go on until considerable disorganization is produced, before attracting our attention by their severity. In many instances, indeed, the disease has been found, on dissection, to have existed to a severe extent, where it had entirely escaped the attention of the practitioner. The following have been given as the principal symptoms in the general run of cases of acute pericarditis; sharp, burning, pricking, or darting pain in the region of the heart, accompanied by fever of an acute inflammatory type; the pain shoots to the left shoulder and scapula, and frequently extends some distance down the arm; it is aggravated by a deep inspiration, by pressure at the intercostal spaces over the apex of the heart, and on the epigastrium; the patient is incapacitated from lying onthe left side, and commonly feels easiest in the dorsal posture; the breathing is accelerated and laborious, or irregular, especially on moving; a feeling of contraction is experienced in the precordial region, and there is extreme restlessness, anxiety, and frequent syncope. The state of the pulse varies a good deal; it is always accelerated, but is sometimes hard, full, and vibratory, while at others it is feeble, irregular, or intermittent; in the advanced PERICARDITIS. 475 stage of the affection it is usually feeble and irregular, although, on applying the ear to the region of the heart, the action of the latter will be found tumultuous and violent. This inequality is of great importance in the diagnosis, since even in insidious cases an inequality will sometimes be perceptible on comparing the strength of the heart's action with that of the pulse at the wrist. The physical signs of pericarditis are-increased and more abrupt impulse of the heart, friction sounds, and an unusual dulness on percussion in the cardiac region when there is considerable effusion. The sounds of superficial friction are very generally discernible when there are partial exudations of lymph on the opposite surfaces of the pericardium. They commonly set in from twenty-four to forty-eight hours after the invasion of the inflammation, but, for the most part, do not continue for many days in succession,-the lymph being either absorbed or changed into false membrane, forming a more or less complete band of adhesion between the heart and the sac, which is' productive of a gradual extinction of the sound; or serum is secreted in such abundance that the heart plays freely in the distended sac, and ceases to rub against it. At the commencement, the sound is soft, resembling the rustling of silk, and is usually heard towards the left or about the centre of the sternum, corresponding with the base of the heart. Subsequently it becomes louder and more prolonged, and is audible beyond the immediate vicinity of the heart, the natural sounds of which it considerably disguises. In some cases the pericarditic friction resembles a crackling noise; but in others, and particularly when it has increased in hardness or roughness, it is closely to be compared to the creaking of a new saddle (the new leather sound). The normal sounds of the heart are completely muffled or disguised by a loud friction sound; they are sometimes to be heard, however, in the carotid arteries and at the top of the sternum. The dulness arising from effusion of serum in the pericardium may, when the effused fluid is very copious, extend up the whole anterior surface of the left side of the chest as high as the second rib, and spread even to the right sternum; but it is generally limited to a space or area of two or three inches at the lower part and towards the left of the sternum. 476 CIRCULATING SYSTEM. An extensive effusion commonly renders the sounds more distant and feeble, and impairs the impulse in a greater or less degree. The sounds of respiration and percussion being still found good in the back and below the axilla, and not much altered by the change of position, the case is thereby distinguished from pleuritic effusion. Again, though the friction-sound is generally stopped and the impulse and normal sounds are commonly rendered distant by displacement of the heart from copious effusion, they may be heard with their usual distinctness and intensity on listening to them in the carotid or subclavian arteries, or at the head of the sternum. By means of this circumstance we are empowered to draw a distinction between hydro-pericardium and an excessively enlarged heart acting with great feebleness; for in the latter, in addition to the weak sound and impulse in the usual region, they would, moreover, be weak in the course of the arteries. Infiltration of the extremities is occasionally met with; when present it ought to claim attention, as it is one of the symptoms of disease of the heart. The physical signs, taken in conjunction with the general symptoms, tend much to remove obscurity from the diagnosis. The region of the heart should, therefore, be always examined whenever there is a probability of implication of that organ during the prevalence of some other disease. The duration of the affection, like that of pleuritis, varies according to the nature, rapidity, and extent of the effusion, from a few days to several weeks. CAUSES. Pericarditis, like other inflammatory affections of the chest, is more prone to occur in persons of a plethoric habit, who are subject to derangement in the digestive organs. It is very frequently occasioned by a metastasis during an attack of rheumatism or gout. Prolonged grief or anxiety, and exposure to cold, may be named as means which tend to excite or develop it.* THERAPEUTICS. The under-mentioned may be considered as the most important remedies in the homceopathic treatment of pericarditis: Aconitum, Belladonna, Cannabis, * The prognosis, in the acute stage, may, generally speaking, be considered favorable when the affection is not complicated with previous diseases of the heart. PERICARDITIS. 477 Spigelia,, Bryonia, Sulphur, Arsenicum, LaclTesis, Arnica, Croton, &c. In acute cases, accompanied by synochal fever, Aconitum should be given in frequently repeated doses; when so employed at a sufficiently early stage, in cases uncomplicated with previous disease of the heart, effusion may be prevented, and a speedy cure effected. In plethoric subjects of sanguine lympathic temperament, it may be found requisite to prescribe Belladonna in alternation with Aconitum. Should the inflammation not yield to the employment of these remedies, although the febrile symptoms may have considerably subsided, Cannabis may be had recourse to if the action of the heart continues to be tumultuous, and is attended with oppression, anxiety, and a feeling of constriction in the precordial region; also when signs of effusion have become apparent. Bryonia may claim a preference to Cannabis, when the patient complains of sharp, pricking pains in the region of the heart, which are increased by taking a full inspiration and by movement; and when there are symptoms of slight effusion. Spigelia may be substituted for Cannabis in the early stage of the disease, when the patient complains of severe lancinations in the cardiac region, or a pain as if the heart were violently compressed or squeezed, and when the oppression at the chest is extremely distressing, particularly on movement, or even whilst speaking; also when there is endocarditic complication, with valvular murmur. Sulphur may be used with advantage after Bryonia in some cases. ARSENICuM has been strongly recommended in diseases of the heart of various kinds. In this inflammation it may be employed immediately after Aconitum, or independently of that remedy, either in the early stage-whether the attack has arisen from the metastasis of gout or rheumatism, or from the repercussion of an eruption, when there is violent palpitation, excessive rapidity of pulse, intense thirst, burning pain in the seat of the surface; anxiety, fainting, extreme restlessness, and when a burning pain is experienced in the seat of the heart-or in a more advanced stage of the disease, when the respiration is hurried and laborious, particularly on the slightest movement, and there is incapability of lying on the left side; pulse feeble and irregular. Veratrum may be administered to some advantage when the extremities become 478 CIRCULATING SYSTEM. cold, and a cold sweat covers the forehead and other parts of the body, the pulse slow and intermittent, the nose sharp, the features sunk and contracted, &c. (Facies hippocratica.) Ccrbo v. may also be of service in cases of this all but hopeless description. It is particularly in conjunction with rheumatism, and especially the acute variety, that pericarditis is met with. We should therefore, as already observed, never omit to examine the region of the heart in such instances, otherwise the disease may attain a dangerous and even incurable height before it is detected, as the general symptoms are often so imperfectly marked as not to create the slightest suspicion of its existence; whereas the physical signs can never fail, where any ordinary attention is paid, to apprize us of the invasion of pericarditis before it has reached a very serious, if not an incurable height. The following cases are not inserted here from anything very remarkable in their features, but simply as illustrative of the power of the homoeopathic remedies in arresting a disorder which, in allopathic practice, is considered to require what are denominated the most prompt and vigorous measures, such as a free and bold use of the lancet, &c. CASE 1. A. M., 13 years of age, of sanguine lymphatic temperament, was seized on the 4th of March, 1845, with acute rheumatism, for which, according to time-honored rule, an aperient was first given, and the pains were sought to be relieved by means of fomentations and hartshorn embrocations. Delirium having supervened, on the morning of the 8th, I was sent for in the evening, and found the patient lying on her back, in bed, complaining of severe darting, aching, rending pains in all the joints, but particularly those of the shoulders, elbows, and wrists, the affected parts being at the same time much swollen, tense, shining, and very sensitive to the touch; countenance flushed, and wearing an expression of anxiety; tongue furred white; mouth parched; thirst considerable; skin hot and dry; pulse 130, full, bounding, but regular; respiration hurried, but unattended with pain; no cough. On examining the region of the heart, the impulse was abnormally strong, the pulsations loud, accelerated, and occasionally reduplicated. About the middle of the sternum, a gentle, superficial rustling sound was distinctly audible, PERICARDITIS. 479 particularly while I kept the patient in the sitting posture; there was no dulness on percussion, and total absence of pain in the region of the heart. i1 Tinct. Acon. 3, gtt. iij. Aq. pur. 3 iij. Dosis. Cochleare mediocre, tertia quaque hora. March 9. Fever diminished, pulse 120, not so full; skin moist; mouth not so parched; thirst lessened; recumbency on the right side supportable, not so on the left; respiration laborious and quick; sound of superficial friction increased in extent and loudness, audible in all positions, and in the interval between the heart-sounds as well as during their occurrence; no perceptible dulness on percussion. The patient had passed a restless night, and was now and then delirious; joints still inflamed and painful. 13 Tinct Bellad. 3, gtt. ij. Aq. pur. 3 ij. Dosis. Cochleare medioc. tertia quaque hora. On repeating my visit in the evening, I found the rheumatic sufferings of the patient considerably alleviated, the redness of the joints no longer so intense, and the tumefaction much reduced; heart-symptoms little changed, perhaps a slight diminution of the friction-sound; skin inclined to be hot and dry, pulse the same as in the morning. JI Tinct. Acon. 3, gtt. ij. Aq. pur. 5 ij. Dosis. Coch. med. sexta quaque hora. March 10. Patient has passed a good night, perspired copiously soon after the first dose of the medicine; skin still moist; no thirst, yellow furred, moist tongue; aversion to all food; pulse 100, somewhat hard; patient cannot yet lie on the left side, and on sitting up in bed she complained of darting pain proceeding from the region of the heart to the left shoulder and scapula, with aggravation of the pains in the joints on movement; sound of friction same as on the previous evening; no perceptible dulness at or near the sternum, and no abnormal sound in any other part of the chest; respiration free, slightly hurried, but occasionally interrupted by the darting pain already noticed, on making a succession of deep inspirations. 480 CIRCULATING SYSTEM. 1c Tinct. Bryon. 3, gtt. iij. Aq. pur. 3 iij. Dosis. Coch. med. quarta quaque hora. March 11. Considerable improvement in every respect. Prescription as before. March 12. Further improvement,-the patient can lie on both sides; tongue clean; appetite returning; pulse 84, feeble but regular; action of the heart still rather powerful, particularly on the least movement; friction-sound only audible after any slight exertion, such as turning in bed or sitting up; all redness and swelling of the joints has disappeared, some stiffness and pain on movement alone remaining. ic Bryon. 6, glob. xxiv. (redig. in pulv.) Pulv. Sacch. lactis gr. iv. Misce intime, et divide in partes sequales iv, quarum capiat unam quotidie. March 17. Convalescent. A year afterwards I saw the patient, and discovered no traces of disease of the heart of any description. CASE 2. R. H., 21 years old, of bilious temperament, was attacked with rheumatic fever about the middle of November, 1845, after having been exposed to a cold and damp atmosphere for several hours. During the three following days the sufferings were so severe that the patient was unable to remain at rest in any posture, feeling, if anything, rather easier whilst sitting up in bed with his head between his hands, resting his elbows on his knees, and giving a rocking motion to the body; towards evening fits of coldness and shivering alternating with heat, accompanied the pains; and about midnight copious sweats supervened, which were followed by remission of pain and some sleep. Early in the morning, however, there was recurrence of sufferings, with increased violence. On the evening of the fifth day of his illness, the patient was induced to drink some hot gin and water, in the double hope of arresting the chills, and allaying the pain. The day afterwards, the rheumatic pains had nearly vanished, but were substituted by intense headache, nausea, giddiness, palpitation of the heart, and sharp pains in the left breast. These symptoms continued in an unmitigated form for five days, and on the day following,-the tenth of the patient's illness-I was requested to visit him. I found PERICARDITIS. 481 him sitting on his bed, half dressed, having been unable to complete his toilet in consequence of the distressing dyspnoea and palpitation which he experienced on making any slight exertion; his countenance wore an expression of intense anxiety, which, together with the history of the case, led me at once to infer, before resorting to auscultation, that some affection of the heart had arisen from rheumatic metastasis; no pain was complained of beyond an occasional twitch in the left side of the chest, during the performance of a somewhat full inspiration, or on turning the body towards the right side; a degree of stiffness in the back and limbs was the only inconvenience complained of in the parts which had been previously so severely affected with rheumatism. The pulse was feeble, irregular, occasionally intermittent, and rather frequent; the tongue furred white, loaded with mucus, and increased in volume; appetite wanting; taste metallic; no thirst; bowels confined for four days. On auscultation, the sounds of the heart were somewhat muffled at the cardiac region, but the impulse greater than natural, and there was distinct, though not loud, friction-sound immediately to the left of the inferior third of the sternum, particularly when the patient inclined the trunk forwards,. or made any trivial effort, such as rising from his seat, or raising up the left arm quickly. On percussion there was decided dulness, confined to an area of three inches, at the lower end of the sternum. In the carotid and subclavian arteries, the normal heart-sounds were audible in their natural strength. The case thus afforded unequivocal evidence of pericarditis, from the metastasis of rheumatism, resulting in liquid effusion. 1~ Laches. 6, gl. xij. Aq. pur. gj. M. Dosis. Coehl. medioc. ter die. Nov. 27. The patient intimated that he felt easier; had passed a better night than he had done since the day he was first seized with indisposition; the bowels had been freely moved early in the morning; pulse same as yesterday; dulness on percussion, sounds and impulse of the heart unchanged; expression of countenance still anxious. Former prescription repeated. On the 28th, and two succeeding days, the patient remained 31 482 CIRCULATING SYSTEM. in much the same state: he imagined himself better, but his countenance bore the same anxious expression; and, if anything, an increase of dyspncea, with tendency to syncope on movement seemed to have taken place; the pulse was rather more feeble and intermittent: Arsenicum 6 (dose, gl. 6 every four hours) was substituted for laciesis, on the 1st of Dec., and continued until the morning of the 3d, when the patient's state was as follows: Dulness on percussion over a larger space, nevertheless the friction-noise at the sternum was somewhat stronger than it had been the four previous days; the impulse was also somewhat more powerful, but the natural heart-sounds impaired and distant; great dyspnoea, and faintness on the slightest movement; pulse still weak and quick, but not so intermittent; some appetite, but increased oppression on the introduction of the smallest morsel either of liquid or solid food into the stomach; no pain in the region of the heart; sleep restless; decubitus dorsal, with the head and shoulders raised. 1f Arsenic, 3, gtt. iij. Aq. pur. g iss. M. Dosis. Coch. med. quarta quaque hora. Dec. 4. Patient felt stronger, and had passed a tolerable night; no thirst; tongue foul; in all other respects the same as on the day previous. 1c Colch. 3, gtt. iij. Aq. pur. 3 iij. M. Dosis. Coch. ampl. tertia quaque hora. Under the employment of this remedy, a striking improvement soon became manifest,-the patient began to breathe more freely, and to be enabled to move about without much in~convenience arising from palpitation, dyspnoea, or faintness; the dulness on percussion commenced gradually to give way,:and the sounds of the heart resumed a normal intensity. Colchicum was continued for six days, latterly at longer intervals between the doses. On the 11th of December N1ux v. and Arsenicum were prescribed in alternation, at intervals of twelve hours,-the former in consequence of the deranged state of the digestive organs, and some slight rheumatic pains, of a dragging, aching description, in the back, chest, and joints, accompanied by a feeling of torpor in the fore-arms,-the PERICARDITIS. 483 latter, from the circumstance that the patient complained of occasional attacks of dyspnoea, and palpitation of the heart at night. A week afterwards convalescence was not only firmly established, but the patient was, moreover, restored to a much better state of health than he had enjoyed for a year or two past. No relapse has taken place, and recovery appears to be complete. CASE 3. C. W., aged 15, of melancholic temperament, and somewhat robust and muscular build for his years, but disposed to suffer from deranged digestion in consequence of frequently over indulging a naturally keen appetite, to which an additional stimulus was usually given by the amount of severe exercise he was daily in the habit of taking, had been confined to the house for a week with a severe attack of acute rheumatism. March 3d, 1846, the patient was seen by me for the first time, when I was instructed that, three days previously, he had been seized with an increase of fever attended with palpitation of the heart and some oppression at the chest. These symptoms had continued to gain ground, and formed the reason that induced the parents of the patient to send for me (previous to which they had been allowing the disease to take its course,-the father having become a complete sceptic in medical science). I found distinct indications of inflammation of the pericardium, with some symptoms of complication with endocarditis, as was evinced by the existence of the following physical signs: loud friction-sound, not only about the middle of the sternum, but also, pretty clearly, beyond the proper cardiac region, in various directions, and greatly disguising the natural sounds of the heart; strong and very abrupt impulse, accelerated pulsations, and prolonged first sound. On listening at the top of the sternum, and also in the carotids, the normal heart-sounds were heard with tolerable distinctness, attended with a grating murmur, which, although somewhat faint, was yet sufficiently well marked to denote endocarditic implication with regurgitation through the semilunar valves of the aorta. The expression of countenance was painfully anxious, the restlessness great, the skin hot and dry, and the pulse full, strong, rapid but regular. Ij Tinct. Acon. 3, gtt. iij. Aq. pur. $ iij. Dosis. 5 ss. quarta quaque hora. 484 CIRCULATING SYSTEM. March 4. Patient somewhat easier; perspired freely after the second dose of Aconite; countenance not quite so anxious; physical signs as before, impulse of the heart perhaps rather less violent; pulse still full, but softer and rather slower; no pain in the region of the heart when the patient lay perfectly quiet, but any sudden movement was immediately followed by excessively increased action of the heart, dread of suffocation, and a sensation of severe constriction as if the heart were violently squeezed or drawn together. Position in bed either dorsal or on the right side, with the head raised,-a sense of suffocation being experienced whenever the patient attempted to recline sinistrad. jc Tinct. Spig. 6, gtt. iij. Aq. destil. 5 iij. M. Dosis. Coch. ampl. sexta quaque hora. The general symptoms having much improved under the employment of the Spigelia, that remedy was continued until the 7th of March, on which day the symptoms encountered were as follows; respiration freer, anxiety of expression only perceptible after the performance of any slight exertion, which was still followed by violent palpitation; valvular murmur no longer audible; friction-sound only perceptible when the heart is tumultuously agitated; pulse quick, somewhat irregular, and rather feeble, even when the action of the heart is powerful. On percussion a slight degree of dulness was discernible to the left of the sternum. The appetite, which had returned immediately after the improvement effected by Aconite, and could with difficulty be kept within the proper limits necessary in such a disease, was now supplanted by a strong aversion even to the smell of food of every description, and there was considerable thirst, which seemed to be materially caused by a sensation of intolerable dryness and burning heat in the throat, as the patient drank but little at a time, and seemed to experience temporary relief from sipping a little cold water every now and then; tongue rather dry and furred; bowels had not been relieved for five days. No pain was complained of in the region of the heart, the feeling of severe constriction having readily yielded to Spigelia. c Arsenic. alb. 6, gtt. iij. Aq. destil. 3 ij. Dosis. 3 ss. quartis horis. PERICARDITIS. 485 March 8. General symptoms considerably amended; physical signs the same. Medicine continued. March 9. Appetite returning, dryness of mouth and throat, together with the thirst, removed; palpitation of the heart somewhat diminished; friction-sound still perceptible on particular occasions, such as after a sudden movement of the body, or even of the arms, but only to a slight degree; dulness on percussion neither increased nor diminished since the 7th; bowels not yet relieved; spirits very depressed. SLaches. 6, gtt. iij. Aq. destil. 3 ij. Dosis. Coch. maj. j. quarta quaque hora. March 10. Rather less dulness on percussion; frictionsound no longer audible; pulse more regular, but still weak and accelerated; impulse of the heart stronger, rather more abrupt, and the palpitation very distressing on movement, but particularly on turning in bed during the night; the patient can lie on either side, yet prefers lying on the right or on the back; spirits better, although sudden fits of indescribable anxiety still occur at intervals. Arsenicum and lachesis were given in alternation every twelve hours, during the six succeeding days. At their expiration the patient was convalescent. The bowels were copiously relieved on the 12th without the aid of an enema. For the space of a fortnight afterwards there was some tendency to violent palpitation of the heart on going up stairs rather quickly, but this completely subsided under the action of the remedies (such as Sulphur, Bryonia, Nux., Natr. m., and Acid. n.) which were called for by the chronic derangement of the digestive functions. In cases of pericarditis arising from external injury, Aconitum and Arnica should be employed. When moral causes, such as prolonged vexation, seem to have assisted in developing this disease,-Arsenicum, Veratrumn, Lachesis, Belladonna, and perhaps also fIyoscyamnus, are medicines which should chiefly claim our attention. Chronic pericarditis. The symptoms here are the same as those of the acute variety, differing merely in degree. When there is fever it is of the hectic type. When dense adhesions form between the apex of the heart 486 CIRCULATING SYSTEM. and the pericardium, they, by interfering with, and confining the motions of the heart, are consequently sooner or later productive of serious organic disease, more particularly hypertrophy with dilatation. The signs by which these adhesions are to be detected are not always distinctly marked. They may only be said to be decidedly appreciable when they are close and rigid, and the pericardium has, moreover, been rendered adherent to the walls of the chest. In such a state of matters, the heart will constantly be found pulsating in close contact to the ribs, its motions will be seen and felt more plainly than usual (drawing in the intercostal spaces at each systole), and there will be dulness of sound on percussion, over a space proportioned to the adhesion and the size of the heart, during every stage of respiration, and in every position of the body. A projection is strikingly observable about the ends and cartilages of the middle ribs, in those cases in which an enlargement of the heart, upwards and downwards, ensues, in consequence of its general adherence to the pericardium, and of the latter to the diaphragm and walls of the thorax. THERAPEUTICS. When lymph has been effused, and become organized, and the adhesions formed materially interfere with the motions of the heart, the case is beyond the reach of medicine. When the exudation is serous, a cure may, in some cases, be eventually accomplished by means of such remedies as Arsenicum, Digitalis, Veratrum, Cannabis, Sulphur, Phosphorus, Carbo v., &c. ENDOCARDITIS. The general symptoms of inflammation of the lining membrane of the heart are, commonly, still more uncertain and obscure than those of pericarditis. There may be tumultuous action of the heart, with fever, irregular action, palpitation, oppression, anxiety, faintness, and some degree of pain, which is generally referred to the sternum or epigastrium; but these symptoms sometimes exist in so trivial a degree as to be entirely overlooked. The physical signs are, consequently, to be chiefly relied on, in distinguishing this inflammation, as well as in pericarditis. The sounds of the heart are louder at first, the impulse greater, and frequently attended with a vibration or tremor, but the pulsations are not in every instance ENDOCARDITIS. 487 more frequent. Soon afterwards the first sound seems double, and is prolonged, or it is accompanied by a slight roughness, which ere long becomes converted into a blowing or grating noise, forming the characteristic valvular murmur, produced by the regurgitation of blood through the diseased or defectively-closed valves. By paying attention to the nature of the sound, and the situation where it is most distinctly heard, we may generally determine with considerable certainty in what part of the heart it occurs. The left side of the heart is where we may almost invariably expect to meet with the deranged valves, so that when the bellows-sound or murmur is perceived, we have, in nearly every instance, simply to discriminate whether the noise is produced at the mitral or aortic valves. The mitral valve, or inlet of the left ventricle, is more commonly the seat of the disease than the semilunar valves of the aorta. Whether the mitral or the aortic valves form the seat of the murmur, it will always be heard over the left side of the heart, synchronous with the first sound. If it is heard loudest an inch or so below, and a little to the inside of the nipple, where the apex strikes, becoming more indistinct as we ascend or approach beyond the upper half of the sternum, it is occasioned by mitral regurgitation, in consequence of the imperfect closure of the valve, caused by the exudation of serum or lymph between its layers, and the irregular spasmodic action of the columnum carne3e. On the other hand, if the murmur be heard most clearly at the base of the heart, along the upper half of the sternum, particularly on a level with the margin of the third rib, and even in the carotid arteries, where it usually has a harsher, more grating tone, but decreases in intensity as we approach the apex of the heart, we may be satisfied that it is generated at the aortic orifice, and is caused by tumefaction of the semilunar valves, or deposition of lymph between their surfaces. The second sound is also frequently impaired in the latter instance, or it is accompanied, or altogether supplanted, by a grating noise. The pulse varies much in endocarditis, but does not partake of the violence of the heart's action. It is generally small, feeble,. irregular, and not in harmony with the impulse of the heart,. when the mitral valve is affected; and more or less full,, 488 CIRCULATING SYSTEM. sharp, jerking, quick, but regular, when the semilunar valves are the seat of derangement. CAUSES. These may in general be considered the same as those of pericarditis. The great majority of cases arise from the metastasis of rheumatism, or occur during the course of pleuritis. There are few instances of acute rheumatism in which some of the signs of obstruction to the current of blood through the mitral or semilunar valves are not discoverable, and the younger the patient is, the greater is the probability of his being affected with rheumatic endocarditis. PROGNOSIS. This malady may be held as rarely fatal during its acute stage. If the valvular murmur be not removed in from ten to fourteen days, it is prone to remain permanent, and the patient will eventually sink under disease of the heart, although the fatal issue is not unfrequently delayed for from five to ten, or twenty years, and even somewhat upwards. It is consequently of the utmost importance to detect the disease early, as it is only during the acute stage that we may entertain any confident hope of preventing it from degenerating into a chronic, and but too often incurable disease of the heart, particularly cartilaginous or osseous disease of the valves, and hypertrophy of the ventricles. THERAPEUTICS. The remedies which have hitherto been principally recommended in the treatment of endocarditis are Aconitum, Arsenicum, Iachesis, Spigelia, Bismuth, Belladonna, Digitalis, Veratrum, N.ux v., Pulsatilla, Asparagus, &c. AcONITUM is, generally speaking, only useful in acute cases, when the pulse is full, hard, and vibrating, and there is pain of a sharp or pricking description in the cardiac region, with oppression, anxiety, faintness, and tumultuous action of the heart. We have found it, together with Belladonna, of speedy and most effectual service at the commencement of endocarditis, with indications of affection of the aortic orifice, and secondary implication of the brain evinced by delirium and occasional stupor. Arsenicum is one of the most important of our remedies in diseases of the heart, and we should say, is all but indispensable in endocarditis with disease of the mitral valves. It may, however, be of fully equal service when the outlet of the left ventricle is affected; ENDOCARDITIS. 489 and is, moreover, to be considered as an invaluable remedy in complications with pericarditis. Spigelia, Digitalis and ZacAesis, are also deserving of notice in the latter instance, and may sometimes be of great service after, or in alternation with Arsenicum. The observations of Dr. Clotar Miller, jun., on " Endocarditis Rheumatica," (which is by far the most frequent form in which inflammation of the lining membrane of the heart is encountered,) and other diseases of the heart, appear to us to be of such striking interest, that we gladly avail ourselves of Dr. J. C. Peters's translation,* to introduce an extract here: "It is our intention here to show more particularly that physical examinations are always of importance in the selection of homoeopathic remedies, and that a continued attention to this point must lead to the most important results in the cure of disease. The present condition of our Materia Medica, at the first glance, would seem not to favor or allow of such an attempt, for we look in vain in it for even a single physical sign, which is as subtle and exact in its signification as 'bronchial respiration,' or ' bellows-murmur with the second sound of the heart,' &c. It could not, and perhaps cannot be otherwise, for the greater part of the experiments and investigations with drugs, which constitute our Materia Medica, were made at a time when auscultation and percussion were but little known, and less practised; and even now it would be extremely difficult to produce physical signs and symptoms in previously healthy persons, by means of drugs; experiments with drugs on the healthy must be confined to certain, and those very narrow limits, whilst natural disease may progress to total disorganization, and often acknowledges no limits short of death. We must even do, in the treatment of organic diseases of the heart and lungs, what has been done in the treatment of other diseases, viz., conclude from slight indications what greater results might have followed, if the experiments with drugs could have been pushed far enough; if one attempt to produce in the healthy subject, with Sulphur, Baryta, Calcarea, &c., the extensive ulcers * Endocarditis rheumatica, by Dr. Cl. Miller. Translated, with notes, by John C. Peters, M.D. Homceopathic Examiner, Vol. v., No. 1. 490 CIRCULATING SYSTEM. and scrofulous derangements which have been cured hundreds of times with these remedies, he will probably be disappointed; one will certainly wait in vain to see Kali carb. produce purulent expectoration, and genuine symptoms of phthisis; or for Silex to produce the manifold alterations, and new formations in the tendons, burse mucosae, joints, &c., which it cures with wonderful celerity, &c. But there is also another source of information open to us, which was not sufficiently cultivated during the early career of Hahnemann, viz. Pathological Anatomy. When we once succeed in establishing certain constant organic lesions to be produced by drugs, as learned by post-mortem examinations in cases of poisoning with these drugs, then we come in possession of strictly homceopathic remedies against similar diseases; this pathological knowledge of the effects of drugs is of especial importance in the homceopathic treatment of endocarditis, for this disease, as it progresses, becomes attended with almost all the symptoms which attend diseases of the heart in general. " AuSENIcuTr. It produces anxiety in the region of the heart; irritable and frequent beating of the heart, with great feebleness of the pulse; frequent, violent, irritable beating of the heart; frightful and very troublesome palpitations, especially at night; nocturnal, irregular and violent palpitations, with anxiety; very much quickened, violent, stormy, irregular and painful beating of the heart; loss of contractility of the heart; piercing, burning, and soreness in the region of the heart. " Patiological Anatomy. Very much relaxed or violently contracted heart; much thickly-fluid, tar-like blood in the right auricle; opalescent spots upon the inner surface of the left ventricle, from the presence of false membranes; violetred spots, with softening of the internal coat of the heart (endocardium); red-marbled spots in the left auricle and ventricle; smaller carmine-red spots, especially on the papillary muscles, and penetrating into the substance of the heart; much darker redness, almost blackness of the right cavities of the heart, and some spots on the papillary muscles; red or black broad spots in the left ventricle; inflammation of the semi-lunar valves of the aorta. "If we recollect, in addition, that Arsenic has been found ENDOCARDITIS. 491 serviceable in palpitations, carditis, endocarditis, rheumatic and organic diseases, especially of the left side of the heart; in the most frightful paroxysms occasioned by hypertrophy, dilatation, or valvular diseases of the heart, it will become evident that Arsenic possesses the most perfect, specific, and homoeopathic relation to endocarditis. It is indicated not only in the commencement of the disease, but also when exudations and vegetations have formed on the endocardium and valves, especially of the left ventricle. It is hence the main remedy in Bouillaud's so-called chronic endocarditis. It is indicated when the following physical signs are present: dulness over a greater extent than usual in the cardiac region, especially in a vertical direction; violent and irregular action of the heart, with feebleness, or almost complete extinction of the pulse; indistinctness, or roughness of both sounds of the heart, or a bellows-murmur with the first sound, heard over the left ventricle (and along the aorta, but loudest over the aortic valves, viz., at the edge of the third rib, near the left edge of the sternum). "BISMUTH. It produces violent beating of the heart; violent palpitations, visible at a considerable distance; a symptom which is almost peculiar to hypertrophy of both ventricles. " Pathological Anatomy. An intensely bright inflammatory redness in both ventricles; in the left ventricle several cherry-red, pretty broad, but not very deep spots. this evidently must prove a very important remedy in diseases of the heart, especially in the acutely inflammatory stage, although it may also prove useful in valvular disease and hypertrophy. It is indicated when the following physical signs are present: dulness on percussion over a great extent of surface; violent beating of the heart, distinctly elevating the walls of the chest (or the hand or head of the auscultator when applied); bellows-murmur with the systole of the heart, and heard both over the right and left ventricles. " COLCICUM. It causes rending pain in the region of the heart; very violent palpitations, followed by very weak beating of the heart. " Pathological Anatomy. Several ecchymosed spots on the pericardium; effusion of serum in the pericardium; 492 CIRCULATING SYSTEM. heart large and lax, its external surface marked by dark violet or brownish spots, and with large circumscribed patches of lymph. It would seem more homceopathic to pericarditis* than to endocarditis. It may be used when the following physical signs are present: dulness over a small, or very great extent of surface (when there is effusion into the pericardium the dulness mounts higher up the sternum, in the direction of the great vessels, than when it is occasioned by mere enlargement of the heart; distinct bulging of the ribs over the heart); action of the heart violent at first, and attended with a marked friction-sound (a vibratory tremor, generally perceptible to the hand; Stokes noticed this tremor in five cases out of six; the friction-sound is a to-and-fro sound, corresponding with the movements of the heart backwards and forwards; it is generally more or less rough, sometimes like the rasping of wood, or the grating of a nutmeg, crackling of parchment, rustling of silk; very rarely it resembles the creaking of the new sole leather; when the quantity of effusion increases, these sounds may change to a continuous hollow rumble, owing to the agitation of as large a quantity of fluid as is compatible with the production of a murmur). When the quantity of serum becomes great, the heart is pushed back from the walls of the chest; hence its impulse can scarcely be felt, all friction and other murmurs cease, and the natural sounds of the heart are heard very indistinctly, and at a great distance. " CRoToN. It causes piercing pain in the region of the heart; loud and perceptible pulsation and throbbing of the heart, especially when lying down; sudden throbbing in the region of the aorta. " Pathological Anatomy. Sixteen ounces of dark bloody serum in the pericardium; softening of the heart; actual extravasations of blood into the substance of the heart; dark stripes and ecchymoses on the endocardium of both ventricles; inflammation of the pulmonary arteries and veins; redness of the valves. " This is evidently one of the most important homoeopa* The marked amendment which speedily followed the employment of Colchicum in case No. 2, article PERICARDITIS, inclines me to corroborate this.-J. L. ENDOCARDITIS. 493 thic remedies in diseases of the heart (and perhaps -the most homceopathic remedy to effusion into the pericardium, especially the hoemorrhagic variety). The physical signs indicating its use are the same as those requiring the use of Colchicum, with the addition that there may be valvular murmurs heard to the right of the sternum, over the right ventricle, and during the diastole of the heart. " ACONITE. It causes pressing together of the chest in the region of the heart; palpitation in young plethoric persons; palpitations with great anxiety, oppression of the chest, general heat, especially in the face, great relaxation of the limbs; slow throbs in the cardiac region; aching, compressing pain below the sternum; pain in the left side of the chest, between the fourth and sixth ribs; disproportion between the heart and pulse beats; for the pulse beats three times, while the apex of the heart strikes the walls of the chest once; the right auricle, however, seeming to be persistently and convulsively contracted. " Pathological Anatomy. No peculiar and characteristic alterations are found, viz., no signs of inflammation, or its consequences, but merely signs of relaxation and debility of the heart, with more or less of venous congestion; the heart relaxed and dilated; the left side filled with fluid red blood, and the right -vith fluid or coagulated black blood, or in general containing much black, coagulated or brownish blood. Hence the pathological appearances afford no warrant for the use of Aconite in inflammatory affections of the heart; still it is advised in predominant arteriality, in palpitations, in endocarditis, with or without articular rheumatism; also as an invaluable palliative remedy in organiic affections of the left side of the heart, and large vessels, dilatation of the left ventricle, &c.; in endocarditis it can only be homceopathic in the very commencement of the disease, before extensive exudations or alterations of the surface of the endocardium and valves have taken place. " Physical Signs. Judging from the above, Aconite will be indicated when there is dulness on percussion over the heart, when the motions of the heart are quick and violent, but do not evidently and visibly raise the walls of the chest at each impulse, and are not synchronous with the beats of 494 CIRCULATING SYSTEM. the radial pulse; when both sounds of the heart are heard louder, clearer [the first sound being almost as clear and clacking as the second, which is the most characteristic sign of dilatation of the left ventricle], and heard most distinctly over the left ventricle fwhen the apex of the heart is found beating nearer to the nipple than one inch below and within it, viz., very near the nipple, or just below it, or outside of it, or even above it, for the larger a heart becomes, the more is the apex carried outwards and upwards]. "ASPARAGUS. It causes: An indistinct sensation of piercing in the cardiac region; frequent violent palpitation while sitting; palpitation with anxious restlessness, caused by motion or ascending stairs; feelable and audible throbbing of the heart from moderate exercise; irregular, quick, double beating of the heart; scarcely perceptible action of the heart. It is less homnceopathic to the inflammatory stage, than to the consequences of endocarditis, more especially to hypertrophy of both, or only of the left ventricle. "1 Physical Signs. Dulness on percussion over a very extensive surface; the action of the heart violent, elevating at each beat the corresponding portion of the chest [so that when the hand or head of the examiner is placed over the cardiac region it will evidently be seen to rise and sink with every contraction and dilatation of the heart; however violent the palpitations may be in simple nervous affections of the heart, no permanent bulging of the ribs over the heart is noticed, and the action of the heart never lifts the hand or head of the auscultator]; violent pulsation of the carotids; sounds of the heart natural, but louder, or attended with murmurs or other abnormal sounds at various parts, either during the systole alone, or also during the diastole. " [Riecke says that a man in Paris, suffering with palpitations, thought he felt relief every time he ate of Asparagus; hence he prepared a syrup in order to have some when it was out of season; this also helped him, and he mentioned it to his physician, who made further and satisfactory experiments and communicated their results to Bronpais, who wrote a short article about it in 1839; then its use became quite fashionable, but lately it has fallen into neglect. Bronpais says, like Digitalis it possesses the power of diminishing the ENDOCARDITIS. 495 action of the heart, and of increasing the urine, without irritating the stomach; hence it is serviceable in hypertrophy and palpitations of the heart, and also relieves the nervous pains, even when dependent upon organic disease. Heyfelder found it very beneficial in hypertrophy; Andral, Fougier, Serres, &c., saw good effects from it in cardiogmus, even organicus; while Buchner, in his experiments with the tincture, often felt violent palpitations with anxious restlessness, both while sitting still or moving about.] " BELLADONNA. It causes aching in the cardiac region, taking one's breath away, and causing anxiety; anxious feeling in the region of the heart, with occasional intermittence of the pulse; irregular, unequal contractions of the heart; clucking about the heart, when going up stairs, with palpitation; trembling of the heart; throbbing pain beneath the sternum, near the epigastrium; very feeble beating of the heart; violent and persistent palpitations; violent heart-thobbing, with jarring of the head and neck. " Pathological Anatomy. Partly fluid, partly coagulated blood in the ventricles; blackish coagula; lividity and great softness of the heart; blackish and very thin blood in the arteries. " From the above it is evident that Belladonna is not a truly homceopathic remedy for endocarditis, but it is an admirable remedy in congestion of the chest, preventing the occurrence of actual inflammation, and moderating the stormy vascular commotions which attend organic diseases of the heart, and cutting short the frequent exacerbations of the disease which threaten to light up inflammation anew. " Physical Signs. Percussion sound normal, or dull over a rather large extent of surface; action of the heart alternately violent, then weak, or even intermitting; sounds of the heart natural, except clearer than usual, of irregular rhythm, first stronger, then weaker, then absent. "VERATRUM ALBUM. It causes extreme agony, which takes away the breath; palpitations, with anxiety and quick, audible respiration; paroxysms of agony about the heart, which then beats very violently and feels as if it were too warm; violent beating of the heart, which forces up the ribs; the heart beats up very high and forcibly, so as to force the 496 CIRCULATING SYSTEM. hand away, without pain. In cases of poisoning of dogs with it, the heart beats stronger, quickly, and irregularly, in strong contrast with the general prostration and stupefaction of the animal; even an hour after death the heart still moved feebly. "The entire absence of pain about the heart, while this organ beats so violently as to shake the chest, elevate the ribs, and lift the hand of the auscultator, deserves particular attention, for this almost never occurs except in hypertrophy with dilatation. " Physical Signs. The percussion sound may be dull over a very large space (the apex of the heart may beat directly beneath, or outside of, or above the nipple; bulging of the ribs over the heart); action of the heart visibly very violent; sounds of the heart either very loud and clear, or else one or both sounds accompanied with abnormal murmurs. "(From the well-known action of Veratrum on the stomach and bowels, it deserves particular attention in those affections of the heart dependent upon or attended by derangement of the stomach; ' in some forms of nervous palpitation there is an increase of suffering after meals, or when the stomach is deranged, while amelioration is produced by dyspeptic remedies; but, as the stomach produces the same effects when there is disease of the heart, these signs are not pathognomonic of nervous palpitation. To this point I [Hope] would particularly direct the attention of physicians; because many, in forming their symptomatic diagnosis of the affections in question, regard the dyspeptic signs as paramount in value to all others, and are apt to refer to the stomach the palpitation which may really belong to organic disease of the heart.' It is easy to show that Veratrum is homceopathic to both these varieties. IHutchinson remarks that, in poisoning with Veratrum, violent palpitations, intermittent pulse, and a condition of things which presents much similarity to organic disease, are very apt to ensue. In the Med. Chir. Rev., vol. II, page 196, we find an article headed,'Veratrum album used for producing artificial disease of the heart.' A man by the name of Chapman, belonging to the Marine Artillery, had found out the secret virtues of the white Hellebore, and turned it to the advantage, or rather disadvantage of himself and ENDOCARDITIS. 497 others, to whom he sold his powders at a high price. By taking the Hellebore every appearance of dyspepsia, attended with great nervous irritability, and violent and continued palpitations, was produced. This Chapman had deserted, and was taken in a remote part of the country, where he completely succeeded in deceiving the staff-surgeon, who examined him, and reported his incapacity for military service in consequence of having organic disease of the heart! Dr. Quavier states that this practice of taking IHellebore was productive of some alarming consequences for a considerable period; some were permanently injured, having actually produced the disease which they merely intended to counterfeit.)" " DIGITALIS. It causes in the healthy subject, slight pain, aching and heaviness about the heart; increased activity of the heart, with slowness of the pulse; increased throbbing of the heart: palpitations which arouse one from sleep; palpitation and commotion of the blood, with great anxiety, forcing one to get out of bed, with quickness of the pulse, congestion to the head, noises and roaring in the ears; diminished action of the heart; scarcely perceptible beating of the heart; very soft and weak beating of the heart; evident throbbing in the right side of the chest. " Pathological Anatomy. Several blackish and quite voluminous coagula in the right ventricle; bright-red and fluid blood in the left ventricle (in a vast majority of instances no blood is found in the left side of the heart after death,-the powerful muscular development of the left ventriole almost always seems sufficient to empty that cavity, even at the last throb which marks the cessation of life; hence, whenever blood is found there after death, it denotes an unusual degree of relaxation, debility, and utter exhaustion of the muscular structure of the heart), fluid, dark-red blood in the heart; extinguishing of the irritability of the heart. (Digitaline, i. e., the active principle of Digitalis, according to Bouchardat and Sandras, in doses of one-tenth of a grain, singularly modifies the circulation, and is capable of irritating the digestive organs in a high degree; all the patients to whom it was administered experienced a marked slowness of the pulse, the greatest depression taking place in general, some 32 498 CIRCULATING SYSTEM. hours after the exhibition of the drug; in several instances it was diminished in frequency to the extent of nearly one-half of the normal condition, very often only one-third or one-fourth; the next morning it became rather more frequent, but always remained from ten to more beats below the normal pulse. In all these cases the pulse was so irregular, the irregularity being of two kinds-the first and most remarkable irregularity was that the intervals between the pulsations were unequal; sometimes the pulse would be hard and very quick, then hard and slow; at others it would be soft at times, then hard; again it would remain soft persistently. Some patients would experience light-headedness, annoying dreams and hallucinations, soon followed by more or less frequently repeated diarrhoea or bilious vomiting, which in spite of all precautions sometimes lasted two or three days; the appetite was lost at the same time; whenever it induced irritation of the digestive organs, the pulse again becomes frequent). "(The marked depressant action of.Digitalis on the heart renders it homoeopathic to dilatation, with thinning of that organ, which state, according to Hope, depends upon direct debility, or deficient power. In this effect the palpitations are of a feeble, oppressed kind, and more or less distressing, frequent and prolonged, according to the extent of the dilatation; in general they are protracted; the pulse is soft and feeble, and if the debility of the heart be great, the pulse is small; irregularity and intermittence are common during the protracted and distressing paroxysms of palpitation and dyspnoea; when the dilatation is attended with softening of the substance of the heart, the pulse is apt to be as small, weak, intermittent, irregular and unequal, as in the worst cases of disease of the mitral valve; cedema of the limbs is very common in this variety; also, lividity of the face, lips, &c.; one of the most constant and characteristic of the equivocal signs of dilatation of the right side of the heart, is permanent turgescence of the external jugular veins, without sensible pulsation. Among the physical signs of dilatation is a change in the character of the first sound of the heart; this, which is naturally dull and indistinct, become louder, shorter, and clearer, so as to resemble the clear, distinct clacking of the normal second sound; the degree of the dilatation can be ENDOCARDITIS. 499 judged of by observing how far the first sound resembles the second. The greater the shortness and clearness of the first sound, the thinner will the walls of the heart be found. The dulness on percussion is increased, and is found lower down than natural; dulness over the inferior part of the sternum denotes dilatation of the right ventricle in particular. Although the heart be enlarged, the impulse is diminished, and in extreme cases absent, even during palpitation; when felt, it is only a brief percussion of the chest, not elevating the hand or ear of the examiner; sometimes several beats of the heart are heard, while one only is felt (Hope). There is old school authority for the use of Digitalis in this disease; Dr. Holland says: 'The enlarged and flaccid heart, though on first view it might seem the least favorable for the use of this medicine, is perhaps not so; at least I have reason to believe, that, in the dropsical affections so often connected with this state of the heart, the action of Digitalis is peculiarly of avail.' (See Med. Notes, &c., p. 574.) Old school physicians also say that it helps in intermittent and otherwise irregular pulse; Pereira says: 'In patients affected with an intermittent and otherwise irregular pulse, I have several times observed this medicine produce regularity of pulsation;' a circumstance also noticed by Dr. Holland. Dilatation of the heart is a treacherous disease to those who auscultate and percuss carelessly, as well as to the mere symptomatologist; for the heart may be two and a half times its natural size, and yet the impulse be by no means remarkably strong; and when the heart is much loaded and oppressed with blood, the sound of the valves, and even of valvular murmurs, may become so faint that they cannot be heard without the patient holds his breath. In a previous article we have referred to the homoeopathicity of Digitalis to diseases of the mitral valve.) " SPIGELIA. It causes oppression of the chest and palpitations; dull stitches occurring synchronously with the pulse, and felt where the apex of the heart strikes the chest; violent and audible beating of the heart, which may also be felt through the clothes, attended with anxious oppression of the chest, especially in the morning, soon after rising, also while sitting down; wave-like motion of the heart; want of har 500 CIRCULATING SYSTEM. mony between the heart and pulse-beats; purring sound in the chest, especially in the cardiac region, resembling the purring of cats. Sp)igelia has been recommended in inflammations and organic diseases of the heart, but we have as yet no pathologico-anatomical proof that it is really homoeopathic to these affections. It may prove homoeopathic to pericardial chorea; Eberle says that it causes spasmodic twitching of the face, alternate fits of laughing and crying, incessant inclination to run and skip about; Pereira says it often causes spasms of the facial muscles and even general convulsions; but spasmodic movements of the eyelids have been observed among the most common attendants of its narcotic action. It is not generally known that chorea may depend upon and mask acute pericarditis; Dr. Bright has seen cases in which there were peculiar spasmodic symptoms, like most fully developed severe chorea, except the convulsion was more violent than is almost ever seen in chorea; the head being thrown from one side of the bed to the other; the lips closed and opened with a smacking sound; the tongue protruded with all the grimace and difficulty as in chorea, and yet the only appearances found after death were recent and profuse effusion of lymph on the heart and pericardium, and recent vegetations of the semilunar and mitral valves. Spigelia may prove homceopathic and curative to this singular form of disease; cantharides also produce chorea, and may light up inflammation in almost any organ. " Physical Signs. Spigelia may be indicated when the percussion sound is normal over the heart, or dull over a very large surface; the impulse of the heart increased, evidently.and visibly elevating the walls of the chest at each beat; want of harmony between the heart and pulse-beats; (apex of the heart beating nearer the nipple than usual, or even outside of it;) valvular murmurs at various parts of the heart, as well with the systole as the diastole, or with both (friction or to-andfro sound of pericarditis). " Nux VOMICA. It causes palpitation in frequent short paroxysms, with commotion of the blood; pulsating throbs in the direction of the heart; great anxiety with severe palpitation. " In the numerous and careful post-mortem examinations ENDOCARDITIS. 501 which have been made in cases of poisoning with XNux, no organic alterations about the heart have been found; its influence upon the heart must be referred to the nervous system. It causes increased activity and evident irritation of the ganglionic system, which may be propagated to the mind and senses; hence the above-mentioned heart-symptoms may arise in consequence of sympathy with the ganglionic and mental affections. For this reason lIahnemann laid so much stress on the mental symptoms excited by Nux, and mentioned the presence of vexability over sensitiveness to all impressions, hypochondriacal humor, passionate irritability and sudden choler, great anxiousness, starting in affright, fearful anxious dreams, &c., as strong indications for the use of Nux vomica. Hence Nzux cannot prove homceopathic to endocarditis, or any other heart affection dependent upon any organic or material change of structure. From the above it becomes evident that even the negative results of physical examinations are of importance in the selection of a remedy. " (We take a different view of the action of Vux; it acts predominantly and specifically upon the motion side of the spinal marrow and the muscular system in general, and tends more particularly to cause tetanic spasms. As the heart is a very muscular organ, it is very probable that it exerts a similar action upon it; in fact, the spasm of the heart may become so complete and persistent, that this organ remains tightly contracted for some time, during which little or no impulse is felt, the respiration being difficult and the pulse extinct; if the spasm of the heart be less complete and tonic,. i. e., more clonic, then violent palpitation may ensue, but N'ux constantly tends to produce long-continued spasmodic contraction of the heart; according to Sobernheim, it often causes an. asphyxic condition, dependent upon an extremely violent con-- traction of the respiratory muscles and heart. Every one familiar with diseases of the heart, must be familiar with this state of things; a patient with organic disease of'the heart will be suddenly taken with what he calls spasms; he sits in; speechless agony, his hands clasped over the cardiac region, his eyes protruded, his face livid, &c.; the physician attempts to feel the pulse, and can scarcely find it; he places his hand 502 CIRCULATING SYSTEM. or ear over the heart, and finds everything as still and motionless as death itself: after a while the spasm relaxes; more or less palpitation follows, and the patient recovers for a time. Such attacks are often mistaken for paralysis, exhaustion, or debility of the heart, and treated with stimulants. Ience it will be seen that the action of Nzux is exactly the opposite of that of Digitalis upon the heart; if the latter be homoeopathic to dilatation with attenuation, the former will be so to contraction with thickening, i. e., to concentric hypertrophy, if any such disease exist. Iron, Bark, Nux vomica, Ignatia, &c., must prove the most homceopathic remedies to simple hypertrophy, i. e., where the walls of the heart are thickened, the cavity retaining its natural dimensions; also in that variety of hypertrophy in which the walls are considerably thickened and the cavity dilated; and in hypertrophy with contraction, in which the walls are thickened and the cavity diminished in size.) PULSATILLA. It causes stitches and anxious aching in the cardiac region, with difficulty of breathing, relieved by walking; heaviness, aching and burning about the heart; palpitation after slight mental emotions, from speaking, and after,eating: palpitation with anxiety, forcing one to throw off his.clothes; palpitation in violent paroxysms, with darkness before the eyes, want of breath, especially while lying on the left side. " Hahnemann has taught us that Pulsatilla is especially suitable for the female organism, for the sluggish, phlegmatic temperament, for gentle, quiet, and lachrymose individuals. If we seek for a reason for this, we will find it in a consideration of the general action and sphere of Pulsatill; in its Sspecific relation to the digestive process it exerts a marked influence upon the formation of blood, and upon the venous circulation; every alteration of the chyme and chylification must produce changes in the blood; excessive exaggeration of the digestive process must produce increased formation of lymph and blood, and predominant venosity (?). As women, in virtue of their sexual formation, require and use a greater quantity of blood, they are more subject to venous derangement, and hence Pulsatilla is particularly applicable to the female organism. Among the venous symptoms produced by Pulsatilla are: swelling of the hemorrhoidal tumors, enlargement of,the ENDOCARDITIS. 503 cutaneous veins, bleeding from the nose, cough, with expectoration of pieces of black coagulated blood; redness of the conjunctiva; the presence of chills, constant internal coldness, predominant coldness of the body, all point to a marked predominance of venosity over arteriality; as a consequence of the overfilling of the large veins of the chest, and of the right side of the heart, we find anxiety, great agony with palpitation of the heart, agony in the cardiac or precordial region, driving one to suicide; trembling anxiety, as if death were about to ensue, with fleeting heat of the body, coldness of the hands, paleness of the face, inclination to weep, &c. " At the bedside it has been found useful in passive congestion, with distension of the veins, and in tedious heart affections; it acts principally upon the venous, i. e., the right side of the heart, and hence is rarely useful in the inflammatory stage of endocarditis; but when insufficiency of the mitral valve has occurred, causing, as it almost always does, hypertrophy with dilatation of the right side of the heart, and consequent excessive accumulation and activity of the venous blood in the heart and chest, then Pulsatilla comes in play. "Physical Signs. Percussion sound dull over a large extent of surface, especially in a horizontal direction; the impulse of the heart either increased or normal; the sounds of the heart increased over the right ventricle, or a bellowsmurmur in the same place; the second sound of the pulmonary artery distinctly louder than the second sound of the aorta; normal sounds of the heart over the left ventricle, or a murmur with the systole; the jugular veins distended, and pulsating evidently (one of the most certain signs of enlargement of the right ventricle). " RHUS TOXICODENDRON.* Symptoms which it is capable of producing in the healthy subject: violent throbbing stitches over the region of the heart, whilst in a sitting posture, so as to cause loud cries; stitches in the region of the heart, with painful paralysis and numbness of the left arm; palpitation * The Nos. of the " Homoeopathic Examiner," containing the remaining remarks on this and the consecutive medicines, not having reached us as yet, we have attempted to supply the deficiency by referring to and translating from the original treatise.-J. L. 504: CIRCULATING SYSTEM. of the heart, whilst sitting still, so violent that the whole body moves at each pulsation; a sensation of weakness and trembling in the heart; excessive anxiety, with aching in the region of the heart, and tearing in the region of the os sacrum; excessive anguish, which prevents sleep during half of the night." There is, in addition to many others, one circumstance in particular which offers considerable difficulty to the correct selection of a homceopathic medicine, viz., the apparently great identity and similarity which exists between the individual symptoms of many medicaments; if the effects of the various remedies differed more distinctly and strikingly, if the natural boundaries and deviations were more prominent, the selection of the proper remedy would be materially facilitated. It is manifest that this difficulty arises rather from the character and arrangement of our AMateria Medica, than from the nature of the medicaments themselves, since it is probable that no two of them possess pathogenetic properties which entirely, or even only partially coincide in essential and particular points, excepting, perhaps, different preparations and combinations of one and the same substance. It is, therefore, of the highest importance to isolate the effects of each medicament by determining and establishing its essential and-characteristic qualities, and to point out distinctly its distinguishing and differing marks and peculiarities. And in fact, when reading the accounts of successful hom oopathic cures, we may easily perceive what a decided influence a single characteristic symptom often exercised upon the correct selection of the remedy, how often, only by such means, the right path was entered upon, and that a single such essential and peculiarly characteristic symptom is of much greater consideration than many unimportant symptoms which are only vaguely or not at all connected with the disease. This is undoubtedly the reason why, when two remedies appear to be equally well indicated, according to the similarity of their general symptoms, still only the one is actually suited to the case under treatment, and it is also partly owing to the same reason that the thinking physician holds an advantage over the layman, who only tries to accomplish cures by opposing symptom against symptom. Hahnemann himself often directs our attention to this point, and ingeniously points out such ENDOCARDITIS. 505 characteristics in several medicaments. Speaking of Rkus tox., he mentions as its peculiarity, "that it produces the more violent paroxysms and sufferings, whilst the body or the affected limb is kept in a state of perfect rest, but that, on the contrary, a remission of the paroxysms and improvement is induced by motion." This assertion is also distinctly suggested and fully borne out by the above-mentioned symptoms of the heart, and it deserves here the greater consideration, from the fact that all the remedies hitherto mentioned yield no similarity to this, but quite the contrary, viz., increase of the symptoms on movement. "Now, if we apply this peculiarity of Rhus to endocarditis and to diseases of the heart in general, we shall unquestionably find that it greatly limits the field of operation of this remedy; for although, in every inflammation, an increase of the symptoms generally ensues from motion, whereas considerable remission follows if the body or the seat of the derangement is kept quiet, still this is more especially the case in inflammations and chronic affections of the heart. For in these, a considerable increase of the paroxysms is almost invariably created by any degree of active corporal exertion, and by any other circumstance which is capable of producing an exciting effect upon the circulation of the blood. Nevertheless, there are some affections of the heart in which we meet with a certain analogy with this peculiarity of ]?Rhus, viz., the symptoms assume absolutely no precarious or dangerous violence, in consequence of an insufficiency or defective state of the valves (usually the valves of the aorta), as long as the heart retains its contractile power in an undiminished ratio, and is yet strong enough to overcome and press on the blood in its impeded current, from regurgitation through the deteriorated and imperfectly closing valves, no interruption is given to the circulation. Everything which, in such cases, exerts a depressive influence upon the energetic action of the heart, as bleeding, large doses of digitalis, etc., superinduces considerable derangements and dangerous symptoms; on the other hand, the evil is always relieved, if we succeed in strengthening the constitution generally, and in imparting to the heart that amount of energy which enables it to keep up the circulation of the blood in its normal state; hence, also, it happens that bodily 506 CIRCULATING SYSTEMI. exercise, judiciously undertaken, is sometimes more beneficial to persons thus affected than uninterrupted rest. "The increase of the symptomns during rest, and their alleviation through the act of motion, consequently form decidedly characteristic and striking indications for the employment of Rhus. It is certainly not adapted to the pure inflammatory stadium, but will be found appropriate to the subsequent diseases of the valves, and the derangements ensuing therefrom, especially in the case.of insufficiency of the valves and constriction of the ostia. As physical signs, we may point out the following: the sound on percussion is normal, or dull chiefly throughout the greater part of the longitudinal direction of the heart; the impulse of the heart is mostly increased, and that to such a degree as to shake the entire thorax; in place of the second sound, a prolonged murmur is audible over the whole heart; during the systole, there is either a sound, or an indistinct one, or none at all. "NATRUM M URIATICUM. It produces continual pains, violent stitches, and pain in the heart as if from contusion; at night in bed aching beneath the heart, as if ascending from the abdomen, with palpitation of the heart, which is increased by lying on the left side, and lessened by changing to the right; palpitation of the heart on the slightest movement, whilst in the erect posture, accompanied by anxiety; fluttering motion of the heart; irregular pulsation of the heart; intermittent pulsations of the heart; strong pulsation throughout the whole body. "The importance of these symptoms is confirmed and increased by experience derived from the practical use of this remedy; it is said to be of great advantage particularly in organic diseases of the heart, chronic palpitation of the heart, and in irregular pulsation of the same. Its effects, however, do not correspond as closely with acute endocarditis, but rather with the sequele of that inflammation. The physical symptoms for its application would be: sound on percussion mostly dull throughout the greater extent of surface; the impulse of the heart violent, irregular, and intermittent; the sounds unequal, louder, or supplanted murmurs. " NATRUM CARBONICUM. It causes aching pain in the region of the heart; stitches in the heart, sometimes increased by ENDOCARDITIS. 507 inspiration; pressing aching sensation, as if some hard substance were placed in, and occupied a space extending from the region of the heart to the scrobiculus, with a sense of constriction in the stomach; painful clucking in the cardiac region; palpitation of the heart on ascending stairs; anxious palpitation of the heart during the act of stooping; nocturnal palpitation of the heart, awakening from sleep when reclining on the left side; palpitation of the heart, which does not admit of rest on either side. "The symptoms of this salt bear so strong a resemblance to those of the foregoing (they are almost verbatim the same, with the distinction that, amongst those which appertain to 1Natrum muriaticum, we meet with, in addition, ' an irregular and intermittent pulsation of the heart,' a symptom, which, as has already been mentioned, is not at all very characteristic or of any importance for any given abnormal state) that we cannot discriminate between them by the physical signs, but, at the utmost, only by the general symptoms. " PHOSPHORUS.. It gives rise to congestions to the heart, with palpitations, which become very violent after dinner; palpitation of the heart, accompanied by anxiety in the evening, and in the morning in bed on awaking; frequent paroxysms of violent palpitation of the heart; violent palpitation of the heart in the afternoon after a slight mental emotion, lasting for an hour, and rendering it impossible to remain in a reclining position; recurrence of the attack on going to bed, but to a milder extent; palpitation of the heart, early in the morning, after the usual breakfast; palpitation of the heart, sometimes several (two, three, six) violent pulsations (when walking or sitting after dinner), one or two pulsations during the night, whilst lying on the left side; some violent paroxysms of palpitation of the heart, after a slight movement, chiefly of the left arm, on sitting up in bed, or stretching, &c., which disappeared again when at rest; violent palpitation of the heart in the morning in bed on awaking, and in the evening after lying down; violent nocturnal palpitations of the heart; accelerated circulation of the blood; palpitation of the arteries of the neck. " The experiments hitherto made by Orfila have been tried with too large doses, and death followed too quickly (after 508 CIRCULATING SYSTEM. twenty minutes to a few hours) to allow of the development of any pathological alterations in those organs which did not come in direct contact with the poison. It was only observed that the blood contained in the left ventricle was liquid and black, like that contained in the right. "Phoosphorus has been chiefly recommended in palpitations of the heart with abdominal derangements and flatulence; also when many of the described symptoms of the heart appear or become exacerbated, particularly after dinner. When we consider that in organic diseases of the heart (especially in hypertrophy) the paroxysms are often increased soon after a meal, and render it necessary for the patient to abstain from all indigestible, flatulent food, this coincidence, taken in conjunction with the other confirmatory symptoms, cannot appear unimportant. In pure, acute endocarditis, Phosphorus can only rarely be indicated. The following physical signs are in its favor: the sound on percussion normal, or dull over a considerable extent of surface; the impulse of the heart increased; the sounds louder, or supplanted by murmur. "SEPIA. It produces stitches in the heart; throbbing in the pit of the stomach early in the morning, then undulating or fluttering sensations in the chest, similar to palpitation of the heart, followed by burning heat in the face and body; throbbing in the left chest; palpitation of the heart in the evening, for a quarter of an hour; palpitation of the heart, with stitches in the left side of the chest; the heart beats convulsively, attended with great anxiety, and trembling of the fingers and legs; palpitation of the heart, lasting for several days, accompanied by a sensation of anguish, and rendering it necessary to take a deep inspiration, but unattended with any moral impression; intermittent pulsation of the heart, with anxiety; intermittent pulsation of the heart, mostly after dinner; in the evening, when in bed, violent palpitation of the heart, and beating of all the pulses; waking from sleep at night, in consequence of violent colic, with an unusually perceptible trembling motion of the heart (without palpitation), and a full pulse. " Notwithstanding the rather numerous symptoms which Sepia gives rise to connected with the heart, it has been but ENDOCARDITIS. 509 little employed against diseases of that organ, and indeed none of its symptoms can be considered as sufficiently indicative of any special form of heart disease, the more so, as those very symptoms which are peculiar to it, viz., the trembling convulsive action and intermitting pulsation of the heart are no fixed diagnostic signs of any particular disease, but merely an irregularity in the rhythmus, which may take place in the most opposite abnormal states of the heart, and even in an apparently perfectly normal condition of the same. "It appears to be indicated when, on auscultation, the following are the principal results: sound on percussion natural, or dull over a large extent of surface; the action of the heart violent, unequal, intermittent, convulsive and trembling; the sounds more violent and louder than usual, sometimes intermitting; or murmurs instead of the natural sounds. " GRAPHITES. It produces tightness in the left side of the thorax, and about the heart early in the morning, for several hours, aching in the region of the heart during respiration; stitches in the cardiac region; after retiring to rest for the night, and while lying on the left side, throbbing in the region of the heart; the paroxysm is attended with anxiety, and is of so violent a character as to cause the bedclothes to be moved by it, but disappears on turning; violent throbbing of the blood at the heart, and in the rest of the body at the slightest motion; strong pulsation of the heart, which moves the arm and the hand, and is productive of anxiety; violent palpitation of the heart; violent palpitation of the heart several times, like an electric stroke from the heart towards the neck. " Although I have not hitherto heard of anything, established by experience, concerning the use and effect of Graphites in diseases of the heart, still the above-mentioned symptoms are too important, and partly too characteristic, as to have admitted of its having been omitted here. The action or efficacy of this remedy embraces a pretty extensive sphere: certain symptoms correspond strikingly with organic lesions of the heart, which have already attained a somewhat advanced stage, particularly hypertrophy and dilatation. The following signs may be considered as appropriate indica 510 CIRCULATING SYSTEM. tions for its employment: dulness on percussion over a considerable surface; the action of the heart so violent as to shake and raise the thorax and the head of the auscultator; the sounds of the heart loud and violent, or supplanted by murmurs. " CALCAREA CARBONICA. It causes painful aching in the region of the heart; precordial anxiety; strong pulsation of the heart after a meal; violent palpitation of the heart, with great anguish and restlessness, oppression at the chest, and pain in the back; palpitation of the heart; violent palpitation of the heart; a long-continued spasmodic constriction in the region of the heart, which interrupts the act of respiration, with subsequent violent shocks; great anguish and palpitation of the heart; stitches in the heart, obstructing the breath, and leaving behind it an aching pain in the cardiac region; very violent palpitation of the heart, with an unequal pulse; pulsation of the large vessels in the chest. " The annals of homoeopathy mention several cures of rheumatic, anomalous gouty affections of the heart. It corresponds, as may easily be supposed, not with the pure inflammatory stadium, but with the sequele. Physical signs: the sound on percussion normal, or dull to the greater extent; the impulse of the heart violent, often not synchronous with the pulse in the wrist; the sounds of the heart louder, or supplanted by murmurs. SIn conclusion we may yet venture to make some general observations on the occurrence of organic diseases of the heart, and on the possibility of their cure. Doubts have repeatedly been raised, and principally in homoeopathic writings, on the actual extstence of affections of the heart in rheumatismus acutus, and more particularly on the safety of depending on auscultatory phenomena for the discovery of organic diseases of the heart, as, for example, copious loss of blood, and peculiar chlorotic and gouty dyscrasie are in themselves sufficient to produce similar consecutive murmurs, and changes in the sounds of the heart, without the actual co-existence of the least organic metamorphosis; many are inclined to consider the supposed rheumatismus. of the heart as nothing else than a consequence of copious bleeding. Although it must be confessed that Bouillaud, who particu ENDOCARDITIS. 511 larly (and was almost the first who did so) directed our attention to the close relation of rheumatismus to the heart, has given occasion to this supposition by his coup-sur-coup conducted venesections, and that others have committed exaggerations, by trying to discover inflammation of the heart in every case of rheumatismus, still innumerable cases (which had run their course without the employment of bleeding, and in which the correctness of the auscultatory diagnosis could be established by autopsy), have but too often proved the existence of structural derangements of the heart. It is certainly true that in chlorotic persons, and under particular circumstances, anomalies are sometimes observed in the beating of the heart, which disappear too quickly, and, in most cases, spontaneously, and are too isolated to warrant us in determining that they should have proceeded from organic metamorphosis, still this identical sudden appearance and vanishing, when taken in conjunction with the other general symptoms, and the circumstance that such inexplicable cases are of rare occurrence, ought to facilitate and correct the diagnosis, and will considerably diminish the weight of the aforesaid objection. Another reason which gives rise to the doubts which many entertain of the frequent occurrence of organic diseases of the heart, and which must necessarily make them, at the same time, very indifferent and sceptical to the possible advantages of a correct diagnosis, appears to be the exaggerated and partly erroneous view which they harbor of the great danger and unconditional fatality of organic diseases of the heart, and of the utter fruitlessness of every attempt to cure them. And yet amongst all the organic diseases and derangements of noble organs, perhaps those of the heart, notwithstanding the great importance of this organ, are the least accompanied by immediate or direct danger; now that we are so much more readily enabled, by the improvements effected in medical science, to discover them more distinctly and more correctly, we can daily convince ourselves that they often exist for many years and even without causing any serious detriment to the whole organism, that they have absolutely not always been the causa mortis, yea, that many have only been discovered at the post-mortem examination, 512 CIRCULATING SYSTEM. having remained quite unnoticed during the existence of the individuals, and consequently without exerting any considerable detrimental influence upon life. Death is, comparatively speaking, seldom directly attributable to them, e. g., by the bursting of the heart, but for the most part indirectly by the derangement of other organs and functions, and by increased disposition to other diseases, such as hydrops, apoplexy of the brain, &c. How very different, in this respect, is the case with other organic diseases, e. g., of the lungs, which, in most instances, produce the fatal termination in a more direct, progressive, and irresistible manner, generally leaving but little prospect to the physician of averting the fatal issue, or often even of retarding it for any considerable time. Although, therefore, medical art may very rarely and perhaps never succeed in effecting a radical cure of advanced organic metamorphoses of the heart, nevertheless there is a much wider scope for preventing their threatened development, or arresting them in their progress, and consequently of obviating, meliorating, or removing the secondary, life-endangering, but not inevitable, consecutive symptoms and derangements of other functions, and of the system in general. It is just in such cases and under such circumstances that homoeopathy has already effected great things; and indeed this system can be greatly promoted by, and derive much advantage from the further cultivation and practical application of the diagnostic auxiliaries. If it appear necessary to substantiate this assertion by practical examples, I appeal, first of all, to the testimony of many practitioners, to whom such cases must have often occurred, if they have ever made their observations and examinations with the necessary attention. For my own part, I shall in this place mention only two cases, which are interesting in more than one respect, and are confirmatory of what has been asserted above. The one is the case which Dr. Goullon has fully described (Neues Archiv, Vol. I. Heft 2, p. 44), and which, therefore, I must content myself with simply referring to. The other came under my own observation two years ago:: M. Held, the daughter of healthy parents, was from her earliest childhood subject to frequent attacks of violent palpitation of the heart, attended with anguish and swooning, ENDOCARDITIS. 513 which were chiefly called forth by bodily exercise and exertions; the evil increased every year in violence, prevented materially the growth of the body, and was pronounced by several physicians to be hypertrophy of the heart, and treated with leeches, cupping, and vesicatories. When she had reached her eleventh year, Dr. Noack was applied to, under whose homceopathic treatment the paroxysms became more scarce and less violent, and the entire constitution of the patient was at the same time essentially ameliorated and strengthened. This gentleman left Leipsic a year and a half afterwards, at which period I was introduced by my father to the patient for the first time. She was then twelve-and-a-half years old, of small stature, emaciated, and weakly; the left side of the thorax was protruded forwards and more elevated than the right, the sternum pressed toward the right hand, the spine also bent sideways, the impulse of the heart exceedingly violent, strongest between the sixth and seventh ribs, both to the sight and touch, and producing vibration throughout the greater part of the epigastrium; the sounds of the heart were strong, loud, quick, irregular, and during the systole there was an additional murmur, audible particularly over the left ventricle; the palpitation of the heart was frightfully increased by the slightest movement. The other functions of the body were all as yet pretty regular; the mental capacities were somewhat precocious, the temper mild, easily excitable and anxious. After the lapse of four weeks, considerable deterioration took place, in consequence of some external, noxious influence, the dyspncea, the anguishb and the palpitation of the heart became almost unbearable, the patient could neither walk nor lie down, but only sit in a half erect posture; violent cough, and paroxysm of threatening suffocation appeared, particularly during the night, accompanied by a continuous, tormenting thirst; the feet, and subsequently the abdomen, the hands and arms then became in the highest degree cedematous; the urine clouded, dark and somewhat scanty; the bowels obstructed. None of the remedies at first prescribed (Arsen., 1Digit., &c.) succeeded in producing the slightest amendment, or in stemming the progress of the malady in this flightfully aggravated form; at length, when death appeared almost unavoidable, the violence of the most dis33 514 CIRCULATING SYSTEM. tressing symptoms abated under the employment of Prunus spinosa (second dilution, one drop every four hours), the nights became more tranquil, the paroxysms of impending suffocation became less violent, the cedema decreased, and, in short, after the continued use of this remedy for a period of three weeks, the patient was enabled to rise, and to walk, and to lie down in an horizontal position; the respiration and the sleep were quiet, the cedema had perfectly disappeared, with the exception of a trivial degree of swelling about the ankles; the action of the heart became more quiet, the sounds more% regular and less loud. For nine months in succession, the patient enjoyed such a state of health as she had never before experienced, she became 'stronger, could bear a much greater amount of bodily and mental exertion without inconvenience, and the repeated physical examinations showed that the anomalous states of the heart were all still existing, but materially lessened in degree. The following year, in consequence of violent constitutional excitement proceeding from the first appearance of the menses, the patient suffered a relapse; nevertheless this event cannot in any measure be considered to weaken the value of this case for proving our asiertion; for this example of such a considerable, and in all probability congenital organic malformation of the heart, being borne for a period of thirteen years, notwithstanding the deformity of the thorax superinduced by it, cannot otherwise than speak forcibly against the generally received opinion of the absolute fatality of organic diseases of the heart; it, moreover, proves the beneficial effects which homceopathic medicines. may yet exercise, even in cases of this desperate character." CARDITIS. Inflammation of the substance of the heart, distinct from the membranous affections, is a rare disease. The general symptoms of the cases on record present similarity to those of pericarditis. In the event of inflammation of a large portion of the heart, a fatal termination is, in all probability, unavoidable, in consequence of the serious interruption which, in such a case, must be offered to its function. The remedies, which are likely to be the most effective in cases where there is any prospect of performing a cure, are Aconitum, Bryonia,, CARDITIS. 515 Lachesis, Arsenicum, Pulsatilla, Cocculus, Spigelia, Croton, Digitalis, Carbo v., Natrum m., &c. The cure of organic diseases of the heart, especially when they are of some standing, or of a complicated nature, is, unfortunately, not often within the reach of art. All that remains to be done, in the majority of such cases, is to mitigate the general symptoms, to render the patient's life as little oppressive yet as useful to him as possible, and to retard the onward march of premature decay, by means of appropriate medicines, diet, and rules of conduct. In HYPERTROPHY, or morbid thickening, or increase in volume of the muscular substance of the heart, indicated chiefly by dyspncea, increased impulse, diminished natural sounds, dulness on percussion, and full, strong, vibrating pulse, the medicaments which have been employed with more or less success are, Ars., Sigel., Bism., Digit., Rhus, Pkosph., Prunus spin., lod., Veratr.; and also Graph., ]err., China, VNux, Ignatia, Natr. m., Aeon. (palliative), Bella., Rhus. In DILATATION or an enlargement of the capacity of one or more of the heart's cavities, characterized by palpitation and dyspncea on any sudden emotion, diminished impulse, increased and more extensive sound, and soft, feeble, undulating pulse, &c., or hypertrophy and dilatation, with combination of the symptoms and signs of these two states: Spigel., Digit., Cannab., Ars., Bismn., Asparag., Zachesis, Lycopod., Carbov., Puls., Rius, Spigel., Veratr., Nax, Phosph., Am., Sep., Sulph., Calc., Acon., Oleand., &c. In DISEASES OF THE VALVES, indicated by bellows or raspsound, heard most distinctly over the situation of the diseased valve, persisting even during quietude, and occasionally accompanied by a purring tremor or vibration, felt on placing the hand on the region of the heart; palpitations and dyspncea aggravated by exercise or by mental emotions; weak, small, and sometimes intermittent pulse; swelling of the feet towards evening; and, as the disorganization advances, discoloration of the face and extremities, extension of cedema to the legs, dropsical infiltration into the different cavities of the body: Ars., Phosph., Argentum, Aurum, Coco., Natr. m., Croton, Digit., Spigel.; and Rhus, Puls., Bella., Lachesis, Assa., Lycop., Veratr., Sep., Graph., &c. (See Dr. C. Mueller's observa 516 CIRCULATING SYSTEM. tions, page 383, where general and physical indications for most of the foregoing medicaments are enumerated.) In ANEURISM of the ascending portion and arch of the aorta, which is frequently indicated by the following signs: loud whizzing or rushing at the superior extremity of the sternum, perceived on the application of the hand to that region; rattling in the throat; oppression at the chest; dissimilarity of the pulse at the wrists; dull sound, and perceptible impulse under the sternum or below the right clavicle when the tumor is large; single or simple pulsation, with increased impulse and louder sound, in contradistinction to the double pulsation and the normal sound of the heart; bellows-sound attending the single pulsation. The general symptoms differ considerably according to the situation, shape, and size of the aneurism. Thus, when it may happen to be so formed or placed as to press against the gullet, it will cause impeded deglutition, and sometimes a constant clucking noise; it may press upon the spine, and give rise to severe dorsal pains, with nervous symptoms of various kinds, and great debility; or it may compress one of the larger bronchial tubes, or produce absorption of a part of the lungs, and create difficulty of breathing, cough, &c.: Carbo v., Lackesis, Lycopodium, Ars., Sulph.; or Spigel., Rhus, Grcph., Calc., Puls., Digit., Natrum m., Zincum, &c., are the remedies which are likely to prove most useful. The most useful remedies, generally speaking, for removing attacks of congestion, in diseases of the heart, are Aconitum, Belladonna, Lachesis, Nux V., Opium, Aurum; or Cocculus, Coffea, Phosporus, Ferrum, Ars., Digit., Plumb. Affections of the heart induced by the injudicious employment of iercury, are commonly remediable by means of those medicines which are the more powerful antidotes to the multifarious, injurious effects which arise from the abuse of that mineral, but especially such as: lIepar sulphuris, Acidum nitricum, Aurum, Pulsatilla, Cinchona, Zachesis, Lycopodium, etc. Those which are manifested in a gouty habit, require the employment of the remedies which correspond to that diathesis, as well as to diseases of the heart in general. An acute rheumatism of the heart: Aconitum, lachesis, ST. ANTTHONY ) FIRE. 517 Belladonna, Bryonia, Arsenicum, Pulsatilla, Spigelia, Colch., and Nux v., form the principal remedies. Against arterial inflammation, in consequence of a wound, etc., lRius has chiefly been recommended. If, at the same time, there has been considerable contusion of the adjacent parts, Arnica will be necessary. When the inflammation is intense and accompanied by great constitutional disturbance, or when it threatens to extend rapidly towards the heart, Aconitum must be employed. Pulsatilla and Arsenicum may be useful in certain cases, the latter more particularly in advanced stages of the affection. The same remedies are equally applicable in Phlebitis, arising from external injury. When inflammatory action is manifested, in the vena porta, with burning pain in the seat and course of that important vessel, and the commencement of its incipient and terminal ramifications, pain and distension in the right hypocho'ndrium, bitter taste, whity-brown, or yellowish tongue, vomiting, yellowness of the white of the eye, and of the face, Vux v. is an important medicament. Lachesis, Pulsatilla, and Sulphur may answer better in other cases; or Arsenicum when symptoms of extreme prostration, with dryness of the tongue, and delirium, supervene. In chronic phlebitis, Zycopodium, Plumbum, Carbo v., Calc., Arnica, etc., may prove of efficacy. (See also VARICES.) CUTANEOUS DISEASES.:T. ANTHONY'S FIRE. ROSE. ERYSIPELAS. DIAGNOSIS. The first local symptoms are heat, tingling or pricking pains, with diffused swelling, tension, and deep shining redness of the affected part. This is, ere long, followed by pungent, burning, and sometimes tearing or shooting pain, which is aggravated by motion or pressure. On pressure, the redness disappears for a moment, but immediately returns on removing the finger. The constitutional symptoms vary according to the severity of the case; they generally consist of shiverings, succeeded by flushes of heat; sleepiness, wandering pains, dry tongue, nausea, oppression at the 518 CUTANEOUS DISEASES. stomach, and headache; vesications frequently arise on the affected parts, attended with increase of fever. (Erysipelas bullosum.) In a few days the redness changes into a yellowish hue. When the face is attacked, the features become much disfigured by the swellings, and delirium supervenes. The disease assumes a very serious aspect when it affects the face and scalp, and accordingly requires the utmost attention and discrimination in the treatment pursued. The hair often falls off after a severe attack of erysipelas of the face. CAUSES. Derangement of the digestive functions, exposure to cold or powerful mental emotions; occasionally it appears during menstruation; certain kinds of food also provoke it in some idiosyncrasies; for example, lobsters, oysters, or other shell-fish. THERAPEUTICS. The principal remedies in the treatment of the ordinary forms of erysipelas are Aconite, Belladonna, Bryonia, Pulsatilla, hus toxicodendron, Arsenicum, and Zackesis. ACONITE, only in case there be much fever or hot dry skin at the commencement, or even during the course of the disease, if required. BELLADONNA, chiefly in Erysipelas phlegmonodes, but also in cedematodes and erraticum, when the redness expands in rays, and an acute shooting pain, with heat and tingling, is experienced in the affected part, which is aggravated by movement. Facial erysipelas, with burning heat, excessive swelling, so that the eyes are almost closed, violent headache, thirst, dry, hot skin, restlessness, disturbed sleep, delirium. In such instances, Belladonna is generally alone sufficient to effect a cure; but sometimes it will be found necessary to have recourse to Lachesis or Rhus toxicodendron, after, or in alternation with Belladonna, particularly when vesications are evolved; or to Fepar s. when the skin is smooth, looks less glassy and inflamed after the employment of Bdladonna, but the heat, pain and swelling remain unaltered. (See Rhus.) BRYONIA is frequently useful when the disorder affects the joints, and when the pain is exacerbated by the slightest movement. Belladonna, however, is equally appropriate in ST. ANTHONY'S FIRE. 519 most affections of this nature. (SuZlphur is sometimes required to complete the cure after Bryonia.) PULSATILLA, when the hue of the skin is less intense, or of a bluish red, and the morbid spots frequently disappear from one place to reappear in another (Erysipelas erraticum). It is fuirther indicated when the disease affects the internal and external ear, particularly in vesicular erysipelas, after Rhus toxicodendron. (Belladonna and R/us, and, in some instances, Graphites, are also frequently called for in fugitive or wandering erysipelas.) RIus TOXICODENDRON is our best remedy in vesicular erysipelas, and also appropriate in erysipelas with gradual but very extensive cedema (Erysipelas oedematodes), particularly when the disease has a tendency to extend itself to the brain and membranes, and the symptoms closely resemble those developed in encephalitis. In some instances it is necessary to have recourse to Belladonna and Repar sulphuris to complete the cure (see the indications for these remedies, p. 311)-or to Belladonna and Rhus alternately,-or to Lachesis, which, next to IRhus, is perhaps the more generally useful remedy in Erysipelas vesicularis. (Graphites is also useful in some obstinate cases of vesicular erysipelas.) It may be likewise remarked that IRhus is especially suitable to erysipelas arising from particular kinds of food in certain idiosyncrasies; in other cases of this kind, however, Pulsatilla or Bryonia will be found equally serviceable, according to the symptoms and temperament of the patient. Nux v. In erysipelas of the knee or foot with extremely painful bright red swelling, this remedy is considered by Reisig to be as preferable to other remedies as huse generally is in vesicular erysipelas. He found it more especially successful in ps)eudo-erysipela8 occurring in irritable subjects, particularly females, and even in mortification of the subcutaneous cellular tissue.* ARSENICUM, when vesicles of a blackish hue, with a tendency to degenerate into gangrene, present themselves (Erysipelas gangrenosum), still more clearly pointed out if great prostration of strength be present. This medicine may also * Allg. Hom. Zeit. xxi, 88. 520 CUTANEOUS DISEASES. be advantageously alternated with Carbo vegetabilis or with Lachesis in such cases. (Lachesis and Jhus are occasionally of great service after, or in alternation with Arsenicum.) CUPRUM ACETICUM. The value of this remedy, upon the testimony of Dr. Schmid, of Vienna, has been already noticed in repercussed eruptions, when a marked metastasis to the brain has taken place, under SCARLET FEVER (which see). Sulphur and Arsenicum are important remedies when erysipelas has terminated in ulceration. In some chronic forms of the complaint, Acidm nitricum, Eaphorbium, Sulphur, Graphites, Silicea (pseudo-erysipelas), and Ilepar s. have been found serviceable. The alternate use of Bella., Rhus, and sometimes Zachlesis, or Crotalus, has succeeded in removing permanently a disposition to erysipelas of the face.* In Erysipelas Scroti (Chimney-sweeper's Cancer), Arsenicum is the most important remedy; RJhzs, Clematis, and Lachesis have also been recommended. The greatest care must be observed to avoid the risk of taking cold, even during convalescence; such an accident occurring during the disease is, as is well known, frequently attended with the most dangerous results. The troublesome itching so frequently attendant upon erysipelas, is often materially relieved by the application of wheaten starch, or the flour of maize. In conclusion, I may be allowed to remark, that by the fortunate discovery of remedies, perfectly homceopathic to most of the forms of erysipelas, we are now enabled to subdue this affection with the same facility and certainty as we treat other diseases curable by well-known specifics. BOIL. FURUNCULUS. ABSCESSUS NUCLEATiTS. DIAGNOSIS. Round, or rather cone-shaped, hard elevations, of different sizes, slowly inflaming and suppurating, discharging matter, generally at first, tinged with blood, but still retaining a portion of morbidly-altered cellular tissue, which may form the nucleus of other elevations after those which appeared first have healed. CAUSES. A peculiar constitutional tendency. Boils are, * Allg. Horn. Zeit. xxii, 20. CARBUNCLE. '521 however, frequently critical, as in gout, following acute fevers or eruptive diseases, and sometimes forming the termination of chronic exanthemata, such as itch, &c. THERAPEUTICS. The following are the remedies most serviceable in this troublesome affection: Arn'ica montana, Szulp2ur, Belladonna, ]fercurius, Aconitum, and lkepar sulphuris. ARNICA is the best remedy in most cases of boils, and will frequently prevent their return; but, in the majority of cases, SULPHI is necessary to eradicate the affection. This desirable result, however, is best accomplished by the use of these two remedies on each attack, for two or three successive times, the employment of Sulphur being invariably had recourse to as soon as cicatrization seems about to commence. It sometimes happens, however, that the pain and constitutional disturbances are so great that it becomes necessary to have recourse to one or more of the subjoined remedies. AcoNITuAt, when the boil presents an extremely inflammatory appearance and the affection is accompanied with considerable fever and restlessness, is promptly efficacious in subduing these symptoms, and may precede a more specific remedy for those which remain. BELLADONNA, should the boil have an inflamed, fiery, or erysipelatous red appearance; or, moreover, should it, if situated upon the extremities, be associated with swelling and tenderness of the glands under the armpit, or upon the groin; dry, hot skin, thirst, headache. MERCURIUS, should the swelling refuse to yield to the preceding remedy, after the inflammatory redness has been subdued. When matter has formed, HEPAR SULPHIUIS will be found conducive to bringing the tumor to a head, and thereby curtailing suffering. A tendency to frequent returns of this affection is, as already stated, often obviated by the repeated exhibition of Arnica and Sulphur; but when, from some innate taint, these remedies are not found sufficient, the same result may be attained by the employment of Lycopodiumn, Nuw vomica, Phosphorus, or Acicdum nitricum. 522 CUTANEOUS DISEASES. CARBUNCLE. ANTHRAX. FURUNCULUS MALIGNANS. PUSTULA NIGRA. DIAGNOSIS. A livid, bluish, or black spot, upon an extended surface, extremely painful, readily running to gangrelie, and proving fatal from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactitation, and sleeplessness. THERAPEUTICS. The best remedies in this affection are Zachesis, Silicea, and Arsenicum album. SILICEA. When administered at the commencement, in simple non-contagious carbuncle, is frequently found sufficient to effect a perfect cure. LACHESIs. When the Anthrax presents a livid appearance, and seems disposed to extend rapidly or to burrow. ARSENICUM. When the carbuncle threatens to terminate in gangrene; it is also the most efficacious remedy when the disease has arisen from contagion. In some cases Cinchona, Rhus toxicodendron, Pulsatilla, and Silicea may be found serviceable in completing the cure after Arsenicum. CHILBLAINS. PERNIONES. This affection is too well known to require any particular description. The exciting cause is exposure to transitions of temperature, from cold to heat, and vice versi, but the origin of chilblains is more deeply seated; the feet are the part most generally attacked, although frequently the hands also suffer. When the chilblains burst, and become ulcerated, they constitute an exceedingly paihful affection. Severe suffering from chilblains is an indication of constitutional taint not to be neglected, and individuals so afflicted should place themselves under a proper course of treatment; for, until the system is completely renovated, they are continually subject to a recurrence of this troublesome affection. THERAPEUTICS. The following are the most useful medicines in ordinary cases:Nux vomica, Pulsatilla, Belladonna, Arnica, OChamomilla, Arsenicum, and Sulphur. NUx VOMICA is particularly indicated when the inflammation is of a bright red color, with swelling, attended with itch CORNS. 