T 1I E TIlE AC TION AND CLASSIFICATION OF MEDICINE, IN CONNECTION WITH THE Anatomy of Temperaments. BY JOHN C. MORGAN, M. D., PROFESSOR OF SURGERY IN HAHNEMANN MEDICAL COLLEGE, PHILADELPHIA. Ieprinted from Transactions of State Homooopathic Medical Society, 1868. ALBANY: VAN BEXTHUYSENI & SONS' STEAM PRINTING IOUSE. 1868. 4 "similar disease" which cures in the form which may exist without medication, as in spontaneous recovery; or it may be induced by drugs, as in homoeopathic medication, though the highest similarity operates directly in the diseased region itself. Plate' I exhibits, under the typical form of vascular alterations (an usual concomitant of diseases), a series of phenomena illustrating the effect of hostile action and conservative resistance, particularly in the influence of cell nutrition of any part on vascular contractility in other parts nervously associated with this, with its concomitant influence on the nutrition of the same parts. This corrective action of nerve currents, proceeding from well nourished parts to others, whose nutrition and vascularity are deranged, will presently be considered. We next notice that, as just hinted, the maintenance of the life status proximately depends on nutrition of all those material parts, by which life finds expression. To this all vital effort tends. The operation of all those agencies by which life thus exhibits itself, may be summed up in the single technical phrase: "nutritive erethism," expressive of the fact that a degree of organic excitement charactizes the process of nutrition. Normal and equable nutrition is health. Disturbance of the same is disease. Predominance of "nutritive erethism," in some general sphere, may be regarded as the basis of temperament, which may be a condition of disease, as it diverges from the health line of equable and normal nutrition; its ordinary influence being, however, consistent with an average standard'of health; perfect equipoise being indeed a rarity. Nutritive erethism is itself the product of certain proximate factors, material, dynamic and spiritual. The first includes two elements, the organism and the plasma. The second comprises two elements, force and stimulus. The third consists of that spiritual element which, acknowledged as the essence of soul in man, has been asserted also of other beings, by some, but which clearly differs from all others in him. Let us review these. The organism is the material structure of cells, tissues and organs, provided for the expression of life phenomena, and to this end, arranged with exact fitness to the local office of each, and also to their perfect co-operation in the vital actions. The plasma is the material of which cells, etc., are formed, 9 forces, to the nervous poles of the body, evoking their action by conversion of their own molecular forces, or by induction, and this, without prejudice to their purely physical effects. Large doses inflame, unless by evacuant exudation, the excess is eliminated. Small doses have the opposite effect, speaking comparatively; hence they cure, in diseases similar to those occasioned by such lalrge doses. But reference has thus far been made alone to the initial region in which excess of stimulus or irritation has been applied. By nervous association, both direct and remote, other and distant regions-the whole body perhaps-may be sympathetically effected, and as the nerve currents of irritation are very complex, and the effects on vascular calibre and nutrition very various, we nay be pardoned if we trace, by study of provings and other diseased conditions, the more occult phenomena, by means of a diagram. As large and small doses act diversely, they are separately presented. See Plate I. From this diagram we may also obtain a conception of the shifting of irritation to distant but sympathizing parts, this being known by the term "metastasis." It will be observed, next, that in the production of the changes of vascular calibre, from irritation, the low potencies and crude drugs present the greatest initial irritation; whereas the higher show but slight changes in the same region; only causing, in fact, just that grade which developes characteristic symptoms of functional derangement, unmasked by the cruder inflammatory effects of large doses, in which every member of a class may equally partake if the doses be the inflammatory dose, in each case, so that high potency provings, though doing less damage to the organism in the way of anatomical lesion, may well give subjective symptoms, at least of greater purity than those made with massive doses. If the most extreme lesions be desired in proving, of course, the large