MANUAL OF HOM E OPATHIC THEORY AND PRACTICE, WITH AN ELEMENTARY TREATISE ON THE HOMOEOPATHIC TREATMENT OF SURGICAL DISEASES, DESIGNED FOR STUDENTS AND PRACTITIONERS OF MEDICINE, AND AS A GUIDE FOB FAMILIES AND AN INTELLIGENT PUBLIC GENERALLY,. BY CHARLES J. HEMPEL, M. D., PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE HOM(EOPATIIOC MEDICAL COLLEGE OF PENNSYLVANIA, AND JACOB BEAKLEY, M. D., PROFESSOR OF SURGERY IN THE HOM(EOPATHIC MEDICAL COLLEGE OF PENNSYLVANIA. PUBLISHED BY WILLIAM RADDE, PHILADELPHIA: No. 635 ARCH STREET. NEW YORK: No. 300 BROADWAY. 1858. __ Entered according to Act of Congress, in the year 1858, b WILLIAM RADDE, JR. In the Clerk's Office of the District Court, in and for the Eastern District of Pennsylvania. Stereotyped and Printed BY KING & BAURD, PIIL&DELPHIA. - ---- -- PREFACE. SEVERAL years ago we published a Domestic Phy. sician, two editions of which were rapidly exhausted. In the meanwhile, a number of domestic works on Homoeopathic practice made their appearance, which seemed to supersede the necessity for a third edition of our own work. The present publication is intended to supply a want which the popular works on Homoeopathic practice now existing have left unsatisfied. It is not only designed for the public generally, among whom the interest for Homoeopathy is rapidly spreading from year to year; it is likewise adapted to students and practitioners of medicine, who wish to obtain a first initiation into the principles and practice of the Homoeopathic school. It was found to be a very difficult task to conciliate the demands of science with the simplicity of popular style and arrangement of materials. We have endeavored to do justice to each, although we arc persuaded that it is impossible to so completely democratize the forms of Science as to render them accessible and attractive to all minds. Nevertheless, we feel satisfied that the end we have had in view in perfecting this work, has been attained, if only approximatively. The __ iv PREFACE. intelligent layman will find this work a reliable guide in his own limited sphere of practice; and the student of Homoeopathy, and the young and still inexperienced practitioner of this system, may study this work as a simple, but tolerably comprehensive exponent of the principles of our School. Students of medicine and alloeopathic practitioners, are often puzzled what to do with our ponderous and intricate Materia Medica. This work will not only give them an initiatory knowledge of our principles and practice, but will also satisfy all the ordinary exigencies of professional business, and pave the way for a complete reception of our doctrines. In regard to doses, we have often found it necessary to recommend the strong tincture, and the first, second or third trituration or attenuation of liquid medicines. If no particular potency is indicated, the fourth or sixth may be used indiscriminately. We are responsible to the public for the whole of this work, except the Treatise on Surgical Diseases, which is due to the pen of our friend and colleague, Dr. Beakley, and may be looked upon as the precursor of a larger and original work on Surgery, which the Doctor is now preparing for the Homoeopathic profession. CHARLES J. HEMPEL, M.D. PHILADELPHIA, June 12th, 1858......... ow SYNOPTICAL DISTRIBUTION OF THE SUBJECTS TREATED OF'IN THIS WORK. PART I. PHYSIOLOGY AND PATHOLOGY.-Use of health. God has given us the means to cure disease. What is necessary to a cure? Improvements in the healing art. Homoeopathy is a truly humane and popular mode of treating disease. All science was originally based upon illusions, also the science of medicine. Errors of the humoral pathology. Wrong practices of the old school, such as bleeding, vomiting, purging, etc. Errors of the Chemical School of Physiology. The vital functions cannot be satisfactorily accounted for upon merely chemical principles. Chemical theory of animal heat, and its application to the phenomena of fever. Fallacies of this theory. Principles embodied in every vital phenomenon. These principles illustrated by the process of digestion. Circulation of the blood. Physiology of the circulation. Theory of fever. The proximate cause of fever resides in the nervous system. Explanation of the heat in fever. Conditions which must exist to produce fever. Palliative treatment. " Contraria contrariis" is the leading principle of this treatment. Expectant method. Counter-irritant method. 