523 ing, increased by warmth, and when the chilblains evince a tendency to burst. PULSATILLA, when the inflammation is of a livid hue, with itching and beating in the part affected, and when the suffering comes on, or is exacerbated, in the evening or towards midnight. (Sulp7iur is often very useful after Pulsatilla, and Thuja is often serviceable when the indications we have given for the latter do not yield to its employment.) BELLADONNA, when the inflammation is of a bluish red (but lighter than that indicating Pulsatilla), and very considerable, attended with a creeping, tingling sensation. ARNICA, when the swelling is hard, shining, and painful, attended with itching. CHAMOMILLA, when with the inflammation and itching a burning sensation is present; followed by ARSENICUM, when the pains are excessively violent, attended with severe burning, or when the chilblain bursts, and becomes converted into an irritable spreading sore. Arsenicum may in some such cases be advantageously alternated with Carbo vegetabilis. SULPHUR is a valuable remedy when the inflammation and itching are very severe, and the affection has failed to yield to the foregoing medicines. In the instance of Arnica we may also apply a lotion in the proportion of one part of the mother-tincture to five of water.* The following remedies may also be consulted in certain cases: Agaricus muscarius, Acidum nitricum, Petroleum, Rhus toxicodendron, Bryonia, Ledum, Mercurius, Cinchona, and Secale cornutum. CORNS. CLAVI PEDIS. That these troublesome excrescences not unfrequently arise from an inherent vice of constitution, is evident from the fact of many individuals who wear tight boots and shoes (unques* The external application of the other remedies also, is frequently very serviceable; in which case we may dissolve a drop or*two of the tincture of the same remedy that we are administering internally, in about an ounce or so of water, and bathe the chilblains with the lotion twice a day; in addition t this, it is sometimes advantageous to envelope the affected parts in a piece of linen which has been dipped in the lotion. 524 CUTANEOUS DISEASES. tionably the principal exciting cause) escaping them, while others, with every precaution, suffer severely; such being the case, the main object must be, by a course of properly selected internal remedies, to eradicate the pre-disposing cause. Among these, Antimonium crudum (externally as well as internally, as described under the head of CHILBLAINS), Phosphorus,?hus, Bryonia, and Ammonium carbonicuim, Lycopodium, Petroleum, Sepia, Acidum phosphoricum and Sulphur will be found useful. Great alleviation of suffering has, however, been found to result from bathing the feet in warm water, and then applying a very weak Arnica lotion (a drop or two of the tincture to an ounce of water) after having previously had the corn pared down carefully. While upon this subject it may be remarked that Nux VOMICA has been found serviceable in cases of swelling and redness of the heel, resembling chilblains, attended with acute, burning, shooting pains, materially increased by the pressure of the boot or shoe, or by walking. Arnica may be recommended for the same symptoms,,should Nux vomica be found insufficient to relieve. ABSCESS. LYMPHATIC TUMORS. DISEASE OF THE CONGLOBATE GLANDS. Abscess. By this term is meant a collection of purulent matter, resulting from morbid action, contained in a sac or cyst of organized coagulating lymph, furnished with absorbent and secreting vessels. Abscesses are divided into acute and chronic. The acute species is preceded by sensible inflammation in the affected part, which is soon followed by suppuration. The commencement of the suppurative process is evinced by a change in the description of pain, which becomes more obtuse and throbbing, by an increase of the swelling, and, when matter is formed, by the perceptible fluctuation of the part, when the abscess is not too deeply seated; lastly, particularly in idiopathic cases, when the formation of pus is in considerable quantity, the fever which attended the previous inflammation is lessened, and irregular chills or rigors supervene, succeeded in turn by heat and increase of fever. When the abscess is mature, the tumor becomes pointed, ABSCESSES, ETC. 525 or presents a sort of conical shape, generally near the centre of the cutaneous surface; over this spot the skin assumes a reddish hue, becomes thin, and ere long gives way, and allows the contents of the cavity to escape. The signs of the formation or existence of a chronic abscess, on the other hand, are, in the generality of instances, devoid of any apparent disorder, either local or constitutional, until it begins to approach the surface and form an external, swelling. The secreted matter is unhealthy, thin, and serous, and contains substances resembling curds, or flakes. When the pus is evacuated, and the air admitted into the cavity, inflammation of the cyst arises, and is productive of a salutary effect, if the abscess be small; but if it be large, great constitutional disturbance ensues, the cavity, instead of contracting and filling up under the process of healthy granulation or incarnation, goes on discharging copiously, and hectic fever is produced. THERAPEUTICS. In acute abscesses we may apply poultices and warm unmedicated fomentations, and forward the suppurative process by the administration of Hfepar sulph. 3, gr. ss, in repeated doses.* The lancet is never necessary, except when the pus, by its extensive diffusion or pressure (especially when seated under ligamentous or tendinous expansions), is liable to injure important parts; or when, from its situation, there is reason to apprehend its discharge into any of the cavities of the body. When it is necessary to effect an artificial opening by means of the lancet, the incision ought to be made at the most dependent point, where this can be safely and readily accomplished; but when this is impracticable, in consequence of the great thickness of the parts between the purulent matter and skin, the most prominent or pointed part ought to be selected. When, on the other hand, this latter point happens to be at the upper part of the abscess, the lancet must be laid aside, and the abscess allowed to open spontaneously, or, still better, through the instrumentality, or at all events * When there is much constitutional disturbance, with intense pain and extensive inflammation, before the formation of pus, the employment of Aconilum and Belladonna, in alternation, is sometimes requisite; antiphlogistic regimen must at the same time be observed. CUTANEOUS DISEASES. the important aid, of Hepar sul.phuris, Silicea, and Lachesis. The two former may frequently be administered in alternation with advantage; the third is more particularly to be preferred, when a considerable portion of the skin has been much distended, and presents a deep red or bluish appearance, or where its structure has been destroyed by the magnitude of the abscess. iMercurius is occasionally useful when there is induration.* The subsequent treatment is generally more easily conducted, and the healing of the cavity more speedily effected, when the matter has been evacuated by the aid of appropriate medicine, instead of the lancet. In chronic abscesses, it has usually been found most beneficial to make an outlet for the matter as early as possible, to prevent its large accumulation, and thereby avoid the consequent frightful constitutional disturbance, which is so prone to occur in such cases, from the extent of the inflammation after the bursting of the abscess. The opening should be made near the base of the abscess, and merely large enough to admit of the exit of the matter. When the collection of matter is very extensive, it frequently accumulates again after having been evacuated; hence it has been recommended to heal up the opening immediately, and to make a new one again when necessary, but before the pus has accumulated in any considerable quantity. When the matter has been withdrawn, a dose or two of Mercurius should be administered, followed by Ihepar sulph., Silicea, and sometimes also by Calcarea and Phosphorus. Silicea and Phosphorus have been described as being useful when atrophy or consumption results in consequence of chronic suppuration. It may here be mentioned that, in LYMPHATIC TUMOmRS, Sulphur chiefly, but also iMercurius or Silicea, and in ENCYSTED (whether steatomatous or otherwise), Calcarea, have been found very efficacious.t Further, that in the state of * Carbo a. is equally serviceable here, and may follow Alercurius, when that remedy fails to answer our expectations. Baryta is also useful in such cases, particularly when there is considerable surrounding swelling as well as induration, even after the opening of the abscess. f Graphites, Silicea, Hepar s., and Sulphur, Causlicum, Baryla c., Carbo v., Acidum nitricum, Lachesis, or Phosphorus, &e., may be required in some cases. ITCH. 527 enlargement and induration of the CONGLOBATE GLANDS, situated in the neck, under the skin, and behind the ears, such as is usually met with in scrofulous habits, 3fercurius and Dulcamara are two of the most important remedies. When the glands have become indurated, Conium, is one of the most efficacious remedies; or, in inveterate cases, Silic., Carb. a., Sulph., Calc., Baryta, &c.; and when suppuration or ulceration ensues, Hepar sulp~hris, Iachesis, and Silicea are more useful. These latter, particularly HTepar sulph. and Silicea, together with Calendula officin., Sulphur and Calcarea, in some cases, are, moreover, extremely useful in materially obliterating the unsightly scars, which are so frequently met with in glandular swellings, that have been neglected or improperly treated by means of stimulating embrocations, caustics, &c.* (See SCROFULA.) ITCH. SCABIES. PSORA. This contagious, inflammatory affection of the skin is characterized by an eruption of pointed vesicles, transparent at the summit, and filled with a viscid and serous fluid. These are subsequently intermixed with, or terminate in pustules. With the exception of the face, they appear on every part of the body, but much more frequently and abundantly about the thumb, wrist, between the fingers, and at the bend of the joints, &c., and are accompanied by incessant and almost insupportable itching, without fever. There are several varieties of the disorder, but it is often very difficult to distinguish their characteristic differences. THERAPEUTICS. Sulphur is unquestionably one of the most important remedies in this disorder, particularly at the commencement. In the milder, uncomplicated forms of the malady, and in the purulent variety, especially when confined to the fingers and wrists, it is indeed specific. * In old-standing or obstinate cases of glandular enlargement and induration or ulceration, Baryta c., Staphysagria, Carbo a. et v., Hepar s., Sulphur, Calcarea, Calendula, and Silicea, as also Kali c., Lycopodium, Iodium, Acidum nitricum, Bovista, Belladonna, &c., are remedies of great utility, and must be selected according to the general features of the case, when Mercurius, Dulcamara, and Silicea are found insufficient to discuss the swelling, &c 528 CUTANEOUS DISEASES. A dose of the said remedy, at a low potency, may, in such instances, be administered night and morning for a week or ten days, but discontinued as soon as signs of improvement set in. In some rather obstinate acute cases, that is, when, after ten days to a fortnight or three weeks, but little improvement has been effected, we shall find the treatment facilitated by the simultaneous employment of the remedy externally, applying the Tinctura sulphuris as a lotion night and morning. A very speedy or a sudden suppression of the eruption is, on the other hand, not to be regarded as a cure, but on the contrary, as a driving in or repercussion of the eruption. Against other varieties of the disorder, and in neglected cases, Sulphur is not a sufficient remedy; therefore it becomes necessary to have recourse to Mlferczrius, Carbo v., liepar 8., Sepia, Veratrum, Lycopod., &c., as follows: Mercurius, when the eruption is accompanied by intolerable itching, especially -on becoming warm in bed; looks dry and cracking, but consists of minute vesicles resembling papilla, when not narrowly examined, which are slightly inflamed, and bleed easily when scratched (scabies p2apuliformis). These little elevations or vesicles are sometimes intermixed with pustules, which, on breaking, form scabs. It is sometimes necessary to administer Sulphlur or Acidum sulpluricum in alternation with Jilercurius, in this form of the complaint, at intervals of four or five days, until an improvement or change in the symptoms results. In the event of an amelioration, it is found useful to cease to administer the medicine as long as it continues; but if the improvement soon comes to a close, or a change occurs in the character of the eruption, another remedy must be prescribed. If the affection has retained the papular-looking form, and Mercurius alone had been previously administered, Hiepar s. may be selected; but if both Sulphur and JMercurius have been employed, Carbo v. may be advantageously alternated with Hepar; and should any symptom remain thereafter, Sepia or Veratrum will generally speedily remove them. In other cases of scabies papuliformis, and particularly where the papular appearance is more strongly marked than in the preceding, Xezereum and Silicea are very serviceable. ITCH. 529 In the pustular or humid variety (scabies purulenta), distinguished by distinct, prominent, yellow pustules, having a moderately inflamed base, which are usually met with on the hands and feet, and subsequently, if unchecked, on the back, shoulders, arms, and thighs, about the axillee, and near the knee and elbow-joints,-Sulphur, as has been already stated, is the principal remedy; in inveterate or neglected cases, considerable benefit will nevertheless be frequently obtained by giving Lycopodium in alternation with it. Should improvement ensue, and the eruption assume a drier aspect, MLercurius and Carbo v. will, in most instances, serve to complete the cure. But if no beneficial effect is produced after two or three repetitions of these remedies, at intervals of four or five days, Graphites may be exhibited at short intervals for three or four successive times, lengthening the intervals at each repetition of the dose; and if no favorable alteration be brought about soon thereafter, MAercurius may be administered in the same manner. Should extensive incrustation ensue on the breaking and discharging of pustules, &c., Acid. sulphuricum is generally of great service. When the pustules are large, they coalesce and form irregular blotches, which sometimes ulcerate to a greater or less extent; in such cases Clematis and hAus will be found serviceable. When, on the other hand, the pustules assume a a prominent and globular form, of a yellowish or bluish color, Lachesis has been found to be the most appropriate remedy. In Scabies lymphatica, or watery itch, characterised by transparent vesicles of considerable size, without an inflamed base, much the same treatment may be pursued as has been described for the dry or papuliform variety; but in some cases the alternate use of Sulphur, hIus, and Arsenicurn is requisite. When Scabies has been materially altered in its character by the abuse of Sulphur in allopathic practice,.Mercurius, Sepia, Rhus and Staphysagria, or Acid. nitricum, Dulcamara, Calcarea, and Pulsatilla, etc., have been used with success. ]Kreosote externally (largely diluted) and internally, has been recommended in some obstinate cases of Scabies, and Sulphur, Arsenicum, and Carbo v. in cases which have been suppressed or repercussed by powerful 34 530 CUTANEOUS DISEASES. external applications.* When furunculi make their appearance during the course of, or on the disappearance of scabies, Silicea generally removes them very speedily and effectually. WHITLOW. PARONYCHIA. PANARIS. By this term is understood an abscess more or less deeply seated, formed near the end of the finger, attended with severe pain and considerable swelling; it has a great disposition to reappear in individuals who have once suffered from its attacks, which clearly demonstrates the advantage of treating it as a constitutional, and not as a merely local affection; in so doing we may have recourse to the following medicines: Mercurius, Hepar suiphuris, Rhus, Sulphur, and Silicea. THERAPEUTICS. We may generally commence the treatment by MEROURIUS. But should the swelling not decrease after a few doses of Mercurius, or the pain become intense, recourse must be had to the alternate administration of Silicea and Hepar s.t RHUs is more particularly indicated where there is a considerable degree of erysipelatous inflammation. LACHESIS. In cases where the affected part is of a dark red or bluish hue, and the pains extremely violent, this remedy may be administered, followed by Arsenicum and Carbo v., if an algry-looking, black, and painfully-burning sore form on the affected finger.4 But we must have recourse to the alternate administration of Sulphur and Silicea at intervals of about eight days, or so, in cases where a constant tendency to a recurrence of the complaint exists. These remedies, particularly the latter, are the most appropriate in those severe cases in which the matter forms between the periosteum and bone, and when the latter has become diseased in consequence. MAGNETIS POLUS ARCTICUS. The application of the north * See Bonninghausen's Therapeutic Pocket-book, by Chas. Hempel, pages 208 to 217. f These two remedies are, moreover, exceedingly serviceable in forwarding suppuration, and are therefore equally useful in bringing the abscess speedily to maturity, and causing the discharge of the pus, when there is no longer any possibility of effecting resolution; but when the matter is deeply seated, and evacuation is not speedily obtained, the lancet must be employed. ] Hering's Hausartz. ITCHING OF THE SKRN. 531 pole of the magnet, for a minute or two, to the finger, will often afford speedy relief, when the pain is so intense as to be almost insupportable. A poultice is also somewhat soothing under such circumstances. IRRITATION OR ITCHING OF THE SKIN. PRURIGO. This affection is usually an accompaniment of other diseases, and is to be treated accordingly; however, in some cases, it declares itself in an idiopathic form, and is generally caused by scarcely perceptible colorless elevations under the cuticle, -which, however, are sometimes of a considerable size, soft and smooth, but without desquamation, or any peculiar eruptive appearance. THERAPEUTICS. Against this extremely distressing irritation, SULPHUR is frequently the specific remedy, particularly when exacerbation ensues in the evening, or when the body is warm in bed; but in other and more ordinary cases, the following remedies will be found serviceable: Ignatia amara, Pulsatilla, 2Mercurius, JRhus toxicodendron, Ilepar sulphuris, N-ux vomica, or Arsenicum album. IGNATIA AMAEA. When the irritation is most severe, after going to bed, and resembles flea-bites all over the body; and after scratching, which relieves, shifts readily from one part to another. PULSATILLA when the irritation comes on in the warmth of the bed, and is aggravated by scratching. MERCURIUS when the irritation continues through the whole night, and Pulsatilla proves insufficient; also in cases when the parts affected bleed readily after scratching. (Sulp7ur is sometimes useful, every four or five days, in alternation with Mercurius in such cases.) RHUS TOXICODENDRON, when itching is accompanied by a violent burning sensation, followed by HEPAR SULPHURIS, if necessary to complete the cure. Nux VOMICA alternately with ARSENICUM, when the irritation or itching appears on undressing. In"bstinate cases of almost all kinds, Sulphur, followed by Carbo v., will be found serviceable. Lycopodium, Graphites, Silicec, &c., may be called for in particular cases. Opium is often useful in the case of old people. 532 CUTANEOUS DISEASES. In Prurigo scroti, Sulphur, Acidum nitricum, Dulcamara, and Rhododendron have chiefly been recommended. Prurigo pudendi: Sulphur, Sepia, Conium, Calcarea, Natrum m., and Sulphur. Prurigo ani: Sepia, Acidumn nitricum, ThIuja, Afercurius, Sulphur, as also Kali c., Baryta c., and Zincum. RINGWORM (HERPETIC OR VESICULAR). HERPES CICRINNATUS. HERPES SERPIGO. This affection generally occurs in children. It has been considered contagious from the circumstance of several children of one family, or at the same school, being sometimes attacked at the same time; but there is every reason to believe that this opinion is erroneous, from the fact of none of the other species of herpes being communicable by contact. When not complicated with another disease it is not attended with any general constitutional derangement. The disorder is characterised by an eruption of small rings or circular bands, the vesicles only occupying the circumference; these are small, and have a red-colored base of greater or less intensity. About the third or fifth day the vesicles become turbid, and then discharge, when little brownish scabs form over them. The portions of skin within the circlets are usually healthy at first; but for the most part subsequently become rough, of a reddish hue, and scale off as the vesicular eruption dies away. The duration of the eruption frequently does not extend beyond a week or two, but when there is a series of consecutive rings on the face, neck, arms, and shoulders, as frequently happens' in warm climates (where the affection moreover assumes a more serious and obstinate character), or during hot weather in this country, it is necessarily protracted considerably beyond this period. THERAPEUTICS. In the majority of cases the affection yields readily under the action of Sepia, of which from two to three globules may be given in a little water, and the dose repeated on the fourth day, if required by any appearance of tardiness in the subsidence of the eruption, or should there be any indications of the formation of fresh rings. In some obstinate cases the alternate use of Rhus and Sulph. every four or five days is found necessary. Calcarea, Natr., Natr. m., Clem., and lMagn., have been recommended EINGWORM. 533 in others.* All kinds of outward applications must be avoided. RINGWORM OF THE SCALP. PUSTULAR RINGWORM. Porrigo soutulata. Tineacapitis. Tinea annularis. Favus confertus. This disease is still more popularly known than the above by the term of iingworm (or ringworm of the scalp). It is unquestionably of a highly contagious nature, being readily communicated among children who make use of the same comb and brush, or even towel, and is of long and uncertain continuance,-indeed there are few cutaneous affections which have more frequently baffled the unwearied efforts of practitioners than this; and it would have been well had less been attempted by those of the old school in the way of treatment; for in too many instances the so-called cure has proved worse than the disease. Pustular ringworm commonly attacks children from the age of two years to the period of puberty; it is not confined to the scalp, but also appears on the neck, trunk, and extremities; when confined to the trunk, it proves by no means so obstinate and rebellious a disease as when located in the hairy scalp. DIAGNOSIS. The affection is characterized at the commencement, by the appearance of isolated, red-colored, irregular, circular patches, on which appear numerous small yellowish points or pustules, which do not rise above the level of the skin, and are generally traversed in the centre by a hair. These pustules, which are much more thickly studded in the circumference, than the centre of the circular patches, soon break and form thin scabs,t which frequently unite with the adjacent patches, and assume a regular and extensive and irregular appearance, but commonly retain a somewhat circular shape. The incrustations become thick and hard by accumulation, and are detached from time to time in small * Boenninghausen's Manual of Homoeopathic Therapeutics. ( Sometimes cup-shaped or concave (characteristic of favus), and at first of a tawny, but subsequently of a light yellow or whitish color; when they crack and break up, they become reduced to a powder, which looks like pulverised sulphur. 534 CUTANEOUS DISEASES. pieces, which bear a close resemblance to crumbling mortar. When the scabs have been removed or torn off, the surface which they had occupied looks red and glossy, but is studded with slightly elevated pimples, in some of which minute globules of matter subsequently become apparent. By these repeated evolutions of the eruption, the incrustations become thicker, the arrears of the primary patches extend, and new ones are formed, so that the corresponding edges become blended, and frequently the whole head thus becomes affected. The circular character of the original groups is still indicated, however, by the appearance of partially-formed arcs in the circumference of the larger incrustations. As the patches or clusters extend, the hair covering them usually becomes lighter in color, breaks off short, and as the process of scabbing is repeated, it is thrown out by the roots, and finally, there remains only a narrow chaplet of hair round the head. If the hair-follicles are destroyed, the baldness remains permanent. CAUSES. The disease is chiefly propagated by contagion, but appears to originate spontaneously in children of scrofulous, flabby, or feeble and emaciated habit, if they be ill-fed, ill-lodged, uncleanly, and deprived of a wholesome degree of exercise. THERAPEUTICS. It cannot be denied that, even under homoeopathic treatment, the disease frequently proves extremely obstinate; but in many cases the difficulty experienced in effecting a cure arises from the previous treatment which the patient has undergone, or from culpable conduct on the part of parents, or others, in allowing the disorder to pursue its course for a lengthened period, unchecked and utterly neglected, ere proper assistance is sought. The following are the principal remedies employed in the homoeopathic treatment: BRhus, Arsenicum, Staphysagric, Hlepar s., Lycopodium, Dulcamara, Bryonia, Phosphor'us, GJraphites, Baryta c., Calcarea, Oleander, Sulphur, &c. The medicines must be selected according to the various changes which take place during the continuance of the disease; but as it would be wholly impossible, in so general a work, to give appropriate directions for the treatment of every RINGWORM. 535 case, we can merely enumerate a few of the leading indications for some of the more important remedies, referring, at the same time, to others, as being worthy of attention in cases which do not yield to the ordinary remedies. While the patches exhibit an irritable and inflammatory aspect, Jhus will usually be found the most appropriate remedy: the head should at the same time be regularly and gently sponged with tepid water twice a day. Should a dry exfoliation and scabbing then ensue, Sulphur may be had recourse to; but if, on the other hand, an offensive discharge break out, attended by violent itching, without much redness, Staphysagria may be administered, and then again R/us. If, notwithstanding the administration of these remedies, very little favorable progress be made, or if, on the contrary, the affection become rather worse, and the exudation take on an acrimonious character, and productive of an extension of the disorder, or of the formation of ulcers, Arsenicum should be exhibited: after the action of which, nhus will frequently produce a satisfactory effect. These remedies may also be occasionally administered externally with good effect, by dissolving a few globules of the remedy selected in a little water, and applying the liquid once or twice a day to the affected parts. When the foregoing means are insufficient to effect a cure, which is unfortunately not a rare circumstance, particularly when strumous or debilitated subjects are afflicted with the disease, the following remedies must be used: Hepar s., when the eruption is not confined to the head, but also appears upon the forehead, face and neck; when, moreover, the eyes and eyelids become inflamed and weakened, and soreness or ulceration breaks out on or behind the ears. In the latter case Baryta c., Graphites, and Oleander are also useful. Dulcamara, when the glands of the throat and neck are enlarged and indurated (or Bryonict, when there is inflammation and tenderness of these glands); after which Staphysagria may be administered, and then one or more of the remedies mentioned at the commencement, followed by Baryta c. If these medicines prove ineffectual, Sulphur, Graphites, 536 CUTANEOUS DISEASES. Calcarea, ]Lycopodium, Phosphorus, or Oleander may answer the purpose required, and must be selected according to circumstances. In some cases the alternate use of two or more medicaments will be found advantageous, such as Sulphur and Calcarea,-Sulphur, Rhus and Graphites,-Graphites and Zycopodium,-Graphites and Phosphorus, and so on. A dry, inert, and scaly appearance of the eruption chiefly requires Calcarea, or Sepia, Silicea, and Sulphur, but also Hepar s., Phosphorus, JRhus, Arsenicum, or Oleander. A humid or moist-looking eruption: Lycopodium, Graphites, and Rus, or Staphysagria, Arsenicum, Sulphur, Sepia; and also Baryta c., Calcarea c., Cicuta virosa, and Oleander, &c. In the other varieties of scald head, such as the Porrigo lupinosa,* Porrigo furfurans,t Porrigo favosa,a &c., the same class of remedies are required as above prescribed; whilst against Porrigo decalvans (characterized chiefly by patches of baldness), Graphites, Phosphorus, Baryta, Lycopodium and Zincum have been found the most serviceable; but Sulphur, Calcarea, Silicea, &c., and most of the other aforesaid remedies may be found indicated in particular cases. * Characterized by small, dry, circular scabs, of a yellowish-white color, having raised margins, and a central depression, like that on the seeds of the lupine. The incrustations are deeply set in the skin, to which their edges are firmly adherent. f This variety commences with the eruption of small pustules, containing a straw-colored fluid, which soon discharge, dry, and form thin laminated crusts, with scale-like exfoliations. The affection is confined to the scalp, ard is attended with considerable itching and soreness, although there is but slight excoriation; the hair partially falls off, and, occasionally, becomes subsequently somewhat lighter in color. t Distinguished by the eruption of large, soft, straw-colored pustules, generally somewhat flattened, possessing an irregular margin, and surrounded by a slight inflammatory redness. They are met with on other parts of the body as well as the scalp, and are accompanied by much itching. On breaking, these pustules dischamge a viscid matter, which hardens into semi-transparent, greenish-yellow scales. The disease extends to the face, and eventually the ulceration spreads over the entire head, and, from the continued discharge, the hair and moist scabs become matted together. Pediculi are generated in large numbers, and aggravate the excessive irritation. The incrustations thicken into irrregular masses, bearing some resemblance to a honeycomb. The acrid exudation from the ulcerated patches on the scalp exhales an offensive and pungent vapor. INTERTRIGO. 537 With regard to the administration of the medicines, it may be stated, that at the commencement of the disorder, a dose may be given daily, or every second day, until symptoms of improvement make their appearance; the medicine must then be discontinued, whilst the case progresses favorably, and only renewed, when the amelioration ceases, or the disorder threatens to extend itself. When no signs of improvement become perceptible, or when, on the contrary, the malady evidently seems to be getting gradually worse, notwithstanding the exhibition of two or three doses of a particular remedy, another must be selected according to the indications. In cases of old standing, the intervals between the exhibitions of the medicine must generally be lengthened, or a dose may be given daily for a week, and then a period of ten to twelve days, and even upwards, allowed to elapse before the medicine is repeated, or another remedy substituted. Undeviating attention to cleanliness must be observed throughout the entire course of the complaint, and the homoeopathic diet rules must be strictly adhered to in the majority of cases.* The hair ought generally to be removed early in the disease. INTERTRIGO. This affection consists of a galling or excoriation of the skin accompanied with inflammatory redness and moisture, around the anus, between the nates, at the inner and upper part of the thighs, the groin, or other parts of the body, such as the axillke, &c. Riding, much walking in the heat of summer, and the irritation of the urine, are the most frequent exciting causes. It is, very frequently, readily relieved by Graphites or Lycopodium, externally and internally, at low potencies. Arnica, and also Nuax., Pulsatilla, Sepia, Sulphur, Arsenicum, and Chamomilla have also been recommended in particular cases: the selection being made according to the temperament and complexion of the patient, as also the state * Adults, affected with this disorder, or indeed with any other cutaneous disease, ought wholly to abstain from fish and salt meat. Children ought to be placed under similar restrictions, and should not be allowed to partake of heating farinaceous food, such as oatmeal (in the form of porridge or stirabout, gruel), maize, &c. 538 CUTANEOUS DISEASES. of the digestion, sexual functions, &c. (See also EXCORIATIONS IN CHILDREN.) PSORIASIS. This cutaneous disorder is distinguished by a rough and scaly condition of the epidermis, sometimes in isolated spots or patches of an irregular form, at other times continuous, but almost always attended with clefts or fissures in the skin. It is usually accompanied by constitutional derangement, and recedes or recurs at particular seasons of the year. The cure of this disorder is generally difficult and tedious, especially when it occurs in the inveterate form (psoriasis inveterata), characterized by nearly universal scaliness, with a harsh, dry, thickened and rigid state of the skin, which is at the same time red and deeply cracked, or when it is chiefly confined to the palm of the hand (psoriasis palmaris). In the simple form (psoriasis simplex), Zycopodium at a low potency, in repeated doses, frequently effects a cure in from four to eight weeks, even when the disorder is of long standing; Rhus and Bryonia are also of considerable value in this variety. In other cases, Suph., Sepia, Calc., Graphites, Clematis, and Ledum may be called for by the nature of the case. In Psoriasis inveterate, Arsenicum is of more or less utility, as also Rus and Sepia; but it is often requisite to have recourse to Sulphur, Antim. c., Ammon. c., Graphites or Cale., etc., to complete the cure. Against Psoriasis palmaris, Sulphur, Sepia, and Acid. muriaticum, or Zincum, have hitherto been principally employed. When there is a discharge from the rhagades of an offensive smell, Rhus, Graphites, Lycopod., Mercurius, or Hepar, &c., are often of important service. And in Psoriasis facialis,-Sulph., Cale., Aurum, Graph., Lycopod.; or Sepia,* Cicuta, Ledum, Oleander, &c., claim a preference. The diet, in this affection, as, indeed, in all other cutaneous maladies, should be simple and unstimulating. Fruits, and also vegetables, are often hurtful when the eruption is in an aggravated form, and ought, therefore, to be avoided under such circumstances. PEMPHIIGUS. 539 PEMPHIGUS. FEBRIS BULLOSA, POMPHOLYX. Pemphigus consists of an eruption of yellowish and transparent bulle or blebs on various parts of the body, varying in size from a lentil, or a split pea, to a walnut, commonly presenting an inflamed base, and generally assuming the shape of an almond. Fever is a frequent accompanying symptom; but some authors maintain that the disorder occurs in two different forms, viz., the acute and chronic, and that fever is only peculiar to the former, and invariably absent from the latter; whilst others, again, create a further distinction by giving the name of pemphigus to the affection, when the vesicles exhibit an inflammatory base, and are preceded or accompanied by fever, and denominating it pompholyx when exempt from these additional symptoms. The disease occasionally comes on without precursory signs; but may also be ushered in by sickness, general uneasiness, proecordial oppression, headache, lassitude, painful stiffness in the joints, and violent itching of the skin: or otherwise it commences with irregular chills, followed by dryness and burning heat of the skin, as also thirst, anorexia, and great rapidity of pulse. The eruption generally declares itself at first by one or more circular or oval red spots or patches, which are slightly prominent, and frequently bear a close similitude to the first signs of smallpox. These patches soon take on a dusky hue, and are preceded or attended by some degree of pain and heat in the affected parts. From the effusion of transparent serum beneath the epidermis, it becomes raised in the form of vesications presenting the appearance of blisters arising from a scald, or produced by the application of cantharides to the skin. The development of these blebs sometimes ensues so speedily after the evolution of the erythematous patches, that some authors have been induced to conclude that pemphigus was never preceded by any redness of the cutaneous surface. The eruption gradually extends over the greater part of the body, but rarely affects the hairy scalp or the genital organs. The vesicles increase rapidly in size, and in some places become confluent. The skin between the bulle presents a natural appearance, except when the latter approximate closely, in which case a more or less marked erythematous blush pervades the 540 CUTANEOUS DISEASES. interstices. When the vesicles have attained their maturity, and burst of themselves, they form incrustations of a whitish, or a pale brown color; but if the epidermis be detached by friction soon after the bulloe have broken up, painful excoriations generally result. The duration of pemphigus with fever (acute pemphigus) varies from one to four weeks, according as the eruption may have been simultaneous or consecutive. Pemphigus without fever, again (or chronic pemphigus), in which the development of the bulle is always successive, generally occupies a period of several months, and even much longer, if unchecked, in some cases. When accompanied by nervous fever the disorder is to be regarded as of serious character; as also when it is very extensive, frequently renewed, and associated with inflammation of the bladder, &c. THERAPEUTICS. When the eruption is preceded or accompanied by inflammatory fever, the employment of Aconitumn becomes more or less requisite; but as soon as the fever and restlessness have been considerably allayed, Cantharides (3-6) or Khus (3-6) must be selected. The former is more especially useful when the bulle present a close analogy to the vesication produced by a blistering plaster, when the irritation is intense and consists of a violent burning itching, or when the disorder is attended with dysuria, hoematuria, cystitis, or, in the case of females, with inflammation of the vagina. This remedy may at the same time be advantageously applied externally by means of a camel's hair brush. Rhus is an invaluable remedy in the majority of cases of pemphigus, although it occasionally fails to relieve the troublesome pruritus so readily as Cantharides. Should nervous fever be associated with the eruption,?hbus will be rendered still more requisite. When the blebs are copiously developed on the face, and there is severe headache, thirst, synochal fever with dry hot skin, tossing about, disturbed sleep, and even delirium, as is prone to be the case in young subjects, Belladonna should be prescribed. (See also HEATSPOTS in children.) After the employment of Belladonna, Lachesis or?Rhus is generally required to complete the cure in pemphigus febrilis. SHINGLES. 541 SHINGLES. ZONA. HERPES ZOSTER. CINGULUM. IGNIS SACER, &C. The term Zona or Herpes zoster, has been given to a cutaneous disorder characterised by the formation of several clusters of vesicles, which usually appear on one side of the body in the shape of a semi-circular band or belt, most commonly at the waist, but sometimes across the shoulder, and occasionally on the neck, face, and scalp, or other parts of the body. The eruption is occasionally preceded, for a few days, by languor, thirst, and loss of appetite, fits of shivering, headache, sickness, restlessness, brownish or whitish coating on the tongue, accelerated pulse, heat and tingling in the skin. More commonly, however, the disorder appears without any precursory symptoms, and the attention of the affected party is primarily drawn to the region where the eruption is about to be developed by a sense of pricking and smarting, or burning heat and sharp pain. On examining the parts several bright red, irregular blotches, more or less widely separated, are observed, and upon each of which, numbers of minute white silvery-looking vesicles show themselves, and ere long increase to the size of a lentil or pea. The vesicles are at first transparent, being filled with a clear limpid fluid, but about the fourth day they assume a milky, or yellowish, or sanguinolent color, and the fluid contained becomes seropurulent, or even converted into true pus. Soon after this, they often become somewhat confluent, and flatten or subside, leaving a very faint outline behind them, or what is still more frequently the case, they dry up and form small yellowish or brownish scabs. Some of the vesicles, again, burst on the second, or between that and the fourth day, and discharge a small quantity of limpid serum; the epidermis being detached, suppuration of the vascular rete of the corion takes place for a few days in consequence of the exposure. While the vesicles of the first groups are acquiring an opalescent aspect, new clusters begin to appear in succession for three or four days, and pursue the same course. From the eighth or twelfth, to about the twenty-first day, all the incrustations of zona are detached, leaving the surface of the skin in a tender state, and covered with marks of a deep-red color, which gradually disappear. Where the vesicles have been confluent, and the inflammation 542 CUTANEOUS DISEASES. severe, the eruption is frequently of longer duration than above stated, and the skin, from occasionally becoming ulcerated below the incrustations, which, in such cases, are rendered very adherent, heals slowly, and presents numerous pits or cicatrices for a considerable time afterwards. The causes of herpes zoster are obscure. It is most common in summer and autumn. It is not contagious, and does not appear to have ever been seen as an epidemic., The disorder is, on an average, not of a serious character, especially when occurring in children and adults, but in the aged it is liable to be followed by sloughing and gangrenous ulceration, and is always distressing from the pains which accompany it. THERAPEUTICS. When the disease is preceded by considerable constitutional disturbance, with severe pain, restlessness, deep-seated darting pains in the chest, heat of skin and quickness of pulse, a dose or two ofAconitum afford speedy relief. Spare diet must at the same time be enjoined. Should the febrile symptoms, pain, and restlessness, not completely yield to Aconitum, Sulphur may be prescribed, succeeded by a repetition of Aconitum, or by Aconitum and Cofec~ in alternation if there be less pain but continued restlessness. When the primary symptoms have been removed, or when the attack has commenced without any precursory symptoms, Rhus toxicodendron generally forms the most useful remedy, and is, in most cases, sufficient to conduct the disease to a happy issue-even in those occurring in individuals of an advanced age; it is sometimes requisite, however, to exhibit Sulphur or Graphites after, or in alternation with Rhus. The patients should, in all cases, be cautioned against lying on the affected side, as gangrene is liable to be induced in so doing, particularly in bad habits and elderly subjects. If sloughing and gangrenous ulceration supervene, notwithstanding all our precautions, Arsenicum must be had recourse to, succeeded or alternated with Lachesis and Cinchona, should a favorable reaction not follow the employment of Arsenicum alone. Sulphur, and sometimes Acidum nitricum usually form the most appropriate remedies to forward the process of healthy granulation and cicatrization. The parts may be dressed with dry lint. Nourishing and easily digestible food must be allowed in such cases, and ULCERS. 543 even wine and water, or a little pure wine if required, as is sometimes the case in old and debilitated patients..fercurius has been recommended as likely to be useful in zona, and may occasionally, along with liepar, prove serviceable when the inflammation has run high, and the fluid contained in the vesicles has become converted into true pus; Antimonium tartaricum when at the very commencement there is considerable gastric disturbance with nausea and vomiting; and Arsenicum when the cutaneous pains consist of a severe burning, and are accompanied by uncontrollable restlessness, dry heat of skin, and great thirst. ULCERS. ULCERA. An ulcer, or sore of continuance, may be the result of a wound, bruise, burn, or abscess; it may also arise from a bad condition of body, particularly when combined with sedentary habits, and gross or otherwise unwholesome living. In the latter case, its formation is preceded by a greater or less degree of pain, heat, redness, and swelling of the part. In many instances a little vesicle or pustule appears, which, on bursting, exposes a gap or breach in the skin. Sometimes there is at the commencement a single small excavation; in other cases, several contiguous ulcerated spots are observed, which speedily become blended together, and form a sore of considerable magnitude. When no effort at cicatrization or healing is taking place, the ulcer always presents an excavation or hollow, the margins of which are red, sharp, sometimes thick, promiinent, rounded, or callous, and often jagged and irregular. The surface of the ulcer, at the same time, presents a dirty white or yellowish color, and is usually covered with, and discharges, a thin watery humor or sanies, frequently tinged with blood, and sometimes so acrid as to inflame and corrode the skin. While the process of ulceration is extending, the edge of the adjacent skin is inflamed and painful; but as soon as a tendency to heal sets in, this ceases, and healthy granulations form, which present a florid color, are of a firm consistence, and have a pointed shape, resembling minute cones. The matter secreted is altered to a bland, thick, and whitish or cream-like fluid (healthy pus) not adherent to the granulating surface. These 544 CUTANEOUS DISEASES. granulations do not rise higher than the surrounding skin, and when they have risen to the level of it, those at the margin of the ulcer become covered with a smooth, thin, bluish film, which is at first semi-transparent, but soon changes to opaque on being converted into new skin. THERAPEUTICS. In the treatment of ulcers in general, the following are some of the most important remedies: Arsenicum, Carbo v., JLachesis, Mercurius, Sulphur, Silicea, Sepia, Lycopodium. ARSENICUM is chiefly useful when the ulcer presents a livid aspect, or looks bloody, and bleeds at the slightest touch, and, instead of healthy pus, secretes an ichorous discharge mixed with blood; the edges of the sore are at the same time hard and irregular, and the patient complains of great pain, particularly of an intense burning description. CARBO v. is indicated under similar circumstances, and is therefore very useful in alternation with the former remedy, especially when the discharge from the ulcer is of a very offensive nature, and the burning pains are much exacerbated towards evening and during the night. When the ulcer is large, or seems disposed to extend rapidly, or when it is surrounded by numerous small ulcerations or pustules; further, when there is considerable swelling and discoloration of the surrounding parts, the leg presenting a mottled, dark-blue or purple appearance,-LACHESIS forms a most important and eminently useful remedy. MERCURIUS will usually be found very serviceable when the ulcer is deep, and secretes a thin and offensive discharge; but should healthy granulation not supervene on the filling up of the cavity under the action of Jiercurius, Sul/phur or Silicea may be prescribed, or both these remedies alternately. When the discharge continues thin and offensive, notwithstanding the employment of Mercurius, Assafcetida may be administered, provided Arsenicum, or some other remedy, does not merit a preference. SULPHUR is almost indispensable in nearly every case of long standing, and is sufficient of itself to effect a cure in many chronic cases. It is more particularly indicated, however, when excessive itching, burning, or gnawing and smarting pains are experienced in the sore, which bleeds much when ULOERS. 55 dressed, presents no distinct appearance of granulation, secretes a thick, yellow, unhealthy pus, or a fetid sanies, and has its irregular, elevated margins frequently surrounded by groups of pimples, which add to the irritation created by the sore; further, where there is oedematous swelling, and a reddish-brown discoloration of the limbs, when the ulcer is seated in the inferior extremities. SILICEA is of nearly equal importance with Sulphur, in the treatment of chronic ulcers. It is accordingly of the utmost service in many cases, when administered in alternation with that remedy, and in those of a very obstinate character, with Sepia and Acidum nitricum. The secretion of a thick and discolored pus is a useful indication for Silicea; at the same time, when the discharge consists of a thin, acrid and offensive sanies, this remedy is of like utility, particularly in sores with imperfect granulation, or the repeated formation of large and flabby vegetations. When the pus is of a citron-yellow color, the margins of the ulcer callous or inverted, and an intolerable itching, sometimes a pain of a burning description is experienced at night in bed,-LYcoroDItm may be given with advantage. In superjfcial chronic ulcers, Lycopodium is, moreover, one of the most useful medicaments. In administering the remedies, it is frequently sufficient to give a dose every eight or ten days; in other cases, it is found necessary to dissolve a few globules, or a drop or two of the tincture in a pint or so of pure water, to which a tablespoonful of spirits of wine has been added, and order a table-spoonful to be taken daily. When the ulcer is inflamed or extremely painful, a soothing effect is often derived from the application of linen dipped in warm water; and if the ulcer be seated in the leg, the affected limb should be kept at rest, and not allowed to remain in a depending position. The application of lint dipped in, and kept constantly wet with cold water, is another simple, but highly useful form of dressing, and is frequently of greater efficacy than the preceding, especially when the ulcer presents a sharp, jagged, and undermined appearance, with no distinct formation of granulations, but exhibits a surface consisting of a whitish spongy substance, covered with a thin and acrid discharge, and bleeds on being dressed. 35 546 CUTANEOUS DISEASES. When, on the other hand, the granulations are sufficiently developed, but of a pale color, and often large and flabby, with a smooth and glossy surface, the edges of the surrounding skin being at the same time thick, prominent and rounded, the pus thin and watery, intermixed with flakes of coagulating lymph, which adheres closely to the surface of the sore, but the pain is trifling, and the sore comparatively insensible, considerable assistance will generally be derived from the employment of a moderately tight and properly applied bandage. The promotion of healthy granulation and cicatrization is further materially forwarded by the external employment of the same remedy which we are prescribing internally (in the same manner as described under the heading of CHILBLAINS); but in other cases it will be found sufficient to keep the dressings constantly wet with cold water; we must, however, never omit the internal administration of the appropriate remedy; as, otherwise, the sore will be liable to break out again and again, at longer or shorter intervals, though apparently healed up in a satisfactory manner, under the employment of the unmedicated cold dressing alone.' In the treatment of healthy or healing ulcers, dry lint may be applied to the wound, and the dressing changed only once in forty-eight hours, when the secretion of pus is scanty and insufficient to moisten the lint in a shorter period. Ulcers attended with or arising from a varicose state of the veins, are usually very obstinate and difficult to heal, particularly when it is inconvenient or impossible for the patient to be kept at rest. Under such circumstances, it is essential that a properly fitting bandage or laced stocking should be worn. The best remedies calculated to effect a permanent cure are, Arnica, Pulsatilla, Lachesis, Sulpkur, and Silicea; also Arsenicum, Carbo v., and Acid. phosphoriczum. The two first-named, when given alternately about once a week, early in the disorder, are occasionally sufficient to effect a cure, but for the most part it is necessary to have recourse to the others, * In chronic, indolent ulcers on the inferior extremities, such as are frequently met with in elderly persons, the treatment ought to be solely internal at the commencement, and the doses administered at intervals of a week and upwards. ULCERS. 547 either to complete the cure or to prevent a relapse. The indications for their selection are, in this form of ulcer, much the same as already given in the treatment of ulcers in general. Acidum phosphoricunm is extremely useful in cases of more or less lymphatic ulceration, particularly when the patient has previously been injuriously affected by the employment of Mercury under allopathic treatment. Acidarm nitricumn will prove of"essential service after Acid. phosph., if required. Sepia, Arsenicum, Petroleum, Silicea, and Sulphur are most serviceable, when proud flesh forms on the ulcers. Against the following varieties of ulcers most of the subjoined medicines have been found of the greatest utility:* PIIAGEDENIC: Arsenicun1, Silicea, 2fezereum, Hepar 8., Sulphur; also Coniumn, Acid. nitricunm, and Janunculus. SCeOFULOUS: Sulphur, Silieea, 6c/lcarvea, lycopod., Carbo V., Arsenicum, Acid. muriaticum, Bair&yta acetica, and Belladonna. PUTRID ULCERS, or those occurring in cachectic, scorbutic subjects: Sulphur, Silicea, Arsenicum, Carbo v., Ilepar s., Acidum muriaticum, Pulsatilla, and, in some instances, Ammon. c. et rm. GANGRENOUS: Arsenicum, Lachesis, Cinlonaz, Silicea, Belladonna, and Conium n; also Jthus tocicodendron, Secale cornutumn, and Squilla. CARCINoMATOUS: Arsenicuin, Jachesis, C(onium, Sulphur, Silicea, Diadema aranvea, fercurius; also Aurum, Staphysagria, and Hepar s. FIsTuLous: Sulphur, Silicea, Calcarea, lycoyodium, Pulsatilla, and Antimonium. In fungous ulcers: SulphEr, Silicea, Calcarea, Graphites, Sepia, Stcayhysagria, Petroleum, Antimonium, lodium, Thq{ja, and Acid. nitric.; and in Fungus hamatodes: Phosphorus, Tlihuja, and Acid. nitr. MERCURIAL: Hepar 8., Aciducm nitricumn, Acidum piwsphoricumn, Aurum, Carbo vegetabilis, Sudlpur, Silicea, Belladonna, Thuja, Sarsaparilla, and Acid. flvoricum (especially about the ankle, with mnore or less implication of the bones). * Characteristic indications for many of the remndies quoted will be found in Bwenninghausen's Manual of Homceopathic Therapeutics. 548 CUTANEOUS DISEASES. SYPHILITIC: iMercurius chiefly, but also Acid. nitricum, to promote healthy granulation, when the former is insuficient, or to combat mercurial complication, when the patient has previously been subjected to injurious doses of that remedy. In other cases Lachesis, Sulphur, and Thuja, &c., are requisite to establish the cure. (See SYPHILIS.) INDOLENT (with thick, smooth, prominent, and rounded margins, a flat bottom, smooth, shining granulations, which are liable to be repeatedly and suddenly absorbed soon after their formation, leaving the sore as much increased in size as it had previously diminished. The pus is thin and aqueous, and contains flakes of lymph which adhere tenaciously to the surface of the sore): Sepia, Ac. phosph., Lye., Carbo v., Ars., Zach., Sulph., Silic., chiefly. INFLAMED: Acon., Ars., M2erc., Hep., Sil., and also Mfez., Puls., Ant., Bella., or Silic., Sulph. INSENSIBLE: Euphorbium, Ars. IRRITABLE (painful, bleeding readily, with thin ichorous discharge, and imperfect or indistinct granulations): Ars., Assa., Lyc., Hepar, Carbo v., e., e., Phosph., Silic., Mez., Acid. m., Lach., Puls., Acid. nitr., Con., Sulph., Bella., Thuja, Staph. ITCHING: Sulph., Szlic., Ac. phosph., chiefly, but also Lyc., Sep., Graph., Ars., Alum., Puls., Staph., Bov., Ran. ITCING at the edges only: Tart. - at night only or chiefly: Lye., Staph. BURNING: Ars., Carbo v., or Lye., Sep., Sil., Clem., Graph., 1Mez., Hep., Acid. n., Acid. m., Rhus, Puls., N2ux, Bov., Cham., Canth., Plumb., Ran., lam. BURNING pain during the night only: Lye., ]Rhus, Staph., Hepar. - pain or heat at the edges: Acid. m. - pain when touched: Lach., Lye. CREEPING or crawling sensations in the ulcers: Rhus, Clem., Cham., Con. EXcORIATION, with pains resembling a recent: X.ez., Rhus, Hyep., Puls., Bella., &c. GNAWING pain, with: Staph., Mierc., P/hosph., Zyc., Bar., Kali, Rut., Sulph., &c. JERKING pains, with: Staph., Cham., Clem., Ac. in., Ac. s., *4rn., Ruta, &c ULOERS. 549 ULCERS. 54 PIERCING or boring pain, with: Szuph., Silic., China. THROBBING pain, with: Sulph., Clem., lHep., Merc., China, Bryon., &c. SHOOTING, darting, pricking pains, with: Ac. nitr., Merc., Silic., Hep., Puls., Sulph., Nux chiefly; but also Staph., Sep., Lye., Ars., Mez., Clem., Graph., Ohina, Petr., Lam., Ran. SHOOTING pain at night only or principally: ]Rhus. - pains at the edges, and only when touched: Clem. - or pricking pains as if from splinters: Acid. nitr. SMARTING: Silic., Graph., Staphi.; Lam., Rhus, Puls., Cham., Bry. - or soreness at night only: JRhus. TEARING, rending pain in the ulcers: Lyc., Sulph., Sep., Graph., Staph., Canth. TEARING, during the night only or chiefly: Lycopodium. TENSIVE pain in the ulcers: Sulph., Con. Ulcers which present a bluish or livid appearance: Ars., Lack., Silicea, chiefly; but also Con., Sulph., Merc.,Assa., Aur. Ulcers with bluish margins: Assa. - which have a greenish aspect: Ars. ULCERS which have a whitish appearance:.Merc., Sa bin., Ars. - smooth: Ac. phosph., Lach., Sil., Ran. - superficial: Ac. ph., Ac. nitr., Merc. - tumid: Lycop., Con., Bella. - with indurated edges: Ars., Sil.; and also Merc., Sulph., Sepia, Assa., Thzja, Puls., JPetr., Lyc., Bryon., &c. Ulcers with inverted edges: ycopodiumz Ars. - with pale edges: Nux v. - with elevated edges: Ars., Sil., Sulph., chiefly; bi, also M2erc., Lyc., Sep., Puls., Thuja, Assa., Petr., &c. Ulcers with jagged edges: iMerc., Thzja, Staph., Hep., Acid. ph., Sulph., Sil., Lach. Ulcers surrounded by papillce: Sulph., Lach., Sep., Ars., Puls., Jhus, Sil., Lyc., &c. ULCERS WITH UNHEALTHY PUS. Pus, serous, aqueous, sanious: 1 erc., Acid. nitr., Sulph., Sil., Ars., Carb. v., Lye., Graph., Clem., Ruta, Assa., Rhus, Ran., &c. 550 URINARY AND GENITAL ORGANS. Pus, albuminous: Ars., Ammn., uSph., Sil., Sep., Cale., yce., Puls., chiefly. Pus, brownish: Ars., Carb. v., il., Bry., &c. - excessive secretion of: Sep., Puls., Sil., Ac.ph., Lye., Chin., Arg., Canth., Staph., Calen., Scill., 31ferc., Phosph., &c. Pus, gelatinous: Arg., erc., Sp)., Sil., chiefly. - gray: Ambr., Lyc., 2ferc., Sil., &c. - yellow: Puls., Lyo., Ars., Kreos., Natr., Nitr., Thuja, Dulc., Aur., Sep., Sil., Clem., &c. Pus, acrid, ichorous: Ars., ier., Sil., Ihus, Staph., Sep., Sulph., Graph., Clem., Kreos., Acid. nitr., Natr., Ac. sulph., Hep., lye., Ran., &c. Pus, sanguineous: Ars., Assa., Rlep., Ierc.; and Sulph., Sep., Lach., Sil., Lye., Rhus, KTali, Garbo v., &c. Pus, scanty secretion, or suppression of: Lackl., Merc., Sil., Cal., and Carbo v., Clem., Sarsa., Phosph., Petr., Staph., Magn., Led., Bar., Graph., &c. Pus, fetid. Sulph., Ac. phosph., Hep.; and Carbo v., Ac. nitr., Aur., Ac. m., lreos., Staph., Sec. corn., Con., Sil., &c. DISEASES OF THE URINARY AND GENITAL ORGANS. INFLAMMATION OF THE KIDNEYS. NEPHRITIS. DIAGNOSIS. Pressing, pungent pain in the renal region, shooting along the urethra to the bladder, dysuria, strangury, and ischuria (when both kidneys are affected), hot and highcolored or red urine; drawing up, swelling, and pain of the testis on the affected side; numbness and spasms of the foot on the same side; nausea, vomiting, colic, and tenesmus: lying on the part affected and motion aggravate the pains. CAUSES. Excessive use of stimulants; shocks of the body, falls or strains, external injuries; long lying on the back, abuse of diuretics or cantharides, suppressed hemorrhoids or menstruation, metastases or calculi. THERAPEUTICS. The principal remedies in this affection are, Aconitum, Cantharides, Nux vomica, Pulsatilla, Belladonna, ifepar sulphuris, Cannabis, Mercurius, Arnica montana. INFLAMMATION OF THE KIDNEYS. 551 ACONITE. In the inflammatory stage of this affection, this remedy should be administered in repeated doses, in the same manner as in Inflammatory Fever; after which, in the majority of cases,CANTIARIDES will be found most efficacious in prosecuting the treatment, and may indeed be had recourse to at the very commencement of the attack, even when the accompanying fever is considerable, particularly when the urine passes off in drops, or is tinged with blood, or when micturition is exceedingly painful, with burning pain in the urethra, and when there are general symptoms of shooting, cutting, and tearing pains in the loins and region of the kidneys, or even in cases of complete strangury. 1* Canth. Tinct. 6, gtt. iv. Aq. pur. 3iv. Dosis. 3 ss. ter quaterve vel saepius quotidie, pro re nata. The proved value of this medicine, when used homoeopathically, in the cure of this painful disorder, is another of the many exemplifications of the truth of the homoeopathic law: its power of causing diseases of the urinary organs, even when applied in the form of blister, being so well known, that in all medical works it has been noted as an exciting cause of this affection. CANNABIs is of nearly equal importance to Cantharides in nephritis. It is especially called for when a dragging pain, or an obtuse aching or pressive pain, or a sensation as if from excoriation is experienced, extending from the region of the kidneys down towards the groin, accompanied by painful and difficult urination. Form of prescription, the same as Cantharides. Nux VOMICA. When the affection can be traced to a suppression of a hemorrhoidal discharge, determination of blood to the abdomen, excess of wine or stimulants, and sedentary habits, and where we find constipation, feeling of faintness, nausea, vomiting, distension of the abdomen, and drawing up of the testis and of the spermatic cord. (Cocculus and Arsenicurn are sometimes required after Nux v.) PULSATILLA. In females of phlegmatic temperament, when the complaint is connected with irregular or suppressed menstruation. 552 URINARY AND GENITAL ORGANS. The dose of the two latter remedies may consist of a few globules or a drop (sixth dilution or potency), repeated every twelve hours, while necessary. BELLADONNA. When shooting pains are experienced in the kidneys, extending to the bladder,-and further, when nephritis is accompanied with colic and cardialgia, heat and distension in the region of the kidneys, scanty micturition, the urine presenting an orange yellow, or sometimes a bright red color and depositing red or whitish thick sediment; anxiety, restlessness, and periodical aggravation--constipation. Form of prescription, same as Cantharides. HEPAR SULPHURIS is useful, when we have reason to apprehend the formation of an abscess or the commencement of suppuration: here the diagnosis is difficult, and the professional student must be careful not to mistake the apparent alleviation of suffering for the subjugation of the disease. The following symptoms may serve as a guide in these cases: cessation of the acute pain, a sensation of throbbing and a feeling of weight in the region of the kidneys; alternate chills and slight flushes of heat, and copious perspiration. 9 Pulv. Hep. Sulph. 3, gr. iv. Divide in partes aequal. octo, quarum sumat unam tertiis horis. MiEROURIUS is also valuable in this stage, but more particularly when diarrhoea and tenesmus are present. CoLCHICU1t. When, in addition to the usual symptoms of this disease, there is excessive nausea with tympanitic distension of the abdomen, and painful and scanty emission of bright red urine. Form of prescription, same as Canthiarides. When the disease has assumed a chronic form, and induration of the kidneys has taken place, Mercurius will often be found useful, followed by Aurum, unless some marked indication calls for the employment of another medicine. In Nephritis arising from contusions or violent concussions of the body, Arnica is the principal remedy. In cases arising from the abuse of Cantharides in blistering we may exhibit a drop or two of the saturated solution of Camphor, and every hour rub the inside of the thighs with the same preparation, twice a day, until relief is attained. OBSERVATION. This disease sometimes arises from the INFLAMMATION OF THE BLADDER. 553 presence of CALCULI in the kidneys; in which case the symptoms of fever do not occur, until a considerable time after severe pain has been experienced;-further, a numbness of the thigh, and a retraction of the testicle of the affected side, are considered as distinguishing marks of the existence of a calculus in the kidney or ureter:-here the use of Nociatiana rusticc has repeatedly been found a useful palliative, administered every half hour. But one or more of the subjoined medicaments may be found more appropriate, and of a more permanent benefit: Lycop., Sarsa., Oannab., Mez., Bella., Calc. In conclusion, the following remedies (the utility of which in various forms of nephritis or nephralgia, either chronic or otherwise, clinical observation has confirmed) may be pointed out, as meriting the attention of the professional student: Calcareca carbonica, Zycopodium, Ca2sicum, Colchicum, Phosphorus, Sepia, Uva ursi, Kali carbonicum et nitricum, and Graphites. Patients suffering from Nephritis should strictly avoid wine, malt liquor, and spirits. In the event of suppuration, the following, in addition to Hepcar s. have been recommended: Arsenicum, S'ulphur, Silicea, Kali nitricum, and Sarsaparilla. INFI.AMMATION OF TIE BLADDER. CYSTITIS. Burning pain in the region of the vesica, with tension, heat, pain when touched, and external tumefaction; frequent and painful discharge of urine, or suppression, and generally tenesmus; fever, and sometimes vomiting, as in Nephritis. The causes of this complaint closely resemble those of Nephritis, but it occurs more frequently in parturition than the latter affection. THERAPEUTICS. We should have recourse to AcoomTUM, as in Nephritis, when a considerable degree of inflammatory fever is present, followed byCANTHARIDES, which here, as in the above-mentioned disease, is the leading remedy. Nux VOMICA. When the affection is attributable to habitual indulgence in wine or spirituous liquors, this remedy, timely administered, will, in many instances, check its further progress; and also, when it results from suppressed hemorrhoids, O=~ URINARY AND GENITAL ORGANS. or other habitual discharges, or from dyspeptic derangements. It may be followed, if required, by Sulphur and Calcarea. The two last-named remedies are well adapted to the treatment of the chronic form of the complaint. PULSATILLA is valuable in checking the development of the affection, when arising from suppressed menstruation; and is, moreover, serviceable in all cases, from whatever cause arising, when occurring in individuals of phlegmatic temperament, with the following symptoms: frequent desire to urinate, painful and scanty emission of slimy or sanguinolent urine, which deposits a purulent-looking sediment; burning and cutting pains in the hypogastrium, with external heat and tumefaction; suppression of urine. HYoscYA.Ius. When there is difficult urination, but the disease is not far advanced, particularly when we have reason to suspect that this symptom arises from spasmodic constriction of the neck of the bladder, or when in fact it is more of a spasmodic or inflammatory character. Digitalis is serviceable when, in addition to the ischuria, a constrictive pain is felt in the bladder; and Arsenicum and Ccrbo v. have been found very efficacious in allaying the burning in the urethra during urination, when Suzlphur, Calcarea, or any of the foregoing remedies have not succeeded in arresting it. Arsenicum is, further, of great service when there is intense thirst, and a distressing degree of anxiety and restlessness. Form of prescription of the first-named remedies, the same as in NEPHRITIS: of Ilyoscyamus, Digitalis, Sul8phur, Calcarea, Arsenicumn, and Carbo v., the same as Nux v. and Pulsatilla. Ielleborus niger, as also Veratrum and Capsicum, have been favorably spoken of in cases which come on gradually, but subsequently become very severe, attended with frequent urging to urinate, and spasmodic pains, during which only a small quantity of water is passed; to these symptoms are added, continual inclination to vomit, aversion to all kinds of food, excessive distension of the abdomen. When the disease has arisen fi-om the application of Cantharides as a blister in allopathic practice, Camphor must be resorted to as described under NEPHRITIS. And when it arises from the presence of stone or gravel, the same remedies 556 URINARY AND GENITAL ORGANS. THERAPEUTICS. The following remedies may be quoted as those which are best adapted to overcome all ordinary cases of ischury: Aconitumn, CamphJora, Cantharides, Sulphur, Cale. c., Nux v., Carb. v., and Arsenicum. ACONITUM is peculiarly efficacious when there is considerable fever, with burning heat in the region of the bladder, outwardly perceptible to the touch. In the case of children, where, in addition to the foregoing symptoms, there is also distension of the abdomen, with suppression both of foeces and urine, this medicine is, moreover, one of our most important remedies. In urgent cases, a dose of this remedy may be exhibited every half hour or so, until the symptoms yield. CAMPHORA forms a valuable general remedy where no occasional cause of the disorder can be detected, but it is also of great service where the complaint evidently arises from spasmodic action. Burning heat in the abdomen and urethra, with shivering coldness of the surface, and shivering succeeded by a hot fit, do not contra-indicate the employment of Camphora, but as soon as the incipient symptoms of fever become more developed, Aconitum must be had recourse to. In administering Carmphora, we shall frequently find it sufficient, particularly with children or very sensitive subjects, to make the patient smell the camphorated spirit; in other cases a drop or two of the first attenuation, or of the common spirits of camphor, may be given on a piece of sugar, and repeated twice or thrice in a space of a quarter of an hour. The attempted cure of hemorrhoids by the knife or ligature forms a not unfrequent source of urinary complaints, and of ischuria amongst others. When retention of urine has arisen from such a cause, or from excessive enlargement of the hemorrhoidal veins, the urine should be drawn off by the catheter, and the pain relieved by the administration of Sulphur, in alternation with Aconite. Should these not permanently relieve, and the pain consist of a severe burning description, Carbo v. and Arsenicum must be prescribed. Nux v. is extremely useful when the patient has been addicted to the habitual use of spirituous liquors; and is, moreover, one of the most serviceable medicaments, in conjunction with Sulphur, Pulsatilla, Carb. v., Arsenicum, etc., according to the characteristic features of the case, in effecting a radical cure RETENTION OF URINE. 557 ]EEENI- OF- IJU 5 where that is practicable. When ischury has been caused by over-distension, from want of opportunity of emptying the bladder while travelling, etc., the catheter should be introduced to draw off the accumulated urine, and the contractility of the bladder restored by means of IHyoscyamus, Arnica, Dulccamara, or Arsenicum. The repeated application of cold water to the hypogastric region may also prove beneficial in this respect. When surgical assistance is not at hand, or when, particularly in the case of females, the introduction of the catheter is objected to from feelings of delicacy, Aconitum or Camphora ought to be tried first, and will very frequently supersede the necessity of resorting to mechanical interference, and, moreover, materially tend to ward off any evil effects which might otherwise arise in consequence of the prolonged retention. The application of hot fomentations to the pubic region, and the use of the hip-bath, or large injections of tepid water are sometimes sufficient to promote the expulsion of the urine. Retention of urine depending upon spasm of the neck of the bladder frequently yields to the use of Camphora, but other remedies, such as Aconitum, etc., may be required in particular cases. When the disorder is occasioned by distension of the rectum from alvine concretions, or flatus pressing upon the neck of the bladder, the effectual removal of the primary disorder must be obtained by means of Opium, Nux v., Pulsatilla, Plumb. c., Sulphur, and, where required, Aconitunm. The employment of unmedicated enemata, and of the catheter, may frequently be found requisite as auxiliary means of relief. If ischuria arise from distension of the uterus in consequence of an accumulation of the menstrual fluid, or from gas or flatus, retroversio uteri, tumors (polypi), &c., pressing against the neck of the bladder or the urethra,-Sepia, Puls., Bella., Nux V., Sulph., Phosphorus, Lycopocdium, Stapiysagria, Calcarea, Belladonna, Cantharides, &c., are the remedies by which a radical cure is most likely to be accomplished. In the instance of retention of urine from hernia of the bladder, the urine should be taken away by means of the catheter, the protruded bladder reduced, and a truss applied; 'f the hernia be irreducible, the swelling should be supported by a suspensory bandage, but we may frequently succeed in effect 558 URINARY AND GENITAL ORGANS. ing the reduction, and of materially guarding against relapses, by the aid of such remedies as NVux., Aconitum, Opium, Sulphur, Plumbum, &c. (See I-IERNIA.) If inflammation or enlargement of the prostate be the evident cause, Aconitum, Pulsatilla, and Thl ja will be found useful. If paralysis of the bladder, Iiyosycamus, Arsenicum, Dulcamara, or other remedies, according to the original disorder which has been productive of the paralytic affection. And when inflammation of the bladder or kidneys, or inflammation or stricture of the urethra, have given rise to the retention, see CYSTITIs, GOORXonnn, and STRICTURE. CALCULI lodging in the urethra, and occasioning obstructed micturition, require to be extracted or cut out. DIFFICULTY IN DISCHARGING THE URINE. DYSURIA. STRANGURIA. Dysury, or difficulty in discharging water, may arise from various causes, such as inflammation of the urethra arising from gonorrhoea, or the employment of acrid injections, inflammation of the kidneys or bladder, spasm in the neck of the bladder, enlargement of the hemorrhoidal veins, a collection of hardened fteces in the rectum; excess in drinking intoxicating beverages, tumor or other diseases of the prostate gland, the suppression of an eruption or of some habitual discharge, or the prolonged application of cold, particularly in gouty habits, the lodgment of particles of gravel at the neck of the bladder or in the urethra, and the abuse of cantharides, either externally or internally, &c., &c. Dysury is commonly attended with frequent inclination to urinate, smarting pain, heat and difficulty in voiding the water, and a sense of fulness in the region of the bladder. When there are painful or uneasy urgings, and the urine passes off only in drops or in minute quantities, the disorder is usually termed strangury. When the disease is induced by the presence of a calculus in the kidney or urethra,-nausea or vomiting, and a sharp pain in the lumbar region, as also in that of the kidney or urethra, accompany the before-mentioned symptoms. When from a similar cause, having its seat in the bladder, or when produced by gravel lodged in the urethra, an acute pain is experienced at the extremity of the penis, especially during the emission of the last drops of urine, and DYSURIA. 559 the stream of urine is either spiral or bifurcated. Should schirrous enlargement of the prostate have given rise to the complaint, a hard, painless tumor may be detected by the introduction of the finger into the rectum, or it may even be felt on pressing the hand against the perinoeum. THERAPEUTICS. As this disease is almost always symptomatic, the treatment must be directed against the primary affection. We shall accordingly confine ourselves in this place to a brief description of the indications of the remedies which have been employed with the greatest success in ordinary cases. When there is frequent inclination to make water, with great pain and difficulty in voiding it, the discharge being, at the same time, very small in quantity, often passed only in drops, and presenting a dark-red, muddy appearance, the symptoms will generally yield, or at all events become materially relieved by the employment of Aconitum. When a sense of fulness in the hypogastric region is complained of, together with a cutting, burning, or aching pain, Pulsatilla may be prescribed with advantage; and Belladonna when a darting or pricking pain, extending from the lumbar region to the bladder, agitation and colic are encountered. [Hepar sulphuris has been found productive of permanent benefit when Bella. gave but temporary relief. If the calls to make water be extremely urgent, and the urine is passed in a very small stream, is acrid, dark-colored, soon becomes cloudy, and exhales an offensive odor, Mercurizus may be prescribed. Hepar s. is frequently useful after, or in alternation with Mere. For dysuria, with almost incessant inclination to make water, Petroselinum is often very serviceable; and when the performance of the act of urination is at the same time extremely difficult, the urine invariably passing only in single drops, attended with severe burning pain in the region of the bladder and in the urethra, Cantharides can with difficulty be dispensed with. The several causes of the disorder must always be attended to, and will, where known, prove of great assistance in selecting the homoeopathic remedy. We shall accordingly find that when excess in drinking (either vinous or spirituous liquors) has given rise to it: N'ux v., Opium, or Sulphur and Pulsatilla, are the most applicable. When disease of the prostate gland, and when enlargement 560 '0RINART Y AND GE;NITAL ORGANS, of the hemorrhoidal veins, or suppressed hemorrhoids: Nux v., Pulsatilla, Sulphur, or Aconitum, Carbo v., lachesis, Arsenicum, Lycopodium, Calcarea, ifercurius. (See art. IIEMORRHOID.) Again, when the disease has been excited by a fall, or a blow on the back, or region of the bladder, Arnica, and when it has arisen in consequence of a fright, Aconitum, are, for the most part, the most serviceable remedies. The abuse of Oantharides, applied externally or taken internally, is not an unfrequent source of the complaint, and is chiefly to be removed by Spirits of Camphor,. which is, moreover, the principal remedy, particularly at the commencement of the cure, when other poisons have occasioned an attack of dysuria. Aconitumr and Pulsatilla are sometimes required after Camphor. When a chill or the prolonged application of cold has induced the disease, a preference must be given to Aconite, Belladonna, or Dulcamara, or to Nux v., Pulsatilla, Mercurius, Sulphur, Calcarea, or Sarsaparilla. And when inflammation of the prostate gland* forms the primary cause, Pulsatilla and Thy{'a often prove of essential service. The age and sex of the patient is also a frequent guide to the selection of particular remedies. Thus, in old men, Lycopodium and Opium are almost always called for at one period or other of the treatment. In ataxic females or pregnant women, Pulsatilla, Calcarea, Acid. phosphoricum, or Sulphur, Coniumn, ux v.; and in children, Aconitum, Belladonna, N2ux V., Pulsatilla, are the medicaments which have hitherto been most frequently used with the best results. In acute cases the diet must be sparing, and sometimes consist exclusively of demulcent drinks, such as gruel, &c., especially if the pain is very severe. Warm fomentations and * At the commencement of PROSTATITIS, Belladonna may be prescribed with advantage, when the pain is increased by the slightest pressure over the seat of the gland, and when there is considerable fulness or swelling in the region of the neck of the bladder. Cannabis is also worthy of attention under similar circumstances. If the pains are less severe, consisting more of an obtuse aching description, Mercurius is useful, When prostatitis occurs as a sequela of suppressed gonorrhoea, Pulsalilla and Lycopodium have been particularly recommended. In chronic inflammation of the prostate and consecutive induration, Thuja, Merc., Carbo v., Calc. c., and Conium form the principal remedies. SUPPRESSION OF URINE. 561 injections of tepid water sometimes give considerable relief. In all cases salt should be partaken of in great moderation, and acids altogether eschewed. In chronic cases considerable relief is often obtained from drinking copiously of cold water throughout the day. Exposure to currents of air ought always to be avoided by those who are subject to urinary complaints. (See NEPHRITIS, CYSTITIS, and also the indications which have been given for the remedies employed in iJEMATURIA.) SUPPRESSION OF URINE. A partial and occasionally even a complete suppression of urine frequently takes place in fever. It also occurs in dropsy, and in inflammation of various organs, such as the kidneys, &c.; and finally, it may arise from loss of secreting power in the kidneys. The term is now, for the most part, confined to the latter form of the complaint; and it is our intention in this place to restrict ourselves to that variety. The disease commonly takes place in individuals beyond the meridian of life; but it is occasionally met with at a less mature age, and is sometimes encountered even in children. Gouty habits appear to be most liable to be seized with it, and particularly after being much exposed to cold and wet, or on the suppression of an eruption, or some accustomed discharge, such as hemorrhoids, &c. Generally speaking, there is no desire to make water, nor is there pain or tumefaction above the pubes indicating an accumulation of urine, the defective secretion of which will be farther confirmed by the introduction of the catheter. Nausea, constipation, and an occasional sense of sinking, usually accompany the disorder. Sometimes a series of other distressing symptoms, such as frequent and severe fits of vomiting, hiccough, pain in the back, intense headache and restlessness, are present from the commencement. The pulse continues for some time normal; when it becomes slower it indicates danger. The skin is generally natural, but profuse sweating sometimes supervenes, and the perspiration has, in some instances, been found to exhale a strong urinous odor. Suppression of urine leads sooner or later to serious consequences, if the secretion be not restored, and is frequently 36 562 URINARY AND GENITAL ORGANS. very speedily fatal, in consequence, apparently, of inducing cerebral disease, and terminating in coma. THERAPEUTICS. The homceopathic remedies which, in most instances, may be employed with success in restoring the functions of the kidneys are: Aconitum, Camphora, Cantharides, Nux V., Puls., Belladonna, Opium, lycopodium, Sulphur, &c. Their leading indications in suppression, or diminished secretion of urine, are similar to those which have been given under the heads of Dysuria and Ischuria. Attention should in every case be directed to the causes which have apparently been the means of developing the disorder, and the selection of the remedies made in accordance therewith. Thus, when the suppression or retropulsion of an eruption has called forth the disorder, Sulphur will form an almost indispensable remedy. The same remedy, together with Nux v., Pulsatilla, Calcarea or Sepia, is equally useful where some habitual discharge, such as the hemorrhoidal, menstrual, &c., has been checked. The affection, as already observed, is prone to occur in gouty habits, conjoined with free living, or excessive indulgence in spirituous liquors. In these cases, Nux v. will prove of great service, especially when we meet with nausea, or frequent and violent vomiting, headache, or heat in the face and head after meals, constipation, nocturnal restlessness, or unrefreshing sleep with frightful dreams. Opium, Lycopodium, Lachesis, or Sulphur may, in some cases, be found necessary, when Nux v. is inadequate to effect a radical cure. When exposure to cold and wet has given rise to the disorder, Dulcamara may be found useful at the commencement, particularly when there is a copious and offensive secretion from the skin. Acidum nitricum and Colocynth may be of some utility where the perspiration is profuse and exhales an urinous odor. In all cases, any signs of an approach of cerebral disease ought to be studiously watched, and, when detected, immediately combatted by the appropriate remedies. (See PHRENITIS.) The following remedies may also be enumerated as worthy of attention in this disease: Cannabis, Alumina, Kreosotum, Bryonia, Carbo v., Euphorbium, Staphysagria, Clematis, Digitalis, Squilla, Colchicum, Graphites, ]Rhus, &c. For the treatment of suppression of urine in consequence of Nephritis, Cystitis, or Hydrops, see those diseases. STRICTURE OF THE URETHRA. 563 STRICTURE OF THE URETHRA. A stricture of the urethra may be defined to be a diminution, or such an alteration of a portion of the tube as renders it, at the affected part, much narrower than what it is in the normal state, or even completely obstructed. The formation of the disease appears, in most instances, to depend upon a thickening of parts of the canal, the result of inflammatory action. The first, or at all events one of the earliest signs of stricture of the urethra, is the retention of a few drops of urine in the passage after the patient has performed the act of micturition; but these drops are soon involuntarily emitted; while another small quantity, accumulated between the cervix of the bladder and the stricture, may be expelled by the effect of pressure below the urethra. The next, and sometimes the first derangement observed is, that there is a frequent inclination to void water, the patient being under the necessity of emptying the bladder repeatedly in the course of the night. As the obstruction increases, the urine cannot be passed without pain and effort, and the stream becomes forked, spiral, or scattered. In the advanced stage of the disease the urine comes away by drops, and is sometimes mixed with purulent matter or glairy mucus. In addition to these symptoms, the patient is distressed with pain about the glans penis, and occasionally in the loins, and is, moreover, often attacked with severe paroxysms of intermittent fever. Exposure to cold, violent exercise, excess in venery, and the pleasures of the table aggravate all the symptoms, and cause entire stoppage of urine. The thin, glairy, or gleety discharge, which commonly attends, has frequently led to the mistake that the case is one of gonorrhcea secondaria, or gleet; but the existence of the symptoms we have above enumerated, together with the unequivocal proof which is to be derived from the introduction of an appropriate bougie, remove all uncertainty. The most common seat of the stricture is just behind the bulb; and that which is perhaps next in frequency is about four and a half inches within the canal; then three and a half; and sometimes close to the external orifice of the urethra. The evils which are liable to result from old and aggravated 564 URINARY AND GENITAL ORGANS. cases of stricture are thickening of the bladder, with deprivation of its usual power of expansion, or inflammation accompanied with discharge of a sort of viscid secretion, bearing a resemblance to pus; retention of urine, and dilatation and ulceration of the urethra between the bladder and the first and principal stricture.' When the urethra ulcerates, and abscesses form and burst, channels are produced, through which the urine escapes into the surrounding cellular membrane, and fistulce in perinceo are constituted. THERAPEUTICS. In the incipient stage of stricture of the urethra a cure may often be effected by appropriate medicines; even in a more advanced stage a cure is sometimes practicable, or at all events such a degree of improvement capable of being brought about that the after treatment by mechanical means, where requisite, is thereby materially facilitated. The following are the principal medicines, from the employment of which results of a satisfactory nature are frequently to be obtained: Cannabis, Petroselinum, Cantharides, Camphora, Mfercuriu8, Aconitum, Sulph.; and, in some instances, with induration, and more or less contraction and thickening of the urethra: Clematis,Dulc., Digit., Petr., Sulph., or, Acid. nitr., Silicea, Calcarea, Lycopodium, Pulsatilla, &c. A few of the leading indications for the selection of some of these remedies will be found in the chapters on Dysuria, Hsematuria, Gonorrhoea. If the symptoms are invariably exacerbated by exposure to cold, Dulcamara may be prescribed with advantage; and when excess in wine or spirituous liquors causes serious aggravation, and occasionally complete retention of urine, Nuwx v. is a useful palliative. (See RETENTION OF URINE.) In old inveterate cases, and particularly in permanent bad cartilaginous strictures, recourse must be had to the ordinary mechanical means. In cases where it seems requisite fi-om the commencement to conduct the treatment on the principle of mechanically dilating the contracted part of the urethra by means of bougies or elastic gum-catheters, but where the urethra is so irritable that the patient cannot bear the introduction of the instrument, or where copious hemorrhage follows its employment, Aconitum or Arnica may be prescribed with advantage. These remedies are, moreover, often of great URINARY ABSCESS AND FISTULA. 565 utility in warding off inflammatory action in the testes from the use of bougies. Where the medical treatment no longer offers any reasonable prospect of success, and the stricture is so complete or extensive as entirely to arrest the introduction of the bougie, a surgical operation becomes necessary, which consists in the perforation of the stricture, with a stilet; or the plan of cutting down to the stricture, and then cutting through the diseased part of the tube must be resorted to. URINARY ABSCESS AND FISTULA. FISTUL1E IN PERIN.EO. Fistule in perinoeo are ulcerated openings in the perinoeum, which not unfrequently take place in consequence of the natural passage for the urine becoming completely impervious from stricture. The urethra becomes ulcerated immediately behind the seat of the obstruction, and the urine escapes into the cellular membrane; the injected parts swell and inflame; suppuration speedily supervenes; the abscess bursts, and the fistulous opening, forming an outlet for the urine, is produced. In some instances no urine is discharged from the aperture until two or three days have elapsed, but in others, it flows from the first, intermixed with fetid pus. The secretion of pus then diminishes, and the urine passes out of the new channel in large quantities. Several external openings are occasionally formed, in place of one. Fistulae, of a similar nature to the foregoing, may be produced in the groin, scrotum, and even at the base of the penis near the pubis; and in some rare cases they form a communication between the rectum and the part of the urethra behind the obstruction. Retention of urine is no longer prone to occur when fistulm in perinmeo are established. THERAPEUTICS. It is recommended by most surgeons to open the abscess which forms the swelling in the perinueum early. The cure of the fistula necessarily depends upon that which has given rise to it, viz., the strictures themselves: when these are removed, either by the ulcerative process which preceded the production of the fistule, or by other means, the urine resumes its natural course, and the fistulous aperture closes. If it should not do so, we must seek to effect this object by the employment of homceopathic medicines; and of these 566 URINARY AND GENITAL ORGANS. the following will generally answer best: Silicea, Sulphur, Calcarea, and, sometimes Mercurius, Arsenicum, Lachesis, or Cantharides. The introduction of a gum-catheter into the bladder, and the confinement of the patient to bed for a few days, is in some cases sufficient; but where this is impracticable from the stricture remaining entire, and refusing to yield to the usual remedial agents, a staff may be passed down the urethra as far as the stricture, the canal laid open, a catheter conveyed into the bladder, and kept there until cicatrization is accomplished. INCONTINENCE OF URINE. Involuntary flow of urine usually proceeds from relaxation, or a paralytic affection of the bladder; or from irritation or compression of the bladder, in consequence of the secretion of acrid urine, the presence of gravel, or a diseased state of the organ itself. THERAPEUTICS. When the incontinence proceeds from relaxation brought on by a too free use of vinous or spirituous liquors, considerable relief, if not a radical cure, will, in most instances, be effected by the employment of Nux v. In other cases having a similar origin, Opium, Lachesis, Sulphur, Calcarea, and sometimes Acid. muriaticum, must be had recourse to subsequent to, or in alternation with, Nux v. If masturbation or excess of venery have induced a relaxed condition of the sphincter of the bladder, NVux., followed by Sulphur and Calcarea, will generally be found the more efficacious remedies; but the auxiliation of Acid. muriaticum, China, and Acidumphosphoricum will often be required. The use of the flesh-brush and frequent sponging with cold water is also of some service in such cases. The incontinence of urine which proceeds from paralysis of the vesica, or is attendant on more general paralytic derange'ment, has been cured by Cicuta and Magn. aust. The aid of one or more of the following medicaments, Aconitum, Belladonna, Hyoscyamus, Cocculus, Nux v., Opium, Natrum m., Arsenicum, Sulphur, Bryonia, zDulcamara, Laurocerasus, Sepia or Silicea, etc., will, however, be necessary in many cases. The employment of electro-magnetism, cold bathing, and of friction at the upper part of the sacrum should not be ne INCONTINENCE OF URINE. 567 glected in inveterate cases of paralytic enuresis. Against spasmodic incontinency, Camphora, Belladonna, Hyoscyamus, Ignatia, Natrum in., Nux, Pulsatilla, Conium, Cina, and Rhus; or Lycopod., Sulph., Lack., Baryt. c., Ruta, &c., should claim most attention, and be selected according to the peculiarities of the case, and with due regard to the collateral symptoms. If inflammation about the neck of the bladder and urethra give rise to the disease, Aconitum and Cantharides should chiefly be employed. (See also CYSTITIS and GONORRHCEA.) When the secretion of acrid or highly acidulated urine produces an involuntary flow of urine, considerable relief will be obtained by drinking freely of cold water, or of barley-water or linseed-tea. Amongst the homceopathic remedies from which the most appropriate selection may be made, to effect a radical cure of such cases, the following may be quoted: Mfercurius, Iepar s., Kreosotum, Laurocerasus, Arsenicum, Graphites, lodium, Veratrum, or Tartarus emet., &c. If the presence of gravel or sand create irritation and consequent involuntary expulsion of urine as soon as it is secreted, the exhibition of Calcarea, Nux u., Cannabis, riea, Phosphorus, or Petroleum is often attended with the most satisfactory results. In all cases where there is much pain and irritation, recourse may be had to the simple diluents above alluded to, together with the employment of Aconitum and Sulphur in alternation, and the injection of tepid water into the bladder. Against nocturnal enuresis, Ammonium carbonicum is often efficacious; as likewise Belladonna, especially when the weakness proceeds from cerebral irritation; Kreosotum when the emission takes place only during deep, almost comatose sleep, and Cina when the existence of worms in the alimentary canal appears to be the irritating cause. (See the other remedies given under the article INVERMINATION.) In other instances of this frequently most troublesome form of the complaint, Pulsatilla, Sepia, Sulphur, Silicea, Carb. v., Arsenicum, or Hepar, Graph., alc., Am., China, Con., Petrol., Natr., Rut., or 3iagn. aust., &c., may be indicated. In the case of children, if the emission of urine take place only at an early hour in the morning, the nurse ought to be 568 URINARY AND GENITAL ORGANS. ordered to get into the habit of raising the child from bed before the time of the usual occurrence of the mishap. DIABETES. By this term is understood an immoderate secretion of urine, containing a large proportion of saccharine matter. Sometimes, however, the quality of sweetness is absent, and the usual urinary taste alone perceived. The complaint has, consequently, been divided into two species, of which the former has received the appellation of Diabetes mellitus, and the latter that of Diabetes insipidus. The mellitic variety is by far the more dangerous and fatal. Diabetes, for the most part, comes on slowly and insidiously, insatiable thirst and voracious appetite, the usual attendant symptoms throughout the disorder, being frequently the only striking symptoms at the commencement. In other cases, the patient complains of great lassitude, and a tendency to perspire after any trivial exertion; the appetite, although keen, is generally accompanied by deranged digestion. Pain, sometimes of a very severe disposition, is often complained of in the lumbar region, and a sense of distressing weakness is generally experienced in the said part of the body. As the disease progresses, especially in the diabetes mellitus, rapid emaciation of the whole body ensues; the thirst continues excessive, but the quantity of urine voided exceeds in quantity that of the fluid and aliment introduced; there is a feeling of complete prostration; the pulse becomes quick and weak; the breathing exceedingly laborious, and dropsical infiltration takes place in the inferior extremities. The disease affects men more frequently than women, and it frequently attends sympathetically in a milder form on hysteria, hypochondriasis, dyspepsia, and asthma. Those who are in the decline of life, or have a shattered constitution arising from intemperance, as hard drinking, excessive venery, or from the prolonged abuse of diuretics or aperients, or other powerful depleting measures, such as repeated venesections, &c., seem to be most subject to its attacks. Many instances, however, have occurred in which no obvious cause could be assigned. The duration of the disease has varied from five or six weeks to many months, and even several years, before terminating fatally. DIABETES. 569 THERAPEUTICS. The very different opinions as to the proximate cause of the disorder, and the contradictory pathological conclusions, which have been drawn by allopathic writers, have led them to promulgate and adopt the most opposite and conflicting varieties of treatment. In homceopathic writings, again, we meet with comparatively few detailed descriptions of treatment, and authentic radical cures, particularly of the mellitic form of the complaint. This is, undoubtedly, in a great measure to be attributed to the rarity of the disease, for the very minute attention which is necessarily paid to symptoms by the homrceopathic practitioner, in order to enable him to reap the peculiar advantages of his materia medica without, at the same time, neglecting to pay due attention to every additional circumstance which may facilitate his choice of the appropriate remedy, such as the history of the case, and a careful discrimination between cause and effect-must materially tend to overcome the difficulties which surround the allopathist, and render the disease in his hands one of so intractable a nature. The medicines which have been chiefly recommended by the limited number of homceopathic authors who, hitherto, have casually written on or referred to DIABETES MELLITUS, are Acizdum phosp/oricum, Jfercurius, Sulphur, Natrulm a., Carbo vegetabilis, Ledum; and, further, Acid. muriaticum, Asclepias vincetoxicm.m, Ammon. c., Arsenicum, Alumina, Graphites, Ambra, Baryta c., Bella., Con., Magn., Terebinth., and eph., &c. Of these the following have, as yet, been principally employed: Mercurius solubilis, Veratrum, Kali carbonicum, and Acidum muriaticum. Their indications are mainly as follows: " MERC.; SOL. is indicated when there is a constant desire to urinate, night and day, swollen moist prepuce and glans penis, both of them painful: drawing, squeezing sensation in the testicles, a cutting, tearing pain in the left kidney, painful swelling of the gums, white coated tongue, constant dryness in the mouth, a bad fetid breath, constant hunger, insatiable thirst, burning, acrid, scraping eructations, burning pain in the epigastric region, wakefulness, owing to the desire to * Homceop. Exam. vol. iv. No. 12, p. 525. 570 IURINARY AND GENITAL ORGANS. urinate; slow, languid pulse, sunken countenance, general weakness and debility, swelling of glands, &c. "VERATRUIM. Great alteration of the countenance, as of a dead person; swelling of the gums, looseness of the teeth, sticky dryness of the mouth and fauces, which cannot be removed by any liquids; great nausea and thirst, painful hunger, drawing pain in the umbilical region, excessive flow of urine, even involuntary, soreness of the prepuce, extreme general prostration and weakness, especially of the extremities, trembling of the whole body, inclination to faint, weak, almost imperceptible pulse. " KALI CARB. Jerking pains in both renal regions, especially on sitting down; and protracted, dull stitches in the left; frequent and violent desire to urinate, especially troublesome at night, the urine of a pale green color; burning sensation in the urethra during evacuations; sharp drawing pains through the penis; painis on motion in the inguinal region; feeling of cold in the intestines, as if water were being dropped upon them; burning heat in the stomach, languor, swollen and ulcerated gums, dry mouth, fetid breath, violent thirst, especially in the evening and at night, very pale and sunken countenance, sunken eyes, irritable surly state of mind, easily alarmed, uneasiness and wakefulness, great prostration, feeling of emptiness in the whole body, drawing pains in the back, frequently proceeding from the sacrum. " AcIDUM MURIATICUM is preferable to all other remedies in cases where there is an entire absence of thirst, and where the urine has a milky appearance; also in cases of drunkards, where it has proved very efficacious.5" When diabetes is symptomatic of dyspepsia, asthma, 7hysteria, &c., see the remedies which have been enumerated under these different heads. The diet in diabetes ought to be wholesome, and contain the greatest amount of nutriment in a small bulk; animal food ought to be preferred; vegetables, especially potatoes, and fruits are to be inhibited. All kinds of liquids which exert a specific or direct effect upon the kidneys should be strictly avoided. Milk should, in general, be also abstained from. ELEMATURIA. 571 HEMATURIA. MICTUS CRUENTUS. The passing of blood with urine may arise from various causes, amongst which the following are the most frequent: falls, bruises, blows, violent exertion, such as leaping and hard riding,-the lodgment of a small STONE in the kidney or ureter, or by inflammation of the kidney; it may also be occasioned by irregular menstruation, hemorrhoidal disturbances, habitual and excessive indulgence in spirituous drinks, the frequent use of certain vegetables, such as asparagus, &c., excess in venery, and by the frequent external and internal employment of Canthcarides. The blood voided is, in most instances, intermixed with the urine, but when it originates from the lacerating effects of an irregular stone, it is generally discharged in streaks and coaguli, and deposits a dark browncolored sediment, bearing a resemblance to coffee-grounds. The act of urination is generally performed with some difficulty, and accompanied with tenesmus. When the blood proceeds from the kidney, the urine first expelled looks muddy and high-colored, is usually very copious, and attended with acute pain in the back, anxiety, numbness in the thighs, drawing up of the testes, constipation, and other abdominal derangements. When from the ureter, the symptoms are nearly the same as the foregoing, with the exception that the pains extend from the lumbar region along the course of the ureter down into the pelvis, with strangury, and perhaps also nausea and vomiting. In hemorrhage coming from the vesica urinaria, we commonly meet with spasm, dysury, occasionally severe burning and other pains in the hypogastrium perinmeum, penis, and anus, during and subsequent to the act of micturition. To these are added, especially when the difficulty of making water is considerable, great anxiety, cold sweats, shivering chills, debility, and fits of syncope. The blood is not so intimately combined with the urine as in the immediately preceding cases, generally deposits a coherent sediment, and is sometimes emitted in a free state. The voiding of sanguineous urine is always to be regarded in a serious light, especially when it is commingled with purulent matter. The prognosis must, however, be regulated by a variety of circumstances, such as the active or passive nature of the discharge, the age and constitution of the 572 URINARY AND GENITAL ORGANS. patient, the duration and recurrences of the affection, the collateral symptoms, and the occasional causes, &c. THERAPEUTICS. Cantharis forms one of the more generally useful remedies in this disease. It may be had recourse to in almost all cases where we are uncertain as to the exciting cause of the disorder, and especially where there is considerable difficulty in making water, with scalding in the urethra during the act of micturition, or violent cutting and spasmodic pains in the hypogastric region, the blood discharged being either pure and passed in drops, or copiously intermixed with the urine, or in streaks or coagulated. Even when the existence of purulent matter is detected in the sanguinolent urine, the employment of Cantharides may be attended with beneficial results. But the assistance of such remedies as Pulsatilla, Clematis, flercurius, I]epar s., Oannaabis, Sabina, or Uva ursi is commonly essential in the latter case. When, on the other hand, the disorder has evidently originated in the employment of Spanish fly itself, in the form of a blister, in allopathic practice, or in large doses internally, a drop or two of Spirits of Camphor must be given, and repeated every two or three hours until relief is afforded. Should any sequelhe, such as burning in the urethra, etc., etc., remain after the employment of Camphor, Carbo v. and Arsenicum will usually cause them to yield. Next to Cantharides, Mezereum has been recommended as one of the principal remedies in the homoeopathic treatment of hoematuria, more particularly where the blood passed does not appear to be in large quantity, and the accompanying pains not very severe; further, when the blood is rarely or never coagulated. When the disorder has resulted from external violence, it usually gives way readily under the use of Arnica; but if the patient be of a plethoric habit, it will be found highly advantageous, if not imperative, to exhibit Aconitum in alternation with Arnica. To pursue the description of treatment required in those cases where the occasional or predisposing cause is known, we shall find that aux vomica forms an eminently useful remedy, when the habitual over-indulgence in spirituous or vinous H.EMATURIA. 