doses are necessary; both have their value. Again, it will be noticed that in high potency irritations, hyperaemia is later in occurrence than is seen from the use of larger doses extending to that range which, being next to the period of restored health, we regard as secondary effects. In this, two points come to view, viz: the diverse development of symptoms from high and low doses, and the superior value of remote symptoms in the former and of the early symptoms in the latter case; true similarity involving a like initiation, as well as [A. C. M] 2 10 a like catalogue of symptoms, at least as to some general regional impression. Lastly, we find that with high potency irritation, hypervemia of distant, sympathizing regions, causing sympathetic and deceptive symptoms, occurs early, subsiding with reaction; whereas, in using low or crude preparations, these are less as a whole, and occur with the process of reaction, after becoming chronic. Hence, early, symptoms from large doses; late symptoms from high potencies, are, for a second reason, the purest and most characteristic. In diseases, even high potency medication often excites characteristic symptoms early. Still regarding the initial irritation as the typical action of a drug or other pathogenetic agent, we perceive that the morbid effect is pre-eminently engorgement of the irritated vessels, with corresponding nutritive changes, causing parallel symptoms, and increasing or diminishing with the doses. With this variation in the power of different doses to engorge the affected region, experience shows that the power of reaction in the opposite direction from that of the morbid impulse, varies in like proportion, being less as the violence of the initial irritation'exceeds the endurance of the vital organism,* and its ability to maintain the health standard, and being greater as the vital abilities exceeds the violence of the irritation; consequently the drug action-primary effect-is most conspicuous after large vital resistance, and reaction after small doses. Vital power differs with every person, so that a dose, small for one, may be excessive to another, or the same person at another time, and vice versa. Assuming an average, we may say that each drug, or other irritant, presents three distinct points in its posology, viz: 1. The dose which just balances the vital endurance. 2. The dose which over-balances this. 3. The dose which is itself overbalanced by the vital ability. Allopathy knows only the first two; the third it rejects. Homceopathy regards the first as neutral and useless, and so does allopathy. Homoeopathy holds the second to be pathogenetic, not curative. Allopathy holds it to be curative, although indirectly and without specific quality. Homceopathy claims the curative specific quality of the third dose, provided the remedy be the similimum. Allopathy regards this quantity as simply more *This vital energy is easily estimated by the general state of nutrition of the body. 11 inert than the first. This, being the merest assumption, and a negation at that, may be outweighed by a single fact, if, indeed, it be above contempt. If any one doubts, let himt sustain by a syllogism the opposite opinion. We may illustrate our position by the admission of the other side. The practice of most allopathic physicians affords instances of the use of emetic drugs in small doses, in gastric irritation. Let the well known emetic, ipecacuanha, furnish the example, for it was long ago used, either alone or as an ingredient, in the celebrated "Lady Webster's Dinner Pills"* for dyspepsia, so commonly attended with sickness of stomach. Now the doses given are comparatively small, and it is plain that the intended effect is just the opposite of that resulting from large doses. Instinctively, this similar remedy is employed in reduced doses, as Dr. Reith, our allopathic contemporary, boldly recommends in the case of aconite, though in the same breath refusing the logical sequence of his own argument. It follows from the opposite effects of large and small doses, thus illustrated and daily observed, that there is a medium dose which has neither effect; and this is the first of the three quantities before named, to wit: that which just balances the vital endurance and is therefore inert or neutral. It further appears that if we increase the dose above this point, the irritant effect increases. Again, the allopathist, exceptionally taking a single step in the opposite direction, secures, sometimes, the anti-irritant effect; if not, he inconsistently refuses to proceed, and fails. The homceopathist, going on in the same direction, reduces the quantity again and