2 (1) __ ~ ~ SYNOPTICAL DISTRIBUTION OF THE HOM(EOPATHY. THE HOMOEOPATHIC LAW OF CURE. Origin of medicine. The development of the healing art has been marked by untold suffering. The most distinguished physicians have repudiated their own art. In what manner did man derive his first knowledge of drugs? Genius was necessary to infer the true principle of cure from the accidental effects of drugs. Homceopathy was known even in olden times. Hahnemann the discoverer of homceopathy. "Like cures like," the fundamental principle of homceopathy. Necessity of proving drugs on the healthy body. Homoeopathic Materia Medica. Mode of preparation of homoeopathic medicines. The first or primary action of drugs does not effect the cure; the vital reaction does. Medicinal aggravations, their truth and fallacy examined. What constitutes the power of a drug, in reference to disease? Difference of action between the alloeopathic and homceopathic remedial agents. Explanation of the modus operandi of a homoeopathic remedial agent. Existing misapprehensions about homoeopathy in the public mind. Triturations. Dynamization or potentization. The medicinal power of a drug is developed by breaking up the cohesion of its molecules. Spiritual or aromal principle of a drug. Gradual growth of the doctrine of potencies. What this doctrine implies. What potencies or attenuations should be principally used? Gradual introduction of the higher potencies. How, or in what form, should the medicine be administered to the patient? Globules, powders, watery solutions, drops, smelling. Progressive solutions. Endermatic use of homoeopathic medicines. Size of the doses. Upon what it depends. In what cases larger, and in what cases smaller doses should be given. The student of homoeopathy should never fail to examine SUBJECTS TREATED OF IN THIS WORK. for himself. Repetition of the dose. Frequency of the dose in acute and chronic cases of sickness. Alternation of medicines. No more than two medicines should be used in alternation. One medicine is sufficient in most cases. Origin of the method of alternating several medicines at one and the same time. Impropriety of mixing up drugs. Examples of homoeopathic treatment taken from old school practice. HYGIENE.--What is meant by hygiene. DIET. Different views in regard to the use and preparation of food. Some propose to eat everything raw. Some abolish the use of meat. Fallacies of these doctrines. On the use of meat. Necessity of using meat in the present impoverished condition of the globe. Impropriety and hurtfulness of eating too fast. Injurious effects of eating fat. List of articles digested in a specified time. List of articles containing a certain quantity of nutritious matter. The inhabitants of cold climates require fat food; those of warm climates require more fruit. Remarks on certain articles of diet, meat, vegetables, etc. Total abstinence. On the use of wine. Propriety of using it. General rules concerning diet. List of aliments which are allowed under homoeopathic treatment. List of aliments which are forbidden under homoeopathic treatment. Remarks thereon. EXERCISE. Walking. Riding on horseback. Dancing. Fencing. Sawing and splitting wood. Gymnastic exercises. CLOTHING. Object of clothing-fashion, protection. Injury from tight shoes. All sudden changes in the amount of clothing should be avoided. VENTILATION. Ill effects of deficient ventilation of cities and houses. Difference between ventilation and a current of air. Precautionary measures in ventilating apartments. Danger of being exposed to ---- SYNOPTICAL DISTRIBUTION OF THE draughts of air. WATER. USES OF WATER: Cleanliness. General ablutions. Cooling. Drinking. Medicinal purposes; hydropathic treatment, or the so-called watercure treatment. Principal operations with water under the water-cure treatment: bathing; sweating,--superior advantages of homoeopathy in this respect;-plungebath; shower-bath; douche; partial baths; wet bandage; injections. DIAGNOSIs.-Obscurity of diagnosis in former periods. Importance of simplifying the diagnosis of disease. General diagnostic signs: fever, pulse, periodical recurrence of the paroxysms of fever, or uninterrupted continuance of the fever, with or without exacerbations at particular periods; pain; nature, locality and duration of the pain, its permanent continuance or its disappearance and recurrence at regular periods; condition of the secretions; sweat, alvine evacuations, urine; condition of the brain and nervous system; condition of the patient's spirits, mental faculties; condition of the gastric functions, appetite, thirst, appearance of the tongue, taste, absence or presence of nausea, vomiting, etc.; color of the skin, eyes, etc.; sleep, dreams, phenomena experienced during sleep; condition of the chest, cough, expectoration, oppression, pain, etc.; condition of the spine, shape and soreness of the spine, etc.; hereditary or acquired character of the disease; temperament, age, sex, and