573 liquors, or suddenly suppressed or checked hemorrhoids, have given rise to it, and painful aching in the back with smarting in the urethra are complained of. After 3Tux v., Sulphur may generally be prescribed with much benefit; and this remedy, again, may in turn be succeeded by Calcarea with advantage, particularly when the blood is discharged in small clots. Pulsatilla is very serviceable in females affected with ataxic menstruation, but it has been found of equal value in the male subject when the disease was attended with a constrictive and cutting pain around the umbilicus, extending with great violence to the lumbar region; or where spasmodic pains were experienced in the inferior extremities, particularly the right knee, and from thence upwards to the groin, with spasmodic retraction of the scrotum and penis, and burning pain at the orifice of the urethra. Sulphur and Calcarea may often, as in the case of Nux v., follow Pulsatilla with good effect. Cases apparently arising from venereal excesses usually require Cinchona in the first instance, and subsequently -Nwx, Sulphur, Oalcarea, or Phosphorus. 3Mercurius, also, is sometimes of much value here, particularly when the blood is often discharged during sleep, along with seminal emissions. -lecpar s. may succeed iMercurius, should the latter produce merely temporary melioration. At other times iedum, or Mfezereum, may be found better indicated. When the voiding of bloody urine arises from the presence of calculi, Nux v., Cannab., Cale., Petrol., Phosph., Canth., Lycopod., Bars., canth., Ac. nitr., Nwu m., and Zincum have chiefly been recommended. When the pain is excessive, Aconitum, and in some cases Arnica, may exert a soothing influence. Squilla, Zincum, Conium?, and 2Millefolium have also been favorably spoken of, as being useful in particular cases of this affection. Water or barley-water should, in most cases, be drunk in considerable quantities. When huematuria occurs merely as a secondary disorder, in connexion with NEPHRITIS or CYSTITIS, see these diseases. 574 URINARY AND GENITAL ORGANS. DISCHARGE OF BLOOD FROM THE URETHRA. Urethrorrhagia. Hcemorrhagia urethrca. Stymatosis. This complaint, like the preceding, is frequently met with in connection with other disorders. It may, however, exist in an idiopathic form either in consequence of mechanical injury, or venereal excess, in either of which cases the same remedies must be had recourse to as those given for the treatment of hsematuria arising from similar causes. When it occurs as a secondary malady, in connection with hemorrhoids, menstrual irregularity, &c., Nux., Pulsatilla, Sulphur, &c., are the most appropriate medicaments, and may be selected according to the indications described above. Should the affection be encountered as a secondary symptom of gonorrhcea, it will commonly yield to Cantha/rides, but Cannabis or Sulphur may sometimes be required to complete the cure. INFLAMMATION OF THE URETHRA. CLAP. Urethritis. Gonorrlwea. Blenorrhiea. Under the above heads we purpose to treat of inflammation of the mucous membrane of the urethra resulting from impure connexion, attended with a discharge of puriform matter. The affection commonly commences a week or ten days after the risk of taking it has been incurred; but in some cases it begins in two or three days, and in others no perceptible symptoms become developed for two or three weeks. The disease varies in severity according to the extent and intensity of the inflammation. In ordinary cases the latter only extends an inch and a half along the urethra, or two inches from its orifice; but in severe forms it occupies the entire course of the canal, and even affects the mucous membrane of the bladder. The earliest symptom of a clap consists of a sense of titillation or itching at the orifice of the urethra, which sometimes extends over the whole of the glans penis, and is accompanied by a frequent inclination to make water. In a short time some uneasiness is experienced on passing the urine, and the orifice of the urethra is observed to be red and swollen, and perhaps a small quantity of discharge is observed. The act of urination now becomes more and more painful, sometimes almost insupportable, while the stream becomes dimin INFLAMMATION OF THE URETHRA. 575 ished and broken, notwithstanding the increased expulsive efforts exerted by the patient. A somewhat copious discharge of thick, white, or yellowish puriform matter soon takes place from the urethra. As the inflammation advances, or when it has been intense from the commencement, the discharge becomes greenish, acrid, and sometimes mixed with blood. The glans and prepuce frequently become red and tumefied; involuntary and painful erections often occur, particularly during the night, and there is sometimes considerable restlessness, headache, and other symptoms. of fever. This, the acute stage of the disease generally goes on increasing, or at least continues with unaltered violence for eight or ten days, but is sometimes prolonged to three weeks and even upwards, if unchecked, or aggravated by the thoughtlessness of the patient, in committing errors in diet, indulging in the use of ardent spirits, exposing himself to cold or the excitement of sexual intercourse. When the acute stage begins to subside, its decline is marked by a diminution of the pain and scalding sensation in making water, and in a month or six weeks none of the symptoms may remain. It very often happens, however, that instead of undergoing a spontaneous cure of this description, the acute symptoms disappear, but a discharge of puriform fluid continues for a considerable period, the affection assuming the form of chronic inflammation. The. above are the symptoms of gonorrhcea as it is usually met with. But it occasionally appears in a much more serious and distressing form, in which not only the whole course of the urethra, but even the bladder itself, becomes implicated in the inflammation. When this happens, the sufferings of the patient become materially aggravated; the calibre of the tube is much contracted, in consequence of the tumefied state of the mucous membrane, and the urine is passed with the greatest difficulty and only in drops, accompanied by excruciating pain in the urethra, hips, loins, and hypogastrium; the involuntary erections are frequent and attended with excessive sufferings, especially when combined with distortion of the penis (chordee) from the effusion of coagulated lymph into the corpus spongiosum urethroe. In the worst cases, small indurations may often be felt in the course of the urethra, and sometimes Cowper's glands and the prostate partake of 576 URINARY AND GENITAL ORGANS. the inflammation, in which event a sense of heat, weight, and fulness is experienced in the perinmum, with pain in the hypogastrium, dysuria, and tenesmus, particularly when the disease has spread to the bladder or its cervix. Abscess, fistula, and permanent disease of the prostate, or stricture of the urethra, are the occasional results of the last mentioned state of matters. Phimosis, orchitis, bubo, not unfrequently take place, from the extension of the inflammation to the prepuce, testes, and glands of the groin during the course of gonorrhoea. Gleet, or the existence of a serous or muco-purulent, pale green, or colorless discharge from the urethra, is not an unfrequent occurrence after an attack of acute inflammation. It is commonly attributed to chronic inflammatory action. The most trifling error in diet, and particularly the use of spirits, wines, and pungent condiments, is generally followed by frequent inclination to void water, a degree of ardor urine, and increased oozing of matter. This state often continues for years, and grows more and more aggravated, until at length a permanent stricture is formed, or thickening of the bladder, disease of the prostate, or even of the kidneys, becomes established. In women the symptoms are, generally speaking, not so distressing as in men. Sometimes, however, the inflammatory action affects the mucous membrane of the vagina, and even that of the uterus itself. The discharge takes place from the secreting surfaces of the labia, nymphe, and clitoris, as well as from the lining of the meatus urinarius and vagina in severe cases. TREATMENT OF GONORRHEEA. The disease sometimes proves very intractable, even in homceopathic practice; but if the treatment is commenced sufficiently early it terminates much less frequently in the secondary form of the malady and the other serious consequences we have detailed, than it does under allopathic treatment. The remedies which have hitherto been chiefly employed by homoeopathists are Copaiba, Petroselinum, Cannabis, Aconitum, Sulphur, Cantharides, Capsicum, Silicea, Lycopodium, Acidum nitricum, Sepia, &c. In the milder forms of the affection, or in cases occurring in healthy subjects, a cure is generally very easily and INFLAMMATION OF THE URETHRA. 577 speedily accomplished when the patient applies before the second stage has set in. We have repeatedly succeeded in arresting the disease at its outset (i. e. when the orifice of the urethra looks fuller and redder, and a disagreeable itching is felt'in the tube, together with frequent desire to make water, and some pain on voiding it) by means of the alternate employment of Aconite and Cannabis, at intervals of at first six, and subsequently twelve to twenty-four hours. So soon, however, as the discharge begins, and ardor urine is experienced, Copaiba 3-6 often proves a very useful if not a specific remedy; but should there be a perpetual urgency to make water, Petroselinum 0 may be prescribed in preference to Copaiba. Cannabis is preferable to either Copaiba or Petroselinum, when the inflammation runs somewhat higher, and the pain and difficulty in passing water are consequently more intense. A drop of the first, second or third dilution may be taken every six or eight hours. In gonorrhoea with phimosis, or extension of the inflammation to the prepuce, JMercuriws is the most important remedy; but it is sometimes necessary to prescribe a dose or two of Aconitum, in the first place, when the inflammatory action is excessive, and the glans, as well as the preputium, very much tumefied. (See PHIMosis.) Kercurisis, further, of considerable efficacy at the commencement of the second stage of the disease, when there remains a muco-purulent discharge, of a white or greenish yellow color, and some degree of pain in passing the last drops of water; or when there is swelling and induration of the lymphatic glands of the penis. Silicea or Hepar s. is sometimes required after Merc. in the latter case; and Capsicum is often useful in removing any ardor urinoe that may remain. Sulphur is still more frequently required thaln Mercurius after the inflammatory stage is over, and particularly when the discharge has become serous, and a feeling of uneasiness alone remains in the urethra when voiding urine. In painless gonorrhcea, accompanied with swelling, we have generally given Mferc., Sulphur, or Silicea, at the sixth potency: a few globules night and morning for four successive days. We now come to the treatment of the severer forms of gonorrhea. Here the employment of Aconitum, Cannabis, and Cantharides is especially called for. The curative power of these remedies 37 578 URINARY AND GENITAL ORGANS. in such cases is frequently very striking, and the rapidity with which they afford relief highly satisfactory. Aconitum is more or less useful in most cases of gonorrhoea occurring in young and vigorous subjects, and attended with headache, restlessness, and other febrile symptoms; but it is almost indispensable where the inflammation is severe and extensive, the pain during micturition excruciating, the glans, or indeed the entire penis, much swollen, and the sufferings greatly exacerbated by frequent or almost constant erections (priapismus). In such cases a drop or two of Aconitum at the third or sixth dilution may be added to an ounce of water, and a dessert-spoonful given every six hours. Relief is generally obtained after the first dose, and it is rarely necessary to continue the medicine after it has been taken for the third time. Cantharides is generally required after Aconiturm. It may be given from six to eight hours after the second or third dose of the latter, when the intensity of the pain and any febrile irritation which may have been present have yielded, but the dysuria, ardor urinoe, and chordee still continue distressing. Cantharides may be exhibited without the previous employment of Aconite, when there is rio marked degree of constitutional disturbance, but the scalding during micturition and the chordee are very severe, and the discharge is greenish and tinged with blood. It may be prescribed at the sixth dilution, and the dose repeated in from six to twelve hours according to circumstances. Cannabis is sometimes required after Cantharides, especially when the dysury proves obstinate; and when Cannabis effects little or no improvement, Petroselinum may be administered. We have occasionally found the alternate employment of Petrosel., Canth., and Cannabis requisite before the continuous urging inclination to pass water and the torture during micturition could be subdued. Jfercurius or Suaph. are not unfrequently useful in completing the cure, when the before-mentioned remedies have removed the active inflammatory symptoms. TREATMENT OF THE SECOND STAGE OF GONORRHIrA. When the disorder has reached the chronic stage before the patient seeks advice, we must generally expect to encounter more difficulty in effecting a cure, than during the first or inflammatory stage; the more so, if the patient has previously INFLAMMATION OF THE URETHRA. 579 drugged himself with large and long continued doses of cubebs or of balsam of copaiba, or has fruitlessly persevered for some length of time in the employment of astringent injections. In a number of cases, early benefit has been derived from the use of Capsicum, Mercurius, Sulphur, and Acid. nitr. Capsicum has chiefly been recommended when the discharge is whitish and purulent, and ardor urinwe is still experienced when making water. Ferrum, Pulsatilla, and also Nux v. have been stated to be useful when Capsicum failed to remove the symptoms quoted. Sulph. and Hferc. are considered the most useful, in general cases, when the patient has previously been under a course of copaiba or cubebs. Acid. nitric, is often very serviceable in gonorrhcea as soon as the inflammatory stage is over; but generally requires to be followed by Sulph. if the pain has subsided, but the discharge continues. When the inflammation had evidently extended far down the urethra, we have found much advantage in the use of Cantharides and Cannabis, and in some cases from N2ux v., when the discharge was serous and scanty, the desire to pass water frequent and urgent, the act of urination painful and difficult, the stream of urine broken or forked; in short, when the symptoms presented the appearance of the formation of stricture or a tendency thereto. In addition to the above medicines, Acid. nitricum may be mentioned as a useful remedy in gonorrhoea secundaria or gleet; also Sepia, Lycopodium, Cubeba, Silicea, Calcarea, Thuja, NVatrum m., and Dulcamara. When in consequence of errors in diet, the use of wines, spirits, acids, &c., an increased discharge takes place, accompanied by frequent desire to urinate, and some scalding pain, Nux v., or one or more of the other remedies enumerated above, as Cannabis, &c., must be resorted to. Tussilago petasites (in the dose of two tea-spoonfuls of the expressed juice of the plant, or of the water containing the plant in a macerated condition) has recently been recommended as a most efficacious remedy in recent as well as chronic gonorrhoeas. If aggravation follows the first dose or two of the medicine, it must be given in a weaker or more diluted form. A case of ophthalmia which had existed for two years, and had made its appearance after a suddenly suppressed clap, was cured by the employ 580 URINARY AND GENITAL ORGANS. ment of this remedy.* When there is a complication of gonorrhcea and chancre, or when the discharge from the urethra if found to proceed from chancres within the tube, iercurius should be prescribed. (See also SYPHILI.) And when there are condylomata on or in the vicinity of the genital organs, or there is reason to suppose that the discharge from the urethra is of sycosic origin, Tihuja, and Acidum nitric., or Cinnab., ferc., and Sulph., are the principal, remedies with which the cure is to be accomplished. (See SYcosis.) Against symptomatic buboes Carbo animalis is considered as one of the most efficacious remedies. Silicea and Mercurius may also be named as likely to be useful in some cases. (See art. BUBO.) If cystitis ensue in consequence of the extension of the inflammation to the mucous membrane of the bladder, Cantharides and Cannabis will claim the principal attention. (See CYSTITIS.) When swelled testicle results from the sudden suppression of a clap, Clematis, Sulphur, and Pulsatilla form the most appropriate remedies. (See ORCHITIS.) And when rheumatism or ophthalmia are produced, the medicaments enumerated in the respective chapters on these affections must be employed. It sometimes happens that pains in the region of the prostate are complained of for a considerable length of time after an attack of gonorrhoea, which prove particularly troublesome during erections, and occasionally incapacitate the individual affected for riding on horseback. Their removal is, in general, accomplished without difficulty by means of Pulsatilla, Thuja, Sulphur, Lycopodium, or Capsicum. (See PROSTATITIS.) During the treatment of gonorrhoea, wine, spirits, and malt liquors ought to be abstained from. Pure cold water is the best diluent, and may be freely partaken of. Active exercise should be shunned during the inflammatory stage; when it cannot be wholly avoided a suspensory bandage should be worn. If the inflammation be extensive or the parts much swollen, confinement to the recumbent posture becomes requisite. * Rosenberg, Gr. u. st. N. Arch., 1-2. 80. INFLAMMATION OF THE TESTIS. 581 INFLAMMATION OF THE GLANS PENIS. BALANITIS. BALANO-BLENORRHIEA. Inflammation of the glans penis may either occur simultaneously with inflammation of the urethra after impure connexion; or it may arise from mechanical injury, or from the inadvertent application of poison to the part, as sometimes happens when the patient has been occupied in handling poisonous plants. When the disorder takes its rise from extension of the inflammation of the urethra over the whole of the glans, and also the prepuce, AMercurius is, in general, the most appropriate remedy. Sometimes it may be found necessary to give a dose or two of Aconitum before Mereurius; and in other cases Cannabis may be more prominently indicated than either of the said remedies. (See INFLAMMATION OF THE URETHRA, and also PHIMosis.) Acidum nitricum is useful when small, superficial ulcerations form on the glans in neglected or protracted cases. If the affection has been caused by a bruise, or has arisen from friction during coitus, Arnica should be administered, and alternated every eight hours with Aconitum, should the inflammation and swelling be excessive. In the event of these remedies failing to relieve the symptoms, Rhus toxicodendron must be employed. Belladonna and Bryonia, sometimes in alternation with Aconitum, have been recommended as the best adapted to the treatment of those cases which have originated in the accidental application of poison. Cannabis, Cantharides, Cuprum, or Ledum are considered by some homceopathists as the most deserving of attention, when no cause can be traced or assigned as having given rise to this inflammation. If the disorder be of syphilitic or sycosic origin, the remedies which we have mentioned in the chapters on these two diseases must be resorted to. INFLAMMATION OF THE TESTIS. SWELLED TESTICLE. ORCHITIS. HERNIA HUMORALIS. This affection is liable to arise from external injury; but it is much more frequently encountered as a sympathetic disease from irritation of the urethra. The inflammation and swelling come on suddenly, and as abruptly subside, or pass 582 URINARY AND GENITAL ORGANS. from one testis to the other. At the commencement of the attack, the testicle is tumefied, soft, and sensitive to the touch; after a short period it becomes hard and excessively painful. The spermatic cord is also rendered very tender, and thickened, whilst its veins are occasionally found in a varicose state. Pain in the loins, colic, sickness, more or less fever, depression of spirits, and occasionally a difficulty of making water, are other not unfrequent concomitants of the disorder. THERAPEUTICS. If the accompanying fever run high, a few doses of Aconitum must be exhibited. On the reduction of the fever, and diminution of local heat, Pulsatilla is one of the most efficacious remedies when irritation of the urethra, and especially that arising from suppressed gonorrhcea, has given rise to the affection. Sulphur and Clematis erecta are sometimes required to complete the cure after the employment of Pulsatilla; in many cases, indeed, these remedies are preferable to Pulsatilla, even at the beginning of the disease. When the swelling has resulted from external injury, Arnica, externally and internally, rarely fails to afford speedy relief. It may be preceded by Aconite, if called for, and succeeded by Pulsatilla or by Conium, if the pain and swelling do not really diminish under the action of Arnica.* In those cases where Aconite has been found necessary, the application of lint dipped in cold water, and kept constantly moist, is frequently productive of great relief. Should induration in the epididymis remain, Aurum, Clematis, and Sulphur will be found the more generally useful. In other instances, and especially in indurations of long standing, we may, in addition to the above, bear the following remedies in mind: Rhododendron crysanthum, erc., Graph.,Lycopod., Agnus castus, Staph., Spong., or Zincum. Against orchitis as a metastasis of Parotitis, Pulsatilla, Mferc., and Nux v. have been strongly recommended; and in that form the abuse of Mercury, Cinchona, Aurum, Acidum nitr., and Sulphur, have proved of great efficacy. SARCOCELE. This is an affection of the body of the testis, in which its substance is, for the most part, converted into a hard fleshy * See art. CoNTUSIONS. VARICOCELE. 583 substance, hence the name. In the mild form of the complaint the tumor is smoother, and produces little of no pain or uneasiness beyond what is occasioned by its weight. This benign condition of matters sometimes goes on without material alteration for a considerable period; but in other cases it very speedily acquires a more serious character, by becoming unequal and knotty, increased in bulk, and attended with acute shooting pains extending up the loins and back. When it assumes a malignant character, it ulcerates and forms a large, foul, offensive phagedenic ulcer with indurated edges; or extremely painful fungi burst forth from the ulcerated surface, subject to repeated occurrences of hemorrhage. Occasionally an accumulation of fluid in the tunica vaginalis takes place co-eval with the enlargement and induration of the testis, producing that mixed variety of the disorder denominated hydro-sarcocele. Sometimes the disease appears to be merely local, particularly when an external injury has given rise to its formation, and the patient is of a good habit of body. But when it proceeds from, or happens to become developed in a tainted constitution, the abdominal viscera and system at large become implicated, severe constitutional irritation supervenes, and a termination is sooner or later put to the patient's existence. THERAPEUTICS. In the mild form of the complaint, or in the first stage, resolution may be effected by means of one or more of the following remedies: Aurum, Clematis, Lycopodium, Agnus castus, Graphites, Rhododendron, and Sulphur. When the scrotum presents a livid color, and its veins are varicose, cLachesis will be found very useful. In more advanced stages, or when the tumor acquires a malignant character, Arsenicum, Lachesis, Clematis, Arenia diadema, Carb. v. or Tltuja may, in some instances, enable us to arrest the fatal progress of the disorder, but in the majority of such cases extirpation is the only resource. VARICOCELE. YARICOCELE, CIESOCELE, or varicose enlargement of the spermatic veins, usually commences close to the testis, and extends upwards to the abdominal ring. The tumefaction of 584 URINARY AND GENITAL ORGANS. the vessels is commonly greater the nearer they approach the testis. The swelling is knotty and unequal, bearing some resemblance to coiled-up earth-worms; it is sensitive to the touch, creates a feeling of weight in the scrotum, also in the loins, and often a degree of numbness in the thigh. Prolonged retainment of the erect posture, exercise or over-exertion of any kind produce an aggravation of symptoms. Cirsocele is to be distinguished from hernia, as follows: after placing the patient in the horizontal posture, proceed to reduce the swelling by compression of the scrotum; then press the fingers against the upper part of the abdominal ring, and request the patient to get on his legs; if it be a cirsocele, the swelling will re-appear with increased size, from the obstruction which is offered to the return of blood into the abdomen by the pressure; but if a hernia, the recurrence of the tumor cannot take place as long as the pressure at the ring is continued. Blows upon the groin, the violent pressure of a hernial truss over the spermatic cord, tumors resting on and interrupting the circulation of the vena cava inferior, excesses, &c., are considered as the most common exciting causes of the malady. THERAPEUTICS. The radical cure of cirsocele is frequently attended with great difficulty; and in many cases it is only practicable to give palliative relief. Pulsatilla, Lackesis, and Arnica, are the more generally useful remedies. In most cases we may commence with Pulsatilla, and desire the patient to support the testis with a suspensory bandage. Lachesis is frequently of considerable service after the previous employment of Pulsatilla, but particularly when the vessels present an extremely livid appearance. When external injury, such as a blow, or the pressure arising from the pad of a truss, has given rise to the affection, Arnica, in the form of lotion (one part of the tincture to ten of water), should be applied. If, from long standing, or violent exercise, the vessels have become more than usually tumid and painful, a dose of Aconitum may be prescribed, the part frequently bathed with cold water, and the patient confined to the recumbent posture. Nux v. is of service where there is constipation, and neither Pulsatilla nor Lachesis correspond to this par HYDROCELE. 585 ticular symptom. (See art. CONSTIPATION.) Sulphur will often prove useful after Nux. Arsenicum and Carbo v. may be selected when severe, burning pains are complained of in the tumor. And in inveterate cases: Sulphur, Graphites, Lycopodium, Carbo v., Sepia, &c., are the remedies from which we can expect to derive the most assistance; but where the symptoms do not yield to any of these or others which may have appeared better indicated, and the tumor is large, extremely painful, and threatens to waste away the testis by its pressure, the varicose veins should be removed, and inflammation subdued by the antiphlogistic measures given under the head of WOUNDs. HYDROCELE. By the term hydrocele is meant a tumor arising from a preternatural accumulation of serous fluid, having its seat in the membranes of the scrotum (Anasarca integumentorum), or the coats of the testis and its vessels (IHydrocele tunica vaginalis). The former is common to the whole bag and enveloping cellular tissue; it is generally accompanied with anasarca in other parts, or ascites, and when pressed upon retains the impression of the finger. The latter is a purely local affection, and is that to which the name of hydrocele is by many writers restricted. It presents the appearance of a pyriform swelling of the scrotum; is elastic, free from pain, and rarely occurs on both sides, but more commonly on the left "than the right. The tumor is primarily manifested at the inferior part of the testis, and gradually ascends towards the abdominal ring. In some cases the accession of the disorder is sudden, and the swelling increases to a painful degree of distension; but more frequently it takes place very slowly, and occasionally continues for many years with little disturbance. The tumor is usually hard at its posterior surface, where the testis is for the most part situated. As it enlarges, and particularly in its early stage, it is transparent, so that a shade of light pervades the whole tumor when a candle is held on the opposite side; and on compressing it with the fingers fluctuation is perceptible,-by which circumstance, together with the absence of pain and the smoothness of the surface, it is distinguishable from hernia of the 586 URINARY AND GENITAL ORGANS. omentum or intestines, sarcocele, fungus heematodes, or schirrus of the testis. THERAPEUTICS. As anasarcous swelling of the scrotum is generally met with in conjunction with anasarca or ascites, we refer the reader to these different headings for particulars, and shall merely add that when there appears to be no marked participation of the whole habit in the disorder, it will frequently yield readily to the employment of Ielleborus, Arsenicum, or China, &c. The radical cure of hydrocele of the tunica vaginalis is in many cases attended with considerable difficulty. In those of recent origin, or occurring in very young subjects, Pulsatilla will often be found an effectual remedy. In more inveterate cases, Hepar sulphuris, Grapdtites, Sulphur, Nux v., Arnica, Conium, &c., externally as well as internally, become requisite, the latter two especially when a contusion has given rise to the affection..Mercurius, Cinchona, and Digitalis have been employed with success in several cases. And in strumous habits, Silicea has been stated to be of greater efficacy than almost any other remedy. In all cases it ought to be the earnest and untiring aim of the practitioner to effect a cure by means of appropriate medicine, in place of resorting to the hazardous experiment of effecting a cure by the operation of injection. When the tumor, from its great bulk, has become a painful annoyance to the patient, palliative relief may, if absolutely necessary, be afforded by the evacuation of the accumulated fluid by means of a trocar. After which process, the parts may be dressed with lint dipped in cold water, and a dose or two of Arnica given internally, prior to the selection of any other remedy, according to the nature of the case, the constitution and temperament of the patient. DIFFUSED IHYDROCELE OF THE SPERMATIC CORD (~ydrocele funiculi spermatici) consists of a collection of watery fluid in or about the cellular membrane surrounding the spermatic cord. The tumor occupies the course of the cord, is soft, colorless, and unaccompanied by pain. It seems to diminish on the application of pressure, but speedily resumes its usual size, either in the recumbent or erect posture, as soon as the pressure is discontinued. It is often no longer than the portion of the cord which occupies the groin, but sometimes it HYDROCELE. 587 extends as far as the testis, and produces excessive distension of the scrotum. When the swelling attains a large size, it is productive of great inconvenience, and the patient complains of uneasiness in the lumbar region. The treatment of this form of hydrocele is closely analogous to the preceding. When the swelling is small, a suspensory bandage should be worn; and if it appears to have originated from the pressure of an ill-made or badly-fitting truss applied to obviate hernia, the occasional cause must necessarily be remedied, otherwise all attempts at a cure will prove abortive. When the disease is associated with anasarca in other parts, or when morbid states of the abdominal viscera, such as indurations, &c., become manifest, remedies must be selected to embrace the whole deranged habit. (See ANASARCA, ENTERITIS, &c.) In some desperate cases, it may be found necessary to lay open the tumor by an incision extending from the abdominal ring to the testis. ENCYSTED IIYDROCELE OF THE SPEMATIC CORD. (Hydrocele cystatc funiculi spermatici.) In this variety of the complaint the fluid is contained in one (rarely two) distinct cell or cyst. The tumor is of an oblong shape, and is placed between the abdominal ring and testis. It is always free from pain, possesses a good deal of transparency, and is commonly very tense. It differs from hydrocele of the tunica vaginalis, by not extending below the testis, feeling like a distended bladder, and throughout exempt from hardness. The testis is, however, always to be felt below or behind it; whereas in hydrocele of the vaginal tunic, when of considerable magnitude, the testicle cannot be discovered. It is distinguished from hernia by its size and form remaining unaltered in the horizontal posture, and by not becoming enlarged or receiving any impulse from sneezing or coughing; further, by its incapability of being returned into the cavity of the abdomen, and its being unattended with any derangement of the intestinal tract. A perceptible fluctuation and the absence of pitting on pressure determine its features from those of anasarcous hydrocele. The homceopathic treatment required is the same as that described for hydrocele of the vaginal coat. 588 URINARY AND GENITAL ORGANS. VENEREAL DISEASE. SYPHILIS. CHANCRE. LUES VENEREA. The symptoms produced by the venereal disease are generally divided into primary and secondary; by the term primary is understood the ulceration, sometimes followed by a swelling of the absorbent glands, which results from the direct application of a peculiar virus to the parts. When the ulceration is situated on the organs of generation it is denominated a chancre, and the glandular swelling receives the appellation of bubo. The ulcer may be on the prepuce, the glans penis, at the angle, formed by the junction of the two former, at the frsenum, the orifice of the urethra, the body of the penis, or even on the scrotum or perinseum. In the female, -the ulcers are commonly formed about the labia, nymphoe, clitoris, and sometimes within the orifice of the urethra or the vagina. The first symptoms of a chancre generally set in from three to six days after coition, and are commonly announced by a feeling of itching, which upon examination is found to proceed from a small pimple or pustule having an inflamed base, which feels hard to the touch; soon afterwards, an elevated point is observed on the minute cone, from an opening in which a limpid fluid is discharged, and succeeded by a more or less rapid development of ulceration. The primary venereal sore varies much, however, both in appearance and intensity in different individuals, these several forms seeming in a great measure to depend on the habit of body, age, and temperament of the patient. The most common varieties are the flunterian chancre, the superficial ulcer with raised edges, the phagedenic, and the sloughing ulcer. The Hunterian chancre commences in the manner we have already described. As soon as this sore is formed, it exhibits a tendency to assume the circular form, becomes deep and spreading, is covered with a tenacious and adherent matter, and has a hard, cartilaginous base and margin; it is met with on all parts of the genital and urinary organs we have alluded to. When on the glans it is usually less painful, and less inflamed than when it is on the prepuce or frsenum, but more inclined to hemorrhage. The superficial ulcer has it margins considerably elevated, and sometimes spongy, but is not attended with induration; it is sometimes accompanied by two or three sores of the same character, and SYPHILIS. 589 has its seat very often on the outside of the prepuce, but is as frequently met with, attended by its superficial satellites, on the corona glandis, under the prepuce, or around its orifice. When located at the side of the froenum it usually destroys that fold of reflected integument. The phagedenic sore is destitute of any marked degree of surrounding hardness, has no granulations, but presents a lividcolored circumference, and is liable to spread most rapidly and alarmingly, particularly when injudiciously treated by irritating external applications, or by excessive doses of iercury. Lastly, the sloughing ulcer is distinguished by displaying itself, at the commencement, as a black spot, which extends, then casts off and discloses a phagedenic or corroded surface. The ulcer which remains after the slough has come away is of a painful character, and has a dark blue or livid crimson margin. A bad habit of body, combined with intemperance, insufficient or unwholesome diet, and a residence in an unhealthy neighborhood, or the effects of improper treatment, and particularly the abuse of iMercury, or the employment of powerful and irritating local applications, are apparently the principal causes which give rise to the formation of this serious description of sore, which, if not checked, or if perseveringly maltreated, will frequently go on sloughing and ulcerating until nearly the whole of the external sexual organs are destroyed. The cleft of the nates, the groin, the perineum and the labia pudendi are frequent seats of the sloughing ulcer. SECONDARY SYMPTOMS. These most frequently consist in an ulcerated state of the fauces, mouth, and Schneiderian membrane. In bad constitutions,* and especially where improper treatment has been employed, such as excessive doses of.Mercury (one of the most fruitful sources of many of the socalled secondary symptoms in general), considerable portions of the velum palati and tonsils, as also the epiglottis, the cartilages of the laryn, and eventually even the bones of the nose become affected, and are sometimes destroyed; affections of the skin (syphilides) of various kinds, assuming the form of * Ricord is of the opinion that secondary symptoms never arise from contagion, but are derived from hereditary taint. (Traite Pratique des Maladies Veneriennes.) 590 5URINARY AND GENITAL ORGANS. papule, pustule, squame, tubercule, etc., also occur, sometimes preceded by febrile symptoms. The syphilitic eruptions chiefly show themselves upon the external organs of generation, about the verge of the anus, on the face, especially the forehead and angles of the mouth; but sometimes also on the back, and indeed the whole body. They have very often a peculiar hue, varying in shade from a violet red to an earthy yellow, but commonly distinguished by the denomination " coppery," and have usually a tendency to ulcerate. Other symptoms of constitutional infection almost constantly accompany the syphilitic eruptions, such as pains in the bones, ulcers in the throat, etc. Constitutional lues often affects the iris, producing inflammation and ulceration. The periosteum and bones are frequently the principal seat of the constitutional symptoms, particularly the bones of the cranium, the inferior maxillary, the clavicle, sternum, distal end of the radius, and the tibia, in addition to those of the nose, as already observed. When the disease settles in the bones, or when the bones have become involved by the employment of 2Mercury in large doses, the patient is tormented with nocturnal pains of a more or less excruciating character. TREATMENT OF THE PRIMARY SYMPTOMS OF LUES. Ricordj" in opposition to Hahnemann, considers a chancre, at its commencement, as a purely local disease, and therefore recommends that it should be treated as such, and destroyed by the application of a cautery within three to five days after the contraction of the infection. He states that he never knew of a case, so treated, which terminated in the absorption of the virus into the system, followed by symptoms of general poisoning. We have not, as yet, been so fortunate as to have had any cases submitted to our observation at so early a period of their career, and cannot therefore offer any testimony in favor of the latter part of M.. Ricord's assertion, if that were needed, seeing that it is founded on extensive practical experience. We have, however, had opportunity of treating a considerable number of cases at a somewhat more advanced * TraitH Pratique des Maladies Veneriennes. 592 URINARY AND GENITAL ORGANS. able effect. If, on the other hand, granulations appeared, but instead of being firm and florid, they were pale, flabby, and prominent, AcIDuM NITR. 3 answered better. Again, when, after the previous employment of Mfercury, the sore improved somewhat, became less cartilaginous at the base, and finally filled up with florid but too elevated granulations, and remained hard at the edges, was very painful and irritable, bleeding rather freely at the slightest touch, and secreting a thin, acrid, offensive discharge, ARSENICUTM brought about a healthy and otherwise favorable action. Nevertheless, a few doses of Sulphur or Acid. nitr. were sometimes required to complete the cure, after the employment of Arsenicum, especially when the ulcer had spread rapidly, and attained a large size at the commencement. From four to six or eight weeks generally elapsed before a cure was established in these cases. When there was excessive pain, swelling, and inflammation, and these symptoms did not yield to the employment of ifercurius,-Sulphur and Aconitum, in alternation, every twelve hours, gave relief. In other cases, the exposure of the part to the vapor of hot water, together with spare diet and the recumbent position, were sufficient to allay the excessive irritation. The dressing, when the ulcer was neither very irritable nor extremely painful, consisted of a small piece of lint. Great cleanliness is requisite in all kinds of sores; and when the chancre is located under the prepuce, and the latter is much swollen and inflamed, water should be thrown up between the prepuce and glans by means of an appropriate syringe. The remedies which are employed against the ulcer with raised edges, were Acid. nitricum, iepar s., Sulphur, Arsenicum, Siliceca, Carbo v., Lycopodium, Acid. phosph., Sepia, and Mercurius. Most of the cases treated had already existed from six to eight weeks, and upwards, and had been subjected to a smart Mercurial course, both outwardly and inwardly. ACID. NITRICUM and HEPAR s. were consequently very generally required. To the former the preference was given when the gums were severely affected, and when aching pains were complained of in the bones; the sore itself not painful, yet disposed to bleed easily and profusely, presenting no signs of central granulation, and having the margins SYPHILIS. 593 elevated and spongy-looking; or when there was a tendency to the production of condylomata (sycosic complication), with secretion of a thin sanious discharge. The dose consisted of one drop of the third dilution, at first night and morning, then daily, and subsequently every other day, according to the results. Sulphur 6 and Thuja were sometimes required after Acid. nitr. had effected all the benefit it seemed capable of. The former, when cicatrization proceeded slowly and imperfectly; and the latter (both outwardly and inwardly), when excrescences continued to form and to discharge profusely. IEPAR SULPHURIS proved particularly useful when the mouth and gums exhibited unequivocal signs of mercurial action, and when the sore was painful, irritable, and had assumed a disposition to spread rapidly. A quarter of a grain of the third or second, and in some instances the first, trituration, were given night and morning, at the commencement of the course, for four days; then daily, for a like period, and subsequently every second or third day. SILICEA, and at other times Acid. nitric., were sometimes called for to complete the cure, after Hepar s. had subdued the more prominent symptoms of mercurial aggravation, and given a healthy character to the sore. Sulphur, as has already been observed, is sometimes of much utility in promoting healthy granulation in the Hunterian chancre, and is also of great service in sores which present a red or bluish margin, and display a tendency to take on a bad character; but it is especially in the treatment of the superficial ulcer with raised margin that we have derived the most satisfactory results from its employment. When a sore of that character occurred in a strumous habit, or in persons of lymphatic or bilious temperament, who were subject to hemorrhoidal attacks and obstinate constipation-when, moreover, the edges of the sore were spongy, very sensitive, and prone to bleed rather copiously, however gently the prepuce might be drawn back -and, finally, when the secretion from the ulcer was thin and ichorous, or thick, yellow, and rather copious, but the centre of the ulcer flat, and presenting no signs of incarnation, we never failed to derive the most satisfactory results from the employment of Sulphur 6, ten or twelve globules daily for from six to eight days, and then at longer intervals, if we 38 594 URINARY AND GENITAL ORGANS. perceived that the medicine had made a favorable alteration in the appearance of the sore. It was rarely that any other remedy was required to complete the cure when Sulphur was indicated as above. Arsenicum, Carbo v., and Silicea were found very useful when the ulcers had been rendered irritable by a free use of stimulating applications under allopathic treatment. Arsen. and Carbo were equally beneficial when the margins of the sore were jagged, sharp, and undermined; the discharge thin, acrid, and offensive; the ulcer painful and liable to bleed somewhat copiously when slightly touched. Carbo v. received a preference to Arsenicum when the patient bore evidence of having been under a course of Mercury, the breath emitting the peculiar fetor, and the gums looking inflamed, spongy, and ulcerated. Silicea was sometimes requisite after the two preceding medicines, when they had produced great improvement, but seemed inadequate to effect cicatrization. When the sore was inflamed as well as painful and irritable, and the discharge discolored, or thin and bloody, the granulations indistinct or altogether absent, Silicea was of vast service. These medicines were prescribed at the sixth potency, and in the same manner as Sulphur. Nux v. and Pulsatilla were occasionally employed with advantage when the appearance of the sore was altered by intemperance in eating and drinking. Mercurius, from the reasons already specified, was rarely an available remedy in this form of chancre; but in two instances in which it had not previously been employed, or at all events in unusual moderation, it was productive of unequivocal benefit at the sixth potency. The sores in the cases in question occurred in subjects of lympathic temperament and of plethoric habit, and displayed an active, spreading character; the secretion being at the same time acrid, ichorous, and rather "copious. In some very obstinate cases of superficial chancre, where the sore assumed all the characteristics of an indolent ulcer, the margins being thick, rounded, and prominent, without the slightest appearance of granulation, or if any granulations formed, they presented a pale and flabby appearance, Lycopodium and Phosphoric acid proved very serviceable. The former particularly in persons of lymphatic temperament and SYPHILIS. 595 mild disposition, with tendency to habitual constipation; the latter in spare, debilitated subjects, who had been addicted to excessive indulgence in venery. When neither of these was sufficient to establish a cure, Sepia and Sulphur brought about the desired result. These, then, were the principal remedies which we employed with unequivocal benefit in the treatment of the Hunterian and superficial chancres; and in not one instance did the slightest appearance of constitutional or secondary symptoms supervene.- Considerable advantage accrued from the simultaneous external employment of the appropriate remedy in some cases, when the sores were of a very indolent character. As regards the treatment of the two other kinds of primary sores, viz., the phagedenic and the sloughing, we cannot say much, having had only three cases of the former, and none of the latter under our observation; but we have every reason to conclude that the homoeopathic remedies would, when timely resorted to, readily succeed in arresting the progess of the disease. In the three cases of phagedenic sores above alluded to, two of them had previously been injudiciously treated by overdoses of iMercury, and had been further aggravated by the employment of irritating external applications. Ifepar s., 3, Zachesis 6, and Acid. nitr. 3, soon brought on a.healthy action in these, and effected a cure. The remaining case, which bordered closely on the sloughing ulcer, yielded to Arsenicum 6 and Silicea 6. We found a striking change for the better in the appearance of the sores from the internal use of Arsenicum and Lachesis,-the livid red or bluish margins soon assuming a healthier color after their employment. The other remedies exerted perhaps a more favorable influence over the process of granulation. Against the true sloughing ulcer, Arsenicum must, doubtless, be an efficient remedy; it corresponds, both in its pathogenetic properties and those which have been derived from clinical observation, so, closely to the local and constitutional symptoms of the disease.. Zachesis,-and Silicea, Bella., China, Mezereum, Hepar, or Acid. nitr., might also be found useful, if not indispensable, in many instances. Simple excoriations on the glans, resulting from coitus, willi generally heal readily without any treatment whatever, if at-- tention be paid to cleanliness. A weak lotion of Arnica (onae 596 URINARY AND GENITAL ORGANS. part in sixteen or twenty) will frequently hasten recovery. Cases which from neglect, and particularly want of cleanliness, have become converted into small, flat, superficial sores, require Acidum nitricum or Acid. phosph.; the latter we found more useful when the spots or sores were of larger size. The diet, in all primary sores, must be regulated by circumstances. In young plethoric subjects affected either with the Hunterian or with the superficial chancre with raised margins, the diet must be low, and if the sore be very painful and inflamed, the reclining posture is often necessary. The drink must consist of nothing but water, toast-, barley-, or rice-water, weak black tea, and cocoa. In somewhat debilitated subjects, or in all cases where the sore is neither in an inflamed state nor very painful, the diet need not be sparing; but stimulants, such as wine or spirits, are rarely, if ever, called for, and are often, if not always, objectionable under homoeopathic treatment. In the phagedenic sore, absolute rest in the recumbent posture is imperative. If there be great prostration of strength, the diet should not be too sparing, and yet not more generous than the state of the digestive functions will admit of. Wine may be called for, where the patient has been long accustomed to the daily use of spirituous liquors, or where the constitution is extremely debilitated, and no reaction is found to take place from the employment of the appropriate, or homoeopathic remedy. BUBO. This term was formerly exclusively employed, as its <name implies, to denote a swelling in the groin, arising from the passage of venereal matter or poison through the inguinal glands; and yet if the patient have a primary venereal sore on one of his fingers, he may have a bubo immediately above the elbow, or in the axilla. Buboes have been divided into venereal, sympathetic, and constitutional. The venereal bubo is supposed to arise, as above observed, from the,direct irritation which the venereal poison offers to the lymphatie gland or glands as it passes through this portion of the absorbent system into the blood. But the matter of syphilis may be taken up into the circulation without exciting any inflammation in the glands of the groin, or similar glands in other pa'ts of the body. The occurrence of a bubo in consequence of ulcers on the external parts is, in reality, com SYPHILIS. 597 paratively rare in healthy subjects, particularly when the primary sore is properly treated; and we are confident that, in many cases, the injudicious and too free use of irritating local applications, such as sulphate of copper, nitrate of silver, and the red precipitate, in allopathic practice, is a frequent source of this glandular implication. The purely sympathetic, or non-venereal bubo is generally preceded and accompanied by some degree of derangement of the health. At times it may be induced by causes apparently the most trivial, such as the wearing of a tight boot, the effects of a sprain or bruise, &c. A boil or sore on the foot, leg, thigh, or nates, an inflamed or painful corn, a bunion on the great toe, are frequent causes of inflammation and enlargement of the inguinal glands. By the constitutional bubo, we here allude to scrofulous swelling of the lymphatic glands of the axilla, or of the groin, especially the latter. Getting the feet wet, or sitting on a damp seat, in a gig or on the top of a coach, frequently develops this form of bubo. THERAPEUTICS. It is sometimes difficult if not impossible to arrive at the true character of a bubo; the patient, from false delicacy, often refusing to admit that he has previously been affected with chancre. In homceopathic practice, this is of no material consequence; the appearance and condition of the swelling, and the state of the general health, forming a sufficient group of symptoms to enable us, in doubtful cases, to select the appropriate remedies. The correct history of the case is, however, by no means unimportant, as it facilitates the choice of the remedy. If a bubo be a venereal one, and the chancre is in existence with it, we should not deviate from the treatment called, for by the aspect of the primary sore. But if the sore assumes a somewhat improved appearance, orremains perfectly unaltered, and the bubo, on the other hand,, becomes considerably aggravated, we ought to give the latterour chief attention, and prescribe according to the features. which it presents. The following is the mode of treatment we have ourselves pursued. Whenever the swellings were either small, or of considerable size, but neither excessively inflamed nor particularly painful, we prescribed iMercuzriu at the third trituration, quarter of a grain night and morning, until signs of improvement made their appearance. In those cases again in which the swelling was large and painful, and 598 URINARY AND GENITAL ORGANS. accompanied by intense inflammation, the integuments presenting a deep red hue extending over a considerable surface, the redness disappearing on pressure, but returning immediately after the finger was removed, Belladonna 6, every six to twelve hours, was found to be of the greatest efficacy. When suppuration threatened, or became established, Silicea 6, every twelve hours, formed an admirable remedy, having either the effect of producing absorption of the matter, and causing the tumor to subside, or of quickly forwarding the suppurative process and the discharge of the pus from the cellular membrane surrounding the gland. The former more desirable result generally took place when the preceding inflammation had not been intense. ITepar s., third trituration, we preferred to Silicea, if the patient had previously been subjected to a course of Mercury. Staphysagria 6 was substituted for Hepar s., when the mouth and gums were much inflamed or ulcerated. When the bubo took on an indolent and indurated condition, or had remained in that state for several months prior to the adoption of the homoeopathic treatment, Carb. v. was often very serviceable, having frequently the effect either of dispersing the tumor, or of causing it to suppurate. Silicea was, however, of nearly equal efficacy in such cases, and at all events rarely failed to do good, when Carbo v. or a. produced only a slight degree of amendment. A swollen, spongy, or ulcerated state of the gums was an additional indication for Carbo v., Sulphur, or Aurum, and Acid. nitricum proved useful in some obstinate cases. Should the matter of a suppurated bubo exhibit a decided tendency to spread, before advice has been sought, it may sometimes be necessary to have the swelling opened by the lancet. After the pus has been discharged, and the bubo has become converted into a sore, the treatment must be conducted according to the character and appearance of the ulcer. (See ULCERS, as also the treatment described for primary sores on the glans, &c.) Silicea and Sulphur are two of the most valuable remedies in all cases where the parts do not show a disposition to heal; but Acid. nitr., Aurum, Carb. v., Assafoetida, or Staphysagria will sometimes be called for, particularly in cases which have evidently been aggravated by the previous use of Mercury in excessive quantities. Against sympathetic bubo, Belladonna, Hepar, Silicea, SYPHILIS. 599 Sulphur, Carbo a., &c., are the more important medicaments. The indications for Belladonna have already been given above. Hepar s. may follow Belladonna if suppuration threatens; or if, after the removal of the excessive inflammation, the gland remains in a tumefied state. Silicea is one of the most useful remedies in sympathetic bubo, either at the very commencement, even when there is a considerable degree of inflammation, or at a more advanced stage of the affection, when suppuration threatens, or is already established. When a bunion on the great toe, or an inflamed bursa in any other part, has given rise to the bubo, there will be additional reason for prescribing Silicea, as that remedy will in such a case be homoeopathic to the originating cause as well as its sequel. In bubo arising from suddenly suppressed perspiration in the feet, this medicine is, moreover, a most important medicament. Sulphur is also an efficient remedy in sympathetic buboes, particularly when they occur in individuals who are subject to hemorrhoids, or to boils on the lower extremities or nates; or when the inflammation and enlargement of the inguinal gland or glands has arisen after the suppression of an old sore on the foot, leg, or thigh. Carbo a. has been recommended as an effective remedy in sympathetic bubo, from the circumstance that even when suppuration seems unavoidable, it has generally either the effect of causing the tumor to subside, or quickly suppurate and discharge. We have found Silicea to answer the purpose better. In the treatment of scrofulous bubo, 2ercurius and Dulcamara are very serviceable when the swelling is of recent origin, and has become developed after getting the feet wet,* or after sitting on a damp seat. A dose or two of Belladonna will sometimes be required, especially if the inflammation runs high. In cases of longer standing, Silicea and Sulphur are generally of greater efficacy. Silicea, as has already been remarked, is a valuable remedy in suppurated buboes; in chronic cases it is particularly required where the swelling is indurated and painless. Sulphur is frequently of much * Silicea is, however, to be preferred to either of these remedies when checked perspiration occurs in persons who have long been affected with sweating of the feet. 600 URINARY AND GENITAL ORGANS. utility when the tumor is hard, but painful to the touch, and the integuments somewhat inflamed, or very liable to become so after any slight exertion. Calc. c., Clematis, and Carbo v. et a. are also deserving of notice in scrofulous buboes. (Calc., after the previous employment of Sulph.; and Clematis, Carbo v. or a. after Silicea, in obstinate, indolent, and indurated swellings.) lodium, Acid. nitr., Arsenic., Aurum, Staph., or Spongia, &c., have likewise been recommended in scrofulous buboes. Silicea and Sulphur are two of the principal remedies to promote granulation and cicatrization when these buboes have become converted into ulcers. (See VENEREAL BUBOES, and also SOROFULA.) Treatment of Secondary Symptoms. Sore Throat. This form of secondary symptoms, so-called, arises, in most cases, as a sequel of the abuse of Mercury, either internally or locally, in the treatment of a primary sore. It, consequently, for the most part, yields most readily to the use of anti-mercurial remedies, such as Hepar s., Acid. nitr., Bella., Lach., Sulph., Silic., Thuja, Staph. -Arsenic., Alumina, Lycopodium. When the mouth and gums likewise are inflamed or ulcerated, one or more of the same remedies, together with Carbo vegetabilis, Aurum, Natrum m., lod., and China must be had recourse to, according to circumstances. We are generally in the habit of commencing with Hepar s., third trituration, when the patient complains chiefly of pain, dryness, and scraping in the throat, with some degree of inflammation and swelling of the tonsils, but little or no true ulceration. When, on the other hand, on examining the throat, the tonsils are observed to be somewhat enlarged, the fauces considerably inflamed and ulcerated, the ulcer or ulcers superficial, and of a gray color, we commence with Acid. nitr. 3 or 6 in preference. Belladonna and Lachesis are very useful when the inflammation and swelling are more severe, and the ulcers extremely painful and irritable. After these remedies have subdued the excessive inflammation, Acidum nitr. and Sulphur are generally of great value, and often sufficient to complete the cure. In other cases Carb. v., Aurum, Silicea, or Arsenicum, &c., are required. (See also the treatment of SYPHILIS. 601 PRIMARY ULCERS.) In those cases where we have no reason to suspect that Mercury has not given rise to, or aggravated the symptoms, ifercurius is an important remedy,* particularly when the ulcer or ulcers are covered with a tenacious and adherent matter, and the surface considerably excavated. Acid. nitricum and Thuja have been recommended after Mercurius or Sulphur. Silicea, or Arsenicum, Lachesis, or Carbo v., may sometimes be found better indicated than either of the preceding remedies. Lycopodium 6 or 9 is considered by Rummelt to be a remedy which can with difficulty be dispensed with in secondary syphilis. He gave it with striking advantage in a case of sore throat, which had long resisted various kinds of treatment (not homceopathic); the tonsils were covered with ulcers, having a gray-colored base. He also found it of great efficacy in several cases where the fauces and tongue were covered with an herpetic-looking eruption, bearing some resemblance to the wrinkled skin on the hands of washerwomen, and attended with a burning sensation on partaking of warm food, or after smoking. Against aching pains in the bones, Acid. nitr., Aurum, and Lachesis, are of great service; and in venereal nodes or other diseases of the bones, the same remedies, together with Acid. phosph., Assafmit., Sulph., Calc., Silic., Dulc., or Mercurius, when the affection has not actually been produced or materially aggravated, as is but too often the case, by the abuse of that mineral. (See OzENA, and DISEASES OF THE BONES.) Against syphilitic Ophthalmia (Iritis), Acidum nitric. is often a most effective remedy, particularly when severe nocturnal pains in the bones are complained of at the same time, and the patient has previously undergone a course of AMercury. (See IRITIS.) * Hartmann recommends the Mercurius prcecipitatus ruber in syphilitic ulceration of the throat, one grain of the first trituration night and morning, for from six to eight days; at the expiration of which period, or sooner, if signs of medicinal action become earlier developed, he discontinues the prescription, and only repeats, as before, in the event of a cessation taking place in the improvement which may have resulted from the employment of this preparation.-Ueber die Anwendung der Homceop. Arzn. Acon., Bryon., Mere., p. 109. f Allg. Hom. Zeit., vol. vii., p. 117. 602 URINARY AND GENITAL ORGANS. The treatment of secondary symptoms in the form of eruptions must be regulated according to the different species of cutaneous disease to which they bear the greatest resemblance, together with the character of the other constitutional symptoms which usually attend. When the eruption partakes of the papular form (LICHEN, STROPHULUS, PRURIGO), Aconitum, Sulphur, Acid. nitr., IIepar s., Sepia, Dulc., Con., Thuja, Cicuta, Lycop., Ac. muriat., Bryonia, Puls. The two last named, together with Lycopod. and Sulphur, particularly when there is considerable derangement of the digestive function. When the secondary symptoms are associated with the tubercular or with the pustular form (SYCosis, ACNE ROSACEA, IMPETIGO, FAVUS, ECTHYMA), Acid. nitr., Thuja, Aurum, Iachesis, Carbo v. et a., Sulph., Lycopod., Calc., Cic., Arsenic., Rhus, Staph., &c. And when they have taken on the form of squamce (SCALY SYPHILIS, LEPRA, PSORIASIS, PITYRIASIS, PELLAGRA, ACRODYNIA), Sulphur, Lycopod., Lachesis, Thuja, Arsenic.,-Calc., Cicuta, Led., Graph., Sep., Natr., Carbo a. et v., Clem., Petr., Phosph., Olean., Alum., Zinc., &c. Secondary venereal ulceration of the skin is frequently preceded by an eruption, possessing one of the before-mentioned characters, and sometimes in the form of bullce (venereal rupia). These ulcers present no uniform or constant aspect, sometimes assuming a circular shape, with an irregular, foul, ash;colored surface; at others displaying the peculiarity of healing in the centre, and extending at the circumference, the edges being sharp, and the unhealed part presenting the same color and appearance as in the before-mentioned instance. The tawny hue, and the shape and situation of the ulcers, are considered as the characteristic signs of their venereal origin. In syphilitic eruptions of most kinds, M3ercurius is more or less useful, but as it so very frequently happens that that remedy has been most injudiciously and abusively employed before the patient seeks the aid of homceopathic treatment, it is seldom that we can desire that benefit from its use which might otherwise be the case. The remedies which have principally been recommended against the venereal ulceration of the skin, whether complicated or not with mercurial erythema, or eczema, or other symptoms of mercurial poisoning, are, SYPHILIS. 603 Acid. nitr., Sulph., Silicea, Ilepar s., Laches., Thuja, Aurum, Carbo v., Acidum fluor., and also Aconitum and Belladonna, chiefly as intermediate remedies when there is excessive febrile irritation. The treatment of phagedenic ulcerations, such as occur in the advanced stages of syphilis, will chiefly consist in the employment of the same remedies as those we have named as the most suitable for primary phagedenic sores. When secondary symptoms exhibit themselves, especially in the form of venereal whitlow, with formation of a very offensive matter under the nails, and exfoliation of the latter, Mercuriuw, Carbo v., and Silicea, are the most useful medicaments. (See WHITLOW.) And when rhagades, or ragged ulcerated fissures, are the more prominent features of the affection, the medicines to be employed are, Merc., Sulph., ycopod., Acid. nitr., IHepar s., Calc., Agnus c., and Graphites. Syphilis in Infants. The venereal poison is not unfrequently communicated to the foetus in utero through the medium of the blood of the mother. The child is also said occasionally to contract the disease at the time of birth from the direct application of the virus of a chancre with which the mother happens to be affected. In the former instance the child is born with the disease. The symptoms of syphilis in the newborn child, or soon after birth, are copper-colored blotches, and scaly eruption over the greater portion of the body, pustules and superficial ulcerations about the anus and nates, and sometimes on the organs of generation, rhagades, warts, hard and soft swellings about the head; also ulcerations and fissures at the corners of the mouth, and in the lining membrane of the fauces, and in some instances on the eyelids. In addition to these symptoms there is often an obstruction of the nostrils with a thick, yellow secretion, so that the child cannot breathe freely; the cuticle peels off extensively; the child becomes excessively emaciated, and if not speedily relieved, it becomes hectic and soon perishes. THERAPEUTICS. The disease has been found to yield readily to Mercurius v. 6; but the homceopathic practitioner is often prevented from having recourse to this remedy by discovering unequivocal indications that the child has previously been subjected to a course of some mercurial prepara 604 URINARY AND GENITAL ORGANS. tions, under allopathic treatment. Under such circumstances it is generally requisite, particularly when the mouth, gums, and throat are severely affected, to prescribe Hepar s. or Acidum nitr. When the mischief done is more extensive, and the hard as well as the soft parts have become implicated, Aurum may be prescribed in the first place, and subsequently Hepar s. and Acid. nitr. in alternation. Should there be great difficulty in. swallowing, Belladonna will generally afford relief, should Acid. nitr. fail to do so. If the mercurial affection does not form a prominent feature, as is frequently the case when the preparation employed has been Calomel in comparatively small doses, we may then administer either Merc. sol. or Merc. corros. at the sixth or twelfth potency, one globule daily or every other day, for four to six days, carefully watching the effect produced, and discontinuing the medicine as soon as we perceive traces of its action on the local symptoms or on the system generally. When the child exhibits great sensibility to external impressions, or when it is frequently seized with spasms or tremors, is very restless and sleepless, and averse to take nourishment, the extremities being at the same time cold, the countenance earth-like, and the nose pointed; when, moreover, there is a lingering, debilitating fever, with excessive thirst, and small, hard, accelerated pulse, China should be prescribed. After the employment of China, Ferrum has been found beneficial, when administered at a low potency. In other cases Acid. phosph. will claim a preference to Ferrum, particularly if the tendency to colliquative sweats does not subside under the employment of China. Sulph., Silicea, and also Calcarea, Lycopodium, and Zachesis are also deserving of notice in such circumstances. If the eyes and eyelids are principally affected, or subsequently become so, iMere. corros. should form the principal remedy, unless Mercury in some form or other has already been used, in which case one or more of the following must be selected; Bella., Acid. nitr., IIepar s., Sulphur, Calc., Aurum, Graphites, Thuja, Cannabis (see OPHTHALMIA). Against affections of the periosteum, nodes or other diseases of the bones, Assafctida is one of the most useful medicaments; and the next in importance are perhaps Mezereum and Acidum phosph.; but Silicea, Salph., and Calcarea must PARAPHIMOSIS. 605 also be borne in mind. (See DISEASES OF THE BONES, and SECONDARY SYMPTOMS.) When phagedenic sores appear on the genital organs or other parts of the body: Lachesis, Arsenicum, Silicea, or Jfezereum, &c., will be required. (See PRIMARY SORES.) The mother or nurse of the affected child should simultaneously be placed under treatment. It is by some thought sufficient to operate on the child through the milk of the nurse, but we are in favor of the preceding plan, with the observance of due caution in the exhibition of medicine to the child. PHIMOSIS. PiMmosis is understood to signify that contracted state of the extremity of the prepuce which prevents its being retracted,so as to expose the glans penis. It is most commonly produced by inflammation and swelling, or thickening of the prepuce. Sometimes it occurs as a congenital affection. The treatment must be conducted according to the nature of the exciting cause. If friction, or any other mechanical injury has given rise to it, Arnica should be employed. In other cases, originating in a similar cause, Calendula officin., ]?hus, or Pulsatilla may be required. If from syphilis,.Mercurius, Acid. nitr., and Thuja chiefly. Division of the prepuce may sometimes be rendered necessary in syphilitic phimosis, when the escape of the pus is entirely prevented by the extent and severity of the inflammatory swelling. When it proceeds from uncleanliness, Aconitum may first be prescribed, if there be much inflammation, and then iMercurius. Tepid water should at the same time be injected between the prepuce and glans by means of a small syringe. Should the prepuce present a puffy or bladder-like appearance, Rhus may be employed with advantage. Circumcision is generally employed in surgical practice against congenital phimosis. When phimosis arises from the irritation caused by excrescences, Thuja and Acid. nitr. must be resorted to. (See SYcosis.) PARAPHIMOSIS. What is denominated paraphimosis is that state of the prepuce in which it is drawn behind the corona glandis, and 606 URINARY AND GENITAL ORGANS. is incapable of being again brought forward. In young subjects it is rarely attended with serious results, but when it takes place in adults, the prepuce often becomes intensely inflamed and ulcerated, and the glans penis destroyed by mortification. In recent cases, the reduction is often affected by compressing the glans, and simultaneously drawing the prepuce forward. When requisite, the process may be facilitated by previously immersing the penis in cold water, or applying it to the part. In more advanced cases, when the prepuce is considerably swollen, it will be necessary to administer a dose or two of Aconitum, and sometimes Mercurius, in order to subdue the inflammation, before the parts can be handled. Warm fomentations are also useful. The division of the stricture is necessary if all other means fail. When suppuration ensues, either prior or subsequent to the reduction, Mercurius, Hepar s., and Capsicum have been recommended. And when induration remains, lachesis. Should mortification threaten, the employment of Arsenicum or Zachesis may avert its development. HERPES PREPUTIALIS. HERPES PREPUTIALIS. This disease is occasionally confounded with syphilis, from the close resemblance which it sometimes bears to that affection. It consists of an eruption of vesicles which appears on various parts of the body, and not unfrequently on the penis, especially at the prepuce, and has therefore received the appellation of Herpes preputialis. When the foreskin is the seat of the disorder, a sensation of heat and itching is ascertained on the outer or inner, or even on both surfaces of the said part, and in the space of a day or two one or more small patches of a vivid red color make their appearance, on each of which five or six small globular vesicles arise, containing a serous and transparent fluid. The heat and itching now increase, and on the third or fourth day the fluid grows turbid, and is converted into pus. The vesicles then burst, and the discharged fluid dries and forms small, thin, scaly incrustations. When the eruptions break out on the inner surface of the prepuce, the epithelium becomes detached after the rupture of the vesicles, and HFRPES PREPUTIALIS. 607 exposes the inflamed vascular rete of the chorion. It is the superficial sore thus produced which is sometimes mistaken for a primary venereal ulcer. The absence of the raised or of the indurated edges, and of the small, gray-colored secretion, covering the base of the venereal sores, forms the leading determination. In the early stages of herpes preputialis, the disease is distinguished by the evolution of a cluster of small vesicles. When the vesicles are developed on the outer surface of the prepuce, the fluid they contain is either re-absorbed, or desiccates on the fifth or sixth day; in the latter event it is altered into minute dry scabs, which, provided the parts have not been irritated by friction, are thrown off about the eighth or tenth day, and the cure is then, for the time being, complete. It is not a contagious complaint, but is prone to occur repeatedly in the same individual. The friction of the clothes during prolonged exercise, and the contact of deranged vaginal secretions, aggravate and often develop the affection in those who are predisposed to it. The use of mercurial preparations in a deranged state of the digestive functions, and the previous occurrence of one or more syphilitic attacks, have all been considered as predisposing causes. THERAPEUTICS. In most cases the disease may be left to itself, particularly when the vesicles are situated on the exterior of the foreskin. But it is always necessary to protect the part from friction, as the cure is invariably delayed when the drying up of the vesicles is retarded. When the inner surface of the prepuce forms the seat of the disease, the vesicles or excoriations ought to be protected by the introduction of a small portion of lint between the glans penis and the prepuce. Cold water may also be freely employed. When the affection proves unusually obstinate, or is reproduced again and again, Acid. phosph., Aurum, Hepar s., and Nitrum have been strongly recommended. The state of the digestion ought to be attended to at the same time. When a chronic inflammation of the urethra exists simultaneously, Canth., Petrol., Petroselinum, Duc., Sulph., Calc., Silic., Sep., or Lycopod. will chiefly claim attention. SYCOSIS. By the above term we allude to the disease described by 608 URINARY AND GENITAL ORGANS. Hahnemann* as having occurred very extensively during the last war, from 1809 to 1814, and which manifests itself externally in the form of excrescences on the genital organs a few days, or even weeks, after impure connection. " These excrescences are occasionally dry, resembling warts, but much more frequently soft, spongy, secreting a fetid fluid, bleeding easily, and similar to cockscombs or cauliflowers; they appear in men upon the glans penis, at the margin and the inner surface of the prepuce, also on the scrotum, perineum and nates; in women, on the vulva and adjacent. parts. They are often accompanied by a gonorrhoeal discharge, which is thick and purulent from the commencement, with little pain during urination, but with hard tumefaction of the penis, or lympathic swellings on the dorsum penis, very sensitive to the touch. The disease was considered by the majority of allopathic practitioners as simply a symptom or modification of syphilis, and was accordingly treated by them with Mfercury, and by violent external application, cautery, excision, ligatures, &c. The immediate and natural sequel of this method was, that, generally, the condylomata reappeared after the expiration of a longer or shorter time, and were again subjected to the same treatment; or if the means employed succeeded in destroying them, the sycosis, deprived of its local or vicarious symptoms, showed itself in another and more aggravated manner, in the form of secondary symptoms; the external means employed, and the Mlercury (which is not appropriate to the disease), given internally, being inadequate to destroy, in the slightest degree, the sycosic miasm with which the systenm was impregnated. In addition to the injurious constitutional disturbance produced by the Mercury, particularly when given in large doses, and in the shape of the most acrid and irritating preparations-analogous excrescences broke out upon other parts of the body; in some cases consisting of spongy elevations, whitish, sensible, and flat, having their seat in the mouth, on the lips, tongue, and fauces; in others, large, prominent, brownish-looking tubercles, situated in the armpits, on the neck and scalp, &c.; or, again, other symptoms were developed, of which I need only mention here, retraction of the flexor tendons, particularly those of the fingers." * See Hahnemann's Chronic Diseases, Vol. i. SYCOSIS. 609 THERAPEUTICS. Hahnemann was the first who recommended and employed Thuja occidentalis in sycosis. When the disease is in its primary form, accompanied or not by a gonorrhceal discharge, and not complicated with syphilis, or occurring in a strumous habit, a few drops of a low potency, or a few globules of the third or sixth dilution, speedily succeed in effecting a radical cure; in obstinate cases, in addition to internal administration, the condylomata may be touched daily with the diluted tincture of 7huja. In some cases the cure is materially facilitated by the use of Acid. nitricum in alternation with 2~uja." Where there is a complication of syphilis with sycosis, Mercurius and Sulphur in alternation, at low potencies (third trituration), are very efficacious. Against the secondary symptoms of sycosis, Thuja and Acidum nitricum are still to be held as the most important remedies; but when they are found inadequate to destroy the disease, either in consequence of complications with secondary syphilis, or some other dyscrasia, Sulphur, Ac. phosph., Euphrrasia, Cinnab., Sabina, StaphJ., or Lycopodium. Of these, Sulphur has commonly been found the most appropriate to administer when the constitutional symptoms, such as sore throat, with enlargement of the tonsils and ulceration, hoarseness, stains on the skin, scaly spots, or eruptions assuming the character of psoriasis or lepra, have undergone little or no improvement under the employment of Thuja and Acid. nitr.; it will, further, claim a preference when there is, at the same time, general derangement of the system, and especially when the patient is affected with symptoms of abdominal plethora, with hemorrhoids, and constipation; or when shooting pains are experienced in the joints, and the flexor tendons of the fingers are in a state of contraction; tongue dry, red, rough, and fissured, lips much tumefied. Lycopodium may follow Sulphur with advantage, when there is superficial, white ulceration of the tonsils; and the tongue is fissured, or is, together with the inner surface of the lips * The aid of Acid. nitric, is almost indispensable in all cases in which the patient has formerly been placed under a course of Mercury during one or more syphilitic attacks, or some other affection. 39 610 URIINARY AND GENITAL ORGANS. and the fauces, covered with a scaly, herpetic-looking eruption. Staphysagria, when the gums are much affected, somewhat ulcerated, swollen, soft, or spongy, and the glans penis covered with soft, moist excrescences. Sabina has been of great service when the condylomata were large, moist, and painful, even when not touched. Acid. ph2osphoricum will deserve attention when the sycosic excrescences are of long standing, or when the patient has previously been treated with Mercury in large doses, and Acid. nitr., Thuja, Sulphur, and Staphysagria, have either failed to do good, or have only effected partial improvement. Cinnabar has been strongly recommended as a valuable remedy in inveterate or secondary sycosis. Hahnemann considered Mercury as inappropriate to sycosis, and as peculiarly hurtful when given in over-doses. When administered in the small doses employed by homoeopathists, it appears to be of great efficacy in some obstinate cases. A complication with syphilis, or secondary symptoms, in the form of enlargement of the tongue, swelling and ulceration of the tonsils (provided these latter symptoms have not arisen from the abuse of Mercury), condylomata, &c., will justify us in anticipating a beneficial action from the use of Cinnabar. Sometimes the sore throat arising from sycosis may bear so close a resemblance to that of secondary syphilis, that it will be difficult to found a diagnosis thereupon; but the history of the commencement of the disorder, along with the existence of tubercular or wart-like excrescences in the vicinity of the anus, genital organs, or other parts of the body, will enable us to discriminate the sycosic from the syphilitic origin. In sycosic buboes, Thuja and Acid. nitricum are the principal remedies, but cases may often occur in which Staphysagria, Sulphur, or Mercurius will be required. (See BuBO.) We shall conclude this portion of the work by giving a short statement of Dr. Goullon's mode of treating Syphilis,* together with an extract from the more extensive and interesting observations of Dr. Attomyr,- on the treatment of Venereal Diseases. * Allg. Hom. Zeit., No. 17, 30ster Band, p. 258. f See Ruoff's Repertorium, by A. H. Okie., M.D., New York. Price $150. TREATMENT OF VENEREAL DISEASES. 611 Dr. Goullon employed Mercurius solub. and Mere. sublim. corros. chiefly, in the treatment of chancres in general. The former in the dose of A1, - of a grain, twice a day; and the latter, to which he gave the preference, as follows: Ic Mere. corros. gr. ss--j; Aq. unc. viij; Spir. vin. q. s. A table-spoonful morning and evening (diminishing the quantity when vomiting followed the first dose or two). When the sores were foul and confluent, attended with fetid discharge, also local application of the same remedy. The greater the degree of improvement effected, the less frequently was the medicine ordered to be taken. In the majority of cases scarcely gr. ij were necessary to establish a cure without risk of a relapse or the occurrence of secondary symptoms. Where syphilis and scabies were encountered in the same subject, the cure of the former was commenced first. The worst complication was found to be secondary syphilis in the form of eruptions, &c., and scrofula. Baths of lerc. corros. (3 j-ij) produced striking benefit here; but when the patients had previously undergone a course of Mercury, the medicament which, more frequently than any other, though not always, did the most good, was Acid. nitr. in repeated doses. In sore throat, Lycopodium; in ostitis, or exostitis, Silicea; and in tetters and herpetic sores, Sarsaparilla (ptisan) proved the most serviceable. Dr. Attomyr observed that " With respect to the treatment of the various forms of the venereal disease, we have in general nothing farther to add, except that in this disease, as in all others, the homceopathic law of cure by similarity of symptoms is applicable, and here too proves its validity. " Before entering specially upon the homceopathic treatment of the venereal disease, it will be necessary to premise some few remarks, which deserve consideration when viewed in reference to my therapeutical results. "Syphilitic patients, with very few exceptions, are young unmarried men, who either board at the hotels or sit at table with their relations, or probably superiors. In either case it is unfortunate for the observance of the homceopathic diet, and indeed much worse here than it would have been in Germany or any other Austrian province, for in Hungary far 612 URINARY AND GENITAL ORGANS. greater quantities of condiments and acids are used with food than in other places. To this must be added the fact that patients conceal their disorders, and in order not to excite suspicion, dare not venture on the slightest aberration from their accustomed diet. In consequence of these uncertain dietetic circumstances, I resolved, in treating such patients, to administer larger doses than usual. "I am still of the opinion, that the lower dilutions recall reaction quicker, but that their effects are less intensive and permanent than the higher. Four grains of calomel in the space of a few hours operate violently, and excite diarrhoea, while the same four grains, if taken in minute portions, result in an indisposition, which continues several days, and in a more intense commotion of the organism. I moreover concluded from these premises that the larger doses could be repeated more frequently, which would seem essential on account of the necessarily frequent dietetical errors. Within the period of two years I treated 156 patients laboring under the venereal disease. Every physician knows how it is with office practice, how difficult to learn anything or obtain any certain experience in this manner. Generally one half of this class of patients stay away, so that it is impossible for us to decide with certainty upon the termination of their disorders. The one remains away because the effects of the treatment did not fulfil his anticipations, the other (and among syphilitic patients the majority) because he is approaching convalescence, and is desirous of avoiding the burdensome thanksgiving for his cure. This last occurred so frequently to me that during the treatment of an interesting case, I was always fearful, as I was led to expect that as the cure progressed, my patient would remain away, and I be unable to arrive at any certainty with regard to the termination of the case. " I requested a patient with eleven chancres (seven of which, of the size of a lupine-seed, were situated on the scrotum), after all were healed, but two of them still presented cicatricular depressions, to return in eight days, and let me see if the two scars had also disappeared. My patient, however, did not return, notwithstanding I had clearly given him to understand that I had no reference to his returning thanlks, but merely as a subject of scientific interest. This plan was TREATMENT OF VENEREAL DISEASES. 613 so often adopted towards my patients, that they ironically termed me the 'gratis Doctor,' for which I in return, during the last three months of my residence in Presburg, punished them very sensibly, although I am sorry that punishment in many instances fell upon those who were innocent. So it happened that of the 156 patients treated, I cannot cite more than 84 who persevered until perfectly cured, and most of these, at my request, returned, and were examined by me fourteen days after their convalescence. "Were cured of Chancres.. 34 Gonorrhoea..24 Gleet..... 9 Balano-blenorrhoea.. 2 Bubo..... 10 Hernia humoralis.. 2 Nodes and eruptions.. 2 " I have observed the following five varieties of chancre: "First form. The edges more or less jagged, elevated, slightly painful, but sensitive when rubbed by the linen, with a copper-colored circumference. The base of the sore is indurated, lard-like, the ichor adheres so firmly to it, that it cannot be removed by washing. The ichor is of a light yellow color, viscid, glutinous, resembling pus, sometimes acrid, offensive; it makes spots on the linen as if from melted tallow. The sore extends far more in depth than in breadth. This form appears on all parts of the glans, and also on the prepuce, but more frequently on the posterior part of the glans, near its junction with the prepuce. "Second form. The sores are superficial, not only do not extend in depth, but are perceptibly elevated above the surface. The edges are never jagged, always sharply circumscribed, painless. The sore looks clean, of a flesh red color, almost spongy; it is never necessary to clean it, as the ichor does not adhere. The ichor is somewhat thinner than in the first form, usually more copious and mixed with blood. This form heals sooner than the first, appears almost exclusively on the prepuce, and there are always several sores present at the same time. "Third form. The sores of the second form gradually 614 URINARY AND GENITAL ORGANS. become elevated so much above the surface of the prepuce, that they resemble more a horizontal section of a wart than an ulcer. This form discharges very profusely. The ichor is more offensive than in the two preceding forms, but still not so bad as it is in those which follow. It is unusual for all the chancres of the second form to become converted at the same time into those of the third, therefore these two forms are usually coexistent. This variety frequently heals very quickly. I have never seen true condylomatous forms of disease arise from this. In my case-book I have given the compound name of ' chancre wart' to this form, which term, on account of its brevity, I will still retain. " Fourth form. The corona of the glans is almost one ulcerated surface. This frequently extends to the posterior part of the glans; occasionally, at the same time, to the prepuce also. The sore is quite superficial, here and there lard-like, but the greater part red and thinly coated with matter, which can be readily washed off. The ichor, which is very profuse, is somewhat less consistent in this than in the varieties already described, and is of a very fetid odor, which apparently depends upon the simultaneously increased secretion of smegma. The sore appears as if the skin had been torn off. This form either heals as such by contracting from the edges towards particular points, forming several chancres, which are nearly separated or only united by linear excoriations; or the above described lard-like spots extend more in depth, and chancres of the first form appear. This fourth variety of chancre has a tendency to appear in company with gonorrhoea. " Fifth form. A chancre which in its incipient state has the appearance of the first form, in a few days becomes covered with a scab which presents the appearance of a psoric sore. The scab absorbs the fluid secreted beneath it, and thus becomes thicker and does not fall off until the sore beneath it has healed. This variety appears either on the common integument of the penis or directly on the verge of the prepuce, which becomes swollen, looks as if excoriated, burns severely while and after urinating, when walking is disturbed by the pressure of the linen, to which it slightly adheres. This variety I term the ' psoric chancre,' and conjecture that it arises from TREATMENT OF VENEREAL DISEASES. 615 a complication of syphilis and psora, which conjecture is strengthened not only by the appearance of the sore, but also by the violent pruritus and the favorable results attending the administration of Sulphur. This form generally appears simultaneous with one of the varieties already described. In the treatment of these different forms of chancre, I have by degrees been obliged to resort to the following eleven remedies: Mercurius sol'bilis, Merc. dulcis, Merc. sublimatas corrosivus, Acidum nitric., Tujia, Hepar sulphur., Corallica rubra, Acid. phosphor., Sulphur, Causticumn, Staphysagria. In the first variety of chancre, Mere. solub. is the chief remedy, it is not, however, adapted to half the cases. Thuja comes next to the quicksilver in this variety. The patient usually took a few doses of AMercur., then a few doses of Thuja, and when its beneficial influence appeared to cease, the iMercury was resumed. In addition to these, I administered Mlere. dulcis, Sablim. corrosiv. and Caasticum in several obstinate cases, and I believe I have observed considerable improvement in this form after each of these remedies. In the second form Acidum nitric, is the chief remedy. When this form is purely pronounced without complication, particularly with the third form, the Nitric acid acts very promptly, and in twenty days, at the extent, the disease is cured. I have, however, cured, or evidently assisted the cure of several of these cases with Mercur. and Thluja. In the third form Thuja appears preferable to Acid nitric., although the latter as well as iMlercurius solub. is a very effectual remedy in this variety. In one case, Acid phosph. acted very strikingly. Stacphysagria in another in the same prompt manner. In the fourth form, preference must be given to Corallia rubra. Although this remedy is capable of curing a chancre of this variety in fourteen, or at the extent, eighteen days, yet still it does not appear to be able to prevent this form from becoming converted into the first, by which the treatment is considerably prolonged. Nitric acid may be ranked with Corallia in the treatment of this form, and in several cases in which rapid improvement did not succeed the administration of Corallia; and where the pruritus was very vehement, I gave Sulphur, which cured the disease in toto. 616 URINARY AND GENITAL ORGANS. " In the fifth form, which was the most rare, Sulphur was the chief remedy. Hepar sulphur. operated favorably in this form, when complication with bubo existed. "At first I gave Mlerc. solub. in doses of a drop of the fourth dilution, and when this was all gone I resorted to the fifth. At the beginning of the treatment I repeated the medicine every six or seven days, and afterwards every three or four days. I have, however, cured several chancres with X000 and 4000. Nitric acid and Thuja were given in similar doses, but also with effect in the thirtieth dilution. Of Corallia I gave about a grain of the third trituration. Sulphur and the liver of sulphur I always administered in the X000, also Causticun, Staphysagria and Phosphoric acid, and the two other preparations of Mfercury in the third potence. One month was about the average time required to cure a chancre, several healed in fourteen days, in which cases I must remark that these patients were individuals who were able to follow strictly the homceopathic dietetic regulations. In several cases, six weeks or more were consumed in the cure of the chancres, for which the patients themselves were in fault, as several confessed to me that they were not able to refrain from coition during the treatment. "The articles of diet which I forbade were" 1. Acids: as vinegar and lemon-juice. " 2. Spirituous drinks: wine, whiskey, beer, liquor, and all alcoholic drinks; beer I would have allowed, had it not been adulterated with bitter plants. " 3. Spices, or rather medicines which have crept from the apothecary's shop into the kitchen, as coffee, tea, pepper, cinnamon, vanilla, the cayenne pepper (Capsicum annum), which is used in Hungary, cloves, caraway, and aniseed. " I also advised my patients to avoid the use of pomatum, medicated dentifrice, and perfumery of every description. Smoking I did not forbid, because no one would have obeyed me in this particular. " One of the most important directions during the treatment of chancre relates to mental and particularly bodily quietude. The patient should go out as little as possible, walk very slowly, not wear tight pantaloons, or remain long standing, and on no account drive or take horse exercise. My attention TREATMENT OF VENEREAL DISEASES. 617 was directed to this latter circumstance several years ago, by the experienced Dr. Mueller, attached to the medical staff in Pesth. As I treated but few venereal patients after that period, this circumstance was forgotten. In Presburg, I treated a young man more than seven weeks for a large deep chancre, which did not lose at all its lard-like base, and although it did not extend either in breadth or depth, it evinced no disposition to heal. The patient was too well acquainted with the superiority of homoeopathy to adopt the advice of trying allopathic treatment. While we were discussing the probable cause which impeded the cure, my patient inquired whether it was not probable that daily horse exercise could be an injury; Dr. Mueller's advice now struck me. I forbade riding on horseback, and in the course of eleven days the chancre was healed, the patient having remained in his room in his drawers, generally reclining upon the sofa. Corporeal rest is decidedly the best prophylactic against the formation of buboes. I must mention still another serious obstacle which greatly impedes the cure of all venereal diseases. I refer to the excessive anxiety of those youths who are infected for the first time; they fancy that they see themselves walking about without their olfactory organs, and covered with eruptions and sores. " At first I applied charpie to the sores; but as this became deranged and formed lumps, I preferred fine, clean, washed linen (not new). I subsequently abandoned this also, as every foreign body adheres to the sore as soon as it commences healing and discharging, and on removing, irritates the chancre, and in general incommodes more than the secretions of the sore. " I have treated patients with several chancres conjoined with phimosis, without having seen the sores more than once, as the phimosis occurred a few days afterwards and continued to the conclusion of the treatment. When the prepuce could be retracted, the chancres were either completely cured or very nearly so. " When washing the sores, care must be taken not to press too violently upon them. Many patients gave themselves much trouble in endeavoring to wash off the lard-like matter forming the base of the chancre. Patients should be informed 618 URINARY AND GENITAL ORGANS. that this is futile and injurious. It is entirely impossible to clean the base of the sore, as this must be removed by the process of suppuration, produced by the action of the appropriate remedy. Chancres of the first form generally discharge copiously, and for a long time, so that the patient's linen appears as much soiled as in gonorrhcea. When I perceive this increased discharge make its appearance, I always continue the remedy which produced it, because this increased suppuration of the sore is the most natural remedy to cleanse and heal it. The period of increased discharge frequently occupies two-thirds of the whole time employed in the cure. I have, however, frequently seen perfectly healthy sores, which were much diminished in size and superficial, remain in statu quo without healing completely. This apparently depends upon the conduct of the patient, on whom the cure has advanced thus far. "If doubt arises respecting the nature of sores on the genitals, whether they are really chancres or not, it is advisable to wait several days before administering our remedy. If in the course of six or eight days the sores are not healed, but have become larger, deeper, and the base lard-like, there can then be no doubt; the patient may talk as much as he pleases about the fidelity of his sweetheart. " In concluding this subject I have still to remark, that in the cases of three patients afflicted with chancres I observed vermin, which are not uncommon in syphilis, and by us termed ' Filzliuse' (Pediculus pubis). One of these patients, who was somewhat of a scrofulous diathesis, was troubled with them in two instances. I need scarcely remark that these patients observed the utmost cleanliness; and as I do not at all consider these vermin as the result of filthiness, it is not improbable that they are produced per generationem oequivocam, in the same manner as in the itch, either by the discharge from the chancre, or in transpiration of the patient, and consequently may be ranked as the product of the venereal disease. S BUBOES. Swelling of the inguinal glands, consequent upon syphilis, are more dreaded by patients than any other form of this disease. It is well known how, under allopathic treatment, they are plastered, cauterized, and incised aQ-ain TREATMENT OF VENEREAL DISEASES. 619 and again. I have treated eight patients with venereal buboes, without the necessity of one of them being confined to bed for a single day. A day or two before the spontaneous rupture of the swelling, the patient experienced a slight tensive pain when walking, but not any other inconvenience either before or after that circumstance occurred. The buboes usually broke while patients were walking, and had they not experienced the sensation produced by the moisture, they would not have been aware of its occurrence. I have witnessed neither sinuses, fistulous openings, callous edges, nor partial remaining indurations, &c., in any of these cases, although I never made use of cataplasms to prevent induration, leeches for inflammation, or of the knife or caustics in opening them. "There is no doubt that buboes, which appear simultaneously with chancres, or immediately after their suppression with external remedies, partake of the venereal character. Scrofulous glandular affections are usually readily recognisable from the general diathesis, and the disorders of the glands in other parts of the body which are commonly present. But there are also buboes which appear sooner or later after coition without any other symptom of venereal infection. Whether these glandular swellings are to be considered as venereal has not yet been determined by adequate experience. I have seen two such cases. The one an arthritic man, aged thirtyeight, the other a young man of three-and-twenty. Both cases were preceded by frequent coition, and in the case of the first individual it was inordinate. In the first case the bubo, which was confined to one side, was cured by resolution under the use of Sulphur and Nitric acid, the second by suppuration by Nitric acid alone. In the latter case there were two buboes of the size of a hen's egg, one on each side. " Buboes are treated homceopathically by the same remedy that is indicated for the particular variety of chancre which they accompany. The medicament that cures the chancre frequently operates so powerfully upon the bubo, that the latter suppurates, and heals before the chancre is completely cured, so that in this case the bubo does not alter the peculiar treatment adapted to the chancre. Sometimes, however, the bubo remains after the chancre has healed, and in this parti TREATMENT OF VENEREAL DISEASES. 621 "In the case of a patient with two large condylomatous excrescences on the anus, who had been previously treated by caustics, neither Thuja, Nitric acid, Acid.phosph., Lycopod., Sulphur, Psorin, nor Sycosin were of any benefit. Staphysagria X00, repeated every five days, removed the disease almost entirely in the course of two weeks, so that I gave the patient a few doses more of the latter remedy, in hopes that the disease would be completely overcome in a short time; the patient, however, did not return; I therefore cannot say how the case terminated, although it is very probable that the patient was cured. "The condylomatous case, which I have mentioned as cured, was that of a patient with three condylomatous excrescences, which had been cauterized, but were reproduced. I gave him Thuja X10, seven days after Sulphur X, seven days later Acid. nitric. 4, gutt. una, for two successive days, all without effect. The Thuja was now repeated, but in the fourth dilution, a drop every third day, after which the excrescences were diminished one half in size. The repetition of Thuja of the fourth dilution entirely cured the disease. " Throughout this work I have avoided the recital of cases, for in this disease one case very much resembles all of the others. In sycosis I have made an exception in order to be able to introduce the remark that Thuja, which in this case was the proper curative when first administered, was not attended with any success, and did not prove beneficial until administered in a lower dilution after two other remedies had been given. I am perfectly willing that this favorable result should be ascribed to the lower dilution, but must remark that in at least ten cases of intermittent fever, in which Ipecacuanac proved fruitless, and several other remedies given subsequent to it likewise proved inefficient, that Ipecac., then administered in the same dilution and dose, was attended with the most favorable result. " GONORRnHCA. This form of the venereal disease is of all others the most troublesome, as well for the patient as his physician. To the patient, as it is the cause of much pain, sleepless nights, fever and other analogous symptoms, which may result in inflammation and induration of the testicles, stricture of the urethra, &c., either owing to the misconduct 622 URINARY AND GENITAL ORGANS. of the patient or to the preposterous and violent allopathic treatment. Gonorrhcea is a troublesome disease to the physician, owing to its tendency to become chronic, and in the form of a gleet to continue long and obstinately. It appears to be the general character of diseases of mucous membranes to run their course sluggishly. We frequently see catarrhs, in themselves unimportant, continue for several weeks. This is also the case with various mucous diseases of the nose, ear, vagina, &c., which are rendered chronic as soon as an increased mucous secretion appears. "The usual time required to cure an acute gonorrhoea was one month. Several were cured in fourteen days; a few cases degenerated into gleet. "I experienced the best effect in the treatment of this disease from the exhibition of Cannabis in the fourth dilution, in drop doses, which were repeated at intervals of five or six days. I occasionally repeated the remedy for two or three days in succession, and then waited seven or eight days. " Pulsatilla was given with effect also in drop doses of the fourth dilution, where general corporeal agitation, very diminished appetite, evening chill, increased thirst, &c., were present. In three or four days, this febrile state was usually allayed, and I then again continued the Cannabis. " A few globules of the 30th dilution of Cantharides were always effectual in very painful erections, violent burning and strangury. In one case hTematuria supervened, which was not relieved by Cantharides but by Mezereum. " MLercur. solub. 4, gutt. una, effected a rapid cure in a case of gonorrhcea, attended with a greenish discharge. In this case, however, several sores were present, which indicated the application of Miercury. The gonorrhcea was cured before the chancres. "At first, before I had effectually tried the efficacy of Cannabis, I tried Blenorrlin, in doses of several globules of the thirtieth dilution.. A gonorrhea in which Capaiva proved inefficient, was cured in two weeks by two doses of Blenorrhin. In several other cases, this remedy effected considerable improvement, although it did not produce a complete cure. But as Cannabis, with an intercurrent dose of Pulsatilla, Cantharides, or in cases of very frequent TREATMENT OF VENEREAL DISEASES. 