again, receding farther and farther from the neutral, inert starting point, wherein he is simply and logically consistent, thus succeeding. Experience at the bedside giving practical proof of this, the efficacy of our doses becomes at once a philosophical necessity and established fact. Continuing the ipecauanha example, we may now, using terms of general significance, say that large doses vomit, small doses arrest vomiting, medium doses have no effect: ergo, the largest doses are the most violent emetic; the smallest doses are most strongly anti-emetic. A diagram will aid in comprehension of this proposition. See Plate II, figure 1. * Sometimes, in our day, the ipecacuanha is significantly omitted. 12 The leading reason for this state of facts seems to be that the impression of a drug being heterogeneous or irritant, the vital organism sets up a counter action, or series of actions, for the purpose of resistance and expulsion of the morbid agent. There is no reason to doubt, however, that only by suitable stimuli can this resistance be induced, in natural diseases, the irritant cause having vanished. Hence the stimulus of solar and planetary forces seems essential to spontaneous recovery; medicines being sulstitutive or supplementary stimuli or force bearers. Without such forces, constantly and intelligently applied, morbid states must be perpetuated under the law of inertia, even if life itself could continue without such intervention. These natural stimuli being, therefore, per se, conditions of vitality. We may conclude then that the primary effect, whatever the stimulus or the dose, is the stimulant or irritant action proper; most marked after large doses; the secondary is the vital response of the organism in the direction of antagonism, i. e., systemic reaction, attempted at the very onset, but best maintained after minute doses, which, however, would seem to be not merely, as in common dead matter, equal to the original action; but also having received vital impulse, must, under the same law, provided no obstacle be encountered, go on in the same direction forever, by mere continuance of the attitude of the parts concerned in reaction, so induced. No such obstacle previously presenting, the organic equipoise or health line is, not without fluctuation, finally reached, and reaction terminates at that barrier. No dose is too small for this, if the agent be really present. Anatomical lesion, if great, may early prove a bar to reaction, demanding repetition of doses, and even crude forms, it may be. A diagram will aid in the comprehension of this also. See Plate II, figure 2. Let A be an elastic spring, firmly erected. B, a ball which strikes it from the right, moving it to C. The elasticity of the spring, representing vital power, returns the ball, on cessation of the original impulse, to A, to D, and finally far beyond to E, expelling it from its position entirely, as happens also with the drug. The spring, meanwhile, vibrates to and fro, illustrating periodicity, until at last it stands firmly in its normal place. If the original impulse were slight, quiescence must ensue the sooner and more easily, and although the original medicinal s!nister impulse from small doses, indeed be slight, the normal status is reached all the more quickly 14 Every physician of whatever school, in all probability range unconsciously, at times, over the whole series, with corresponding good or ill success; the homceopathist having the advantage of the guiding law. To resume: Whatever the theory of physiology and pathology, cellular or vascular, which may obtain the confidence of the medical profession, all are now agreed that the primary condition of life is nutrition; disease being only an error of the same. Therefore, the question of cell function and vessel function are subordinate, and we may add, these are in reality questions of methods rather than of results, and the dispute is as to the order of events rather than the entity of those events, both being included in normal, both disturbed in abnormal or diseased nutrition; in varied degree and proportion, it is true. All existing doctrines, except those of homoeopathy and chronothermalism, seem to agree in discarding as obsolete, the views reviewed a century ago by Brown, Mesmer, and others, concerning the agency of the forces, and particularly the nervous force, in producing health and disease, though all admit its implication in both normal and abnormal nutrition, to use the modern phrase.