general occupation of the patient. Names of diseases; origin and rationale of names. _ __ __ I~ ~Ld-*--C-------~--~--~--L--~---~I--~--~ SUBJECTS TREATED OF IN THIS WORK. 5 PART II. DISEASES OF THE MIND: Consequences of disappointments, sudden or violent passions or emotions; hypochondria; melancholia; hysteria; mania; weak memory, or loss of memory. FEVERS: General remarks on fever. (See the Essay on Physiology and Pathology.) Simple catarrhal or irritative fever; inflammatory or synochal fever; gastric fever; bilious fever; bilious remittent fever; congestive fever; intermittent fever; fever and ague; apoplectic intermittent fever; typhoid or nervous fever; typhus fever, cerebral, pulmonary, hepatic, abdominal, putrid or malignant; ship fever; jail fever; hospital or epidemic typhus; yellow fever; lentescent, hectic or consumptive fever. DISEASES OF THE NERVOUS SYSTEM. CEREBRAL DISEASES: Rush of blood to the head; vertigo, dizziness; sea-sickness; apoplexy; inflammation of the brain; hydrophobia; insolation or sun-stroke; delirium tremens; headache from various causes; nervous headache or hemicrania; catarrhal and rheumatic headache; headache from derangement of the stomach; congestive headache; headache caused by sudden emotions; headache from exposure to the sun or from mechanical causes; acute inflammation of the spinal cord and its membranes. General and local Nervous Affections: Neuralgia of the brain, face, teeth, heart, stomach, bowels, extremities; 2" SYNOPTICAL DISTRIBUTION OF THE cramp in the leg; general and partial paralysis of the extremities, face and jaw; fainting, swooning; epilepsy; chorea or St. Vitus' dance; tetanus, trismus, lock-jaw; catalepsy; twitching; nervousness; fatigue; over-heating, nervous debility; innervation; marasmus, atrophy or nervous consumption; pain in the back, spine-disease, irritation of the spinal-marrow; lumbago; palpitation, tremor, fluttering and spasm of the heart; spasms and convulsions. EXTERNAL, CUTANEOUS DISEASES; Acute Eruptive Fevers: Rash; hives; nettle-rash or urticaria; measles; rubeola; scarlet-fever, scarlatina; scarlet-rash; purplerash; small-pox or variola; varioloid; chicken-pox; erysipelas or St. Anthony's fire; purpura haemorrhagica. Chronic Eruptions and External Diseases: swellings, tumors; mumps; boils; carbuncles; chilblains; corns; indurations of the skin; warts, wens, ganglia; whitlows; felons; sores, ulcers; abscesses; goitre; swellings and tumors; mumps; swelling of the glands; scirrhus, cancer; irritation of the skin; unhealthy skin; itching, pruritus; freckles; hepatic spots; excoriations, chafing, soreness, intertrigo; chapped hands; itch, scabies; eczema; saltrheum; herpes, tetter; ring-worm; acne; scald-head or tinea capitis; falling off of the hair, alopecia. GENERAL DISEASES: Rheumatism, acute and chronic; rheumatic pains; gout; arthritis; inflammation of the psoas-muscle; abscess of the psoas-muscle; pains in the loins; sweaty feet; tuberculosis and scrophulosis; cholera morbus; Asiatic cholera. DROPSICAL EFFUSIONS: Effusions into the cellular tissue, anasarca; dropsy of the brain, hydrocephalus; dropsy of the chest or hydrothorax; dropsy of SUBJECTS TREATED OF IN THIS WORK. 7 the pericardium; dropsy of the abdomen or ascites; dropsy of the scrotum or hydrocele; dropsy of the kneejoint; dropsy of the spine or spina ventosa. DISEASES OF THE DIGESTIVE ORGANS, teeth, mouth, throat, stomach, bowels, liver: Toothache of odontalgia; caries or decay of the teeth; gum-boil; foul breath; bad taste in the mouth; canker-sores; stomach-ache; ulceration and swelling of the jaw-bone; scurvy; ptyalism or salivation; inflammation and swelling of the tongue, glossitis; paralysis of the tongue; difficulty of speech; stammering; ranula or swelling under the tongue. SORE THROAT: Angina faucium, tonsillaris, uvularis; quinsy sore throat; ulcerated sore throat; malignant quinsy. Loss OF APPETITE: Anorexia; voracious appetite, or bulimy; indigestion; weak stomach; dyspepsia; wind on the stomach; flatulence; eructations; water-brash; heart-burn; acid stomach; pyrosis; derangement of the stomach; bilious derangement; nausea, vomiting; spitting up of the food; vomiting of blood; vomiting of bile; impropriety of using emetics for this condition; spasm of the stomach, cardialgia; stomach-ache; colic; bilious colic; bloating of the bowels; congestion of the bowels; inflammation of the diaphragm, diaphragmitis; inflammation of the stomach, gastritis; inflammation of the bowels, enteritis; inflammation of the peritoneum, peritonitis; inflammation of the liver, hepatitis; liver complaint; jaundice; inflammation of the spleen, splenitis; weakness of the bowels; constipation, costiveness; diarrhoea, bilious