623 urination, Petroselinum, acted very favorably in a majority of cases, I made no farther trials with jBlenorrhin in acute gonorrhoea, although I made use of it in gleet. " GLEET. Nine cases of this disease were cured with Blenorrhin 30th, Sulphur 30th, and Cannabis 4th, gutt. una. I repeated Cannabis every five, and the other two remedies every eight days. I am unable to mention any particular indications for the employment of any of these remedies. Generally Sulphur, given at first, produced considerable improvement, diminished the discharge perceptibly, but excited slight burning in the urethra, after which I usually gave Cannabis with effect. I observed this frequently. I have, however, perfectly cured painless gleets with Cannabis aided by Sulphur or Blenorrhin. " As regards the dietetic treatment in gonorrhcea, all violent exercise must be avoided. If the testicles are sympathetically affected, the patient must wear a suspensory bandage, or at least support the testicles with a handkerchief. Beer should not be taken during the existence of acute or chronic gonorrhoea. " I saw discharges, unattended with pain, reproduced in several patients who indulged freely in wine immediately after their gonorrhoeas had been cured; it, however, soon disappeared; the very severe burning can be much diminished by the patient's drinking water very freely, by which means the urine is increased in quantity and rendered less acrid. This innocent palliative produces great relief to the patient, and should therefore never be neglected. " INFLAMMATION OF THE TESTICLES. I treated but two cases. One was in company with a gonorrhoea, or rather gonorrhcea conjoined with swelled testicle. The patient being afflicted with gonorrhoea, went out a hunting in cold damp weather, and returned with violent pain in the testes. The disease increased during the night, and both testicles were swollen, hard, not bearing the slightest touch, the scrotum red and tense, some fever which continued until the evening of the succeeding day. There was scarcely any discharge from the urethra. Two doses of Clematis, 12th dilution, three globules repeated every three days, cured the disease, after which the gonorrhceal discharge re-appeared. Swelling 624 URINARY AND GENITAL ORGANS. of the epididymis of one of the testes, which still remained, was removed by Aurum dissolved in water. " The second case was a relapse, which had previously been subjected to allopathic treatment. It was relieved by China IV000 and Aurum IVOOY. China was administered three times, Aurum twice. "The patient should remain in bed and have the testes properly supported. " GONORRH(EA GLANDIS. Incorrectly so termed. It could with more propriety be called inflammation of the glans penis. I treated two cases. One case was conjoined with gleet. The glans was very red and swollen, small fissures appeared on various parts of it, and in a few days, a very offensive mucous secretion succeeded, which increased very much in a short time, and affected the prepuce also. Corallia 3, one grain repeated in four days, cured the balano-blenorrhcea, and Cannabis and Sulphkr the gleet. The second case was connected with chancre, was not so violent, and was cured by the use of AMercury. "A few years ago I cured several of these cases with Thuja X000. " NODES. The patient had been afflicted three years before with a chancre which was cauterized. After taking a violent cold from exposure to moisture, the patient had a gouty attack. It was treated without effect; a depot formed on the tibia, which was attended with such violent boring and rending pains, particularly at night, that he was deprived of all nocturnal rest, and obliged to quit his bed. He then underwent a course of 'Dzondischer' pills, which rather increased than relieved his malady. After the administration of half a grain of Hepar sulph., Calc. 3d trituration, he was able to sleep several hours in the morning. Two additional doses of IIepar, given at intervals of eight days, removed the pain almost entirely, the patient ate, drank, and slept as in health, though the swelling was not perceptibly diminished; this, however, disappeared entirely on administering three doses of Acid. nitric. x, at intervals of from eight to ten days. " The other patient had two osseous swellings of the size of a pigeon's egg on the head, and an eruption over the whole body, for the relief of which he had taken several TREATMENT OF VENEREAL DISEASES. 625 hundred baths, and as many mercurial pills. The patient was cured after eighteen months' treatment, which was repeatedly interrupted. Of course he took very many homceopathic medicines, so that I am unable to mention the results obtained by any particular one, especially as during the latter period I treated him only by letter. " Complications. " CHANCRE AND BUBO. The treatment of this form of complication has been described under BUBo. " CHANCRE AND GONORRHIEA. If the gonorrhoea is very painful, the treatment of the chancre, which otherwise is preferable, must be suspended, and Cantharides, or some other appropriate remedy, be exhibited. This also holds good if profuse and continued heematuria supervenes. " CHANCRE AND CONDYLOMATA. In this case, the treatment can be united, as Thuja and NTitric acid are particularly indicated in both forms. "GONORRHIEA AND HERNIA HUMORALIS. Here of course the latter must be treated without delay. " The other complications are not of importance, and the treatment of them is obvious. "Syphilis secundaria. Secondary Syphilis. "Aurum. Nasal speech, stinking ichor and small pieces of bone discharged from the nose, ulcers on the palate, the tonsils are corroded by ulcers, offensive discharge from the ears, with violent boring pains in them, painful periosteal swelling on the hairy scalp, forearm and tibia, on the head itching nodes, rending pains in the bones of the extremities. " Aurum. INVETERATE SYPHILIS, the nasal, frontal, and superior maxillary bones swollen and reddened, with sticking pains in them, bloody, fetid discharge from the nostrils, the margins of the eyelids reddened at their inner canthi; if the head is not kept warm, headache as if a draught of air passed through it. "Acidum nitric. On the head isolated, humid pustules; the face full of maturated pustules, with broad red margins, which after some days form crusts; on the right ala nasi, a condylomatous protuberance of the size of a bean, covered 40 626 URINARY AND GENITAL ORGANS. with a scab; tonsils red and swollen; there was formerly a raw spot on the anus between the legs: pruriency and humidity of the integuments. "Hlepar sulphuris, /Rhus. " Sepia. INVETERATE SYPHILIS, with ulcers of the glans and prepuce. After Mfercur., Acidum nitric, and Thuja had been given without perceptible improvement. "In the case of a subject who had previously taken much mercury, Thuja, Graphit. and Sepia, were employed. The symptoms were:-copious discharge of pure mucus from the urethra, slight burning when urinating, the bulbous portion of the urethra painful internally, the orifice of the urethra red, swollen, the inner surface of the prepuce red, pain in the region of the bladder, ulceration of the base of the glans, scrotum painful, many nocturnal pollutions, headache, melancholy, inclined to suicide." APPENDIX. (Sypkiis.) Dr. Miiller, after having, in the first instance, had recourse to Mercurius solubilis where Mercury was indicated, and which he considers it to be in by far the greater number of cases of this affection (dose, 1-2 gr. of the 1-3 trituration, dissolved in a drachm of water, five drops twice or thrice a day), with but indifferent success, having frequently found it necessary to resort to Ac. nitr., Aurum, Arg. nitr., Thvj., &c., and even then not always with the most satisfactory results, decided upon administering Mere. prec. rubenr; and was so struck with the beneficial effects which were produced by this preparation, that he employed it in all the subsequent cases, both of chancres and buboes that came under his observation. He prescribed one grain, once or twice a day, for from eight to fourteen days, and found that the sores sometimes increased in size in place of diminishing or otherwise improving during that period; but very soon afterwards the process of healing set in with marvellous rapidity, and continued uninterruptedly until cicatrization was complete, provided the succeeding doses were administered at longer intervals, or the remedy entirely discontinued as soon as the first signs of improvement became manifest. Ulcers of considerable depth and magnitude healed under the use of this preparation in from two to four weeks, without the slightest constitutional disturbance or any considerable sequelse, such as disfiguring cicatrices, or secondary or tertiary symptoms. In one case, in which the Mfere. precip. rzber. failed to produce its usual happy effects, Dr. C. Miiller accomplished a rapid cure by means of Cinnabar. He is of opinion, from the success which attended the use of this latter mercurial preparation in eight cases, that it is capable of acting with even greater rapidity and certainty than the red precipitate, when administered as above described. Hie, therefore, resorts to Cinnabar in indurated and very deep, or in neglected chancres, and employs the red precipitate in all cases of a more ordinary and simple kind. Against chancres on the scrotum and the external surface of the foreskin, or on the body of the penis, Dr. Miller has found Aurum m. the most serviceable remedy. Lastly, he has derived the greatest assistance from Kali hydriad. in pains in the bones, and tophi; and from Mer. bi')od. (bin iodide) in syphilides. Dr. Sommer, of Frankfort, A. 0., whilst corroborating the value of Cinnasbar in the treatment of chancre, particularly when occurring in cachetic subjects, adds that when a bubo remains hard and without fluctuation after the cicatrization of the chancre, he has often succeeded in dispersing it rapidly by means of the internal employment of Hepar s. (1-1000 gr. to 1-400 gr. per dose, once or twice a day.) When the tumor, in place of resolving, suppurates and discharges, he promotes cicatrization by dressing with adhesive plaster; and when the sore becomes stationary, and the process of healing proceeds too slowly, he administers, after the chancre has been thoroughly healed, Silicea 30 every forty-eight hours. By such means he states that he has repeatedly succeeded in accomplishing cicatrization much more speedily than ever he did by the ordinary allopathic mode of treatment. DISEASES OF PARTICULAR ORGANS AND REGIONS, OR OF THE SYSTEM IN GENERAL. GOUT. ARTHRITIS. THIS disease, particularly when it has assumed the chronic form, requires a long and discriminate course of treatment. The chief danger arises from its liability to transfer its seat from the part first attacked to some of the principal internal organs, such as the head or stomach; in such instances, it assumnes a peculiar, critical character. From some peculiar predisposition, gout is often hereditary; until therefore this constitutional tendency is eradicated by a proper mode of treatment, where practicable, it is -useless to expect a permanent cure. DIAGNOSIS. Pains in the joints, with inflammatory or chronic cold swelling, and symptoms of deranged digestion. These signs, however, may only partially declare them-. selves, or be marked by some other chronic malady; indeed there is scarcely any disease of that character with which gout may not be complicated. Prior to the attack, we generally find symptoms of general derangement of the digestive functions, with a slight access of fever: the veins of the feet become swollen, and a sense of numbness, cramps, or twitching is present, with a deficiency of perspiration. When the attack conies on, which most frequently occurs in the evening, or during the night, it is generally attended with a feeling of dislocation in the joints of the feet, and burning or severe scalding pain in the part attacked, more or less intense; after a time these sensations disappear, leaving the part red and tumefied: the fit occurs again at intervals, generally diminishing in intensity; in many instances considerable fever is present. Among the exciting causes of gouLt may be numbered the followinog: a luxurious mode of life; stimulating diet or drinks; a sudden check of perspiration; mental emotions; sedulous application to studious pursuits, and neglect of proper exercise in the open air; and the -use of aperient medicines and tonics. In plethoric habits, the gout shows a 628 DISEASES OF PARTICULAR ORGANS AND REGIONS. considerable inclination to shift its seat to the head, and in dyspeptic individuals to the stomach and intestines. THERAPEUTICS. In general cases of this affection, the principal medicaments are Aconite, Pulsatilla, Nux vomica, and Bryonia, etc. ACONITE, in plethoric or corpulent habits, where there is considerable inflammatory fever, with hard and quick pulse. PULSATILLA, where the pains are of a shifting nature, exacerbated towards evening or in bed, with a paralytic or torpid sensation in the part affected, and more particularly when the dyspeptic symptoms, given under this medicine (see INDIGESTION or DYsPEPsIA), present themselves, and when the pain is relieved by uncovering the affected limb. When, on the contrary, the pain is increased by uncovering, and relieved by warmth, and the patient is weak, depressed and exhausted, Arsenicum, will be found of material service in affording relief. Pains worse at night, with restlessness, and constant necessity to change the position of the extremities, pale and anxious or haggard countenance, are generally relieved by Ferrum, or Ferrumn and RIus in alternation; and, in other cases, by Cinchona, especially when there is sensibility to the touch, and aggravation of the sufferings from the most trivial pressure or blow. Nux VOMIcA, when the pains are worse towards the morning; paralytic and torpid sensations, with cramps and throbbings in the muscles: and, moreover, when, in addition to other dyspeptic symptoms, we find constipation and hemorrhoids, or an inclination to that affection, and an irritable or choleric temperament: furthermore, when indulgence in wine or fermented liquors has been the inducing cause. BRYONIA, where the pains are increased by the slightest motion; aggravation of suffering at night; coldness and shivering, with general perspiration or fever. For the dyspeptic symptoms present, see article INDIGESTION. SANGUINARIA. Dr. Bute used this remedy beneficially in a case of gout, with swelling of the joints of all the extremities, displacement of the right shoulder and shoulder-blade, cramp in the nape of the neck and larynx, and bad taste in the nouth.--ED. Each of the medicines here mentioned may successfully RHEUMATISM. 629 follow Aconite, when the febrile symptoms have been in some measure subdued by the administration of that medicament. In chronic cases, the applicability of the following medicines should be consulted: Argentum, Lycopodium, Aurum, Sulphur, Calcarea carbonica, Colocynth, Hepar sulphuris, Colchicum, Phosphorus, Conium maculatum, Dcphne, Kali, Guaiacum, lodium, Rhododendron, Clematis viticella, and iianganum. Also, as intermediate remedies,-Arnica, Ledum palustre, and Sabina. In ARTHRITIS VAGA the following remedies have been recommended in addition to Pulsatilla: Nux v., Arnica, Manganum, Nux moschata: and also Rhododendron, Plumbum, Daphne, and Assafwetida. ARTHITIC NODOSITIES, or NODES: Lycopodium, Aurum, Ledum, Graphites, Calcarea, Rhododendron, Silicea, Sepia, Berberis, and Staphysagria in alternation; as also Agnus, Antimonium, Bryonia, Phosph., Sabina, Zincum. ARTHRITIC CONTRACTIONS are sometimes benefitted by Sulphur, Bryonica, Rhus, Guaiacum; or Colocynth, Silicec, Calcarea, etc. Arthritis occurring in individuals, whose occupations compel them to work in the water, is chiefly to be relieved by Calcarea, Pulsatilla, Sarsapccrilla, and Sulph.: and in some cases by Arsenicum, Dulcamara, Antimon., NVux moschata, and Rhus. Nux v. is one of the most important remedies against the precursory symptoms of gout; and Belladonna against recent metastasis. In CHIRAGRA: Nux, Bry., yc., Cocc., Ant., Agn., Rhod., Suljph., ach., led., etc., are the most generally appropriate remedies. And in PODAGRA: Arnica, Sabina, Ledum; but in many cases the following are equally important: Bry., Sulph., Calc., Cocc., Am. c. et m., Ambr., Lye., etc. RHEUMATISM. RHEUMATIC FEVER. FEBRIS RHEUMATICA. RHEUMATISMUS. DIAGNOSIS. Pains in the muscular or membranous structure, generally with swelling of the adjacent cellular tissue, with slight redness and increased generation of heat, caused by taking cold. This disease is of two kinds, the Acute and Chronic the former is accompanied by fever, preceded by restlessness; 630 DISEASES OF PARTICULAR ORGANS AND REGIONS. heat alternating with chills; thirst; coldness of the limbs and extremities; constipation and accelerated pulse, followed by pains in the large joints, generally shifting their situation, leaving redness, swelling, and tenderness of the parts affected; it is also frequently attended with excessive perspiration and weakness. In the latter, or Chronic Rheumatism, the swelling of the parts, except in very severe cases, is commonly less perceptible: sometimes there is present a feeling of general stiffness or numbness, with little or no fever. Other symptoms incidental to this complaint, we shall notice more particularly under the head of the different medicaments most efficacious in the treatment. The principal exciting causes are damp, chill, or a sudden check of perspiration. People who have resided long in a tropical climate, or have been subject to continual exposure to cold or wet, are vvery liable to suffer from rheumatism in the chronic form. THERAPEUTICS. In the treatment of this affection, the following medicaments have been found particularly useful: Aconiturn, Belladonnc, Bryonia, Chamnomilla, Nux voomica, XMercurius, Pulsatilla, ]?hus toxicodendron, etc. ACONITUM, when we find high fever, dry heat, thirst, and redness of the cheeks; excessive shooting or tearing pains, extremely violent at night; occasionally redness or shining swelling of the parts affected; aggravation of pains by the touch; excessive irascibility of temper. BELLADONNA is useful when the pains are of a shooting or burning description, principally in the joints, aggravated by movement, and worse at night; when the parts attacked are much swollen, rigid, very red, and shining, and particularly when there is fever, with determination of blood to the head, throbbing of the vessels of that part, and redness of the face; heat of skin, thirst, accelerated pulse and sleeplessness, aggravation of the pains on movement..BRYONIA may follow Aconite, Phus, or the preceding medicine, with great benefit, or be administered independently. The following are its more prominent indications: severe shooting pains, much increased by motion of the affected part, or by a cold draught of air; swelling of the joints of the'upper and lower extremities; fever; headache, RHEUMATISM. 631 gastric derangenent, and constipation; pains aggravated at night, or particularly on the slightest irritation; irascibility and perverseness of temper; the pains seem situated more in the muscles, and particularly about the joints, than in the bones. Bryonia is, like Belladonna, particularly indicated in rheumatic fever, when the pains are excessively increased by the slightest movement, but the accompanying fever less of a synochal type than that which calls for Bella. CHAMOMILLA, when we find dragging or tearing pains, with a sensation of numbness or of paralysis in the parts affected, feverishness; great agitation and tossing; desire to remain lying down; perspiration; exacerbation of suffering at night, with temporary relief from sitting up in bed, or frequent changing of posture; dragging rheumatic pains in the gums or upper and lower extremities, with nocturnal exacerbations, or excessive aggravation of pain from the slightest movement. Aching pains all over on waking in the morning, and chilliness during the day. Nux voMAIc. Sensation of numbness, paralysis, or tightness in the parts affected, with cramps and palpitation of the muscles; pains of a dragging description, chiefly confined to the joints, trunk of the body, back, loins, and chest, aggravated by cold; gastric derangement; constipation; irritability of temper. In rheumatism in the muscles of the neck, with stiffness and drawing of the head to one side, and nocturnal exacerbations; as also in rheumatism having its seat in the gums, muscles of the chest, abdomen, and back, with flatulence and constipation, Nux is one of the best remedies, seldom suitable at the commencement, but often after Acon., Cham., Ignatia or Arnica. (Cocculus and Ignatia are sometimes called for, when Nsux brings only temporary relief.) MERcURIUS is indicated in cases where the pains are increased by the warmth of the bed or exposure to damp or cold air, aggravated at night, and especially towards morning; also where there is considerable puffy swelling of the parts affected. This medicine is particularly useful when the pains seem seated in the bones or joints; profuse perspiration without alleviation of suffering is also a good indication for its employment; rheumatic fever with continual alternations of chills and heats, or internal heat, with fugitive chills in the affected parts. 632 DISEASES OF PARTICULAR ORGANS AND REGIONS. (Lachesis is often efficacious when.Mercurius fails to relieve the foregoing symptoms.) PULSATILLA is useful in shifting rheumatic pains, particularly if attended with a sense of torpor or paralysis in the parts upon which the patient has been lying, relieved by exposure to cool air, and worse at night or in the evening; rheumatic fever, with predominating chills, and pains in the long bones. Suitable after Chain., Ignatia or Arnica. (Camphora is often of great service in pains which disappear in one place to reappear in another, such as from the feet to the arms, and so on, when Pulsatilla or /hus, etc., produce merely palliative amendment.) iHus TOXICODENDRON is indicated by a sensation of torpor, dulness, and crawling, with feeling of numbness, or creeping in the affected parts, especially those on which the patient lies: paralytic weakness or trembling of the extremities, when attempting to move them; a sensation of bruising or of laceration, as if the flesh were torn from the bones, or as of scraping of the bones; pains worse during rest, relieved by motion; inflammatory or shining redness in the joints, with stiffness, and sometimes a darting pain when handled. This remedy is particularly useful when rheumatism or rheumatic fever has arisen after a thorough wetting, or when the sufferings are aggravated in cold or damp weather, and when in rheumatic fever the pains set in especially during the chills, and the chilliness alternates with heat throughout the course of the disease, except during the night, when heat prevails, and gives rise to a constant inclination to stretch the limbs. This medicament may sometimes follow Bryonia with considerable advantage. Ferrumn is sometimes useful in alternation with Phus, particularly when the pains are relieved by frequently shifting the position of the limbs; or after, or in alternation with Pulsatilla, when the pains fly about from one part to another, and are of a lancinating description. It is suitable after Arnica. ARSENICuM is a most valuable remedy when the pains are of a tearing, dragging, lancinating, burning character, accompanied by anxiety and uncontrollable restlessness and sleeplessness, with great heat of skin and excessive thirst, small accelerated pulse and swelling of the extremities. In rheu RHEUMATISM. 633 matic metastasis to internal organs, especially the heart, ArTsenicuEm is one of the most important remedies. Accessions of sweat, with mitigation of suffering, is a characteristic indication for Arsenicum. COLCHICUM. Rheumatism, with gastric derangement and slight fever, during the prevalence of cold, damp weather; or rheumatic fever (continua remittens), exacerbated in the afternoon, with general dry heat, palpitation of the heart, thirst, and fugitive sweats; shooting, tearing pains in the affected part, becoming almost insupportable at night, subsiding towards morning, and then suddenly fixing upon some other part of the body, which in its turn becomes painful and inflamed, whilst the previously affected part loses its former redness, but remains in a tumefied state for a few hours. CHINA is of much service at the commencement of an attack of rheumatic fever, when the following symptoms are met with: nocturnal, pressive, aching pains in the head, with excessive general restlessness, which disturbs sleep; fugitive chills in the back, and tendency to sweat on covering up the parts, or on the slightest excess of clothing; the chilliness gradually extends over the whole body, but consists more of an internal than an external feeling of chilliness, with exception of the hands and feet, which are as cold as ice; by degrees partial heat supervenes, with exacerbation of headache, and distension of the vessels, dragging, tearing pains in the back, sacrum, thighs, and knees, with weakness in the affected parts, and aggravation or renewal of suffering on touching or handling them; sometimes symptoms of gastric or bilious derangement make their appearance at the same time, as bitter taste, with yellow furred tongue, bitter eructations, nausea, and even vomiting, and excessive thirst.* IANUNCULUS BULBOSUS. This remedy is also of considerable efficacy in rheumatic fever, and is indicated by some of the characteristic symptoms which call for the employment of China, such as aggravation or renewal of the tearing, shooting pain by the touch, or by movement or alteration of posture. The fever partakes of the type of a continua remittens, becomes exacerbated towards evening, and is attended with a * See Hartmann's Acute and Chronic Diseases. 634 DISEASES OF PARTICULAR ORGANS AND REGIONS. strong full pulse. The pains are of a fugitive character, and are, in addition to the above peculiarity, which is common to China, generally aggravated by cool air. Semilateral heat, with coldness of the hands and feet, is likewise an indication for Ranunculus bulb. in rheumatic fever.* RHODODENDRON CHRYSANTHUM. Rheumatic fever (of fhe character of synochus), in which the chilliness alternates with heat, accompanied with pressive headache from within outwards, and drawing in the limbs; dry heat in the trunk during the night, with restlessness and sleeplessness, followed by slight general heat towards morning, on mitigation of pain. The nocturnal drawing, or dragging and tearing pains occupy the periosteum chiefly, are aggravated by bad, changeable weather, and by rest. SULPHUR. Drawing, pricking, or drawing tearing pains in the extremities and joints, with slight swelling of the latter; mitigation of pain from external warmth, and aggravation from cold; exacerbation or accession of pain when at rest, and amelioration on movement; but chiefly when the pains are of a fixed character. Rheumatic fever, with alternate heats and chills, anxietas praecordii, and pains in the head and neck, and severe pricking in the sacral region; the headache increases, by its violence, the great tendency to restlessness and disturbed sleep, and admits of no rest in any position. The accompanying fever is a continua remittens, with exacerbations in the evening, or after retiring to rest, consisting of shivering chills, which it is impossible to allay by warmth, and which terminates in heat after an hour or two; towards morning, sweat of an acid odor. Commonly there is complete absence of appetite, or desire for acid food only, with great thirst, parched mouth (or sensation of dryness), sour eructations, distension of the scrobiculus and abdomen, and sensibility to the touch; costiveness.t ARNICA is characteristically indicated when the extremities are affected with tensive, tearing pains, or pains as if caused by a bruise, attended with debility, redness, and swelling, exacerbation from the slightest movement, and yet it is found impossible to retain the limbs long in one posture, in conse * See Hartmann's Acute and Chronic Diseases. t Ibid. RHEUMATIS IM. 635 quence of the unremitting pain and the restlessness which arise from so doing. In pains of a similar description affecting the thorax, particularly the posterior portion, this remedy is still more efficacious, with the contradistinction that they are mitigated by movement; chilliness and heat exist at the same time, i. e., whilst one part feels warm to the touch, another feels cold,* especially suitable before or after Ohina, Arsen., Ferr. or E-hus. LACuESIS has been found of great efficacy in rheumatic fevers, and especially in those occurring after the abuse of mercury. It is chiefly indicated by pain and stiffness, with swelling of the affected part, sensibility to the touch, and exacerbation of the pains during movement, towards evening and at night; sweat, which brings no relief. MEZEREUM is equally efficacious in rheumatic fever after a course of mercury in large doses, when the pains occupy the long bones, and are principally of a drawing and tensive description. CARBO v. Drawing tearing pains in the thorax, with paralytic sensation, and obstructed respiration; also when excessive flatulency is present. EUPHOEBIUM. Tearing, or pressive, aching, shooting pains, exacerbated during rest, ameliorated by movement. Obstinate cases of rheumatism frequently require a long, careful, and discriminative treatment. In some cases much benefit will be obtained from repeated doses of Sulphur; in others, Ccalrcea, particularly when the pains are increased at every change of the weather. Hepar sulzphuris and LackZesis alternately have been recommended in the severest kinds of acute rheumatism. Colocynth is frequently useful against the stiffness which remains; or, Nux, Cocculus, and Ignaaic, when there is stiffness of the entire frame, with threatening rheumatic paralysis. In the event of a sudden metastasis to the chest, attended with oppressed respiration, palpitation of the heart, and excessive agitation, Aconitum should be immediately administered in repeated doses until relief is obtained; but should the improvement only prove temporary, Sulphur and Pulsatilla have been recommended to be * See Hartman's Acute and Chronic Diseases. 636 DISEASES OF PARTICULAR ORGANS AND REGIONS. given in alternation. Belladonna and Bryonia may also be of service in dangerous results of this kind. When the heart becomes implicated in acute rheumatism or rheumatic fever (Endocarditis or Pericarditis rheumatica), Belladonna, in repeated doses, is frequently, in addition to Arsenicum, a most useful remedy if timely administered; and may, in some cases, be advantageously employed in alternation with Aconitum, and followed by Sjigelia 1-3 and Digitalis 1-3, or Oannabis or Bryonia, according to circumstances. These remedies, together with Cannabis, Arsenicum, and Lachesis, in some instances, are the most valuable in the treatment of idiopathic ENDOCARDITIS, CARDITIS, OR PERICARDITIS, which see. Against rheumatism with FEVER rheumatic fever), Aconitum, Belladonna, Bryonia, and Chamomilla are the most appropriate medicaments when the accompanying fever runs high or is of a synochal type; and iMerc., Rhus, Nux V., Puls., Cocc., Calc., Chin., Ars., Ran., Rhod., Dule., Indig., Am., and Sulph., when it is of a sub-inflammatory type. Against NON-FEBRILE rheumatism: Argent. m., Assa. (when the pains proceed from below upwards, as, for instance, from the hand to the arm and shoulder)," Clem., Hep., lach., Lyc., PhosphA., Yeratr., Nwux, Puls., Thlja, Sang. can., Ign., Merc., Dul., Sulph., chiefly. For rheumatism in the JOINTS, with or without swelling (articular rheumatism), Acon., Bry., Bella., 2hus, Ant., Clem., Arn., Ied., Lye., Hep. s., Sulh., Calc., Sep., Argent. metal. (without fever). For rheumatism in the UPPER EXTREMITIES: 1st, The SHOULDER: Acon., Bry., Puls., Rhus,--KaliA, Magn., Assa., Carb. V., Sil., Thuja, Niux, Staph., Hep., &c. 2d. The ARM: Assa., Cocc., Led., Puls., Sab., Veratr., Guaj., Chin., Ant. c., Bella., Bry., Kali, M. arct., &c. 3d. The FORE-ARM: hus, 2Mere., Staph., Cale., Nux v., Sul ph., Sep., Sil., Hep., Lyc., Ran. bulb., Ran. scel., &c. LOWER EXTREMITIES: 1st, The HIP OR HIP-JOINT: Bry., Calc., Led., Rhus, Ant., Coloc., Chin., Dule., Ign.,. austrtr., ierc., Nux V., Puls., Veratr., Phosph., Arn., Bella., &c. 2d. The THIGH: M2erc., Guaj., China, * Allg. Horn. Zeit. No. 21, 31ster Bd. RHEUMATISM. 637 Bella., Bry., Calc., carb. a., Clem., Coloc., Ign., Puls., Saulph., Arn., Carb. v., Coco., Nue v., 'Rhus, Tihuja, &c. 3d, The LEG: CalC., Lye., P'ls., Sep., Sil., Staqph.,-Ant c., Am., Ars., chain., Chin., Coloc., Guaj., Led., Aag. aret., ilag. aust., Phosph., ThjCa, Veratr., iMerc., Nux v., Ran. scel., &c. Against rheumatism in the THORAX (pectoral and intercostal muscles particularly): Am., Phosph., Ran. bulb., 8pig., Sulph.,-Ars., Bella., Carb. v., Hep., ilierc., Ran. scel., Sep., Sil., Bry., Calc., Chin., Dulec., led., lye., Cocc., Nux V., Rhus, Staph., Veratr., &c. In the HEIART;: Aeon., Lach.; and Ars., Bry., Bella., Puls., Sjpig., Suiph., Calc., cham., Chin., iferc., Nux, ]Thauja, Sabin., Carb. v., Rhus, Phosyp., &c. BACK: 1st, The SHOULDER-BLADES (scapnla): china, Aierc., Rhus, Sep.,-Acon., Am., Bry., Coloc., Phosph., Ac. ph., Ran. lbulb., Rhoci., Staph., Assa., Bella., cCalc., Coce., Nux V., Sulph., Veratr., &c. 2d, The DoRsuM: Am., Ars., Bella., cocc., Nux, Puls., SIulh., Calc., lyc., Sep., Sil.,-Assa., Bry., cham., Dulc., Hep., Ign., lach., led., fag. caust., Phosph., Ac. ph., Rhod., Spig., Staph., Thuja, China, cof., Guaj., ilerc., Rhus, Ieratr. (See LUMBAGO). 3d, The SACRUM: Nux., Puls., Rhs, Sep., Sul4ph.,-Ars., Bellca., Carb., Duic., Hep., fag. aust., Ac. ph., Staph., Thuja, Arib., Bry., Calc., cham., China, Coce., Jgn., lye., Phosph., Veratr., &c. For rheumatism in the HEAD, Spigelia is one of the most effective remedies; in other cases, Aeon., Bella., Bry., lyc., Acid. nitr., Merc., Ipecac., Ign., Coloc., Sulph., led., lach., China, Phosph., or Cham., followed if reqnired by Nux v. and Puls. at intervals of twelve hours. In rheumatism arising from the abuse of MERCURY, Sulph., Carbo v., Sars., Lycop., Guaj., China,-Acid. n., Hep., lach., Bella., Calc., Ac.ph., Puls., Duic., are the most useful in general cases. In that which has been produced by the excessive and injudicious employment of CINCHONA: PuIs., Ars., Carb. v., Mere., Sumph., Sep., Veratr., and calec. And in GONORRHEAL rheumnatism, Clemn., Sars., Thuja, Puls., Tussilago petas., Daph., lyc., and Sulph., may be considered the most appropriate medicines. For CHRnoNIC RHEUMATISM the following are the principal remedies: Veratrumn, Phosphorus, Carbo iv., Sulph., lycop., 638 DISEASES OF PARTICULAR ORGANS AND REGIONS. Hepar, Lach., Clem., Indigo, Yaleriana. When the pains are aggravated or excited by the slightest chill,-Aconite, Calc., Bry., Dulc., Merc., Suiph., Acid.phosph.; will generally be found the best remedies from which to select. When the attacks are excited by unfavorable weather,-Calc., ]?hus, Dulc., Rhod., Yerat., or ycop., Carbo v., Zach., Hepar, J~fang., NIux m.; and when every change of weather brings on a relapse,-Calc., Silicea, SulZph., Dulc., Meerc., Lach., Khus, and Veratrum are usually the most useful. Form rheumatism arising from a chill in the water, or from cold, moist weather,-Calcarea, Nux m., Sarsaparilla, or Sulph., Dulc., Carbo v. Rheumatism with paralytic weakness,-Arnica, Ferrum, China, &c., or Electro-magnetism, when painful jerkings are experienced in the part. SAgainst unsettled or shifting rheumatic pains, in addition to Pulsatilla: Rhus, Arnica, Bryonia, Nux m., and in some instances, Rhod., Dcphne, Mang., Plumb., or Crocus, Valeriana, and Assafaetida, are the most appropriate medicines. Rheumatism from congelation,-Arsenicum, Bryon., Nux moschata, chiefly. LUMBAGO. NOTALGIA. PAINS IN THE SMALL OF THE BACK, LOINS AND NECK. DIAGNOSIS. Violent pain, of a rheumatic character, in the lumbar region, either periodical or permanent, frequently accompanied with a considerable degree of fever. THERAPEUTICS. The medicines most valuable in its treatment are, Aconite, Bryonia, Nuw vomiccl, nus toxicodendron, Belladonna, Pulsatilla, and.Mercurius. ACONITE may be given at the commencement, if much fever declare itself. BRYONIA where the pains in the back are of a severe aching or lancinating description, constraining the individual to walk in a stooping position; aggravated by the slightest motion, or draught of cold air, and attended with a general sensation of chilliness. Nux voMICA is particularly indicated when the pains resemble those produced by a bruise, or by excessive fatigue: also when they are much increased by motion and turning in INFLAMMATION OF THE PSOAS MUSCLE. 639 bed at night, and attended with considerable weakness; and moreover, when irritability of temper and constipation are present. Nux v. is often of great service after Bryonia in acute lumbago. In chronic cases it is a remedy of no mean importance. RHIUS TOXICODENDRON. Dragging or shooting pain in the dorsal and lumbar region; severe aching or pain as if from the effects of a bruise or a sprain in the loins; a feeling of stiffness or tension in the affected parts on attempting to move, but aggravation of the pains when in a state of rest, or when pressure is made on the seat of the sufferings. It is also a useful remedy in chronic cases. BELLADONNA, where the pains are deeply seated, causing a sensation of heaviness, gnawing, or stiffness; it may follow Aconite with considerable benefit, when slight inflammatory symptoms are present. PULSATILLA, when the pains, resembling those mentioned under Nux VOMIcA, are moreover attended with a sensation of tension or constriction at the affected parts; it is particularly indicated, as remarked in other parts of this work, for females, or individuals of mild, sensitive, or phlegmatic temperaments. MERCURIUS, when the pains are much of the same description as those given under Nux vomica, but considerably aggravated at night, incapacitating the sufferer from taking rest. (See also art. RH-EUMATISM.) INFLAMMATION OF THE PSOAS MUSCLE. PSOITIS. DIAGNOSIS. Pain in the renal region, hip, and downwards to the leg. The limb can neither be stretched nor drawn upwards without pain; in walking there is a hobbling in the gait, with the body inclined forward; turning in bed, or lifting any weight increases the pain. Occasionally, but seldom, we find some degree of external swelling. The affection, in some measure, resembles NEPERITIS, from which, however, it is distinguishable by the absence of disturbances of the urinary system, &c. This disease is generally more painful than dangerous; it may, however, prove fatal from matter forming and discharging itself into the cavity of the abdomen, but more 640 DISEASES OF PARTICULAR ORGANS AND REGIONS. frequently abscesses open in the groins, anus, perineum, or thighs; it may also produce caries. THERAPEUTICS. The remedies given under LUMBAGO and RHEUMATISM (which see), are equally useful in most cases of this disorder; however, as there is generally a greater degree of fever present than in that affection, Aconittum, followed by Belladonna, should generally form the commencement of our treatment. The following may be mentioned in addition: COLOCYNTH, when there is a feeling of contraction in the psoas muscles when walking, and the disease is more of a chronic nature. When rigors are complained of, followed by a sensation of throbbing, and increase of pain in the affected part, and we have reason to apprehend incipient suppuration, we may give Staphysagria in repeated doses, followed by Silicea or Hepar, to bring the abscess to a head as quickly as possible, and thereby relieve the sufferings of the patient. In by far the greater number of cases ofPsoas or Zumbar abscess, however, we have no premonitory symptoms which might lead us to anticipate such a disease, and are but too often unaware of the existence of the disorder, until an external tumor is formed. (See CHRONIC ABSCESS.) When the bones have become affected, or when an abscess has arisen from diseased vertebre, Silicea may be productive of all the benefit we can look for in so serious a case. STAPHYSAGRIA may follow the above when a discharge of a peculiarly offensive sanies takes place. Aurum, Assafctida, Argentumr, Plumbum, or Sulphur may also prove of service in the latter form of lumbar abscess. SCIATICA. HIP DISEASE. DIAGNOSIS. Pain in the region of the hip-joint, which frequently extends to the knee and foot, following the course of the sciatic nerve. It often interferes with the motion of the foot, causing stiffness and contraction. THERAPEUTICS. The principal remedies in ordinary cases are Aconitum, Arsenicum, Chamomilla, Ignatia, Nux vomica, Pulsatilla, Colocynth, and Rhus toxicodendron. ACONITUM. When considerable constitutional disturbance attended with fever is present. INFLAMMATION OF THE PSOAS MUSCLE. 641 AESENICUM. When burning pains are complained of, or sometimes a sensation of coldness in the affected part-acute dragging pains in the hips, with great restlessness, obliging the patient to move the limb frequently in order to obtain relief; occasional intermissions of suffering or periodical returns; great weakness and inclination to lie down-mitigation from the application of external heat. It is also useful in those cases of marasmus or emaciation which arise from a long continuance of want of rest, the result of pain, and from derangement of the digestive system. CHAMOMILLA is more particularly indicated when the pains are frequent at night, attended with excessive sensibility and irritability of fibre: sensation of torpor in the affected parts. IGNATIA. When the pains are of an incisive nature, particularly on moving the limb, and more especially when they occur in individuals of a mild melancholic temperament, or in those who are subject to alternations of extremely high and low spirits. Nux voMICA. When the pain becomes aggravated towards morning, and is attended with a sensation of stiffness and contraction so as to interfere with the motion of the foot, and also a sensation of paralysis or torpor and chilliness in the parts affected, particularly in individuals of an irritable temperament. PULSATILLA. When the pains are aggravated towards evening, and during the night, or when the patient is seated, but somewhat relieved in the open air; this remedy is best adapted for persons of mild disposition and leucophlegmatic temperament. COLOCYNTH is an important remedy in this distressing disease. It has been found of the greatest service in cases where the right leg was affected, and the pains liable to be excited, or much aggravated by a fit of anger or indignation. RHUs. This medicament is more peculiarly indicated when the pains are aggravated by rest, relieved by motion, or by warmth: with disposition to melancholy, or an unaccountable feeling of dread. Veratrum, Staph ysagria, Manannum, Jlezereum, Hepar 8., Sepia, Plosphorus, Ruta, Kali c., Conium, &c., may also be 41 642 DISEASES OF PARTICULAR ORGANS AND REGIONS. found useful in particular cases of this complaint, or Neuralgia, generally, which see. (See also the remedies described for the treatment of rheumatic pains, article RHEUMATISM.) PAIN IN THE HIP. HIP-GOUT. RHEUMATISM IN THE HIP. COXALGIA, COXAGRA. ISCHIAS. DIAGNOSIS. A pain in the hip-joint dependent upon a true gouty inflammation, almost universally of an acute description; the pain is extremely violent, and extends from the hip-joint to the neighboring aponeurosis, the periosteum, and the adjacent ligaments; it consequently sometimes reaches upwards to the back, or downwards to the thigh, rendering motion excessively painful, either in walking, rising up, sitting down, or turning in bed. When the pain is not deeply seated, there is generally absence of either swelling or redness. This species of gout usually assumes the irritable character, runs its course quickly, and forms an active local inflammation, which very rapidly terminates in suppuration, when unchecked. It occurs more frequently in the male than in the female subject. When suppuration supervenes, the pain becomes more obtuse, pressing, and throbbing; the inflammatory fever assumes the suppurative character (febris sup)puratoria), indicated by shivering and shuddering, alternating with heat, to which a number of other sufferings become united, such as swelling, pains in the knee, limping, luxatio spontanea, &c. THERAPEUTICS. The following remedies have been found most effective in the treatment: JMercurius, Rhus toxicodendron, Aconitum, Belladonna, Clamomilla, Pulsatilla, Hepar sulphuris, Colocynth, Arsenicum, &c. MERCURIUS is a useful remedy when the disease is attended with halting in the gait, and sharp, cutting, tearing, and burning pains, which are materially aggravated at night and during every movement, and are usually attended with profuse nocturnal sweating; also where exudation threatens, or has already taken place. RHus TOXICODENDRON. When darting, tearing, or dragging pains are experienced in the hip-joint, attended with tension and stiffness in the muscles, aggravated, or chiefly felt, during HIP DISEASES. 643 rest. Also painful sensibility of the joint when rising from the sitting posture. ACONITUM. When the affection is attended with marked febrile symptoms, or inconsiderable inflammation of the joint itself exists from the commencement. BELLADONNA is particularly indicated in the inflammatory stage when attended with a marked redness of the skin, and considerable pain on the slightest movement, with lameness; in such instances it may advantageously precede Miercurius. CHAMOMILLA is of great efficacy in recent cases, with exacerbation of pain, at night in bed. PULSATILLA is occasionally found serviceable in mild cases of this disorder, partaking of a rheumatic character, when the patient complains of wrenching pains in the hip-joint, which are aggravated towards night, and even when in a state of rest. (Acid. nitr. is sometimes useful after Puls.) HEPAR SULPHURIS is chiefly useful in case of exudation, and may in such instances follow Mercurius with some advantage. COLOCYNTH is a useful remedy in subacute or chronic cases,, when the pain is constant, and of a squeezing description,, accompanied by a sensation as if the entire joint were tightly and painfully bound; also when the attacks are liable to be brought on or aggravated by a fit of passion, indignation, or mortification. ARSENICUM deserves a preference to other remedies when the pain extends or shoots along the interior of the affected limb like a hot stream (increased by every movement, and, especially, by every change of temperature); great prostration of strength, disappearing in the intervals between the paroxysms; paleness of the face, oppression at the chest, or even attacks of faintness from the slightest exertion. (Hygea, xvi, 67-74.) The following remedies have also been found useful in many cases: Sulphur, Silicea, Grcphites, Bryonic alba, Calcarea carbonica, Digitalis, Argentum, Acidum nitriczum, ]reosotum, Assafcetida, Aurum foliatum, Cantharides, lachesis, Chacmomilla, Stap2hysagria, Nux vomica, Acidum jphosphoricum, Sepia, and Calcarea phosphorata. (See also the following article on HIP DISEASE, and that on RHEUMATISM, where indication for some of the above-mentioned will be found.) 644 DISEASES OF PARTICULAR ORGANS AND REGIONS. HIP DISEASE. MORBUS COXARIUS. DIAGNOSIS. Chronic inflammation of the bones composing the hip-joint (particularly the acetabulum), frequently commencing only with pain or uneasiness in the knee of the limb attacked, or a slight weakness of the part affected, attended with limping; afterwards emaciation, and elongation of the limb itself takes place, and as the complaint progresses, a severe fixed pain is felt behind the trochanter major, increased by pressure on the front of the acetabulum, extending down to the knee, ankle, and foot, which is accompanied with feverish symptoms, restlessness, and flattening of that part of the nates which is generally fullest and roundest, depression of the crest of the ilium, and distortion of the spine. This complaint is most frequently met with in children, but no age, sex, or condition of life is exempt from its attacks; it is peculiarly insidious in its approach, the pain and uneasiness in the knee above-mentioned being frequently the first symptom denoting its presence; hence it is not unfrequently mistaken for some complaint of that joint-a deplorable oversight, since it is only in the incipient period of the disease that a favorable prognosis can be given; if no appropriate relief be timely administered, matter forms within the joint; the acetabulum, and sometimes the head of the femur, becomes destroyed by caries, luxation upwards and outwards takes place, and the limb, which had previously been preternaturally elongated, now becomes contracted and shortened; the sufferer is then either destroyed by excessive constitutional irritation, or recovers with an anchylosed joint. CAUSES. An inherent constitutional taint, such as scrofula, is no doubt the principal pre-disposing cause; but it is generally attributed to external violence, or exposure to damp or cold, as lying down on damp grass in summer, &c. THERAPEUTICS. Mercurius, Belladonna, and Rhus are our principal remedial agents, at the commencement of the disease; and Calcarea, Colocynth, Sulphur, Silicea, Calcarea phosphorata, Pulsatilla, Sep2ia, and Stapihysagiria in more advanced stages, or after the previous employment of the first-named medicines. MERCURIUS. This remedy is of itself sometimes found to HIP DISEASES. 645 act as a specific in the early and curable stage of the disease; it is more particularly indicated when the patient is of a scrofulous diathesis and sallow complexion, and when no pain is complained of, but the disease is insidiously advancing. BELLADONNA is more especially called for in the inflammatory stage, when the patient suffers considerable pain. In some cases it may be found advantageous to alternate these remedies according to the symptoms that present themselves. RHUS TOXICODENDRON. In the first stage of the disorder, with darting or dragging or tearing pains in the hip-joint, increased by suddenly pressing the head of the femur into its socket, accompanied with tension or stiffness of the muscles; most painful when in a state of rest; and severe pain on arising from a sitting posture. COLOCYNTH has been found of much value in this disorder, either after Belladonna and Mercurius, or in preference to those medicines when, from the commencement, the hip-joint is described to feel as if firmly and painfully bound by an iron clasp, with pain extending down the limb, and stiffness in the knee-joint. SULPHUR is generally required in chronic cases, particularly when arising from a scrofulous or psoric metastasis. Calcarea carbonica has been recommended as particularly worthy of attention at the commencement of the second stage of the disorder. In cases of abscess or caries in this disease, Silicec and Calcarea phospkorata may be employed with advantage. The following remedies are likewise deserving of attention in the treatment of this serious malady: alcarea, Bryonia, JIepar s., Acidum phosphoricum, Phosphorus (in the stage of shortening), and Zachesis. AFFECTIONS OF THE KNEE. In affections of the knee-joint, Silicea forms one of the most important remedies, particularly when the disease begins in the synovial membrane. Acid. nitricum, Aurumn, Ac. p2hosphor'icumn, Zycopodizum, Lacheesis, Sz2ulp r, or Calcarea, have, in addition to Silicea, been found useful in inflammation of the synovial membrane of the joints, in consequence of the effects of iMercury; and Rhus, Bryonia, Lycopodium, Nux v., China, or Sulphur, 646 DISEASES OF PARTICULAR ORGANS AND REGIONS. when the complaint occurs as a result of gout or rheumatism. Sulphur and Calcarea have chiefly been recommended in lympathic or scrofulous enlargement of the knee; but also the following, in some cases: Silicea, Lycopodium, Arsenicurm, lodium,, and Arnica. In the event of suppuration: Silicea, Afercurius, Ilepar s.; and in that of serous infiltration: Silicea and Sulphur; or Calcarea, lMercurius, and lodium. In glazed or shining, white, soft or doughy swellings of the knee, Pulsatilla is an excellent remedy, and is indeed more or less useful as a general remedy in soft, colorless swellings of the knee, whether painful or otherwise. Sometimes the alternate employment of lodium and Pulsatilla is required, especially in strumous habits. When the swelling is red, and very painful, Bryonia is more appropriate (or Bryonia and lodium in alternation, in scrofulous subjects). DETERMINATION OF BLOOD TO THE ABDOMEN. CONGESTIO VISCERUM ABDOMINIS. CONGESTIO AD ABDOMEN. This derangement is characterised by a disagreeable or painful sensation of weight, heat, and burning, with hardness and tension in the lower portion of the abdomen. Nux VOMICA is one of the most frequent sources of relief in those who lead a sedentary life, or are much addicted to overindulgence in the pleasures of the table, particularly when the following symptoms are complained of: hardness, tension, and fixed pain in the abdomen, sense of great weakness or prostration, rendering it difficult or almost impossible to walk about; constipation, with pain in the loins, spirits oppressed and irritable. SULPHUR will frequently be found serviceable in completing the cure after the above, or it may be selected in preference in cases of long standing, when we meet with the following indications: dull pains, and a disagreeable sensation of distension in the abdomen, constipation, tendency to obstinate hemorrhoidal attacks, extreme dejection. CARBO VEGETABILIS may be selected when the symptoms are accompanied with excessive flatulency, and will frequently be found of great service in some obstinate cases, when alternated with the two preceding remedies. ACUTE INFLAMMATION OF THE EYES. 647 ARSENICUM will also be found useful, especially when there is a disposition to diarrhoea with extreme weakness; or CAPSICUM, when these symptoms occur in individuals of a lymphatic temperament. SEPIA is often of much utility in the case of females, particularly when the symptoms are analogous to those enumerated under Sulphur. In particular cases the following will also be found useful: Pulsatilla, Lycopodium, Belladonna, Mercurius, Bryonia, Chamomilla, Rhhus toxicodendron, Veratrum. By consulting the articles on DYSPEPSIA and HEMORRHOIDS, the reader will find further assistance in the selection of the above remedies. Daily exercise in the open air, together with a careful attention to regimen, must be observed by those who are afflicted with this disease. ACUTE INFLAMMATION OF THE EYES. OPHTHALMIA. DIAGNOSIS. Superficial, bright scarlet redness, pain, and heat of the eye, generally with marked sensibility to the action of light; either with dryness or an increased secretion of ophthalmic humors. When severe, accompanied by cephalalgia, febrile symptoms, and increased intolerance of light, particularly when the entire eyeball (Ophthalmitis) or the sclerotic coat (Sclerotitis) is affected, in which latter case, moreover, the redness presents a pink appearance. This affection may arise from a variety of causes, such as exposure to extreme light, the strong heat of a fire, particularly after coming out of an extremely cold atmosphere, external injuries, or cold. THERAPEUTICS. The following remedies are those which are more generally required in the treatment of this affection, according to the form in which it presents itself, namely, Aconitum, Belladonna, NVux vomica, Cinchona, Digitalis, Euphrasia, Ignatia, Arnica montana, Pulsatilla, Mercurius, and Sulphur. ACONITUM. Valuable at the commencement of the treat. ment, in general cases of non-catarrhal inflammation; but even in simple inflammation of the conjunctiva or simple catarrhal ophthalmia, should the inflammation be considerable and attended with fever. 648 DISEASES OF PARTICULAR ORGANS AND REGIONS. BELLADONNA may follow Aconitum,. if great sensibility to light remains. Also in Acute, Arthritic, Rheumatic, and even Scrofulous ophthalmia, when the following symptoms present themselves: redness in the conjunctiva, margin of the eyelids, and corner of the eyes, with a swollen and tumid appearance; or redness of the sclerotica, with intolerance of, and pain increased by, light; great sensibility of the eyes and eyelids; aching pains above and around the orbits, or pains which penetrate deeply into the orbits and head, with aggravation on moving the eyes; flashes of light, sparks, or darkness before the eyes, with extreme dimness of vision towards evening; objects appearing reversed or double; moreover, when there are the following catarrhal symptoms: severe cold in the head, with acrid discharge, causing excoriation, and sometimes an eruption of pimples under the nose, and on or about the lips; periodical return of short, dry, barking, spasmodic cough, aggravated towards night, and severe headache. (MIercurius and Hepar s. are often required to complete the cure after the employment of Belladonna.) Nux VOMICA. In catarrhal, arthritic, or rheumatic inflammation of the eye, when there are burning, pressive, or aching pains, a feeling as of sand in the eye, with stiffness, smarting, tickling, and itching; foul tongue and other symptoms of disordered stomach; slight fever in the morning and towards evening; irritable temper; pressure on the eyes and eyeballs on attempting to open them; redness of the canthi; the eye streaked, bloodshot, and swollen, with adhesion of the eyelids; sensibility to light; briny lachrymation; affection worse towards morning. Nux v. and Pulsatilla are two of the most useful remedies in simple inflammation of the conjunctiva, particularly at the commencement of the attack; but Sulphur is often required to complete the cure. CINCHONA. When the inflammation is less intense, but the motion of the eye painful, accompanied by the sensation before noted as of sand in the eye, with the distinction that an exacerbation takes place towards evening; when the pains are of a burning or pressive nature, with headache in the forehead, as if arising from suppression of the nasal secretion. ARSENIOUM, chiefly in catarrhal and scrofulous ophthalmia, vhen there exists a violent burning pain or pains of so severe ACUTE INFLAMMATION OF THE EYES. 649 a description as almost to drive the patient distracted; specks and ulcers on the cornea. EUPHRASIA. For the employment of this medicine, the particular indications are: white of the eye much inflamed and of a pink or rose color (Selerotitis); painful pressure and smarting in the eyes; profuse and acrid flow of tears, excited or increased by exposure to cold; copious secretion of mucus, sometimes sanguinolent; or bright redness of the conjunctiva, with distension of the veins; minute pustules on different parts of the conjunctiva; white opaque specks on the cornea; excessive intolerance of light (scrofulous inflammation of the conjunctiva); severe cold in the head with profuse fluent nasal discharge; violent headache, aggravation of the symptoms towards evening. IGNATIA may be administered with advantage when there is pressure in the eyes, a profuse flow of tears, great intolerance of light, but with little or no perceptible redness of the eyeball; severe coryza; in catarrhal, rheumatic, or scrofulous inflammation. PULSATILLA. Aching or burning and smarting irritation in the eye, as if from the insertion of sand under the lids, with scarlet redness of the eyes and eyelids, and copious secretion of mucus, disordered stomach, foul tongue, and chilliness towards evening, followed by febrile heat; or pricking, shooting, piercing pains in the eye, with bright redness of the eyes, and profuse lachrymation, especially on looking at the light, or on going into the open air, and generally of a scalding or acrid nature; or, on the other hand, excessive dryness of the eyelids, especially in the evening, with nocturnal agglutination; photophobia; swelling of the eyelids; aggravation of the symptoms towards evening; sensitiveness with disposition to weep. (Ferrum is occasionally very serviceable after.Pulsatilla, especially in scrofulous ophthalmy; at other times Sulphur is preferable.) MIERCURIUS. In many cases of catarrhal, rheumatic and scrofulous ophthalmia, as also in iritis, this medicine is frequently to be employed with advantage. Its ordinary indications are lancinating pains, or painful and irritating pressure, as if from sand, especially on reading, or otherwise fatiguing the eyes, but also when at rest in bed; pricking and itching 650 DISEASES OF PARTICULAR ORGANS AND REGIONS. in the eyes, particularly in the open air; rose-colored redness of the eye (sclerotitis), with injection of the veins; profuse lachrymation; great sensibility to light, but especially that of the fire or a candle; vesicles and pustules on the sclerotica; ulcers on the cornea; pustules and scabs round the eyes, and at the margins of the eyelids; cloudiness of the sight; violent pains in the orbit and forehead; renewal of the inflammation on the slightest exposure to cold. (Hepar s. or Sulph. are frequently required after IMercurius.) SULPHUR is an important remedy in inflammations of the eye of all kinds, whether catarrhal, rheumatic, or scrofulous, when of an obstinate or inveterate character. It is, however, more particularly indicated by the following symptoms: pressure, smarting, and burning, as if from sand; itching in the eyes or eyelids; dimness of sight, with dusky appearance of specks, vesicles, or pustules and ulcers on the cornea; pustules or granular elevations in the eyelids, and scabs round the orbits; inflammation of the iris, with irregularity of the pupil; copious lachrymation, and excessive photophobia, and aggravation or suffering on moving the eyes; painful dryness of the eyes, especially within doors; contraction of the eyelids; imperfect vision, with scintillations; cephalalgia, and violent pains in the orbit, &c. Chronic cases of this affection frequently require a long and careful course of constitutional treatment to effect a perfect cure; one of our best remedial agents for this end is Hepar sulphuris, which is also of great service in acute attacks after Bella. or Mferc., in individuals predisposed to this affection. Among the other medicines which may be consulted with advantage in catarrhal, rheumatic, or even scrofulous ophthalmia are, Sulphur, Oalcarea carbonica, or Graphites, Sepia, Spigelia, Acidum sulphuricum, Petroleum, Lachesis, Acid. nitricum, Ferrum metallicum, Colocynth, &c. If inflammation arise from external injury, caused by a blow, or the entrance of any foreign body into the eye, we should employ Aconitum, which is eminently superior to Arnica in lesions of the ball of the eye; in severe cases it may be used externally as well as internally. Should Aconite not suffice to effect a cure, Sulphur must be had recourse to, followed, if called for, by Calcarea, or any other DISEASES OF THE EYE. 651 remedy which may appear better indicated. When the lids have been injured Arnica is more appropriate; and when both the ball and the lids have suffered, Aconite and Arnica should be employed alternately; or a dose or two of Aconite given first, and subsequently a lotion of Arnica applied. Finally, the following medicaments may be pointed out as being eminently useful, or worthy of attention in the varieties of ophthalmia enumerated. For CATAREHAL OPHTHALMIA, in addition to those above mentioned: Cihamomilla, IFepar sulphuris, Lycopodium. RHEUMATIC (Sclerotitis): Bryonia, Chamomilla, ]huss, and Veratrum; Lycopodium, Spigelia,* in addition to those described under the heading of INFLAMMATION OF THE EYE. SCROFULOUS: Arsenicum, Conium, HIepar s., Sulphur, and Calcarea; also D ulcamara, Ferrumn, Graphites, Sepia, Petroleunm; or Aurum, Baryta c. et m., Lycop., Cannabis, Chamomilla, Digitalis, lodium, Miere. corrosivus,t Magjnesia, Nlatrum m., in conjunction with the remedies alluded to, as suitable to this variety of the disease, at the commencement of this article. SYPHILITIC: Mfercurius and Acid. nitricum chiefly; in some cases Aurum, Lachesis, Sulphur, Bella., &c. SYcosic: Thuja, Acid. nitr., and sometimes Mercurius. GONORRHIEAL: Pulsatillcc, chiefly. Tussilago petasitis Arnica (in Hypopyum). Sulphur is still more serviceable than Am. in hypopyum. ABUSE OF MERCURY under allopathic treatment: Hepar sulphuris, Acid. nitricum, Sulphur, Pulsatilla; and in some cases Belladonna, lachesis, Stcapysagria, Lycopodium, Thuja, or Cinchona. FUNGUS HIEMATODES: Thuja, Carbo a., and Phosphorus.4 * Spigelia is specific in a large number of cases of arthritic and rheumatic ophthalmia. Aconitum is sometimes required in the first place. Sulphur, preceded by, or alternated with Acon. is of nearly equal efficacy in some instances. Rummell, Allg. Horn. Zeit. No. 21, 32 Bd. f This remedy has been found exceedingly efficacious in the acute form of scrofulous ophthalmia, with ulceration of the cornea and disposition to staphyloma, hypopyon, &c.-Hygea, XIX. Band, 1 Heft. t For the description of an interesting cure of fungus hbematodes in the eye, vide "Brit. Jour. of Homceopathy," No. 2. DISEASES OF THE EYE. 653 WEEPING OR WATERY EYE (involzntary flow of tears). When this affection proceeds from an obstruction of the lachryimal duct, it must be treated by the remedies above enumerated; but when it merely consists in a relaxed condition of the glandular apparatus of the eye, with a superabundant secretion of tears (epiphorc), the subjoined remedies have been found successful: Eiphrasia, Spigelia, Paris. In other cases a selection may be made from amongst the following: Puls., Bromium (especially the right eye), SulpA., Eupkorb., Clematis, Sepia, Merc., Ferrumn, Zedum, Grcaphites, Phosph., Lycopod., Silicea, Acid. sulph., T]zja, VYeratrum,, Petrol., Bihs, Sabad., Digitalis, Nux v., &c. AEGYLOPS (Anc/Z ylops8). Against this sore, which has its seat immediately under the internal angle of the eye, Acidumn nitricum has chiefly been employed. (See also FISTULA LACHRYMALIS, of which this affection is now commonly considered to be a mere modification or only a certain stage.) BLOODSHOT EYE. This derangement may arise from a blow or fall, the act of retching, vomiting, or violent coughing, crying, &c. It presents a bright scarlet appearance in most instances at the commencement, but usually assumes a livid hue at a subsequent period. The affection generally disappears of itself; but as it is occasionally liable to prove exceedingly obstinate, absorption is materially facilitated, and the unsightliness removed by the internal and external employment of Arnicc. (See EXTERNAL INJURIES.) Belladonna, Lachesis, JNVux V., or Chamomilla may be required in certain cases. Against hemorrhage from the eyes, the following have hitherto been employed with the most success: Belladonna, Carbo vegetabilis, Chamomilla, and Nux v. SHIORT-SIGIIT, NEAR-SIGHTEDNESS (iJfyopia). The medicines which have been employed with the greatest effect in this affeclachrymalis by means of homoeopathic remedies administered internally. In the majority of cases, and particularly when on the right side, Petroleum proved efficacious. I could never enforce a cure with lower potencies when X (the 30th) failed. In addition to Petrol., Calcarea was sometimes useful, especially when given alternately with the former; in other cases, Ruta and Staphysagria, or Stannum and Pulsatilla. In some instances, Silicea did good-Constantine Hering. Arch., 3ter Bd., Istes Heft, p. 122. 654 DISEASES OF PARTICULAR ORGANS AND REGIONS. tion are: Pulsatilla, Sulphur, Oarbo v., Acid. phosph., Phosphorus, Conium, Acidum nitricum, Ammonium c., Anacardium, and Petroleum. Of these Pulsatilla and Sulphur have proved the most serviceable in the affection when occurring as a sequel of ophthalmia;-Acidum phosph., when resulting from typhus, or from a debilitating loss of fluids;-and Carbo v., Acidum nitricum, and Sulphur, when attributable to the effects of mercurial action. Against sudden attacks of blindness: Aconitum, followed by M3ercurius, Sulphur, and Silicea. Against blindness towards evening, Belladonna is the principal remedy, but in some cases, Veratrum will answer better. Should neither of these effect much improvement, Hyoscyamus may be administered. HORDEOLUM. STYE. DIAGNOSIS. This is a little hard tumor appearing like a small dark-red boil, generally in the corner of the eye, or upon the eyelids, attended with severe inflammation, and frequently causing fever, considerable pain and suffering. It suppurates slowly and imperfectly, and has no tendency to burst spontaneously. THERAPEUTICS. The two most valuable medicines in the treatment of this affection are Pulsatilla and Aconitum. PULSATILLA will, in most cases, suffice to remove the stye, if given on its first appearance. AcoNITUM. When inflammation runs high, attended with great pain, fever, and restlessness. In some instances, Staphysagria may be found useful to complete the cure, particularly when the swelling degenerates into a hard white tumor. In obstinate cases, Sep., Calc.; and in some scrofulous habits, Arsenicum, Sulphur, Lycopodium, &c., may be required. LIPPrrUDO (Blear-eyedness): Aconitum, Euphrasia, Mercurius, Pulsatilla, chiefly, but possibly also: Sulph, Calc., Kali, Lycopod., Sep., Staph., Silic., Phosph., iMJagn. c. et m., Cham., Carb. v., Cic. or Sars.,&c. Against BLEPHARITIS (inrfammation of the eyelids): Aconitum, Belladonna, Hepar, Pulsatilla, N2uex v., Ctamomilla, and Euphrasia have chiefly been employed with the most success in the acute form of the complaint; and Arsenicum, DISEASES OF THE EYE. 655 Sulph., Calcarea, Antimonium, Cinchona, &c., in the 'chronic variety. In INFLAMMATION OF THE MARGINS OF THE EYELIDS, or MEIBOMIAN GLANDS (ophthalmia tarsi): Belladonna, iMercurius, Hepar, Euphrasia, Nux r., Pulsatilla, Chamomilla, &c. CATARRHAL INFLAMMATION OF THE EYELIDS (inflammation of of the conjunctiva palpebrarum): Arsenicum,.fercurius, Hepar, chiefly. When the external surface of the eyelid is inflamed, Acon., Belladonna, Hepar sulphuris, and Sulphur are more particularly called for. ECTROPIUM. This affection consists in a retraction or eversion of the eyelids, owing to which circumstance their conjunctival tunic or internal surface is turned outwards. There are two species of the disorder: one occasioned by turgescence and relaxation of the lining of the eyelids, produced by violent inflammation; the other is caused by contractions of the skin covering the eyelids, or of that in the vicinity, induced by the cicatrices of confluent smallpox, burns, or wounds. In the former variety the morbid swelling not only pushes the margins of the eyelids from the ball, but renders them everted; in the latter the edges are primarily displaced to some distance from the eye, and afterwards turned entirely outwards, along with the whole of the affected eyelid. In both varieties the eyeball, from being exposed, and submitted to constant irritation, is rendered dry and inflamed, the tears escape over the cheeks, vision is impaired, and sometimes ulceration or opacity of the cornea surpervenes. The conjunctiva, from the same circumstance, becomes thickened, fleshy, and finally indurated. THERAPEUTICS. When ectropium arises from turgescence and relaxation of the palpebral lining, jfercurius and Iirepar sulphuris are often sufficient to effect a cure; but in other cases, Arsenicum, Sulphur, or Calcarea are required, particularly when the affection is met with, as it commonly is, in debilitated, unhealthy subjects. Belladonna, Euphrasia, China, &c., have also been found useful. When contraction of the skin has produced the complaint, the cure may be said to be only attainable by means of an operation. 656 DISEASES OF PARTICULAR ORGANS AND REGIONS. ENTROPIUM. TRICHIASIS. In this complaint the eyelashes and the margin of the eyelids are inverted towards the ball of the eye, and cause great pain and inflammation. When it has existed for a considerable time, the cornea is rendered opaque, prominent, and indurated, or ulceration and even complete loss of vision result. Relaxation of the skin of the eyelids, in consequence of previous chronic inflammation, disease of the meibomian glands, and the cicatrices of ulcerations, or wounds on the palpebral conjunctiva, form the general exciting causes of the disorder. THERAPEUTICS. Pulsatillc is one of the most servicable medicines in entropium, and is frequently sufficient to effect a cure. In other cases, Borax has been found useful. Belladonna, Mercurius, Hepar s., Euphrasia, and occasionally Nux v. and Chamomilla may also prove efficacious, particularly where the malady has originated in disease of the meibomian glands. When the contraction of cicatrices has given rise to the affection, it is to be remedied by cutting out as large a portion of the skin of the affected eyelid, opposite the centre of the entropium, as will be adequate, on the approximation of the lips of the wound, by means of adhesive plaster or a small suture, to replace the tarsus and cilise in their normal position. SWELLING OF THE LIPS (scrofulous): Bella. and fere. are two of the most useful remedies in this affection, when there is simultaneous retraction of the lip. If ulceration and incrustations accompany the disorder, Belladonna, Merc., Hepar, Sulphur, Staphysagria, Silicea, and Sepia. If there be tumefaction simply, Aurum, Mere., Bryonia, Belladonna, Hepar, Lachesis, Sulphur, and Calcarea, (See SCROFULA). ScHIRRus. Against indurations of this serious character, either in the face or lips, Bella., Conium, Sulphur, Silicea, Carbo a. et v., Phosph,. Staphysagria, and Magnesia m. are chiefly to be recommended; and the following against carcinomatous ulcerations (both internally and externally): Arsen., Lachesis, Clematis, Coniumr, Sulph., Silicea, Acid'an nitr., Aranea, Carbo v. et a., &c. WARTS on the face. Kali, Sepia, Dldcaamara, Thuja, Acidum nitricum, and Sulphur are, generally, the most useful. The employment of the knife or of caustic in such INFLAMMATION OF THE EARS AND EARACHE. 657 cases is highly improper, and often attended with the worst effects. Against these excrescences on other parts of the body, such as the hands, &c., Sulphur and Calcarea form two of the best remedies in cases of long standing; Zycopodium, when large, and intersected with deep clefts; when moist, Thuja, Acid. nit. and Sabina (externally and internally); Natrum, Sepia, and Rhus have also proved useful in some cases. INFLAMMATION OF THE EARS AND EARACHE. OTITIS. OTALGIA. OTITIS. DIAGNOSIS. Violent, frequently insupportable, pain in the ear, with sensibility, and even inflammation of the meatus auditorius, externus, and greater or less fever. The pain, when excessive, communicating with the whole head, may bring on delirium, or even inflammation of the brain. OTALGIA may either exist as the effect of otitis, or, if neglected, may pass on to inflammation; in many cases again, it may arise by sympathy from toothache, or declare itself as a purely neuralgic affection. THERAPEUTICS. The medicaments applicable to the majority of cases of these troublesome and painful disorders are Mercurius, Pulsatilla, Belladonna, JNux vomica, Arnica, Dulcamara, and Chamomilla, Hepar, Cinchona, Sulphur, &c. MERcuRIus. When the pain is attended with a sensation of coldness in the ears, and exacerbation of suffering in the warmth of the bed; shooting or tensive pains in the internal ear, extending to the cheeks and teeth; inflammation and induration of the ear, with soreness of the orifice, and discharge; swelling of the glands. When Mercurius affords only partial relief, a dose of Hepar s. will often subdue the remaining symptoms; but if a purulent discharge continue, accompanied by humming in the ear, and pricking pains, Sulphur will generally be found requisite. PULSATILLA is a most valuable remedy in this affection. It is particularly indicated when the external ear is much affected, and appears inflamed and swollen; attended with heat, shooting and tensive excoriating pain internally; moisture in the ear, or somewhat copious discharge. This medica42 658 DISEASES OF PARTICULAR ORGANS AND REGIONS. ment is particularly useful for females, and individuals of chilly habit. BELLADONNA, when there is determination of blood to the head, with redness of the face, digging, boring, tearing or shooting pains extending to the throat, fever, and extreme sensibility to the slightest noise; when the pains are more severe internally; also when the brain partakes of the irritation or inflammation, and delirium is present. (Ilepar is sometimes required after Belladonna to complete the cure in obstinate cases; and particularly when the inflammation has ended in suppuration.) Nux VOMIcA. When the pains are of a tearing, shooting nature, extending to the forehead, temples, and bones of the face, worse towards morning; dryness of the ear, particularly when the affection occurs in persons of a lively, choleric disposition. ASSAF(ETIDA. Burning, shooting pain, occurring in paroxysms, and proceeding from within outwards. ARNICA. In individuals of nervous, excitable temperament, subject to be attacked from slight causes; also, when great sensibility to noise is present. (Cinchona is often useful after Arnica, especially when the pains are aggravated by lying on, or touching the affected ear. In other cases, Sulphur will be found more efficacious, particularly when the sensibility is excessive.) DULCAMARA, when the affection has arisen from a chill or wetting, will, in many cases, prove sufficient for its removal; it is also indicated when the pains increase at night, and are,attended with nausea. CHAMOMILLA. When there are stabbing pains in the ear, as from knives; great sensibility to noise, or even to music,.extreme sensitiveness, susceptibility, and irritability. In external inflammation of the ear, Pulsatilla forms one of the most generally useful medicaments. Sulphur is also of frequent efficacy, especially after the previous employment of Pulsatilla; Calcarea is sometimes required after Sulphur. When the inflammation runs high, or threatens to extend to the face or scalp, Belladonna usually becomes requisite. Miercurius, 2Magnesia, and Boras sodce, have also been recommended in this form of otitis. Against chronic inflam INFLAMMATION OF THE EARS AND EARACHE. 659 mation, or scrofulous ulceration of the external ear, Merc., Iep., Puls., Lyc., Sulph., Alum., Kreos., Kali, Phosp)h., Stan., Calc., Baryta, etc., are the most useful. Against humming or buzzing in the ear, Nux v. will be found serviceable in recent cases, when the annoyance is worse in the morning; Puls., when in the evening; Dulc., when at night, or Mere. when accompanied by sweating. China, Carbo v., and Acid. nit., Hepar, Lach., etc., when the affection occurs in individuals who have taken mercury in large quantities. In chronic cases, Aur., Petrol., Sulph., Baryta c., Natr. in., Lye., Phosph., Sep., Con., etc., have been found useful; the last-named remedy particularly, when there is great sensibility to cold, and a tendency to suffer from rheumatic pains in the limbs. OTOREHEA. When this disorder results from acute inflammation of the ear, Puls., Sulph., and Merc. are the principal remedies. In chronic otorrhoea occurring after repercussed scabies, Cale. c., in repeated doses, has been found very efficacious.* CATARRHAL, or MUCOUS OTORRHX A: Bella., Merc., Puls., and Suaph., chiefly. PURULENT OTORRH(EA: 2ere., Puls., SulTh., Bella., and IHepar, or, Silic., Calc., Acid. nit., Assafostida, Lachesis, Petrol., etc. When the discharge is offensive, Hepar, Aur., Carbo v. Sulph., and Silicea. SANGUINEOUS OTORRIIEA: Merc., Puls., and Silic., also lach., Cicuta, etc. When the disorder has arisen from the abuse of mercury: IHepar s., Acid. nit., Aur., Assafoetida, Sulph., and Silic., have proved the most useful: and when over-doses of sulphur appear to have given rise to it, Puls. and MAer. When we have reason to apprehend caries of the ossicula auditoria: Slic., Sulph., Aur., and Natr. m., are the remedies from which we may hope to obtain the most assistance. Against the effects of suppressed otorrhcea: Bella., Puls., and Merc.; and, in some cases, NVux., Bryonia, or Dale. may be selected, according to circumstances. Bella. and Bryonia chiefly when there is fever, headache, or unequivocal signs of cerebral irritation: M ferc., Bella., and Puls., followed, * Dr. Maly. IHygea, XX. Bd., 2tes Hteft. 660 DISEASES OF PARTICULAR ORGANS AND REGIONS. if required, by Sulph., Cale., and Ilepar, when the glands of the neck or the parotids become tumefied. When orchitis results: Puls. and Nux v., or Mere. In DYSECOIA, or DEAFNESS, the following remedies have chiefly been employed with the most success: Puls., 2ere., Sulph., Calc., Caustic., Graph., ledum, Acid. nit., Phosph., Petrol., Ammonium c., etc. For CONGESTIVE DEAFNESS: Bella., Hyosciamus, Sulphur, Silic., Mere., Graph., Phosph., etc., have more particularly been recommended. NERVOUS DEAFNESS: Causticum, Petrol., Phosph., Acid. phosph., etc. CATARRHAL, or RHEUMATIC DEAFNESS: leTrc., Auls., Arsen., Bella., Zedum; or, Sulph., Calc., Hepar, Zachesis, Acid. nit., Cham., and Cofea. DEAFNESS from the repercussion of eruptions: Sulph. and Antimon.; or, Caustic., Graph., etc. When deafness occurs as a sequel of measles, Puls. is one of the most useful remedies; in other cases, Carbo v. will be found requisite. When it results from SCARLATINA: Bella. and IIepar; and when it is produced by SMALLPOX: Mer. and Sulph. DEAFNESS from the abuse of Mlerc. is generally capable of being removed, or materially relieved by Acid. nit., Staphysagria, Assafetida, or Aur.; Ilepar s., Petrol., or Sulph. When the disorder is attributable to hypertrophy of the amygdalae, Aur., Merc., Acid. nit., and Staphysagria have principally been recommended. When it comes on as a sequel of fevers, or other disorders, particularly of a nervous character, Phosph., Phosphoric acid, Veratrum and Arnica; and when it occurs as a result of a suddenly checked discharge from the nose or ears, Hepar, Lachesis, and Ledum; and also, Bella., Merc., and Puls., have generally been found the most appropriate. BLEEDING OF THE NOSE. EPISTAXIS. Bleeding of the nose often appears at the termination of many diseases, such as fevers, epilepsy, etc., and is, in such instances, salutary; it also frequently relieves or cures headache, vertigo, etc., and ought therefore not to be interfered with, unless it be excessive, last too long, recur too frequently, BLEEDING OF THE NOSE. 661 or take place under a debilitated state of the system. The attack is occasionally preceded by a degree of quickness of the pulse, flushing of the face, throbbing in the temporal arteries, confusion or dimness of sight, heat and itching in the nostrils, and other signs of congestion. The remedies usually required are, Aconitum, Arnica montana, Belladonna, Bryonia, Cinchona, Pulsatilla, Mfercurius, 2hus toxicodendron, Secale cornutum; or, Oarbo vegetabilis, Graphites, iMagnes artificialis, Ammonium muriaticum, Ferrum, Kali, Sepia, Sulphur, Calcarea, Acidum nitricum, Baryta, Bovista, Grocus, Conium, Oina, &c. When the bleeding is excessive, Acon., Arn., Bellad., Oin., Merc., Puls., Rhus, or Sec., are the most useful. When the hemorrhage arises from congestion in the head, a preference may be given to Acon., Bellad., Cin., Crocus, Con., or to Graph., JRhus, Chamom., Alum, &c. When from being overheated, or in consequence of indulging to excess in spirituous liquors, &c., Nux vomnica, or Acon., Bellad., Bryonia, Thuja. EPISTAXIs in females, who have too scanty catamenia: Puls., Graph., Caust., Sep., or Sec. In those, on the contrary, who have too copious a menstrual discharge: Acon., Calc., Croc., Sabina. In debilitated subjects, or those who have previously been exhausted by loss of humors: China chiefly, or Ferrum, Sec., and Ac. nitr. In consequence of physical exertion: ]hus, or Arnica principally. In consequence of a blow or contusion: Arnica. Bleeding from the nose in children, arising from worms: Cina or Mere. Accompanying every attack of coryza: Pulsatilla, or Arsenicum. When nasal hemorrhage is liable to occur from the most trivial cause: Sulphur, Silicea, Sepia, Calcarea, and Carbo v., and in some cases, Graphites and Zycopodium, are the best remedies to eradicate the constitutional tendency. The following are characteristic indications for some of th< above remedies: 662 DISEASES OF PARTICULAR ORGANS AND REGIONS. AcONITUM. Prolonged or violent bleeding at the nose, in plethoric subjects, with a considerable degree of fever, flushing of the face, pulsation of the temporal and carotid arteries, or general fulness of the vessels of the head. BELLADONNA is frequently of the greatest service, after, or in alternation with, the above remedy, but also when there is bleeding from the nose at night, which awakens the patient from sleep, and sometimes returns in the morning; bleeding from the nose from being overheated. (See Bryonia and JBhus.) BRYONIA, bleeding from the nose, chiefly in the morning, or at night during sleep, causing the patient to awake; or when it arises from suppressed menstruation; or from overheating during warm weather; obstinate or irritable disposition. MERCURIUS, bleeding of the nose during sleep, or while coughing, with speedy coagulation, so that the blood hangs in clots at the nostrils: or when the affection is preceded by a sensation of tightness round the head, as if it were bound. CARBo v. Bleeding at the nose during the night, with ebullition of blood; violent nasal hemorrhage in the morning while in bed, followed by pain in the chest; discharge of a few drops of blood from the nose every forenoon; excessive bleeding from the nose several times a day, particularly after stooping, or after every exertion, preceded and followed by great paleness of the face. (See ]Rhus.) GRAPHITES. Bleeding of the nose towards night, with heat in the face, preceded by determination of blood to the head in the after part of the day, particularly in females who have scanty catamenia. (See Pulsatilla and Causticum.) PULSATILLA. Hemorrhage from the nose every afternoon, evening, or before midnight, especially in females with suppressed or scanty catamenia, or in those of a mild and placid disposition. CALCAREA. Violent bleeding at the nose, chiefly in plethoric, lymphatic persons; or in females in whom the menstrual flux returns too early, and is excessively copious. MAGNES ARTIFICIALIS. Bleeding from the nose, particularly in the afternoon, preceded by aching and weight or pressure at the forehead; protracted bleeding after blowing the nose. ARNICA, in addition to being the principal medicine in BLEEDING OF THE NOSE. 663 violent nasal hemorrhage from external injury, or from great physical exertion, is, moreover, an important remedy in all cases in which the hemorrhage is preceded by itching in the nose and forehead; and when the nose feels hot, and the blood discharged is red and liquid. RHUS. Bleeding of the nose from physical exertion, such as lifting a heavy weight, or, when blowing the nose, spitting, &c., or nasal hemorrhage which becomes aggravated or renewed on stooping, or during the night. FERRUM. Nasal hemorrhage in debilitated subjects, with excessive paleness of the face. (Especially after China.) SEPIA. Frequent attacks of hemorrhage from the nose, with pale or sallow complexion, especially in females with obstructed catamenia. Sulphur, either alone or in alternation with Sepia, and sometimes Carbo vegetabilis, Graphites, and Lycopodium, is of great service in removing a susceptibility to this affection. (See also the remedies enumerated under Nasal hemorrhage from the most trivial cause. Nux v. Bleeding of the nose, especially in the morning, from being overheated, or after drinking wine, &c., or in habitual drunkards. (Lachesis and Calcarea carbonica are sometimes requisite here, in addition to Nux v.) DULCAMARA. Bleeding at the nose after getting the feet wet; flow of hot, clear blood from the nose. CRocus. Discharge of dark-colored, thick, or viscous blood from the nose, particularly in females who menstruate too copiously, sometimes followed by fainting. Moscnus. Frequently serviceable when the nasal hemorrhage occurs in nervous, hysterical females. AMMONIUA c. Bleeding from the nose after a meal. SILICEA. Nasal hemorrhage in scrofulous subjects. When the hemorrhage is of an active kind, the patient should be placed in the erect posture, and kept cool and quiet for some time afterwards. The diet in all cases must be low and unstimulating. When there is reason to fear suffocation from the bleeding continuing inwardly, and getting into the throat, as is liable to happen in extremely debilitated subjects, in whom little or no reaction appears to follow the administration of the remedies, the anterior and posterior outlets from the nose may be 664 DISEASES OF PARTICULAR ORGANS AND REGIONS. plugged; the latter by passing threads up the nostrils and bringing them out at the mouth, then securing pieces of sponge, or small rolls of lint to the ends; after this the threads should be drawn back and tied sufficiently tight, so as to bring the plugs somewhat firmly against the orifices. Sprinkling or dashing cold water on the face, exposing the face to a current of cold air; placing the feet or hands in warm water; applying a wet cloth round the abdomen, and even dipping the head into a pail of iced water, or salt and water, are among the best of popular means, or occasional auxiliary modes of stopping an excessive or prolonged discharge of blood from the nose. With regard to the administration of the remedies, the repetition of the dose, if called for, must depend upon the greater or less degree of the severity of the attack. We ought to be in no hurry to repeat in the majority of cases. (See also what has been said on this matter in the INTRODUCTION.) SWELLING OF THE NOSE. The remedies for this as well as all other maladies must be selected according to the cause, where known. Thus, if the affection has arisen from a contusion, Arnica (externally and internally) must be prescribed. If the disorder is encountered in scrofulous subjects, one or more of the following must be had recourse to: Aurum or Assafcstida; or Sulphur, followed by Calcarea; or Bellad., followed by Merc. and Hepar s. When the disease has been excited by the abuse of Mercury: Hepar s., Acid. nitr., Aurum, Bellad., or Sulph. will be found the most efficacious. When attributable to the habitual use of spirituous liquors Calc., Arsen., Nuwx v., Puls., Sulph., or lach., Bellad., Merc., Hepar s. Finally, Bellad., Mere., and Hepar have been found most serviceable in cases where the tumefaction was red and very painful; in similar cases of an obstinate character: Bry., Sulph., Calc., and Rhus have proved efficacious. When there are, moreover, incrustations in the nose, Silicea, Sepia, Carbo v., and Natrum m., are the most appropriate remedies. Redness of the point of the nose, Calc., Carbo animalis, or iRhus toxicodendron. Coppery redness, Arsen. and Cannabis, &c. SWELLING OF THE NOSE. 665 Acne rosacea: Lach., ]hus, Cic., Led., Ruta, Sepia; or Ars., Calc., ]Ereos., Aur., Carbo v. et a., Canth., Hep., Caust., Thuja, Acid. nit., &c. Against swelling of the interior of the nose (Schneiderian membrane), Teucrium marum verum especially; but also Staph., Phosph., Calc., Sep., Sil., Sulph. These remedies, together with Stannum, Aurum, and Kreosotum have likewise been employed with success against nasal polypi. In CARIES of the bones of the nose, whether of a scrofulous or mercurial origin, Aurum is the most important remedy. When of syphilitic origin, iercurius is to be preferred, provided the patient has not already been placed under an injurious course of that powerful medicine, in which case the affection is as likely to have arisen from the remedy as from the disease, and will consequently require to be combated by anti-mercurial medicines, among which Aurum will in this instance form the most valuable remedial agent; the other general antidotes to the injurious effects of mercury on the constitution, such as Hepar s., Acid. nitr., Sulphur, and Calcarea; or, Zachesis, Carbo v., Stcph., Lycopodium, Assafcetida, Acid. phosph., Silicea, &c., may, in some cases, become necessary, particularly when the system generally has become impaired by the cause in question. (See OSTITIS.) Oz.ENA. This disorder consists of an ulcer, having its site in the nose, from which a fetid purulent matter is discharged. It usually commences with slight inflammation and tumefaction about the alae nasi, accompanied with sneezing, increased flow of mucus, with which the nostril becomes obstructed, and sometimes slight hemorrhage. The ulceration soon spreads from the Schneiderian membrane to the nasal cartilages, the mucus gradually assumes the nature of pus, and if the disease be not checked, the bones become implicated, and caries results; a thin, acrid, offensive matter or sanies is then constantly discharged, and often excoriates the lips and throat, and the sense of smelling becomes abolished; eventually the ossa spongiosa inferior, and also the vomer, and in the worst cases-particularly when there is complication with scrofulous and venereal or mercurial disease-even the palate and superior maxillary bones exfoliate, the bridge of the nose falls in, and leaves a frightful deformity of countenance. 666 DISEASES OF PARTICULAR ORGANS AND REGIONS. THERAPEUTICS. The remedies which have chiefly been employed in this malignant disease are: Teucrium marum verum, Pulsatilla, Sulphur, Calcarea; Jagnes m., Bryonia, Belladonna, Lachesi8, Lycopod., Natrum m., Caust., in the first stage, with mucous obstruction; Mere. and Aurum in the second, with discharge of pus, and also affection of the bones; followed, if required, in OZXENA SCROFULOSA, by Sulph., Silicea, Acidum? nitricum, Phosph., Conium, or Potassce bich. In SYPHILITIC OZJENA, 3fere. forms the principal remedy; but if the patient has already been subjected to an injurious course of that medicine, Aurum is to be preferred, and succeeded, if requisite, by Acidun nitricum, Ilepar s., Assafcetida, Zachesis, Conium, or Thuja. In disease in the antrum higzmorianum, the following have been recommended: -Teucrium marum verum, Arsen., ycopod., Sulph., Silex, Aurum, iMerc., Ilepar s., Mlezereum, Staph., Carbo v., Antimonium c., Kali hiydr., Phosph.; and Spigelia, Nux, China, Phosph., as palliatives when the pains are very severe.Y CANCER NASI. Arsenicum, Carbo v., Auzrum, Sepia, Silicea, Sulph. and Calcarea, are the remedies which have principally been pointed out as the most appropriate to combat this serious and frightful malady. CANKER OF THE MOUTH. SCURVY IN THE MOUTH. Cancrum Oris. Gangrena Oris. Stomacace. This affection consists of a fetor in the mouth, with a viscid, bloody discharge from the gums, which are at the same time hot, red, tumid, spongy, very sensitive, retracted from the teeth, and subsequently ulcerated along their margins. Sometimes there are also glandular swellings, salivation, or ptyalism; and usually looseness of the teeth, impeded mastication and deglutition, great debility, and slow fever. * Goullon considers Arsenicum and Lycopodium as almost specific in this disease. He recommends Arsenicum to be given when the pains are excessively severe, of a throbbing and splitting, or bursting description, when at their height. Lycopodium when there is a thick and yellow discharge.-A.H. Z. 2, 24. CANKER OF THE MOUTH. 66-7 THERAPEUTICS. Miercurius is the most useful remedy here, and may generally form the first prescription in almost every case of the kind, as it will rarely fail to prove serviceable, if not sufficient to effect a perfect cure. When, however, we have reason to conclude that the symptoms above described have in reality been created by the injurious employment of mercury, under allopathic treatment, it will be necessary to have recourse to the appropriate antidotes to that powerful mineral, amongst which Carbo v. will be found of primary importance; should the improvement effected by Carbo v. be only of a partial character, the treatment must be followed up by Ilepar s. and Acid. nitr. alternately; or by Staph., if fungous excrescences form on the gums. Carbo v. is, moreover, of great service when the disorder has arisen from unwholesome food, the daily use of kitchen salt in excess, or the prolonged use of salt meat; when the gums smell most offensively, and bleed during mastication; the teeth loose, mouth hot, tongue much excoriated, and moved with difficulty. After the employment of Carbo v. we may have recourse to Arsen., if the ulceration continues extensive, and the patient complains of burning pains in the gums, with great prostration of strength; or Arsen. and China in alternation, if, in addition to the foregoing symptoms, the gums present a black, spongy, and somewhat gangrenous appearance. Nux v. is an admirable remedy in this disorder, particularly when it occurs in meagre, dark-complexioned subjects, of bilious temperament and choleric disposition, who lead a sedentary life; the gums presenting a putrid aspect, and so much swollen as completely to cover the teeth; countenance pale and sunken. CAPSICUM has been found useful, under nearly similar circumstances, the affected party being, moreover, of a plethoric habit and phlegmatic temperament. DULCAMARA may be used with advantage after Merc., when the glands of the throat are implicated in the derangement; * Constantine Hering recommends a drop of Spiritus actheris nitrosi once or twice a day, in the event of Carbo v. or Arsenicum failing to bring about a favorable action in such cases. 668 DISEASES OF PARTICULAR ORGANS AND REGIONS. or it may be selected in preference to 2ferc., when the disease is prone to be excited by the least exposure to cold, during damp, or cold, raw, wet weather. NATRUM Al. is frequently a valuable remedy in completing the cure after the administrtion of Carbo v., Acid. nitr., Hepar, &c. It is more especially indicated when the ulcers are indolent, and do not put on a healing aspect; the gums being at the same time much swollen, very sensitive to heat or cold, and disposed to bleed at the slightest touch; moreover, when painful vesicles or blisters are observed on the tongue, inner surface of the lips, and cheeks, which impede speech, and, together with the irritable gums, render the act of mastication a work of labor and excessive torture. When, notwithstanding the employment of the last-mentioned remedy, the complaint seems disposed to linger, Sulph. may be prescribed, and followed or alternated with Acid. sulph., Sepia, or any of the other medicines already treated of, if required by the bent of the succeeding changes in the features of the case, &c. Silic., Sub-boras sodce, Ifelleb. and fodium may also prove useful in some cases. Lemon-juice, which is well known as a most valuable remedy in scurvy, is equally useful as a dowestic remedy in stomacace; but its use must be discontinued during the employment of the above medicaments. Sage is equally useful in some varieties of the disorder. Rinsing the mouth with brandy has also been found of service. The use of wholesome, easily digested food, with a due proportion of vegetables, must be enjoined in order to expedite the cure. SCURVY. SCORBUTUS. This disorder is characterized by excessive debility, pale and bloated countenance: cedematous swelling of the inferior extremities; hemorrhages; livid spots on the skin, or foul ulcers; offensive urine, and extremely fetid stools. The gums are spongy, or otherwise diseased, as described in the preceding article. It chiefly affects sailors, or others who from circumstances are deprived of fresh provisions and an adequate quantity SCURVY. 669 of ascescent food, and are exposed to cold and moisture, together with fatigue. Intemperance, want of exercise, impure air, uncleanliness, with depressing emotions, further tend to predispose to the disease, when combined with unwholesome food, or the aforesaid alimentary deficiency. In the cure, as also the prevention of this malady, it is requisite, in the first place, to remove the probable causes of its invasion, where that is practicable; and to supply the patient, if possible, with wholesome diet, fresh vegetables, and those fruits which furnish citric acid, such as lemon, the juice of which made into a drink forms an invaluable remedy. Sourkraut, and other substances which have undergone the acetous fermentation, cider, spruce-beer, and the like, as also vinegar, have been likewise recommended. The homceopathic medicines which may be prescribed with the most advantage against the ulcers and diseased gums are, Carbo v., Nux., Arsen., Merc., Staphysa. and Sulph.; or also Acid. nitr., Cistus, Nat. m., Ammon. c. et m., Dulc., Kreosotum, Acid. mur., Sepia, &c. (See the preceding article, and also that on ULcERS.) The use of lemon or lime-juice and other acids must be discontinued during the employment of the above remedies. GUMBOIL (Parulis). Silic., Staphysag., and Cale., but particularly the first, are the principal remedies against this affection. When there is much inflammation and considerable swelling, Bella. may be prescribed, followed by -Merc. and Hepar sulph., if little relief is obtained from its use. Nux V., Puls., and Sulph. are sometimes very useful. In swelling of the jaw, with suppuration, whether in consequence of carious teeth, or the unskilful abstraction of a tooth, Silic. is the most important remedy. In gumboil from irritation, arising from the cutting of the wisdom-teeth, Acon. and Calc. are useful; as also Bella., Arnica, and Cham., particularly when there is considerable inflammation with swelling of the face, &c. Against hemorrhage from the gums Staphysa. is one of the principal remedies. 2eri.c. is also a good remedy in such cases, especially when the gums are painful, swollen, spongy, and jagged at the margins; but when the foregoing abnormal state of the gums has evidently originated in the abuse of 670 DISEASES OF PARTICULAR ORGANS AND REGIONS..ierc., they must be combated by such remedies as Carbo v., China, or Hepar s., Acid. nitr., &c. Acid. phosph. is another important remedy in bleeding from the gums, especially when it is readily excited by touching or rubbing the gums, and when the gums feel as if excoriated. Alumina, Sepia, Nat. mn., Silic., Lycopodium, Kali c., Acid. sulph., Rhus, Ambra, and Ruta may also be enumerated as useful remedies in affections of the gums, such as ulceration, &c., with tendency to bleeding from the most trivial cause. In the case of morbid growths or excrescences on the gums, Staphysa. is deserving of notice. INFLAMMATION OF THE TONGUE. GLOSSITIS. DIAGNOSIS. Tumefaction, with heat and redness of the tongue, the swelling is sometimes so great as to fill the whole cavity of the mouth, rendering swallowing impossible, and threatening suffocation; unless resolution takes place, it may terminate in induration, suppuration, or gangrene. CAUSES. Besides a general strumous habit, local injuries, acrid substances, rheumatism, catarrh, and metastasis. THERAPEUTICS. The following medicines will be found most appropriate in the treatment of this affection, according to the exciting cause: Arnica montana, Urtica urens, Mierc., Acon., Bella., Puls., Zachesis, and Arsenicnm. ARNICA, in cases of lesion of the tongue from the points of decayed teeth, &c., or of burns or scalds. (Acid. phosph. is occasionally required after, or may, in severe cases, be given in preference to Arnica: in other instances, Silic. and Sulph. will be required to complete the cure.) URTICA URENS has been recommended in preference to Arnica in burns and scalds of the tongue and mouth. MERCURIUS is almost specific when glossitis presents itself in the form of a disease of the tongue, attended with excessive inflammatory swelling or induration. AcoNITUM may, with advantage, precede the above remedy, should the inflammation be very intense. BELLADONNA. When the affection does not speedily yield to Jferc., or when the inflammation is of an erysipelatous or active phlegmonous nature. After the inflammation has abated we may, in many cases, return to i/erc. INFLAMMATION OF THE TONGUE. 671 PULSATILLA has been found useful in cases arising from suppressed hemorrhoidal and arthritic affections. Against indications of threatening gangrene, Arsen. and -Lachesis are the principal remedies. They may both be given, and repeated according to results. In some rare cases when, from great tumefaction of the tongue, suffocation threatens, it may be found necessary to have recourse to longitudinal incisions; and after having thus warded off the more pressing danger, exhibit Cinchona, and then fall back upon the more specific remedies. In some extreme cases of this nature, where the disease has made head before the arrival of professional assistance, it may be found necessary to resort to tracheotomy. This is, however, a dangerous mode of relief, from the risk of consequent tracheal inflammation; but when it should be found absolutely necessary, we may, by the exhibition of Arnica, two globules, internally, and also in the form of lotion-in the proportion of four minims of the mother tincture to a hundred of water, materially diminish the danger of so serious a result. Such cases will, however, rarely, if ever, occur to the homoeopathic practitioner, if the disease be taken in time, and the remedies judiciously selected. In cases of soreness or ulceration of the tongue, Merc., Nux v., Ars., Carbo v., Sulph., Ac. nitr., Acid. sulph., Natr. m., Acid. fluor., Silic., and Staph., are the most effective remedies. Against RANULA, or the formation of an inflammatory or indolent tumor under the tongue, in consequence of obstruction of the salivary ducts from cold, inflammation or other irritating causes, iMercurius, Calc., and Th'ja have chiefly been employed. In some cases, one or more of the following remedies may be requisite for the removal of the obstruction, after the tumor has burst, and left the usual obstinate ulcer behind: Petroleum, Sul2p., Silicea, Puls., Stann., or Staph., provided Mercurius or Calc. should not be more appropriate in this stage of the disease likewise. When the tumor is of an inflammatory nature, Merc. and Silicea may generally be resorted to. 672 DISEASES OF PARTICULAR ORGANS AND REGIONS. OFFENSIVE BREATH. The most frequent causes of this unpleasant affection are, uncleanliness, leaving particles of food in the teeth; an accumulation of tartar; carious teeth; a diseased state of the gums; aphthae in the mouth; derangement of the stomach; or an abuse of mercury. THERAPEUTICS. When there is reason to suppose that the first-named circumstance is the chief cause of the complaint, its removal will be readily effected by proper attention, rinsing the mouth with tepid water, and brushing the teeth with a moderately hard brush. night and morning, as also after every meal. When attributable to the second cause, a dentist of known skill and respectability ought to be consulted. Lastly, when the annoyance can be traced to any of the remaining sources enumerated, the remedies given under these different headings should be had recourse to. When, on the other hand, no apparent cause of the derangement can be assigned or detected, benefit will often be derived from one or more of the following medicines: Nux v., Silicea, Pulsatilla, Sulph., and Chamomilla; or Arnica, Bellad., Hyos., &c. If the heaviness or fetor of the breath is chiefly perceptible in the morning, Nux v. and Silicea will frequently be found successful in affording relief. Arnica, Bellad., and Sulph. have also proved effectual in similar cases. If after a meal, Nux v. succeeded by Chamomilla and Sulph. If in the evening, or during the night, Puls. or Sudph. Mercurius, Bryonia, Arsen., Hyos., Agaricus, Ambra, Carbo v. et a., Sepia, Lycopod., &c., may also prove useful in particular cases. In young girls at the age of puberty, Aurum is often the most appropriate medicine; but occasionally, Pals., Sepia, Bellad., or Hyos. will be found preferable here. When the abuse of Mercury has evidently been the cause of the evil, Aurum, Carbo v., Lach., Sulph., Hepar, Bellad., or Acid. nitric., &c., will be found the most suitable remedies. DERBYSHIRE NECK. 673 CRAMP IN THE LEGS. Veratrum, N., puxhur, Ct., Lycopodiunm, Acid. nitric., Sepia, Camphora, Argilla, Colocynth, and thus are amongst the best remedies for cramps in the calves of the legs. Veratrum has been recommended as one of the most useful medicaments for eradicating the tendency to frequent returns of this painful and troublesome disorder, succeeded by Sulphur, and Colocynth, should it not suffice to effect a cure. Ahus, when the attacks occur during the day when sitting, as well as at night; Sepia, ILyco2ood., and Acid. nitr., when the affection is experienced chiefly in walking. Sulphur, after Nux v., or Rhus, when the attacks occur chiefly during the night. Calcarea when stretching out the limb brings on the cramp. Argilla, in cramps which arise on crossing the legs, or even on descending stairs. Colocynth is frequently beneficial, when stiffness and pain are always experienced in the limb for some time after the attack. BRONCHOCELE. GOITRE. DERBYSHIRE NECK. This disfigurement arises from a tumefied state of the glandula thyroides. As the enlargement increases, it is productive of a considerable degree of obstruction to free inspiration, from the pressure which it exerts against the windpipe. The disorder is most frequently encountered amongst the inhabitants of mountainous districts. Women are more prone to be afflicted with it than men, and particularly those who have suffered from severe labors. An inherent constitutional taint seems to be the chief predisposing cause. In the treatment of the affection, Spongia marina has generally been found the most useful remedy, administered in repeated doses. In cases of long standing, one or more of the following remedies may prove of service in materially diminishing the size of the tumor, if not sufficient to disperse it entire'y. Calcarea, Carbo v., StapJ)ysagria, Lycopodium, lod., Ammon. c., and NVatrum c. et m. Or Ferrum, Sepia, Thiuja, particularly when the superficial veins of the swelling are in a varicose and painful state, and Carbo v. or Zycopod. fail to effect any amendment. When, either from 43 674 DISEASES OF PARTICULAR ORGANS AND REGIONS. exposure to cold or otherwise, the thyroid gland has become slightly tumefied, and there is at the same time redness of the integuments over and around the swelling, attended with impeded deglutition, violent headache, cough, and a considerable degree of fever, a dose or two of Belladonna, at intervals of twelve hours, will act beneficially; should the accompanying fever become intense Aconitum may be resorted to. If, on the other hand, there be no discoloration of the surrounding skin, and the fever be of a less active character, 3fercurius should be prescribed. When symptoms of suppuration have set in, iifercurius is still called for, and should then be administered every four to six hours, in order to forward the bursting of the abscess. Silicea is sometimes required, if the suppurative process proceeds very tardily. When the tumefied gland does not disperse under the action of Bella. or I3Terc. or when it has already become indurated before medical aid has been sought, Spongia, Natrumr Conium, Sul/lzur-^, and Calcarea are amongst the most useful remedial agents. SWEATING FEET. Some individuals are much troubled with a disagreeable, clammy sweating of the feet, to such an extent as to render it necessary to change the stockings several times daily. This evil is, moreover, a source of extreme annoyance to others, from the offensive odor which is usually exhaled at the same time. The utmost attention to cleanliness is insufficient to remedy the complaint; and to attempt to suppress the secretion by cold water, or powerful astringents, is highly culpable, from the dangerous consequences which are liable to ensue from producing a sudden suppression. Amongst the homceopathic remedies by which a safe and permanent cure has most frequently been brought about, Silicea and PIus toxicodendron merit priority of notice. A few globules of the former may be taken every four days, for a fortnight or three weeks; at the expiration of which period, a few days may be allowed to elapse, and if improvement then set in, the medicine may be continued, at intervals of increasing length, until the cure is effected. But should no melioration result, Silicea may be had recourse to in the same manner. After 676 DISEASES OF PARTICULAR ORGANS AND REGIONS. (often for the express purpose of warding off inclination to sleep), also weakness of the digestive functions, are frequent causes of sleeplessness. Under such circumstances, Nux v. will generally be found the most appropriate remedy; but, unless the acquired habits above detailed are given up, or materially altered, no permanent benefit can be expected from the employment of the remedy referred to. Overloading the stomach, particularly towards night, with the habitual employment of stimulating, or rich, indigestible food, form additional fertile sources of disturbed sleep, which can only be obviated by the observance of a more simple mode of living. The attainment of the desired relief may, however, be considerably forwarded by means of a dose or two of Pulsatilla. Mental emotions often originate sleeplessness. When excessive joy is the excitable cause, Cofea is a useful remedy. When the affection arises from dejection, caused by grief, unpleasant ideas, vexation, &c., Ignatia. If it be attributable to fear, or fright, or when the sleep is disturbed by fantastic or frightful visions, Opium, followed, if required, by Bella. in the latter instance; and when anxious, annoying, or agitating events disturb or retard sleep, Aconitum. Sleeplessness arising from nervous excitement in sensitive or irritable subjects will often yield to Iyoscyamus; or to Bell., when there exists a strong but ineffectual desire to obtain sleep. The latter medicine is further indicated when agitation or anguish, with frightful visions, timidity or terror, apprehension of real objects, &c., are complained of; or when the sleep is disturbed by frequent starting, and is attended with extreme sleeplessness early in the evening, or towards morning. MoscHUS is a useful remedy in sleeplessness occurring in hysterical or hypochondriacal individuals, arising from nervous excitement. Acid. phosph. and Sepia are also occasionally useful in such cases. Sleeplessness in old people can scarcely be considered a disease. But when it occurs in children, it almost invariably arises from some bodily ailment, which ought to be attended to and removed without delay, if practicable, as deprivation of sleep is more detrimental during infancy and childhood SLEEPLESSNESS. 