* Indeed, the old, like the new, systematists had little clear conception of this point; hence their transient influence. Science, too, is eclectic; the systematists, old and new, somewhat too partisan. May we not hope, in again calling attention to nerve force, in this connection, to be exempt from their mistake? In the classification of those agents which we call medicines, we have to bear in mind that they are such by virtue of their molecular pathogenetic forces, that is to say, their capacity of producing, in accordance with certain polaric or dynamic affinities, irritation and abnormal nutrition, somewhere in the body, so changng the totality of its functions and its polaric or dynamic relations as to constitute disease, just as occurs from other non-medicinal factors of the same morbid dynamism. Such, indeed, is the similarity of both, that we may assert that whether morbid agents be material or.immaterial, and whether their means of access to the minutiae of the organism be alike or * Hahnemann, although an opponent of Brown, so far agreed with him as to maintain the dynamic nature of diseases in general, which means the same as the debility of Brown. 16 The sun, therefore, is to he regarded in its relation to us, not of course, as the originator, but the depot of supply of that entity which we term force. The vegetable world receives its emanations directly, and appropriates the same to the purposes of nutrition, etc.; also, alternately, mediately, or indirectly through the earth which supports it, and probably through other planetary bodies more remotely. These are evidently periodic in increase and decrease. The animal world is influenced in like manner, doubtless by all these, but the peculiar nature of animal organization and life forbid the direct access of solar or planetary force to the minute structures except il an incomplete manner. Another channel of access is necessary, developing and storing up force and conveying it from point to point as required under the inducement of appropriate stimuli, material and immaterial, physical and psychical. This necessity is provided for in the nervous system. Force, however originated or supplied to the cell structures of a living body, is manifested to us on reaching these by all the phenomena of cell life, and we call it "cell force," and this varies in respect to the fertility of nutritive action, very nearly in the same proportion as the known sources and channels of force remain intact, and in particular those of nerve force. Since our present inquiry is one concerning mainly the susceptibilities of animal organisms of a high order, the nervous system thus becomes the main point of interest in connection with this subject of force, nutritive force, in both normal and abnormal conditions. In a word, then, we may regard the nervous system as a complex source and channel of force in addition to the direct agency of planetary and solar force, like to that of the vegetable world. As a source the grey neurine is to be considered, the white being the channel of conduction, and presenting antagonistic centric and excentric poles, each end of every nerve fibre being the one or the other. Grey neurine is not limited to the brain and spinal cord, therefore these are not the sole source of nerve currents. The whole body is more or less supplied with grey neurine, therefore nerve currents may originate in all parts of the body. Those which arise in the grey neurine of the nerve centres may be distinguished as centric; those arising at the opposite ends or poles of the nerves as excentric. Grey neurine, in both situations, 19 with incapacity in this respect.* See Plate I. The effect of mental emotion and will on the vascular system affords an interesting field for study in this connection. Again, an excentric drug, as ipecacuanha in high potency, anremic doses, by indirect promotion of distant hyper.emia and proliferation at the centric poles of the nerves concerned, will act as a tonic. And in like manner we may account for the apparently contradictory symptoms of our provings, even in respect to those on which we herein propose to base our classification, viz: morale, periodicity, etc.; for since these vary with the stages of the proving, as well as with the doses, causing both initial and remote effects, one of three things may mar the accuracy of the record. 1, The proper moments for observing such class traits may escape us. 2. The quantity of the doses may be such as to exaggerate some individuality, standing in the way of development of class signs in their characteristic order. 