diarrhoea, chronic diarrhoea; constant urging to stool; dysentery, inflammatory, bilious;, piles CI~ _ _~ _ 8 SYNOPTICAL DISTRIBUTION OF THE or haemorrhoids, blind, and flowing; haemorrhoidal tumors; impropriety of treating them surgically; worms and worm affections; itching and soreness of the anus; prolapsus of the rectum and anus; fistula of the rectum. DISEASES OF THE URINARY AND GENITAL ORGANS: Inflammation of the kidneys, nephritis; inflammation of the bladder, cystitis; strangury; ischuria; inability to pass urine; incontinence of urine; enuresis; diabetes; hmmorrhoids of the bladder; polypus of the bladder; bloody urine; hmmorrhage of the bladder; purulent urine; gravel, calculus, stone; soreness of the penis in children; inflammation and swelling of the testicles; ill effects of onanism; eruptions on the genital organs; ulcers; syphilitic ulcers or chancres; inflammation of the urethra; discharges from the urethra, caused by worms; inflammation; gonorrhoeal discharge, primary and secondary, clap, gleet, consequences of a sudden suppression. DISEASES OF THE RESPIRATORY ORGANS, larynx, lungs, pleura: Hoarseness; loss of voice or aphonia; catarrh, with or without fever; cold in the head; influenza; inflammation of the air-passages, or bronchitis, acute and chronic; pulmonary catarrh; cough; croup; determination of blood to the chest; congestion of the lungs; inflammation of the lungs, or pneumonia; pneumonia of little children; pneumonia of old people, or pneumonia notha; inflammation of the pleura or pleuritis, pleurisy; false or spurious pleurisy, or a stitch in the side; blood-spitting, hvemorrhage from the lungs or hemoptysis; pulmonary consumption, pulmonary tubercles; angina pectoris; asthma, asthma millari; diseases of the heart; inflammation of the -C---~--~---~--~--~-L------- SUBJECTS TREATED OF IN THIS WORK. heart, rheumatism of the heart, carditis, endocarditis, pericarditis; dropsy of the chest or hydrothorax. AFFECTIONS OF THE JOINTS: Pain in the hip, hip-gout, hip disease, sciatica, coxagra: affections of the knee; inflammation of the knee-joint, dropsy of the knee-joint, scrofulous enlargement of the knee. AFFECTIONS OF THE BONES: Inflammations, swelling, periostitis; rickets. AFFECTIONS OF THE EYES: Acute inflammation of the eyes or ophthalmia; chronic inflammation, sore eyes; scrofulous, rheumatic, arthritic, syphilitic, traumatic ophthalmia; inflammation of the lids; swelling of the eyelids; styes; weeping or lachrymation; weakness of sight; amblyopia, blindness or amaurosis; near-sightedness or myopia; far-sightedness or presbyopia; squinting or strabismus; cataract, glaucoma; falling or paralysis of the eyelids; eversion and inversion of the eyelids. AFFECTIONS OF THE EARS: Inflammation of the ear or otitis; earache or otalgia; deafness, hardness of hearing; discharges from the ears; noises in the ear; sore ears; polypus in the ear; foreign bodies in the ear. AFFECTIONS OF THE NOSE: Sore nose, inflammation and swelling of the nose; itching of the nose; bleeding of the nose or epistaxis; catarrhal and scrofulous discharges from the nose; suppressed catarrh; dryness of the nose, impropriety of taking snuff for it; ulceration of the nose, ozmena narium; ozmna of the antrum Highmorianum; polypus in the nose; cancer of the nose. 10 SYNOPTICAL DISTRIBUTION OF THE AFFECTIONS OF THE FACE, LIPS, JAWS: Inflammation and swelling of the face; erysipelas of the face and lips; prosopalgia, face-ache, tic douloureux (see neuralgia); eruptions in the face; freckles (see freckles under cutaneous diseases); warts and spots (see warts); cancer of the face. SLEEP, deranged wakefulness, dreams, nightmare, etc. PART III. DISEASES OF FEMALES.- General remarks on the nature and treatment of these diseases; Menstruation: menstrual irregularities, suppression or amenorrhcea; retarded appearance of the first menses, chlorosis or green-sickness; painful menstruation or dysmenorrhcea; profuse menstruation or metrorrhagia, flooding; premature menstruation; delaying and scanty menses; change of life, critical period, cessation of the menstrual flow; prolapsus, or falling of the womb; prolapsus, or falling of the vagina; leucorrhcea or fluor albus, whites. Pregnancy: Symptoms of pregnancy; rules to be observed during pregnancy, in regard to exercise, diet, clothing, conversation and social intercourse, mental and bodily employment, emotions, derangements and diseases occurring during pregnancy: nausea and vomit. ing; itching of the vagina or pruritus; menstrual appearance; varicose veins; spots, hepatic spots; constipation or diarrhoea; fainting, hysteric paroxysms; toothache; swelling of the face; pains in the back and SUBJECTS TREATED OF IN THIS WORK. 11 