671 than at any other period of life. (See SLEEPLESSNESS IN CHILDREN, Part III.) Coldness of the feet is a frequent cause of retarded or disturbed sleep. Daily exercise in the open air is here, as in most other cases, to be recommended; also gentle and general friction, when there is, at the same time, chilliness or stiffness of the limbs. The application of a vessel containing hot water to the feet is the only mode of obtaining any refreshing sleep in some cases, when coldness of the feet is the disturbing cause. This languid state of the circulation is often capable of being permanently removed by means of homoeopathic remedies, combined with frequent bathing of the feet in cold water, and appropriate exercise. Ammon. m. and Carbo v. et a., as also Graph., Kali c., Nux v., Lyc. or Szlph., &c., will generally be found the best adapted to the attainment of this object. When the digestion is in a deranged state, the remedies noted under DYSPEPSIA must be resorted to. When, on the other hand, sleep is prevented or retarded by burning heat in the feet, Lackesis, and, in other cases, Puls., Acid. plosplzoricum, Stannum, Lycopodium, Kali c., Sepia, or Secale c., &c., must be selected. Sleeplessness from a harsh, dry, and imperspirable state of the skin, may be remedied, after the removal of the said cause, when not impracticable from too long continuance, &c., by means of Graphites, Natrum c., Silicea, Sepia, Acid. nitr., or Oalcarea, &c. Sleeplessness and other derangements resulting from tea, require the employment of the antidotes to that drug for their removal. Of these, Cinchona will usually prove the best; should it not be adequate to effect the purpose required, Ferrum will often succeed. (Cofea is to be preferred in sleeplessness, or other more serious cases of indisposition arising from green tea; but it must be followed by the exhibition of incliona, if relief is not soon obtained.) When coffee is the originating cause of the affection, 3Nux v., as has been already remarked, is the principal remedy; on other occasions Chamomilla will be required, particularly when sleeplessness and other sufferings, such as headache, colic, &c., occur in nervous, highly excitable, and irritable subjects, 678 DISEASES OF PARTICULAR ORGANS AND REGIONS. who are extremely impatient under sufferings even of a description that would be deemed trivial by ordinary people. Ignatia, particularly in the case of mild, sensitive, or changeable dispositions. Cocculus, in nearly similar circumstances to those described under Chamomilla, with the distinction of a sensation of emptiness or lightness in the head. When sleep is prevented, disturbed, or accompanied by the symptoms hereafter noted, the remedies mentioned will be more or less indicated, and must be selected according to the entire group of symptoms. ACHING pains in the body (sleep disturbed by): Lyc., Mang., Phosph. ac., Merc.,-Am. m., Anac., Aur., Bary. c., Lach. ANXIETY (sleep disturbed or prevented by): Ars., Bella., Ferr., Kali, Op., Petr., Rhus, Veratr., Cale., Carbo v., Cham., Mere., Hep., Phosph., Puls., N-ux v., Sulph., &c., ARMS, heaviness in the (sleep disturbed by a feeling of: Diadema. AGITATED sleep: Nux v., Zed., Ac. nitr., Oleand., Sulph., Zinc. ARMS, swelling, enlargement of the (sensation of): Diadema. BACK, pain in the: Am. m. BULIMY: Cinchona, Bry., Phosph., Sel., Sulph. BURNING heat in the blood-vessels: Arsenicum. CARPHOLOGIA (during sleep): Op., Bella., Hyos., Cocc., Ars., Phosph., Phosph. ac., Rhus, Strain. CHEST, pain in the (aching and oppression): Alum., Am. c., Am. m. COLDNESS or shivering: Alum., Amb., Am. m., Carbo v. et a., Graph., Kali, Nux, Sulph., Merc., Arg., Ars., Staph., Calc., Acid. m., Arg., &c. COLDNESS, sensation of, during sleep: Ambra. CONGESTION in the chest during sleep: Puls. COLIC: Lyc., Plum., Sep., Sta ph., Acon., Amb., Am. c., Am. mn., Kali, Magn., 1Kagn. s., Ac. nitr., RJhus, Ars., Aur., Merc., Nux mos., Puls., Sulph., Ac. sulph., Fer., &c. CONVULSIONS: Cin., Cup., Hyos., Calc., Lyc.,.erc., Op., Puls., Sec. c. CRAMPS (in the calves of the legs): Anac., Kali c., JRhus, Sulph., Nux v., Lye., Bry., Carbo v., Cham., Mlagn., Magn. nm., Sep., Staph., Veratr., &c. (See JERKING.) SLEEPLESSNESS. 679 CRAMPS in the legs: Anac., Kali, &c. (See CRAMPS.) CREEPING, crawling sensations (formication): Sulp A., Lye., Carbo v. CRIES during sleep: Puls., Sulph., Bella., Bry., Calc., Cham., lin., Coco., Lyc., Sep., Sil., Stram., Croc., Gran., Ac. nitr., &c. DEGLUTITION, during sleep: Calcarea. DELIRIUM, wandering during sleep: Nux v., Zlach., Op., Puls., Sulph., Bella., Bry., Cham., Aur., Dig., Camph., Colocynth, &c. Dreams. DREAMS, sleep disturbed by AGITATED, ANXIOUS: Nuc V., Puls., Arm., Graph., Mfagn., Phosph., Suiph., Thuija. Alum., Ant. tart., Bar., Calc., carb. a. et v., Uhamn., China, Con., Cocc., Dig., Graph., Guaj., Hyos., Laur., led., Lye., Niagnet. arect., Mfagnet. austr., Ji ang., JXez., iiferc., iur. ac., Nactr., Natr. In., Nitr., Op., Petr., Ph. ac., Plat., Plumb., Ran. bulb., Ran. seel., Spig., Stann., Staph., Verb., Suiph. ac., Yeratr., Zinc., &c. AMOROUS Dreams (sleep disturbed by): Lach., Viol. tr., iagn. aret., Natr., Nux v., Staph., Op.-Alum., Bismi., Gale., China,Coco., Hyos., led., Lyc., JMfag*n., ferc., NYatr. m., Phosph. ac., Rhod., Samb., Spig., Stann., Stramn., Saiph., Tlhuja, Valer., Veratr., canth., Ign., Graph., Oleand., Sep., Plat., Puls., Sabad., Par., &c. ANIMALS, dreams of (sleep disturbed by): Arn., Iferc., Bella., Phosph., Hyose., Sil., Sulph. ac., Nux v., SulpA., &c. APPREHENSION (attended with): Arsenicuns. ASSASSINs (dreams of): Bella., Silicea, &c. BODIES, mutilated: Arm., NXe V., Con. BUSINESS, OCCUPATIONS, EVENTS OF THE DAY: iux V.), Bry., Puls., ulph., Bella., Lye., Jiere., S il., Gic., 19ep., Phosph., Rhus, Ac. nitr., Jlagn., Staph., Stan., &c. BusINESS, of urgent: NvYu vomnica. CARES, of: Arsenicum. COMAPLICATED, confused dreams: Aeon., Alum., Bar., Bry., Chinca, Hell., liagnet. aret., ifagnet. aust., fagn., Phosph., Puls., Sil., Yaler., C0nn., Cic., Stann., & c. CONTRADICTORY, irritating: AsTar., Aeon., Ambr., A mo., Anac., Ars., Calc., China, Gina, Dig., Lye., Ign., Hag. 630 DISEASES OF PARTICULAR ORGANS AND REGIONS. 9in.,)llfr. a.car., Ndl ux Vol0,9O., P71oi1ph., ]?Aeum, ]?hns, &il., Staph., Suniph,)., Bry., (Cale., &c. CONTINUED after waking: Aeon., -Bry., N~atr., ('aIle., Ign., Nat. c.) &C. CRUELTIES, dreams of: Nine ml Siliea. DANGERS, of: Anae., (Cale. ph-., ('on., Rep., u-hcd, JA7itr., Ran., Tituja, Salph. DARZKNIESS, of: Arsenieu'in. DEATHT, of: Ars., i2ifagno, TIhaya.-Anae., Amw., ('ale., Grapqjh., Jitile, Jiy.i.,Poph., Phosph. ae., Plat., Sarsa., DEATH, dreamns with fear of: Alumi., Jihtja. DEMONS, dreams of: Kfahi earbonicain, Natrmuin arbonienmn. DISEASE, of: Nine vornsea.-('aie., ('oce., Ifreos., Kali.iMiagnet, aret., ('an., Seill., Zinc. DISGUSTING dreams: Nwr v.-sSuiph., ]Larin. 'in., Nair. 'i., Zine.-Auru'in, Anac., ('Ad., ]i~reos., Ji'ur. ae., PhosphA., DISAGRZEE ABLE, 1imnpleasant: Nux V.,l('hina, la~ur., Phosph., Nair. in., Phus, &C. DANCING, of: liagnesia ear~boniea, MJagnesia muriatiea. DISAPPOINTMIENTS, MTORTIFICATIONS, of: Dig.,.Jfosch., -Ignatia, Staphk., Pheum'in&C. FALLING, of: ThDja.-Amm'i.'n, Dig., Awr., Bella., K'iY08., Hep., i11fagn. 'in., Mferc., Sep., &c. FANTASTIC dreams: ('ale., Nair. muriaticum, Opiwmn.-('arb. a., ('on., Graph9., Kali, -Lye., Nat". e., Sep., Sulph.-Bary. e.) ('arb. Vol -ach., Nux iVoSl., pong., -Led., Arnb., P"08-1 &C. FESTIVITIES (dreams of): Antiinoniu'n eruduin, 3Jagnet. art~f,, Ac. nit., &c. FIEIf:Hp Aslh, Afagnesi'a carb., 2Jfagnesla 'inuriat'iea.Anac., ('roe., P/iosphA.-Alvq'in, Ar~s., Bella., ('al., Ki-eos., -laur., lqant.as., Spi.,Slph., Szdph. ac., &c. FLOODS, of: -Magnesia car-b., Afeme., NYair.earb. FLYING, Of, Natrum in uphuricu'in. IFRIGHTFUL dreams (sleep disturbed by): ATax iv., Op., ('oce., Graph., Puls., lye., lXere., Pkosp~h., Pan. se., Sars., Sep., SLEEPLESSNESS.. 681 FURUNCULI: Pr-unus sjrnosa, &e. (See Dreams of -Diseases.) rnEMNOPTYSIS (dreams of): diXephites, &c. (See -Dreams of Disceases.) HEMORRHAGE: Pkosp~h., &C. (See Dreams of Diseases.) HISTORICAL dreams: Ammn. c., iLrrc. ) &C. INDECISION, of: Arnica v montana. IGNOMINIOUSI HUMILIATING dreams: 3foschus, Asctr., Alum., Am., Arn., Con., Staph., &e. LEARNED SUBJECTS, of: Jqn2?atia, X. aret. LINEN (of f0ou1): ]ireosotum. LIVELY, VIVID: Ekosphorus, Rnus toxicoclen dron, ISulphur, Silieea.-NX- xv., Pa'ls., Op., -Lyc., Gale., Aniac., Arnica, Bella., Bry., Cic., Xag., XAkr., Nair., Pkosph. ac., Scabad., Sep., Stann., Amb ra, Ars., Garb. v., Glemn., Gkian., Con., lach., Groc., Graph., Dros., iligs., MXig. arct., ilfagn. carb., XIgn. nur., 2ifosch., lkfur. ac., JVAstr. in., Petr., 'Rheum, Xpig., S3tcg-A., Tart., a rtra., TI'aer., VioSt. ba., nc. LOSSES, of: ilfephites. MAIRRIAGE: Alumina. MEDITATION, REFLECTION (dreams with): Bry., Ign., Nux vomica.--Lachesis, Anac., Sabaci., Sabin., Thuja, Aeon., Armn., Gaph., CGarb. a., Graphites, 3fagnet. aret., fagnet. austr., Puls., khus, &C. MISFORTUNES, dreams of: NYbx v., Pulsatilla, iyc., GraphA., T/ljaa.-Amlm. in., Arn., Bella., Oham., China, Kili c., Phosph., Sarsa., Sulph., Sulph. ac.-Aluin., Anac., Ars., Goco., Ign., Led., A/crc., Pan. bulb., StophA., &c. MONEY, of: Gyclanen, iifagnesia, P1lS. MURDERS, Or crimes: Bella., -Lye., Natr. in., Nitr. cc., Phus vernim, Silicea. PE RPLEXING dreams: Arsen., Graph. (See Gomplicated, Confused Dreams.) PLEASANT, AGREEABLE: Calrea, X Natruml carbonicum, Opium, Pulsatilla, Sepia, Staphysagria, Vl'iola tricolor.-Ant. c., Aur., Garb. a., Grcap)h., Kali, -lach., Jfagn., NaIr. i., Pkosph., Pibosph. (c., Plat., Sil., Alum., Amn. in., Garb. V., Groc., ilfagn., Ars., Bary., Bism., CGoc., Goff., 1g)., IJos., 3fZiagn. mn., XZierc., Ac. nitr. Olead., Spig., TIe~ja, Veratr., &e. &c. POETIC: liachesis, Calcarca, Sp0ongia, Aini. c. 682 DISEASES OF PARTICULAR ORGANS AND REGIONS. POISONING, of: Kreosotum, &c. PROJECTS, Of: Anacardium. PURSUITS: Kreosotum. QUARRELS: Niux vomica, Am., Iclyn., Pho8ph., Stann., Alum., Aur., Calearea, Hep., iH austr., Puls., &elen., Staph., &c. REALITIES, dreams which appear to be: Natrum carbonicum, Natrum murritaticum. REMEMBRANCE With, Of things forgotten: Caladium. REMEMJ3RBANCE, dreams of which one loses the: Bella., Hell., Cic., Ccc., Lye., elen., ig., iTcarax., Veratr., Yit., Am., Aur., Bry., Con., Lac., IJaur., X. arct., ilLeny., iXierc., Natrum mn., Rhus ab, Sabad., Stra., ul., &c. REPENTANCE, dreams of: Arsenicum. REPROACHES: Arnica. REVOLTS: Jercuri&s. ROBBERS: ifagnesia carbonica, Jlfrc., iMfgn. in., Alum., Aur., Kiali, Sil., Natr. c., Plumb., Veratr. SAD, MELANCHOLY dreams: Rheum, Lyec., Spong. SERPENTS, Or Reptiles (dreams of): Kali carbonicum. SHOTS: Hlepar sulpkuris,.iMercurius. SHow: Kreosotum. SPECTRES, Or Frightful Visions: Alum., Bella., Calc., Ammon. c., Carb. v., IJn., Kali c., iXerc., Ac. nitr., Puls., Sil., Sulph., NVux v. SToRM, of a: Arnica, Arsenicum, Euphr., Natr. TEETH, Of the falling out of the:. Nux vomica. THREATS, of: Arsenicumn. TRAVELS, VOYAGES, JOURNIES: ifagnesia ccarbonica, Natrum carbonicum, Opium, Amm. in., Amnm. c., ifagn. in. TYPHUns FEVER, of death from: Kali ciloroticum. VERMIN, dreams of: Nux v., Acid. muriat., Chel., Phosph., Am. c. WAR, of: 7hnja, 1-Verb., Plat., Fer. WATER, Of: Ammon. muri at., GrCaph., Iagn., Alum., Dig., Kali, ifagn. m., iXerc., Ran. bulb., Sil., &c. WATER, of, desire to void (of inclination to urinate):.Zfreosotum. S7eep disturbed or Prevented by: EXCITEMENT (lervous): Colch., Jferc., 0ofea, NYux v., Lack., SLEEPLESSNESSN. 683 Amb., Camph., Canth., Caps., Chin., IHyos., lfosch., Puls., Sep., Lye., Laur., Ac. nitr., iMagnet. aust., Teuc., &c. EXCITEMENT (vascular): Bry., Nux v., u8ls., Sep., Sil., Cale., Baryta c., Natr. mn., Carb. a., Xierc., Phosph., Sabina, Sep., Am. c., Asar., Bnhus, Ran., &c. - by vascular, in the chest: Puls., Cyc. - vascular, in the head: Puls. Abnormal states during sleep: EYES, open: Bella., Op., Bry., Veratr., Sulph., Coloc., Phosph. ac., Fer., Hell., Tart., Sarnb. - convulsed: Op., Hell., Phosph. ac. - fixed: Tart. FACE, puffiness of the: Opium. - coldness of the: Belladonna. - paleness of the: Belladonna. - redness of the: Op., Arnica, Viola tricolor. FATIGUE, feeling of, during sleep: IKreos., Antim., Ambra. FEAR, during sleep: Garb. v., Puls., Cocc. - or dread of losing one's reason: Calc. carb. FRIGHT: Puls., Silica, S lph., Veratr., Kali c., Arn., Sab. GASTRIC sufferings: Chain., Con., Hep., Kali, Ac. nitr., Sil., Rhus, Graph., &c. GRINDING Of the teeth: Ars. HALLUCINATIONS: Belladonnar, Chaam., Sulph., Ced., 2er., Phosph., Stram. HANDS, coldness of the: Bella., ier., Carb. v. - heat in the: Lach., Staph. HEAD, pain in the: Sulph., Xlerc., Lyc., China, Galec., Carbo v., GCam., Con., Hepar, Haem., Kreos., Jag., Ac. nitr., Phosph., Phosph. ac., Puls., Sil., fagsy. arc., Zinc., &c. HEAD, congestion in the: Puls., Sil., Am. c. - heat in the: Siliceca, Gamphora. HEARING, delusions of: Cham., Sep., carb. v. HEART, pain in the: Barytca carb. - palpitation of the: Ars., Lye., Puls., Sulph., Merc., Acid. nitr., Calc., Barytce c., Ncatr., Agar., Dulec., &c. HEAT, general: N-ux v., Puls., Lach., Gkam., Daule., IHep., Afere., 3fagn. in., Calc., Petr., Phosph., Bry., Ars., Natr. in., Sep., Sil., Garb. ca. et v., Bry., Viol. tr., Alum., Am. c., Colch., Graph., Sulph., &c. 684 DISEASES OF PARTICULAR ORGANS AND REGIONS. iEAT, with anxiety: Putls., Natr. nm. - with dread of, or aversion to beiing uncovered: Iagnesia. IDEAs, sleep disturbed or prevented by flow of: Nm x v., Puts., Gofet, Lyc., China.-Supk., Calce., Stap., Sil., Graph., Hep., Kat., Coco., Led., Sabad., Bar., &c. IDEAS, by fixed: Puls. - gloomy, annoying: Graph., Rhus, Alumina. INQUIETUDE, restlessness in the limbs (sleep disturbed by): Puls., Nax v., suiph., lfreos., C/hdna. ITrCHING, or tickling in the body: NCax vonica, Puts., 1fere., Suiph., Thija, Am. c., Am. n., Barytae c., Gocc., Groc., ]Ireos., lez., Berb., &c. JACTITATION: Acon., Ars., Betlla., Gkam.-Cofea, Alun., Asa., Gate., Lach., Hlep., KIIreos., Pat., Guaj., Iletl., Tart., Nlax v., Op., Gran., Carb. a. et v., liferc., Puts., P. od., Phosph., Sil., Jaap, Clemn., Gin., &c. JAW, hanging of the, during sleep: Nur r., Op. JERKING, SHOCxS, Starts or twitchings (sudden): Amb., Ars., Belta., Gipr., IKali, Lye., Natr., Puts., Sil., Sutph., Tart., Thaja, Carb. v., GClnam., Op., frn., Con., Staph., Sep., ilfagnet. are., lfere. c., Phosph., Cast., &c. JERKINGS, Or CONVULSIONS in the eyes: Goce., Puts. - in the face: Op., -heum. JERKINGS, or CONVULSIONS in the fingers: Goco., /Rheum, Ae. sulph., Anac., Ars. - - in the feet: Phosph., &c. - - of the head: Gocc., fagnetus polus arcticus. - of the legs: Phosph. - - of the mouth: Op., Anac., Puls. - - of the tendons (subsultus teildinum): Belladonna. JOINTS, sleep disturbed by pain in the: Silicea. LAMENTATIONS (during sleep): Stan., Nux v., Alum., Phosph., Sutph. LANCINATIONS, or shooting pains in different parts of the body: Cann., Euph. LAUGHTER (during sleep): Alumina, Lyec., Stramn. LIMBS, pains in the: Nux v., lach., Satpyh., CGaC., CGon., Ac. nitr., Am. c., Am. m., Anac., Berb., Garb. v., Phos. SLEEPLESSNESS. 685 LoINS, pains in the: Am. in., Berb., reos. MASTICATION (while sleeping): (calcarea. MEDITATION, reflection during sleep: Lach., Anac., Briyonia, Ignatica. MOANING, during sleep: lach., Pul8satilla, Acid. in., lyecac., Bella., Alum., Bry., Num v., ckam., Op., Saiph., Lye., YIeratr., Phosph., Ars., Arn., Rheulm, &c. MURnURs, or nmuttering during sleep: Op., SZtlh. MOUTH OPEN, during sleep: Op-, f erc., Rhus, Samb., iqgs. NIGHTMARE (I1hUbM8, Ep7hialtes): Narn v., Puls., Op., ualph., - Sil., Ruta, Valeriana, Acon., Am. carb.-Lyc., Jagn. m., Natr. mn. Bry., Ilepar,(' Con., Bella., Am. in., Kicali, Alum, &c. OPPRESSION at the chest (during sleep, or at night and preventing sleep): Arsen., ccrb. v., (ham., Giraph., Sulph.,'alc., Lye., Op., Aeon., Almn., Kcali, Ifali ch., Phosph., Ran., &c. POLLUTIONS, during sleep: Kali c., Kali A., Salph., lye., Ac. phosph., Phosph., Con., (arb. v., Puls., Petr., Led., Pacr., &c. QUARRELLING, during sleep: Ars. RESPIRATION intermittent, during sleep: Opium. - rapid, accelerated: Acon. - short: Acon., (haam., Rhus, llere. - slow: Op., Cinchonca. - WHEEZING, whistling: Nux V. SCROBIcULUS CORDIS, pain in the: (ale. c., Kali c. SIGHS, during sleep: Lach., Afere. SINGING: Bella., Croc., Phosph. ac., Igs. arc. SLIDING, Or sinking down to the foot of the bed during sleep: Ars., Acid. m. SNORING loud, or stertorous breathing: Op., (c'rb. v., Stranm., Nux vomica, Ign., (haam., Sulph., Sil., ('ina, JReum, Rhus, &c. SOMINAMIBULISI: Op., Bry., Phosph.-Alum., XTatr. in., 11., Sulph. SORENESS of the throat (pain in the) during sleep: Ammon. m. STARTS: Anmb., Ars., Bella., (ham., C(pr., Dros., Ilep., Lye., Pals., Sil., Sulph., Tart., TAhja.-Nc xv., lIep., Cale., ccrb. v., Chin., (occ., C astor, Daph., Hyos., Acon., Agn., 686 DISEASES OF PARTICULAR ORGANS AND REGIONS. Alum., Am. c., Ant. c.,.1erc., 3i agn., Ign., lach., Kali, Plumb., &c. STAnTs, when touched: Stram. - with gestures indicative of fright or terror: Stranm. SToMACI, pain in the: iyc., Con., Alum., Grcaphites, K ali, Am. c., Acid. nitr., SulykA., Sil., JBhus, Sen., &c. TALKING, during sleep: Puls., Sulh., Nux v., Alum., Am., Ars., Bella., Calc., 6Camph., Carbo. a. et v., c/am., Jfali, Magn., Jiagn. m., Mercurius, iMuriat. ac., Natr. m., Nitr. acid., Phosph., Phosph. acid., Plumb., Sep., Sil., Straam., &c. TOES, pains in the, during sleep: Am. carb. TREMBLING: Euphorbium. - internal: Natrum m. UNCOVERING Of the arms, &c., during sleep: Plat., Corr. rubra, /aqgn. polus arcticus. UNEASINESS, general sensation of, during sleep: Ars., ferc. URINE, emliSSion of, during sleep: Am. carb., Am. muriat., lach., Con., Graph., Hep., Bella., Ars., Daph., fod., CuTp., Cofea, Natr. m., Sulph., Calec., Carb., Op., Zyc., Sepia, SiliceCa, iMerc., Petr., Jfagnet. aus., Cin., &c. (See Enuresis.) VERTIGO: Sulph., Calc., Am. c., Natr., Phosph., Spong., &c. VISIONs, during sleep: Bella., Ckam., led., iMerc., Phosph., Phosph. ac., Stram., ASulp., &c. - frightful: Bella., Sulph., Calc., Carb. v., Merc., Sil. - h rrible: Carb. anim., &c. VOLUPTUOUS, sleep retarded or disturbed by: Calc. carb. WEEPING, during sleep: Puls., Sulph., Cale., Nux v., Alum., Arn., Ars., Bella., Camph., Carbo a. et v., C/ham., Kali., XIagn., Maian. m., Mgs., il/erc., ilfur. ac., Natr. m., Nitric. acid., Phosph., Phosph. acid., Plumb., Rhus, Sabin., Sep., Sil., Stann., Tart., Zinc. SLEEP, LETHARGIC, stupefying: Acon., Ant., Bella., Calad., Camph., Graph., lach., Nax v., Op., Puls., Hyos., Laur., led., LMoscth., Nux mosch., Phosph. ac., Plumb., Stram., Tart., Verat., Jiag. are., &c. SLEEP, lethargic, alternately with sleeplessness: Zachesis. SOMNOLENCY, or drowsiness in the open air: Tartarus. - day and night: Baryta c. SLEEPLESSESSNESS. 687 SOMNOLENCY, in the evening: Ant., Ars., Tart. - in the forenoon: Ant. crudum. - in the morning: 4Xephlites putorius. SLEEP, broken, interrupted: Cocc., Ars., Dig., Par., Zinc. - incomplete, imperfect, half asleep: Ars., Bella., Bry., Lach., Mere., Hep., Cham., Cocc., Op., Acid. nitr., Cic., Eunph., Sil., Magnet. arc., Graph., Kali, &c. SLEEP, light: Nux vomica, Lach., Ign., Sulph., Mierc., Acon., Alum., Ars., Sel., Sil., Calad., 01. an., Tart. SLEEP, protracted, too prolonged: l~ferc., Sulph., Plat., Puls., Hfep., Berb., Bar., 01. an., Phil., &c. SLEEP, profound: Ant. tart., Nux mosch., Op.--Ars., Bella., Ign., Icur., Zed., Mgs., Phosph. ac., Puls., Rhod., Sec. corn., Seneg., Stram., Veratr., Acon., Anac., Ant. c., Bar., Bry., Camph., Con., Croc., C~u., fHyos., Petr., Phosph., autCa, Sep., Spig., Zinc., &c. SLEEP, unrefreshing: Bry., Con., Hep., Op., Sul2ph.-Amb., Bism., Calc., Cann., Lach., Lyc., Natr. m., Nitric acid, Petr., Selen., Sil., Staph., Alum., Am. m., Anac., Carb. a. et v., Cham., Kali,.Magnet arc., Afagnet. c., ilfagnet. im., 2iferc., Ran. bulb., Sepia, Spig., Stann., Stram., Veratr., &c. SLEEP, of too short duration: Nux v., Calc. carb. - tendency to fall asleep when in the open air: Acon., Tart., X. aust. SLEEP, tendency to fall asleep early in the morning: Nux v., Lack., Puls., Sulph., Phosph. ac., Sil., Con., Croc., Calc., Carb. v., Lye., Plat., Sep., Kali, liep., China, &c. SLEEP, tendency to, during exercise: Acon. - during and after a meal: Nux vomica, Sulph., Acon., Anac., Arum, Aur., Bor., Chlina, Phosph., Phosph. ac., Verb., Natr. m., Graph., Kali, Calc., Sil., Zinc., &c. SLEEPINESs in the afternoon: Sulph., Puls., Bov., Bruc., Canth., Grat., Viol. tri., &c. (See SLEEP, tendency to, after a meal.) SLEEP, tendency to, during employment: Sulphur. - when reading and writing: Natr. sulph. -- when sitting: Bruc., Ferr. Aagnet., Petr., Tart., &c. - during a storm: Silicea. - retarded: Calcarea, Carbo a. et v., China, Cyc., Fer., 688 DISEASES OF PARTICULAR ORGANS AND REGIONS. Graph., Hyos., Icali, lach., Lye., 3/crc., Natr., 01. an., Phel., Phosph., Phosph. ac., Pals., Ran., Stann., Staph., Saiph., Na V., Natr. i., Nitr. ac., Sep.! &c. SLEEP, retarded, or difficult to be renewed after waking during the night: N.atr. In., Sep.. Saiph., Pzas., LdgTh. Am. c., Ars., Berb., Bor., Fer., Phosph., PRa., Pan. sc., &c. SLEEPLESSNESS, alternately with somnolency: Lache8sis. after midnight: Nux v., Coffea, Ars., Cap., KIfali carb., Sil.-Asscf., Aur., Cainn., Dule., liie-p., 3'lagm., Natr., Pam. scel., Sep., Sallph. ac., Acon., Am., Ant. c., Bry., Caic., Con., lach., Graph., 3/crc., J/fez., Nitr. ac., Phtosph. ac., Plat., PhUS, StaphA, &c. SLEEPLESSNESS, before midnight: Bry., 6Calc. car--b., Carb. v., 3/crc. ) Phosph., Pul's., P'hus tox., Sep.-Ars., Bella., Bar., Calad., Carb. a., Chidna, Grcyph., Hep., Igm., Kdfai, lach., led., ILyc., 3/. aust., 1k/ar., 3/1ar. ac., Selem., Spil., Sig.,, Nux v., (Con., Alum., Am.in., Ant. tart., Arm2., Bar. Ereos. litbr. acid., 1 at". in., Stamm., Stap)h., Feratr., &c. SLEEPLESSNESS, with desire. or inclination to Sleep: Bella., (ham., Phosph., Puls., Sep.-Ars., Bry., (Cale., China, Cam., I7ep., KIali c., 3/crc. N atr., Nex V., Phosph. ac., Phus, S., Sl. ph., C'arb. v., Graph., Egos., lach., 3/a gmet. aret., Natar. in.,.A7itr. acid., Staph., Veratr., Selem., &c. SLEEPLESSNESS, arising from griping pains in the intestines: lye., Plumb., Sep., Staph)., ZT-ah, Ambr., Am. c., Am. in., 3/ragn. c., 3/agm. s., Natr., Ac. nitr., Phuts, Phosph., &c. WAKING, difficult and retarded: Nux v., Calearca, GraCiphites, Sepia.-N atruin, Natr. in., Nitr. ac., Phosph. ac., Tab., Teuc., Alum.,]/g., 3/gm. in., 3/cr'c., Nlatr., Phosph., Phosph. ac., Sil., Salph., Eaphr., Amac., Arm., Assaf., Carb. V., Hepar, Ilyos., Kali, Iaur-., Natr. 9n., Nitr. ac., Puls., Veratr., &c. WAKING too early: Nux v., KYahi carb., Natr. carb., Pam. bulboosus.-Ars., Aur., Cadp)s., Dule., 3/agm. c., 3/mr. ac., Sallph. ac., Assýf., ('ale., Graiph., IfeTp., -lacbesis, 3/ang., 3/c'rc. 3/Xez. Nitlr'., Nitr. ac., Plat., Pan. se., Phod., Sep., Sil., Staph., [fhznja, &c. WAKING early and always at the same hour: Selenizun. incomplete: (onium. SLEEPLSNENESS. 689 WAKING with a start: Amb., Ars., Bella., Cham., Dros., Hep., Lyc., Puls., Sulph., -Rheum, Tart., Tkija, Bry., Graph., Carbo. v., Cale., &c. WAKING at the slightest touch (generally with a sudden start or cry): Selenium. WAKING at the slightest noise: Selenium. - early, from a feeling of coldness: Acid. muriaticum, Fer. magnet. WAKING caused by violent shocks or jerks in the head and neck: Magnetis polus arcticus. WAKING caused by a feeling of suffocation or obstructed respiration: Hepar, Ipecac., Sambucus nigra. WAKING with headache: Lach., Bella., Anac., Berb., Fer. magnet., Rheum. WAKING with colic: IITcmatoxylum compechianum. - congestion in the head: Berberis. congestion and heat in the legs: Xephites putorius. - diarrhoea: HTematoxylum. - dizziness or giddiness: Ars., China, Plat., Puls., Sol. m. - erections: Lachesis. - fear of ghosts or spectres: Sulphur. - hallucinations: Sul2hur. - hunger: Bella. - vexatious thoughts or ideas: Alumina. - lassitude in the arms: Ferrum magneticum. -- lassitude general, or fatigue. See Sleep, unrefreshing. - pains in the limbs: Nux vomica, Lachesis. - pains as if beaten: Lachesis, Viola odorata. - pains in the loins: Zachesis. - a sensation of paralysis: Kreosotum. - perspiration: 3Merc., Clem., Chel., Cic., Dros., Fer. magnet., &c. - with rigidity or stiffness in the limbs: achesis. - stretchings and convulsive yawning: NzVx v. - with bitter taste: Bry., Rhus toxicoden., &c. - putrid taste:?heum, &c. - tears, cries, &c.: iercurius. 44 690 DISEASES OF PARTICULAR ORGANS AND REGIONS. WAKING, with thirst: Berberis. - sore throat: Lachesis. - trembling: Ratanhia, Sambucus. - visions (visions are seen waking): Dulec., Sulph. - weakness in the knees: Ferrum magneticum. YAWNING, incessant: Bry., clan., Euph., Lye., Oleand., 01. an., Phell., Rhus, Staph., Suiph., Viol. od., Zinc., Nux v., Puls., Ign., Amm., Ant. tart., Am., Ars., Bryonia, Gina, Kreos., C/tel., Croc., ]~aur., llagnet arct., ien., fiur. ac., Natr. mn., Oleand., Par., Phosph., Phosph. ac., Sabad., Sassafr., Sep., Sil., Stann., Staph., Alum., China, Carb. v., Salph., Merc., Yeratr., Bella., Caps., Bar., Canth., Hep., Zinc., &c. YAWNING, abortive: Lyc., Cham., Ruta, Acon., Ign., Croc., Phosph. YAWNING, violent: Jgn., Ilep., Flat., nM s, Agar., loseA., Cor., Fer. magnet., Afaqn., Mfgs. arc. YAwNING, spasmodic: PIl6tna, ]i u s.-Ign., Ilepar, X. arc., Sep.-Ang., Bry., Cap., Magnet. aust., iJosch., Laur., NJatr. in., Scill. YAWNING, without feeling sleepy: Plat., Rhus.-Ign., AMag. arc., 2dagnet. aust., Sep., Bryonia, Ifep., Lach., Scill., Ang., Natr. m., ilosch., Chamn., Cap., Sulph., Staph., Alum., Amm. m., &c. YAWNING, frequent in the afternoon: Canth., Ign., Plat. - - morning: Nux v., Ign., Viol. od. - while walking: Eaphorbium. - Natrum sulphuricum. - Cutis anserina: Lauroceresus, Paris quadrifolia. - shaking, shivering, or shuddering: Laur., Ereos., Natr. s. Par., Sil. - lachrymalian: M]eph., Viol. od., Staph., Ireos. - with oppression or tightness at the chest: Stan. - stretching: Staph., Nux vomica, China, Guaj., Natr. s., 01. an., Ruta, Sabad., Canth., Oniscus, Tart., &c. YAWNING, with tremor: Cina, Oleander. - vertigo: Agaricus muscarius. Position during Sleep. Arms above the head (during sleep): Puls., Nux v., Plat., Calce., Coloc.-Rheum, Ruta, Thtja, Veratr., Sulph. NIGHTMARE. 691 Arms across the abdomen: Puls., Coc., Magn. artif. Back on the (dorsal): Bry., Puls., Rhus.-Nux v., Sulph., Calc., Lye., Ignatia, Cic., Fer.-Acon., Ant. tart., Aur., China, Coloc., Dros., lagn. artif., iagnet. arct., Phosph., Plat., Viol., &c. Hands under the head: Nex v., Ars., Bella., Plat., Coloc., Men.-Acon., Ambr., Ant. tart., Ign., Xfagn. artif., Magnet. aust., Puls., Ihus, Sabad., Spig., Viol. od. Head inclined forwards, with the: Staph., Acon., Puls., Cic., Cup., Viol. od. Head inclined to one side: Cina, Spong., Tarax. - elevated high, with the: Sulphur. - low, or buried under the bed-clothes: Spong., Am., Hep., Nux v. - thrown back, with the: Bella., Cina, Spong.-Cic., He.,.Hyos., Ign., Sep.-China, Nux v., Cap., Magn. artif., Stan., Viol. tr. Knees, bent: Viola odorata, Ambr., Magn. artif. Legs, drawn up: Pulsatilla, Plat., Carb. v., Stan.-Anac., Oham., Chin., Many., Mien., Rhod. Legs widely separated: Cham., Puls., Bella., Plat., ihus.-- Agar., China, Dulc. Legs, one of the, bent, the other extended: Stannum. - crossed: Rhododendron crysanthum. - stretched out: Cham., Plat., Magn. art., Puls., Viol. od. Seated (in a sitting posture): Sulphur, Cina, Lye., Ars., Rhus.-China, Hep., Phosph., Puls., Sabin., Spig. Forwards: Cic., Cap. Side, on the left: Baryta carbonica, Sabina. Positions in which it is impossible to recline or sleep. Back, on the: Phosph. Recumbent posture, inability to remain in the: Sulph., Lyy& Side: Acon., Sulph. - left (incapability of lying on the): Lycopodium. NIGHTMARE. INCUBUS. EPHIALTES. When this well-known and distressing disturbance occurs very frequently in an aggravated form, it becomes necessary to prescribe for it. The homceopathic remedies which have 692 DISEASES OF PARTICULAR ORGANS AND REGIONS. chiefly been employed against it to the best advantage are Aconitum, Nux V., and Opium. ACONITUM. When there is considerable febrile excitement, with quickness of pulse, thirst, palpitation of the heart, oppression at the chest, anxiety, and agitation. Nux v. When nightmare is occasioned by sedentary habits, the habitual indulgence in spirituous or malt liquors, &c. PULSATILLA. When there is derangement in the digestive functions, arising from gross living, heavy suppers, &c. OPIUM is a remedy of importance in all cases of a severe character; but particularly when, during the attack, the respiration is nearly suspended, or stertorous, the eyes only half closed, the mouth open, the countenance expressive of extreme anguish, and bedewed with cold perspiration; subsultus tendinum. When any of the foregoing remedies, but especially J.Yuc v. and Pulsatilla, are insufficient to effect a cure, Sulphli or Silicea may be resorted to in repeated doses. In other cases, one or more of the following may prove useful: Phosphorus, Ruta, Valerian, Ammonium c., and Hepar. Every apparently exciting cause of the attacks must at the same time be avoided; the diet should be light and wholesome; suppers altogether.abstained from, and a glass of cold water taken instead, on retiring to rest. Daily exercise in the open air, the shower-bath, or sponging with cold water every evening, are useful preventives, or auxiliaries during treatment. RUPTURE. HERNIA. By this term is understood a swelling occasioned by the protrusion of some of the viscera from the cavity of the abdomen. In the generality of cases, the displaced intestines are included or contained in a bag, derived from the peritoneum, which they push before them in their descent. The situations in which the swelling most commonly makes its appearance are the groin, the navel, the scrotum, the labia pudendi, and the upper and anterior part of the thigh. It also occurs in the vagina, perineum, foramen ovale, and sciatic notch, and occasionally at every point of the fore-part of the abdomen. The viscera which are most frequently protruded:are the omentum and the small and large intestines, or a por RUPTURE. 693 tion both of omentum and intestine. But the stomach, liver, spleen, bladder, uterus, and ovaria, &c., have been known to form component parts of hernial tumors. In consequence of the tumor escaping at the different situations above mentioned, it has received the appellations of inguinal,* umbilical,t scrotal,T pudendal,~ crural or femoral, vaginal, perinapal, thyroideal,11 ischiatic and ventral, &c. Further, from containing different kinds of viscera, it has been designated epiplocele, when its contents consist of a piece of the omentum only; enterocele, when of a fold or portion of intestine; and entero-epiplocele, if both intestine and omentum contribute to form the swelling. A hernia or rupture, for the most part, appears suddenly after some violent corporeal exertion, and presents an indolent, and usually soft and elastic tumor, at some of the points or situations already referred to, but most frequently at the lower and lateral part of the abdomen (the groin), or towards the inner part of the bend of the thigh, or at the navel (descending from the abdominal ring in the firstmentioned instance; from below Poupart's ligament in the second; and out of the umbilicus or navel in the third). The swelling is subject to a change of size: being smaller or quite imperceptible when in the recumbent position; larger or only apparent on assuming the erect posture, and particularly when taking a full breath, coughing, or sneezing; also on walking or standing long after a hearty meal. It is frequently diminished, or caused to recede completely when pressed upon, but returns as soon as the pressure is removed. Vomiting, constipation, colic, and other signs of a deranged state of the stomach and intestines, are frequent concomitants of rupture, arising from the abnormal situation of the viscera. The nature of the contents of the hernial tumor are generally known by the following distinctions: if the case be an enterocele, the swelling is smooth, elastic, rendered tense by coughing, or by holding the breath; is in general very easily returnable, and usually attended with a gurgling noise when ascending. An epiplocele, or omental hernia is, on the other * Or a bubonocele. f Or an exomphalos. Omphalocele. j Or an oscheocele. Or a bubonocele. |! Or hernia foraminis ovalis. 694 DISEASES OF PARTICULAR ORGANS AND REGIONS. hand, of a more uneven and doughy or flabby texture; is neither made tense, nor receives any impulse from coughing; is more compressible, and, if large, or in the scrotum, is more oblong and heavier than enterocele; it recedes very gradually, and its reduction is unattended by any gurgling noise. An entero-epiplocele, or a hernia composed both of intestine and omentum, has the characteristic marks less distinct than either of the preceding cases; when reducible, it is known, in pressing back the contents, by the gurgling noise which attends the ascent of the intestinal portion, while that of the omentum is reduced without noise, and with greater difficulty; otherwise, the feeling comunicated to the touch is often sufficient to render this variety distinguishable from the others. CAUSES. The predisposing causes of hernia are: general relaxation, or unusual largeness of the natural openings of the abdomen. When any such proclivity exists, particularly in children and the aged, the viscera are occasionally protruded by trivial circumstances, such as crying, coughing, sneezing, or even by the act of a somewhat full inspiration; but in other cases, or where there is no marked predisposition, the protrusion only takes place under great bodily exertion, or in consequence of external injury. When rupture ensues in consequence of predisposition, or seems to take place spontaneously, its formation is very gradual; but when it results from extreme corporal exertion, it appears very suddenly, and if the opening through which the bowels protrude be small, as is generally the case in such instances, there is much danger of strangulation. H-ernia is termed reducible when it can at any time be readily returned into the abdomen, and when, in an unreduced state, it is productive of no pain, or hindrance to the performance of the intestinal functions; irreducible, when it cannot be replaced, in consequence of its bulk, or from the contraction of adhesions; and strangulated, when the protruded parts are not only incapable of being returned, but are moreover affected with constriction, pain, and inflammation, attended with nausea, frequent retching or vomiting, tension of the abdomen, obstruction of the bowels, quick, hard pulse, and more or less fever. If the return of the intestine be RUPTURE. 695 not effected under such a state of matters, an aggravation of all the said symptoms at first ensues, and subsequently the vomiting is exchanged for a convulsive hiccough, with frequent bilious eructations; after the abdominal tension, fever and extreme restlessness have continued for a few hours in an increased degree, the patient suddenly becomes relieved from pain, the pulse low, feeble, and intermittent, the eyes dim and glassy, the belly ceases to be tumid and tense, and the skin, particularly that of the extremities, becomes cold and moist; the hernial swelling disappears, and the integuments over the part often change to a livid hue, but invariably convey an emphysematous feel or crepitus to the touch, indicative of the establishment of gangrene; finally, spasmodic rigors and convulsive twitching in the tendons supervene, and death soon terminates the scene. THERAPETUTICS. When the dicease has not been neglected, or is not of long standing, it may very generally, if not invariably, be cured by means of internal homcoopathic remedies. In effecting the reduction of a hernia by the taxis, the patient should be laid upon his back, a pillow being placed under the chest and pelvis, so as to curve the trunk of the body, and thereby relax the abdominal muscles. If the case be one of inguinal or femoral hernia, the muscles, &c., of the thigh must also be relaxed, by placing the limb in a state of flexion, so as to be rotated inwards. Then gently compressing the tumor, we should push upwards and outwards, in the case of inguinal hernia; and first backwards and then upwards, in the case of femoral, if the tumor be small; but first downwards, and then backwards and upwards, when it is large and reflected over Poupart's ligament.* Even strangulated hernia is capable of being reduced by the taxis with facility, after the employment of the proper remedies, particularly Aconite and Nux vom.; the operation, which is always more or less dangerous, being thereby avoided. In almost every instance, but particularly when the rupture causes pain, and is tender to the touch, the appropriate medi* In Umbilical hernia the pressure is to be made directly backwards. 696 DISEASES OF PARTICULAR ORGANS AND REGIONS. cine ought first to be prescribed, since, if the remedy selected should not prove adequate to produce reduction, it will at all events have the effect of removing the irritability, and, consequently, of rendering replacement by the taxis comparatively easy, and free from the danger which would otherwise have attended any attempt at manual reposition, preparatory to the dispersion of the irritation. In some cases, the application of warm fomentations to the part reduces the hernia, and the general relaxing effects of a warm bath are well known as being useful in facilitating reduction. The following treatment has been strongly recommended when the symptoms encountered are as described: AcOMITUw. When there is considerable fever, with quick, hard, full pulse, inflammation of the affected parts, with excessive sensibility to the touch; violent burning pain in the abdomen; bitter, bilious vomiting; agonizing restlessness, and cold perspiration. A second dose to be given, if required, an hour after the first, or even a third after a similar interval. In the majority of cases, marked benefit has resulted after the administration of the first dose of Aconitum, under the circumstances mentioned; but when no change for the better resulted after the third exhibition, or when the bilious eructations and vomiting become converted into an acid character, SULPHUR must be prescribed, and if the patient fall asleep thereafter, he should be allowed to repose quietly. When the tumor is not so painful or tender to the touch, and the vomiting less severe, but the respiration oppressed and laborious, and the strangulation has arisen fr'om errors in diet, from exposure to cold, fr'om being overheated, or from a violent fit of passion, etc., iNux v. is to be preferred, and may be repeated every two hours or so. If no change results in about. two hours after the second dose of Nux v., Opium should be prescribed, or this remedy may be had recourse to from the first, and repeated every quarter of an hour, until improvement takes place, should there be hardness and distension of the abdomen, putrid eructations, or even vomiting of frecal matter. (PLUMBUM may be given after the third or fourth dose of Opium, if no decided change for the better become perceptible.) RUPTURE. 697 When there is retching and vomiting, with cold moist skin and coldness of the extremities,-VERATRUM should be administered and repeated in from half an hour to an hour or so; and in the event of no favorable turn taking place after the second dose,-BELLADONNA should be prescribed. When the case has been neglected, or we find, on visiting the patient, the malady already advanced so far that the integuments over the rupture have assumed a livid hue, and there is reason to apprehend the invasion of gangrene, the patient may yet be saved by the administration of LACHESIS in repeated doses; if no relief follow in the space of about two hours, ARSENICUM may be tried. RHus has also been spoken of as being serviceable in extreme cases. The operation should not be delayed, when symptoms of a serious character do not speedily yield to the remedies indicated; but the latter should always be tried first, as no bad consequences will result from the delay under the precautions stated; on the contrary, the subsequent manual treatment has been found to be thereby materially facilitated. [The following practical remarks of M. Traub,* on the homoeopathic treatment of incarcerated hernia, appear to us to require no apology for their insertion here.] Incarcerated Ruptures. (flernice incarceratce.) Incarcerated hernise belong undeniably to those diseases, in the treatment of which the old method appeared in one of its brightest lights; having, in most cases of incarcerated ruptures, treated in accordance with its dictates, succeeded in accomplishing the two desirable ends, viz.: the removal of the incarceration, and the reposition of the prolapsed parts, without resorting to an operation. According to my own calculation, this has always been the case in three out of four. But if we consider that the remedies which the old method employed for this purpose were by no means of the most agreeable description to the unfortunate patient, but that, on the contrary, he had to suffer excessively during the treatment, we may justly rank homceopathy above her older sister, * Beitrage zur Homceopathie, vom Landchirurgus Traub in Sch6ningen. Allg. Horn. Zeit. No. 12, 31ster Bd. 698 DISEASES OF PARTICULAR ORGANS AND REGIONS. (even if we were to take it for granted that the former also succeeds only in three cases out of four) because she attains her object byfar more gentle means. But homceopathy does more, though not so much as some exaggerating panegyrists boast, yet decidedly more than some talented practitioners are disposed to admit. Dr. Lobethal, of Breslau, e. g., assures us in his contributions to the " Pharmako dynamik, nach homoeopathischen Principien," (Allgem. Homoeop. Zeitung, 13 Band, 18 Numnmer), where he describes the effects of Nux vomica with his customary exactness, that he has not observed, in incarcerated hernia, the effects ascribed to and expected from this remedy, and he adds that the external treatment of hernia appears to him, according to the character of the incarceration, to be more efficacious than the employment of Nux, Belladonna, and Aurutm. It were much to be regretted if the prejudice caused and promulgated by such unfavorable experience were to induce practitioners never to have recourse to specific medicines in cases of incarcerated hernia, or, at all events, to do so with but little confidence. In order to prevent the possibility of this prejudice taking place, it is desirable that many such cures should be made known; and this is the reason which induces me to communicate the observations that I have hitherto had an opportunity of making, in my own practice, on the homceopathic treatment of incarcerated hernia. From the time that I commenced to treat my patients on the principles of homceopathy, but few incarcerated ruptures have occurred to me in which the homoeopathic medicines have failed to prove their specific power (the proportion is as one to ten), through which I have become convinced that homoeopathy has obtained a great triumph over the old method in the cure of this disorder also. In treating incarcerated hernioe with homoeopathic remedies, I consider it necessary that the patient should preserve, uninterruptedly, such a position that, after the incarceration has been removed, the protruded parts shall either fall back into the cavity, of the abdomen by their own gravity, or be drawn back by the other intestines, and no manual efforts whatever be made to attempt the reduction. RUPTURE. 699 To remove the incarceration, homoeopathy selects, as is well known, such medicines, which, if taken by a healthy person in an appropriate manner and in sufficient quantity, produce positive symptoms, very similar to those of hernia incarcerata, with the view of lessening and removing the morbid muscular contraction by the reaction of the vital power (according to the unchangable law of nature, through which the reacting vital power constantly strives to call forth a tone and activity opposed to that which has been positively excited in the organismus by some extraneous influence, and thus restores the equilibrium and the harmony of the vital functions). In order to insure the most favorable action of specific remedies, the patient should be kept as quiet as possible, and allowed to remain undisturbed, all manipulations made for the purpose of accomplishing reposition, having the effect of pro ducing a primary, or so to speak, violent or forcible dilation of the contracting muscles, by which an increased contraction is caused through the reaction of the vital power, and in consequence of which the beneficial effect of the medicine employed is thereby materially obstructed. The same is the case with most remedies which are applied externally, wherefore the external treatment of an incarcerated rupture is, in most cases where homoeopathic remedies are employed, not only superfluous, but even detrimental. If, in treating an incarcerated hernia, both homceopathic medicines and external treatment are employed, and the reposition succeeds, this result is no doubt to be looked upon rather as the effect of the latter than of the former, because the homceopathic medicines are interrupted in the display of their positive effects, and the vital power cannot, under such circumstances, exert a beneficial reaction; in this case Dr. Lobethal is perfectly right when he says: The external treatment of a rupture appears to him to effect more than ANux, Belladonna, and Aurum. But if, under the external treatment of a rupture, the reposition does not succeed, the bad effects of the incarceration will increase the more rapidly, and the necessity of an operation will be indicated the sooner; moreover, the success of the latter will be rendered the more doubtful the greater the degree of external violence which may have been used, since the evil consequences of these rude interferences continue even after the operation. RUPTURE. 701 in the region of the rupture; violent dragging pain with periodical tearing, and a sort of spasmodic constriction in the abdomen; nausea, inclination to vomit, and actual vomiting of an acid mucus; obstruction, with frequent inclination for stool; most of these symptoms are increased by the slightest pressure on the rupture, as also by movement. Nux vomsCA corresponds with the symptoms of this form of incarceration. I accordingly give 10-15 globules of one of the higher potencies every half hour or every hour. Frequently a remission of the symptoms takes place after the first dose or two; if, at the same time, a sensation of movement takes place in the rupture, or if a gurgling noise be heard, then a remission of the incarcerating muscular contraction, and a speedy replacement, without any external treatment, may be expected. Should this not be the case, but, on the contrary, the sufferings return again with unabated vigor; or if an oppressive soreness or pain as if from a wound, and a violent burning, prevail in the region of the rupture, and the superincumbent integuments become very sensitive to the slightest touch; or if the heat in the affected parts increases, and thus betokens an increased determination of blood towards these parts; or should the incarceration have been preceded by a fright, or some other mental affection, and the patient be in a state of general irritation or excitement, then I usually give one drop of Aconitum of the third to the sixth dilution, and, an hour afterwards, VNux vomica at a lower dilution than in the first instance, and in a liquid form in preference (Nux vom., 2. gtt. x-xv, Aq. destill. 3 ij), a tea-spoonful every half hour to an hour. Second form of Incarceration. The rupture becomes suddenly incarcerated and is generally small; tearing, dragging pain, both in the rupture itself, and in the whole abdomen predominates; the patient sometimes experiences fugitive stitches in the region of the rupture; the pains undergo periodical remissions-disappearinmg almost entirely for a time, and then returning with increased violence; the patient feels much exhausted during the remissions; he complains of a general sensation of cold; the abdomen is much distended by flatus; after a continued desire to vomit, 702 DISEASES OF PARTICULAR ORGANS AND REGIONS. the patient eventually vomits an acid-tasting fluid; and, notwithstanding a very urgent inclination for stool, no evacuation takes place. In this form of incarceration likewise, Nutx vomica is an excellent medicine, but Lycopodium vies with it in efficacy; I generally administer both these medicines alternately, at intervals of one to two hours. If, however, these symptoms appear in a crural rupture, if they take place in a woman, or has the incarceration in the latter case taken place during or immediately after the appearance of the menses, and if, moreover, the individual is of a mild, yielding disposition, ]Lycopodium is to be preferred. I give this medicine in the middle attenuations (10-15) either in globules or in the liquid form (Tinct. lycop. gtt. xv; Aq. destill. 3j), a tea-spoonful every half hour or every hour. If throbbing, burning, and other symptoms indicating Aconitum become predominant, I administer the latter as an intermediate remedy. 2hird form of Incarceration. The third form of incarcerated hernia (which occurs chiefly in aged persons, and in ruptures of long standing, that have, for the most part, been kept back by appropriate bandages, or have been continually protruding, and have attained a large size) is that in which the incarceration comes on insidiously and imperceptibly, and betrays itself at first only by a distressing, pinching, and constrictive sensation of the region of the rupture, by uneasiness and fulness in the abdomen, and by periodical sickness and constipation. The rupture is not very painful to the touch, the incarcerated part is also not so tense and hard as in the two preceding forms, but feels more doughy. This incarceration may often exist for days, without any perceptible increase in the concomitant symptoms; gradually, however, twitchings and pinchings, combined with periodic, transitory, tearing pains, supervene in the abdomen and groin; the sickness then becomes more lasting, a sweetish, saline, or bitter fluid is sometimes eructated, and is not unfrequently followed by vomiting of a watery fluid, and subsequently of ingesta. In this form, also, two medicines concur, and the one is again XNux vomica, which competes here with Acidum sulphu RUPTURE. 703 ricumf for the rank of priority. If the patient is of a sanguineo-choleric temperament, which, however, is but seldom the case, Nux vomica, at a low dilution, must be given first; and should the removal of the incarceration not be effected within twelve hours, Acidum sulphuricum must be administered. If the incarceration takes place on'the left side, and the patient is of a melancholic-phlegmatic temperament, Acid. sulphuricum should be employed from the beginning. I have hitherto been in the habit of prescribing in the disorder in question, a drop of the tenth dilution of this medicine to be taken every hour. By means of the foregoing treatment of incarcerated hernia, I say it with heartfelt joy, I have always more readily and more frequently succeeded in attaining the desired result, than was the case in my former practice, when I treated my patients in accordance with the principles of the old school. If my assistance was sought sufficiently early, it formed a rare exception to the rule, when an incarceration of the first and second form was not removed within eight hours, and that of the third form within twenty-four hours. Still more rarely did it happen that the homceopathic medicines entirely failed to remove the incarceration, and where it consequently became necessary to perform an operation. It is very much to be regretted that homceopathy cannot yet renounce the operation as the last resource in the treatment of incarcerated hernia; whether this will ever be possible, I shall not investigate here; we may, however, presume, with every appearance of certainty, that those cases in which the operation is now deemed indispensable will become more and more scarce the more closely that the re-provings of medicines already known, and the provings of others yet unknown, or untried, will be discovered to approach in similarity individual forms of this disease. If the homoeopathic medicines do not remove the incarceration within a given space, to be determined by each individual case; but if, on the contrary, symptoms of a more troublesome and dangerous character make their appearance; if not only the rupture itself, but also the abdomen and the epigastric region become very sensible to the slightest touch; if the existing pains and the tension of the abdomen become 704 DISEASES OF PARTICULAR ORGANS AND REGIONS. more intensely violent; if nausea, the inclination to vomit, and the vomiting itself increase, and the patient vomit more liquid than he has taken, even during the prevalence, of excessive thirst; should traces of bile or of other intestinal contents be discovered in the matter ejected; if high fever, with a hard, full pulse supervene, and the patient become more and more restless, it is to he presumed that the inedicines administered (although no others can be found that correspond better with the form of the disease under treatment) are either not strictly homceopathic to the case, or that they have been employed in an improper dose, or, finally, that the medicine appropriate to this individual case is as yet unproved, and therefore unknowvn. -Under such circumstances I never hesitate for a momenit to propose an operation, and if the patient consents, to perform it as soon as possible. FAINTING. SWOONING. SYNCOPE. Individuals of weak nerves and delicate constitutions, particularly of the female sex, are frequently subject to fainting fits, which, although rarely dangerous, yet when -utterly neglected, or in appropriately treated by violent or very debilitating means, are prone to become serious, and even fatal. The usual causes are sudden transitions from. cold to heat; breathing vitiated atmospheres; great fatigue; loss of blood; long fasting; grief, fear, and other mental emotions. When fainting occurs, the patient ought immediately to be removed to where a stream. of pure fresh air can be obtained, and freed from all tight clothing about the neck, chest, and abdomen; hie should at the same timie be placed in a comfortable position, with the head low. If the foregoing prove insufficient to effect restoration, sprinkle cold fresh water on the face and neck, and, if necessary, on the pit of the stomach. Should there still be no marked benefit produced, or if the patient becomes cold, a little spirits of camphor may be applied to the nose. When the fainting has arisen from fright, the best medicines for the consequences are, Aconite or Opiumt, and sometimes colocyn -thl. (See MLENTAL E~MOTIONS.) After great depletion, or other debilitati-ng causes,- Cinchona, and, in some instances, Nax v., FAINTING. 705 Carb. v., and Veratrum; also a little wine in very small quantities at a time, or a little bread or biscuit, soaked in wine, and sometimes a little strong soup may be administered. Should the fainting arise from mental emotions, Ignatia and Chamomilla are the remedies in general cases. (See MENTAL EiroTIoNs.) When slight pain causes fainting, Hepar sulph. Fainting from violent pain, Aconite, Chamomilla, or Cocculus. If the affection is liable to result from even the most trivial degree of fatigue, Veratrum. When it is produced by excessive mental application, or in those who have been addicted to the use of ardent spirits, Naux vomica. In other cases, the following remedies have been recom mended where the corresponding symptoms are met with:ACONITUM. When there is a palpitation of the heart, with determination of blood to the head, humming in the ears; or when the paroxysms come on usually on assuming the erect posture, and are accompanied with shivering and flushing of the face, succeeded by deadly paleness. COFFEA may be prescribed after Aconitzm in highly excitable or nervous subjects, when the fainting fit has arisen from fright, and the last-named medicine has not relieved much. HEPAR SULPHURIS, when the fit generally comes on towards evening, and is preceded by vertigo. LACHESIS, when the fainting fits are either preceded, accompanied, or followed by asthmatic symptoms, vertigo, paleness of the face, nausea, vomiting, convulsions, spasms of the jaw, rigidity of the body; bloated appearance of the face; epistaxis; aching pain or stitches in the forepart of the chest; cold perspirations. (See YERATRUJM.) MosCus. Fainting fits, attended with spasms in the chest, or succeeded by headache, and occurring towards evening, during the night, or in the open air. VERATRUM, when the attacks are excited by the slightest fatigue; or when they are often preceded by a feeling of extreme anguish and excessive dejection, or despair, and accompanied by spasmodic clenching of the teeth, and convulsive movements of the eyes and their lids. Nux v. is a beneficial remedy when the fits take place particularly in the morning, after a meal, or after taking 45 706 DISEASES OF PARTICULAR ORGANS AND REGIONS. exercise; and there is nausea, with paleness of the face; also, when the patient complains, on recovery, of pain in the stomach, sparks before the eyes, or dimness of sight, together with a feeling of anxiety; and is, further, affected with anxiety, trembling, and congestion in the head, or oppression at the chest. ACIDUM PHOSPHORICUM has been found useful after Nux v., when that remedy has not removed or diminished the tendency to suffer from fainting fits after a meal. When, as is frequently the case, the fits of swooning or fainting take place in hysterical females, the remedies which will commonly be found the most appropriate are, Ignatia, Nux moschata, Cocculus, Chamomilla, Nux v., Natr. mn., or Arsenicum, &c. If the attacks are attended with asthmatic symptoms, Kreosotuzm and Berberis in addition to Nux v. When accompanied by headache, Lyco2podium, Mfoschus, Graph., JVatr. n., Stramn.; loss of consciousness, Lycopodium, Oleander, Arnica, &c. Creeping or crawling in the limbs, 2Nux v., Borax. Humming, buzzing, or tingling in the ears, Aconitum, Nuex., Petroleum, &c. Paleness of the face, Berberis, Natrum mn., Pulsatilla, &c., in addition to NAux v. Copious perspiration or sweating, Calcarea. Pain in the heart, Lackesis, &c. Benumbed limbs, Natr. n. Coldness or shivering, Acon., Calc., Colocynth, &c. Vertigo, Sul2k., Arsenicum, Berberis, Lach., &c. Vomiting, Zach., Nux v., Puls., Kali c., &c. In conclusion, it may be remarked that C'aladium, in addition to Acon., is useful in cases that are liable to come on after assuming the erect posture. Kreosotum and Spigelia, when occurring from the heat of the room. Lycopodium and Silicec, when in the recumbent posture. Caladium, when engaged in meditation. Carbo v., Natrum in., Ereosotum, in addition to Nux v., when in the morning. When writing, Caladium. Persons who are subject to fits of fainting or swooning should, if possible, strictly avoid all those frequent causes of fainting fits which have been alluded to at the commencement of this chapter; as also, where practicable, any other cause known by experience to be productive of the attacks; otherwise the cure will be rendered difficult, or even hopeless. PAINS IN THE LOINS. 707 PAINS IN THE LOINS. NOTALGIA. As these pains are frequently purely symptomatic, the treatment must be directed against the disease from which they originate. Thus as Hemorrhoids, Leucorrhcea, Afetritis, fMyelitis, &c., are frequent sources of the complaint, the reader is referred to the treatment of these affections in their respective chapters. When the pains arise from the habitual indulgence in wine or spirituous liquors, coupled with confirmed sedentary habits, or late hours, an occasional dose of Nux v. will generally afford relief; and when a strain from lifting a heavy weight. or from any sudden twist on turning the body, or throwing up a window, &c., has given rise to the pain, Ithus toxicodendron must be had recourse to; followed, if required, by Sulphur and Calcarea. (Vide also LUMBAGO, RHIEUMATISM, &c.; and for pains in the back, or lumbo-sacral pains, occurring in females during pregnancy, see that article, Part II.) DROPSY. HYDROPS. The term dropsy is used to imply an abnormal or unusual collection of serous or watery fluid in the cellular tissue, or in any of the cavities of the body. It has, consequently, received the following different appellations according to the particular seat of the effusion: Hydrocephalus, when the fluid is deposited in the cavity of the cranium; Hydrothorax, when in the chest; Ascites, when in the abdomen; Hydrocele, when in the scrotum; Hydrometra, when in the uterus; and Anasarca, when it is diffused through the cellular substance. The usual symptoms of dropsy are, pale and sickly complexion; dryness of the skin; red and parched, furred and moist, or, on the contrary, a preternaturally clean and florid tongue; failure of appetite, and impaired digestion; constipation, but sometimes diarrhoea, and, occasionally, an alternation between these two states; urine scanty, high-colored, in some instances coagulable by heat, and of low specific gravity; pulse variable, being sometimes quick, at others slow, and frequently irregular and intermitting; general debility; feverishness, especially towards night. In some cases there is cough, with dyspnoea, or a feeling of suffocation, particularly in the recumbent posture; and occasionally violent palpitation of the heart, with sudden starting during sleep. 708 DISEASES OF PARTICULAR ORGANS AND REGIONS. The remedies which have hitherto been employed, with greatest advantage, by homceopathists, are: Arsenicum album, Helleborus niger, Lycopodium, Zincum m.,* Ononis spin., Aurum m., Digitalis purpurea, Ledum palustre, Cinchona, Mercurius, Sulphur, Euphorbium, Kali carbonicum, Dulcamara, Colchicum autumnace, Prunus spinosa, Sep)ic (especially in drunkards), Bryonia, Ferrum, Phosphorus, Rius toxicodendron, Sambucus, Solanum nigrum, Ccmphora, Cantharides, Scilla maritina, Convolvulus arvensis, Veratrum, Zactucca virosa. In dropsy supervening after the retropulsion of exanthematous diseases: Helleborus, Arsenicum, Digitalis,?Rhus and 2ulphur are found the most efficacious. In that resulting from intermittent fevers: Arsenicum, Ferrum, Dulccamara, Mfercurius, Solanum nigrum, and Sulph. In drunkards: Arsenicum, Ielleborus, Sulphur, Rhus, and Leducm. In that from depletion: Cinchona, Ferrum, liercurius, Sulphur and Phosphorus. And in that from the excessive use of mercurial preparations: Sulphur, Cinchona, Dulcamara, and Helleborus. For further particulars, see ASCITES, ANASARCA, HYDROTHORAX, )YDROCEPHALUS, &c. Hydrops occurring at an advanced period of life is chiefly to be relieved by the employment of ]Kali c., Conium, Sulph., Lycopodium, and Oleum terebinthince. The diet of patients affected with dropsy should be light, but of nutritive quality. ASCITES. Ascites, or dropsical effusion in the cavity of the peritoneum, may be complicated or not with hydrothorax or general anasarca. In the majority of cases there is also cedema of the lower extremities, or other parts of the body. The disease, in many cases, goes on gradually and insidiously, the abdominal distension being at first attributed to corpulency. In others, again, and especially the idiopathic and acute forms, whilst there is an equal absence of marked constitutional disturbance, the effusion takes place so sud* Zincum m. is one of the most important remedies in dropsical affections, and especially when pains or disagreeable sensations are experienced in the region of the kidneys.-Wahle, Neues Archiv. Dritter Band, Erstes Heft, p. 28. ASCITES. 709 denly, accompanied with such characteristic indications, that there is little risk of falling into error as to the true nature of the enlargement. But on some occasions the invasion of the disease is announced by striking premonitory symptoms, such as fever, restless nights, thirst, impaired digestion, foul tongue, nausea or vomiting, costiveness, scanty high-colored urine, pain in the lumbar or hepatic regions, &c. The swelling of the abdomen in ascites is somewhat tense, the sound on percussion dull, and when the quantity of the effusion is considerable, the swelling gravitates to the side towards which the patient inclines, and a sense of fluctuation will be felt on placing one hand on one side of the abdomen, and striking the opposite side sharply with the other. There is frequently more or less difficulty of breathing, with incapability of lying in the recumbent posture, either in consequence of accelerated circulation, or from the encroachment of the accumulated fluid on the thorax. Mfuscular attenuation is a common attendant on this form of the disorder, as well as on general dropsy. Those parts of the body which are not puffed up by serous infiltration, are accordingly found to be in a state of emaciation. The prognosis in dropsy must be regulated by the nature of the case, and the age and temperament of the patient. When combined with any organic disease of the abdominal viscera, or the contents of the thorax, with effusion into its cavities, we can scarcely anticipate any other than an unfavorable termination. When occurring in individuals at an advanced time of life, or in sickly children, accompanied with emaciation and extreme prostration of strength, fever, cough and difficulty of breathing, scanty and offensive urine, feeble, irregular, and intermitting pulse, petechiae and hemorrhages, we must generally expect a like unfortunate issue. But when the disorder sets in as a consequence of scarlatina or other exanthemata, or arises suddenly after the suppression of some accustomed discharge, or from exposure to cold, or exhaustion from fatigue, although properly held as a serious malady, it is yet, in such cases, by no means to be considered in the light of a fatal one. THERAPEUTICS. Helleborus niger, Arsenicum, Cinch., Mercurius, Sullphur, Bryonia alba, ledum pcalustre, Kali 710 DISEASES OF PARTICULAR ORGANS AND REGIONS. carbonicum, and Lycopodicumn, &c., are amongst the most useful medicaments. IHELLEBORUS NIGER. This important medicine is often of equal service here, and in dropsy in general, as in anasarca, and particularly in the acute idiopathic form of the disease, in which indeed it is almost superior to any other remedy. Occasionally it will be found necessary to have recourse to Aconite in the first instance, in order to allay any excessive degree of arterial excitement; but when that is inconsiderable, or when the febrile symptoms are accompanied with great debility, and a tendency to torpor or lethargy; the urine extremely scanty, or almost suppressed, and the motions loose and gelatinous; also when shooting or other pains are complained of in the extremities, Helleborus should at once be employed. In chronic dropsy, Helleborus is also sometimes of unequivocal utility as an intermediate medicament. _Bryonia, Ledum, Lach., or Mfercurius, are useful auxiliaries to lielleb., when required, in the acute variety of anasarca. ARSENICUM. As has already been stated, under the head Anasarca, this remedy is peculiarly valuable when extreme debility is a characteristic feature, and has arisen from the depressing effects of other maladies. It is of speedy efficacy in acute cases, when called for, but is also valuable in the chronic forms occurring in shattered or broken-up constitutions; and even in cases connected with organic affection of some important viscus, it will be found a most useful palliative, however inadequate it may be to effect a cure in such hopeless cases. Digitalis, Zedum, Bryonia, Solanum nigrum, and ielleborus are sometimes useful after Arsenicum. (See ANASARCA, for some of the principal symptomatic indications for this remedy.) CINCHONA. In ascites occurring in constitutions which have been much debilitated by loss of fluids, Cinchona can rarely be dispensed with. But also in chronic dropsy arising from organic disease of the liver or spleen, particularly the latter, considerable advantage is obtained from its employment. When, in connection with either of the above conditions, we meet with a short distressing cough, accompanied or not with some expectoration, extreme paleness of the skin, general chilliness, small, feeble, and slow pulse, frequent calls to make ANASARCA. 711 water, which are usually ineffectual or followed by a scanty discharge,-there will be additional reason for having recourse to this remedy. Ars. and Ferrum are often found exceedingly useful after or in alternation with Cinchona. MERCURIUs, together with Arsenicum, Cinchona, Bella.,,Bryonia, Lachesis, and Sulphur, forms an important remedy in chronic cases associated with disease of some viscus, such as the liver or spleen, attended with great debility, incipient, short, and shaking cough, &c. When we encounter symptoms of peritoneal inflammation, Acon., Bry., Bella., Lach., or Mere. are chiefly brought into requisition. In ascites connected with the suppression of accustomed discharges, Sulph. and iyc., as also Sepia, Calc., Kali, Puls., and Silicea are the most useful medicaments. CANTHARIDES has been recommended as particularly serviceable in hydrops connected with deficiency of tone in the urinary organs, and attended with strangury, tenesmus, and pains in the limbs, &c. In ascites consecutive on scarlatina or other exanthemata, lHelleborus, Ars., Rhus, Bella., Sulph., and Digitalis form the most valuable remedial agents. And in the chronic forms of the malady, especially when occurring at an advanced period of life, the following are the most important: Kiali c., Con., Sul2ph., fd., Lyc., and 01. tereb. (See also HYDROPS and ANASARCA.) DROPSY OF THE CELLULAR TISSUE. ANASARCA. This form of dropsy consists in a preternatural accumulation of serous fluid in the cellular membrane, immediately under the skin. As the collection of fluid increases, the skin is frequently rendered inflamed and swollen, and exhibits an erysipelatouslike aspect. An outlet is eventually given to the effused liquid by the partition of the distended cuticle; but the serous infil* In general I found Rhus more useful than any other remedy in hydrops occurring after scarlatina, but the other remedies, and especially Helleborus, occasionally proved useful. The extent of the anasarcous swelling does not always indicate the degree of danger, as children are often carried off by hydrothorax or by hydrocephalus, who have exhibited only a slight degree of tumefaction. (Rummel, Allg. Hom. Zeit. 21-32.) 712 DISEASES OF PARTICULAR ORGANS AND REGIONS. tration into the cellular texture continues with undiminished rapidity. The affection is, in the greater number of cases, symptomatic of some other disease, and is, most frequently met with in combination with general dropsy. It sometimes, however, exists as an idiopathic affection, particularly in the sthenic form. The disease in the acute form generally affects those who are in the prime of life. It comes on suddenly, either after taking a large draught of cold water when the body is heated, or after exposure to cold under similar circumstances; and generally gives the first indication of its invasion by a feeling of oppression at the chest, occasionally attended with a distressing cough and pain, particularly on drawing a full breath. In the course of a few hours, dropsical swelling becomes apparent, at first, for the most part, in the face, from whence it spreads downwards to the trunk and extremities. The urine in this, as in the other forms, is scanty and high-colored. The pulse is frequently neither above nor below the natural standard, although in some cases it is rather quick, and accompanied with heat and dryness of skin, whilst in others it is weak or irregular. If the disease be unchecked, the swelling increases, respiration is performed with increasing difficulty, and the patient is incapacitated from assuming the recumbent posture, or at the utmost can only recline in one particular position. A fatal termination may take place in a few days, but several weeks sometimes elapse before the patient sinks exhausted. The asthenic form of anasarca generally comes on slowly. It is most frequent amongst the lower orders, who are necessitated to dwell in damp, dark, and ill-ventilated apartments, and who, from poverty, can only obtain the most unwholesome food. When met with in a higher walk of life, it is commonly superinduced by sedentary habits, depressing emotions, excessive depletion, arising either from the loss of blood, diarrhcea, or dysentery. The abuse of spirituous liquors, or debility resulting from chlorosis, scurvy, rheumatism, etc., may also be enumerated as appertaining to the predisposing causes of this variety. The feet are commonly first observed to be in a swollen state, especially towards evening, and are found to pit on pressure; occasionally the face is also noticed to be puffy, and the anasarcous swelling then gradually ascends ANASAROCA 713 higher, until it, in some cases, pervades and distends the cellular tissue of the entire body. The pulse varies; sometimes there is considerable fever and dry skin; but the temperature of the parts affected is in general diminished. The bowels, although usually costive, are sometimes met with in the opposite extreme; the urine, small in quantity and dark red, depositing an abundant sediment. A great thirst is generally complained of. The skin becomes pale and often milk white; soft, but deprived of its natural moisture, and as the collection of fluid increases, its vitality is so depressed by the effects of prolonged distension, that the slightest injury will induce erysipelas, ulceration, and gangrene. There is another form of ana,sarca which, from the circumstance of its supervening after exanthemata, has received the appellation of consecutive anasarca. This variety is much more frequently encountered in children than in adults, and especially as a consequence of scarlet fever. It is apparently of an inflamnmatory nature, and connected with imperfect cutaneous transpiration, or obstructed secretions and excretions. Exposure to cold or wet, or to a cold and damp atmosphere, favors its occurrence. THERAPEUTICS. The remedies required for the treatment of anasarca are, for the most part, the same as those which are employed in general dropsy. The following may, however, be specified as more particularly applicable to meet the several varieties of this species:-Helleborus niger, Bryonia, Phosph., Jeerczurius, Arsenicum, Cinchona, Ferr., Sudlph., Leclum, Dulcamara, Colehicum, Lactuca virosa, Sepia, Zycoyodium, Prunus spinosa, Digitalis, etc. In the acute form of anasarca, IIeleborus, Bryonia, Phosphorus, Arsenicum, and Mercurius, are commonly the most serviceable. Helleborus, especially where we encounter febrile symptoms, with constriction in the chest, and lancinating pains in the extremities, and almost total suppression of urine; or where there is coma somnolentum, with great debility and looseness of the bowels, the motions generally presenting a gelatinous appearance; prolonged shivering, short and rapid respiration, much thirst. (Arsenicum is sometimes required to complete the cure after the previous employment of Helleborus.) 714 DISEASES OF PARTICULAR ORGANS AND REGIONS. BRYONIA is of very great service in some cases of the acute, asthenic variety, whether idiopathic or otherwise, where there is oppression at the chest, with acute pricking pain, particularly during a full inspiration; increase of the anasarcous swelling during the day, and diminution at night; constipation. Should the foregoing symptoms have come on suddenly after partaking of a long draught of cold water when in a heated state, or should the dropsical swelling make its appearance during an attack of pneumonia, there will be additional reason for selecting this remedy. Occasionally, however, it may be found necessary to follow up the treatment with Cinchona or Lycopodiumn, the latter particularly where there are obstinate constipation and diminished activity of the skin. PHOSPHORUS is chiefly used in anasarca accompanied with inflammation of the lungs; here it forms one of the most important remedies. Should it not prove sufficient to overcome the entire disease, Sulphur, Lycopodicm, and perhaps also Arsenicum and lachesis, will, in general, be found the most appropriate medicaments to combat the remaining symptoms. MERCURIUS. In acute or chronic anasarca, attended with oppression at the chest, incessant, short, and extremely fatiguing cough, this is a useful remedy, particularly in the asthenic form, with disordered liver, general heat, thirst, great weakness. Dulcamara and Colchicumn have been found useful in anasarca resulting from the effects of a chill from exposure to cold and wet when heated. In the asthenic or in the chronic form of anasarca, Arsenicumi, Cinchona, Ferrum, ilercurius, Sulphur, Camphora, Lycopodium, Sepia, ledumn palustre, Pius, Ilelleborus, &c., form the principal medicaments. Arsenicum is one of the most invaluable remedies in anasarca with debility, either when the attack has come on suddenly as an idiopathic affection after a chill from drinking copiously of cold water while in a state of perspiration; or when it has been induced by the depressing effects of other maladies, such as dysentery, diarrhoea, scorbutus, &c., and the habitual indulgence to excess in spirituous liquors; or further, when the disorder occurs in combination with gastritis, pericarditis, and other ANASARCA. 715 affections of the heart or other viscera. The following symptoms constitute some of the leading characteristic indications for the employment of Arsenicun. Tightness in breathing, or attacks of oppression at the chest which threaten suffocation on assuming the recumbent posture, and particularly when lying on the back; dry, harsh, and thickened skin, which is, at the same time, of extreme paleness, or of an earthy, greenish hue, particularly at the face; parched and somewhat reddened tongue; excessive thirst; aching or dragging and rending pains in the back and limbs; extreme weakness, amounting to complete prostration; feeble or irregular pulse; coldness of the extremities. Helleborus niger occasionally proves of essential service after or alternately with Arsenicum. In other cases Cinchona, Br)yonia, lack., Zledum, or Solanum nigrum may claim a preference. CINCHONA. In anasarca combined with affections of the liver or spleen; or when the disorder has been induced by debility arising from loss of blood, diarrhoea, or dysentery, &c., this remedial agent is of much utility, but will generally require to be succeeded by Arsenicun, Ferrum, Helleborus, f1ercurius, or ulphtur, &c. Shooting or pricking pains in the parts affected with the dropsical swelling, together with a pale, sickly, or death-like hue of the skin, are characteristic indications for Ferrum. MERCURIUS. Some general indications for the employment of this remedy have already been given. In anasarca with debility it is more frequently useful than in the sthenic form. SULPHUR is a useful general remedy in chronic cases, or in those with debility induced by CHLORosIS, ScuRVY, DIARRH(EA, SYPHILIS, &c. Sepia, lycopodium, or Kali, &c., are occasionally of some service after ir in alternation with SulpI2hr. In other cases of anasarcous swelling with a deficiency of vital energy, Camph]ora, Rhus, Phosph., Prunus spinosa, Antimonium cruclum, &c., have been found of considerable efficacy. Against consecutive anasarca, Helleborus niger and Bellad. are the more generally appropriate remedies; but in some cases it is necessary to have recourse to Arsenicumm, Mlerc., ikhus, Digitalis, or Sulphur. When mortification threatens 716 DISEASES OF PARTICULAR ORGANS AND REGIONS. in consequence of anasarca, Lachesis, Cinchona, and Arsenicum, are the remedies from which the greatest possible assistance is to be hoped. (See also art. HYDROPS.) In anasarca arising from a long-continued residence in a damp, unwholesome dwelling, ColeMicum may prove a valuable palliative, if not a curative remedy. A radical cure was performed by it in a case which appeared to have been excited by the aforesaid cause, in which the following were the predominant symptoms: At the commencement of the attack, slight gastric derangement, then very gradual anasarcous swelling, attended with pains in the joints and extreme sensibility of the skin to the slighsest breath of air, no thirst, and a perfectly normal state of the urine. (Kurtz A. h. Zeit. xxvi. 90.) DROPSY OF THE CHEST. HYDROTHORAX. HYDROPS PECTORIS. HYDROPS THORACIS. Dropsy of the chest may exist without complication with effusion into the cavity of the abdomen, or any other dropsical affection. The collection of fluid may take place in both sides of the chest, or in one only. Occasionally the exudation is lodged in the cellular texture of the lungs as well as in the sacs of the pleura. The disease is often ushered in by a sense of uneasiness at the inferior portion of the sternum, attended by some difficulty of breathing, which is greatly increased by any exertion, but more especially whenever the recumbent posture is assumed. An annoying cough, at first dry, but subsequently accompanied with expectoration of thin mucus, is experienced, and the feet are observed to be in an cedematons state towards evening. In addition to these symptoms, we encounter those which are met with in all forms of dropsy, such as paleness of the skin, thirst, and diminished secretion of urine, &c.; further, a fluctuation of fluid is frequently perceived in the thorax, either by the affected party himself or by his medical adviser, on particular movements of the body. Along with the above symptoms the existence of hydrothorax is to be detected by means of auscultation. Percussion gives a dull sound, and the respiratory murmur is either very obscure or entirely absent, except in the vicinity of the spinal DROPSY OF THE CHEST. 717 column. Enlargement of one or both sides of the chest is sometimes observed, together with an increased or more prominent appearance of the intercostal spaces. As the disease advances the dyspnoea increases, particularly at night, when it sometimes creates a dread of suffocation; the extremities become more and more swollen, and the patient is frequently affected with palpitation and fits of excessive anxiety. Numbness is often complained of in one or both arms. Eventually the patient finds it impossible to keep the recumbent posture, or even incline backwards, and cannot indeed fall asleep in any position, especially if the water is collected in both cavities of the pleura, without starting up suddenly with increased difficulty of breathing and apprehension of asphyxia. The cheeks and lips become pale from the impeded circulation, and the pulse becomes irregular and intermittent. Finally, the patient is carried off by suffocation and exhaustion, or becomes comatose. In some cases the termination is sudden, but in others death is preceded by a spitting of blood for the space of five or six days. Organic lesions of the lungs, heart, or their great vessels form the most frequent sources of hydrothorax; but disease of some of the viscera of the abdomen, and especially induration or scirrhus of the liver, is an additional frequent cause of the affection. THERAPEUTICS. The prognosis in this serious and distressing malady must, in a great measure, depend on the cause of the effusion. But in truth, in almost all cases we can rarely speak otherwise than in the most unfavorable terms. The remedies from which the greatest alleviation, and occasionally the ultimate cure, has hitherto been most frequently attained in homoeopathic treatment, are, Aconitum, Arsenicum, Ocarbo v., IIelleborus, Clina, Lycopoclium, Golchicum, Digitalis, Spigelia, Dulcamara, &c. The most important and more generally applicable remedy in hydrothorax, whether resulting from inflammation of the pleura, or organic affection of the liver or spleen, and even of the heart, is Arsenicum, particularly when the following train of symptoms are encountered; distressingly impeded respiration, but especially after any exertion, such as going up stairs, 718 DISEASES OF PARTICULAR ORGANS AND REGIONS. &c.; incessant thirst with inclination to drink but little at a time; painfully obstructed breathing on getting into bed, notwithstanding that the act is performed with the utmost caution and slowness, attended with palpitation of the heart and excessive anguish as if from impending suffocation; extreme dyspncea on assuming the recumbent posture, or on changing the position in bed during the night; coldness of the extremities; oedema of the feet; pale or greenish hue of the skin, pains in the back and loins; complete prostration of strength. When the above symptoms do not arise from or are unconnected with organic lesion of the heart, lungs, &c., they will rarely fail to yield to the employment of Arseniczm. In complications with organic affections of the liver, spleen, or heart, a greater or less degree of amelioration is generally the utmost we can look for from the use of this, and but too often it must be added, of any other remedy. Carbo v., Cinc/hona, Ferrum, and M3ercurius are of considerable assistance after Arsenicum, when there is disease of some one or other of the abdominal viscera, such as the liver or spleen, &c.; and Digitalis, Colchicum, and Spigelia when there is organic lesion of the thoracic viscera, particularly the heart or large vessels. DULCAMARA has been found of considerable service in alleviating the sufferings in hydrothorax when they become aggravated during the prevalence of cold,, foggy, damp, or rainy weather, and continue so until a change takes place in the form of a pure and dry state of the atmosphere. COLCHICUM, as has already been stated, is a useful palliative along with Digitalis and Sjpigelia in dropsy of the chest connected with organic lesions of the heart or great vessels. It is to be preferred to Dulcamara in those cases where, in addition to the tendency to an increase of suffering during cold and humid weather, there is, moreover, extreme susceptibility to cold. In hydrothorax resulting from inflammation of the pleura (chronic pleurisy), Arsenicum, Carbo vegetabilis, Lycopodium, Lachesis, Kali carbonicum are the most important remedies in the generality of cases. When there are febrile symptoms accompanied by sharp pains in the chest, a dose or two of Aconitum is occasionally &CROFULA. 719 beneficial; but in most cases of this description we shall commonly find it more advantageous to have recourse to Bryonia, without the previous employment of Aconite. The following medicines may also be enumerated as likely to prove of service in hydrothorax: Stannum, Ammonium carbonicum, Scilla maritima, Aurum, Mercurius8 and Senna. SCROFULA. The most common form of this disease is that in which the conglobate glands in different parts of the body, but especially the neck, under the chin, and behind the ears, become converted into hard, indolent tumors, and subsequently pass through the stages of suppuration and ulceration. The discharge which succeeds, instead of consisting of pus, is found of a white curdled matter bearing some resemblance to the coagulum of milk. In some cases, and those generally of an inveterate character, the eyes are the principal seat of the disease; whilst in others, of a still more virulent description, the joints become swollen and extremely painful, and if the course of the malady be not checked it extends to the ligaments, cartilages, and adjacent bones; or tubercles are developed in the lungs; hectic fever is then superadded, and often puts a fatal termination to the disorder. THERAPEUTICS. The remedies which have hitherto been chiefly employed in homoeopathic practice in the early stage of this disorder, are Bella., Silicec, Szilph.., Calc., Ars., Puls., Sepia; and, when the glands of the neck, &c., are prominently affected, the following, in addition to the foregoing, are commonly of the greatest efficacy: Con.,t * A one and a half year old, highly scrofulous (hereditary) child; treated for a length of time allopathically, by means of Baryt., Hydr. pot., and latterly Calomel, and then lod.: around the neck glandular swellings partly commencing to suppurate, partly open and discharging thin yellow pus; moist scabs on the head and ears; eyelids reddened and swollen; cornea obscured by old cicatrices and fresh ulcers; excessive salivation; dry cough; violent fever from dentition. Tinct. Sulph. 1, a drop night and morning. After some little time the child became lively and vigorous, and the ulcers healed. f Enlarged and indurated cervical glands of scrofulous children, which, if anything, rather increased than otherwise under the employment of Calc., lod., and Silic., became strikingly diminished and softened within eight 720 DISEASES OF PARTICULAR ORGANS AND REGIONS. Dulc.,* Merc., Ilepar, Uistus, Staph., Phosph., Aur., Baryta c. et m.,t Rhus, Olem., &c. (See DISEASE OF THE CONGLOBATE GLANDS.) A careful selection from amongst these remedies, according to the nature of the symptoms, combined with great attention to cleanliness, ventilation, and the quality of the food, which should be wholesome and nourishing, will rarely fail to be attended with satisfactory results. In young subjects, indeed, it will frequently be found practicable after patient perseverance, completely to eradicate, by the said means, the scrofulous diathesis. When the joints or bones have become affected, Szlph., Calc., and Silicea are of striking utility; in other cases,-Mferc., Aurum, Lye., Phosph., Cistus, &c., may be called for. And when the glands of the mesentery are in a diseased state (scrofula mesenterica), Sulphur, and Calc., as also Xerc., Ars., Baryta, Lec., Baryta c., Bella., China, Puls., RTus, Nux, &c., are those from which we may generally look for the most important aid. (Vide also ENLARGEMENT AND INDURATION OF THE CONGLOBATE GLANDS IN THE NECK, &c., ATROPHY, IACHITIS, OSTITIS, OPHTHALMIA, and ULCERS, &c.) days from the use of Conium internally and externally. (Ohlhauth, Hyg. xvii, 262). * Dulcamara (Tr. gtt. x, Sacch. lact. Dr. aliq.), about a fifth of a grain twice a day (for a period of from six to eight weeks), cured hard, circumscribed, painless swellings of the cervical glands, the size of a pigeon's egg, occurring in young persons of from 14 to 18 years of age, who were otherwise of parents sound and healthy (Diez. Hyg. xvii, 262). t The sphere of action of Baryta mur. is more particularly confined to the lymphatic system. I have found it useful only in scrofulous cases (inflammations of the eye, eruptions, diarrhoea, blenorrhcea of the lungs). Dosis, 3d trituration (4: 96) scr. j. in aq. destil. ij, for children of a twelvemonth old, a tea-spoonful every three hours, and so on, increasing or diminishing the dose, according to the age and temperament of the patient. The fol. lowing cases are examples of its successful employment:A child, two years of age;-the neck surrounded with glandular indurations of about the size of an egg; abdomen hard and distended; tongue furred; appetite only for dry bread; stools hard, white, and take place only; after clysters; urine yellowish and fetid; offensive otorrhcea; emaciation swelling of the feet; hump-back. (Had been treated allopathically for a twelvemonth.) Milk, mucilaginous diet. Baryta mur. ( xij), as above, effected a perfect cure, inclusive of the hump, in three months. A child, one year and a half old, covered with ulcers; thick offensive incrustations over the head, fetid discharge from the ears; inflammation of DISEASES OF THE BONES. 721 OSTITIS. CARIES. NECROSIS. EXOSTOSIS. Inflammation of bone may either be acute or chronic. It is usually characterised by pain, more or less severe, followed by swelling, and often with heat and redness of the integuments covering the affected parts. In chronic cases the enlargement takes place very slowly, and the pain varies according to the cause of the attack, being much more intense and accompanied by nocturnal exacerbation, in ostitis arising from syphilis or from the abuse of mercury, than when induced by the effects of external lesion. The accompanying fever is not often very intense, and displays itself chiefly towards evening and at night. When the inflammation is acute, it soon, if unchecked, terminates in caries, in necrosis, or in suppuration of the cancellous texture. Caries or ulceration may either arise in consequence of an external injury followed by considerable inflammation and abscess; or it may occur as a sequel of scrofula and syphilis. The latter is the more frequent source of the disorder. It may take place in any of the bones, but is most commonly encountered in those of a spongy texture, such as the bones of the tarsus and carpus, the sternum, vertebre, and the extremities of the long bones. In the commencement of caries an obtuse, deepseated pain is experienced in the affected bone, and the superincumbent integuments become discolored, flabby, and tender to the touch; the soft parts then ulcerate, and a sinus is formed, which is in communication with the caries, and from whence a dark-colored, thin, ichorous matter, having a peculiarly offensive odor, and occasionally containing osseous particles, is discharged. The diseased part of the bone is usually soft, moist, accompanied with the production of pale, spongy granulations, and sometimes perforated at innumerable points (worm-eaten caries); at other times the surface of the bone is dry, brittle, and of a pale white color. Partial the eyelids, photophobia; tumid belly; stools, watery and fetid; swelling of the feet. In six months, restoration to sound health. A girl, six years of age, dismissed as incurable after having been under allopathic treatment for a twelvemonth. Complete dimness of the cornea, sclerotica inflamed and relaxed; both nostrils inflamed and excoriated. After three weeks the inflammation was subdued; after four months, the vision clear and normal. (Altmiiller, Allg. Hom. Zeit. xxi, 213.) 46 722 DISEASES OF PARTICULAR ORGANS AkND REGIONS. absorption of the bony texture frequently takes place, some of which is rendered so fragile as to crumble away at the slightest touch. Caries may take place at any period of life, but is most frequently met with in young subjects, particularly when originating, as it so frequently does, in scrofula. The bones which are most liable to be affected with syphilitic caries are those of the cranium, the tibia, the sternum, the palate, and the nasal bones. While those which more commonly become carious from scrofula are the vertebrae, the bones of the carpus and tarsus, and the extremities of the long bones. The disease is attended with the greatest danger when it exists in the bones of the cranium, the large joints, the vertebrae, the carpus and tarsus, particularly if, at the same time, it arises from a constitutional cause. Necrosis, or the death of a portion of a bone, may be induced by violent inflammation of the periosteum, or by anything which affects the substance of the bone or the medulla in such a manner as to interfere with or interrupt the process of nutrition. Consequently severe contusions, compound fractures, the protracted exposure of the surface of a bone, which has been deprived of its periosteum, to the air; irritating applications, such as strong acids, caustics, &c., are frequent causes of the disease. But, in addition to these external means, it may also proceed from an internal or constitutional source; and accordingly we find some of the worst forms of it attributable to the effects of scrofula, lues venerea, scorbutus, the abuse of mercury, and the debilitating results of typhus fever, small-pox, &c. The symptoms of necrosis vary according to the nature of the cause and the extent of the disease. In scrofulous or syphilitic individuals the pain is deep-seated and extremely violent; and it is in such cases that a large portion, sometimes indeed the whole shaft, of a long bone is destroyed. In all cases a swelling of a greater or less extent soon takes place, and the pain, when excruciating, is rarely relieved until matter forms and the abscess bursts. When the necrosis is inconsiderable, and arises from external injury, the patient being, at the same time, of a healthy habit, there is little or no constitutional disturbance. But when the disease is more extensive, and occurs in scrofulous or otherwise unhealthy habits, the DISEASES OF THE BONES. 723 derangement of the system is sometimes very violent. On the bursting of the abscess, and particularly in the severer forms of necrosis, there remains a large tumor of a firm, unyielding description, resulting in the effusion of coagulable lymph around the dead bone, together with the oedematous and thickened condition of the cellular membrane. If a probe be introduced through the orifice from whence the matter escaped, and passed down to the bone, the surface of the latter will often be found bare and rough. Cicatrization does not take place after the evacuation of the abscess, but, on the contrary, the openings are, for the most part, converted into fistuls, chiefly in consequence of the continued irritation which is caused by the dead bone, and serve as a passage for the exit of any pus that may be formed, as well as for the sequestrum itself. We can never be certain of the existence of necrosis until we can touch a portion of dead bone with a probe, or can obtain a sight of the affected bone, and find it presenting either an excessive whiteness, or a darker color than natural. All the bones are liable to necrosis, but the tibia, femur, clavicle, humerus, maxilla inferior, radius, and ulna, are those which are most frequently affected. The diaphysis is the general seat of the disease. Regeneration of the long, cylindrical, or flat bones may take place, but those of the cranium, carpus, and tarsus cannot be reproduced. Old age, lues venerea, cancer, scurvy, and rickets impede the regenerative process. Suppuration principally takes place in the spongy texture, or medullary cavity of a bone. Its invasion is speedily followed by absorption to a greater or less extent: and occasionally, while the interior structure is removed by the absorbents, the external shell is expanded (spina ventosa). After the suppurative process has gone on for some time, the matter makes its way under the skin, and gives rise to the foundation of a soft swelling or abscess, which, on bursting, affords considerable alleviation of suffering. Necroses or caries frequently originate in disease of the medullary membrane, in consequence of the obstruction which is thereby offered to the nourishment of the bone. THERAPEUTICS. In inflammation of bone we shall rarely find occasion to have recourse to Acon.; at the utmost 724 DISEASES OF PARTICULAR ORGANS AND REGIONS. it may only be found useful as a palliative, and that chiefly in idiopathic ostitis occurring in young plethoric subjects. In some of the milder forms, attended with redness of the integuments, slight swelling of the bone and extreme sensibility to the touch, Bry. and Puls. have proved very serviceable; the former particularly in persons of nervous or bilious temperament and of a dry meagre habit; the latter in those of phlegmatic temperament, with relaxed, lymphatic constitutions. When external violence has given rise to the disorder, and the periosteum has been considerably injured, Ruta is a valuable remedy. Lastly, Mere. may be named as one of the most important remedies in acute ostitis with excessive nocturnal exacerbations of pain, and especially when the disorder occurs in persons of lymphatic temperaments, or in those who from having been badly fed, ill lodged, or have had their constitutions otherwise much reduced and enfeebled. Warm fomentations may be beneficially applied along with the internal employment of the appropriate medicines; spare diet and perfect rest must, at the same time, be enjoined. In chronic ostitis, which is the most common form of this inflammation, Sulph., Calcarea, Silic., Phosph., Acid. ph., Staph., and Assaf. are, in general cases, the most important remedies at the commencement of the attack. In other cases, and more particularly when the affection has originated in the abuse of mercury, Hep. sulph., and Acid. nitr. are two of the most important remedies; but when there is a considerable degree of erysipelatous redness, a dose or two of Bella. will generally be found requisite ere we proceed to employ the aforesaid medicines, or any other remedy which may appear more appropriate to the aggregate features of the case. If traces of scorbutus accompany the inflammation, Carbo v., Merc., Staph., Sulph., Ac. nitr., Dulc., Sepia, &c., are the most appropriate. And when syphilis, or the joint effects of mercury and syphilis, have evidently given rise to the disorder, the following medicaments, in addition to those described as the most applicable at the commencement of ostitis in general, have hitherto been foundthe most useful, viz., Aurum, Assafcetida, Staph., Mezereum, Lycopodium, Mianganum acet., Lachesis, Dulcamara, Baryta, Carbo v., Acid. fluorieum. Manganum aceticum and Mez. are more especially adapted to inflammation of the periosteum, attended DISEASES OF THE BONES. 725 with pains of an almost insupportable nature.* Merc., Aur., Staph., and Phosph. generally claim a preference when the bones of the face form the seat of the inflammation; 3Merc. and Staph. when those of the hip; and Assaf. and AMezereum chiefly, when the shin and other superficial bones are affected. In the treatment of caries it is, as in ostitis, of importance to consider the cause from which the disease has arisen. In the early stage of the malady the remedies which we have named as being very useful in the milder forms of acute, and at the beginning of chronic ostitis, are frequently of considerable service, and indeed will often prove sufficient, especially in cases which have arisen from a local injury, and unattended by signs of general constitutional derangement, to stay the morbid action and eventually effect a radical cure without the expediency of an operation. In cases depending upon a constitutional cause, such as scrofula, scorbutus, or from syphilis and the abuse of mercury, the same medicines are required as have been quoted under Chronic Ostitis. We must, in a great measure, be regulated by the law similia similibus in the selection of the different remedies; but when, from the paucity of the symptoms, or the absence of any of a characteristic or sufficiently wellmarked character, there is some difficulty in finding the appropriate remedy, the alternate or successive employment of two or more medicaments, which embrace the main features of the case, and which experience has proved to be remedies of great value in caries in general, may be resorted to. Thus, Sulph. and Cale.; Sulph., Calc., and Silic.; Silic. and Phosph., administered in alternation or rotation, have often succeedll in effecting a radical cure. In like manner, Perussel mentions three cases of caries which were cured by Hep. s. and Silicea in alternation. In another case he had recourse to Jez. and Rhus in addition to the foregoing. And in a fifth, in which there was considerable complication with mercurial disease, Sulph. and Acid. nitr. established the cure. (Bib. Hom. d. G., x, 321.) Caries articulationis cubi* Hartmann's Therapie, zweite ausgabe, p. 290. We have found Assaf. and Acid. phosph. of much efficacy in periostitis. Merc. and Silicea, and sometimes Bella., Staph., Puls., China, &c., may also do good in particular cases. (Or see Hartmann's Acute and Chronic Diseases.) 