3. The timing.of the doses may be unfavorable to the same; each class of the four acting initially in its own class sphere; consecutively or sympathetically, everywhere else to the extent of its nerve connections. We must also keep in mind the fact that not all apparent periodic aggravations are really such. As for instance, " expectoration only in the morning," under pulsatilla, is not an aggravation at all, but an amelioration from dry cough in the evening, etc. In pursuance of the same point, we see the impropriety of fixing a uniform dose for provings, any more than for treatment of disease; since, as I have noticed, an individual whose temperament is of the same class with the drug, has most symptoms from moderately large doses; a contrary temperament, most from small and infinitesimal doses; and it is in the latter sort of cases that aggravations, by high potencies, often denied, but real as any others, arise in practice. Allusion having been made in the preceding paragraph to temperamental classes, it is enough to add that these are based upon the fact, elsewhere hinted at, that within those limits which consist with a state of average health, there exists, in the majority of persons, a preponderant erethism in one or other of the four spheres described; which is the temperamental basis of the individual. * The consequent deficit in its nervous influence on associated parts developes the conservative, sympathetic hyperemia therein. Here we also observe the dependence of vtttLity on organism. This is liable to fluctuations in sickness, from hour to hour, or clay to day, each temperament, as before stated, being peculiarly liable to the influence of those agents, material or immaterial, solar, planetary or medicinal, which act specifically in the temperamental sphere; moderate or small and rare doses, primitively, acting healthfully, or sedatively, anoemically; excess causing hypersemic disease. The signs of each in health, with the changes in disease, are given hereafter. The ancient classification of temperaments is thus superseded, or perhaps it were better to say, reconstructed on a new foundation. The classification of medicines is made by the symptoms, so far as known, of moderately large doses, the provings being continued long enough to confirm their class conditions, other drugs being added to the lists, according to analogy of chemical and symptomatic traits. In such provings an artificial diathesis supplants or else exaggerates the natural temperament; the class characteristics being ordinarily clearly marked; changing, however, when reaction sets in, into some co-related sphere requiring an antidote, it may be, of this last class; just as the remedial use of the same remedy may be followed by a like necessity for the same consecutive drug in curing a given case of disease. Affinities and comparisons among related drugs, differing in class, thus assume great value, and in the use of low potencies, we may even predict the consecutive remedy a day or two in advance, in acute cases. Before stating the characteristics of the classes, either of temperaments or the casual general states observed in disease, or of the corresponding drugs, the grouping and titles of the last named may be given and accounted for in a general sort of way. Thus: Class first, the organic centrics, or ganglionics, consists, so far as ascertained, of but two remedies: aconitum and veratrum viride. Class second, the animal centrics, or spinants, comprise all the narcotics and bitters, so called in allopathy. Nux vomica is a type of the class. Class third, the organic excentrics, or anti-ganglionics, comprise the common acrids, alkalies, salines and acids, of which pulsatilla is a general type. Class fourth, the animal excentrics, or anti-spinants, includes a variety, as alcoholic liquors, all the aromatics, the feetid and pungent substances, the oleo-resins and gum-resins, the anti-spas 22 with the oleo-resins and gum-resins; and naturally, the "vegetable astringents," all containing tannic acid, go with these, though bordering on another class, containing other organic acids. Nature, indeed, abhors the trammels of aly absolute lines of classification and distinction. So, it may be as difficult, at times, to say absolutely where a drug belongs, as to declare whether a very low animal is not, after all, more a vegetable in its qualities. Finally, the volatile nature of the oleo-resins, coupled with their stinulant quality, associates with them other substances similarly endowed, viz: the aromatics, the alcoholic substances, and the ethers. All these, then, mainly and primitively affect the peripheric or terminal, excentric portion, or the "excentric poles" of the animal nerves. The fourth class, above described, being composed of apparently diverse elements, illustrates the rest, but the others may be briefly touched upon also. Thus, most of the