loins; miscarriage; premature birth; labor-pains; false labor-pains, spasmodic pains, cramps and convulsions, or eclampsia; adhesions of the placenta; flooding; after-pains; treatment after delivery; duration of confinement; sore nipples; milk-fever; inflamed breasts; caking of the milk, ague in the breast; gathered breasts; suppression of the secretion of milk; excessive secretion of milk, galactirrhoea; bad milk; refusal of the child to take the breast; weaning; constipation or diarrhoea of lying-in-women; lochial discharge; canker-sores in the mouth; inflammation of the womb or metritis; puerperal fever, child-bed fever. PART IV. TREATMENT OF INFANTS: Treatment of infants after delivery; apparent death of new-born infants, asphyxia, still-born; swelling, elongation of the head; umbilical hernia; expulsion of the meconium; diet of infants; nursing, feeding, necessity of attending to their wants; colic; crying and sleeplessness of infants; snuffles; cold in the head; stoppage of the nose; swelling of the breasts in infants; ophthalmia; hiccough; regurgitation of the milk; flatulence, acidity; milkcrust or crusta lactea; thrush or aphthe; constipation and diarrhoea; summer-complaint; incontinence of urine; retention of urine; soreness, excoriations; jaundice; complaints incident to dentition; spasms and convulsions; tumors and swellings; infantile remittent fever; vaccination. SURGICAL DISEASES. SURGICAL DISEASES. IRRITATION, Inflammation, Suppuration, Mortification, Granulation, Cicatrization. Abscess. Whitlow, (or Felon). Furunculus, (or Boil). Anthrax, (or Carbuncle). Psoas or Lumbar Abscess. Ulcers, Cutaneous, Varicose, Menstrual, Sanious, Venereal, Mercurial, Irritable, Inflamed, Indolent, Phagedenic, Gangrenous. Scalds. Burns. Diseases of the Eye, Ear, Throat, Thorax, Abdomen. Urinary Organs.-Kidneys, Ureters, Bladder. Organs of Generation.-Penis, Testicle, Prostate Gland, Vesicula Seminalis, Uterus. Disease of the Rectum.-Haemorrhoids or Piles. Diseases of Joints.-Morbus coxariuA, White Swelling. Wounds: Incised, Contused, Lacerated, Punctured, Poisoned, Wounds of the Scalp, Face, Neck, Thorax, Lungs, Heart. Wounds of the Abdomen, Stomach, Intestines, Liver, Gall-Bladder, Pancreas, Spleen, Kidneys, Bladder. Wounds of Blood-Vessels. Wounds of Joints. Injuries of the Head.--Concussion, Compression, Fracture of Skull, Spine, Joints; Sprains, Dislocating Fractures. __ ~_I_ ~___~~__ ___ _ ~ AN ESSAY, EXPLANATORY OF THE MOST IMPORTANT PHYSIOLOGICAL FUNCTIONS AND ANATOMICAL RELATIONS OF THE HUMAN BODY. THIS ESSAY SHOULD BE READ BY EVERY ONE WHO DESIRES TO USE THIS WORK UNDERSTANDINGLY AND PROFITABLY. HEALTH is one of the greatest blessings which man enjoys in this life. Without health, it is almost impossible to accomplish much good in the world, and it should therefore be every body's earnest endeavor to study and live up to the conditions of health. It is wrong to suppose, that because the Creator allows sickness to exist in the world, it is therefore an unavoidable element in our earthly state. If, on the one hand, God allows sickness to befall us, he has, on the other hand, given us reason to provide against and neutralize it. We have it in our power to investigate and remove the causes of disease; and it is a well known fact that, although there is yet much physical suffering in the world, the average mortality of mankind is less, and the average amount of physical well-being greater, now, than it has been at any 3 (13) 14 AN ESSAY ON THE ANATOMICAL previous period of human history. Disease must necessarily decrease in proportion as man succeeds in subduing the surface of the globe, and regulating the influences to which he is exposed, agreeably to the laws which govern his own being. It is the study of these laws, and their application to social life, including education, government, industry, and so forth, that will gradually redeem man from sickness, and render this earth what the Creator originally designed it should be, an abode of good and happy beings. But until the conditions of health are fully and permanently realized all over the globe, there will be more or less sickness; in other words, the normal functions of the body will be disturbed by a variety of causes, and such disturbances will be characterized by a variety of painful sensations and appearances, which we will designate as morbid phenomena. The study of the nature, cause and relation.of these phenomena has, from time immemorial, been a subject of high interest to man, and now constitutes one of the most important branches of human knowledge. It would seem as though a proper knowledge of the morbid phenomena were impossible, until we shall have previously acquired a knowledge of the healthy