726 DISEASES OF PARTICULAR ORGANS AND REGIONS. talis, cum ulceribus ossis fistulasis: Calc. c. (Rhus), Sil., Lyc. et Sulph. (A. H. Z. viii, 120.) Caries femoris pueri scrophulosis: Sep. 10 et Acid. nitr. (Ann. 11, 365.), Caries fungosa manus: Rhus et Ars. (T. h. 1.) Caries ossium faciei: Cale. carb. et Silic. (A. H. Z. viii, 309.) Caries pedis cum febre hectica: Arnica, Lyc., et Sil. (Arch. xii, 191). Caries radii, with bluish red swelling of the fore-arm and hectic fever: Puls., Mez., Sabina, Silicea, Calc. c., and Lye. (Arch. viii, 1, 42.) Caries tibiarum et antibrachii sinistri, with several fistulous passages, debilitating diarrhoea, and utter prostration of strength. Sulph., Assaf., Acid. nitr., and Acid. phosph., accomplished the cure. One medicine alone, when homceopathic to the entire disease, is often sufficient to stop the caries and bring about a healthy action in the carious part. Thus, Aurrum has repeatedly effected cures in caries syphilitica ossium palati et nasi; as also in caries syphilitica processus alveolaris cum ozaena. Silicea, in several doses (at the thirtieth potency), frequently cured chronic caries in scrofulous children. Other cases required lower potencies of the same remedy (Kampfer, Allg. h. Zeit. xxiv, 135). Silicea 30, cured, in two cases, caries of the mastoid process (Goullon, Gr. u. St. Arch. xv, 3, 55.) Caries tibia recens: Silio. 10 (Arch. viii, 1, 23). Caries of the third phalanx of the middle finger, in a female who had applied all sorts of unguents to the part for a whole year, and from which a piece of bone had exfoliated. Eight days after the exhibition of Silicea the pain was removed, and another small exfoliation took place, after which cicatrization ensued. (Riichert's Therapie.) Acidum fluoricum* has been employed in some cases of caries with striking effect, and promises to be a remedy of great value in diseases of the bones in general. We may quote the two following cases as illustrative of its curative powers in disease of the bones: "A boy became affected, after scarlet fever, with caries of the temporal bone, which, during a period of five or six years, periodically broke out afresh, discharged an offensive pus, and then healed again. The entire left side of the cranium was arrested in its growth, and consequently rendered much * The provings of this important remedy appeared in the Neues Archiv zweiter Band, erstes Heft. DISEASES OF THE BONES. 727 smaller than the other side; the left eye also appeared strikingly smaller than the right one. The intellect of the boy was, nevertheless, not in any way affected. Several remedies improved, but failed in curing the caries. After the employment of fluoric acid the periodical attack came on earlier, and in a more aggravated form than usual, but never returned. From that time onward the left half of the cranium commenced to grow, and the previous inequality of size between the two sides of the head became gradually less, and finally imperceptible." (Neues Arch. 3ter Bd. Istes Heft.) " The first and second phalanx of the left index finger, particularly the former, were swollen to four times their natural size, so that the finger presented the shape and appearance of a pear. On the dorsum of the finger an opening sometimes made its appearance, from which pus and ichor oozed out. The entire tumor was very hard to the touch; the skin otherwise unaltered; the cause of the affection was not ascertainable; the pains were intermittent. With exception of some degree of dyspepsia, the health of the patient was good. Of Silicea 10, two doses were prescribed. The patient returned, and said that she thought the finger better; but there were no outward signs of improvement. Acidum fluoricum 10, in two doses, was next prescribed. Twelve days afterwards, the patient returned, and said that she thought the finger better; but there were no outward signs of improvement. Acidumfluoricum 10, in two doses, was next prescribed. The patient did not come back again until about twelve weeks after her preceding visit. The affected forefinger was so much restored that it exhibited little or no difference in its appearance from that of the other hand. The patient had merely returned because her digestion, after having been rendered much stronger, had threatened to become somewhat disordered again. Silicea 10, two doses, was prescribed for the general symptoms remaining. The patient did not show herself again." (Neues Arch. 3ter Bd. Istes Heft, Seite 128.) In caries of the ossa nasi, Acidum nitricum is, as well as Aurum, a most efficacious remedy. In that of the inferior maxilla (when the disease has not arisen from exposure to its vapor), Phosph. And in caries of the bones contributing to form the Antrum highmorianum, Arsenicum, Zycopodium, and Silicea have repeatedly proved curative; but in some 728 DISEASES OF PARTICULAR ORGANS AND REGIONS. instances it may be found necessary to have recourse to other medicines, as Sepia, Sulph, etc. Where caries is attended with ulceration of the integuments, and thick, lemon-colored discharge, Lycopodium acts beneficially. When caries fails to yield to the agency of medicines, and the symptoms of constitutional irritation increase in intensity, an operation for the removal of the carious portion of bone becomes necessary. The medicaments employed in the treatment of the two preceding forms of disease of the bones, are also more or less requisite in necrosis. In the first stage of the disorder, if there be severe and extensive inflammation of the soft parts, Aconitum, Belladonna, Bryonia, Pulsatilla, Mercurius, and Sulphur, together with warm fomentations and poultices, are more or less useful. (See OSTITIS.) When matter forms, and is confined under the periosteum, it should be evacuated early, by means of a deep and free incision. When the disease has reached the second stage, or that in which the sequestrum has been formed, yet remains adherent to the living portion of bone, the process of absorption or of exfoliation may be aided and quickened by the administration of Symphytumn offcinale, or by Silicea, Phosphorus, Sulphur, and Calcarea. These remedies, especially the four latter, materially serve, moreover, to lessen the tendency to renewed inflammatory attacks and their sequelae, as also to mitigate any undue severity in the constitutional disturbance which is so prone to set in during this stage of the affection. When, notwithstanding all our efforts, the health of the patient begins to be seriously injured by the pain, profuse discharge, and hectic fever, an operation for the removal of the sequestrum, or even amputation of the affected limb, if the necrosis be extensive, becomes necessary. But as long as the health remains tolerably good, we should abstain from any harsh interference with the operations of nature, and endeavour to forward her efforts by judicious medical treatment. The principal medicines by means of which this commendable aim is most likely to be promoted are Sulphur, Calcarea, Silicea, Lycopodium, &c. These remedies are equally applicable, whether the disease may have arisen from the effects of external injury, or originated in internal causes-such as Scorbutus, Scrofula, Syphilis, or the abuse of mercury, which have affected the bones through the me RICKETS. 729 dium of the constitution, or has proceeded from a debilitated state of the system resulting from severe febrile disturbance. Sulphur is chiefly required when necrosis occurs in persons of lymphatic or bilious temperament; also in those who are disposed to eruptions, enlargement of the glands, hemorrhoids and constipation. Calcarea may generally be exhibited with advantage after the previous employment of Sulphur. Silicea is, if anything, still more frequently required than either of the two preceding remedies, when the sequestrum is completely formed, but is still firmly attached to the living part of the bone (second stage); or when it is loose (third stage), and there is an excessive discharge from the fistulous openings consisting of pus and ichor; further, when there is a considerable degree of nervous excitement, and the sleep is restless and unrefreshing. Lycopodium is often useful when the matter discharged is very copious, thick, and lemon-colored. In other cases Assafwetida, Acid. nitricum, Phosphorus, ]?uta, or Jfezereum may be required. The alternate use of Sulphur and Calcarea, Silicea and Phosphorus; or of these four in rotation at intervals of from six to eight or ten days is sometimes beneficial. Suppuration of the spongy texture is to be treated at the beginning of the disease in the same manner as has been described for ostitis; and on the bursting of the abscess, those remedies which have been noticed under caries and necrosis must be resorted to. In exostosis, or the growth of a bony tumour from the surface of a bone,-Sulphur, Calcarea, Silicea, Phosphorus, Assafcetida, Dulcamara, MIezereum, and Mercurius have chiefly been recommended. And in Tophus, or the formation of a soft swelling on a bone, Bella., Mere., Phosph., Acid. nitr., Sulph., Calc., Assa., &c. RICKETS. RACHITIS. This malady almost invariably begins to show itself at the tender age of from one to two years, and is distinguished by great development of head, abnormally prominent forehead, projecting sternum, flattened ribs, enlarged abdomen, with emaciation of the extremities, and extreme general debility. As the disease progresses, the muscles become more flaccid, the epiphyses of the limbs increase in size, the bones and 730 CASUALTIES. dorsal spine become more or less distorted, the bowels relaxed and the motions frequent; and frequently, if the disease be not arrested, slow fever, with cough, oppressed breathing and atrophy supervene, and a fatal termination results. THERAPEUTICS. The remedies which have hitherto been employed with the greatest success in the treatment of this distressing affection by homceopathists are: Belladonna, Mercurius, Arsenicum, Sulphur, Calcarea, Silicea; also, Assafwtida, Acidum phosph., Phosphorus, Baryta muriatica, Staphysagria, Lycopodium, Acidum nitric., Mezereum, Petroleum, and Rhus. (See ATROPHY, HYDROCEPHALUS, and ScROFULA.) CASUALTIES. CONCUSSION, BRUISES, SPRAINS OR STRAINS, WOUNDS, DISLOCATIONS, AND FRACTURES. IN Concussion of the brain (which may arise from a violent shaking of the brain or of the whole body, without any direct violence having been offered, such as a severe blow or fall on the head), the symptoms vary, according to the degree of injury which the brain has sustained. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result; but when slight, a temporary stunning or confusion, with more or less headache, is produced, followed by increased action of the pulse, vertigo and sickness. When, on the other hand, the violence done is greater than in the latter instance, though not so severe as to cause the fatal termination alluded to in the former, the patient is rendered insensible and incapable of movement; his limbs become cold; the pulse weak, slow, and intermittent; the respiration laborious, but usually without stertor. (This has been denominated the first stage of concussion.) As the patient begins to recover from this condition, the pulse and respiration improve, and warmth begins to be felt in the extremities; the sensibility to touch then returns, and the contents of the stomach are in most cases rejected; still he CONCUSSION. SPRAINS. 731 continues to remain in a dull, confused state, and inattentive to, or almost unconscious of, slight external impression (second stage). On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to questions spoken in a loud tone. When, however, the stupor has considerably or entirely abated, inflammation of the brain, of an active character, will, in many cases, then begin to develop itself (third stage), with all its wonted symptoms (see PHRENITIS), and if not checked, suppuration or effusion within the head, preceded by rigors, will result. THERAPEUTICS. In all cases of injury arising from external violence, Arnica is an invaluable remedy, and its timely administration in cases of concussion of the brain will, in most instances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes.* We may administer internally two globules in a tea-spoonful of water; and, if there be an external wound, we may bathe the injured part with a lotion, in the proportion of a few drops of the Tincture of Arnica to an ounce, or about two table-spoonfuls of water, twice or thrice a day; should the swelling, pains, and other symptoms increase, after one or two applications, we must discontinue the lotion, but shall almost always find a marked improvement follow such aggravation. When, however, the contusion has been serious, and extreme restlessness or jactitation, and irritability of temper, with sensibility of the eyes to light, small quick pulse, delirium, or subsequently rigors, &c., supervene, the same treatment must be pursued as that described under INFLAMMATION OF THE BRAIN, and also HYDROCEPHALUS, which see.t After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to * In simple irritation of the brain, Arnica rarely fails to act beneficially. In some cases, Cicuta virosa is serviceable. ( In fracture of the cranium the same treatment must be pursued, but when compression of the brain takes place, attended with its usual concomitants, such as stupor, stertorous breathing, &c., from the effects of a depressed portion of bone, the trephine must be employed if the symptoms continue unabated, notwithstanding the use of the medicines indicated. 732 CASUALTIES. partake of any stimulating liquids, such as wine, spirits, &c., until at least three or four weeks have elapsed, even although he may appear to have entirely recovered from the effects of the accident; he ought likewise to be kept quiet, and not be permitted to expose himself to excitement of any kind, otherwise the most serious consequences may result. When the chest has been injured by a contusion or violent concussion, &c., and soreness, or a sensation as if from incipient suppuration, with heat and throbbing, is experienced in some particular spot; fever, or alternate chilliness and heat followed by fever, which becomes aggravated in the evening; sleeplessness or disturbed sleep, with general heat, and sometimes perspiration towards morning; short dry cough which increases the pain, or cough with spitting of blood; further, when the pain in the chest is rendered more acute by taking a full inspiration, laughing or sneezing, or when pricking pains or a sensation of fulness or pressure, as if caused by extravasated blood, is experienced, together with a feeling of constriction that obstructs the freedom of respiration,-it will be necessary to have immediate recourse to Arnica and Aconitum alternately, at intervals of from three to six hours, until an improvement in the symptoms becomes manifest; but should a degree of fever continue after the exhibition of several doses of these remedies, attended with a sensation as if there were an internal excoriation or wound, Pulsatilla should be given. In the event of a continuance, or even an increase of cough, with expectoration of thick, yellow mucus occasionally streaked with blood, 2Mercurius should be prescribed; if, on the other hand, the expectoration has a sweetish taste, and is accompanied by difficulty of breathing, Nux v. is to be preferred. When a degree of delicacy of chest remains behind, after the employment of any of the preceding medicines, with tendency to suffer from shortness of breath, and a dry short cough, combined with paleness of the face, impaired appetite, and restless, unrefreshing sleep, Cinchona has been strongly recommended. In other cases, especially those which have been neglected, where we have reason to apprehend the development of Phthisis pulmonalis, the employment of Stannum, Acidum nitricum, Silicea, and Kali c., or Phosphorus, Sulphur, Calcarea, and Lycopo CONCUSSION. SPRAINS. 783 dium, may yet enable us to arrest the progress of that ruthless malady. The effects of a shock to the nervous system, with pains in the limbs, &c., from stumbling or making a false step, are generally relieved by Bryonia or Pulsatilla. When the accident has been accompanied with fright, Opium may be prescribed in the first instance, Aconitum where there is syncope; and Chamomilla when, from extreme pain, convulsions ensue.* But in almost all such cases, Arnica may be employed with advantage, either subsequently or at the commencement; in the event of headache resulting from a contusion or from stumbling, and Arnica not being found to afford much relief, Belladonna may be^given;t the patient should at the same time remain quiet, and avoid any exertion, whether of the body or mind, until the pain is removed. SPRAINS. In the treatment of these troublesome casualties, at the commencement, prescribe a lotion of Arnica, when there is much tumefaction and redness, with great pain on the slightest movement. After the employment of Arnica, we may in like manner have recourse to RHIUS TOXICODENDRON,. which is, properly speaking, more specific to this description of external injury, and is often of speedy efficacy, even in cases of some standing; the remedy should also be taken internally. If severe pain continue, notwithstanding the employment of Arnica and Rhus, the following remedies have been recommended: Bryonia, Ammonium c., and Ruta, and in some instances, Belladonna, Pulsatilla, Nux v., Agnus, or Silicea. * Ignatia has also been recommended in the event of convulsions; and Coffea when uncontrollable agitation and agonizing jactitation result. ( Cocculus, Cicuta, or Acid. phosphoricum, may be required to remove prolonged headache arising from the above-named causes. (See also CEPHALALGIA.) I When an individual muscle has been injured by the effects of a violent strain, Rhus will more readily restore its tone and remove the pain than any other remedy. A dose may be prescribed thrice a day, and locally Tr. Rh. gtt. xv-xx, in aq. libr., as a lotion. Frequently, every symptom is removed after a few hours; but in bad constitutions, many troublesome sequelae occasionally arise, against which Sepia is often useful. (Goullon Gr. u. St. Arch., xix, 3,12.) 734 CASUALTIES. STRAINS. When pricking or other pains are experienced in the back, &c., after a strain caused by any powerful or sudden exertion, such as lifting a heavy weight, or throwing up a window, with aggravation from the slightest movement of the arms or trunk, Bryonia should be exhibited, and succeeded by Sulphur, if only partial relief is obtained. When headache results from a similar source, or when the pains are confined to the extremities, or if at all in the back or loins, are equally, if not more severe, during rest as well as on movement, Rhus may be prescribed, followed in turn by calcarea, if the sufferings remain almost unmitigated. When sickness and great pain in the abdomen are produced by the effects of a strain, Veratrum has been recommended as being speedily serviceable. WOUNDS are divided into incised, lacerated, contused, punctured, poisoned, and gunshot wounds. By an incised wound is meant one which has been produced by a sharp instrument, as a sword, knife, &c., and is not accompanied with any contusion or laceration. Incised wounds, although more liable to be attended with a greater degree of hemorrhage, are, generally speaking, the least dangerous and the most easily healed. L-acerated wounds are those in which the muscular fibres, instead of being divided by a sharp cutting instrument, have been torn asunder with some violence; the edges, in place of being even and regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely heal without suppurating, and are frequently succeeded by violent inflammation. The terms contused wounds, or bruises, are applied to those injuries which are occasioned by some blunt instrument, or hard blunt surface, being brought in violent collision with a part of the body. When severe they are dangerous, from being prone to terminate in mortification and sloughing. Punctured wounds are those which have been caused by pointed instruments; they partake more of the nature of lacerated than incised wounds, and are dangerous from the great depth to which they frequently penetrate, and the serious consequences they often entail, by occasioning violent inflammation of the fascia, and tetanus. CONCUSSION. SPRAINS. 735 Gunshot wounds partake of the character of lacerated and contused wounds. For poisoned wounds, see HYDROPHOBIA. THERAPEUTICS. In the treatment of wounds of all kinds, the first object is to arrest the hemorrhage. This is to be done by means of the tourniquet, by compression, by the ligature, by cold water or ice, and astringents, &c., according to the degree and source of the discharge. Wounds of the arteries are, for the most part, the most serious; they are to be distinguished by the bright color of the blood, which moreover issues very rapidly and in jets; while that firom a vein flows in a smooth, uninterrupted stream, and has a dark or deep purple hue. When the injured vessels are of a small size, they spontaneously cease to bleed, or do so, at all events, as soon as the wound is dressed; but when the hemorrhage is considerable, one or more of the above-mentioned arresting measures require to be immediately resorted to. Bleeding from wounds, &c., in the mouth, sometimes requires the application of styptics, such as alcohol, kreosote water, &c. The same may be said of slight superficial wounds, as also of fungous tumors, and other diseased surfaces, when cold water fails to answer the purpose. Arnica, Diadema, and Phosphorus, internally and externally, have likewise been strongly recommended in such cases. Copious hemorrhage after the extraction of a tooth is usually readily suppressed, by pushing a compress of lint into the hollow space left; or by the aid of styptics, and the medicines above mentioned, when requisite. A simple, and sometimes extremely efficacious mode of checking this current of blood is by replacing the extracted tooth, and keeping it in its former position, until the risk of further hemorrhage is obviated. When we find severe syncope, with deadly paleness of the face, or when the countenance assumes a livid appearance, and subsultus tendinum and other signs of extreme exhaustion set in from excessive loss of blood, Cinchona ought to be prescribed; and if the patient should not exhibit any indications of rallying, a little wine may be given, and subsequently Arnica; but if the stimulating effects of the wine prove only 736 OASUALTIES. of temporary service, another dose of Cinchona must previously be had recourse to. The next step to be taken in wounds of every description, after the hemorrhage is stopped, is to remove all extraneous matter, as sand, fragments of glass, splinters, shot, rags, &c.; then relax the muscles so that the wound may not gape; finally, to place the lips of the wound in accurate contact, and keep them so by bandages, plasters, sutures, &c. Bandages are usually indispensable in deep, and even in small, superficial, incised wounds, but care must be taken not to apply them too tight, nor when there is excessive inflammation. Sutures are generally necessary in wounds of the face or abdomen, and sometimes of the hands, and in old people generally. In the young and vigorous they are seldom called for, and are even improper and hurtful when the patient is of an irritable habit of body. Strips of adhesive plastercut narrow in the centre or portion which is to cross the wound, and sufficiently long to retain their hold as firmly as possible, and act with the required compressive powerform, in the majority of incised wounds, the most frequently useful means of bringing the sides into close approximation and effecting adhesion. It sometimes happens, however, that even incised wounds, particularly when deep and of considerable magnitude, terminate in suppuration; it is consequently necessary to leave intervening spaces between the strips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign substances, it ought to be only lightly, and so to speak, incompletely dressed, as it will be necessary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to facilitate the abstraction of a splinter, &c. With regard to the constitutional treatment of wounds of all kinds, we should commence with the administration of Arnica,* of which a few globules should be given, as soon as the patient has been made as comfortable as circumstances will admit. The patient should at the same time be kept * See Dr. Kaser's remarks on the employment of Calendula oficinalis, at the end of this chapter. 738 CASUALTIES. about one part of the tincture in ten of water, to stimulate absorption and otherwise forward the cure. In the event of an abscess resulting from the effects of a contusion, see that article. When the joints,* synovial membranes, or tendons are injured by a contusion, Rhus has been particularly recommended: in some cases Silicea will be found of great utility, as we can testify from experience. If the periosteum be affected, Ruta is said to be useful; we would, however, recommend an incision to be made in the membrane, if ecchymosed blood or matter is evidently pent up beneath it, and the Helianthus anuus may be used as a substitute in contusions, and Aqua calendule oficinalis in wounds of all kinds. In recent contusions of glandular organs, such as the testes, Arnica is the best remedy; but when induration has resulted, Conium is of greater efficacy. When the mammary gland is the seat of injury, Aconite is frequently required in preference to Arnica, as is generally the case in wounds or contusions of any part when they are followed by severe or extensive inflammation. If suppuration threatens, in a contused mamma, Phosphorus or Acidum phosph. should be employed. If induration has taken place, Conium is commonly of greater and more speedy efficacy than any other remedy. In wounds of the eye, Aconite, as has elsewhere been observed (art. OPHTHALMIA), is the specific medicament. In superficial contusions of the trunk or limbs, and in those of long duration, Acidum sulph. has repeatedly been used, externally and internally, with much advantage. * In cases of swelling, with considerable pain, stiffness, or inflexibility of the knee, from the effects of kneeling, to which housemaids (hence the name of Housemaid's knee) and others, from the nature of their occupations, are liable-and which affection, it may be added, consists of a degree of inflammation and consequent thickening of the bursa mucosa, situated between the patella and the skin, attended with increased secretion of the slippery lubricating fluid contained in the sac,-Silicea, either administered daily, or at intervals of four to eight days in susceptible habits, is a most important and eminently successful remedy. The same medicament is equally efficacious in similar swellings in other parts, such as the ball of the great toe (where the tumefaction is commonly known by the name of a bunion), or the joints of the fingers, and indeed in.most of the situations where tendons play: the use of these little sacs, or bursae mucosce, being to facilitate the action or play of the muscles. During the treatment of these swellings, it is very necessary that the patient should at the same time be careful to avoid pressure on the affected part, and that he should walk about as little as possible. In the case of a bunion, when there is active inflammation, his own suffering will sufficiently remind him of the necessity of these precautions. WOUNDS. 739 patient's sufferings are great; after which the treatment to be pursued must be the same as described for open abscesses. When a bruise or contusion is so violent as to squeeze the limb nearly flat, or otherwise disfigure it, cold water ought to be constantly applied, and Arnica prescribed internally. But if gangrene threatens, Cinchona must be given, and when the skin has assumed a livid and black appearance, amputation may still be avoided, and life and limb saved, by having recourse to Lachesis and Arsenicum alternately, in frequently repeated doses. In the greater number of such unfortunate cases, however, amputation becomes imperative, and ought to be performed without hesitation, when it becomes evident that the patient will fall a sacrifice to further delay. When amputation has been found necessary, the stump ought to be dressed with lint and dipped in cold water, and Am. should be given internally; subsequently the said medicine may be employed in alternation with Acon., if required by the accession of traumatic fever. Hepar, Silicea, and Sulph. may also be required at the ensuing stages in the healing of the stump. Subsequent trials of Calendula oficinalis, as recommended by Dr. Thorer, may confirm his opinion as to its superiority over all other remedies in severe wounds, or after important surgical operations, where extensive suppuration is to be apprehended. (See ULCERS, for indications for the employment of these and other remedies.) In the case of punctured wounds, the treatment to be followed is the same as that described for wounds in general, but unless compression, by means of adhesive plaster or a bandage, can be brought to bear against their entire extent, the cure by the first intention must not be attempted.* When suppuration ensues,.Mercurius may be prescribed, followed by Hepar s., and then Silicea, if required. Chamomilla, Belladonna, and Rhus may be found serviceable in the event of excessive local inflammation; the two latter particularly, if the inflammation partake of an erysipelatous char* In punctured wounds of the abdomen Aconitum should be given as soon as possible, in order to prevent the development of active inflammation, which is so prone to follow in such cases. Belladonna is generally required after Aconit., when symptoms of peritonitis have already made their appearance. (See also PERITONITIS and ENTERITIS.) 740 CASUALTIES. acter. (See ERYSIPELAS.) When spasmodic twitchings make their appearance, Cicuta is frequently serviceable; but Arnica will generally be found sufficient to subdue these symptoms when timely administered; when the constitutional disturbance is severe, Aconitum may be alternated with Arnica; and when the wound arises from violent inflammation of the fascia, a transverse incision may in some instances be necessary; in which event a dose of Arnica must be prescribed almost immediately afterwards. If tetanus supervene, Arnica must be employed, and followed, if required, by Angustura or Cocculus, &c. (See TETANUS.) Gunshot wounds must be treated by the exhibition of Arnica internally, and cold water constantly applied by means of lint, externally. In some cases it may be found advantageous to apply a very weak lotion of Arnica, in preference to water simply, at the commencement. When splinters of bone, a ball, &c., are lodged in the wound, they ought to be extracted with as little irritation as possible, if they press on some important viscera, &c.; but if not, they may be allowed to remain, particularly when deeply seated or difficult to be found, until loosened by suppuration, which process will be materially forwarded by the administration of Silicea. In other cases Ilepar s. and Sulph. may afford valuable aid. In the event of fever, gangrene, &c., see Contused wounds. When a joint is greatly injured, or much of the soft parts, together with the blood-vessels and nerves of importance, are carried away by a gunshot wound, the bone remaining entire; -when there is a fracture of a bone with destruction of the soft parts adjacent; when the bone is shattered, and the principal vessels lacerated or ruptured-or when a limb is completely shot or torn off, or other serious injury done, which renders the prospect of saving the limb hopeless, amputation should be performed.* * " After amputations, extirpations, and other surgical operations, I have invariably derived the most important service from the employment of ACONITUM. In most instances, a complete cessation of pain took place three hours after its administration; traumatic fever never supervened, and the patients almost always fell into a placid and refreshing slumber; but WOUNDS. 741 It may be added that Staphysagria has been recommended as a useful remedy in severe incised wounds; and Aconitum, Cicuta, or Acid. nitr. in addition to Silicea and Hepar s., in wounds from splinters, &c. (For oisoned wounds, the treatment will be found under HYDROPHOBIA.) Dr. Thorer, of Gorlitz,* strongly recommends CALENDULA OFFICINALIS in preference to Arnica, in wounds of every description, but especially incised, punctured, or lacerated wounds, and those with considerable loss of substance. The sphere of the latter as a traumatic remedy he confines to contusions, sprains, bruises without abrasion of the surface, or laceration of the soft parts. Dr. Thorer speaks, moreover, in favorable terms of the effect which CALENDULA appears to exercise over the process of granulation and cicatrization. Very frequently, even after amputations, the cure, under the employment of this remedy, was effected by the first intention, and in almost every instance where it was impossible to avoid suppuration, the extent to which it occured was comparatively insignificant. He employed two different preparations of this remedy as lotions, the one, to which he gave the name of Aqua Calendudce Oficinalis, he prepared as follows: "I filled one-third of a clean bottle with the petals or leaves of the flowers, the remaining two-thirds with fresh, pure spring water, corked it well, and exposed it for two or three days to the warm rays of the sun. The water was, by this process, rendered slightly aromatic, and having been poured off from the leaves, it was put into a bottle, well sealed up like wine bottles, then immediately placed in the lower temperature of the cellar. Whilst the bottle with the mixture of the leaves and water is exposed to the higher temperature of the sun it should be narrowly watched, and the moment that any signs of incipient fermentation make their appearance, measures must be taken to arrest it. The second preparation was a Spiritus Calendulae, for which I employed the same quantity of the leaves of the flower as in the precedrarely was it found necessary to have recourse to Opium, and that only when startings from sleep took place from local or general convulsive jerkings or twitchings."-Dr. Wurzler. Allg. Hom. Zeit., No. i, 21 Band. * Neues Arch., dritter Band, erstes Heft. 742 CASUALTIES. ing instance, and pure rectified spirits of wine in place of the water. I employed the latter preparation only on one occasion, very much diluted, in order that the spirit of wine might not exercise a detrimental influence on the injured parts. Its effect was equally beneficial." We give the following cases as instances in which Dr. Thorer applied Calendula as a lotio vulneraria homceopathica with success: "1. R. K. had the under lip much bruised and lacerated from the kick of a horse. The lips of the wound were brought into approximation, and retained there by means of a strip of adhesive plaster. In addition to this, the patient was furnished with a phial containing Aqua calendul., and desired to keep the wound covered with a compress saturated with the lotion. Already, after an interval of three days, healthy cicatrization began to set in, without suppuration. The process of healing went on quickly and uninterruptedly per primam intentionem, and the scar of the divided lip is now scarcely perceptible. "2. M. A. had the misfortune to fall down a flight of stairs, and in addition to several contusions on the chest, two extensive wounds were inflicted, one on the forehead, and the other along the ridge and at the point of the nose, producing great disfiguration. In this case, also, the healing process proceeded most rapidly and favorably, without suppuration, and without leaving any disfigurement, such as a wound of so severe a character might reasonably have led me to anticipate. " 3. This case was of infinitely greater importance than the above. F1ider, a boy, 16 years of age, while engaged at his occupation in a cloth manufactory, had the misfortune to become entangled in the machinery; in consequence of which, the following injuries were sustained:"1. Compound fracture of the left arm, the sharp extremities of the broken bone protruding through the integuments. "2. A deep wound at the bend of the elbow. "3. The bones of the left forearm completely stripped of their muscles, and laid bare to the extent of six inches. " 4. The hand torn off, being only kept adhering to the stump by a slip of skin. WOUNDS. 743 " 5. The skin and portions of the muscles of the exterior surface of the right leg were torn off, leaving a large and deep wound extending down to the bone. " 6. Face and chest severely contused, and exhibiting many small flesh wounds. " The unfortunate patient was reduced to a state of extreme exhaustion by loss of blood and excessive suffering; amputation of the left upper arm was nevertheless rendered imperative, and was accordingly performed. Compresses, saturated with Aqua calendulae, were applied to the exposed lacerated muscles of the right leg, up to the period of the recovery of the patient, and it was striking to observe how dry, and without suppuration, incarnation proceeded in the parts to which the Calendula was applied, in comparison with the extensive suppuration and slow curative process which took place in the stump of the amputated arm, treated according to the ordinary surgical rules. I was not at the time aware of the peculiar properties of Calendula, but in consequence of the striking beneficial effects which it produced on the injured lower extremity of the patient, I subsequently applied it to the wound of the stump, and was gratified by the peculiarly favorable granulation which soon ensued there likewise. All the wounds henceforward filled up and healed in so satisfactory a manner, that it was scarcely possible to conceive that they could have been of so serious a character, and attended with such loss of substance as they in reality were. The patient was restored to perfect health, and I have no hesitation in attributing his recovery to the very favorable process of granulation and cicatrization which took place under the employment of the Aqua calendulaE. " 4. 0. in G. lost his footing when in his mill, and had the third phalanx of the left index-finger, the second and third phalanx of the ring-finger, and the flesh of the point of the middle finger torn off. A small portion of the bone of the second phalanx of the ring-finger remained, but was entirely bared and exposed; the patient was desirous that this remnant of bone should be removed. I refrained from doing so, however, in the hope that it might become covered by means of favorable granulation. And so the result proved. After the hemorrhage had been arrested by the application of cold 744 CASUALTIES. water dressings, Aqua calendulc was employed, two days from the occurrence of the accident. The wounds thereupon assumed a drier aspect, incarnation went on uninterruptedly, and a perfect cure was rapidly accomplished. On the ringfinger alone, a very minute exfoliation came off from the exposed bone. " Mr. Surgeon Schulze, to whom I had recommended the Calendula as a remedy in wounds, and who had employed it extensively with much satisfaction to himself for the past two years, recently favored me with the following cases, amongst others, in which he had used it with success: "5. A laborer received a comminuted fracture of the right index-finger, while engaged in lifting a heavy stone. The splintered and more or less loose pieces of bone were removed, and the Aqua calendulce applied as a lotion. The cure followed rapidly, and without any particular suppuration. "6. A miller's apprentice had two of his fingers so completely crushed that, as in the foregoing case, it was necessary to remove the shattered particles of bone. The Calendula effected an equally rapid cure, with a very trivial degree of suppuration. " 7. In a case of complicated fracture of the leg, with a wound nine inches in length, from which the tibia was laid bare, Arnica, largely diluted, was employed for a few days, in consequence of the accompanying extensive sugillation. The Calendula was then brought into requisition, and produced a speedy cure without extensive suppuration. " I could quote a multitude of other cases in which the Calendula alone was employed, and with singularly successful and satisfactory results; but I shall content myself with adding, that in all instances in which there is extensive loss of substance, and where it is found impracticable to bring and retain the lips of a wound together by means of adhesive plaster, &c., I consider the Calendula to be the best aqua vulneraria. It has long been occasionally employed by the lower orders in the form of an ointment, made of fresh butter, mixed up with the ground or powdered leaves of the flower, and sometimes, though rarely, in the form of infusion, and taken internally. Its hommopathicity in wounds, as well as WOUNDS. 745 several other affections, has moreover been demonstrated and confirmed by the provings of Dr. Franz."* Dr. Thorer concludes his remarks by expressing the hope that his statement, in respect to the properties of Calendzla, as a remedy in wounds, may have the effect of calling the attention of surgeons to it; and that if their observations tend to confirm its healing properties in recent wounds, attended or not with loss of substance, the Chirurgia Homoeopathica will possess a new remedy which presents the advantage of causing very slight suppuration, a circumstance of no mean importance in the treatment of extensive wounds, where there is often exhausting suppuration, lasting a long time, and severely taxing the strength of the patient. DISLOCATIONS. LUXATIONS. Violent pain, swelling, distortion of the joints, loss of motion, with an alteration in the shape, length, and direction of the limb, characterise the existence of this species of injury. THERAPEUTICS. The reduction of a luxation ought to be effected as soon as possible by the surgeon. When there is excessive pain and inflammation, a dose of Arnica ought to be given, followed by Aconitum in an hour or two, if the pain continue violent,,nd the inflammatory symptoms active. Cold water, or weak Arnicated water (one part of the tincture in ten of water), should be applied locally. When the luxation is reduced, the same treatment may be pursued if called for; and the usual beneficial mechanical measures employed. In compound luxations, the same treatment may be pursued in the first instance as above described; and the wound treated so that it may be healed if possible by the first intention. (See WouNDs.) FRACTURES. The symptoms of fracture are pain, swelling, deformity, and sometimes shortening of the limb; loss of power, with preternatural mobility, when we attempt to bend the limb, and crepitation on rubbing the broken surfaces of bone together. Fractures are divided into transverse, oblique, and longitudinal; and also into simple, compound, complicated, and comminuted. By a simple fracture is understood one in * Arch., Bd., 17, Heft 3. 746 CASUALTIES. which the bone is broken, without there being at the same time a wound of the soft parts. A compound fracture consists, not only of a solution in the continuity of the bone, but also in the co-existence of an external wound, caused by the protrusion of the extremity of one or both fragments of the bone through the integuments. Again, a fracture is termed complicated, when it is attended with a wound of a large artery, extensive laceration of the soft parts, or with the dislocation of a joint. Lastly, it is designated comminuted, when the bone is broken into several pieces. THERAPEUTICS. As soon as a limb is discovered to be fractured, the patient ought to be placed on a litter of any kind which happens to be at hand, such as a board or shutter, and removed to some neighboring place of shelter, or to his own abode if it be not far distant. Great care and gentleness ought to be exercised in lifting and transporting the patient from one place to another; otherwise a fracture, originally of the simple kind, is liable to be converted into a compound or at all events into a complicated one, from laceration of the soft parts, &c., by the serrated extremities of the fractured bone, whereby the probabilities of recovery will be rendered much more unfavorable, particularly if the accident has happened to a debilitated or aged individual. In the case of a simple fracture, the reduction should be immediately effected. When that is accomplished, a dose of Arnica should be administered, for the double purpose of preventing the invasion of undue inflammation, and of promoting the reunion of the fracture. Symphitum officinale has also been most favorably spoken of as being extremely valuable in facilitating the last-named important object.O Those who have had ample opportunities of testing the virtues of these remedies, and the homoeopathic treatment generally, in cases of fracture, unhesitatingly declare that the patients are thereby enabled to regain the use of their limbs, and to be discharged with safety from the hands of the surgeon at an earlier period than when treated according to the old method; and further, that the formation of false joints is less liable to occur under the new mode of treatment. * Ruta has likewise been mentioned as useful in some cases. 748 CASUALTIES. of a few hours, the patient never rallying from the collapse. The extent and depth of the burn, wherever its seat may be, together with the age, temperament, and habit of body of the patient, determine the degree of danger to be apprehended. THERAPEUTICS. In slight burns or scalds the injured part should be held for a couple of minutes to the fire; a temporary increase of pain will be amply repaid by the prevention of future suffering and annoyance. The application of Arnica is of speedy service in superficial burns. When the pain is excruciating, Carbo v. often relieves; and failing it, CoJfea. If, however, the injury be more severe, the affected part may be dressed with heated alcohol, or oil of turpentine, taking care to keep the surface continually moist, and well protected from the external air. The application of raw cotton to the part is frequently found very efficacious, particularly when the injury presents a large surface; having previously punctured any blisters that may have arisen, and bathed the sore with tepid water, cover it with carded cotton or wadding, in three layers; when suppuration sets in, remove the upper layer only, and substitute fresh. At the same time we may prescribe HEPAR suLPHURIS, a grain to an ounce of water, a dessert-spoonful every twelve hours. China is sometimes serviceable after Hepar, when the discharge has been excessive. SOAP, a remedy generally at hand, is extremely serviceable in burns, where not only the cuticle, but the true skin has been destroyed: pure white or curd soap is the best for this purpose. Its application will, as in the instance of dry heat, &c., at first increase the pain; but this temporary inconvenience will be superseded by a marked amelioration; after a lapse of about twenty-four hours, the plaster may be gently removed, and a fresh one substituted; generally speaking, however, we must be guided by the feelings of the patient, and renew it as often as a return of pain is complained of; and so continue until the injury is completely healed.* * "When erythema alone results from a burn, warm alcohol, oil of,urpentine, or radiated heat, are the most appropriate applications. When FATIGUE. 749 ACONITUM, is essential in the event of extensive inflammation, with considerable fever; or when the system has received a severe shock from fright at the time of the injury. Opium is also of use under the latter circumstances. URTICA URENS has recently come into repute as a valuable remedy in burns. The mode of application recommended consists in applying linen cloths, saturated with the mother tincture, to the injured part; and in severe cases, a drop of the tincture may be taken internally also, either in a little water, or on a piece of lump sugar. Kreosote water has likewise been recommended as a lotion in burns of all kinds, either at the commencement or subsequently, to induce healthy granulation and cicatrization. Crocus sativus (applied externally) has also been favorably spoken of as most serviceable for the latter purpose, in burns or wounds with considerable loss of substance, and disposition to mortification and sloughing. It is probable that Calendula oficin. may prove useful in similar cases. (See also ULCERS.) Arsenicumn, and sometimes Acid. nitric., favor the sloughing of eschars. FATIGUE. When a feeling of contusion is experienced in all the limbs, Arnica will generally be found the most appropriate remedy to afford relief. Pains in the joints, &c., arising from lifting heavy weights, or from violent physical exertion of any kind, are usually speedily removed by BAhus toxicodendron. the epidermis is destroyed, the principal object to be kept in view, in order to facilitate the cure, is to protect the injured part from the atmospheric air, and from any other irritation or pressure. The best mode of effecting this is by covering the affected surface with thick layers of carded cotton, having previously opened the blisters with the point of a needle, and bathed the part with tepid water. Pencilling with white of egg, which has been beat into a froth, is sometimes attended with beneficial results. Should the cotton have become hard and inflexible, like a coat of mail, in which case some effluvium is also more or less perceptible, it may be moistened once a day with largely diluted kreosote water. If the dermis be also injured, it cannot be healed without suppuration; in such cases thick warm soap lather or paste is the best external remedy."--(Kurtz. Allg. Hoem. Zeit. xxvi. 368.) 750 CASUALTIES. CINCHONA will frequently assist in renovating the strength, when there has been profuse perspiration. VERATRUM, when tendency to fainting ensues from the effects of extreme fatigue; and COFFEA, when abstinence from food, combined with violent exercise, has produced a state of exhaustion. COCcULUS, when fatigue occurs after the most trivial exertion either of body or mind. (Veratrum and Calcarea are sometimes necessary when Cocculus does not give much relief.) In fatigue from long watching Cocculus is the most generally useful medicament; but Nux v.. Ipecac., Puls., and Carbo v. are also of service occasionally. Aconitum is a valuable remedy when dyspnoea, with palpitation of the heart, pain in the side, or aching in the extremities, arises from running a short distance, or even from walking quickly. (Bry. is sometimes necessary when these symptoms continue notwithstanding the employment of Aconitum. At other times Arnica will be found more efficacious, particularly when the pain resembles what is termed a stitch in the side. Ran. bulbosus is also very useful in the latter case.) OVERHEATING. EXPOSURE TO HEAT. When heat in the head and flushing of the face have arisen from over-exertion in hot weather, care should be taken not to drink cold water until a sufficient time has elapsed to admit of a diminution of the temperature of the body. The early employment of Acon. in such cases affords speedy relief, and acts as a preventive to any ulterior troublesome consequences. Violent headache, with congestion, fever, vomiting, sleeplessness, great anguish or despair, and a sense of weight at the forehead on bending forward, or on stooping, as if the contents of the cranium would burst forward out of their containing cavity, Belladonna should be given, and repeated from six, twelve, or twenty-four hours, if required, shortening or lengthening the interval according to circumstances. Bry. may be selected in preference to Bella., where there is illhumour and apprehension of some future misforture. When headache with loss of appetite, a degree of fever with thirst, or diarrhoea is brought on by exposure either to the rays of the sun or to the heat of the fire during any exertions, Bry. is SEA-SICKNESS; 751 again the most useful remedy in most instances. If nausea is the only or principal symptom which is produced by exposure to heat, Silicea will generally be found the more efficacious medicament in removing the said susceptibility. Against headache from over-heating, with weight over the orbits and pain in the ball of the eye on looking intently at any object, Carbo v. usually affords speedy relief. STINGS OF INSECTS. The severe pain and febrile irritation which sometimes ensue from the stings of insects, such as bees, wasps, &c., is frequently speedily alleviated by the olfaction of spirits of Camphor. Should, however, considerable inflammation with swelling supervene, Acon. should be administered, and subsequently Arnica internally and externally, as described under WouNDs. Should the tongue or any part of the mouth be the part where the sting has been inflicted-as occasionally happens to children when biting a piece out of an apple or pear, &c., into which a wasp may have greedily inserted itself-the mouth ought to be rinsed with diluted Arnica tincture; and should that not suffice, Belladonna should be prescribed. In some instances it will be found necessary to have recourse to iMerc. after Bella. The bites or stings of gnats require an Arnica lotion; lemonjuice will likewise be found useful in relieving the pain and itching caused thereby. Immediate relief, when a person has been severely stung by nettles, will often be found by the application of a lotion of Arnica, prepared according to the formula given under BRUISES. SEA-SICKNESS. THERAPEUTICS. The medicaments found most useful in the treatment of this distressing and painful malady are Nux v., Cocculus, Tabacum, Arsenicum, and Ipecacuanha. Nux voMICA should be taken fasting, from six to twelve hours before embarkation; this precaution will, in some cases, prove sufficient to ward off the attack. (Nux v. and Ars. alternately every hour or so, at the commencement of the voyage, or oftener should a degree of nausea have already 752 CASUALTIES. come on, frequently ward off the sickness, or at all events afford great relief. As soon as decided improvement is experienced, the remedies must be discontinued, or taken at much longer intervals.) Should, however, a feeling of giddiness, or a sensation of emptiness in the head be experienced, shortly after going on board, attended with headache, nausea, and inclination to vomit, as the motion of the vessel increases, which is aggravated by standing erect, CoccULUs may be had recourse to, and repeated every one, two, or three hours, as those symptoms recur. (This remedy has also been found useful in sickness arising from travelling in a carriage.) TABACUM. Excessive giddiness, attended with distressing nausea, headache, and deadly paleness of the face; or nausea, with sickness, or a sensation of burning in the stomach, renewed by the slightest movement of the head or body. This remedy is further indicated, when the symptoms are somewhat relieved by exposure to the fresh air. ARSENICUM is useful when the sickness becomes excessive, and is attended with a feeling of utter prostration and helplessness, violent retching, burning sensation in the throat, and the other severe concomitants of this malady. It should be administered between the paroxysms, and will rarely fail of relief. This medicine may be followed by Tabacum or Cocculus, to dissipate the symptoms of nausea and swimming in the head that may supervene. IPECACUANHA is serviceable in attacks of vomiting unattended with great prostration of strength given under Arsenicum. Of course, in order to avoid interfering with the action of the medicines, the homoeopathic regimen should be carefully observed during the period of their administration. PETROLEUM,5 SILICEA, and THERIDEON, from the close analogy of their pathogenetic symptoms to those of the ordinary forms of this distressing malady, deserve a trial. * "I have found that Petroleum is the best specific for sea-sickness. It has become quite a celebrated remedy among those who travel on the lakes. As soon as the nausea, swimming in the head, etc., sets in the patient takes three or four pellets, 6 upon the tongue, and the symptoms disappear almost instantaneously, without ever returning. I know that numbers have been relieved by Petroleum, and that it has so far failed only in one instance."(Dr. D. Chase, Homoeop. Examr. Vol. iv, No. 2.) APPARENT DEATH. 755 4. If the foregoing measures produce no re-action, administer a few globules of Lachesis on the tongue, and in injections, and resume the rubbing. Solanum mamosum has also been recommended, and may be tried after lachesis, when that remedy fails to do any good. 5. Again, should our efforts still fail, or should the medicines quoted not be at hand, we may, in order to restore the natural heat of the body, move a heated, covered warmingpan, over the back and spine; place bottles, or bladders filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet; put the body in a warm bath, in the sun, or at a proper distance from the fire; use friction with hot flannels, flour of mustard, or other stimulants; rub the body briskly with the hand, and at the same time not suspend the employment of other means. To restore breathing, introduce the pipe of a common bellows into one nostril, carefully closing the other and also the mouth, at the same time drawing downwards, and gently pushing backwards, the upper part of the windpipe, to allow a more free admission of air; blow the bellows gently in order to inflate the lungs till the chest be a little raised, the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest; continue this process until signs of life appear. 6. Electricity, or a stream of galvanism passed through the chest, promises to be of great service. 7. Apply pungent salts, as sal volatile or spirits of hartshorn, to the nostrils. These means should be persisted in for several hours, and till there are evident signs of death. When the patient shows signs of life, and can swallow, small quantities of warm wine, or spirits and water, may be taken; but till then, nothing should even be poured down the throat, either by a flexible tube or otherwise. At this period the patient should never be left alone, as some have been lost for want of care who might otherwise have been saved. Apparent death from being frozen. When an individual is found in a state of frost-bitten asphyxy, arising from exposure to intense cold, he should be removed with great 756 CASUALTIES. gentleness and caution, to guard against any injury, as fracture, &c., to a place of shelter, such as a barn or unheated apartment, since even a moderate degree of heat might annihilate all hope of restoring animation; at the same time the patient ought to be protected from the slightest draught. iHe should then, especially if the limbs have become stiffened by the frost, be covered over with snow to the height of several inches, the mouth and nostrils alone being left free. The patient ought to be put into such a position that the melted snow may run off readily, and its place be supplied by fresh. When there is no snow a cold bath, the temperature of which has been reduced by ice (or a bath of cold sea or salted water), may be substituted, and the body immersed therein for a few minutes. The process of thawing is by these means to be effected, and when every part has lost its rigidity, the patient should be undressed by degrees, or the clothes cut from the body, if requisite. As the muscular or soft parts become pliable, they may be rubbed with snow until they become red; or the body should be wiped perfectly dry, if snow is not to be had, placed in flannel, in a moderately warm room, and rubbed with the warm hands of several parties simultaneously. In the event of no signs of returning animation declaring themselves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symptoms of approaching restoration become perceptible, small injections of lukewarm black coffee (coffee without milk) may be thrown up; and as soon as the patient is able to swallow, a little coffee may be given, in the quantity of a tea-spoonful at a time. The measures above detailed ought to be persevered in for several hours. Against the excessive pain which is generally experienced when life is restored, Ca'rbo v. should be prescribed in repeated doses, and if it fails to relieve the sufferings, Ars. may be given. The party rescued must avoid subjecting himself to the heat of the fire or stove for a considerable length of time after his recovery, as serious consecutive ailments, and particularly disease of the bones, is liable to result therefrom. HYDROPHOBIA. 757 Apparent death from noxious vapors. The treatment consists in removing the body into a cool, fresh current of air; dashing frequently cold water on the neck, face and breast; if the body be cold, applying warmth, &c., as above recommended to the drowned; inflation of the lungs; early and judicious application of electricity or galvanism;-after life has been restored Op. or Acon. may be given with advantage. HYDROPHOBIA. It is acknowledged that no allopathic cure has hitherto been found for this disease, when fully established. The plans of treatment, which are reported to have been successful in some few instances, have generally failed in all others; thus rendering it probable that in these supposititious cases of success, the persons bitten might have escaped without any treatment whatever. But it is not to my purpose to enter into the multitude of ineffectual remedies which have been recommended by the Allopathists. Hydrophobia is a disease which arises in consequence of the bite of a rabid animal, and sometimes spontaneously, particularly in the course of some other disease; in which form it is known under the term of symptomatic hydrophobia. Ere proceeding to the homceopathic treatment, a few remarks descriptive of the disease as it appears in the human subject, may not be misplaced. The first symptoms that show themselves in a person who has been bitten, are usually, general uneasiness, anxiety, and disturbed sleep; the eyes are glassy, inflamed, and sensitive to light; there are also ringing in the ears, giddiness, and paleness of countenance; frequent paroxysms of chilliness; oppressed respiration, and quickness of pulse, which latter is usually at the same time small, contracted, and irregular; and loss of appetite. These symptoms generally come on at some indefinite period, occasionally after the bitten part seems quite well. In the second or convulsive stage, the wound, which may have already become completely cicatrized or healed, begins to assume a somewhat inflamed appearance, and a slight pain and heat, now and then attended with itching, is experienced in it. It now breaks out afresh, and an ulcer, with elevated margins of proud flesh, which secretes a dark colored and offensive dis 758 CASUALTIES. charge, is subsequently formed; and wandering, drawing, and shooting pains from the lacerated part upwards towards the throat, present themselves. These symptoms, with the state of testiness and anxiety, increase daily; and the patient complains of a state of confusion in the head, or giddiness, with sparks before the eyes; is afflicted with sudden startings, spasms, sighing, and is fond of solitude; the pulse is small, irregular, and intermittent; the breathing laborious and uneasy; the skin cold and dry, and general chilliness, especially in the extremities, is complained of; then hiccough, colic, and palpitation come on; the patient looks wild, and the eyes have a fixed, glassy, and shining appearance; the act of deglutition is impeded by a sense of pressure in the gullet, which occasionally renders every attempt to swallow liquids impracticable; convulsions also take place in the muscles of the face or neck. In this stage, however, the deglutition of any solid substance is performed with tolerable ease. In ordinary cases the sufferer remains affected in the above manner for a few days, after which, the disease passes into the hydrophobic stage, in which it is utterly impossible for him to swallow the smallest drop of liquid; and the moment that any fluid, especially water, is brought in contact with the lips, it occasions the individual to start back with dread and horror, although he may, at the same time, suffer the most excessive thirst; even the sight of water, or the very noise produced by pouring it from one vessel into another, in fact, anything that tends to remind him of that fluid, produces indescribable anxiety, uneasiness, convulsions, and even furious paroxysms of madness; he dreads even to swallow his own saliva, and is constantly spitting; vomiting of bilious matter soon comes on, succeeded by intense fever, great thirst, dryness and roughness of the tongue,.hoarseness, and fits of delirium or madness, with disposition to bite and tear everything within reach, followed at intervals by convulsive spasms. These attacks commonly last for a quarter or half an hour, and at their expiration, the patient is restored to reason, but remains in a state of great despondency; finally, the paroxysms come on more violently and frequently, and in some instances a fit of furious delirium closes the frightful scene; in others, nature sinks exhausted after a severe attack HYDROPIHOBIA. 759 of convulsions. The disease may be communicated to the human subject, from the bites of cats, and other animals not of the canine race, which have been previously inoculated with the virus. It may be remarked in this place, that the best and most experienced of our writers upon this subject, consider the human species as the least susceptible of contagion from the hydrophobic virus; scarcely one out of twenty, or even thirty, of those actually bitten by an animal in a state of rabies, suffering from its effects. I consider it my duty, while making this statement, which I hope may prove a means of relieving the minds of many from painful apprehensions, to enforce, at the same time, the necessity of taking those precautions, which are about to be pointed out, against the danger. It may also be added, before proceeding to the treatment of the malady, that the possibility of the poison being communicated through the medium of the epithelium is exceedingly questionable; but scarcely a doubt exists of the incapacity of the cuticle to absorb it. As many have been made wretched from having allowed a dog, which has afterwards shown symptoms of rabies, to lick their hands, it may be stated with confidence that if no abrasion of surface exists, there is not the slightest danger. In the homceopathic treatment of this disease, and its prevention, the following are the principal remedies employed: Belladonna, Lachesis, Hyoscyamus, Stramonium, and Cantharides.* * The use of dry or radiating heat in this disease, and in envenomed wounds by snakes, &c., is recommended by Dr. Constantin Hering, whose directions for the treatment of envenomed wounds in general are as follows: Envenomed wounds. The best domestic remedy against the bites of venomous serpents, mad dogs, &c., is radiating heat. This should be done by the readiest means at hand,-a red-hot iron or live coal, or even a lighted cigar, for instance, must be placed as near the wound as possible, without, however, burning the skin, or causing too sharp pain; but care must be taken to have another instrument ready in the fire so as never to allow the heat to lose its intensity. It is essential also that the heat should not exercise its influence over too large a surface, but only on the wound and the parts adjacent. If oil or grease can be readily procured, it may be applied 760 CASUALTIES. BELLADONNA. HAHNEMANN states, in the introductory article to Belladonna, in his Mfateriac Jiedica Pura, that he considers the smallest dose of that medicine, repeated every three or four days, to be the most certain_ preventive against Hydrophobia; and when we refer to the pathogenetic effects of Belladonna, described in the aforesaid work, it is impossible not to be struck with the great resemblance which many of them bear to the symptoms of this malady; and it is from this circumstance, according to the great law of Nature, on round the wound, and this operation should be repeated as often as the skin becomes dry; soap, or even saliva may be employed, where oil or grease cannot be obtained. Whatever is discharged in any way from the wound ought to be carefully removed. The application or burning heat should be continued in this manner, till the patient begins to shiver and to stretch himself; if this takes place at the end of a few minutes, it will be better to keep up the action of the heat upon the wound for an hour, or until the affections produced by the venom are observed to diminish. Internal medicines must be judiciously administered at the same time. In the case of a BITE FROM A SERPENT, it will be advisable to take from time to time a gulp of salt and water, or a pinch of kitchen salt, or of gunpowder, or else some pieces of garlic. If, notwithstanding this, bad effects manifest themselves, a spoonful of wine or brandy, administered every two or three minutes, will be the most suitable remedy; and this should be continued till the sufferings are relieved, and repeated as often as they are renewed. If the shooting pains are aggravated, and proceed from the wound towards the heart, and if the wound becomes bluish, marbled or swollen, with vomiting, vertigo, and fainting, the best medicine is Arsenicum. It should be administered in a dose of three globules in a tablespoonful of water; and if after this has been taken, the sufferings are still aggravated, the dose should be repeated at the end of half an hour; but if, on the contrary, the state remains the same, it should not be repeated till the end of two or three hours; if there is an amelioration, a new aggravation must be waited for, and the dose ought not to be repeated before its appearance. In cases in which Ars. exercises no influence, though repeated several times, recourse must be had to Bell.; Sen. also frequently proves efficacious. Against chronic affections arising from the bite of a serpent, Phos. ac and Mere. will generally be most beneficial. For the treatment of persons bitten by a mad dog, after the application of dry heat, as directed and described above-(see Hydrophobia, p. 641.) If morbid affections or ulcerations exhibit themselves, in consequence of a bite from a rabid man or animal, Hydrophobine, administered in homceopathic doses, will often render essential service. 762 CASUALTIES. Dose. A few globules repeated every two or three hours, or at every return of the convulsions, until benefit result, or decided symptoms of medical action make their appearance; but should this remedy appear to exert no perceptible influence in checking the progress of the malady we must again have recourse to. BELLADONNA, particularly when the following characteristics are present; drowsiness, with constant but useless efforts to sleep, chiefly in consequence of excessive anguish and great agitation: sense of burning; great burning in the throat, with accumulation of frothy nucus in the mouth or throat, frequent desire for drinks, which are immediately pushed aside when presented, or a suffocating or constricting sensation in the throat on attempting to perform the act of deglutition, or complete incapacity to swallow, with glowing redness and bloated appearance of the face; pupils immovable, and generally dilated; great dread; occasional desire to strike, spit at, bite, or tear everything; inclination to run away; continual tossing about; and great physical activity, with twitching in various muscles, especially those of the face: ungovernable fury, with foaming at the mouth; and tetanic convulsions. Dose. A few globules to be placed on the tongue at every threatening of a return of the convulsions, but with the same precaution as enjoined under Lachesis. HYoscYAMus is more particularly indicated either before or after Belladonna, when the convulsions are severe and of long duration; where there is not so much inclination to bite or spit, but a desire to injure those that stand around, in some manner or other. The spasms in the throat are not so violent, but great dryness and burning are complained of, attended with a sense of shooting or pricking, which causes a difficulty in swallowing, resembling a sensation of constriction in the throat, and threatening to produce suffocation on attempting to satisfy the thirst; dread of liquids in consequence of the pain and difficulty that is experienced in deglutition, with ejection of the saliva for the same reason; excessive convulsions, with loss of consciousness come on soon after the dzstressing act of swallowing has been performed. There is, moreover, foaming at the mouth, with constant raving; sometimes the patient seems wrapped up in his own thoughts; or HYDROPHOBIA. 768 is full of fear, and inclined to run away from the house, being afflicted with a sort of Anthropophobia; there are also attacks of excessive fury, attended with apparently supernatural physical power; or excessive anguish and fear, alternating with fits of trembling and convulsions; the individual exhibits a peculiar dread of being bitten by animals; the pupils are dilated; sleep is much disturbed by great nervous excitement; starts, and agonizing dreams. Dose. Same as Belladonna. STEAMONIUM is chiefly indicated in this disease, when we observe severe convulsions taking place whenever the eye becomes fixed on brilliant objects, or on whatever tends to remind the patient of water; great thirst: dryness of the mouth and throat, with horror of water and all liquids; spasmodic constriction in the gullet, with foaming at the mouth, and frequent spitting; mania, with great loquacity and gesticulations; fits of laughter and singing, sometimes alternately with acute fits of passion and moaning; the convulsions, when severe, are generally attended with ungovernablefury, restless, agitated sleep, sudden shrieks, and starting up with wild gestures; insensible and dilated pupils; and great disposition to bite or tear everything with the teeth. Dose. Same as Belladonna. CANTHARIDES. This medicine also possesses various pathogenetic properties, which bear a close resemblance to the symptoms that are met with in many cases of this disorder,* and should be selected in preference to any of the foregoing remedies when we meet with the following indications: great dryness and burning in the mouth and throat, much aggravated on attempting to swallow; paroxysms of fury, alternating with convulsions, which are renewed by any pressure on the throat or abdomen, and also by the sight of water; fiery * Drs. Hartlaub and Trinks consider Cantharides to be the most certain prophylactic against hydrophobia, when administered early; they recommend a drop to be given every three or four days, and are of opinion that the virus is not eradicated as long as the cicatrized wound presents a livid hue, and is attended with induration, but affirm the danger to be over as soon as the part assumes a healthy and natural appearance. (Vide Hartlaub and Trinks, R. A. M. L., vol. i, p. 173.) " 64: CASUALTIES. redness and sparkling of the eyes, which become prominent and frightfully convulsed; spasms in the throat, excited by the pain produced by the act of swallowing, especially fluids; continual burning, titillation and other irritating sensations in the lower part of the abdomen, &c. Dose. Same as Belladonna. We have now enumerated and described the characteristic indications for the principal homceopathic remedies, which have been successfully employed against Hydrophobia;* others have also been strongly recommended, but those mentioned have repeatedly proved sufficient, when administered early, and exclusively adhered to throughout the course of the disease. Belladonna has frequently been tried by the Allopathists, but the cases in which it seemed to fail were evidently attributable to the improper manner in which it was administered. We shall not treat of the several remedies which have from time to time appeared, and have, by their inventors, been highly eulogised, as time and experience alone will prove whether they possess any virtue or not. MENTAL EMOTIONS. We shall conclude this part of the work with the consideration of those particular Mental Emotions which exercise so great a control over the human organism, among which, fright, passion, or anger, and concentrated grief, are the most prominent and continually recurring. THERAPEUTICS. The remedies found most serviceable for derangements of the system, arising from the above-mentioned causes, are, Opium, Aeon., Puls., Bell., Ign. amara, Oham., Nux v., Staph., Ars. album, Bry., &c. Oriu. When the sufferer has been exposed to sudden fright, with terror, horror, or fear, is generally efficacious, if administered immediately, in restoring the patient, and obviating any evil consequences, such as convulsive fits, swooning, lethargic sleep, involuntary evacuations, diarrhcea, &c. (When Opium is not sufficient to remedy the mischief, Aconitum may be administered, or Aconitum and Opium * Vide Hartmann's Acute Diseases, under Hydrophobia. -MENTAL EMOTIONS. 765 alternately. In some cases Ignatia will answer better than Aconitum, especially when the convulsions continue: Bella. or Hyosciamus, and Veratrum, are also serviceable, when none of the other remedies are sufficient to remove all the effects. (Causticum is a useful remedy when a constant dread haunts the child after a previous fright, &c.) See also Samb. ACONITUM is the appropriate remedy, when the system is laboring under the joint influence of fright and passion; and especially when there is headache, feverishness, heat in the face and head (congestion); fear. PULSATILLA, in cases of fright, fear, or timidity, particularly when accompanied with an effect upon the stomach and bowels, as also heat of the body, with coldness of the extremities; or passion, in people of generally mild temper; it is also suitable for highly sensitive persons. BELLADONNA. Two globules, when there is particular liability to be startled by trifles, or extreme general nervous excitement, after a fright, &c. IGNATIA. Where the cause is gnawing, inward grief. Acid. phosph. and Staphysagria are sometimes requisite after Ignatia. CHAMOMILLA. Where suffering has arisen from vexation or a disposition to irritability; or great anguish and mental depression, are present. Nux voMICA. Suffering arising from a sudden fit, or outbreak of passion or rage. STAPHYSAGRIA. Anger and vexation, arising from just cause. ARSENICUM is useful where passion is followed by great weakness and dangerous prostration of the vital powers. BRYONIA is indicated where a fit of passion is followed by coldness and shivering over the whole body, great irascibility, want of appetite, nausea, vomiting, and bilious sufferings. COLOCYNTH. When indignation accompanies the above described effects of a fit of anger. Against the injurious effects which occasionally result after excessive joy, such as headache, trembling, and tendency to fainting, Cojfea is the most useful remedy. But when the consequences are more serious, and violent headache, with congestion to the head, frequent vomiting, diarrhoea, swooning, &c. result, Opium must be given. CHLOROSIS. 767 frequently declares itself, if the affection has been allowed to proceed unchecked; and to an experienced eye the sufferer appears to be on the verge, or even passing through the different stages of a decline, the disease appearing to stand in closer relation to the functions of the stomach and lungs than to those of the uterus, as indeed it virtually does in the generality of cases. THERAPEUTICS. The medicines which have hitherto been found most useful in ordinary cases of this affection are Pulsatilla, Sepia, Bryonia, Sulphur, VNatrum muriaticum, Calcarea carbonica, Ferrum, Lycopodium, and Plumbum. PULSATILLA is, together with Bryonia, Sulph., Zycop., &c., peculiarly efficacious in emansio mensium, when the complaint seems to have been excited by and is intimately connected with deranged digestion, and when it is accompanied by frequent attacks of semilateral headache, with shooting pains, extending to the head and teeth, sometimes shifting suddenly to the other side; also when we observe aching in the forehead, with pressure at the crown of the head, and sallow complexion; difficulty of breathing, and sense of suffocation after the slightest movement; palpitation of the heart* coldness of the hands and feet; often changing to sudden heat; disposition to diarrlhac and leucorrhoea; pains in the loins; sensation of weight in the abdomen; almost constant chilliness and shivering; spasms in the stomach, with nausea, inclination to vomit, and vomiting; periodical expectoration of dark, coagulated blood; hunger, with repugnance to food, or want of appetite with dislike to food; swelling of the feet and ancles, great fatigue, especially in the legs. This medicine is peculiarly adapted to females of mild or phlegmatic disposition, disposed to sadness and tears. GRAPHITES, when there is retention of the period with congestion of the vessels of the head and chest; dark red flushing of the face, oppression at the chest; and a feeling of anxiety when in the recumbent posture. Graphites is, moreover, one of the most important remedies in scanty, insufZcient menstruation. Belladonna is often called for when the congestion of the head and chest is of an active character, and accompanied with violent throbbing of the carotids. SEPIA is also a very valuable remedy in this affection, when 768 TREATMENT OF FEMALES. many of the above symptoms are present, with, at the same time, hysterical mogrims; complexion sallow, with darkcolored spots; frequent colic and pain as if arising from bruises in the limbs. It may, when the above symptoms declare themselves, advantageously follow Pulsatilla; if the latter have failed to relieve, which it generally does, if the pathognomonic sign of chlorosis, denominated cantus carotidum, be absent. BRYONIA. Frequent congestion in the head or chest; bleeding at the nose; dry cough; coldness and frequent shivering, sometimes alternated with dry and burning heat; constipation or colic; bitter taste in the mouth, tongue coated, yellow; sense of pressure in the stomach as if from a stone; irascibility. SULPHUR is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to the nape of the neck; or, pulsative pain in the head, with determination of blood; humming in the head; pimples on the forehead and round the mouth; pale and sickly complexion, with red spots on the cheeks; voracious appetite; general emaciation; sour and burning eructations; pressive fulness and heaviness in the stomach under the lower ribs and in the abdomen; bowels irregular; difficulty of breathing; pain in the loins and fainting; excessive fatigue, especially in the legs, with great depression after talking; great tendency to take cold; irritability, and inclination to be angry; or sadness and melancholy, with frequent weeping. CALCAREA cARB. is often of the most striking benefit in chlorosis. Sometimes a complete cure is affected by it alone, even in the worst cases, with cedema of the extremities, and extreme dyspnoea. Occasionally it is found necessary to follow up the treatment, on the disappearance of the more important symptoms under the employment of Calc., with Ferrum carb. in repeated doses, in order to prevent a relapse. Ferrum is especially required when the pale and sickly hue of the face continues, as it frequently does, notwithstanding the previous use of Calc. When Ferrum is employed at the commencement of the treatment, it has been found to aggravate the anxiety, cough, and other pectoral symptoms. AMENORRH(EA. 769 Where there is a complication with tubercular diathesis, accompanied by cough, &c., coeval with the first appearance of chlorosis, Sulphur and Calcarea often prove highly beneficial in alternation.* In the generality of cases, during the employment of Calcarea, a dose of Lycopodium is required when there is obstinate constipation and extreme languor, or Sepia when oppressive headache is complained of.t Sometimes the menses do not appear for some time afterwards, although the general health may have been thoroughly renovated by the remedies prescribed. YALERIANA has been found of great service in daily repeated doses, when a feeling of constriction was experienced in the gullet or chest, accompanied with signs of threatened suffocation, and followed by frequent yawning, as soon as the patient sat down to dinner. NATRUM iMURIATICUM is a most valuable remedy in many obstinate cases of chlorosis with habitual constipation. Plumbum aceticum has repeatedly been found useful in inveterate cases with dyspncea, oedema, and anasarca, but no organic disease either in the chest or abdomen. Ammonium c., Phosphorus, Conium, Lycopodium, Kali, China, Ignatia, Aurum, Acid. nitricum, &c., have also been advantageously employed in chlorosis. In enlargement of the abdomen, occurring in young girls at the critical age, Lachesis has been employed with success. AMENORRHIEA. SUPPRESSIO MENSIUM. Suppression of the menses occasionally takes place suddenly from some accidental cause, such as exposure to cold, powerful mental emotions, &c. In other instances the suppression is symptomatic of some other disease, either organic or functional, and can only be removed by the cure of the primary malady. It is of the former that we here propose to treat. When a suppression takes place from the sudden effects of a chill, we may have recourse to Pulsatilla, when the symptoms generally correspond to those of that remedy, as detailed under Chlorosis. In other cases arising from this cause, Nux moschata, Dulcamara, Sepia, or Sulphur may be * Allg. Horn. Zeit., Gr. u. St. Arch. xx, 3, 58. f Arch. xx, 3, 58. 49 770 TREATMENT OF FEMALES. necessary. (See CHLOROSIS for indications for Sulph. and Sep., which are remedies of great service in a large number of cases, when the affection has become chronic.) When a sudden fright has given rise to the affection, Aconitum should be immediately administered, followed by Lycop., Opium, or Veratrum, if the bad consequences which frequently result do not yield, or if only partial relief is obtained from the employment of Aconitum. (See MENTAL EMOTIONS, Parts I. and II.) In chronic cases occurring in weak or debilitated individuals, in addition to Sulphur and Sepia, the following remedies are useful: Natrum m., Conium, Arsenicum, Cinchona, Graphites, lodium. Whilst in those which occur in plethoric subjects, whether of a chronic or recent description, Aconitum, Bellad., Sulph., Bryonia, Vuwx v., Sabina, Opium, Platina, &c., will generally be found the most serviceable. When there is not a complete suppression, but the menstrual discharge is scanty and insufficient, Graphites, Kali, Conium, Natrum m., Phosphorus, Pulsatilla, Sulph., Lycop., Magnesia, Silicea, Veratrum, or Zincum, are the most important remedies. MENSTRUATIO NIMIA. MENORRHAGIA. The quantity of the menstrual discharge varies a good deal in different women. Considerable influence is for the most part exerted by climate, constitution, and the manner of living. The duration of the discharge and the period of return are also variable. In some women it continues from four to ten days, in others it lasts only a few hours; from three to six days is, however, the most usual period. The regularity is in many exact to a day, or even an hour, while in others a variation of several days is a usual occurrence, without the slightest disturbance to the general health resulting therefrom. When the discharge is excessive, and attended with pains in the back, loins, and abdomen, resembling those of labor, it becomes necessary to prescribe remedies calculated to arrest it, and to correct the tendency thereto. Amongst these the following are of great utility: Ipec., Crocus, Sabina, Cinchona, Nux V., Cham., Platina, Sulph., Cal., &c. IPECACUANRA is one of the most generally useful medica MENORRHAGIA. 771 ments in severe cases of this derangement, as well as in flooding after labor, and may in most instances be administered first, unless there are strong indications for a preference being given to any of the others. CRocus is more especially called for when the discharge is of a dark color, viscid, and very copious; and the menses have appeared before the usual time. SABINA, when the discharge is excessive, of a bright color, and occurs in plethoric females who are prone to miscarry; rheumatic pains in the head and limbs; great weakness; pains in the loins similar to those of labor. CINCHONA is of considerable utility after the previous employment of either of the foregoing, and in all cases where there is great debility in consequence of a more copious menstrual discharge than natural. Nux v. when the discharge is of too frequent occurrence, too profuse, and of too long duration; and when it commonly stops for a day or so and then returns, attended with spasms in the abdomen; sometimes nausea and fainting, especially in the morning; pains in the limbs; restlessness; irascibility. Nux v. is especially serviceable when the above symptoms occur in females who are addicted to the daily or frequent use of coffee, liqueurs, and other stimulants. CHAMOMILLA is frequently useful after Nux v., but particularly when there is a discharge of dark, clotted blood, with severe colic, or pains like those of labor; great thirst; paleness of the face, and coldness of the limbs. IGNATIA is of considerable service when the derangement happens in hysterical females. PLATINA. Preternaturally increased menstrual discharge, with painful bearing-down pains, and venereal orgasm; thick, dark-colored, menstrual blood; great excitability. VERATRUM. Too early or too copious menstrual discharge, always attended with diarrhoa. KREOSOTUM has been found of great service in metrorrhagia, where the discharge was excessive, dark-colored, frequently in large clots, and very offensive. The cervix uteri and uterus itself being, at the same time, swollen and very sensitive; and the accompanying pains of a severe burning or corroding description. 772 TREATMENT OF FEMALES. SULPHUR, administered thrice during the intervals, allowing ten or twelve days to elapse between the second and third doses, and followed by Calcarea, in the same manner, has frequently been found successful when any of the previous remedies had afforded but temporary relief. In other cases, Bella., Cortex mali granati (often where Sabina, Bella., and other remedies fail), Bry., Lyc., Natrum m.,.Magnesia m., Sepia, Silicea, or Phosph., &c., may be useful. In menorrhagia occurring at the change of life, and coming on in daily paroxysms for eight, ten, fourteen days, and then ceasing for a time, after which the discharge broke out anew, Laurocerasus has been found of great efficacy. The blood was darkcolored, and frequently in large coagula.* DYSMENORRH(EA. In painful and difficult menstruation, or menstrual colic, the most important remedies are the same as those enumerated under MENORRHAGIA and CHLOROSIs, but particularly Chcam., Pulsatilla, Bella., Nux, Cofea, Sulph., and Calc., &c. When the disorder occurs with great vehemence at the critical age (tour d'dge) LACHESIs is of invaluable assistance, and particularly when diarrhoea, attended with almost insupportable tormina, usually sets in before and after the menstrual period.t The following are likewise of considerable utility against the sufferings which are often experienced at the critical age: Puls., Sepia, Sulph., Cocculus, uta, Conium. Against uterine spasms, Cocculus, Puls., Ignatia, Platina, Cuprum, form the most valuable remedial agents; but in some instances, NVux., Cinchona, Sulph., Graphites, Conium, or Natrum m., &c., may be more appropriate. HYSTERICS. HYSTERIA. PASSIO HYSTERICA. This disease appears in paroxysms, is preceded generally by depression of spirits, anxiety, effusion of tears, dyspnoea, nausea, and palpitatio cordis; also with pain in the left side, which seems to advance upwards till it gets to the throat, when it feels as if a ball were lodged there (globus hystericus); * Allg. Horn. Zeit., Vol. xxxi. f Against flushes of heat occurring after the change of life, Acidum sulphuricum is an excellent remedy. HYSTERICS. 773 if it advances further, there is a sense of suffocation, stupor, and insensibility, with spasmodic clenching of the jaws; the trunk of the body is moved about, and the limbs agitated; alternate fits of laughing, crying, and screaming; incoherent expressions; foaming at the mouth; relief ensues generally with eructation, and frequent sighing and sobbing, followed by a sense of soreness over the whole body. Hiccough is sometimes a concomitant, and a very distressing one, in hysteria. These are the usual symptoms indicating this disease, but the complaint appears in a great variety of forms; and in many cases the patient is attacked with a violent spasmodic pain in the back, which extends from the spine to the sternum, and eventually becomes fixed at the epigastric region, and is often so intense as to cause clammy perspiration; a pale, cadaverous countenance; coldness of the extremities; and a feeble, thread-like, or scarcely perceptible pulse. Hysteric affections are more frequent in single than in married life, and usually occur between the age of puberty and that of thirty-five, and generally about the period of menstruation. The disorder is readily excited, in those who are subject to it, by sudden mental emotions. Hysterics have also been known to arise from sympathy and imitation. Women of delicate habit, and of extreme nervous sensibility, are chiefly prone to be affected with hysteria, and are predisposed to the attack by an inactive or sedentary life, distress of mind, suppression or obstruction of the periodical illness, excessive depletion, or constant use of spare or unwholesome diet. Females of a nervous, sanguine, or plethoric temperament are chiefly liable to this disease. The best medicines against hysterical affections are, Aurum, Bella., Calc., Caust., Cocc., Con., Crocus, Ign., Lach., Mosch., N. mosch., N. vom., Phosph., Plat., Puls., Sepia, Sil., Stram., Sulph., Yerat., Val., Viola odorata, &c. When the affection arises from CHLOROSIS or AMENORRH(EA, see the remedies mentioned under these headings. When from MNENORRHAGIA, see that article.-MENTAL EMOTIONS, see that subject. 774 TREATMENT OF FEMALES. When the attacks are attended with clenching of the jaws, or general spasm, coldness of the extremities, and clammy sweat, particularly on the face and forehead, Veratrum is a valuable remedy. (See also the remedies mentioned under TETANUS, and likewise LocKJAw IN INFANTS.) When violent, spasmodic hiccough predominates: Nu v., Bella., and Strami.: or Hyoscyamus, Veratrum, Ignatia, Puls., Cicuta, Bryonia, and Sulphur, will be found the most frequently useful. INFLAMMATION OF THE OVARIES. OVARITIS. Inflammation of the ovaria is more particularly liable to occur a short time after delivery; but the affection may arise at other times, and particularly in highly excitable females who are addicted to pernicious habits, such as venereal excesses, onanism, or to over-indulgence in spirituous liquors. The signs by which the disorder is to be recognised consist in pain in the ovarian region, sometimes of a severe shooting, pulsating character, which is occasionally, however, only experienced under the influence of external pressure over the part. After a careful examination, per vaginam aut rectum when necessary, a small, hard, circumscribed swelling is detected. In combination with these symptoms, a constant itching is frequently complained of in the internal organs of generation, also gastric disturbance, headache, constipation, diminished secretion of urine, fever, frequently of an active, inflammatory type, and derangement of the entire nervous system. But it is chiefly in the subacute or chronic form that the inflammation is encountered; coming on gradually and insidiously, materially implicating the nervous system, and often occurring in association with a species of nymphomania. THERAPEUTICS. In phlegmonous inflammation of the ovarium, attended with a high degree of fever and shooting pain, a few doses of Aconitum are necessary, after which we must select another remedy to meet the remaining local symptoms; being guided in our choice by the exciting cause of the malady, where known, as well as by the particular nature of the pain, or the circumstances under which it becomes aggravated, &c., &c. INFLAMMATION OF THE OVARIES. 775 When the pain in the affected parts is increased by movement, Bryonia is, generally speaking, the most efficacious remedy, and when, on the other hand, movement somewhat relieves, whereas rest is only productive of aggravation,1ihus will rarely fail to produce considerable relief, if not a radical cure. Should the pains be so violent as to cause the patient to toss about with agony, and continually shift the position of the feet, from experiencing some slight temporary alleviation of the sufferings by so doing, they will commonly yield to the use of Arsenicum or Colocynth. In cases where the disease has gradually arisen from the habitual use of spirituous liquors, material service will commonly be derived from the employment of Nux vomica; but where there is reason to apprehend that the inflammation has terminated in suppuration, Lachesis will be more appropriate, and subsequently Staphysagria, -Mercurius, or Hepar s. In the event of excess in venery or onanism having given rise to the disorder, Cinchona may be employed with advantage. Nux v. and Staphysagria are also calculated to be of assistance in similar cases. Ignatia, Staphysagria, and Acidum phoosphoricum have been recommended where unrequited love and consequent perpetual dwelling of the imagination on sensual subjects has proved the originating cause. In those cases where the affection is accompanied with a continual prurient irritation in the internal genital organs, and where nymphomania has thereby been developed, where, moreover, the local pain which is commonly experienced changes to a beaten or bruised feeling on the application of external pressure, and the patient is affected with anxious oppression at the chest, palpitation at the heart, pricking in the forehead, together with alternate fits of elevation and depression of spirits, Platina is often capable of effecting a radical cure. Belladonna may be beneficially employed where there is no nymphomania, or internal itching, but the symptoms otherwise analogous to those above given. It rarely happens that a cure is to be obtained from the employment of one remedy alone; it therefore becomes requisite to select others which seem appropriate to meet the remaining symptoms, when we have derived all the assistance that the remedy first selected seems capable of accomplishing. Ambra, Cantharides, 778 OBSERVATIONS ON PREGNANCY. health, or constitutional taint of both or either of the parents; very early or late marriages; great inequality between the ages of the parents; errors in dress, diet, and general habits of life; and lastly, powerful mental emotions. Medicine, under the present enlightened system, possesses power considerably to obviate the first of these causes, not only by materially modifying or destroying the hereditary taint in the parents, but also by nipping it in the bud when transmitted to the infant. Whilst upon this subject, we may remark, that in many families hereditary diseases are fostered, and even exacerbated in virulence by intermarriages between their different members, sometimes disappearing in one generation, and again declaring themselves in the next; but when the habits or mode of life of communities became more adapted to the natural law, and Homceopathy, as it must do eventually, completely supersedes the present system of medicine, we may safely calculate upon the gradual extinction of all hereditary diseases; and so far, at least, children will not have to suffer for the faults and follies of their progenitors. Females should seldom, at least in this country, enter into the marriage bond before their twenty-first or twenty-second year; prior to that period, their organization is scarcely ever fully developed; those who marry at sixteen or eighteen years of age incur the risk of a severe after-suffering themselves, and also of giving birth to weak and delicate children. How very often we see the first children of -such marriages perish in infancy, or after contending through a childhood of continued delicacy, sink into a premature grave. Women who marry late in life incur considerable personal risk and severe suffering in giving birth to children, and the offspring is seldom healthy. The children of old men, although by a young wife, are very often extremely delicate and susceptible to illness; they not unfrequently precede their father to the grave, or linger but to drag on a miserable and wearisome existence. In concluding these observations, we may remark that so far is the period of pregnancy from being destined for one of suffering or danger, that Nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the AIR AND EXERCISE. 779 expectant mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and even chronic complaints are frequently suspended; in fact, with the exception of some slight morning sickness, and occasional trifling uneasiness, a well-constituted organism should enjoy as good health during pregnancy as at any other time; and many women pass through this period, and give birth to vigorous children, without even the most trifling inconvenience. Though, as we have said, Nature seems during this period to adopt every possible precaution for the health and preservation of the parent and her future offspring, yet are her wise arrangements, in too many instances, rendered nugatory by a direct contravention of her laws. The expectant mother should therefore bear in mind, that the duty of leading a regular and systematic course, so essential to every individual, devolves upon her with double force, since every neglect or -breach of these ordinances of Nature upon her part, is frequently visited with fearful energy upon her yet unborn infant. AIR AND EXERCISE. Nothing tends more to the preservation of health than a proper attention to these two important points, and yet, unfortunately there are perhaps few more completely lost sight of. Neither air nor exercise is individually sufficient, and females of the more opulent classes in this country, who merely take the air in their carriages, and shun the slightest physical exertion, from long-continued habits of acquired indolence, and who feel any attempt of the kind at this period attended with increased inconvenience, can scarcely expect to enjoy the benefit that Nature has annexed to the observance of her laws, in a course of pregnancy free from suffering, and the production of a fully-developed and healthy offspring. During this epoch, therefore, passive or carriage exercise is not sufficient; walking brings not only the physical, but the whole of the organic muscles into play, and communicates the increasing vigor of the mother to her offspring; whilst, on the contrary, continual passive exercise in a carriage has been found particularly injurious during, and towards the 780 OBSERVATIONS ON PREGNANCY. end of the second period of pregnancy, and is frequently the cause of premature and abnormal births; exercise on horseback, even without taking into consideration the risk of fright or accident to the rider, and the fearful consequences that may thence result, is still more objectionable for many reasons. A second class, that of thrifty housewives, take a great deal of exercise, yet without a corresponding benefit, from their work occupying them wholly in-doors; this is a strong proof of the inutility of ex:ercise in itself, unless combined with pure air. Moreover, many of these women, either from too great activity of temperament, or coerced by hard necessity, frequently over-fatigue themselves, go to bed late, rise early and sometimes unrefreshed, and thus in a manner deaden the energies of the organic powers, to their own injury, and that of the unborn child. A third class of females injure their health, and frequentlyinduce miscarriage, through their excessive levity and thoughtlessness, by unrestrained indulgence in active exercise, riding on horseback, dancing, &c. A femnale ought to recollect that, if through her own folly she has brought on miscarriage, the greatest possible care is necessary to prevent its recurrence; that a second attack increases her liability in future; and that she who has suffered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Furthermore, continued casualties of this nature not unfrequently terminate in premature death, from that serious and painful disease, uterine cancer. The best exercise, therefore, for a female during this epoch, is walking every day (when the weather permits) in the open air. In order to prove beneficial, and not to interfere with the process of digestion, exercise ought to be taken two or three hours after a moderate meal, about mid-day, or in the afternoon, except during hot weather, when the evening may be preferred, care being taken to avoid the night damps, by not remaining out too late. CLOTHING. The dress of the female should of course be suited to the season, and if she pass from a warm into a cold atmosphere, CLOTHING. 781 she ought to have her neck and throat well protected, so as to avoid any risk of taking cold. But a point of far greater importance is the adaptation of her clothing to her form, so as to preclude all unnecessary pressure upon any part of the frame, calculated to interfere with the functions of those important organs, which are destined for the birth and nourishment of the infant; tight lacing, therefore, at all times most objectionable, is particularly so during this period, inasmuch as it cramps the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatics, and the whole intestinal economy, produces narrowness of the chest, disturbed circulation, and induration or other derangements of the liver, and exercises a most baneful effect upon the breasts and uterus. We should bear in mind that a pressure upon these organs during development, takes place in direct contravention of the operations of nature. Females, in their efforts to preserve the elegance of their shape during pregnancy, are little aware that the constringing force thus exercised upon the abdominal muscles, destroys their elasticity, prevents a proper retraction after parturition, and thus proves one of the most common causes of permanent abdominal deformity. Moreover, to the culpable vanity of their mothers, in this and other respects, many, it is probable, owe their club-feet and other malformations; and in addition to these evils, this practice not unfrequently deranges the position of the fcetus,-a displacement which, together with the consequent want of energy in the muscles and the parts concerned, generally brings on protracted and dangerous labors. Besides this, continual pressure on the uterus is liable to produce premature labors. To tight lacing also may be attributed the difficulty many women of the present day experience in suckling their offspring, from the incipient process required for the subsequent secretion of milk being deranged by the unnatural pressure on the beautifully constructed mechanism of the mammse; from this also sometimes arise those dangerous indications, cancers and other affections of the breast, and also retraction and diminution of the nipple, from which the act of suckling is rendered difficult, and in some cases impracticable. Young girls of seventeen or eighteen are frequently found 782 OBSERVATIONS ON PREGNANCY. with pendulous breasts, owing to the artificial support having usurped the office of the muscles, intended by Nature for that purpose, and throwing them out of employment. GARTERS too tightly bound are generally injurious, more particularly to pregnant females, for the pressure thereby exercised upon the blood-vessels encourages the development of varicose vessels in the inferior extremities (to which affection the system is already sufficiently predisposed), which, in many instances, become exceedingly painful and troublesome. DIET. The greatest simplicity should regulate the diet of the pregnant female; she should avoid taking too great a quantity of nourishment, because any excess in this respect, besides causing dyspepsia and general uneasiness, has a bad mechanical effect upon the future offspring; and, moreover, the foetus shares in the derangements of the mother. Much depends upon the quality of her food; nothing should be taken that is not of a simply nutritive nature, and everything possessing a medicinal property avoided. Coffee and strong tea should be laid aside. Wine, liquors, beer, and other stimulating beverages are also injurious. If, however, the female has been long habituated to wine, it may be taken, if of good quality, in extreme moderation, and diluted with water; but it will be far better if stimulants of every kind are altogether avoided; indeed, the usual homoeopathic diet (for which see the article REGIMEN) should be adopted as closely as possible during pregnancy. EMPLOYMENT OF THE MIND AND HABITS DURING PREGNANCY. It is not sufficient that the body may be in perfect health; the mind must also be kept in a state of serenity. An easy cheerfulness of temper is essentially useful in promoting the well-being of the unborn infant. Experience has presented us with many instances in which the predominant feeling on the mind of the mother during pregnancy has influence on the future mental organization of the child. This shows how essential it is for females to keep their minds well employed during this period, to avoid all improper meditation, and dissipation, and to abstain from reading works not calculated to MENTAL EMOTIONS. 