first and second classes depend on an alkaloid active principle. But this is a decidedly less distinctive point for them than is their pathogenetic record-particularly in separating these two centric classes from each other. Thus, the first class, as aconite, clearly affect the organic tissues most; whereas, the second class (instance, nux vomica) as clearly bear most on the animal organism, together with such viscera as are freely supplied by nerves of animal life, as the liver, stomach, etc. Further, none of these cause any local change of importance in either viscera, muscles, or organs of sense, when applied to their tissues directly-yet how marked is their indirect effect I Only through the nerves which supply them, can this be brought about I Therefore, the inference by exclusion is, that their initial action is in the corresponding nerve-centres. Learning, now, from their pathogeneses, what else they have in common, especially as to diathetic generalities,.we may, in studying any new remedy, on finding like traits strongly marked in the proving, by moderate doses, slowly and long taken-the typical posology for purposes of class diagnosis-we may at once assign it to the same class; as has been done with certain of the "New Remedies." But it must be kept in mind that the primitive action is, conformably to Hahnemann, the typical one for classification; and besides, that the primitive effect of an infinitesimal dose resembles, measurably, the consecutive effect of a large one. Therefore, undue haste in determining the class of a drug, alone from provings, should be cautiously avoided. 27 sickness. No real "vacillation" is seen in either. That which indicates nux vomica of the second class, is rather a result of conflict between a willful determination, and the superior claims which demand a contrary course; whereas a real vacillation is an excentric sign, and is the fruit of insufficiency of will; a distinction which ought to be more generally made. In both centric types, the predominant periodic erethism occurs between midnight and noon, though the admixture of excentric elements in the constitution, sometimes masks the fact by minor erethism in other parts of the twenty-four hours, as in the afternoon symptoms of aconite, of the first, and belladonna, of the second class. Again we note a distinction between classes one and two; the erethism of the former, the ganglionic, being mainly between 12 and 3 o'clock at night, and from 9 to 12 in the daytime; whereas that of class two, the spinal, occurs mainly between 3 and 9 A. M. Finally, if two men, respectively of classes one and two, enter into any business together; the former becomes at once the leader of enterprises; the latter, the manager of them. Both may still be used by others; the first by seconding, or appearing to second his blows; the last, by furthering, or appearing to further his schemes. Both, however, victimize persons of the other two classes, with facility, when unrestrained by principle or otherwise. General Likeness of Excentric Types.-Both class three and four are in common characterized by a strong line of distinction from the two centric classes-i. e., whereas the centrics are characteristically impressive, the excentrics are decidedly impressible. General Distinctions between Classes III and IV.-They differ from one another, however, markedly, in that, whilst the organic excentric, anti-ganglionic, or third class, have the quality of inertia, the animal excentric, anti-spinal, or fourth class, exhibit sympathy and sensibility as a prevalent condition. Mingled, as they usually are, proportionally, these modify each other. The four classes may here be briefly compared, thus, the first, with the Northern mountaineer, who pursues the agile game from crag to crag, with a singleness and fixity of purpose which insures success, and overcomes all obstacles; the second, with the careful merchant who plans the purchase and sale of the product of the chase, and of the merchandize required in return by the hunter; 33 complexion is, normally, finely and universally crimsoned; but certain localizations (" habits," aforesaid) and certain climates (as the tropics), and also certain modes of life, greatly affect and modify this. The organs and tissues of the sphere are of course active; the senses are quick; the eye is bright, meaning, restless; the features mobile and expressive; blushing readily occurs (in youth); the manners are sprightly. In sickness, languor and indolence, or great excitability and restlessness, change or exaggerate all these signs. Illustrated by gelsenminum and coffea. Partly for the sake of contrast, the two excentric