functions. This is really so, and this is the reason why the study of disease, and the study of the natural or normal functions of the organism, have always gone hand in hand. Any one who will take the trouble of reading the history of medicine, will see that, in the knowledge of -the human organism, we are superior to the ancient philosophers. I will mention a single discovery which has been fraught with immense consequences to the interests of suffering humanity, the circulation of the blood. What horrible tortures patients were RELATIONS OF THE HUMAN BODY. 15 exposed to before we knew that arteries can be tied, and obliterated by ulceration; and what truly invaluable advantages have been derived from Hunter's great discovery, that wounds will heal by the first intention! The whole modern art of rhino-plastic, which has restored to thousands of deformed human beings an appearance of beauty, is based upon these two cardinal principles: circulation of the blood and adhesion by the first intention. But the science of the natural functions of the organism-animal physiology; the science of the organs which perform these functions-anatomy; and the science of the conditions and circumstances in which these functions can alone be normally performed-hygiene;-are not the only branches of medical science that have been cultivated by modern investigators with untiring industry and zeal. The science of diseases, or of the phenomena by which we recognize a disordered or disturbed state of the normal functions, and the science of the means which will effect a restoration of the original harmony of the organism in the safest, speediest, most economical and most pleasant manner, have likewise been the objects of our solicitude and watchful care. The treatment of disease is not only much more positive and certain than formerly, but it is likewise much less complicated, and the most enlightened.members of the medical profession are constantly endeavoring to render it so simple, that it requires but an ordinary degree of intelligence and education to administer medicines in a successful manner, without much previous preparation in the class-room or hospital. The discovery of homoeopathy favors the adaptation of medical science to the plain, non-professional understanding. Homoeopathy is _ __ C 16 AN ESSAY ON THE ANATOMICAL destitute of the technical jargon of the old school of medicine, of its Latin formulas, and the undecipherable scrawls of pedantic practitioners; and all attempts to engraft the superannuated gibberish of the past upon the lucid science of the present, and of the future, should be discountenanced. Homoeopathy being nearer to truth than any of the medical doctrines that have preceded it, its practice is, of course, more simple and more accessible to the generality of intelligent laymen, and it is undoubtedly the duty of physicians to popularize this new science, not only by a more successful treatment of.disease, but also by direct and popular teaching. The present work, which is the third edition of our Domestic Physician-and is vastly superior to the former editions, both as regards the quality and quantity of the materials of which it is composed-will, it is hoped, be somewhat instrumental in dispelling the illusory and often pernicious practices of the old school, and convincing all earnest and intelligent seekers of truth, that the means which the Creator has given us for the purpose of curing disease, can be applied in a manner that will neutralize their deleterious action and convert them into positive and direct supporters and restorers of the embarrassed or sinking vitality. All science was originally based upon illusions. In geography, for instance, it was supposed that the earth was a flat square of land floating upon the water; in astronomy, that this earth was the fixed and immovable centre of the universe, and that the sun and all the stars of the firmament revolved round it every twenty-four hours; in medicine, that the arteries, because they were found empty after death, contained nothing but air during a person's life, whence they were denominated _ __ ___ RELATIONS OF THE HUMAN BODY. 17 arteries, from the two Greek words, aer and terein, the former of which means air, and the latter contain, aircontaining vessels: whereas we now know, thanks to the genius of Harvey, that they not only contain the red or vital blood, but that the whole volume of blood, existing at any time in the organism, rushes through this immense and wonderful network of blood-vessels as often as we feel the throbbing of the pulse at the wrist, or in any other accessible portion of the arterial system. The rational observation and interpretation of phenomena, and a