783 improve their understanding. Nothing can act more effectually against the future mental and corporeal health of the unborn infant than an oscillatory state of intellect, in combination with physical indolence on the part of the mother; the late hours, turning day into night, and other practices of fashionable life, injurious as they are to the most robust constitutions, are doubly reprehensible on the part of the expectant mother. INFLUENCE OF EXTERNAL OBJECTS UPON THE UNBORN INFANT. The effect of any unpleasant or unsightly object upon the imagination of the mother, and the transmission of that effect to the offspring, evidenced in various mental or physical peculiarities after birth, is a theory as old as tradition: without entering upon the various arguments brought forward both for and against it, we would simply advise females to keep as much as possible out of the way of such objects, to preserve both body and mind in a state of health, which will lessen every fear of being affected by such occurrences; and endeavour, as constantly as possible, to direct their attention to pleasing subjects; as it must be perfectly evident that brooding over such unpleasant impressions can scarcely fail of being both physically and mentally injurious. MENTAL EMOTIONS. This subject has been already treated of in Part I., to which the reader is referred, as the remedies there mentioned are equally applicable to affections arising from these sources in either sex. A not unfrequent symptom during pregnancy is great DESPONDENCY OF MIND, and uneasiness about the future; some females, whose spirits are generally good at other times, suffer much from this affection during this period; and in others, we find the same feeling and excessive low spirits, during the time of nursing; this symptom, however, is not permanent, and when it commences early in gestation, usually disappears before delivery, without material injury to the general health. THERAPEUTICS. As this affection is apt to create 784: OBSERVATIONS ON PREGNANCY. some uneasiness, both to the sufferer herself and her friends, we have thought it advisable to mention it, and at the same time to point out remedies which will frequently be found efficacious. Such are Acon., Bry. alba, Nux v., Natr. muriaticum, Phosph., Cale. carb., and Cinchona. ACONITUM. If the state of despondency is preceded by one of excitement, marked by heat of skin and frequency of pulse, attended with apprehension and presentiment of approaching death.* BRYONIA. Great inquietude and fear of the future, attended with irascibility and derangement of the digestive functions. Nux VOMICA. Morning sickness and melancholy, with great uneasines, impaired appetite, constipation, fretfulness. NATRUM MURIATICUM. Melancholy, with weeping, uneasiness about the future; also obstinate cases of morning sickness, not yielding to ANux v. When the affection comes on during lactation, arising from an over-secretion of milk, so that this fluid escapes involuntarily, and is attended with great emaciation, melancholy, and apprehension of the future, we may give PHosPHORUs. CALCAREA is also efficacious when the above symptoms present themselves, and more particularly so, when there is excessive dejection with great lassitude. This remedy is further very serviceable when there is suppression of the secretion, and also excessive obesity, or the individual is of plethoric habit. Both the last-mentioned remedies are also valuable, when there is a disposition to consumption. When there is lowness of spirits, attended with dyspepsia, which may arise from the energies of the mother being too severely tasked in the nourishment of her offspring, either from keeping the child too long unweaned, or from rearing twins, we may administer CINCHONA. The practitioner will further find occasion to select the following remedies in parti* In the treatment of pregnant women of exalted nervous sensibility, considerable caution is frequently requisite in the repetition of the doses. (See also the rules laid down for the Repetition of the Dose in ordinary cases, in the INTRODUCTION.) 786 DERANGEMENTS DURING PREGNANCY. THERAPEUTICS. The homoeopathic treatment of this derangement, at once simple, prompt, and efficacious, has in almost all cases been stamped by the signet of success. In instances free from complication, with a tendency to relaxation of the bowels, IPECACUANHA is generally sufficient. Nux vOMIcA. When there is nausea or vomiting every morning on rising, heartburn, depraved appetite, or craving for chalk, earth, beer, &c., constipation, and irritability of temper. ARSENICUM. Excessive vomiting after eating or drinking, with attacks of fainting; great weakness and emaciation. PULSATILLA. Nausea after every meal; vomiting of ingesta, heartburn, depraved appetite, or longing for particular articles, such as acids, beer, wine, &c. Disposition peevish and sensitive, though naturally mild. Conium, Acidum nitricum, ilfagnesia,.PhospTporus, Bryonia, and Lycopodium, &c., will also be found useful in particular cases. When this affection shows itself in a mild form, we may leave it to Nature, adopting at the same time the homoeopathic rules for regimen, and being careful not to overload the stomach. In severe cases, depending upon a plethoric tendency, Aconitum is an excellent substitute for the venesection recommended by the old school. CONSTIPATION. Constipation is a very common attendant upon pregnancy, and those females usually suffer most from it who are naturally of a costive habit; when it does not arise from a mechanical cause, active exercise in the open air, and avoiding indigestible food, coffee, and other stimulating liquids, are often sufficient to remove the complaint, or at all events to render it less troublesome. When Nature requires further assistance: Nux VOMICA will often answer the purpose; if after the completion of its action, there still remains some inconvenience, IGNATIA should be given as an immediate remedy, followed by Nux vomica; in other cases, when Nuxw omica does not show a marked improvement, and the temper is extremely irritable, Bryonia will sometimes cure, or Opium FAINTING, AND HYSTERIC FITS. 787 globules,* which is especially indicated to follow VNux omica when there appears to be a weight in the stomach, dryness of the mouth, and deep flushing of the face. In other cases Sepia, Lycop., Alumina, &c., will be found useful. (See CONSTIPATION, Part I.) DYSURIA. Pulsatilla, Cocculus, jux V., and Acid. phosphoricum, as also Sulphur and Conium, are the remedies which are of the greatest service in the generality of cases of this derangement in pregnant women. DIAnRRHEA DURING PREGNANCY. See DIARRH(EA, Part I., and DIARRH(EA IN LYING-IN-WOMEN, in this division of the work. FAINTING AND HYSTERIC FITS. Many delicate and nervous females are frequently attacked with fainting fits during pregnancy. The attack generally passes over easily and without deleterious consequences. Exercise in the open air, and attention to the rules of regimen, are the best safeguards against the affection; but in cases where these are insufficient, and the attacks prove distressing, we must endeavor to ascertain their origin. If the fits arise from tight lacing, warm rooms, or any other obvious excitant, the simple removal of the cause will prove sufficient; should the sufferer remain long insensible, the speediest means of revival is sprinkling the face with cold water. When arising from plethoric habit, returns of the attack may be prevented by AcoNITE, of which we have had occasion to speak several times, as a general regulator of the circulation. CHAMOMILLA. When the fainting is excited by sudden fits of anger. Nux vOMICA. When from general irritability of system, and consequent gastric derangement. BELLADONNA. When there is determination of blood to the head, with simultaneous flushing of the face and perceptibly increased action of the arterial system. (Alternately with Aconite when required.) * See Constipation, page 223, for additional indications for the employment of this remedy. TOOTHACHE. 789 SEPIA is particularly indicated when there is pulsative, shooting, drawing toothache, with pain, extending to the ears, or to the arms and fingers, excited by compressing the teeth, or by cold air, and attended with impeded respiration, swelling of the cheek, and enlargement of the submaxillary glands. CALCAREA. When the toothache is excited or aggravated by cold air, or anything hot or cold, and attended with painful sensation of the gums, and pulsative gnawing or shooting pains, which are aggravated by noise. ALUMINA. When the pains are excited by mastication, or in the evening in bed, and when they are of a tearing nature, extending to the cheek-bone, temple, and forehead. MAGNESIA CARBONICA. Nocturnal pains in the teeth, insupportable when lying down, and compelling the patient to get up and walk; pains generally boring, burning, drawing, tearing, and resembling those of ulceration, attended with swelling of the cheek on the side affected; throbbing and shooting in the teeth after a meal; pain aggravated by a cold. The above are the four leading medicines, though there are others which may be called for by peculiar symptoms. MEZEREUM. Continuous dull pains; teeth feeling as if elongated; sensibility to the touch. COCCIONELLA. Pains in hollow teeth, particularly of a throbbing description. (Cynips rusarum has likewise been found useful in similar cases.) SARSAPARILLA. Rending pains in the teeth, especially in the evening, on exposure to a current of air. CARBO v. Gnawing, pulsative constriction, or dragging pains, especially in hollow teeth, usually increased by partaking of food or drink, whether hot or cold. (See TOOTHACHE, Part I.) The following remedies are those which are generally of the greatest efficacy when the pains are excited, aggravated, or relieved under the circumstances hereafter mentioned: AIR (toothache, on exposure to) cold: Staph., Sep., Sil., Nux V., Sars., lIerc., Hyoscy. AI (diminution of pain from) cold: Puls., Natrum s. - (aggravation from exposure to) damp: Nux mosch., Rod., Bor. M90 DERANGEMENTS DURING PREGNANCY. AIm (aggravation from exposure to) the evening: Nux mosch., Sars., ifer. AIR (toothache excited or aggravated by inhaling, or drawing in): NCtr. m., and Staph.; or, Nux v., Alum., Alags., lMags. arc.; or Alum., Bella., Sil., Spig., clem., Sabina. AIr (toothache in the open): Bella., Nun v., S lph., Phosph., Con., Magn. s., Ant. c., China. AIR (diminution of or exemption from pain in the open): Rhus, Con., M)gqn. s., Nux v. BED (aggravation of pain in): ChaDn., 7ifer., Puis., Acid. Sulph., chiefly; but also: Ant. c., Alum., Amnm7on. c., Graph., Phosph., Ac. nitr., Kali, Sab. BED (diminution or cessation of pain in): Lye., Jiiagn. s. - (diminution or cessation of pain on getting out of): Oleander, Sabina, Antim. cruldum. CLENCHING, or compressing the teeth, or masticating (aggravation from): Am. c., Graph., Colch., Sep., Ile., Petr., Tab., Guaj., Sab., Phosph., Tlhuja, Veratr., Staph., Suiph., Alun., China, Zinc., Euph. CLENCHING the teeth, amelioration on: cinchona. COLD substances (aggravation from the introduction of, into the mouth): Merc., Sulphur, Spigelia; Ant. c., Thzja, Plumb., &c. DRINKING (cold fluids, aggravation from): Nux v., Sulph., Staph., Graph., Ac. mur., Bor., Nux'1 rosch., Afere., chiefly; but also, hahm., Calc., Lach., Puls., Carb. a., Sars., Agys. artf. DRNINING coffee (aggravation from): Nux v., Okam?. - hot fluids (aggravation, from): Agnus, C am., Drosera, Nux v., Lach. DRINKING tea (aggravation from): Thuja. - wine - Nux V. EATING (aggravation while): Bella., IKali, Lyc., ferc., Natr., iMags. arc., chiefly; but also, Ant., Bry., curb. a., cocc., Graph., IHep., Ign., Alagn. m., Puls., Sulph., Thuja, &c. EATING (aggravation after): Bella., chani., Lack., Nux v., Staph., Sabin., Spig., lags. arc.; or, yIgn., Graph., 3ilacgn., Ncutr. m., China, Bry., &c. EATING cold food (aggravation from): Conium. - hot food - Agn., Phosph., Sil. TOOTHACHE. 791 EVENING (aggravartiOn Of the toothache towards): HOT substances (aggravation from the introduction of, into the mouth): N vuxv., Cale., Bryon., Carb. v., Lach., Salph., IJlerc., Phosph., &c. HOT substances (mitigation on the introduction of, into the mouth): Nux 9nosch., Kali A. MORNING (aggravation of suffering in the): Naqx v., Lach., Phosph.; Tart. emet., Ka-li, KHreos., Ran. NIGHT (aggravation or accession of the toothache during the): Bella., CJam., Nix v., Ars., Putls., R s,.pig., SuLph., Staph., ifero., Phosph., 3atgn., China, CYC., Gran., Am. c., Sep., Rhood., Baryta c. et m., &c. NOISE (aggravation of pain from): Calc. c. NOON, in the after-, Nex v., Iach., Puls., Berb. QUOTIDIAN toothache: Diadema, Tart., &c. READING, Reflceting, Meditating (aggravation from): NIco v., Bellad. REPOSE, Rest, Quietude (aggravation from):.cagn. RooM (aggravation in a warm): Puls., Nax v., Hepar s. POSTURE (aggravation while in the horizontal): Clem. - (aggravation whilst lying on the affected side): SALT food (toothache increased or excited by partaking of): Crlrb. v. SMOKE (aggravation from tobacco): Spig., Clem., Sabin. - (mitigation from ditto): SPEAKING (aggravation While): Sepia. SUCKING the teeth (aggravation or accession of toothache from): Nax mnosh. SWEETMEATS (sngar, &c., aggravation fiornm): Natruqn. TEA (aggravation from): Thqja. TOOTHACHE, With extension of pain to the arms and fingers: Sepia. TOOTHACHE With extension of the pain into the ears: feroc., Ars., Nux V., Puls., Sulphur epi, Ciamn., IVNatr. n., &c. TOOTHACHE with pains extending into the face: iferc., Puls., NWax V., Hyos., SulAh., Rhus, fez., &c. TooTnACHE with pains extending into the eyes: Puls. - with pain extending into the head: Ant. c., Ars., Baryta c., Iyos., ifere., Nux v., Pihus, Putls., Su lphur., Cham, chiefly. VAIICES, OR SWELLED VEINS. 793 for the removal of that affection. Sometimes it happens, nevertheless, that whilst the toothache diminishes from the employment of the proper remedy, the swelling of the cheek remains unaltered. In this case Arnica is generally of great service, especially when the swelling is hard and stiff. If this treatment is of no avail we may have recourse to Puls., or to.Mere. vius, which is of especial service when the swelling of the cheek is accompanied with a drawing, tearing pain, an increased flow of saliva, and considerable erysipelatous redness; followed by Bella., and Hepar s., if the inflammation threatens to extend. (See ERYSIPELAS.) Cham.n, Bry., &c., are also occasionally of service. Where the employment of the appropriate remedy has been neglected at the proper time, or the swelling has been maltreated by some external application, the tumor is frequently rendered of an obstinate character. In most cases, however, the dispersion of the tumor, or, when matter is forming, the speedy completion of the suppurative process and consequent bursting of the abscess, will be readily enough affected by means of Hepar sulph., one grain, repeated, if necessary, in from six to twelve hours. In obstinate cases, Lachesis and I2epar, or _lerc. and Hep., in alternation, are sometimes required; and occasionally Silicea, particularly in strumous habits. The application of a poultice to the cheek, or a fig boiled in milk and placed in the mouth between the affected cheek and gums, is sometimes useful. If the tumor has burst, and the opening is internal, no especial care need be taken of it, but if it has burst externally, a simple bandage, smeared with melted suet or fresh butter, must be applied. VARICES, OR SWELLED VEINS. Many females suffer much during pregnancy from distension of veins in the thigh and other parts, which, becoming exacerbated, eventually cause great pain and inconvenience. These varicose veins generally arise from obstructed circulation caused by the pressure of the gravid uterus upon the blood-vessels, but are also frequently a sure indication of the existence of constitutional debility, particularly when they occur in an aggravated form. They are much increased by 794 DERANGEMENTS DURING PREGNANCY. partaking of stimulating liquids, which should consequently be avoided. Considerable alleviation is experienced by constant bathing with water, or with diluted alcohol; also by bandaging from the foot upwards with a gentle and equable pressure, and by preserving a recumbent posture, which is requisite in severe forms of the complaint, accompanied with considerable swelling of the feet, ankles, &c. In order to afford relief, we may have recourse to the following remedies: PULSATILLA is one of the most useful medicines, particularly when there is excessive pain and swelling, with a good deal of inflammation, or when the veins are of a livid color, which is imparted to the whole limb. Should Pulsatilla give some relief, but the swelling and livid discoloration continue in much the same state, Lachesis may be substituted. Arnicc is of material service when the occupations of the patient render it impossible for her to lay herself up, or avoid much standing and moving about in discharge of her domestic duties. Arnica and Pulsatilla in alternation, every six or eight days, have been found of great efficacy in such cases. Nux vOMICA, when the affection is attended with constipation, hemorrhoids, and irritability of temper. Sulptur is sometimes very beneficial after Nux v. ARSENICUM, when the veins are of a livid color, and are attended with severe burning pain. CARBO VEGETABILIS, where Arsenicuzm is not sufficient to subdue the constant scalding or burning. BELLADONNA. Varices, with considerable erysipelatous inflammation. LYCOPODIUM has been employed with success in some inveterate cases. The simultaneous external application of the remedy employed is occasionally attended with benefit. For a permanent eradication of the affection, a course of treatment is requisite, in which Agaric'us muscarius, Sulphur, Grap/ites, Carbo vegetabilis, Sepia, &c., are the most effectual medicaments. (See ULCERS, Part I.) MISCARRIAGE. 795 PAINS IN THE BACK DURING PREGNANCY. LUMBO-SACRAL PAINS. Some females suffer much from pains in the lower part of the back during pregnancy, which occasionally prove extremely distressing, particularly when they occur during the night, and tend to disturb sleep. They generally consist of an almost indescribable aching, or of an obtuse, heavy dragging, or pressure, as if caused by a dead weight resting on the affected part..Kali carbonicume is frequently adequate to remove them, especially when they partake of the character described. In other cases, Bryonia, Rhus, Sul2ph., Lycopodium, Pulsatilla, Nux v., Sepia, Platina, Natrum mn., &c., may be given with advantage. If hemorrhoidal sufferings become added to these troublesome pains, and Kali c. prove insufficient to relieve the complaint in this 'complicated form, JVux v., Sulphur, or Sepia, may be prescribed with advantage. (See HEMORnHOIDs; as also the indications given for the remedies under the heading of FALSE PAINS.) MISCARRIAGE. ABORTUS. Women who have once suffered from this affection are exceedingly obnoxious to its recurrence, and this liability is still further increased, if the event has taken place a second or third time. Miscarriage may occur at any period between the first and seventh month, but, in the majority of cases, it takes place about the third, or the beginning of the fourth. When it occurs- before or about this period, it is frequently attended with but little pain or danger, although repeated miscarriages, from the great discharge that is generally present, break down the constitution, and frequently develop severe chronic diseases. When miscarriage takes place at a more advanced period, it assumes a very serious complexion, and is often accompanied with a considerable degree of peril to the sufferer. The premonitory and accompanying symptoms of miscarriage vary much in their nature; sometimes the discharge is exceedingly profuse, at others moderate or inconsiderable; the pains, in many instances, extremely severe and protracted, are in others very slight and of short continuance. Sudden mental emotions, or great physical exertion, 796 TREATMENT OF FEMALES. mechanical injuries, a luxurious mode of life, fashionable habits, powerful aperients, neglecting to take air and exercise, are a few of the exciting causes of this affection, which is particularly apt to occur both in highly plethoric and delicate or nervous habits. An abnormal condition of the constitution is undoubtedly the predisposing cause. Miscarriage is, in most cases, preceded and attended by the majority of the following symptoms:-A sensation of chill, followed by fever, with more or less bearing down, particularly when occurring late in pregnancy; also severe pains in the abdomen, drawing and cutting pains in the loins, or pains frequently bearing a close resemblance to those of labor; discharge of viscid mucus, and blood, sometimes of a bright red, not unfrequently mixed with coagula, at other times dark and clotted, followed by the emission of a serous fluid. The miscarriage generally takes place during this discharge, which occasionally continues, if not properly checked, to flow for hours after, placing the sufferer in considerable jeopardy. When the pains increase in intensity, and the muscular contractions become generally established, with their characteristic regular throes and efforts to dilate the mouth of the womb, miscarriage is almost inevitable. THERAPEUTICS. As preventives of this affection the principal remedies are Sabina, Secale cornutum, Kali c., Lyc., Sep., and Calc. When the premonitory symptoms declare themselves, Chamomilla, N u vomica, Ferrum metallicum, Ipecacuanka, Sabina, and Oalcarea. The same with the addition of IIyoscyamus, Crocus, and Secale cornutum, after the misfortune has taken place. Cinchona is also valuable when the indications which we shall give for that medicine are present. In cases where there is an evident disposition to miscarriage, or where from a variety of reasons, it is apprehended, the employment of SABINA, in the early stage of pregnancy, will frequently prevent its occurrence. ADMINISTRATION. We may allow four or five days to elapse between the first and second dose, and gradually lengthen the interval between each successive administration, until the period of danger be past, being careful, however, to MIISCARRIAGE. 797 watch the effect of each dose, to discontinue the medicine whenever any indications of its action on the system become apparent, and to abstain from repeating until the symptoms atributable to the medicine have passed away, and then only with increased caution and at longer intervals. Hartmann* strongly recommends SECALE CORNUTUM, two globules, as useful in similar cases, but particularly when this misfortune has already occurred more than once; it should be administered every fourteen days, commencing immediately after the cessation of the monthly period, and continuing until the period at which miscarriage usually occurs is past; one dose more, at the utmost, being allowed after this period. Both these remedies are also extremely valuable after miscarriage has taken place, the latter particularly in weak or exhausted persons, or in those cases of hemorrhage in which the discharge consists of dark liquid blood, and is followed by considerable debility; this remedy is also efficacious in cases of inevitable mniscarriage, attended with feeble expulsive efforts; the former (Sabina) when there are dragging and forcing pains, extending down the back and loins; profuse, bright-colored hemorrhage; sensation of sinking or faintness in the abdomen; frequent desire to relieve the bowels; diarrhoea; nausea or vomiting; chilliness and heat, with fever. Lycopodium and Kali carbonicum have also been recommended as useful preventive remedies against habitual tendency to abortion, the latter especially when the symptoms are always preceded or attended by severe pain in the loins. We shall now treat of miscarriage when the premonitory symptoms have set in, giving, under the same head, the indications for the use of the medicaments, where the result is unavoidable or has already taken place, as even in these cases their administration is decidedly beneficial in obviating further injurious consequences, and in alleviating the sufferings of the patient. The remedies in these cases are, in addition to the two above mentioned, Arnica, (Clamomilla, Nux voraica, Ipecacuanha, H yoscyamus, Belladonna, Crocus, Ferrum metallicumr and Calcarea. * Therapie akut. Krank. Form., vol. ii, p. 352, 2d ed. 798 TREATMENT OF FEMALES. AnNIcA. When the symptoms have been excited by an accident, such as a fall, blow, or concussion, &c., this remedy should be immediately administered. CHAMOMILLA. When there are present: excessive restlessness, convulsions, twitching in the back and limbs; severe pains in the loins and back, worse at night, generally of a sharp cutting description, extending downwards, strongly resembling those of labor; sometimes also abdominal spasms, with a species of sanguineous discharge; or discharge of deep red or dark coagulated blood; frequent yawning; coldness and shivering. Nux vOMICA. Obstinate constipation, with a varicose condition of the internal organs of generation: also when the patient has been accustomed to a stimulating diet, and the use of coffee: severe burning, or wrenching pains in the loins; painful pressure downwards and mucous discharge. (Bryonia is sometimes of benefit when N x v. fails to do much good.) See also Calcarea. IPECACUANnA. Chilliness and with heat; violent pressure downwards, flooding; cramp and rigidity of the frame; sometimes convulsions; vomiting, or desire to vomit; disposition to faint whenever the head is raised; cutting pains in the umbilical region. (Platina or Cina have been recommended when Ipec. fails.) IHYoscYAMUs. When the convulsions are very severe, with cries, great anguish, oppression of the chest, and loss of consciousness. BELLADONNA is, perhaps, more frequently required either at the commencement, or subsequently, than any other remedy. The following are its leading indications: great pains in the loins and entire abdomen; severe bearing down, as if the whole of the intestines would be pressed out; pain in the back, as if it were dislocated or broken; bruised pain in the sacral region; sensation either of spasmodic constriction, or of expansion in the abdomen. It is also particularly valuable in cases of profuse hemorrhage, the discharge of blood being neither very bright nor dark-colored after miscarriage. Platina is sometimes to be preferred to Belladonna, when, along with the bearing-down pains, there is a thick and darkcolored discharge, attended with venereal orgasm. 800 TREATMENT OF FEMALES. In concluding the subject, I shall briefly notify a few precautionary measures, which the patient ought to observe while threatened with, or after having suffered from, the affliction. When miscarriage is threatened, the individual must assume the recumbent posture, and in some cases, indeed, should be strictly confined to bed, sleeping with few bed-clothes; the apartments should be kept cool, and every means must be employed to ensure perfect tranquillity of mind. The diet prescribed in cases under hominceopathic treatment should be closely followed, and warm fluids generally avoided. When the misfortune has proved unavoidable, or has actually taken place, before assistance has been sought, the patient ought still to be confined to bed for a few days, lest a fresh discharge should be brought about by too early a change from a horizontal to an upright posture; and on future occasions, when a similar period comes round, great care should be taken that the mishap may not again occur: in the attainment of this desirable object we feel confident that nothing will tend so fully to ensure success as a timely exhibition of one or other of the preventive remedies already commented on in this article. TREATMENT BEFORE PARTURITION. PREPARATION OF THE BREASTS. YouNG mothers frequently find great difficulty in suckling their children, in consequence of some organic defect or incapacity of the nipple. In almost every case, a preparation of the breasts is necessary some weeks before delivery, in order to prepare them for their future office. In many instances the structure of the breasts is disorganised from an ignorant nurse having compressed them in childhood, under the idea of such a process being needful for the expulsion of some matter in the breasts of a child-a vulgar error, against the practice of which mothers ought to be particularly watchful. Inability of function is also likely to occur from the pressure of stays REMEDIES BEFORE LABOR. 801 in after life by which the cuticle is rendered so tender as to preclude suckling. The first two cases are beyond the power of art. If suckling be attempted, induration of the nipple and mamma ensues, attended with severe suffering: when, however, a simple tenderness of the epidermis exists, this evil is much alleviated by bathing the nipples with brandy twice a day, for several weeks anterior to delivery. Another difficulty, frequently accompanying this state, is a shortness or retraction of the nipple, so that the infant cannot take hold of it; this defect is frequently the cause of the first, from the ineffectual efforts of the child to suck injuring the part; in this case appropriate shields of soft wood may be applied to accustom the nipple to elongate and protrude, so as to present sufficient hold for the infant, when the period for suckling arrives, and when the efforts of the child will still further contribute to effect this object. In this case also, bathing with brandy will naturally tend to correct any tenderness of the skin and prevent subsequent excoriation. It may also be here remarked, that when any tenderness exists during the period of lactation between the intervals of the infant being applied to the breast, the shield should be resumed, and the bathing continued, due care being always taken to lave the nipple carefully with tepid water before it is again offered to the child.* REMEDIES BEFORE LABOR. Many things are recommended by the old school previous to labor, such as frequent bloodlettings and aperients; but these, instead of promoting the object desired, have a contrary effect, by lowering the energies requisite at such an eventful period, and by placing the nervous system in an abnormal state of irritation and excitement; when this loss of humor is brought about in the first period of pregnancy, it defeats its own object, by developing what are commonly called plethoric symptoms, induced by the reaction in the organism, necessary to supply this uncalled-for waste, and which always * When severe pains are experienced in the breast after each application of the infant, the employment of Phellandrium aquaticum has been found advantageous. 51 PARTURITION. 803 BRYONIA, when there are pains in the loins resembling a dragging weight, attended with constipation and irritability, much increased by motion, with abdominal pains preceding those in the back. (This remedy is more particularly indicated, when the above symptoms have been excited by a fit of passion.) Nux VOMIcA. Similar pains in the abdomen and back; also when there is pain in the region of the pubis, as if from the effects of a bruise; the symptoms arise chiefly at night. When the exciting cause appears to be constipation, or mental irritation, or a too luxurious mode of living, stimulants, coffee, or spirituous liquors, there is additional reason for selecting Nux v. PULSATILLA. Similar abdominal pains; pains in the loins resembling those from continued stooping, or the pressure of a tight bandage, attended with a sensation of rigidity, and painful dragging and aching in the thighs; constipation or relaxation; mildness of temper or great sensibility. This remedy is particularly valuable when these pains appear to have arisen from indigestion brought on by rich, indigestible food. DULCAMARA, is chiefly useful when the origin may be traced to cold, and the pains are of a violent shooting and drawing nature, situated in the small of the back, generally coming on at night. When spurious pains arise from emotions of the mind, we may consult MENTAL EMOTIONS. ACONITUM. When these pains occur in young plethoric subjects, attended with accelerated and strong pulse, flushing of the face, and increased temperature of the skin. The employment of this remedy completely obviates the necessity for venesection. PARTURITION. Natural labor takes place at the end of the ninth month of pregnancy; the uterine contractions are regular and effective, and the whole process does not continue beyond twenty-four hours, rarely above twelve, and very frequently not longer than six. Were it not for the acquired habits of civilized life-improper diet-the distortion of the proportions of the 804 TREATMENT OF FEMALES. female frame by tight-lacing,* and the consequent displacements and disturbances of the regular functions of the abdominal viscera-diseases generated by the want of proper air or exercise, or both-hereditary maladies, &c., parturition would be comparatively free from pain and remote from danger, as in fact it so generally is, even at the present day, among savages. TEDIOUS OR COMPLICATED LABORS. When labor is protracted beyond the normal period stated, or is attended with an excessive degree of suffering, which is more prone to happen when the female is of a slender form, and of a highly nervous and sensitive habit, it becomes incumbent on us to avail ourselves of all the means which art affords, in order to endeavor to alleviate the sufferings of the patient as much as possible. Amongst the medicines best suited to attain this desirable result, we shall frequently find COFFEA CRUDA of considerable service in mitigating the pains, when they are extremely violent and occur in rapid succession, scarcely allowing the female an interval of ease, and are attended with excessive agitation, bordering on despair. When Cofea. affords but little relief, which is generally the case when the patient has constantly or frequently been in the habit of using coffee as a beverage, Aconitum should be resorted to, followed by Chamomilla if required. If little or no benefit ensue after several doses, another medicine may be prescribed. When we find that the throes are insufficient to accomplish their object, and the female becomes exhausted by the protracted nature of the labor, BELLADONNA is a medicine of the greatest value, and will generally prove serviceable ini almost every case of tedious labor, which arises from the rigidity and unyielding state of the parts (as is so frequently the case with elderly females giving birth to their first child); but it is more particularly * It is to be regretted that the attention of mothers is not more particularly directed to the development of the female frame by means of calisthenic exercises, instead of distorting its symmetry by means of stays and tight lacing; health being destroyed for the sake of that fashionable and unnatural absurdity-a thin waist. TEDIOUS LABOURS. 805 where labor is protracted by a spasmodic contraction of the inferior portion of the uterus, owing to which circumstance, notwithstanding the existence of powerful throes, the os uteri does not become correspondingly dilated, that Belladonna is indicated. On the other hand, this valuable remedy is further of equal efficacy when, on the escape of the waters, an almost complete cessation of labor-pains ensues, or the uterine contractions are rendered so feeble as scarcely to be perceptible, and are only made known to the patient by a periodic sensation of pressure and aching at the sacral region-while the dilatation of the os uteri is found, as in the above instance, to make no further progress.* The following remedies will also occasionally claim attention:-Nux v., Pulsatilla, Secale cornutum, and Opium. Nux v., when the labor is somewhat protracted, from the irregularity and insufficiency of the pains, and the female complains of a continual urgency to relieve nature. PULSATILLA, where the labor-throes are imperfect, and frequently extend upwards from the sacral to the epigastric region, attended with spasm of the stomach and vomiting; or when they are almost unfelt, and occur only at long intervals, attended with acute pains in the loins, and painful drawing sensations in the thighs, which tend much to weaken the woman, without furthering the labor. When Pulsatilla has not had the desired effect, and there is a continual deficiency of uterine contractile power; or when the labor-pains return every quarter of an hour, not increasing in intensity, SECALE CORNUTUM ought to be administered. Again, when we find the pains, although powerful at first, suddenly cease, followed by a tremor of the whole body, and occasionally interrupted by violent jerkings, and when the patient falls into a sort of lethargic slumber, with open mouth, stertorous breathing, eyes half closed, and there is great dgficulty in arousing the suferer, even by violent means, OPIuM is indicated. Dose. A few globules of the remedy may be dissolved in about an ounce of water, and a dessert-spoonful given between each pain, until benefit results, or a marked action of the remedy calls for a * Kallenbach. 806 TREATMENT OF FEMALES. pause. When the pains suddenly disappear without other indications, one or two drops of the Mother Tincture of Cinnamon may prove of service, especially where the labor is far advanced. We have now, in a great measure, treated of the course to be pursued when Nature seems to call for our assistance to further her exertions; but we must, at the same time, reprobate a rash and ill-advised interference with her operations; and we cannot, in common with most men of eminence of the other school, too strongly reprehend the practice of administering spirituous beverages, or stimulants, such as chamomile tea, and other ptisans, coffee, etc., under the absurd idea of thereby facilitating delivery. Spirituous liquors are objectionable, from their accelerating circulation, and consequently producing difficult labor, and too great a loss of blood; Coffee, from its causing high nervous excitability; Chamomile, from its pathogenetic property of producing, or creating a tendency to metrorrhagia; ptisans, whose peculiar properties we need not enter upon here, are all more or less of a stimulative or irritative nature. As a general rule, every substance, possessing a medicinal property, administered upon the false premises above noticed, tends to injury, and must therefore be carefully avoided. With regard to the after-birth, when common, gentle, and rational mechanical means* for its expulsion fail, we may have recourse to Belladonna, Pulsatilla, Secale cornutum, or Opium, selecting by the symptoms already mentioned, and shall rarely be disappointed in our expectations of their beneficial effects. "* We do not understand or mean to express by the said term, the exercise of brute force; it is truly melancholy, and almost impossible to conceive, that men, who have received a medical education, and have had opportunities both of reading and hearing the warnings of enlightened and experienced obstetric practitioners, against the distressing and serious consequences which almost inevitably result from the employment of harsh and inconsiderate measures, whenever the expulsion of the placenta happens to be somewhat tardy, could be guilty of such culpable and infamous conduct. Some of these reckless individuals do not appear to wait for any signs of tardiness, but as if in anticipation of an obstinate and prolonged retention, they set to work with their ruthless proceedings immediately, and are, consequently, but too often the authors of all the mischief and danger, and even the fatal termination which sometimes result after the natural process of labor. 808 TREATMENT AFTER DELIVERY. IGNATIA. Spasmodic and compressive pain8, with sensation of suffocation; confusedfeeling in the head. CICUTA VIROSA. General convulsions, or cramp-like contortions of the limbs; pallor or sallow hue of the face. IPECACUANHA. Spasmodic convulsions; paleness or bloatedness of the face, occasionally with desire to vomit. CoccuLus. Cramps or convulsions of the limbs and whole body, more especially in the lower part of the abdomen, with heat, redness, and pujfiness of the face. Acidum hydrocyanicum, Platina, and Cina have also been recommended against convulsions during labor. TREATMENT AFTER DELIVERY. AFTER the termination of delivery, both body and mind must be kept in a state of perfect repose; everything which may tend to arouse the excitability of the patient, such as noise, strong light, and odors, must be carefully avoided, and the room kept at a moderate temperature. After the birth, the female should be allowed to enjoy that slumber, which in natural cases generally follows, without interruption; but it is commendable to feel the pulse from time to time, to ascertain if a healthy action is going on. Sometimes this desirable state of rest is kept off by great nervous excitement on the part of the female, with incessant tossing in bed and restlessness. A few globules of COFFEA CRUDA will often suffice to dissipate these symptoms, and procure a refreshing slumber; should it be insufficient, and any febrile symptoms be present, ACONITE will generally produce the desired effect. When these remedies, which answer in the majority of cases, fail of their accustomed success, we must endeavor to trace the cause of the derangement, and shall generally discover symptoms pointing out a different remedy, which, if judiciously chosen, will, with almost absolute certainty, afford a satisfactory result. (See the article SLEEPLESSNESS, Part I.) Here again we must severely reprobate the practice of administering stimulating, and even spirituous, beverages to AFTER PAINS. 809 females after delivery, which, far from possessing a strengthening property, tend only to excite and irritate the whole nervous system. For some time after parturition, Nature calls for but little nourishment; it should be given only when the female herself expressly feels the want of it, and then be of the lightest and most digestible kind, and in very small quantities. It is highly reprehensible to endeavor to induce a female to partake of food, under the absurd idea of strengthening her. We must allow Nature to pursue her own course, which prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessity of calling the bowels into action, which state of Constipation (if it may be so called) is ordained for the wisest purposes, and attended with the most beneficial results; while the temporary inactivity of the alimentary canal is compensated by the vicarious action of the skin (demonstrating itself by increased perspiration), and the balance of the system thus kept up. We cannot, therefore, sufficiently condemn the use of aperients, which only tend to promote irritation, and bring on puerperal fever, and other evil consequences; in many cases, also, this artificial relaxation interferes with the proper secretion of milk. After the fourth or sixth day, Nature generally acts spontaneously, and when it appears necessary to afford mechanical assistance, we may do so by the application of warm friction to the abdomen, or the employment of a simple lavement, consisting of tepid water, with a little linseed oil or thin gruel. When this state, which seldom happens, continues so long as to cause inconvenience, Bryonia, or Nux vomica, Pulsatilla, and Opium, may be resorted to. (See article CONSTIPATION.) AFTER-PAINS. These pains are considered salutary, and perhaps justly so to some extent; at the same time, when they occur in an aggravated form, and are unduly protracted, as frequently occurs in females of exalted nervous sensibility, they tend to deprive the patient of her rest, and ought, under such circumstances, to be subdued as speedily as possible; their early mitigation, in all cases, by means of homceopathic remedies, is, moreover, always attended with the most satisfactory results. In many instances the employment of Arnica internally, 810 TREATMENT AFTER DELIVERY. and likewise externally as a lotion (a few drops of the tincture to an ounce or so of tepid water), when the labor has been somewhat severe, is sufficient to prevent the excessive development of these pains, as also in most cases to ward off fever and inflammation.* But when the pain still continues, and the patient is highly excitable and sensitive, we should give CHAMOMILLA, followed in about an hour by NVx v., if no change is effected by it. If the pain is of an insupportably intense description, or followed by convulsions, coldness, and rigidity of body, COFFEA CRUDA ought to be selected. We may give PULSATILLA, when the convulsions do not supervene, but the pains are protracted, and the patient is of a mild and gentle disposition, but sensitive and easily alarmed about herself. Again, when the after-pains are very severe, and there is a continual inclination to relieve the bowels when in a recumbent posture, but passing away when rising, followed by spasmodic pains in the lower parts of the abdomen, they are usually readily relieved by Nux VOMICA. SECALE CORNUTUM and CUPRUM METALLICUM have been strongly recommended in preference to any of the foregoing remedies, in severe and protracted after-pains occurring in females who have already borne many children. With regard to the dose, we may dissolve a few globules in a wine-glassful of water, and give a tea-spoonful every hour, or only every three or four hours, according to circumstances; carefully watching the effect produced, and discontinuing the medicine as soon as relief is afforded; in many cases a single dose will suffice. When, on the other hand, no improvement follows after a dose or two of the same remedy, another must be selected. In the event of flooding, the following remedies must be had recourse to: Ipecacuanka-or Crocus, Platina, or Sabina; also Belladonna, Chamomilla, or Cinchona, in particular cases, according to the symptoms. (For indications see MISCARRIAGE.) * The soothing effects of Arnica are properly appreciated by those females who have had opportunity and occasion for its employment; and we believe there are few who, having once experienced the beneficial effects of the homoeopathic treatment generally, during the entire period of confinement, would willingly return to the old method of treatment. DISEASES FOLLOWING PARTURITION. 811 DURATION OF CONFINEMENT. Even a strong and healthy female, during the first five days, should remain in bed; in the four following, if she feel herself perfectly strong, and desirous to rise, she may gradually accustom herself to longer periods of sitting up; the great risk is from the extreme susceptibility of the system to cold. After this period a female who still finds herself weak and languid, should prefer the horizontal to the half-recumbent posture; and if this prove wearisome she may sit up for an hour or two, but not so as to fatigue herself. The diet should be regulated according to the habit of body and the state of the digestive functions; in all cases it should be light, and, at first, extremely light, and not of a very nutritious quality; the patient ought only gradually to partake of food of a more nourishing nature, never having recourse to anything in the least degree stimulating, and all strong odors, from flowers or other aromatic substances, must be carefully avoided, the mind being also kept in as perfect a state of tranquillity as possible, and the room dark. DISEASES FOLLOWING PARTURITION. SUPPRESSED SECRETION OF MILK. IT is of paramount importance that the normal operations of the organism peculiar to this state proceed with due regularity. Among these the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, determination of blood to the head, and the usual array of symptoms which form the disease commonly denominated puerperal fever, which, however, also results from internal injuries consequent upon difficult or protracted labor; but if the precaution of administering Arnica, already enjoined, has been taken, that source of danger will almost always have been effectually guarded against. When, however, puerperal fever arises or threatens to set in, from a sudden suppre8ssion of the lacteal secretion, the immediate administration of PULSATILLA, three globules in a 812 DISEASES FOLLOWING PARTURITION. tea-spoonful of water, repeated in six, twelve, or twenty-four hours, according to necessity, will frequently be found sufficient to check it at the outset, restore the flow of milk, and re-establish the equilibrium of the organism; if any unpleasant symptoms still remain, they will, in most cases, yield to the administration of CALCAREA, followed by ZINCUM, if it appear called for. In other cases, particularly where serious metastases result, Belladonna, Byronia, Khus, or Sulpwur may be required. If the suppression of the secretion arise from any sudden mental emotion, we may select one of the remedies mentioned in that article, which see-giving perhaps a preference to Bry., Cham., Puls., or Coffea. Should active feverish symptoms, such as hot, dry skin, &c., set in, ACONITE should be given at short intervals, until a favorable impression is made: when there is excessive restlessness along with the above, considerable advantage will accrue from the alternate use of Aeon. and offeca. We may here refer back to our remarks upon the evil effects of aperients, which, by their action upon the intestines, frequently cause a suppression of the lacteal fluid, and the consequent fever. EXCESSIVE SECRETION OF MILK. Sometimes, on the other hand, it happens that too abundant a secretion takes place, causing a distension of the breasts, and involuntary emission of milk, and productive of extreme emaciation, and sometimes development of phthisis. CALCAREA will be found useful in this affection; or, should it fail to relieve, PHosPHORUs. When febrile symptoms arise from distension of the breasts, induced by an excessive secretion, and indications of what is generally denominated milk-fever (which, however, frequently arises from other causes), we may have recourse to Rnus TOXICODENDRON. ACONITE may be exhibited, as a precautionary measure, when there is high febrile action of the whole system, and we are ignorant of the exciting cause. The dose to be repeated every six hours, or oftener, if necessary, until the rapidity of the circulation is diminished, and the skin rendered moist. IRREGULARITIES OF THE LOCHIAL DISCHARGE. 815 when the precautionary measure of the administration of Arnica has been neglected. BELLADONNA is very useful in particular cases; a reference to INFLAMMATION OF THE BREASTS, and other parts of the work where that medicament is mentioned, will serve to point out in what instances it is most likely to prove efficacious. RHUS is also of considerable service in some cases of milk fever. (See the indications given for this remedy under the heading of EXCESSIVE SECRETION OF MILK.) IRREGULARITIES OF THE LOCHIAL DISCHARGE. This discharge varies considerably in different females; with some it continues for several weeks, in others only a few days; sometimes it is thin and scanty, at others so profuse and long-continued, as imperatively to call for medical assistance, which may be frequently traced to sitting up too soon after confinement, to errors in regimen, keeping the chamber of the female at too high a temperature, or mental emotions. If, after nine days, the discharge continues profuse, containing pure blood, whereby an abnormal state is indicated, Crocus, Bryonia, and Calcarea are the principal remedies. CROCUS. In most cases where the discharge is of too long duration, and particularly when the blood is of a black or dark color, and viscid consistency. ]BRYONIA. When of a deep red, with internal burning pains in the region of the uterus. CALCAREA is more particularly indicated, when there is an itching kind of sensation in the uterus. When the lochia are suddenly suppressed, which they sometimes are, from a variety of external causes, such as mental emotions, &c., and from this source puerperal fever threatens, the danger may freqently be warded off by the employment of PULSATILLA. When the sudden suppression arises from fright, and is attended with febrile symptoms, ACONITE will generally be found sufficient, or OPIUM, when the indications given under MENTAL EMOTIONS are present. (See also the other remedies mentioned under that heading.) When the suppression is caused by exposure to cold or damp, DULCAMARA will be found efficacious, and may be advantageously followed by PULSATILLA. 816 DISEASES FOLLOWING PARTURITION. On the other hand, when the discharge continues, but becomes sanious, fetid, and offensive, BELLADONNA will generally suffice to restore it to its normal state; if this remedy prove inefficient, we may administer CARBO ANIMALIS in the same manner; and, if the occasion still seems to require it, SECALE CORNUTUM, until benefit results. SILICEA, when pure blood is discharged with the lochia, each time that the infant is applied to the breast. The following remedies may also prove useful: Nux v., Hyos., Zincum, Coloc., Veratrum, and Secale cornutum, chiefly in the event of a suppression; and Platina, Secale cornutum, Hepar s., 2ihus, against too copious or protracted lochia. DIARRH(EA IN LYING-IN WOMEN. Diarrhcea, during this period, is a state to be looked upon as highly injurious, and immediate means should be taken for its suppression, by the administration of Dulcamara, IHyos., Rheumn, Antimonium crudum, Phosphorus, and Acidum phosphoricum, &c. The first remedy is generally indicated by the cause being a check of the naturally increased perspiration in lying-in women, from a chill: and, when timely administered, it will generally be found sufficient to answer the purpose required. In painless and almost involuntary evacuations, HYoscYAMus is most effectual. RHEUM and ANTIMONIUJ CRUDUM, in watery or very offensive evacuations; the former when they emit a sour smell. In very obstinate cases, when the discharge is watery, almost involuntary, and painless, PHOSPHORUs, followed, if necessary, by ACIDUM PHOSPHORICUM. (Vide also DIARRHIIEA, in the First Part of this work, and administer or repeat the remedies as there directed.) ABDOMINAL DEFORMITY. Although in natural cases and healthy constitutions no abnormal derangement should follow parturition, still we frequently find that a number of unpleasant symptoms, generally arising from maltreatment, supervene. Among these we may mention the thickening of the abdominal FALLING OFF OF THE HAIR. 817 coats, occasionally ending in a permanent malformation and pendulous appearance. Abdominal deformity is more commonly incident to females who have borne many children, or who present a pre-disposition to corpulency; and is found especially difficult of treatment, when tight stays, which we have already remarked upon as one of the principal exciting causes, have relaxed the abdominal muscles, and by so doing, increased the existing bias to the affection. When, however, it is caused by the natural strain upon these muscles during pregnancy, the inconvenience may be considerably alleviated by the internal and external use of RHUs TOXICODENDRON. The internal administration of SEPIA is recommended by Dr. Gross* as still more effectual; he, at the same time, advises the adoption of an elastic bandage, laced at the back, and exerting an equable pressure over the whole of the abdominal region. In some cases where there is a tendency to this affection, particularly in corpulent habits,t we may, soon after delivery, have recourse to mechanical aid, by transferring the weight from the abdominal muscles to the shoulders, by the aid of a properly constructed apparatus; but we must, in the strongest manner, object to this or any other pressure being exercised upon the abdominal region during pregnancy, as such a measure is obviously calculated to entail malformation, as, for instance, club-feet, &c., upon the offspring. FALLING OFF OF THE HAIR. Another evil that some females, particularly those who nurse their infants themselves, suffer after confinement, is a falling off of the hair. * Das Verhalten der Mutter und des Siuglings, p. 95. f Against Polysarcia (occurring in either sex), Calcarea is one of the most useful remedies, especially in lymphatic persons. In other cases, Sulphur, Arsenicum, Baryta, Antimonium, are very useful. When the abnormal secretion of fat takes place exclusively, or chiefly, in the abdomen (omentum), and forms the pot- or Falstaff-belly, Colocynth has been recommended as a medicine of considerable utility. One or more of the remedies mentioned as applicable to general corpulency may, however, be called for after the previous employment of Colocynth. Spare diet and regular exercise must, in both varieties of corpulency, be inculcated. 52 818 DISEASES FOLLOWING PARTURITION. This frequently arises from an innate delicacy of constitution, against which the following medicaments have proved efficacious, and may be repeated every eight days. TINCTURA SULPHURIS six globules, NATRUM MURIATICUM siX globules, CARBO VEGETABILIS six globules, SEPIA six globules, LYCOPODIUM six globules, and CALCAREA six globules. The last, particularly in those cases in which the lochial discharge has proved very profuse, or in which the catamenia are generally too abundant. China, followed by Ferrum, is useful in debilitated females, particularly if there has been flooding after labor. JMercurius is serviceable when there is excessive perspiration at the head. In females who have suffered much from hysterical affections, Iepar is often of considerable efficacy. If the hair falls off after metritis or other inflammatory attacks, Hep., Zyc., and Sil., Slph., Calc., Ac.phosph., Natr. m., or Carbo v. may be employed with advantage. With regard to the other medicines we would, in most instances, recommend a commencement with Tinctura sulphuris. LEUCORRHCEA AFTER PARTURITION. A third evil is Leucorrhoea, which, although at the commencement merely a consequence of the relaxation of the internal uterine economy, after the completion of the lochial discharge, and at first of an innocuous character, frequently proves exceedingly troublesome, and finally puts on a morbid appearance, becoming acrid, and productive of excoriation. We generally find a pre-disposition to the disease in scrofulous, torpid, and leuco-phlegmatic temperaments; in some families this malady is hereditary, and only to be removed by a careful course of anti-dyscratic treatment. It is frequently of a very obstinate character, requiring the exercise of considerable study and attention on the part of the Inedical attendant, on the one hand, with much patience and strict attention to dietetic rules on that of the patient, on the other, ere a successful result can be attained. The remedies which have been found the most efficacious against the affection, either occurring after parturition, or at other times, are Pulsatilla, Sulphur, Sepia, Bovista, Calc., Lycop., and Carbo v., Causticum, Conium, Xezereon, Nat r INFLAMMATION OF THE WOMB. 821 soreness or pain, as from a bruise, is constantly experienced in the epigastrium; when there is severe aching in the lumbosacral region; and when all the symptoms become exacerbated towards morning. MERCURIUS is useful when frequent fits of perspiration or shivering take place, and when shooting, pressive, boring, or piercing pains are complained of in the region of the uterus. Chamomilla, Ignatia, Cofea, or Bryonia may be of much service in some cases, particularly when mental emotions have preceded the attacks. (See the different indications which call for the one or the other of these remedies in the article MENTAL EMOTIONS.) Cinchona is indicated in metritis, by most of the symptoms which have been mentioned under Belladonna. The latter is better adapted to plethoric habits, whereas the former is more appropriate in feeble or exhausted constitutions, who have suffered from excessive hemorrhage, or other debilitating causes. In other cases recourse may be had to Lachesis, Platina, Pulsatilla,?hus, Sec., Thuja, &c. In IRRITABLE UTERUS, so-called, the most important remedies are: NVux v., Plat., Bella., Stan., CAam., China, Ipec.; and also: Sepia, Sulph., Calc., Cocc., Con., Graph., Natr. m., Kali, Kreos., Croc., Ac. muriat., Magn., &c. Against UTERINE SPASMS: Cocculus, Ignatia, Conium, ilagn., Magn. m.;-Bella., Cham., Nux, Hyoscy., Natr. m., China, are the principal homoeopathic remedial agents. Against UTERINE POLYPUS: Staphysagria, Thuja, Calc., Ac. nitr., Carb. v., have been chiefly recommended. Against ULCERATIONS at the os uteri, &c.: Carbo v., Graph., Sulph., Silic., Sep., Ars., ferc., or Thuja, may be successfully employed. In INDURATIONS of the uterus: Aurum, Bellad., Sep., Staph., Tad., Calendula, have hitherto claimed the principal attention. And in CARCINOMA: Bellad., Ars., Staph., Thuja, Carbo v. et a., Clem., Con., Sil. 822 OBSTACLES TO SUCKLING. WEAKNESS AFTER DELIVERY. We frequently find a high degree of weakness or exhaustion remaining after delivery; when it has been caused by very considerable hemorrhage, during or after that period, CINCHONA is particularly indicated, and will generally be found efficient in restoring the vital energies. When, however, the derangement is attributable to nervous weakness, and is attended with restlessness and want of sleep, we may administer ACONITE, followed, if necessary, by COFFEA, or substitute VERATRUM for the latter medicine, when the prostration of strength is excessive. In some instances we must have recourse to KALI CARBONICUM, or to SULPHUR, CALCAREA, or ACID. PHOSPHORICUM. OBSTACLES TO SUCKLING. DISINCLINATION OF THE INFANT. WHERE there is a tendency to consumption in the mother, or she is of a strumous habit, the infant ought, for its own sake, to be reared with the spoon, or a nurse provided. But even some healthy mothers find a difficulty, before they become accustomed to it, in nursing their children, which, however, a little perseverance will soon effectually overcome; but when the child itself refuses to take the breast (a rare instance, if it be applied soon after delivery), the administration of CINA, followed, if not speedily efficacious, by MERCURIUS SOLUBILIS, is often found to remove this repugnance in the course of a few hours. SILICEA is also an excellent remedy in some cases, particularly when the child takes the breast readily enough, but returns the milk almost immediately after; the remedy selected ought to be given to the mother as well as the child. EXCORIATION OF THE NIPPLES. In the majority of those cases in which no malformation of the parts is present, the main difficulty arises from the nipples having become sore and cracked, which the efforts of the inf.,nt tear open afresh, and cause to bleed. EXCORIATION OF THE NIPPLES. 823 This excoriation of the nipples is frequently prevented by following up the treatment, of which we have already spoken under the head of PREPARATION OF THE BREASTS, of course taking the precaution of laving the nipples with a little warm milk and water, before the child is applied to the breast; the shield before mentioned ought always to be worn during the intervals of suckling. When there is a tendency, however slight, to rawness or excoriation, great care must be taken lest the shield adhere to the skin; it ought to be frequently removed, and together with the nipple, kept perfectly dry; attention to these particulars will generally remove this difficulty. The mother ought, however, gradually to accustom herself to nourish the infant, using a sucking glass, which should be carefully washed every day. Should, however, the nipples have already become very sore and irritable, from the neglect of these precautionary measures, it will be necessary to have recourse to specific remedies, without which, if suckling be persisted in, suppuration frequently ensues. In the first stage of the affection, ARNIcA should be employed internally, and the breast laved with a weak lotion,* say about a tea-spoonful of the Mother Tincture, a few globules to one ounce of water. If this fail, we must have recourse to anti-dyscratic remedies, as this disease almost always arises from a constitutional cause, females of healthy temperament being generally exempt from it. Among these, TINCTURA SULPHURIS seems particularly indicated for most cases of this affection, and a dose of one or two globules may be administered every five or six days until improvement sets in, which will generally be the case in the space of a few days; and if this fail, CALCAREA, administered in the same manner, will in most instances suffice. We may also mention GRAPHITES, SEPIA, LYCOPODIUMt, MERC., and SILIC., as remedies of much value in some obstinate cases. In the choice of the fitting medicament in complicated cases (as indeed in all others), the physician must be guided by the aggregate of the symp* This lotion may also be applied with advantage in the PREPARATION OF THE BREASTS, when irritation or inflammation appears to arise from the pressure of the shield. DEFICIENCY IN THE SECRETION OF MILK. 825 treatment, such as the application of deleterious unguents, &c., SILICEA will generally have the effect to restore the breast to its former condition; in some extreme cases, however, it will be found necessary to follow up the treatment with Phosphorus, Calcarea, or one or more of the remedies above mentioned, such as Ilercurius and IIepar sulphuris. If this disease has evidently arisen from the effect of a sudden chill, DULCAMARA ought to be given immediately, and will frequently obviate all injurious consequences. In cases where the disease has arisen from external injury, ARNICA should be employed, and a lotion, one part of the tincture to seven of pure water, locally applied. When the consecutive inflammation is of an intense description, Aconitum is preferable to Arnica. When induration has taken place, Conium is required. And when suppuration has ensued, Phosphorus is, in general, the most effective remedy; when given sufficiently early, it will rarely fail to promote rapid absorption of the collected matter. In strumous habits, TINCTURA SULPHURIS, CALCAREA, GRAPHITES, and IoDIUM, will occasionally be found necessary to complete the cure after Belladonna has removed the active inflammatory symptoms. MENTAL EMOTIONS AFFECTING THE MILK. It is a well-known fact, confirmed by numerous examples, that Mental Emotions have a most powerful effect upon milk, in a moment changing it from a source of nutriment into a substance most injurious to the infant. Mothers ought to bear this in mind, and after having suffered from fright, passion, &c., should desist from suckling until they are perfectly composed; and ere the infant be again applied to the breast, a portion of the milk should be drawn off. Fortunately for evils arising from these causes, Homoeopathy presents prompt and efficacious remedies (for which see MENTAL EMOTIONS), which, if at hand, should be administered immediately, according to the cause and symptoms. DEFICIENCY IN THE SECRETION OF MILK. SUPPRESSED SECRETION OF MILK. Sometimes a deficiency of milk is found to arise from a want of energy, either functional or general. For disturb 828 TREATMENT OF INFANTS AND CHILDREN. period of his existence, might have been preserved had this system been more extensively known and acted upon. Again, the receptivity of the infant organism to the influence of homoeopathic remedies, is a fact established by experience. Here, therefore, from the minuteness, yet sufficiency of the dose, all risk is obviated of producing hurtful and even fatal consequences by the accidental exhibition of one medicine in place of another-an event unfortunately of but too frequent occurrence in the old mode of practice. The tasteless nature of the medicaments is another point of no small importance in affections of infants and children, and by means of which nausea and annoyance are completely avoided. In such complaints as occur at all periods of life, and which have been treated in the First Part of this work, we should be guided in the selection of the dose by the age of the patient; with infants we may use the highest potencies, and rarely, even in acute diseases, give more than a single globule; children, from four to eight years of age, may take about onefourth to one-third of the dose prescribed for an adult, and above that age, one-half to two-thirds. A great deal, however, depends upon the constitution of the patient, whether delicate or robust, and upon the child's susceptibility to medicinal influence, a point only to be determinated by experience; in very acute diseases we may sometimes be called upon to administer as low as the sixth potency, and even lower, particularly when employing such remedies as Sambucus, Tartarus emeticus, &c.; from the great receptivity, however, of the system in early life, as above remarked, we should be particularly careful in repeating the medicines. TREATMENT AFTER BIRTH. As soon as the child is born, it should be wrapped in fine flannel, with a piece of soft linen rag inside, the flannel itself being too rough for its delicate skin; the wrapper should be heated to a temperature of 98 degrees, as it is only gradually that the infant becomes inured to the temperature of the surrounding atmosphere. The skin should be gently washed with a little lukewarm water and bran, applied with a sponge, but care must be taken not to continue the first washing too TREATMENT AFTER BIRTH. 829 tong, for fear of irritation; soap must on no account be used; the room should be kept rather dark, and perfectly quiet, and all strongly-scented substances removed. After washing, the body ought to be dried immediately, to avoid the risk of taking cold; the child should be bathed twice a day, to keep up the action of the skin, the temperature of the water being gradually lowered, after weaning. The best time for bathing the infant is in the morning, when it is taken out of bed, and again on returning to it for the night; immersing the whole body, with the exception of the head, is preferable to any other mode of washing, as the practice of placing it in a tub, with part of the frame alternately laved with tepid water, and exposed to the action of the atmosphere, is apt to bring on a chill. Nothing can be more evidently opposed to Nature and the dictates of common sense-although, like many other absurdities, it bears the impress of custom-than the practice of swathing and bandaging the tender bodies of infants, and loading them with a superfluity of clothing, which by its weight and length, presses upon their lower extremities, and is the frequent cause of deformity and weakness in after life; in this opinion we are fully borne out by the corroborative testimony of the most eminent practitioners of the old school. ASPHYXIA. The first danger that the infant incurs on its entrance into life is Asphyxia. SYMPTOMS. Suspension of the functions of vitality, respiration, circulation, and motion. CAUSES. Natural debility; difficult parturition; injury from the forceps; pressure of the umbilical cord round the neck; tying the navel-string too tightly; accumulation of mucus in the throat; too sudden an alteration of temperature, the respiratory action of the lungs not having commenced. The usual mechanical means, under the direction of a competent person, must, of course, be instantly had recourse to; I shall, therefore, content myself with simply pointing out the homceopathic remedies most useful in such cases. They are Tart. emet., Opium, Cinchona, and Acon. 830 TREATMENT OF INFANTS AND CHILDREN. TARTARUS EMETICUS. Dose. A grain in eight ounces of water, a few drops into the mouth of the child every quarter of an hour. OPIUM. If after half an hour no change for the better takes place, and the face is livid and bluish. Dose. A few globules in a wine-glassful of water, a few drops into the mouth of the child every ten or fifteen minutes, until some effect is produced. CINCHONA. If the face be pale during the affection; and also when the infant is reviving and respiration commencing -if the same indication present itself. Dose. Same as Opium. AcoNITUM. When the child is reviving and beginning to breathe, if the face has been previously flushed, or of a bluish tint. Dose. One globule on the tongue, repeated if necessary, after a shorter or longer interval, according to the effects produced. SWELLING OF THE HEAD. Immediately after birth, the head of the infant appears more or less swollen; this is in most cases but a trifling affection, and generally goes off of itself. The administration of ARNICA, one globule, will materially hasten its disappearance; should, however, the swelling be at all excessive, bathe the part affected in a weak lotion, consisting of three drops of the tincture of Arnica to a wine-glassful of water. Occasionally a considerable swelling in the larger mould (fontanel), consisting of fluid, is observable; this affection is of greater import than the other, though seldom dangerous; if it does not disappear in a day or two, we may administer RIeUS TOXICODENDRON, one globule, to the infant t; or Cal. carb., one globule, in six days, in cases where the fontanel is long in closing. In some instances Silicea or Sulph. is also requisite in addition, if not in preference to Calcarea. NAVEL RUPTURE IN INFANTS. In cases where there is an evident tendency to navel rupture, a properly made bandage* should be applied, and will usually * 1 he following is a simple, and commonly an efficacious mode of applying a compress: take a piece of lint, just sufficiently large, when folded five EXPULSION OF MECONIUM. 831 prove sufficient to effect a cure; but if not, we must prescribe Nux VOMICA: if, however, we discover no amelioration from the employment of NTux vomica, we may have recourse to VERATRUM. Obstinate cases are frequently found to yield to the application of the NORTH POLE of the MAGNET."' These medicines are equally useful in cases of inguinal hernia. In scrotal hernia, iMagn. m., Naux v., and Lyc. have, more especially, been recommended. (See HERNIA, Part I.) This disease being frequently brought on by the violent fits of crying to which delicate children are subject, the bandage may be worn, and retained for some time after the cure, as a precautionary measure against its return. In cases of soreness of the umbilicus or navel, remaining after the falling off of the ligature, or even before, we may give SULPHUR, one globule, a single dose, and repeat in six days. If, however, during that time, no amelioration has been observable, we should exhibit SILICEA, one globule, which, if marked benefit result, may be at the same interval repeated with advantage. MECONIUM, EXPULSION OF. After having been permitted to sleep for five or six hours undisturbed, the infant should be applied to the breast as soon as the mother feels herself sufficiently recovered to permit it, which is generally from six to eight hours after delivery, and this should never be deferred, as we elsewhere observed, longer than twelve hours; the milk of the mother exciting a mechanical action of the alimentary canal, and assisting in the expulsion of the meconium. Here again we cannot too strongly reprobate the too general practice of administering laxative medicines for this purpose, possessing, as they do, a most deleterious effect upon the tender organism of the infant, or six times, to cover the rupture effectually; then press in the protusion, and keep it reduced with the hand, until the compress is rightly adjusted and secured in its position by means of two strips of adhesive plaster (which have been previously warmed by being held at the fire, so as to make them adhere) placed over the compress in the form of a cross. It is still better, however, to get an efficient bandage made to measure by an intelligent and experienced maker. * Chamomilla, Aurum, and Sulphur are occasionally found necessary, particularly the last-named, in order to effect a permanent cure. SUCKLING OF THE INFANT. 833 And again:" As a further inducement it should be remembered that medical men concur in their opinion, that very rarely does a constitution suffer from secreting milk; whilst the health of many women is most materially improved by the performance of the duties of a nurse." (Ibid, p. 194.) Upon this subject the same author also remarks in another place: "But few mothers, comparatively, are to be found who, if willing, would not be able to support their infants, at least for a few months; and parental affection and occasional self-denial would be abundantly recompensed by blooming and vigorous children. " Presuming that the laudable determination is formed to indulge the child with that nutriment which is designed for its support, it becomes necessary to state, that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and child. "By this commendable practice, the patient is generally preserved from fever, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. "If the breasts should not have secreted milk previous to delivery, the act of sucking will encourage and expedite the secretion. Thus the mother will be saved from much of the pain connected with distended breasts. Besides which, if the infant be not put to the nipple till the breasts become full and tense, the nipple itself will sometimes almost disappear on account of its being stretched; and without much, and often ineffectual, labor on the part of the child it cannot be laid hold of, and even then the pain endured by the mother is exquisitely severe, and not unfrequently the cause of sore nipples." (Ibid, p. 195.) Having premised thus much upon the advantages resulting to both mother and child from following the law of Nature, which enjoins the female to nourish her own offspring, and having, moreover, elsewhere noted some of the causes which 53 834 TREATMENT OF INFANTS. may prevent its being fully carried into effect, we shall now proceed to that important point-for those who do not intend nursing their own children-the choice of a nurse, and also the regimen to be observed, which is equally applicable to both parties. THE CHOICE OF A NURSE. In the selection of a nurse, the medical attendant ought generally to be consulted; and the following points merit particular attention: She should be apparently of sound health, full and moderate plumpness, with a fresh complexion, and clear eyelids, free from any appearance of redness, scurfiness, or thickening. She should be thoroughly exempt from glandular enlargements; possess deep-red lips without cracks, sound white teeth; and well-formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions; the child of the nurse is one of the best criterions to judge by-its being plump and healthy is a great point in her favor. We should also endeavor to discover if she is free from any hereditary taint; she should, moreover, be of a mild, patient, and equable temper, not irritable or disposed to fits of passion, nor nervous; of regular and temperate habits, neat in person, and fond of children. She ought also to be about the same age, and delivered about the same time, or, at least, within three months of the same period as the mother; with respect to the age we must, of course, avoid extremes. A woman, having given birth to a child very late in life, should choose a nurse several years her junior, and fully qualified for her duties; the reverse of the rule applies to extremely young mothers. DIET DURING NURSING. As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers, by the suppression of the menstrual discharge, and a moderate increase of appetite, which may be safely indulged; but all food of a highly concentrated, nourishing nature, is injurious, causing the SUPPLEMENTARY DIET OF INFANTS. 835 milk to become too rich, and unsuited to the delicate digestion of the infant; the best guide is the regular homceopathic regimen, which may be consulted with advantage. We cannot too strongly repudiate the too prevalent, but deeply erroneous idea, that women, during the period of suckling, require stimulants to keep up their strength; under this impression, both wine and malt liquors-and, among the latter, more particularly porter-are frequently resorted to. Porter is not only injurious from its stimulating properties, but the deleterious effect, which the different ingredients composing it produce upon the milk, forms one of the most prolific causes of the many evils that attack infancy. Our own opinions in this respect are corroborated by the physicians of the old school, though, we regret to say, not to the same extent. We shall conclude this part of the subject with a single quotation from a well-known medical writer: " There is an evil too generally prevalent, and most pernicious in its consequences on individuals and society, and by no means confined to mothers in the lowest classes of the community, which cannot be too severely reprobated; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably followed by a greater degree of languor, which demands a more powerful stimulus, which at length weakens, and eventually destroys the tone of the stomach, deteriorates the milk, and renders it altogether unfit to supply that nutriment, which is essential to the existence and welfare of the child." SUPPLEMENTARY DIET OF INFANTS. Unfortunately, some mothers do not possess sufficient milk for the proper nourishment of their offspring; if this arise merely from a deficiency in the secretion, and the female is in other respects healthy, we must have recourse to supplementary diet, to make up for the diminished quantity of the natural nutriment. Goats', asses', and cows' milk are excellent substitutes, especially the latter, diluted with one third of water; goats' milk being apparently objectionable from its 836 TREATMENT OF INFANTS. peculiar aroma. The milk, therefore, of the cow ought, when possible, to be obtained, and, if given undiluted, to be boiled; -cow's milk being generally considered too heavy, which boiling, in a great measure, obviates; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse; it should, moreover, be about the same temperature, say from ninety-six to ninety-eight degrees, a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exist in the mother, the sooner the child is transferred to another breast the better for both parties; if a nurse be not procurable, the above will generally prove sufficient nourishment until the front teeth appear, which is a clear indication that the digestive organs are prepared for more solid food; if, however, the milk diet appears to disagree with the infant, we may mix a little thin arrow-root, rusk, or well-toasted bread in water, to which the milk may be afterwards added; such alterations in diet are, however, but rarely required. We may here observe, that no portion of the milk ought to be retained for a subsequent meal, from the quickness with which it becomes sour; the same remark applies to any of the above preparations, in which milk forms the principal ingredient. In the cow's milk, at first diluted as above described, we may, after two or three weeks, gradually diminish the quantity of water, as the digestive organs become stronger, but we cannot too stringently press the point that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which Nature intended for it at its birth. When it is necessary to give supplementary nourishment, a suckling-bottle ought to be used, as the best imitation of nature in giving the food slowly; particular care being taken to observe the utmost cleanliness. The child ought, in feeding, to be kept in a reclining, not supine, position, as the latter frequently causes it to incur the risk of suffocation; and when it evinces disinclination to its food, no more should be offered. When the front teeth appear, which is about the fifthl or sixth month in healthy children, an alteration may DURATION OF SUCKLING. WEANING. 837 take place in the diet; and a well-made panado, diluted milk sweetened, and thickened with a small quantity of arrow-root, sago, semolina, or rusk, may be given twice a day. When milk, even when prepared with farinaceous substances, disagrees, we may substitute barley-water, fine well-boiled gruel, or weak chicken-broth, and beef-tea, adhering to that which seems best to agree with the infant, and taking care to vary according to circumstances, as too long an adherence to barley-water may occasion looseness in the bowels, while the animal diet is liable to lead, if too long continued, to a contrary result; the best precaution in these cases, when the predisposition becomes evident, is an immediate change of aliment. The child should be accustomed to take its nourishment from each breast alternately; as, if this precaution be not adopted, inflammation is likely to arise in the breast not used, and the child is apt to become crooked, from being always retained in the same position. The physician is frequently asked how often the child ought to be applied to the breast; the best rule on this point is, to give the breast when the infant appears to desire it, and to withdraw it when the child appears satisfied. As the infant increases in strength, it may easily be accustomed to regular hours, the breast being given late at night, and again early in the morning; but during the first six weeks or two months, three times during the hours of rest, late in the evening, the middle of the night, and early in the morning, will generally be found sufficient. DURATION OF SUCKLING. WEANING. The period of suckling ought seldom to last longer than forty weeks; but in this we must be guided, in a great measure, by the constitution of the infant; weak, ill-conditioned children, in whom the teeth are long in making their appearance, it has been recommended to continue at the breast for eighteen months, or even a longer period Weaning ought, in fact, to be regulated both by the constitution and mother of the child; full development of the front teeth, which in healthy children is from nine to ten months, but in delicate or scrofulous constitutions is delayed for several months later, SLEEP. SLEEPLESSNESS. 839 SLEEP. SLEEPLESSNESS. The sleep of the child is the next consideration; from the inability of the infant itself to maintain a proper degree of warmth, it should sleep by its mother's or nurse's side, for at least the first six weeks, particularly during winter or early spring. Care must be taken not to overburden it with bedclothes, and to place it in such a position as to prevent it slipping under them, and thereby becoming exposed to the risk of breathing a vitiated atmosphere, or even of suffocation; after six or eight weeks, when the organism becomes stronger, and able to preserve a proper degree of natural warmth, a separate bed or cradle will be more conducive to the health of the infant; this change of arrangement will be found beneficial to both parties-to the child from its breathing a purer air, and the continual appetite for the breast diminished; and the mother, being freed from the necessary watchfulness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, it is generally known, that sleeping in the same bed with an adult is detrimental to the health and proper development, not only of infants, but even of children; a child sleeping in the same bed with a very old person will very soon begin to exhibit signs of a falling off in its general appearance. With regard to the kind of bed best suited to the infant, the suspended cradle seems the most eligible; we must, however, be careful not to allow the nurse to abuse its use by continual rocking, which frequently causes irritation of the brain: it should not be closed up with curtains, but the room may be a little darkened; and in cases where there is danger of draughts, a screen will answer every purpose. As to the length of sleep allowed to the infant, the chief business of the first months of its existence being sleep and nourishment, we may safely leave the point to Nature, and not attempt to coerce the inclinations of the child; if the infant is lively on waking, we may conclude it has not slept too much; and as it increases in vigor, and is able to endure longer intervals of wakefulness, we may proceed (recollecting that night is the proper period for sleep), so to regulate its 842 TREATMENT OF INFANTS. reclining position, so as to avoid an undue pressure upon the vertebral column; a neglect of this precaution, and a premature carrying of the infant in an upright position, are a too frequent cause of deformities of the spine, and derangement of the internal functions in after life. As its powers gradually develop, the infant seems inclined to exercise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength by keeping it sitting up during the greater part of the time it is awake. A careful attention to Nature in this, as in all other cases, is the best guide. The practice of dandling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of parental affection, than from any benefit the child can, by any possibility, be expected to derive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise of the muscles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasional crying seems sufficiently active exercise during this period. In mild spring and summer weather the child may, after the first fortnight has elapsed, be carried out into the air for a quarter of an hour at a time, and the period of exercise gradually increased; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in the winter, advantage may be taken of a fine day, after it is a month or five weeks old, as the frame is gradually acquiring the power of generating heat; but at the same time, great care must be taken to prevent its catching cold; and should the child exhibit the slightest sign of being affected by the atmosphere, the practice of carrying it out of doors should be immediately discontinued, and it should be carried up and down in a well ventilated room, the nurse moving it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by accustoming them to endure cold; this can occur only through ignorance, for Nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long protracted chill. We may recommend an occasional gentle friction of the hand over the body and limbs, which materially INFLAMMATION IN THE EYES OF NEW-BORN INFANTS. 843 assists in the promotion of the circulation of the blood, and will, in unfavorable weather, serve in some measure as a substitute for exercising the infant out of doors. In carrying the child, it should be from time to time transferred to different arms, as a continuance on one side is a frequent cause of deformity, and in some cases of squinting. The child, as the organization develops itself, seems to evince a desire for independent movements, in which the nurse may very properly indulge it, by removing every impediment in its dress, and allowing it to roll about, or crawl upon a soft carpet. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing curvature of the limbs, the bones not being yet sufficiently formed to bear the burden imposed upon them. By allowing Nature to act, the infant's powers will become more gradually, but at the same time, more fully developed; its carriage will be more firm and erect, and its limbs straight and well-formed; moreover, it will walk with greater confidence and independence by the expiration of the first year, than those who have been taught to walk by the assistance of the nurse, leading-strings, or mechanical inventions. When the period at which a child should make attempts to walk is retarded by evident debility of constitution, this evil is to be overcome by many of such remedies as Calc., Sil., ulph., Bella., Merc., or Staph., &c. DISEASES OF INFANCY. INFLAMMATION OF THE EYES IN NEW-BORN INFANTS. A SUDDEN exposure to the strong light of day, or the glare of a fire, is the general cause of this affection; and no doubt many children who are what is vulgarly denominated born blind, owe their misfortune to the neglect of those precautions which we have so strongly enforced under the head of TREATMENT OF INFANTS, in many cases the external indications of this affection being so very slight as to escape observation. As soon, however, as, on a careful examination, we become 844 DISEASES OF INFANCY. aware of the existence of this evil, we should administer ACONITE, which will generally be found promptly efficacious in its removal. When, from the constitution of one or both of the parents, we have reason to suppose that the exposure to light has been merely the exciting cause, but that the real origin of the evil is more deeply seated, or if the Aconite seems to produce no effect, and the disease continues to increase, we may have recourse to TINCTURA SULPHURIS, and in some cases CALCAREA, alternating these remedies every eight or ten days, if we find it necessary to resort to Calcarea. Tinctura sulphuris having been found in many cases to act as a specific. CHAMOMILLA is useful some weeks after birth, when the perceptive faculties are more developed, and the child exhibits great intolerance of light; also when redness, swelling, and agglutinations of the eyelids, with other indications, given under ACUTE INFLAMMATION OF THE EYE (Part I., which see), are present. LYCOPODIUM CLAVATUM and RHUS TOXICODENDRON may also be named as useful remedies in this inflammation, the former especially in inveterate cases. The eyes may be gently but repeatedly bathed with tepid water. COLD IN THE HEAD. This affection frequently becomes exceedingly distressing to the infant when it appears in the form of an obstruction of the nose, impeding the action of sucking, by not allowing the breath to pass through the nostril, obliging the infant to release the nipple frequently in order to breathe, and causing it to become fretful and irritable; sometimes also leading to irritation and excoriation of the nipple, and thus, in its repeated efforts to suck, the child causes suffering both to itself and the nurse. Whilst this state continues, it operates considerably against the infant's thriving, both by hindering it from taking a sufficient quantity of nutriment, and, by the impediment it causes to respiration, preventing the child sleeping at night. When the nose is dry, and the secretion of mucus suspended, we may, whilst administering a remedy calculated permanently to relieve the evil, afford relief, by imitating the natural secre COLD IN THE HEAD. CRYING. 845 tion by the application of a little almond oil or cream to the interior of the nostrils with a feather. This malady is often excessively obstinate, and presents itself under many different phases, which of course demand remedies suited to the entire group of the symptoms. Among these, Nux vovIia is most frequently successful, particularly when the following symptoms are present:Obstruction of the nose, with dryness or nocturnal obstruction, slight discharge during the day; irritability and peevishness. SAMBUtrUS NIGER is' frequently efficacious when Nux v. fails to relieve; but is also of service in cases when there is an accumulation of thick and viscid mucus in the nostril; when, in addition to the cold in the head, there is a suffocating cough, with wheezing in the chest, and quick laborious breathing, Tartarus should be had recourse to if Sambucus does not soon relieve the latter symptoms. CHAMOMILLA is very useful when there is cold in the head, with a watery discharge from the nose, more particularly when there are febrile symptoms, soreness of the nostrils, and redness of one cheek. CARBO v. is chiefly useful in obstinate cases, and particularly when the cold in the head becomes aggravated towards evening. CALCAREA, when the nose is stuffed with mucus, and the affection occurs in stout, lymphatic children. PULSATILLA, thick green or yellow, or purulent-looking discharge from the nose, attended with frequent sneezing. Dose. A globule of the remedy selected may be dissolved in half a wine-glassful of water, and one tea-spoonful given at bed-time and another in the morning. Sulphur may follow Pulsatilla, after an interval of a few days, if the latter fails to act beneficially. Mercurius, Aurum, or Lycopodium may be required after Sulphur, if the discharge continues to present a purulent appearance. (See also CoRYZA, Part I.) CRYING AND WAKEFULNESS OF NEW-BORN CHILDREN. As we have already remarked, the occasional crying of new-born children is a wise provision to bring the respiratory organs into play, and to expand the chest. When, however, the crying becomes excessive, and threatens to prove injurious, we must, in the first place, endeavor to discover its ori 846 DISEASES OF INFANCY. gin, which frequently will be found to be some mechanical cause, such as derangement in the infant's dress, or a pin sticking into its flesh, &c. THERAPEUTICS. When, however, no exciting cause or guiding symptoms of disease present themselves, and the infant is peevish and irritable, affected with incessant whimpering and wakefulness, or prolonged fits of crying, BELLADONNA will frequently be found sufficient to remove the evil. When a fit of crying arises from the child having been irritated or excited by any cause, such as suddenly rousing it from its rest, and when it seems willing to sleep, but finds a difficulty in composing itself to slumber, COFFEA CRUDA will prove efficacious. (Aconitum may follow Coffea when there is considerable heat of skin and extreme restlessness.) CHAMOMILLA is often more efficacious than Belladonna when the infant is of a very spare and delicate habit; or when we can trace the fits of screaming and wakefulness to a derangement of the digestive functions, and the child appears to suffer from griping pains, indicated by contortions of the body, drawing up of the little limbs upon the abdomen; and when a whitish, yellowish, or greenish, or watery excoriating diarrhoea is present. JALAPA, in similar cases, but without diarrhoea, or with motions tinged with blood. In other cases, when the screaming and vigilance are attended with colic and flatulence, SENNA will answer best. RHEUM is more appropriate when, in addition to screaming and wakefulness, combined with griping, there are ineffectual efforts to relieve the bowels by frequent straining, or when, at the utmost, only scanty, sour-smelling motions are passed, of grayish appearance, and which seem to afford no relief. When flatulent colic, accompanied by sudden fits of crying, drawing up of the legs or of the scrotum, and a costive state of the bowels, appears to be the source of the disturbance, Nzix v. will commonly succeed in restoring ease to the little sufferer. PULSATILLA is very efficacious when the derangement arises from overloading the stomach, or improper food, and the crying or wakefulness is accompanied with flatulence and diarrhoea, or with constipation. REGURGITATION OF MILK. 847 REMARKS. The milk of a nurse who has suckled for some months previously is much too heavy for a new-born infant; here the only alternative is a change of nutriment. When, however, the above-named or any other infantile derangement arises from congenital weakness of the stomach, the most useful remedies, in addition to NVux v. and Puls., are Sulpihur, Calcarea carbonica, and Baryta c. REGURGITATION OF MILK. ACIDITY, FLATULENCE, ETC. Children, in sucking, sometimes overload their stomachs, and regurgitate a portion of the milk; so far, mothers have no cause for uneasiness, nor is medical assistance requisite; but when this changes into vomiting, and the whole of the nutriment is returned from the stomach, or when sickness and regurgitation of food occurs in children who have been weaned, at times followed by mucus and watery fluid and even bile, it must be looked upon as a disease, and treated accordingly. THERAPEUTICS. IPECACUANHA will generally afford relief, and may be repeated, if not soon followed by some amendment. In the case of spoon-fed infants, or in children at a more advanced age, this remedy is equally efficacious, when the derangement is evidently owing to their having been over-fed (a most culpable error, which most nurses are prone to fall into by cramming the stomach of their little charges, and but too often with food of an indigestible nature, whenever they are seized with a fit of crying). Should the vomiting or flatulence, and also the diarrhoea when present, not decrease after some doses of.pecacuanka, Pulsatilla may be given, and succeeded in turn by Antimonium crudum, if the symptoms continue, though in a mitigated form. Nux VOMICA, and that failing, BRYONIA may be prescribed when the disease is attended with flatulence, constipation, uneasiness, or irritability of temper. Gentle friction with the extended hand, which has previously been warmed, is a simple and frequently efficacious mode of affording temporary relief in cases of flatulent distension of the stomach and bowels. But permanent relief is only to be attained from Pulsatillac, Vux v., Chamomilla; or Carbo v. and Sulphur, when the former are insufficient. 848 DISEASES OF INFANCY. The diet must at the same time be attended to, and altered, if of an indigestible nature and the undoubted cause of the mischief. When there are diarrhoea and excessive flatulency, China is very useful. CHAMOMILLA. When the disease is attended with convulsions, or diarrhea, as described elsewhere under this medicine (see those Articles). A single dose of Sulphur, followed by Calcarea carbonica, in from five to ten days, and then again one or more of the preceding remedies, according to indications, will often be the means of effecting a cure in inveterate cases. SPASMODIC ASTHMA. SPASMS IN THE CHEST. Children are sometimes seized during the night with sudden attacks of suffocating spasm in the chest. The little patient suddenly awakes from sleep, and utters a shrill cry, in consequence of the feeling of suffocation which is experienced. The countenance soon assumes a livid hue, and is expressive of extreme anxiety. A dull, hollow-sounding, dry cough usually accompanies the attack, and the breathing is rapid, very laborious, and painfully distressing to witness. In such cases a globule or two of Ipecacuanha ought immediately to be dissolved in about a wine-glassful of water, and a few drops of the liquid put into the mouth of the patient. If relief follows, the medicine must be allowed to act, and only repeated when the symptoms threaten to become worse again. But in the event of no favorable signs resulting in from an hour to half an hour or so, according to the severity of the symptoms, Sambucus may be given in the same manner. In other cases Arsenicum will be found more efficacious than either of these remedies; or Ipecacuanha and Arsenicum may be administered alternately until improvement takes place. Whenever a sudden aggravation ensues after the administration of any of these remedies, nothing further should be done, as on waiting patiently for a short time, if the change arise from the effects of the medicine, the symptoms will subside, and gradually give way to unequivocal signs of improvement. (See ASTHMA of MILLAR.) Some children are liable to be seized with obstructed res 850 DISEASES OF INFANCY. affection, and when the skin around the parts is red, inflamed and itching. As soon as beneficial effects have resulted from the employment of the above remedy, we may follow it up with VIOLA TRICOLOR, which is often sufficient to effect a cure in the simple uncomplicated form of the disease. RHUS TOXICODENDRON may sometimes succeed or supersede Viola tricolor, when the scalp is considerably affected, and thickly studded with incrustations. When Rhus is insufficient to complete the cure, Calcarea or Lycopodium are generally to be selected in preference to other remedies, the former more particularly when there is little or no discharge, the latter when there is considerable oozing (suppuration), and the temperament of the patient lymphatic. If, after the employment of RSus, the affection is found to have made but little favorable progress, Sulphur may be given and repeated in four days. The alternate use of Rhus and Sulphur every four or five days has been found very efficacious in cases of the aforesaid description, and when the eyes are a good deal affected. Sarsaparilla and Mezereum have also been strongly recommended in Crusta lactea. The former in the earlier stage of the malady, when small, burning, itching pustules appear on the face. Mfezereum, when from the bursting and discharge of the contents of the pustules, incrustations have formed, from which an acrid exudation flows, and gives rise to a fresh eruption of vesicles wherever it comes in contact with the skin. Graphites, as also Sepia, Bella., Hepar, Baryta c., Dulc., Cic., lod., Mere., Natr. m., Acid. fluor., have been recommended as likely to prove of service in complicated cases. (See also SCALD HEAD.) THRUSH, OR APHTHAE. This disease commences by the formation of small, isolated, round, white vesicles, which, if not checked, become confluent, and sometimes present an ulcerated appearance, or form a thin white crust, which lines generally the whole of the cavity of the mouth, and in severe cases extending to the throat, and even throughout the alimentary canal. Although the affection 852 DISEASES OF INFANCY. or nurse, who ought to be changed, or immediately put through a proper course of treatment, under the direction of an experienced homoeopathic practitioner. CONSTIPATION. OBSTRUCTIO ALVI NEONATORUM. This derangement generally appears in children who are either wholly or partially reared by the hand, and also in those whose mothers or nurses are similarly disposed; if it arises from a peculiar diet or want of exercise, such as too much animal food, &c., on the part of the last-mentioned, it may be removed by a proper attention to these points; but in many instances it is necessary for them also to have recourse to proper remedial agents at the same time with the infant. THERAPEUTICS. VNux vomica, Bryonia alba, and Opium are the principal remedies, and in more obstinate cases, Sulphur, Veratrum album, Lycopodium, and Alumina. Most of the medicaments have been already mentioned under CONSTIPATION (PART I.), which see. Dose. One globule of the three first-mentioned remedies, every three to four days, until relief is obtained, or another remedy called for; and of the last, the dose at intervals of a week. An enema of tepid water may occasionally be resorted to, if required, or a suppository consisting of a small slip of paper, or linen, spirally twisted, and lubricated with oil, may be introduced by a gentle rotatory movement, until the medicine has remedied the irregularity. Rubbing the stomach and bowels frequently in the course of the day, with a warm hand, sometimes assists the other means employed. BOWEL COMPLAINTS OF INFANTS. DIARRHiEA NEONATORUM. Diarrhoea, like constipation, is to be regarded merely as a symptom, not as a disease; the real disease here consists in irritation or inflammation of the mucous membrane of the intestines, arising from the effects of aperients, indigestible food, cold, fright, &c. It has already been mentioned (article MECONHIM) that much mischief is too often occasioned by the deleterious practice of administering laxative medicines, and even drastic purgatives, to the tender new-born infant, for the purpose of hurriedly expelling the blackish green-looking matter, BOWEL COMPLAINTS. 853 technically known by the name of ifeconium, that collects in the large intestine of the foetus during the last month or two of its uterine existence. This unwarrantable and extremely reprehensible conduct is frequently persevered in, even for some time after the expulsion of the first discharge has taken place, and is in many cases the too evident cause of bowel complaints and other sufferings in infants. The introduction of inappropriate, indigestible food, such as thick gruel, &c., into the delicate stomach of a new-born infant, is another very frequent source of intestinal derangement; this unpardonable error is not unfrequently committed by ignorant nurses, in order, as they say, to keep it from starving during the few hours of necessary repose to which the mother is left after delivery. This disturbance is, moreover, likely to be excited in those cases in which, either from a deficiency in the secretion of milk or other causes, it becomes requisite to administer supplementary diet to make up for the diminished supply, and again at the period of weaning, when serious disturbances are occasionally produced in the stomach and bowels, from want of proper attention and caution in the selection and administration of the food. (See art. SUPPLEMENTARY DIET OF INFANTS.) Fright and exposure to cold are, as already noted, two other most frequent exciting causes of the disorder. THERAPEUTICS. A healthy child at the breast passes, on an average, from three to six motions in the twenty-four hours, but in some instances the evacuations are more frequent, while in others they are much less so, yet without in any degree affecting the health of the child; in such cases, then, little or no interference ought to be made, so long as the stools remain free from fcetor, possessing merely the slightly acid smell peculiar to the infantile state, and are evidently unnattended with pain, or any other abnormal indication. When, however, the stools become green and watery, or yellow and watery, brown and frothy, or white and frothy, as if fermented, mixed with mucus or consisting entirely of mucus, and emit an offensive odor, and are generally preceded or accompanied by signs of suffering, it becomes imperative to have recourse to remedial aid. BOWEL COMPLAINTS. 