temperaments may here be be considered together more at length, as has already been done with the two centrics. Both excentric types of erethism and temperament being characterized in common by impressibility, as already shown, we repeat that they yet differ essentially in the fact that the organic type tends to inertia, whilst the animal is marked by sympathy and sensitiveness. The former bears repeated doses of medicine with ease; the latter is easily wrought up, even by high potencies, to violent aggravations, with febrile or nervous symptoms; especially if the medicine be foreign to this class. In the organic, the skin is comparatively flabbyvarying in color with the "galvanic" relation of inner and outer parts; darker and tougher when the skin is predominantly active; delicate, if the mucous membranes. In the anti-spinal, however, it is either fine and crimson, or more dense and brunette, or even leaden. The eye may in both be alike in softness; but in the anti-ganglionic, rather immobile; whereas, in the anti-spinal, it is inclined to flash. The former is captivated by "creature-comfort;" the latter, by sentiment, feeling, thought. In both, the morale corresponds with these external and social characteristics. Thus the anti-ganglionic tends to apathy, sadness, hopelessness, inertia-or else to the cool boldness of non-appreciation. The whole vital voice is organic. Disease here takes close hold of tissue; vital resistance is slight; anatomical lesion is set up (this being, indeed, its great sphere) very soon, close upon the heels, as it were, of functional derangement, or rather, coincidently with it. On the other hand, the anti-spinal, whilst easily receiving impressions, is speedily roused to active response, and develops a keen appreciation of all influences, agreeable or otherwise; and is of changeable morale. Violent diseases may occur, in which, sometimes, the keenest pains are suffered; but withal, they do not equal, in shock to the vitality, and gravity of symptoms, similar [A. C. M.] 5 34 conditions in the other sphere, with which, however, it is, we may again say, anatomically combined by contiguity; yet only a few of the worst cases in the anti-ganglionic sphere, equal the antispinal in external demonstrativeness, under pain. Extreme erethism in the anti-ganglionic sphere is commonly marked by utter prostration in the anti-spinal, by spasm, paraly. sis or coma. In meningitis,* with effusion, the same may obtain in the former, also, combined with the proper class-signs; but in the latter, languor occurs, in lieu of real prostration. The periodicity of the anti-ganglonic sphere has already been stated. That of the anti-spinal, or animal excentric, is most varied and composite, as though made up of the periodicities of the other spheres; the most typical being compounded of morning and evening erethism, or any other two daily periods. Thus, the increase of erethism, marked by disturbed sleep, or uneasiness of some kind, may occur in the afternoon and evening, or, evening and midnight, or midnight and morning, or morning and forenoon, or forenoon and afternoon, or morning and evening, or all dayt only, or all nightt only; and yet other combinations. In grave anatomical lesions, which involve all the four spheres more or less prominently, these periods, which seem to show the vital resistance, are in great measure suppressed, until restoration and convalescence begin. Sometimes, even when clearly marked, it is impossible, owing to the influence of conventionality, to elicit from an individual, any evidence of the real periodicity, morale, etc., except after the most rigid cross-questioning and explanation. Even then it is not always possible. In this, and all similar emergencies, we have to rely on other class-signs, as physiognomy, manners and complexion, as well as the "keynotes," or " characteristics," "totalities;' using any and all the means at hand for the proper selection. In sickness, as already stated, persons belonging to this fourth class, will usually present a restless eye, nervous mobility, exquisite sensibility to pain, solicitude about their surroundings; or general feverish languor, with flushed face, suffused eyes, drowsiness and quiescence, or else irregular muscular motions. For such a state, attending a febrile or inflammatory affection, aconite could not but do mischief. Gelseminum would be probably curative. * The cerebro-spinal meninges largely involve class III. t These are sometimes simulated by the third class. 37 Ignatia. Quassia. Kalmia. Rhus tox; and rad. Lachesis. Secale. Laurocerasus. Spigelia. Lobelia inflata. Stramonium. Nux vomica. Tabacum. Opium. Class II1. "Anti-ganglionics,". "Organic excentrics," "Pulsatilla type," comprises the drugs known as "Acrids," or "General Irritants," by many, and divided thus: Group A.-The halogen elements, the alkalies and alkaline earths, with their carbonates and borax. Group B.-The simple acrids, some of which, by chemical constitution, are allied with the other groups, in inferior degree, yet so as to give occasion for preference in individual instances. Group C.-The salines. Group D.-The acids, in general. These groups, in the order named, approach in properties, class IV. Such medicines as apis, bryonia, causticum, helleb ore, etc., which stimulate cerebral action, appear rather to influence the meningial tissues, in fact; those being decidedly of the organic periphery; notwithstanding the consequences to the animal functions. GROUP A.-ALKALIES, ALKALINE EARTHS, HALOGENS, ETC. Ammonium carbonicum. Corallium. Ammonium causticum. Iodium. Baryta carbonica. Kali carbonicum. Borax. Lithia carbonica. Brominum. Magnesia carbonica. Calcarea carbonica. Natrum carbonicum. Calcarea caustica. Spongia. Carbo vegetabilis-(kali carb.) Strontiana. Causticum. GROUP B.-COMMON ACRIDS. Many are allied with other groups or classes; a, like group A; c, like group C; d, like group D; e, like class IV. Aloes. Arum triphyllum. Antimonium crudum. Bryonia. Apis mellifica. Caladium. Apocynum cannabinum. Calcarea phosphorica. 38 Cantharis. Petroleum. Carbo animalis (Calc. phos.). Phosphorus. Chelidonium. Phytolacca. Cinnabaris. Podophyllum. Clematis. Pulsatilla. Colchicum. Ranunculus-bulb. and scel., etc. Creosotum. Rheum. Croton tiglium. Rhododendron. Daphne indica. Sabadilla. Dioscorea. Sanguinaria. Dolichos. Sarsaparilla. Euphorbium. Scilla. Gambogia. Selenium. Guaiacum. Senega. Helleborus niger. Senna. Hepar sulphuris calcarea. Staphysagria. Ipecacuanha. Sulphur. Iris versicolor. Taraxacum. Jatropha curcas. Tartarus emeticus. Leptandra virginica. Tellurium. Lycopodium. Urtica urens. Mercurius sol. (viv. and corr.) Veratrum album. Mezereum. Viola tricolar. GROUP C.-SALINES. Ammonium bromatum. Kali nitricum. Ammonium muriaticum. Magnesia muriatica. Kali bichromicum. Natrum muriaticum. Kali bromatum. Natrum sulphuricum. Kali hydriodicum. Sepia. GROUP D.-ACIDS. Acetic acid. Nitric acid. Arsenicum album. Phosphoric acid. Citric acid. Silicea. Fluoric acid. Tartaric acid. Muriatic acid. Class IV. "Anti-opinants," "Animal excentrics," "Zincum type," comprises the (1) alcoholic, (2) etherial, (3) foetid, and (4) aroma 43 better by hot applications; not thirsty. Cured by six doses of arsenicum 200. Case 19.-A gentleman of swarthy complexion had yellow fever; treated allopathically. Afterwards complained, impatiently, but in a jocose manner, that his "' spleen filled half his abdomen." He was himself a physician. Relieved after one dose of nitromuriatic acid, strength of the U. S. Pharmacopoeia; ten drops, in water, two ounces. CLASS IV. Case 20.-A swarthy lad, got cold feet and hands, and general chilliness towards night, followed by heat all night, with sleep; throat sore and full; sensitive manner. Cured by three doses of gelseminum 1000 Case 21.-A babe, brunette, recovered from whooping cough; took cold; coughed and retched; worse afternoon; sleepless towards morning "composite periodicity"; excitable manner. Cured by three doses of cuprum 200. Case 22.-A rosy, excitable lady got measles, which did not come out well, until after pulsatilla. Then, had fever every day, after 12 o'clock, noon, with much excitement, until night. After aconite, became wild and restless, vomiting and purging; early in the morning watery, smelling and tasting of faeces. Relieved immediately by one dose of coffea 200. The excitable morale, the composite periodicity, and the natural high color, are proper to class IV. But some "nervous" cases have only a sickly color; and the same occurs in organic disease. Case 23.-A pregnant lady, of sensitive temperament, got colicky diarrhoea; cutting pain only with the stools, doubling her up; sickly appearance; worse evening and morning. Relieved by repeated doses of colocynth 6 Case 24.-A little girl, whose sensitive cutaneous surface had been exposed to the heat of the weather, and to cold, also got diarrhoea, large, thin, painful stools; sitting on the vessel, screaming. At other times drowsy, sleeping much. Skin cool. When awake, sensitive and peevish. "Composite periodicity." Cured by nux moschata 200, in repeated doses. The foregoing are illustrative cases, nearly all from recent practice, of the practical use of this classification. A few may now be added, showing the proper procedure in cases of conflicting indications.