855 generated by indigestion, or has arisen from the prolonged use of antacids, such as magnesia, &c., and when there are flatulent distension of the abdomen, colic, crying, restlessness, tenesmus before and after the evacuations, which are either of the consistence of pap, or watery and somewhat slimy, occasionally of a grayish, or of a brown color, and when a sour smell is emitted from the body of the infant. It is sometimes necessary to give Chamomilla after Rheum, to complete the cure; in other cases, and particularly those of an obstinate character, Magnesia c. is more efficacious. PULSATILLA. -Diarrl3ea arising from indigestion," or from a chill, with watery, slimy, whitish, or bilious, greenishlooking evacuations, occurring chiefly at night; want of appetite, fretfulness. Pulsatilla, as before stated, is also very serviceable in obstinate cases, where the affection has been brought on by the abuse of Rhubarb, or by Rhubarb and M2agnesia, when the symptoms are as above described; it is further often efficacious under similar conditions, when fright has been the exciting cause, and Opium has not sufficed, or has been administered too late to procure relief. (See VERATRUM.) IPECACUANHA is particularly valuable when the diarrhcea is excited at the period of weaning (weaning-brash), from the sudden change offood, which the stomach is unable to digest; and when the following symptoms result in consequence: bilious derangement, with repeated attacks of vomiting, paleness of the face, frequent crying, diarrhoea, with stools of a bilious, slimy, or greenish yellow, sometimes blackish, or streaked with blood, and of a putrid odor; on other occasions, evacuations resembling matter in a state of fermentation, or containing substances like white flocks or flakes, followed by straining. When this remedy is insufficient to effect a complete cure, we should have recourse to Pulsatilla, or to Antimonium crudum, should the vomiting not speedily subside. MEREucRIUS. This medicine will be found very serviceable in some cases where the irritation owes its origin to the abuse of aperients, such as Rheeum, &c.; or when it has arisen from A CHILL. The following are the principal indications: watery, slimy, or bilious stools (sometimes streaked, or mixed 856 DISEASES OF INFANCY. with blood), of a blackish, greenish, or whitish-yellow color: frothy, or having the appearance of beat-up eggs; attended with symptoms of severe colic, and frequently also severe tenesmus and protrusion of the intestine; diarrhoea, with redness of the whole body, as from general excoriation. DULCAMARA. This is an admirable remedy in derangements of every description arising from exposure to a cold, damp atmosphere; and is indicated in cases of diarrhoea from this cause with the following symptoms: watery, bilious, or slimy evacuations, of a greenish yellow color, and occurring chiefly at night. (ilere. or Cham. may be required to complete the cure in some instances.) Nux voMICA is very useful in cases arising from a chill, or from indigestible food at the period of weaning, or earlier; it is also useful in some cases, in which the disorder has been created by the frequent employment of laxative medicines. Its indications are: very frequent but scanty evacuations of watery, slimy, whitish or greenish stools, attended with colic and tenesmus, sometimes followed by protrusion of the intestine; extreme fretfulness. This medicine is also of great service in many cases when the diarrhoea alternates with constipation. BRYONIA is a useful remedy in cases of diarrhoea, which recur whenever the weather becomes very warm. (Ccarbo v. has been found efficacious, when only temporary benefit had resulted from Bryonia, in diarrhoea during the heat of summer.) AnSENIcM. This medicine becomes indispensable in neglected cases, or in those at an advanced stage of the disorder, when there is reason to fear that it will terminate in marasmus. The following are its characteristic indications: watery or:slimy stools, mostly profuse, of a greenish, whit'sh, dark, or ibrownish color, or of a putrid or gangrenous odor, taking place chiefly during the night, or after drinking or partaking,of any kind of food, often preceded by crying and restlessness,:and followed by exhaustion or tendency to faint in children of.a more advanced age; great thirst, sleeplessness, paleness of the face, sunken cheeks, and blue circles round the eyes, eenlargement of the abdomen, with extreme weakness and exces BOWEL COMPLAINTS. 857 sive emaciation. In diarrhoea attended with vomiting, Ars. is one of the most valuable remedies. SULPHUI is an invaluable remedy in protracted cases, or in those occurring in children who are the offspring of delicate parents-when there are great weakness, emaciation, distension of the abdomen, redness or soreness of the anus, and excoriations between the thighs and adjacent parts, or a sort of miliary eruption over the whole body. (Calc. is sometimes required to complete the cure after Sulph.) In other cases, Sepia, Hepar s., Acid. sulph., Magnesia, Graph. or Veratr. may be required. (See DIARRHIEA, Part I.) OPIUM, as has been stated in another part of this work,* is a most valuable remedy, when immediately employed, for averting the bad results which sometimes arise in consequence of a sudden fright. When convulsions, with derangement in the stomach and bowels are excited in children by such a cause, we ought to administer Opium, followed by Veratrum, should Op. prove insufficient, and the vomiting and diarrhoea become excessive; or we may select a remedy from amongst those above mentioned, in preference, such as Puls., &c., if the symptoms correspond. Against DIARRHEA unattended with pain (painless diarrhoea) the most useful remedies are: Ferrum, Ars., Lycopod., Hyos., Phosph., Phosphorus ac., Stram.-- hina, Sulphur, Barytca mn., Clem., Cina, Nitr., Mags. artif., Cham., Bella., Chel., Puls., Ran. bulb., Rhod., Rhus, Merc., Ign., Graph., Con., Calc., Acid. nitr., Opium, &c. DIARRnHEA stercoral: Cin., IIepcar, Gran., Ld., Ac. mur., Plumb., Mosch., Prun., Spig., &c. - arising from acids (acid food, fruit, lemon-juice, &c.): Lach.,-Ars., Puls. - after exposure to cold: Mlercurius, Cham., Dulc., Bry., Bella., Nmux moschata.-Puls., N ux ~., Sulphwur, TVercarum, &c. - which manifests itself on exposure to the cool, fresh air of the evening: 2Mercurius. - which manifests itself in damp weather: Lachesis, Rhododendron. - - itself day and night: Sulphur. * Vide MENTAL EMOTIONS. 8- 8 DISEASES OF INFANCY. DIARRHEA which manifests itself after drinking: Ars., cina. - in the evening: Lachesis, Eali c. - after eating (after a meal): Ars., Col., Bry., China, lach., Am. m., ileum, Bor., Ferrum my., Veratrum. - which occurs after eating and drinking: Bryonia, Arsenicum, Rhus. - eating fruit: Lachesis, China, Rhod., Cist., Ars., Puls. - drinking milk: Bryonia, Lyo., Sepia, Sulph., Natrum. - which takes place in the morning: Bryonia, Caps., &c. - at night: APs., Puls., Mierc., China, chain., ifoschus, Sulpur, &c.. - (during sleep): Puls., Am., RAus, loschus. - which occurs during warm weather: Bry., Lach. Concomitant Symptoms. - attended with distension of the abdomen (flatulent): Veratr., Colch., Sulph., Graph., &c. - attended with distension of the anus, pain (burning) in the: Mere., Puls.-Lach., Veratr., &c. - attended with excoriation of the anus: Cham., Mere., Suph., Ferr., Sars. - attended with loss of appetite: Nux mosch.Antim. c., Puls., &c. attended with pains in the back: Ferrum. - - cephalalgia: Rhus tox. - - coldness: Spig., &c. - - colic: Ars., Xierc., Puls., Cham., Nux V., Veratr., Ipec., Bry., Rheum, Jalap, Rhus, Rat., Saulph., Canth., Baryta c., Ant., Agar., Petr., &c. - attended with crying or screaming (in the case of children): c/tam., Ipec.-Rheum, Jalap, Sen., Carb. v., Suiph. - attended with dyspncea: Sulphur. BOWEL COMPLAINTS. 859 DIARRmEA attended with eructations: Mere., Con., Dulc., &c. - flatulency: Ferrumi mg., &c. - pains in the limbs: Rhs, Ammon. m. - - lassitude, debility: Ipec., Ars.,. Veratr., Kali, Ferr. mg. - attended with nausea: iMere., Ipecac., Ars.,. - Lach., Bella., Gran., Hell. - attended with cold perspiration on the face: Jierc., YVeratr. - attended with pains in the rectum: Alum. S- shivering: ]Jerc.,. Puls., Sliph., Veratr., Cast., Cop., Dig. - attended with shuddering: fMere., Puls., Veratr., Rheum. - attended with inclination to sleep: N-uc mosch. - - tenesmus: J/ero., Iach., Ars., Nux V., Alum. - attended with thirst-: Ars., fagn. s., DulC. - - tremor: /erc. - - vomiting: Ipec., Ars., Veratr., iuprum, Tart., Rheum, Lachesis, Ant., Phosph., &c. Color of the Fcces. Ash-colored: Digitalis purpurea, Asarum europcurm. Black, or very dark: Ars., Ipec., China, T76eratr., Camph., Ac. sulph. IBrownish: Ars., Rheum, Feratr., Camph., Merc. c., Dulc., Salph., ilagn. m., Tart., &c. Clay-colored: Caicarea carbonica, He ar sulMhris, Petroselinum, Dig., Puls., Sulh., & c. Frothy: Lach., Rhus, Calc., (oloc., i/erc.-Iod., Natr. s., Sulph. ac., Op. Grayish: Digitalis, Mier., Phosph., Rheum, Ac. phosph., Asar. Greeuiish: camomilla, Puls., Arsenicum, Merc., Sulphur, Phosph., Veratrum.-Bella., Ipecac., Hep., Nux v., i/agn. m., Sep., &c. 860 DISEASES OF INFANCY. Pale: Lycopodiumn, Carbo vegetabilis. Whitish: Pulsatilla, Saiph., China, Digitalis, Chamominrilla, flepar, Colch., Ign., Aeon.-Nux v., iXere., Rh-as, Ars., C'ale., &c. Yellowish: Ohamomilla, 3iereurius, Puls., Ipecac., Ars., Phosph,., Tart., (Cale., Jfagn. m., Coloc., Chiina, &c. Nature of the Alvine -Discharge. Acrid (producing excoriation of the anus): 9lfere., Ars., lach., ('ham., Puls., C'hina, Jgn., Veratr.-Ferr., SarS., ]~ach., Staph., Sulph., Kali, Phosph., Graph., Nux v., &c. Bilious: Pulsatilla, C('amornilla, Ipecac., Veratr.-JJfere., NXu V., )Dulc., Ars., Oleand., ('hina-Bism., Coloc., Ingesta containing (lienteria): China, Ferruzn, Oleander.Ar8,., Bry., i/en., Pkosph., Phosph. ae.-Ant. c., Am., Asar., Bar., ('ale., Can., Nyitr. ac., Jke'um, JIhus, Sil., Salph. ac. Gelatinous: Colch., Hell., R]ihus, Sep. Membranes (containing portions of false): ('antharis, (olch., Sepia. Mucous: Puisatilla, ('apsicum, C(hamomilla, Borax, Nure vomica, Phosphorus, Sulphur, Asamum, Amn., Ars., ('arb. V., Coloc., Graph., Ihell., Ipec., Kali, Ii/agn. in., Ifere., Petr., JRheuin, Rhus, Sep.-A 't. c., Canth., CI'ina, Colch., -Hep., Hlyos., Ign., hod., led., Natr., Nitr. ac., Phosph. ac., Sabad., Sabin., Stann., Veratr., Viol. tr. )&c. Pitch, or tar, resembling: -Lachesis, Ipecacuanha, ierczuriucs, Nex vomica. -Purulent: JJerc., Silicea.-Puls., Sulph., ('anth., Am., lye. -Col., KIfali, ('hina, Bella., 'oce., Sep., &c. Sanguineous: Xrc,, C(anth., Nax in., Puls., Ipecac., Sepia, Sulph.-Arn., Ars., Asar., Bry., Cole., 'aps., ('arbo v., ('hina, -Dros., Ferzr., Led., Lye., Nitr. ae., Phosphorus, Rhus, Sabin., Sil.-Alum., Ainin., Ant. e., Bella., Cl(am., Coloc., Con., Civec., Cqqgr,, Dulei~., Graphiles, 17ye.,ios., Jtfagn. in., Jifur. ae., Natr., Natcr.in., Salbad., Se/e. corn., Selen., Strain., Suiph. ae., Zineum, &c. Viscous, glutinous: Jfereurius, Asar., Sarsap., Ijell., Nvua in., Pluamb., Ars., ('oleh., ('arb. v., hlep., Kali, i fezer., Natr., VeRratrucm. 862 DISEASES OF INFANCY. IGNATIA, PULSATILLA, BORAX, or CARBO VEGETABILIS, has been recommended to be given. MERCURrUS. When a yellow color of the skin is present, which Chamomilla has not removed, and when the excoriation is extensive and severe. In very obstinate cases we may have recourse to Carbo v., followed in four to six days by Tincture szulpFhris; Graph., Lye., Acid. sulph., Silicea, and Sepia, are also useful in this malady. JAUNDICE. ICTERUS NEONATORUML, This disease, as we have before observed, frequently takes its rise from the mischievous practice of administering aperients immediately after birth; exposure to cold is also one of its exciting causes. When it has arisen from the latter cause, and when there is, together with the distinguishing characteristic of the diseasea yellow hue of the skin-considerable distension of the stomach, the administration of CHAMOMILLA will be found prompt in affording relief. Mercurius may, in many cases, follow this remedy, if it has only partially relieved; after which, if any symptoms still remain, we may exhibit CINCHONA. Nux VOMICA, when the complaint is combined with costiveness, and the little patient appears generally of an irritable temper. For more particular indications for the medicines above given, and further information, see article JAUNDICE, in Part I. of this work. INDURATION OF THE CELLULAR TISSUE. INFANTILE ERYSIPELAS. ERYSIPELAS INFANTUM. SYMPTOMS. Fever with red spots, generally appearing first upon the nates, but sometimes on the extremities, afterwards upon the abdomen and genital organs, accompanied with induration of the skin and even of the maxillary muscles, which prevents the child from uttering other than a dull sound; the skin at last becomes as dry and hard as parchment. Some times, instead of fever, the induration is accompanied with cold. This affection generally presents itself in the first two months of infancy; its duration is from four to fourteen days, and if not promptly treated, it is generally fatal. BOWEL COMPLAINTS. 863 THERAPEUTICS. The remedies principally required in this affection are: Aeon., Bella., RuAs tox., Ars. album, Zach. and Sulphur. ACONITUM. At the commencement, when fever is present. BELLADONNA may follow the exhibition of Acon., particularly when the spots present an erysipelatous appearance. RHus TOXICODENDRON, if the appearance of the skin exhibits a vesicular character. (In some cases Bella. and Lhus alternately may be found necessary.) AESENIOUM, should the dryness and hardness of the skin remain undiminished, or become increased; should we also find rejection of food from the stomach, evacuation green, watery, acrid, and very offensive; moreover, when there is a tendency to gangrene, with livid spots and vesications, and when the scrotum is especially affected. LAcHESIS may, in some cases, be called for after Bella., when that remedy does not appear sufficient to combat the malady; or it may sometimes be advantageously exhibited in alternation with Arsenicum. When the joints, particularly the knee or ankle, are the principal seat of the disease, and the bowels are in a very costive state, Nux v. is useful. SULPHUR may be usefully employed against the sequelhe of this affection, such as torpidity of the intestines, and is also indicated where we have reason to suspect some constitutional taint. Sil., Graph., Hep. s., or Clem., may also prove useful. The body, during this disease, must be kept as dry as possible, and lint applied to the parts affected; when practicable, the infant's only nourishment should be from the breast, to which it should be frequently applied, but only allowed to suck a little at a time. LOCK-JAW OF INFANTS. TRISrMUS NASCENTIUM. This serious and, under the old mode of treatment, so generally fatal disease, usually occurs in the first few days of infant life; at first the child vainly attempts to suck, and even if it succeed, the milk is returned. On examination, from stiffness of the masticator muscle, the lower jaw cannot be depressedthe jaws gradually close, the whole frame becomes rigid, and death ensues. DERANGEMENTS DURING TEETHING. 865 fever, restlessness and sleeplessness, a globule of Aconite may be dissolved in three tea-spoonfuls of water, and a tea-spoonful given every twelve hours. Rhus, one globule, may follow Aconite after an interval of twelve or twenty-four hours, when the eruption is extensive. Should the affection continue to spread, and the vesicles increase in size, notwithstanding the employment of these remedies, Sulph., one globule, may be administered, and then again Aconitum if renewed irritation succeed the exhibition of the former. Chamnomilla and Bryonia are also useful in some instances; the first-named especially when the restlessness does not yield to Aconite, and the child is fretful and much excited; the latter when it is peevish and sleepless, yet seems languid, and cannot bear to be moved. DERANGEMENTS DURING TEETHING. About the fifth or sixth month, as already stated, the teeth generally begin to protrude. 1 Under a proper system of treatment, if due attention has been paid to the rules for exercise and diet which we have already laid down, and the child is free from any constitutional infirmity, we may safely calculate upon the period of dentition being exempt from much suffering. Broths and jellies should, during the acute stages, be wholly prohibited, and if the infant take other nourishment than the breast, its food should be of the lightest and simplest description. The mother or nurse should also pay particular regard to her regimen, and avoid all substances of a stimulating and indigestible nature. Here again we may remark, that the indulgence in vinous or fermented liquors is, from their irritating properties, one of the most frequent causes of the suffering of children during this period. During dentition there is always a tendency of blood to the head, which from simple irritation may, if not quickly checked, terminate in inflammation of the brain; the best preventive against this affection is keeping the head perfectly cool. In order, as much as possible, to allay the anxiety of parents, who may be led to mistake the natural symptoms attendant upon dentition for those of disease, we shall in the 55 CONVULSIONS IN CHILDREN. 867 When in the assemblage of these symptoms, constipation takes the place of diarrhcea, we may prescribe Nux VOMICA. When strong symptoms of cerebral irritation set in, we should have instant recourse to BELLADONNA, or CUPRUIM ACETICUM: when marked cerebral sensibility declares itself, and the child almost spasmodically clenches the spoon or cup with its gums when drinking. ZINCuM is strongly recommended by Dr. Elb, of Dresden, in apparently hopeless cases, with symptoms of incipient paralysis of the brain, such as sopor, half-closed eyes, or motionless eyes with insensible pupil; loss of consciousness moaning; icy coldness of the whole body, and bluish color of the skin; pulse nearly imperceptible; respiration interrupted. Dose. Gr. ss. every two hours, until the temperature of the skin increases, and consciousness returns, upon which the intervals between the doses may be lengthened; but if some other remedy, as Belladonna for instance, should be called for by the nature of some of the remaining symptoms, it ought to be given in alternation with Zincum, until all signs of danger are removed. When the irritation seems to arise from dificulty of teething, we may administer CALCAREA, and repeat it every eight days for about a month, which will materially assist the protrusion of the teeth. Kali nitricum is a useful remedy when inflammatory symptoms set in during dentition. When obstinate constipation is present, see that article in this part of the work. (See also CONVULSIONS IN CHILDREN, where additional indications will be found for the selection of Belladonna, Chamomilla, and other remedies which are frequently required in fever and other derangements during teething.) CONVULSIONS OF YOUNG CHILDREN. (BY DR. HULL.) In no case of infantile sufferings are the maternal sympathies more agonizingly excited than by the occurrence of convulsive paroxysms. These maladies are frequently developed completely in a very rapid manner. Almost without a single instant of warning the transition from the calm repose of the unwatched cradle, to the frightful contortions of a most perilous state, makes the awful appeal to the 868 DISEASES OF INFANCY. mother, in whose bosom God has implanted the most earnest will to protect, defend, and soothe her offspring, for the immediate and most effective interpositions of art. Ignorance of the few necessary and simple rules of art for these dreadful exigencies must, independently of a fatal issue in any case, be productive of indecision and helpless dismay, or lead to the adoption of violent, inappropriate, and even destructive measures. No mother of tolerable education can willingly remain unqualified for the discharge of the preliminary medical offices which may be put into action before the physician can be summoned to the charge of her little sufferer; and, as in our mode of cure, there are certain steps which we deem more efficacious than those of the ordinary practice, and which are certainly more in accordance with our indispensable general maxims, we consider it our duty to call the attention of those females who employ homceopathic physicians to the following considerations and practical expedients: PREDISPOSITION. Early childhood is peculiarly exposed to these maladies, in consequence of anatomical and physiological peculiarities. Thus the relative volume of the brain and nerves is greater at this than at any other period of life, and especially the nerves that appertain to the most important part of the system (technically designated ganglionic). The circulation of the blood is exceedingly rapid; the pulsations of the infant approaching 120 in a minute, while those of the adult average about 75. The muscular system is delicate and acutely susceptible in consequence of the redundant vitality of the nervoas and circulatory systems. The infant system is on these accounts very highly susceptible to impressions, whether mental or physical; as is manifest in the sunshine of smiles and showers of tears-the swift-bounding leaps and almost convulsive springs that alike gladden and terrify. As long as this mobility of the infantile system endures, so long are convulsive difficulties to be apprehended, for its dependent susceptibility is only subdued in the ratio it matures as it approximates nearer and nearer to the period of puberty..Hereeditary predispositions form a second consideration of importance. Numerous generations of particular families CONVULSIONS IN CHILDREN. 869 have been observed to inherit convulsive habits in conjunction with malformations of the head, nervous irritable temperaments, and also sometimes lunacy. Dr. Eberle observes that convulsions occur most frequently among the denizens of crowded cities, especially in the luxurious and pampered classes, and proportionate infrequency among the temperate and laborious, who enjoy the free and uncontaminated air of the country. Dr. North, who has investigated the phenomena of infantile life with diligence and acuteness, has observed that the offspring of parents who marry prematurely, or at an advanced age, are more frequently subject to convulsive disease than the children of those who are united at sexual maturity, an opinion which, we think, deserves the attention of those who are hastening mere children into relations they are physically unfit to sustain. EXCITING CAUSES OF CONVULSIONS. These causes deserve a more careful attention on the mother's part than those of constitutional predisposition, which, however, should never be lost sight of. If any of these we are about to enumerate exist during childhood, appropriate measures should be speedily adopted to arrest their progress; for, if the paroxysms of convulsions are not entirely suspended by the suppression of the causes that frequently create them, they will be so far modified by anticipatory treatment as to be quite mild, and certainly exempt from all danger. Again, if the development of the paroxysms is immediately dependent upon one of these causes, the specific cause must never be forgotten in the selection of the remedies opposite to the occurrent symptoms. 1. Dentition. This is one of the most frequent causes of convulsions in children; either when the vascular system seems crowded to excess in very healthy plethoric infants, or when the teething has been protracted beyond the ordinary periods by tedious sickness or immature constitutions. 2. Repelled Eruptions. Experience has demonstrated that, in acute eruptive diseases, as scarlet fever, measles, &c., the sudden repulsion of the eruption has been frequently followed by convulsions. The sudden and quackish suppression of ulcers and chronic diseases of the skin, by external applications, has been followed by the same results. We seize the present occasion to reprobate this pernicious and 870 DISEASES OF INFANCY. unscientific practice, which every physician of any observation has known to prove hurtful and even fatal. We can recur to three marked cases we have been called to, where all the symptoms of dropsy in the head supervened upon the suppression of scald-head disease through the external application of unguents and washes-an immoral expedient adopted to satisfy the demands of parents who required an immediate extinction of the disease, because " it was unpleasant to the sight." 3. Irritating substances in the stomach and intestines. Irritating and poisonous substances, acrid and indigestible food, and the overloading and distension of the stomach, have been observed to engender convulsions. The possibility of such results from these provocatives, points emphatically to the adoption of a plain and rational diet for children, and to the avoidance of confectionery, cakes, pastry and coffee, with which their tender stomachs are too often surfeited, abused, and permanently injured. 4. Worms. Verminous irritation unquestionably produces convulsions. The existence of this cause should not be too hastily decided upon, for, with all the care taken to elaborate its symptomatic phenomena, they so closely simulate those arising from other kinds of irritation, that no strong reliance can be placed upon this discrimination, except when aided by the absolute presence of the worms in the evacuations either from the stomach or intestines. This uncertainty should serve as a salutary caution to the presuming, who are so fond of deluging infants with. pink-root and other vermifuges, thus producing or magnifying the very sufferings they aim to relieve. The maw or thread worms (ascarides vermiculares), small white worms that gather in countless numbers at the lower part of the intestinal canal; and the common round worm (ascarides lumbricoides) are the two prominent species to be sought for as exciting causes of convulsive difficulty in children. 5. Mechanical injuries. Falls and blows upon the head and other parts of the body have produced convulsions both immediately and remotely. The mechanical depression of a part of the skull-bone, or the presence of a splinter in the fleshy part of the body, have been known to excite convulsions, until the bone was elevated or the splinter removed. CONVULSIONS IN CHILDREN. 873 is to be hoped, will banish from every house the pernicious " simples," as paregoric, laudanum, cough syrups, panaceas, bilious pills, freckle and pimple lotions (many containing corrosive sublimate and arsenic), plasters, unguents, &c. MEDICINES FOR CONVULSIONS AND THEIR SYMPTOMS. In offering instruction to laymen in regard to the selection of medicine for disease, whether here or elsewhere, we feel satisfied that the intelligence of those who extend their attachment to homoeopathia to a provision of medicines, will guard them from an abuse of these means by thoughtless prescriptions or random experiments. The practice of homceopathia by laymen, in all acute or dangerous maladies, is unquestionably hazardous, as our arguments in their proper place will prove; but, in particular cases, careful practice is not only commendable bat necessary. The present disease will illustrate the propriety of this position, either when the parent has become accurately familiar with the treatment of special forms of convulsions by watchful experience-or, when a physician cannot be procured-or, when no resource is left beside, but application to allopathic physicians or measures. The selection of remedies is to be made with reference to the causes. The symptoms in italics represent the distinctive indications of their remedies in convulsive diseases. CONVULSIONS FROM )ENTITION. Belladonna. This remedy is principally indicated for plethoric and corpulent children, and those of sanguineous temperaments. Characteristics of the paroxysm: the child starts suddenly while sleeping, seemingly under the impression of a frightful dream, stares about wildly, the pupils are much enlarged, the whole body or single limbs become stiffly convulsed, the forehead and hands are dry and burning, and occasionally there follow clenching of the hands and involuntary urination. On returning consciousness, the attacks will sometimes recur from the least touch. Belladonna is applicable also when the spasms are preceded or attended by smiles or laughter. COamomilla is indicated for children of nervous sanguineous temperament, and endowed with extreme sensitiveness, and peevish, fretful irritability. Characteristic symptoms: the child is fretf ul, restless, and disposed to drowsiness while awake; the eyes become half closed, one cheek is red, the 874 DISEASES OF INFANCY. other pale; moaning for drink, consciousness ceases, twitches of the eye-lids and muscles of the face, with contortions of the eye-balls, jerks and convzlsions of the arms and legs, with clenched thumbs, while the head is constantly rolling from side to side. The Belladonna and Chamomilla harmonize in alternation. If the Belladonna is first indicated, and does not promptly suppress the convulsion, it will frequently modify the symptoms, so that the group will be successfully controlled by Chamomilla, which, if it does not, will in its turn create a susceptibility, so that the repetition of the Belladonna will remedy the predicament it primarily failed to reach. If the Chamomilla is first indicated, the converse also holds good as to its succeeding alternation with Belladonna. Ignatia. This remedy applies to the melancholic temperament-to pale and delicate infants of tame or peevish dispositions-and to hysterical alternations of vivacity and sadness in children, such as laughing and crying at the same breath. Characteristic symptoms: the child, while reposing in a moaning, light slumber, becomes suddenly and repeatedly flushed with burning heat; awakes and springs with a convulsive start, the most soothing attentions scarcely availing to quiet the excitement; a tremor seizes the entire body, attended by violent crying or agonizing shrieks, and the muscles or single limbs become convulsed. The Ignatia is further indicated when the spasmodic paroxysms occur every day at a regular hour, followed by fever and perspiration; or when they occur every other day at variable hours; or, again, when the Belladonna and Chamomilla do not appear to be efficient in teething convulsions. Cina best accords with the melancholic temperament. It is especially suitable for children who are scrofulous; have become debilitated and emaciated from continued disease; are painfully sensitive to motion and society; have hooping cough; or have had a tedious dry cough, resembling hoopingcough; or who are having their second teething; attended with picking at the nose, and griping and itching at the fundament, both prior and subsequent to the spasms; who have had previous convulsions from worms; and habitually wet their beds. Distinctive symptoms: spasms of the breast, CONVULSIONS IN CHILDREN. 875 then of the limbs, and finally paleness and rigid stifness of the entire body. Arsenic has been used with great benefit in the spasms of dentition. As illustrative of its indications, we refer to a case in the Archives successfully treated by the prior administration of Stramoniuzm, the intermediate use of Arsenic, and concluded by Belladonna. Collateral indications: the child is irritable and restless; cries for some particular thing, which, when offered, it rejects; has an insatiable thirst; frequently throws off the little it will scarcely eat; has a diarrhoea, often of undigested food; constantly points with a painful expression of countenance to the lower part of the abdomen; tosses about at night, and obtains short restless sleep towards morning only. Paroxysms: they recur frequently; the child cries as if from a perverse temper; stretches its feet out, and hands convulsively backward (opisthotonos); then throws its hands about, and rolls over with violent shrieks; alternates his position, convulsively bending forward (emprosthotonos), with clenched fingers and extended thumbs. All efforts to allay the spasmodic excitation by soothing expressions irritate instead of allaying, so that the child attempts to strike and bite those around him. Stannum. This remedy has been advised when spasms occur upon the appearance of each tooth, every paroxysm increasing progressively in violence. Characteristics: burning heat of the skin, with violent bounding pulse; spasmodic twitches of the muscles of the face, eyes, and neck; and fmecal and urinary evacuations in the midst of the spasms. 2. REPELLED ERUPTIONS. Belladonna is a specific remedy in convulsions derived from suppressed Scarlet Fever; also in alternation with Opium and Stramonium. Its symptoms are detailed above. Bryonia relieves spasms dependent upon suppressed MAeasles. Bryonia is also indicated for the results of some forms of chronic eruptions. Characteristic symptoms: the child is seized with great lassitude and debility; there is a great tremor of the entire body; the face becomes very pale; the limbs flaccid, tzoitchings of the muscles and of single limbs; and, finally, convulsions. Occasionally the convulsions are preceded by deep and violent coughing, and oppressed respiration, especially if owing to suppressed measles. 876 DISEASES OF INFANCY. Stramonium is sometimes applicable to spasms arising either from acute or chronic eruptions suppressed. Symptoms: sudden flushes of heat, thirst, vomiting, and watery diarrboea; general tremor; foaming at the mouth; the eyes fixed, and the pupils d lated; the respiration labored and groaning; and rigid stiffness of the body. A premonition, characteristic of this remedy, is occasionally witnessed--an extreme aversion or dread of water, similar to that of hydrophobic sufferers. Tartar emetic has been a successful remedy in our hands in the treatment of spasms arising from repelled eruptions of the head, when the symptoms closely resembled those of dropsy in the head. Sulphur, however, is to be esteemed one of our prominent agents when the spasms are directly attributable to repelled chronic eruptions. If the symptoms indicate any one of the previously named remedies, let it be administered at once; but if an immediate impression is not obtained, apply the Sulphur speedily, and continue the alternation until successful. After the paroxysm is past, the Sulphur and other appropriate eruptive remedies should not be spared until such a possible cause of peril to children has been effectually eradicated. 3. IRRITATION OF THE STOMACH, &c. Neux vomica is a remedy quite apposite to the infantile age, and also to lively, sanguineous and nervous temperaments. It is also peculiarly adapted to all spasmodic difficulties dependent upon derangements of the digestive system, as acid eructations, colics, constipation, &c. Symptoms: cough, with expectoration of slime, and difficult hurried respiration; gripings and distension of the abdomen; constipation; violent spasms, attended by shrieks; bending the body backward, especially the head; fixed eyes, and trembling of the limbs. The paroxysms are constantly repeated, with much thirst and excessive perspiration during the intervals. Pulsatilla is suited to dull, phlegmatic, or to mild, merry temperaments, and to female infants. It answers for such spasms as are directly traceable to an overloaded stomach. It also relieves the subjects of its peculiar temperament when the nux would be otherwise indicated. It acts efficiently in alternation with nux when the temperament is questionable. CONVULSIONS IN CHILDREN. S 7 Cofea. This remedy will relieve spasms that arise from the immoderate use of laudanum, paregoric, &c., given habitually to quiet the restlessness and cries of infants. If it is not prompt in its action, follow its administration by Spirits of Camphor, every five or ten minutes. If the spasms become frequent, consult the indications of Mercury, NVux v., and Belladonna. Ignatia, the symptoms of which have been already recorded, will be found to correct spasms that have sprung from the domestic use of " Chamomile tea." Ipecacuanha applies to convulsions preceded and attended by pale, bloated face; frightful distortions of the muscles of the face and twitchings of the extremities; aversion to everything but water: oppression of the chest, nausea, vomitings, and diarrhea. 4. WorMs. Hydrargyrum. This mineral forms an admirable agent in the cure of verminous spasms. It is prominently indicated when the attacks are developed about evening, and the skin is disposed to perspiration. Paroxysm: the child is taken with painful eructations; water drools or is ejected from the mouth; a watery diarrhcea sometimes succeeds; the limbs are thrown about and become convulsed; stupefaction follows, attended by fever and moist skin. Previous to, during and after the fit, the abdomen is distended and hard. After the paroxysm the child will frequently lie for a long time apparently exhausted and dying. Cina is also applicable to convulsions from worms, which correspond with the symptoms of this remedy, detailed under Dentition. It also succeeds when the Hydrargyrum fails to effect its group, or materially aids in alternation with this latter remedy, or with Hyoscyamus. Hyoscyamus. The distinctive indications of this medicine point to spasms that occur periodically and immediately after meals. Paroxysm: the child sickens after eating, and sometimes vomits, with evident suffering in the pit of the stomach; or, else, suddenly shrieks and becomes insensible; the limbs or entire body are moved convulsively, and especially the muscles of the face; the face is somewhat pale and bluish, or turgid and fiery-eyed; the eyes are exceedingly protruded and distorted; grinding of the teeth and foaming at the mouth follow; while the respiration is sonorous and oppressed. 878 DISEASES OF INFANCY. cicuta is pre-eminently serviceable, while during the undoubted existence of worms, the child is first taken with violent abdominal gripings and colic, which persist until they are merged in convulsions. Tremor of the limbs, jerks like electric shocks, and finally insensibility, constitute the paroxysm. 5. MECHANIcAL INJuRnIs. Arnica is the specific for convulsions derived from contusions, &c., when the presence of foreign bodies, or the derangements of the bones, are not the causes, in which predicaments surgical aid must mainly avail. But after appropriate surgical assistance, this remedy can be depended upon for efficient impressions of a favorable character. 6. FRIGHT. 0piumn is antidotal to the effects of this cause. Paroxysm: the child is taken with a general tremor; throws his arms and legs about; a melancholy expression of countenance is supplied by one of stupidity, during which he cries, seemingly unconscious; finally becomes senseless; the body swells, and the frecal and urinal evacuations are quite suppressed. Ignatia avails according to its indications. Stramonium is useful when the child becomes suddenly convulsed and senseless from fright. Secale answers when the Stramonium fails, and also in alternation with it. 7. UNKNOwN CAUSES. All the preceding remedies may be administered when the causes are not discoverable, provided their symptoms coincide accurately with the convulsive phenomena. Aurum has been used by Ran in convulsions attended with alternations of laughter and weeping. Aconite. Dr. Hartmann values this medicine in spasmodic affections attended with high fever. Other remedies, as Cocculus, Cuprum, Cicuta, &c., have been recommended by some physicians, in consequence of their utility in convulsive difficulties of adults; but, as the testimony is not explicit, and as children are amply provided for by the medicines already enumerated, we do not deem it necessary to enlarge on their effects at the present time. WATER IN THE HEAD. 879 WATER IN THE HEAD. DROPSY OF THE BRAIN. DROPSY OF THE HEAD. Hydrocepialus membranarum et ventriculorum. General pathognomonic signs: headache, particularly frontal, nausea, vomiting, dilatation of the pupils, stupor, abnormal slowness of pulse, and convulsions. This fatal and frequent disease is liable to be excited by a variety of causes, and is particularly prone to take place in scrofulous children, who are born with unusually large heads, and in whom the fontanels remain long unclosed. The symptoms of acute hydrocephalus are sometimes so mild and insidious, that parents are thrown off their guard, and attribute the apparently slight indisposition of the little patient to some comparatively trivial circumstance; such as teething, or gastric derangement. In other instances, the symptoms are much more striking, and in many respects strongly resemble those described under INFLAMMATION OF THE BRAIN. In general, the skin is hot; pulse rather quick, chiefly at night -but often very variable. The child becomes peevish whenever it is raised from the horizontal position; at other times it is affected with fits of screaming; grinding of the teeth; redness of the face and eyes; peculiar expression of countenance; strabismus; convulsions and stupor. Dropsy of the brain is liable to be confounded with other diseases, as invermination, inflammation and ulceration of the mucous membrane of the small intestines (ileum particularly), coma from exhaustion, occurring after protracted debilitating diseases, &c. The history of the case, together with a close scrutiny of the whole of the symptoms, will rarely fail in establishing the diagnosis. THERAPEUTICS. The most appropriate remedies are: Aconite, Belladonna, Bryonia, Helleborus, iMercurius, and Sulphur, or Sulphuris tinctura. The indications for the first two have already been given under INFLAMMATION OF THE BRAIN, Part I. BRYONIA may be administered after Aconite, or Belladonna, if necessary, or may be given at the commencement, when there are heat in the head, with dark redness of the face, and great thirst; eyes convulsed, or at one time closed, and at another time wide open or fixed; delirium; sudden starts, with cries, or constant inclination to sleep; continual move INFANTILE REMITTENT FEVER. 883 tenderness of the abdomen; obstinate constipation; sometimes diarrhoea, or frequent desire to go to stool with but little effect; motions discolored, fetid, frequently mixed with mucus, and occasionally with blood. The hands and feet are often cold, while the rest of the body is parched; the head hot and heavy, or attended with other symptoms resembling hydrocephalus, such as coma, &c. The tongue, at first moist, loaded, and occasionally very red along the margins, often becomes dry over a triangular spot at the point. When the febrile exacerbation takes place at night, it is accompanied by violence and jactitation; when during the day there is, on the other hand, drowsiness and stupor. An annoying cough with bronchitic indications, succeeded by wheezing and expectoration, sometimes appears. Although, as is characteristic of remittent fever, the febrile symptoms never entirely subside, still the patient will frequently appear to be steadily recovering for a time, and the unwary or inexperienced may consequently be led to pronounce an unduly favorable prognosis, which will too often be contradicted by the occurrence of a relapse, followed perhaps again by another encouraging but deceptive remission, and so on, unless the progress of the disease be checked, until either the mesenteric glands become affected, or dropsical effusion into the cavity of the abdomen, or unequivocal signs of cephalic disease supervene, or the little sufferer is so emaciated and reduced by protracted disease, that the vital powers give way, and he sinks exhausted. THERAPEUTICS. In mild attacks occurring in tolerably healthy children, the disease is generally readily subdued in a few days, by means of one or more of the following remedies: 1pecac., Puls., China, Nux v., Acon., Bella., lferc., Bry., Lach., Cham., and Sulph., combined with light farinaceous diet. Solid food must be strictly prohibited, even though the appetite should be good, which it occasionally is, and even ravenous at times. With regard to the indications for the remedies quoted, IPECACUANHA may be given, if, as is commonly the case, the attack has been excited by overfeeding, or by indigestible food, and particularly when the patient has contracted a habit of bolting the food without having previously masticated it properly, and the symptoms encountered are as follows: General dry heat, or harsh and parched skin, especially INFANTILE REMITTENT FEVER. 885 remain: loaded tongue, nausea or vomiting, with continued tenderness of the abdomen; thirst, sometimes with aversion to drinks when offered; no motions, or diarrhoea with excessive tenesmus. If, on the other hand, the head continue hot and heavy, the pulse quick, the tongue foul, and other symptoms of gastric derangement are prominent, together with a tumid and painful state of the abdomen, constipation, excessive restlessness, and quick, laborious respiration, particularly at night, with drowsiness during the day, BrTONIA is to be preferred. LACHESIS may follow Bella. or Mere., when the signs of intestinal irritation or inflammation continue with but little abatement. Or it may precede these remedies, when the tenderness and distension are more marked at one particular spot (the most trivial pressure there being intolerable,) than over the entire abdomen; and when the fever is highest at night. SULPHUR may be given with advantage to complete the cure in many cases, after the previous employment of any of the foregoing medicines. It is, however, when the attack is characterised by the following features, that this remedy is more directly called for: feverish heat, especially towards evening, but also in the morning, or during the day; flushes, alternately with paleness of the face; dryness of the skin; hurried and laborious breathing; palpitation of the heart; nocturnal perspiration; languor and great weakness, particularly in the inferior extremities; tense, tumid and painful abdomen; dry, hard, or loose and slimy motions. These, then, are the most generally useful remedies in cases of the above description, and will materially tend to facilitate recovery, and prevent the disease from assuming an obstinate character. When, however, the malady occurs in children of relaxed and feeble habits, or of a decided strumous diathesis, it becomes, especially if neglected, and not checked at the commencement of its course, a most intractable and frequently fatal disease, from the proneness which it then has to become complicated, and terminate in one or other of the serious forms alluded to in the diagnosis. The remedies from which the most benefit is to be anticipated under such unfavorable circumstances are, in addition to those previously mentioned, Silicea, Sul2ph., Cale., Bary. c., Ars., Coco., Cina, Sabadqila, &c. 886 DISEASES OF INFANCY. SILICEA. When there is great emaciation, languor and debility, paleness of the face, want of appetite, or craving for dainties; shortness of breath on movement; feverish heat in the morning or towards evening. This remedy is also a most important one when the patient is afflicted with worms, and when the disease is in a great measure attributable to invermination. Cina and Sabadilla may likewise be found useful along with Silicea in the latter instance. (See INVERMINATION.) The indications for Sulphur have already been given. CALOAREA. Great debility, with flabbiness of the muscles, dryness of the skin, and excessive emaciation; frequent flushes, or general heat, followed by shivering towards evening; exhaustion, or dejection after speaking; impaired, fastidious appetite, with weak and slow digestion, or, on the contrary, extreme voracity; perspiration towards morning, hard, tense, and tumid abdomen. (Barita c. is sometimes useful after Calcarea.) ARSENICUM. Extreme prostration of strength and emaciation, with desire to remain constantly in the recumbent posture; dry, burning heat of the skin, with great thirst, but desire to drink little at a time, or merely to moisten the lips, which are frequently parched; impaired appetite, and sometimes excessive irritability of the stomach, so that very little food can be retained; hard and tense abdomen; restless, unrefreshing sleep, and frequent starts, or subsultus tendinum; fretful and capricious disposition. COCCULus. Great weakness, with excessive fatigue, depression, and tremor after the slightest exertion; heavy expressionless eyes; flushes of heat in the face; nausea or aversion to food, distension of the abdomen, constipation; oppressed respiration; perspiration on attempting any trivial exertion; lowness of spirits; mildness of temper. BELLADONNA, -LacheiS, or Baryta c., will be required when the head becomes much affected. Belladonna, especially when there are heat, heaviness, flushing and delirium; or deep and protracted sleep, with subsultus tendinum, coldness of the hands, pale cold face, small quick pulse, hot, tumid, and tense abdomen. LACHESIS. Either before or after Belladonna, when we encounter deep, prolonged sleep; grinding of the teeth; or ATROPHIA. 887 somnolency alternately with sleeplessness; tremulous, intermittent, or scarcely perceptible pulse. BARYTA. Lethargy, jactitation, or agitation, moaning and muttering, feeble and accelerated pulse. (SEE HYDROCEPHALUS.) Other remedies, such as Antimonium, Acid. phosphoricum, Phosphorus, Hepar s., Kali, Acidum nitr., Lycopodium, Rhus, &c., may be required according as the symptoms happen to vary: we have merely given some of the medicines which have been found of valuable service, when the indications of the disease have corresponded with those above given. It may be added, that when the skin is hot and parched, the sleeplessness and restlessness are often temporarily removed by sponging the body with tepid water; this expedient is, however, only to be had recourse to when the remedies fail to afford this relief, and that in a more permanent degree. (See also ATROPHY.) ATROPHY. ATROPHIA. The medicines from which the most appreciable benefit has hitherto been obtained in this serious malady are: Sulph., followed by calcarea; also Ars., Bar. c., Bell., China, Nzux vom., Phosph., and Rhus. SULPHUR in almost all cases at the commencement of the treatment; craving appetite; enlargement of the inguinal or axillary glands; slimy diarrhoea, or obstinate constipation; pale complexion, sunken eyes, &c. CALCAREA. Great emaciation, with craving appetite; enlargement and induration of the mesenteric glands; great weakness, clayey evacuation, a dry and flabby skin; too great a susceptibility of the nervous system.* ARSENIOUM. Dryness of skin, which resembles parchment; hollow eyes; desire to drink often, but little at a time; excessive agitation and tossing, especially at night; short * Calc. c., 3-4, gtt. j, once or twice a day for the space of six or eight weeks, is (together with embrocations of oil (?) and, perhaps, also single intermediate doses of Sulphur) one of the most efficacious remedies in Tabes mesent. infant.; and, in general, a much superior remedy to Iod., Cicuta, Baryta, &c. In most instances the abdomen becomes smaller, the stools more regular, in from eight to fourteen days after its employment. Furuncles and a sort of miliary eruption then frequently break out.-Hygea. 888 DISEASES OF INFANCY. sleep interrupted by jerks; fieces of greenish or brownish color, with evacuations of ingesta; extreme prostration. BARYTA. Enlargement of the glands of the nape of the neck; continual desire to sleep; great indolence, and aversion to exertion and amusement. BELLADONNA. Capriciousness and obstinacy; nocturnal cough, with rattling of mucus; enlargement of the glands of the neck; unquiet sleep; precocity of intellect, blue eyes and fair hair. CHINA. Excessive emaciation; voraciousness; diarrhoea at night, with frequent white motions or evacuations of ingesta; frequent perspirations, especially at night; unrefreshing sleep. CINA. Vermiculous symptoms; wetting the bed. (See WonMs.) Rnus. Slimy or sanguineous diarrhoea; debility; voracity. In children past the age of infancy, great attention should be paid to diet; pure air and exercise are also of great importance. VACCINATION. This is an operation purely homceopathic, and one which, from its efficacy in the prevention of a disease exhibiting analogous symptoms, has been frequently quoted by our Great Founder and his disciples, as one of the best illustrations of the immutable law of SIMILIA SIMILIBUS CURANTUR. Vaccination, when the child is strong and healthy, may be safely performed during the fourth or fifth month; but when the small-pox is rife as an epidemic, we may have recourse to this prophylax with infants of a still more tender age. If, however, we are allowed a choice of time, summer is the best period for performing the operation, as then the infant, after having taken the infection, incurs least risk of catching cold. It is of the utmost importance to obtain the lymph from a perfectly pure source, as experience has too truly proved that other diseases have, from a neglect of this precaution, been frequently transmitted to healthy children. For this reason, a child that has suffered from eruptions of the skin, affections of the glands, or soreness of the eyes, or one born of scrofulous parents, is an unfit subject for taking the vaccine matter from, although at the time apparently in health. INTRODUCTION. A FEW general remarks, in addition to the particulars contained in the following work, may be of service to the young practitioner. Few, if any, diseases require a more careful study, in order to treat each individual case successfully, than Intermittent Fever. There are so many elements in the different stages of the paroxysm, and in the apyrexia, that each case constitutes a considerable study of itself. The symptoms \ hich are generally to be considered of most importance, are, perhaps, those which occur during the paroxysm; and of these the character of the chills, heat and thirst, claim precedence; then the sweat and other concomitant symptoms, and those of the apyrexia. But in cases in which the apyrexial period is marked by coated tongue, bilious symptoms, loss of appetite, and general feeling of illness, the symptoms of the apyrexia are more important than those of the paroxysm, and the remedy should be chosen chiefly in reference to these. No disease is perhaps more efficient in arousing latent psora in the system than Intermittent Fever; and where well-selected remedies fail to effect a cure, it may be attributed to this cause, and the appropriate anti-psories administered. In cases where the disease has been prolonged by the injudicious use of the Peruvian Bark, Quinine in any of its mixtures, as Cholagogue, &c., reference should be had to this fact in the choice of a remedy. The most prominent among these remedies will be Arn., Ars., Bell., Calc., Eupat., Ferrum, Ipec., Lach., Staph., Sulph., Verat. Some high authorities recommend commencing the treatment of many cases of the Intermittents with a few doses of Ipec., to be followed by Nux or other appropriate remedies. This practice is quite prevalent in the West. Not a few experienced practitioners commence the treatment of almost every case with Ipec., and assert, that in a great proportion of cases no other remedy is found necessary. I believe nearly all agree that it puts the system in a better condition for the action of other remedies. When should the remedies be given. Hartmann says, immediately after the paroxysm, and repeated before its next invasion. Others repeat every three, four, or six hours during the whole apyrexia, and others still continue them, without interruption, during the paroxysm also. My own more general practice, when giving such articles as Ars., Chin., &c., has been to give them every three to six hours, according to the length of the apyrexia, and only during the apyrexia, giving a dose of Aeon. at or before the commencement of the paroxysms. On the,other hand, when I have been giving Bry., Bell., Lach., Nux, Puls., HOM.EOPATHIC TREATMENT OF INTERMITTENT FEVERS.* CHAPTER I.-CHARACTER OF THE THREE STAGES OF THE PAROXYSM. General chilliness. Alum. anac. ant-tart. aranea, amrn. ars. bell. bry. calc. caps. canth. carbo, caust. china, chin-sulph. cina, cinch-sul. cimex, coc. cof. cycl. daph. digit. dros. eupat. graph, hell. hep. hyos. ig. ipec. kal. lauroc. lob. led. lyce. mag-sulph. men. mere. am-mur. nat-m. nit-ac. nux-v. op. petr. phos. phos-ac. plumb. pod. puls. ran. rat. hus-rad. rhus-tox. sabad. samb. sep.sil. spig. spong. stan. staph. strain. sulph. tarax. thuja, valer. verat. General chilliness, with partial heat. Aeon. anac. bell. cal. cham. chin. cina, digit. fer. hell, ig. kali, lach. lye. petr. ran. rhus-tox. rhusrad. thuja. External chilliness. Ars. bell. calc. china, chin. sul. ig. nux-v. rhus-tox. Internal chilliness. Ars. calc. caust. china, chin-sul. daph. eupat. hell. ig. ipec. kali, lach. lye. mere. phos. plumb. sil. thuja. Partial chilliness. Bry. caps. caust. chin, graph. hell. hep. ig. rhusrad. rhus-tox. sabina, samb. spig. spong. thuja. General heat. Aeon. anac. ant-tart. arn. ars. bell. bry. cale. caps. carbo-v. caust. chamn. china, chin-sul. cimex, cina, cinch-sul. cof. con. cycl. crot. digit. dros. eupat. grap. hell. hep. hyos. ig. ipec. kali, led. lobel. lye. meny. mere. natr-m. nitr-ac. nux-v. op. petr. phos. phos-ac. plumb. pod. puls. rhus-tox. rhus-rad. sabad. sabin. samb. sil. spig. spong. stan. staph. stram. sulph. valer. verat. - with partial chills. Bry. chin. ig. petr. rhus-rad. samb. spong. thuja. General heat, with partial sweat. Alum, ant-tart. chin. cimex, eup. puls. sep. External heat. Anacard. ars. con. eupat. ig. mere. phos. plumb. rhustox. sil. thuja. Internal heat. Acon. anac. ars. calc. carbo-v. con, hell. kali, nux-v. phos. phos-ac. puls. sab. stan. sulph. verat. Partial heat. Aeon. anac. bell. bry. calc. cham. chin. cycl. digit. dros. fer. graph. hell. ig. ip. kali, lyc. men. nit-ac. petr. phos-ac. ran. rhustox. sep. sil. spig. stram. sulph. thuja. cGeneral sweat. Anac. ars. bell. bry. caps. carbo-v. caust. cham. china. chin-sul. cimex, cina, cof. con. dig. dros. fer. graph. elat. hell. hep. hyos. ig. ip. kali, ledum, lobel. lyc. mere. natr-m. nit-ac. nux-v. op. phos. plumb. pod. puls. rat. rhus-tox. sabad. sabin. samb. sep. sil. spong. strain. stan. staph. sulph. thuja, verat. General sweat with partial chills. Petrol. Partial sweat. Bry. caps. caust. chin. cimex, graph. hell. hep. ig. ip. rhus-tox. sabin. samb. spig. spong. thuja. * NOTE.-The abbreviated names of the remedies used in this article, will be found in full, on pages 910 to 928, the abbreviations being placed at the top. 896 INTERMITTENT FEVERS. Appearance of new symptoms. Ars. Aversion to every kind of food. Ars. kali. Bilious ailments. Ant-c. cham. nux-v. puls. Bitterness of the mouth. Alum. aran. ant-c. ars. phos. sep. Bleeding of gums. Carb-v. natr-m. nit-ac. phos. phos-ac. staph. sulphur. Bloatedness round the eyes. Ferrum. Cerebral symptoms. Bell. crot. lach. op. pod. stram. Coated tongue. Ant-c. aran. nux-v. phos. Colic. Ars. calc. china, cinch-sul. fer. phos. rhus-rad. rhus-tox. sepia, sulphur. Congestion of the head. Ars. cinch-sul. fer. phos. sep. sulph. Constipation. Bell. cimex, cinch-sulph. coc. lyc. nux-v. staph. verat. Cough. Ars. calc. china, ip. kali, phos. sulph. -- dry. Bry. lob. - nightly. Hyoscyamus. Delirium. Nux-vomica. Diarrhoea. Ars. chin-sul. con. phos. rhus-tox. sulph. Distension of the veins. China, cinch-sul. fer. - of the abdomen. Ferrum. Dulness of mind. Ipecac. Eructations. Alum. ant-c. carb-v. cinch-sul. nux-v. Eruption on the lips. Ars. natr-m. nux-v. Fainting from motion. Eupat. Flushed face. Eupat. Gastric symptoms. Ant-c. aran. cham. cinch-sul. ip. nux-v. puls. sabad. Headache. Ars. bry. calc. china, daph. elat. graph. ip. kali, lach. lyc. natr-m. nux-v. phos. sep. spig. Hooping cough. Kali. Inability to recollect. Ars. natr-m. phos-ac. sep. Languor. Cinch-sul. Lassitude of the legs. Ars. china. Loathing of food. Ant-c. kali. Nausea. Ant-c. ars. ip. lyc. phos. Nervous irritability. Belladonna. Nettle-rash. Rhus-tox. Oppression of the chest. Ip. lob. Obtusion of the head. Kali, phos. sep. valer. Pain in the face. Spigelia. - liver China. - left hypochondrium. Cinch-sulphur. - joints. Ars. calc-c. carbo-v. china, lye. phos. pod. sep. sulphur. - back. Ars. calc-c. caust. crotal. eupat. lach. lyc. natr-m. rhus-rad. - stomach. Ars. cinch-sul. eupat. lye. nux-v. sepia, sil. sulphur. Pains intolerable. Ars. cham. coffea. 898 INTERMITTENT FEVERS. Drinking, much. Arn. fer-acet. gummi-gut. Delirium. Sulph. Desponding. Chin-sul. Eructations. Alum. gummi-gut. ran. Feet, deadness of. Cimex. Hands, deadness of Cimex. sep. - clenched. Cimex. Headache. Acon. ars. bry. caps. chin-sul. cina, daphne, dros. elat. eupat. fer-acet. natr-m. rhus-rad. sep. tarax. Heat of the cheeks. Calc. cham. - forehead. Acon. calc. - face. Acon. anac. bell. calc. cham. china, digit. fer. lach. lye. ran. rhus-tox. - ears. Acon. ran. - external. Rat. Hoarseness. Hep. Inability to recollect. Ars. caps. strain. Intolerance of noise. Caps. Loathing of food and drink. Bry. kali. Lassitude. Ars. calc-c. carb-v. caust. dros. Lips, blue. Chin-sul. Limbs, painful weariness of. Eupat. rlius-tox. Nausea. Ars. bry. cina, con. eupat. ig. kali, lye. rhus-rad. sang. sep. verat. Nausea from motion. Eupat. Nails, blue. Chin-sul. coc. dros. natr-m. nux-v. Obtusion of the head. Calc. kali. Oppression of the chest. Ars. bry. cimex, daph. ip. lach. puls. Pain in the limbs. Ars. caps. cimex, eupat. nux-v. rhus-rad. rhus-tox. sepia, sulphur. - - rending. Bry. caps. lach. lye. phos. rhus-tox. sab. - pit of the stomach. Ars. eupat. - hip. Rhus-toxicodendron. - bones. Ars. eupat. natr-m. rhus-rad. - small of the back. Ars. calc. caps. elat. eupat. nux-v. - liver. China, nux-v. verat. - abdomen. Ars. calc. china. ig. nitr-ac. phos. sep. - ears. Graph. - left side. Elat. Pain in both hypochondria. Pod. - in the stomach. Eupat. lye. sil. sulph. - in the ribs. Sabad. - in general. Arsenicum. - in the calves. Eupat. rhus-tox. - in the back. Ars. calc. caps. caust. eupat. hyos. ig. natr-m. puls. veratr. - under the shoulder-blade. Elat. Paleness of the face. China. Pressure in the forehead. Fer-acet. 900 INTERMITTENT FEVERS. Deliria. Ars. carb-v. cina, crotal. ig. lach. meny. nitr-ac. pod. sabad. veratrum. Diarrhcwa. Con. pulsatilla. Distension of the abdomen. Cinch-sul. Drinks little, but thirsty. Arnica. Dryness of lips. Rhus-tox. Dullness of mind. Natr-m. Ears, humming in. Nux-vomica. Emission of flatulence. Cinch-sul. Eructations. Cinch-sul. Eyes, weak. Natr-m. sepia. Fingers, deadness of. Thuja. - coldness of. Thuja. Face, paleness of. Ars. cina, lyc. rhus-tox. sep. - redness of. Alum. carbo-v. china, chin-sul. coff. con. crotal. cycl. eupat. fer. ig. lach. lyc. nux-v. sep. spig. stramn. sulph. verat. - swelling of. Ars. crotal. lach. Faintishness. Anac. bell. calc. minere. natr-m. nux-v. phos. Faintness from motion. Eupat. Headache. Ant-t. ars. calc. caps. carb-v. cina, crotalus, dros. elat. graph. ig. kali, lach, meny. natr-m. nux-v. puls. sabad. sep. sil. - throbbing. Eupat. Heaviness of the limbs. Calcarea. Hunger, ravenous. Cina, phos. Inability to recollect. Ars. natr-m. phos-ac. pod. sep. Loquacity. Pod. Mlouth, dryness of. Nit-ac. nux-v. phos. phos-ac. sep. sulph. Nausea. Ars. carb-v. ip. nit-ac. nux-v. phos. sep. Obscuration of light. Natr-m. Obtusion of the head. Ars. cham. phos. sep. valer. Oppression of the chest. Acon. ars. carb-v. cimex, cinch-sub crotal. ip. kali. Pain in the legs. Carb-v. Pain in the limbs. Ars. calc. caps. carbo-v. crotal. elat. nux-v. puls. sep. sulph. - throat. phos. phos-ac. sep. - chest. Ars. caps. carb-v. ip. kali, nux-v. - bones. Ig. natr-mn. pulsk - liver. Arsenicum. - abdomen. Ars. caps. carb-v. cina, elat. - stomach. Carb-v. cina, cinch-sul. eupat. - back. Caps. crotal. ig. natr-m. - region of the thoracic dorsal vertebrce when pressed upon. Cinch-sul. Pain, shooting to the extremities of the fingers and toes, and shooting back into the body. Elat. Pains, labor-like. Pulsatilla. Painfulness of the body. Puls. stram. DURING THE APYREXIA.9 905 Mrouth, bad smell froln. Arn. chain. crot. mer. nux-v. petr. pod. rhusi'ad. sep. suiph. Nauseca. Ars. crot. hep. hyos. graph. ip. nux-v. rhus-tox. sabaci. sil. Oppression qf the chest. Ais. caps. carL-v. ccc. crot. ig. lob. natr-rn. plumb. sabad. samb. spig. stan. stram. supiph. verat. Orgasmn of the blood. Aeon. lyc. petr. puls. sep. sil. Pain in the chest. Bry. ci-ot. puls, ran. rhus-tox. sabad. spig. stan. joints. Ain. ars. bry. caust. chai. china, coc. eupat. ig. ip. phos-ac. plumb. puls. i-bus-i-ad. rhus-tox. sabin. suiph. - pit of the stonzach. Bell. bry. caic. chine, crot. lye. mere. natr-m. nux-v. phos. puls. sabad. sep. sil. spig. stan. verat. hip. Ars. bell. chain. mere. nux-v. puls. rhus-tox. liver. Bell. bry. chai. chin-sul. lye. mere. nux-v. puls. abdomen. Ant-tart. chin-sul. elat. led. plumb. ran. sulph. kidneys. Bell. china, hep. lye. staph. back. Am. ars. eale. caps. chain. cina, erot. ig. nit-ae. nuxv. petr. rhus-rad. samb. sep. sil. spig. strai. thuja, verat. - rheumatic. Aeon. ant-t. arn. bell. bry. carb-v. caust. chain. nux-v. pills. rhus-rad. rhus-tox. thuja, valer, verat. labor-like. Bell. op. puls. in the stomach. Aeon. amD. ais. cale. caust. eec. con. ciot. fer. ig. lye. natr-m. nux-v. puls. sabad. sep. sil. stan. Palpitation of the heart. Aeon. ig. mere. natr-m. pod. sep. spig. sulph. verat. Ptyalism. Chai. digit. dros. gummi-g. hyos. led. lob. mere. nit-ac. pod. rhus-rad. rhus-tox. spig. verat. Redness of the cheeks. Caps. chain. china. Repugnance to beer. Alum. bell. chain. china, nux-v. puls. bread. Bell. ehin-sul. con. cycl. ig. k.ali, lye. natr-m. nux-v. nit-ac. puls. rhus-tox. cofee. Bell. carb-v. chain. china, coff. coc. hyos. ig. lach. mor-c. natr-m. nux-v. rhus-tox. sabad. samb. spig. stram. fat food. CarL-v. hell. hep. natr-m. petr. sulph. - meat. Alum. urn. ars. bell. cale. carb-v. chain. daph.. fer. graph. hell. ig. lye. mere. nit-ac. op. petr. puls. rhus-tox. sabad. sep. sil. sulph, milk. Am. bell. cale. cina, ig. nux-v. pils. se>., sil, stan. sulph. sour. Bell. ig. phos-ac. sourcrout. Helleborus. sweet. Amn. ars. caust. graph. ig. mere. nit-ac. verat. tobacco. Alum. arn. bell. cale. china, coc. daph. ig. lach. led. lye. riatr-m. nux-v. phos. puls. rhus-tox., sep. spig. stann. - warm food. Anac. ant-t. ars. bell. cale. chain. china,, coc. coff. cycl. fer. graph. hell. ig. lye. mere. nux-v, petr. puls. sabad. sil. sulph. verat. wo ter and watery drinks. Rhus-rad. 58 906 INTERMITTENT FEVERS. Senses, weakness of. Anac. caps. cham. crot. eye. hell. plumb. puls. sil. - excessive irritability of. Acon. bell. cham. china, coff. ig. merc. nux-v. puls. valer. Sight, vanishing of. Crot. Sleepiness. Aeon. arn. bell. bry. calc. carb-v. cimex, hyos. mere. op. sabad. spig. stan. striam. sulph. valer. Sleeplessness. Ars. bell. bry. carb v. china, chin-sul. cina, coff. byes. ip. led. merec. natr-m. nit-ac. op. puls. ran. rhus-tox. sil. spig. Smell, sensitiveness of. Aeon. bell. dros. nux-v. - loss of. Anac. ant-t. cycl. daph. byos. nux-v. op. puls. sep. sil. Skin, distension of. Ars. bell. bry. china, con. digit. fer. hell. hyos. Op. plumb. puls. rhus-tox. samb. sep. - desquamation of Acon. daph. digit. hell. mere. phos-ac. rhus-tox. sabad. sulph. verat. Somnolence. Ant-t. bell. cham. cimex, coc. con. hyos. op. puls. rhus-tox. Sopor. Cham. op. puls. verat. Spasms, in the stomach. Ars. bell. bry. calc. carb-v. cham. coc. fer. ig. natr-m. nux-v. puls. sil. stan. sulph. valer. - uterine. Bry. coc. con. ig. Swelling of the head. Crot. - cheeks. Cham. crot. rhus-tox. - pit of the stomach. Bry. carb-v. chain. coff. hell, lyc. nux-v. op. puls. sabad. - spleen. Caps. chin-sul. ig. nit-ac. nux-v. sulph. - tongue. Ars. bell. china, crot mere. nit-ac. Taste, bitter. Ars. bry. calc. carb-v. cham. chin-sul. cinch-sul. elat. fer. lob. lye. merc. natr-m. nit-ac. petr. phos-ac. puls. rhus-rad. sabin. sulph. - of food. Ars. bry. china, chin-sul. fer-acet. ip. phos-ac. Taste, flat. Bry. chin-sul. eupat. cycl. nux-v. - lost. Eupat. fer-acet. lauroc. lob. lye. puls. sil. - metallic. Cimex, coc. merec. nux-v. rhus-rad. rhus-tox. - nauseating. Ip. kali. - putrid. Bell. fer-acet. mere. nux-v. puis. - saltish. Ars. carb-v. china, merc. nux-v. - sour. Ais. calc. -coc. graph. kali, ig. lye. mere. natr-m. nux-v. nit-ac. petr. phos. phos-ac. puls. sep. sil. stan. sulph. - sweetish. Alum. bry. fer. ip. mere. puls. rhus-tox. sabad. spong. sulph. thuja. - for Acids. Ant-t. arn. ars. bry. con. hep. ig. kali, pod. puls. sabin. sulph. S - beer. Aeon. caust. china, coc. mere. nux-v. op. petr. phos-ac. puls. sabad. spig. sulph. - bitter things. Digit. natr-m. brandy. Ars. mere. nux-v. - bread. Plumb. - chalk-lime. Nit-aa. nux-v. DURING THE APYREXIA. 907 Taste for cofee. Ars. bry. caps. cham. con. - coldfood. Sil. thuja, verat. -- dainties. Cale. china, ip. petr. rhus-tox. - pungent things. Hep.puls. - salt things. Cale. carb-v. - spirituous liquors, wine, &c. Aeon. ars. bry. cale. china, hep. lach. mere. nux-v. puls. sep. staph. sulph. - sweetmeats and sugar. Carb-v. ip. kali, lye. sabad. sulph. things that are not wanted when obtained. Ignatia. - tobacco smoke. Daph. staph. - uneatable things. Bryonia. S undetermined things. Bry. china, puls. Throat, inflanunction of. Acon. alum. bell. cham. ig. mere. nux-v. puls. rhus-tox. samb. - roughness of. Gummi-g. kali, nit-ae. phos. ran. stan. - sore. Bell. caps. hep. ig. led. mer. nitr-ac. nux-v. phos. phos-ac. plumb. ran. sabad. sabin. spong. Tongue, feeling as if burnt. Ars. cimex, daph. fer-acet. hyos. lauroc. merc. puls. rhus-rad. rhus-tox. sabad. - coated on the right side, and clean on the left. Lob. - blackish. Ars. china, mere. phos. - brown. Ars. bell. hyos. phos. rhus-rad. rhus-tox. sulph. - dirty. Bryonia. - grayish. Ant-t. puls. - with mucus. Bell. lach. mere. phos-ac. puls. sulph. thick. Bell. chain. mere. nux-v. puls. rhus-rad. sabad. sulpli. - coated white. Alum. ant. arn. bell. bry. cale, cimex, cycl. eupat ig. ip. lauroc. mere. nux-v. petr. pod. puls. sep. sulph. - yellozoish. Alum. bell. bry. cham. china, chin-sul. cinch-sul. coc. eupat. ip. nux-v. plumb. puls. rhus-rad. sabad. verat. - dry. Ant-t. ars. bell. calc. chin-sul. cinch-sul. lauroc. mere. nux-v. phos. phos-ac. rhus-rad. rhus-tox. sep. - red. Ant-t. ars. bell. bry. cham. hyos. lach. nux-v. rhus-rad. rhus-tox. stan. sulph. verat. - redness of papillce. Ant-t. belladonna. - burning in tip of. Gummi-g. lauroc. Tremor. Arn. bry. chin. coc. cinch-sul. con. graph. ig. lach. nux-v. op. puls. rhus-tox. sabad. Tcenia. Cale. carb-v. graph. petr. sabad. sulph. Uneasiness. Acon. ars. bell. chain. cina, dios. phos. sil. spig. Urinek, urgent desire to pass the. Ant-t. bell. bry. dros. kali, lach. hell. lye. merc. natr-m. nitr-ac. phos. phos-ac. puls. rhus-rad. rhustox. sabad. sep. sil. spig. stan. staph. sulph. thuja. - difficulty of passing. Ars. caps. con. caust. digit. staph. - profuse. Ant-t. alum. bell. hell. lach. natr. natr-m. rhus-tox, spig. spong. staun. thuja. - scanty. Alum. bell. bry. carb-v. digit. graph. ip. puls. rhus-tox, stan. sulph. verat. - dark. Ant-t. bry. cale. carb-v. china, eupat. mere. ep. TIME AND TYPE. 909 Mood, changeable. Ant-t. bell. cycl. fer. ig. spong. Peevishness, obstinacy, want of disposition to do anything. Ant-c. arn. bell. calc. caps. caust. cham. china, chin-sul. coff. con. cycl. daph. digit. hep. ip. kali, lach. led. merc. nux-v. petr. phos. phos-ac. plumb. puls. rhus-rad. samb. spong. stan. staph. sulph. thuja. Restlessness, impatience, hurry. Acon. ant-t. ars. bell. chamn. cina, dros. hyos. ig. ip. lach. mere. nit-ac. phos-ac. puls. stan. sulph. valer. veratrum. Sadness, melancholy. Anac. ars. bell. cale. caust. coc. con. graph. hell. hyos. ig. lach. lyc. natr-m. nux-v. petr. phos. puls. rhus-tox. sep. sil. stan. strain. sulph. verat. CHAP. V.-TIME AND TYPE. 1. TIME. Morning. Arn. coff. con. eupat. fer. graph. hell. hep. kali, lob. merepod. rhus-rad. sep. sil. Forenoon. Dros. kali, merc. Afternoon. Alum. ant-c. coff. daph. elat. hepar. hyos. ig. lach. mer. ran. bulb. rhus-rad. stan. Evening. Aeon. amn-mur. anac. caps. carb-veg. daph. graph. hell. hep. hyos. kali, lach. lye. inmag-sulph. mere. rat. ran. bulb. rhus-rad. sep. sil. stan. Night. Ant-tart. con. hyos. ig. vlyc. am-mur. mag-sulph. Allperiods. Ars. bry. chin-sulph. cinch-sulph. crotalus, gummi-gut. led urn, lauroc. sulph. All periods, except morning. Sabina. - morning and forenoon. Spig. spong. - forenoon. Nit-ac. nux-v. puls. rhus-tox. - afternoon. Bell. op. afternoon and night. Calcarea. - evening and night. Chamrnomilla. - forenoon and evening. Caust. phos. strami. thuja. - forenoon and night. Cina, phos-ae. verat. - night. China. - evening. Natrunm. 2. TYPE. Quotidian. Ars. caps. carb-v. chin. chin-sulph. dros. eupat. elat. gummi-gut. graph. ig. ipec. kali, natr-m. nit-ac. nux-v. op. puls. rhus-rad. rhus-tox. sabad. spig. stan. staph. sulph. verat. Double quotidian. Chin. chin-sulph. cinch-sulph.eupat. graph, stram. Tertian. Alum. anac. ars. bell. bry. calc. caps. carb-v. chanm. chin. chin-sulph. cimex, cina, crotal. dros. fer. fer-acet. elat. eupat. gunlmnigut. ig. ipec. lach. lye. natr-nmur. nux-v. puls. rhus-tox. sabad. staph. veratrum. Double tertian. Chin-sulph. rhus-rad. rhus-tox. Quartan. Anac. ars. carb-v. chin-sulph. cimex, eupat. hyos. lach. pod. puls. rhus-rad. sabad. Postponing type. Chin. cina. Anticipating type. Ars. chin. ig. natr-m. nux-v. 910 ACON. AL. AM-MUE. ANAC. ANT. ANT-T. CHAPTER VI.-PATHOGENESIS OF THE MEDICINES CORRESPONDING WITH THE SYMPTOMS OF THE FEVERS. Aconite corresponds to a plethoric habit. The paroxysms come on in the evening, commencing with chilliness, followed by long-continued dry heat. Heat of the head and face, with redness of the cheeks and pressing headache, anguish and oppression of the chest. Chilliness reproduced by movement or lifting the bed-clothes, with hot forehead and lobules of the ears and internal dry heat. Aconite should be given during the paroxysm, and is often of great service in equalizing the circulation, and diminishing the congestion of the head, chest, &c., which is often so distressing and sometimes dangerous. It has been recommended, we think judiciously, to exhibit a dose of Aconite some time before the paroxysm, and it should be continued after the paroxysm if the congestions are not wholly dissipated. Alumina. Fevers, especially of the tertian type, with despondency, apprehensiveness and mental anxiety. First, chilliness and shuddering over the whole body, especially the back and feet, sometimes with heat of the face, and alternation of coldness and warmth, or followed by heat of the body and sweat of the face. Paroxysm in the afternoon or evening. Ammonium muriaticun. Especially in lymphatic and scrofulous constitutions. Paroxysm chiefly in the evening. Chilliness, sometimes preceded by, or attended with thirst, and followed by sweat. Heat followed by sweat. Heat in the palms of the hands and soles of the feet, and in the face, with thirst, when lying down at nights; afterwards sweat. Anacardium. General chilliness, with heat in the face, without thirst. Heat in the face, with nausea and heaviness in the whole body every afternoon at 4 o'clock; she is obliged to lie down. Chills without thirst, followed by internal heat with a cool sweat all over, but most abundant on the head, with thirst, short breathing and lassitude in the abdomen and knees. Antimonium crudum. Tertian and quotidian fevers with predominance of gastric and bilious symptoms, such as want of appetite, eructations, nausea, vomiting, bitter taste, coated tongue, tightness and pressure in the stomach and pain in the chest. Hartmann adds, particularly when the sweat sets in with the heat and disappears speedily, dry heat remaining. Antimonium tart, (Tartaremetic.) Characteristic indications for this remedy are chills at evening, especially during motion, alternating with heat. The patient wakes at night with thirst and desire to urinate. Chilliness, with flushes of heat. Violent febrile motions, with restlessness, great heat, thirst and headache, with profuse sweat the following night. Slight chills, great heat, profuse sweat, sleepiness, and increased secretion of urine. Additional indications are gastric symptoms, red tongue, covered with raised papillte as in scarlatina, or tongue bright red and dry in the centre. Prof. Freedly, of Philadelphia, says 912 BRY. CAL. CA CPS. CANTH. CARB-V. the digestive powers, and violent headache during the paroxysm." -Hartmann.. Bryonia. Bry. corresponds to intermittents occurring at all hours, but chiefly in the morning, with predominant chilliness, and quotidian or tertian type; thirst during the chill and heat, dry cough, with stitches in the chest, asthma, nausea, and gagging, and paleness of face. Before the paroxysm, vertigo and violent headache, as if the head would burst; stretching and drawing in the limbs. During the chill heat in the head; redness of the face, and thirst; dry and viscid tongue; aversion to food and drink; nausea and vomiting. SIn the hot stage increase of headache and vertigo. Calcarea. This is particularly indicated in lymphatic and scrofulous constitutions, and for females with too early and profuse menstruation. The indications drawn from the symptoms of the paroxysm are not so clearly marked. The following symptoms, however, may be regarded as indications: chilliness, with thirst; chilliness of the body, with heat in the face and head; external heat and internal chilliness; heat in the face, followed by chilliness every third day; sweat when walking or at night; fever in the forenoon; alternate chills and heat; heat and burning thirst, alternating with chilliness; fever in the evening, with external chilliness, internal heat and violent thirst; the sweat commences during the chilliness, and terminates in profuse sweat; fever from morning till noon, or after, commencing with tearing in the joints and heaviness of the head, followed by languor, heaviness, stretching of the limbs, heat, and a constant sensation, as if sweat would break out, with trembling and uneasiness of all the limbs. Capsiculm Capsicum corresponds to the quotidian or tertian type, with predominant chilliness, especially after abuse of China or Quinine. During the chilly stage thirst, anxiety, restlessness, inability to collect the senses, intolerance of noise, headache, ptyalism, vomiting of mucus, painful swelling of the spleen, pain in the back, tearing and contraction of the limbs. In the hot stage stinging in the head, bad taste in the mouth, cutting colic, with ineffectual urging, pain in the chest, back and limbs, either with or without thirst; sweat during the heat; cold sweat. Cantharis is sometimes a good remedy in tertian fevers with predominance of chilliness, irritation of the urinary organs, and difficult micturition. The chilliness is mingled with heat, with heaviness of the feet, lameness and immobility of the limbs, loss of appetite, pain in the eyes, and desire to lie down. Carbo-veg, Carbo corresponds to quotidian, tertian, and quartan fevers, with the following symptoms: before the chill beating in the temples, tearing in the bones of the limbs, and in the teeth, cold feet, stretching of the limbs. During the chilly stage languor and thirst. In the hot stage headache, vertigo, redness of the face, obscuration of sight, nausea, pains in the stomach, abdomen, or chest; oppression of,the chest; pain in the lower limbs. Headache continues after the 916 ELAT. EUPAT. liness with blue nails, icy cold hands and necessity to lie down. After the chill, thirst. At noon, heat in the face, heaviness in the head, beating in the occiput, and afterwards inclination to vomit. Feels well in the evening and profuse sweat at night, particularly on the abdomen. Chilly during the day and heat at night. Elateriium. Quotidian, tertian and quartan fever. It has been successfully employed in fevers with the following symptoms: Quartan ague of six weeks' standing, paroxysms occurring at noon, when an attack resembling cholera supervened, afterwards severe and copious discharge of frothy fluid matter frequently dejected from the bowels with cutting pains and vomiting. Obstinate tertian ague for five years, suppressed by quinine, but recurring at intervals. Symptoms: Chill every third day, twice in the day, continuing for two hours; pains in the head, under the shoulder-blades, in the left side, in the calves of the legs and small of the back; yawning and gaping, with a sound resembling the neighing of a horse; running at the nose; cramps in the legs and soles of the feet. The chill was followed by high fever, ending in copious perspiration. Tertian fever, paroxysms preceded by much gaping and attended by much thirst, with pain in the abdomen and great pain in the extremities darting down into the fingers and toes. Quotidian fever, repeatedly suppressed by quinine. Paroxysms preceded by headache, soreness of the limbs, pains of the bowels, continued gaping and stretching. In the chill slightly increased pain in the head and limbs. In the hot stage, violent, tearing pains throughout the head, but most in the region of benevolence; increased pain of the bowels and extremities, and pains shooting to the very tips of the fingers and toes, and then shooting back into the body. Thirst intense. In the sweat, all the symptoms gradually subside. Access at 1 o'clock P. M. Eupatorium. This remedy, as seen by its pathogenesis and as found in practice, is one of the most valuable of the materia medica in the treatment of Western intermittents. It corresponds to strongly marked and frequently recurring forms of fever, of all types. The paroxysm generally commences in the morning. There is thirst some hours before the chill, which continues during the chill and heat. Sometimes there is chilliness through the night and in the morning with nausea from the least motion, and aching pain and soreness as if from having been beaten in the calves of the legs, small of the back and arms. Vomiting at the conclusion of the chill. During the heat, flushed face and dry, hot skin and violent throbbing headache. Chill in the morning, heat during the rest of the day and slight perspiration in the evening. Heavy chill early in the morning of one day, and a light chill about noon the next, and so on. Pain in the bones early in the morning, before the chill. Increased headache, but diminished thirst during the heat. Chill with excessive trembling and nausea. Internal trembling and external heat. The patient feels worse in the morning of one day and FER. FER-ACET. GUM-G. GRAP. HELL. HEP. 917 afternoon of the next. A greater amount of shivering during the chill than warranted by the degree of coldness. Retching and vomiting of bile. Distressing pain at the scrobiculus cordis during the chill and heat. Violent pain of the head and back before the chill. Little perspiration. Cough in the night before the paroxysm, and loose cough in the apyrexia. Great weakness and prostration during the fever, and faintness from motion. Coldness or pungent heat during the perspiration at night. Ferrum met, Intermittent fever from abuse of China, with determination of blood to the head, puffiness round the eyes, swelling of the veins, vomiting of food, shortness of breath and paralytic weakness. " Chilliness with heat of face; extreme redness of the face during the hot stage. Sweat coming on early at day-break, and continuing until noon, every other morning; the sweat is immediately preceded by headache." (Bann.) Ferrum aceticum has been employed in tertian fevers commencing with a pressing in the forehead, followed by violent chilliness for three quarters of an hour, with increase of headache and great thirst, then moderate heat and sweat with bitter taste, loss of appetite, constipation, yellow complexion, great languor and headache during the apyrexia. Gummi gutti. Violent chills proceeding from the back, with chilliness of the whole body, even the forehead, from eve till morning. Chills for two hours with chattering of the teeth, the skin feeling warm to the touch, with violent thirst. Quotidian or tertian fever, rather postponing than anticipating type. Chilliness, with empty eructations, yawning, thirst, pain of the back and biting as of ants over the whole body (at night), or with excessive stitches of the ears at the commencement. Graphites. Chills early in the morning and in the evening; then heat followed by sweat. Fever every day, commencing with a shaking fit in the evening, followed by heat in the face and cold feet, without sweat. In the evening, stitching pain in the temples, in the left ear and in the teeth, with shiverings; sweat the following night. H.elleborus. Violent heat in the head, cold hands and feet, afterWards general slight sweat for an hour. When out of bed is constantly affected with chilliness of the body without thirst, cold hands, internal burning heat and dulness of the head, drowsiness, heaviness and weakness of the feet; after lying down in bed, is immediately attacked with heat and sweat all over the body, without thirst. "Towards five or six o'clock in the evening, and especially after lying down, there is a burning heat over the whole body, especially about the head, accompanied by internal chills, without thirst; when he attempted to drink, he could only drink a little at a time."-(Boenn.) lepar sulph, Violent chilliness with chattering of the teeth at 8 o'clock in the evening, for a quarter of an hour, with cold hands and 918 HYOS. IG. IP. feet, followed by heat and sweat, especially on the chest and forehead, with slight thirst. Shuddering at 2 o'clock at night, with hot, dry skin; occasional creeping chills along the back and on the chest, with a pressing pain in the back, in and near the hips, and in the abdomen, with inclination to vomit. Paroxysm early in the morning; first, bitter taste in the mouth; after a few hours, chilliness and thirst. Burning, feverish heat, with great thirst; red face, headache and muttering delirium from 4 o'clock P. M., through the night. Hyoscyamns. Tertian and quartan fevers with epileptic fits; great weakness, flashes before the eyes and congestion of blood to the head. " Quartan fever, with dry cough at night. Quartan fever, with a short, dry, hacking cough at night. Fever in the afternoon where the coldness is the characteristic symptom, with pain in the back. In the evening violent and long chills, with uneasy sleep, followed by copious sweats, especially on the thighs.' In the evening, burning heat of the whole body, with much thirst; putrid taste and much mucus in the mouth."-(Bonn.) Ignatia. Ignatia is adapted to intermittents with thirst during the chill, and absence of thirst during the heat. The chilliness is relieved by external warmth; some parts are hot, while others are cold. The heat is mostly external. Chilliness over the arms; afterwards heat and redness of the cheeks, and heat of the hands and feet without thirst. Fever in the afternoon; shuddering, with colic; afterwards, weakness and sleep, with burning heat of the body. Chill, followed by external heat, then sweat. Quotidian, tertian and quartan fevers, with anticipating type. Chill, with thirst and external coldness (frequently proceeding from the abdomen), followed by heat without thirst, with cold feet, with or without thirst. The symptoms during the paroxysm are: Headache, pain in the pit of the stomach, great languor, paleness, or alternate redness and paleness of the face, lips dry and chapped, white tongue, deep sleep with snoring; nettle rash. During the chill, nausea, vomiting of food or bile and mucus; sallow complexion, pain in the back, lameness of the lower limbs. During the heat, redness of the cheeks, absence cf thirst, internal shuddering, cold feet, stinging in the limbs, pain in the back, delirium, vertigo, beating headache, tearing in the bones, and sleep. During the sweat, stinging and roaring in the ears. Ipecac. Ipecac. is an important remedy in intermittents. It is remarked of it, and we think truly, that it possesses this advantage, that even if it does not entirely suit a given case, it effects a favorable change, so that the cure can be afterwards completed by arn. chin. ig. nux., &c. In this region it cures very many cases alone, and many more, followed, after two or three days' use of it, by ars. china, nux., &c. The following are the characteristic symptoms of Ipecac. The chilly stage moderate and short, with thirst; the heat great, without thirst. Sometimes the heat is only felt about the head with red cheeks, dil ta 920 LED. LOB. LYC. MAG-SUL. Ledum. Chilliness without subsequent heat, with thirst, especially for cold water; heat all over, without thirst. On waking up the body is covered with perspiration, accompanied by itching of the whole body. Intermittent fevers, with malignant rheumatic pains. Lobelia inftl. Lobelia has proved an efficient remedy in intermittent fevers with the following characters: attack at half-past 10 o'clock A. M. Severe coldness, alternating with flashes of heat till 12 o'clock A. M., when the heat, which was moderate, became more constant, but alternating with slight chilliness, till evening; profuse sweat at night, with quiet sleep; thirst great from the first chill during the hot stage, but worse in the chill; respiration short, anxious, laborious and wheezing, with sensation of tightness in the chest; tickling in the throat-pit, with frequent backing cough; severe headache, extending round the forehead from one temple to the other; loss of appetite both in the paroxysm and apyrexia; tongue white, scaly, coated on the right side, but clean on the left; great debility. Shaking chill, with thirst; then heat, with thirst and sweat. The thirst is sometimes observed before the chill, and through the whole fever; often only before the chill, and not in it, and then again in the heat. The coldness is increased after drinking. The sweat begins with the heat, or after the heat is continued for some time. Lycopodium. Paroxysm every afternoon, from 3 o'clock till evening, the chilliness increasing progressively without any subsequent heat or sweat. Paroxysm at 7 o'clock in the evening; chills and great coldness, even when in bed, as if she were lying in ice, for two hours, with drawing in all her limbs, in the back, and in the whole body. On waking from her sleep, which was full of dreams, she is covered all over with sweat, with violent thirst after the sweat. Coldness of the body in the evening, with heat of the forehead. At 8 o'clock in the morning violent chilliness for half an hour, followed by but little heat. Early in the morning she wakes with chilliness; soon afterwards has much heat and pain in the occiput, and feels quite sick. Evening fever every day; chilliness, followed by heat. Evening fever, a little chilliness, followed shortly by violent continued heat; weariness and pain in the limbs. Chilliness every evening when in bed till midnight; after midnight feels warm and hot; early in the morning sour-smelling sweat. In the evening alternate chilliness and heat, with aching of the whole head and coryza. Alternate chilliness and heat, and great redness and heat of the cheeks. First nausea and vomiting; then chilliness, followed by sweat, without any previous heat. Fever, with great weakness, heat predominant, afterwards chilliness. Tertian fever, with sour vomiting after the chills, and bloated face and hands. Magnesia sulph. Chilliness in the evening until he lies down, afterwards sweat, with thirst early in the morning. Chilliness from 9 o'clock in the evening until 10 in the morning; afterwards, towards noon, he is obliged to lie down; sweat at 3 o'clock P. M. Shaking SPIG. SPON. STAN. STAP. STRAM. SULP. 927 Siliea. Repeated shiverings through the day for half an hour, followed by moderate heat, mostly in the head and face. In the evening, after lying down, violent chilliness which produces pain in the stomach; afterwards genera Iheat, with thirst; copious sweat, with thirst. Profuse, exhausting, night sweats. Spigelia. For five days in succession, chilliness, in the morning after rising, at the same hours, and heat at noon, five hours afterwards, mostly on the trunk, but more so in the face, with redness, but no particular thirst. Alternation of heat and chilliness; the chilliness being especially felt in the back, the heat in the hands and face. As soon as he lies down he feels chilly; after which he is covered with a profuse foetid sweat. Heat, with great desire for beer. Great heat, with sweat over the whole body, especially about the head, without thirst. Spongia. In the afternoon, aching, in the occiput, with heat of the face, hands and feet, chilliness of the rest of the body, and disposition to coryza, with weariness of the body and bitterness in the mouth; in the evening after taking off his clothes, he had shaking chills, followed, in a quarter of an hour, when in bed, by heat of the whole body except the thighs, which were numb and chilly; sweat at night. Starilllm. First, heat and sweat over the whole body from four to five o'clock in the afternoon; followed by slight chills; thirst during and after the heat: the thirst returns for several afternoons at the same period. Staphysagria. A marked febrile symptom of Staph. is predominant chilliness. Fever at evening, night or morning, consisting only of chilliness without thirst. Internal shuddering with violent thirst, for several days at 3 o'clock P. M. without subsequent heat. Sometimes there is slight heat after the morning shuddering. Tertian fever with scorbutic symptoms, as putrid taste in the mouth, bleeding gums, want of appetite and constipation. Stramonium. Heat in the head; afterwards coldness of the whole body, followed by heat of the whole body, with anguish; sleep during the hot stage, and violent thirst after waking up, which causes a stinging in the throat until he drinks something. Violent fever at noon, which returns with the same violence at midnight. Chills over the whole body, without thirst, accompanied by an inability to collect one's senses, and by twitchings of the limbs; afterwards heat without any thirst, with a highly red face, painful chilliness consequent upon the slightest bearing of the body, and anguish; during these symptoms he falls asleep; violent thirst after waking up. Heat and sweat over the whole body without thirst. Sulphur., Heat in the face, and sense as if just recovering from a hard sickness; the heat is followed by a little chilliness, with a good deal of thirst. Slight chills for an hour in the forenoon, at ten o'clock; afterwards ease until 3 o'clock P. M., then heat for two hours in the head and hands, with desire for beer. At noon, a good deal of internal heat, with 928 TAR. THUJ. VAL. VER. redness of the face and chilliness; all the limbs feel tired as if bruised, with great thirst, till midnight; then abatement of the chilliness and heat, and the body is covered with perspiration for three hours. In the afternoon feverish heat, mingled with chilliness and continual palpitation of the heart. Violent chilliness in the evening when in bed; afterwards exaltations of the fancy; lastly heat and profuse sweat. Chilliness every evening, which cannot be relieved by warmth of the stove; considerable warmth when in bed, and sourish-smelling sweat in the morning. Taraxacum. Quotidian fever: in the evening the hands and nose become cold, after which sleep sets in with considerable sweat, particularly about the head. The apyrexia is characterized by languor and vertigo. Febris intermittens quotidiana sudorifera? Debility, loss of appetite, profuse sweat every night, thirst day and night, restless sleep; Ars. was of no avail; Tarax. effected a complete cure.-Jahr. Slight chills through the whole body; chilliness with continual pressure in the head; violent chills when walking in the open air. This remedy has been employed with success against endemic fevers where the plant grows. In general, drugs which grow in regions where endemic fevers prevail, seem to be the best remedies against those fevers, provided that the drugs have at all a febrifuge power.Hempel. Thuja, Violent shaking chill at 3 o'clock A. M. for a quarter of an hour; afterwards thirst, lastly violent sweat all over the body, but not on the head, which is only moderately warm. Shaking chill, with external and internal coldness, then sweat without intervening heat. Predominant chilliness, with heat of face. Valeriana. Predominant heat. Much dry heat, preceded by little chill, and irregular pulse. Violent heat with thirst and great obtusion of the head. Veratrum. External coldness, with dark urine and cold sweat. Coldness with internal heat, dark urine and cold sweat. Chilliness succeeded by warm sweat, which is soon changed to cold sweat. Tertian fever, consisting of mere chilliness. Simply nightly chills, with violent pain in the small of the back. Chilliness with great desire for cold drinks, and accompanied by nausea, alternating with increasing heat, afterwards heat with unquenchable thirst, delirium, redness of the face and constant slumber; finally sweat without any thirst, with a pale countenance. Chilliness in the evening, alternating with thrills of heat: afterwards heat with violent thirst: and finally, after a considerable interval, sweat. Chilliness and heat alternating from time to time, accompanied by vertigo, continual anxiety and inclination to vomit. Intermittent fevers, with obstruction or indolence of the intestinal canal. INTEX PAGE Ab-dmen, lIetermnination of blood to the.... 244-646 Abdominal deformity...816 Abortus.,..795 Abscess.....524 ace-Lte....524 chronic....525 urinary and fistula. 565 Abscesses in ano. 234 Abseessus nucleatus.,520 Acidity in children...8411 Acute in-flammnation of the eyes.6417 of thehlver.285 of the spinal cord.. 443 rheumatism of the heart. 516 /gulops............65 3 Affections of the ýknee 644: After-painis 18091 Agrypaia.675 Ague..............8 Air and. exerc3ise '1779 Aliments allo-wed. 67 prohibited.68 Al-vi.............222 Alviac discharge, color of the (sQec bowel complaints of infants) 852 Anabustiones....747 Amenorrhrn-a...76 Anasarca...71 inte~gumontoruin scroti. 585 Aneurisim of the aorta... 516 Angina aphthosa... 174 faucium. 1 74 membranm~a.e..9348 parotifica...189 pectoris. 4170 permiciosa...348 pha~ryiig2ea.187 Anorexia...........202 A nthrax..............2 Aorta, aneurisim of the.. 516 Apepsia.............202 Aphth...............8500 Al-ppetite, wa-rt of.... 202.Apparent death.1 53 firom afall. 1.,53, being frozen 755 (30 Pr VAG - App-arent death fromn drownsing 754 -hunger.753 lightain.o- 7o14 suffoo ati-oa:(hanging Iressuire, Apoplexi-a 4W,43 Apok-plexy...437 Arteries, in-flam-mation of the. 517 Arthritic nodes. 6 29, Arthrits s.............27 vaga. 629 Aocsetes. 768 Asiastic choleria. 262 A sphyxia 1* 53-829 Afrtmn. 42T Ilimudm427 of iMillar.881 spasmodic.. 84-8 Atrophia...........887 Atrophy.....887 Attenuations in general v 41 Backý, pains in the small of the. 638 Balanitis *.0,. 81 Balano ble norrhcea,. 0.-81 Bastn rd or spurious pleurisy. 406 Bilious Ifecver...12 6 Pirtb, treantent after...828 Blaick wlater....219 Bladder, diroisie infdammintn-ion of -55 PitiffiomlIationl of thle 0553 BIlear c yed ness....654 -Bleedino'from lthe nose..660 iistest~inorum..315 reeti....316 ventriculi. '9. 13 Blephanitis.....654 Blindness,- sndden attack of., 654 -Blood, dletermina'tion of, to the abdomen....646, discharge of, from the urethra....574 determination of, to the hlead.,.. 428 930 INDEX. PAGE Blood, spitting of... 409 vomiting of... 219 Bloodshot eye... 653 Boils...... 520 Bowel complaints of infants.. 852 Bowels, hemorrhage from the (see Iemorrhoids)... 227 inflammation of the.. 297 looseness of the.. 245 Brain, concussion of the.. 30 diseases of the... 428 dropsy of the... 879 fever.... 433 inflammation of the.. 433 Breasts, inflammation of the. 824 preparation of the.. 800 Breath, offensive.... 672 Bronchial tubes, imflammation of the mucous membrane of the 358 Bronchitis..... 358 chronica... 365 Bronchocele..... 673 Bruises..... 730 Bubo...... 596 Buboes...... 618 scrofulous... 599 sycosic... 610 sympathetic... 598 venereal.... 590 Burns.... '747 C PAGE determination of blood to the..... 355 dropsy of the.. '716 spasms in the... 848 Chicken pock... 163 Chilblains..... 522 Children, convulsions of young. 867 diseases of... 843 Chimney-sweeper's cancer.. 520 Chlorosis.... 66 Choice of a nurse... 834 of the remedy... 5 Cholera.... 259 accessory treatment. 283 Asiatic... 262 causes of... 276 epidemica... 262 fever, or hot stage of. 269 first stage of... 267 malignant... 262 preliminary symptoms of 267 spasmodica... 262 Cholerine..... 284 Chronic abscess.. 526 bronchitis... 365 inflammation of the bladder..... 553 of the spinal cord.... 444 laryngitis... 327 rheumatism... 637 Cingulum... 541 Cirsocele.... 583 Clap...... 574 Clavi pedis.. 523 Clavus histericus... 462 Clothing during pregnancy. 780 Cold, common... 318 in the head.. 328, 844 on the chest... 358 Colica pictonum... 240, 446 Colic......239 Devonshire... 240 from a chill.. 240 from hemorrhoids. 240 from external violence. 240 from passion or indignation 240 from indigestible food. 240 from worms... 240 hysterica... 240 in infants... 846 lead... 240, 446 menstrual... 241 ofPoictou.. 446 painters'... 240, 446 Common cold.. 318 Concussion.... 730 of the brain.. 730 Condylomata.. 620 Camp fever... Cancer nasi..... Cancerum oris Canker of the mouth Carbuncle... Cardialgia..... Carditis.. Caries...... Casualties..... Cataract.. Catarrh. pulmonary Catarrhal fever. Catarrhus bronchiarum Cephalma.... Cephalalgia... arthritica. nervosa Chancre and bubo and condylomata and gonorrhoea Hunterian phagedeni. sloughing. superficial, with raised 95 666 666 666 522 212 514 721 730 652 318 358 318 393 462 462 462 462 625 625 625 588 588 588 edges.. 588 Chest, cold on the.. 558 I-NDEX. Febrisinlmaoasipe lenta iservosa iiervosa ilI'IVOSC ta?)d nervosa -versatilis pitmitosa simplex... synoeh'ilis etsweeitiivr Females, d(ne'i esof 4lecverI hi liois Camp eat'asihal con itt' io eP eruiptiv e,general treatmeno-t of. hectic infantile remittenlt inflammuatory intermiftent j ail. malign_,ant. 'marsh ii1-l1COliS......... nervous. lieteclsi"Al puitridl scarlet slow.......... synochal. t~yphusi yvellow. Feers.i simiple or ephemeral. Fis'Aain Pt i-0 nechrsmalis i t s n 111 esincmso 31'stidcnco in inf~antS Flatuleney.......... 1 latulenti'.Fos mul'ce of homocopathic piescriptions. Fractures Fungus hmcmaatodes Furunculus. PAGE 97 121 77 80 S0 121 629 674 95 95 128 126 '1-1 117 95 94 -101 121 -71 94 95' 94 115 629 '73 '71 115 69 '7-2 234 652 5 65) 847 210 210 210 58 1745 651. 520 5 242 rAGI.-.isri-;293 Gus tro d y an...........2 1 Genitaii and ucii` nary organs, dieeases of the.............5 Giddin es............431 GhmS ccls egloblooate, disease of.5 2 -Glen 'dtharsiv sellings. 5217 G6l23 (ilobuiles )0ý G-1,SIa i............670 Goitie.............673 G onor.-h"................6211 and hernia itumorali.ss. 62 5 glandis 6)..62 Goat.621 Gravc'l (see 1.Inleatasia).57 1 G um-b oil............. Camts) lamorrius-re from th'Ele,(see Gases am oris an,.d Odontnlgrift) 66'r Pilmtees)s 2 219 I-einlos s lina pal monuam. 409 uavrcth 1e. "U.5741 Headaclie.46 Head, cold inl the... 328. 844 detenimination otf blood to lb 428 dropsviii lbs 8"T9 ssvelliln. 0f the) in infpats.830 -water inl the 879 Heart, acute riieainsatiam of thc '5 16 dilatuation oft111.5 15 disc ases of the 47'ý oftl'e valvesOftile 5iiý Heartburn 219 Heat, oxpossare -to..150o Hlectic foci'. 111.il Ile]msnhthiasis30 I Iemietiniei ni' mgii).4 612 I-lemoi'iha'e from t Ite eyes..62 from -1the Imug (s..4 091 Helemosihoids 2it2)* 22 chaig-e. 229 Ilenatit.is.............285 chssosca.288 Hlerisia 61921 h-u-neral.is.. 581 llernirc incarceratnes 697 Hierlpes circinnatxis.5 3 pre~patialis.606 s e r pego............. z-oster.541 iangrena oris Gastralgiat Gassrie fever 126 INDEX.93 L. Miliforrnis paIpulosa. 135 SA G E Mil'k blotchies 849 Labor, reme-idies before. 801 excessive Secretion of.8112 tedious or Consilh ated. 804 crust...........819 Laryngitis...........33 fever...........813 chronic. 0027 regrurgitation of the. 847 Laryn-gisnums striduilus 881 scab.............49 Larynx, inflaimmation of thme 002)3 suppiessed secretion ofl 8,11, 82 5 Lend colic (see Colic and Palsy,) 446 Mlineral and animial substance, pieLeg~s, cramps in the.67 paration. of (Trituristious) 38 Leuecorrlsea after partum1ition 818 Miscarriage75 Lienteria 2. 46 Moist tustlua.4 27 Lippitudo...60-4 AMorbus, caducuis.. 453 Lips, swelling of the 656 cereaibs. 109 List of miedicines adapted to pta. -comitialis... 4 539 ticulni tempeiameuts 6 coxarius... 644 Liver, acute sinlaimmation ot.218 5 diviisus... 4053 chiionie in-1anmmason. 0f5.288 hIscruleus.. 453 complainot.'28 4 Morbus sneer.... 453) Loehial dischauge, rre'yul'smtics Morning, sickness.. 178 of the (915 Mothers not suckling their children 826 Lockj.aw oi infamnts 863 Mouth, canker ini the. 666 Loins, pains in 11he s707 scsurvy in the 66 Looseness of the bowelo No45 Mucous fever...........12 Lucs, veneica 588 Mlumps............18 9 Lumbag-o...........638 Myeliti.............443 L-umabo-sneral pains...7~Moi............5 Lungs, hem-orrhage from thme. 409N inflammation. of thme 367 Lsixations 74-0 4 o Natcuro also form of hsoi-necopathiei Lymphatic tumiors..524- umedicmines.1 mNavel iriupture iniinifants.830 -ScoinjesIess of the (I _830( Maligrnant ehmolcia. 2 6 26 _ N arss h.' disA1ess.6530 putreid or gangremio]s 'NerC1,o ss............72)1 some thio t 1> N-ephsiritis.55 0 quIASY 1,,-,2 Ncrve:,,im 4. 58 -Mamnma, dise'ases of thse. S,4 Nrcm ios 5fever.7 Mlarsls faese.101 betide m ish.161 Measles.lo-1 N-euralgis.4.56 re!ýcreussiou Of itb,OrlapfacinIis 458 i P_ us ten bm lstine. tl Mecolisin)ý, e pnhsmon 0of 8 8) 1 ipplcs, ex--corilition of th 8)202 Mleuhm'sc~is pinssshis.443 bodes.............64 Aeioiha.i'1 70 N osebleedsiso of time. 60 Mlen sti natiosas "ca-is of thebolb s of" the. 665 Mosiualomimii. I 70 sx cii o.the. 6 64 Allental eomotiomis..164, 7 83 -Natasl s, 68,1707 affeelsung the iad11ek8 2 'D burse, choice of ai.8 3 4.)yet-itiS............89 Nursincrdiet durino..83 M~ictus eruentus,. 571.S 0 )Miliusa... 164 alba.. 164 Observastions on lremeialicy. 777 purpurca... 1315 Obstacles to suckling 8 2 2 -Miliaris 1Jhalemaammi...135 Obstipustio........... 22 repercussion of the erup- Obstipsition. 222 tioii.n.. 167 Obstructie alvi. 090) sudatoria... 1064 aonatoruma.1-852) Mliliary fever.... 164 Occulta...........39 INDEX. rAGE, Preparation of the breasts SOO80 Prcscriptions, for1m-ulre of hommcopathie.............58 Preservation of hommcopathic medicines 55 O~ Preservatives, rules for the seci-ctions of..30 Proctalgia...........238 Prohibited aliment.6 Proinpsus an.. 38 Prosopalgia.4 Prostatitis (see Hoemerturia). 571. Protrusion of thec intestinec. 238 Prurigo.............531 Pseudo- pleurit-is... 406 Psons muscle, inflnmrpat~ioa o-f the 63)9 Psoitis.............639D Psora..............5!7 Psoriasis..............8 Pulmonary catarrh. 358 Consumuption. 415 Puirnonitis............67 Purpurea rabra. 135 Pustula -nigra..............21 Pustular ringworm. 533 Putrid fever....94 Pyrosis..21 Rugwsiorni puetul r Rose Rubeola, Rupture Ruptures, inenareerated s PAGE.533 0517.154 06921.6 97l Quinsy splincelated 1.74 174 Pachitis.............29 Ranula.............71 Raphania.1109 Rnsh., nettle.107 scarlet.135 R~aucitas............325 Rectum, stricture of the..23,0 Regimenn.... 2 'le - fgurgitatio n o ilk...8 47 Remarks.. -..14 R~emedies bef'ore, labor. 11801 Remi1ttent, fever 11 Re-petition. of medicines 10 R-etentionl of urine i Rheuma"ic fever. 6,219, 600 Rheumatism chre6i9 chron10.637 in thme ben-d (see!-.Ldache, p). 462 a Y!4 Rheumaf.ism, p),629) in. tbe hip 6 wIthout fever 636 Ricets 0..729 Ringworm, herpetic or vcs~cul.-r.50 of the- scialp a 4 533 Sarcocelc e..482 Seabies....5 2 7 lymphtica..529 ]Ympulifori-nis 5 215S8 pturuieitca..5ý2 9 Scald bend..533 Scalds.....747 Seaslatina aIinoa.. 19 11n-1...135 Scalp, rinmlyorimof ihe..533 Scarlet fever....128 rsoh 13 Seeatca...640 Scarb-us 65 Scorbutus 66 Scrofula....719 Scurvy.....668 inl the mouth...666 iSea-siekncc-s.. 7,51 Second~ary,-yphli *... 625 Secret-on,e x (1Cs i ve, of m~ilk. 8 1 susppressed, 0of milk 811, 82 Shiulle~s....541 Short slilt 6 Siruplc- orephemernial fevcr Skie ýirritaitosm or1,itching i ey 1ý 31 SSlee-p..830 'ibnomnial staite dur'ing 08) auiemed6.8 distmrbed by agitated anxious (beans.6.16 9 dlistuibed by aching pi us InI the body..67 8 disimibed or prevented by xc lteeniet. 682 pneýi~on durinzg. C90 positioi n wi eb DThit is napessible to recline duriuc.691 Slcepl, -ssne ýs. 6 7 5 oF i n 11at ks 8359 Slow fever 77. Smn-nil of the back, p~ainls inl the 638 S 1-1 P0 I, -15`6 confluent 158 d'et to be obsemned inl 16) niodified. 16G m pecxrussion of the cl UPtiolm in1( Ri-re tt tactl Or (uin~y. i aiplithomis. 174 Spu alof tie Stomtrach. P21) Spasmodic "sthma. 8S8 INDEX. 939 PAGE PAGE Ulcers, indolent.... 548 Vehicles which serve for the premercurial... 547 paration of homceopathic mephagedenic.. 547 dicines.... 19 putrid.... 547 Venereal disease.... 588 scrofulous... 547 Vomiting of blood... 219 syphilitic... 548 Ulcer of the rectum (see Stricture W of the rectum). 230 Wakefulness of new-born infants 845 Urethra, discharge of blood from Want of appetite... 202 the. 574 Warts on the face... 656 inflammation of the. 574 Water brash.. 249 stricture of the. 563 in the head. 879 Urethritis..... 574 pure.. 27 Urethrorrhagia... 574 Watery itch.... 529 Urinary abscess and fistula. 565 Weakness after delivery.. 822 Urinary and genital organs, dis- Weaning..... 837 eases of the... 550 Weeping, or watery eye. 653 Urine, difficulty in discharging. 558 Whitlow..... 530 incontinence of.. 566 Womb, affections ofthe.. 819 retention of... 555 inflammation of the. 819 suppression of.. 561 Worms.... 305 Uterine or internal swelling and Wounds.... 730, 734 prolapsus.... 819 contused.. 437, 734 Urticaria... 167 ongnshot. '7.i 740 V Vaccination.. 888 Vagina, inflammation of the 776 Varicelea... 163 Varices... 793 Varicocele... 583 Variola.... 157 spuria.. 163 Vegetable substances, preparation of exotic... 36 incised.. 734 lacerated.. 437, 734 poisoned... 35 punctured... 734 Y Yellow fever.... 115 Young children, convulsions of. 867 Z Zona..... 541