perception of their real nature, origin and relation, have been reserved for the later periods of human development; and even now, when the most amazing progress in science and art is constantly unfolding new and gigantic truths, the rationality of man is still in its infancy, and no where is this more sadly seen than in everything that has a direct bearing upon the political and social sciences, including that vast science of life, of which the preservation and restoration of health is, in a special sense, a mere fragment. It may be truly said, that medicine has been a tissue of illusory perceptions and false inferences, of which the patient has been the victim. The limits ofour space will not allow us to enumerate all the errors and pernicious practices of the old system of medicine; a few will suffice to show that, like every other science, the science of curing disease, or therapeutics, was based upon a sensual, not upon a rational perception of the morbid phenomena. 3* ----~-~111111 1. ~_ 18 AN ESSAY ON THE ANATOMICAL Humoral Doctrine. One of the most wide-spread and most popular illusions in medicine, has been the doctrine of humors. It was believed, and is even now believed by thousands of physicians and laymen, that all disease originates in bad humors which vitiate the blood, and in this way poison the whole organism. Bad blood, bad humors, and similar expressions, are consecrated modes of speech which show, that, in the interpretation of morbid phenomena, reason was subservient to the senses. The practice which was based upon the doctrine of humors, was correspondingly illusory and mischievous. The bad humors had to be expelled from the system, and, for this purpose, the various medicinal substances were classed under appropriate heads: one class, the diuretics, containing those that expelled the humors by the urine; others, the diaphoretics, those that expelled humors by the skin; others again, the cathartics and drastics, those that expelled all the vitiated humors by the bowels. Cupping and venesection were likewise humoral remedies. According to the humoral pathology, people had to be bled once in a while for the purpose of getting rid of the old blood; and we have heard more than one humoral doctor boast, I have not a drop of old blood in my veins. Such practices seem very plausible, but, on a closer examination, they will be found to be fallacious. In the first place, there is no such a thing as old blood in the human body; there is a constant system of waste and supply taking place in the human organism; the blood, like every other fluid in the body, is continually being re-made out of the food which man takes into his stomach, and, while performing the office of nutrition RELATIONS OF THE HUMAN BODY. 19: as the blood courses through its appropriate channel, all those ingredients which are no longer essential to the maintenance of the organism, are carried off by means of organs specially adapted to this purpose, the bile by the liver and its appendage, the gall-bladder; the urine by the kidneys and urinary, bladder; excrementitious matter by the intestines; the aqueous secretions by the bladder, skin and lungs. To be sure, these organs may not perform their offices in a proper manner, and the urea, which is one of the chief constituents of the urine, or the chlorophyl and soda, which are two of the principal ingredients of the bile, instead of being carried out of the system, may remain as foreign, heterogeneous bodies in the circulation, and disturb and irritate the organism in a variety of ways. Blood thus mixed up with substances that have ceased to be normal constituents, cannot be healthy blood, and might be called bad, vitiated blood. But is it not apparent that the bodily removal of this blood from the circulatory apparatus, would not alter the essential condition of the organism? For the kidneys and liver would not perform their secretory functions any better after the withdrawal of the blood than before; and yet it is to the condition of the bladder and liver that our remedies should apply; it is these organs that require to be specifically stimulated and relieved of the embarrassment or torpor under which they are laboring. For as soon as the secretory organs resume their functions in a normal manner, the blood will at once be freed from the heterogeneous irritants which it, innocently, has to carry along with it through the whole organism. Or let us look at what physicians have been in the habit of calling inflammatory blood. When there is 20 AN ESSAY ON THE ANATOMICAL high fever, the blood, from time immemorial, has been supposed to be at fault; there was too much action in the circulation, and the first thing a physician had to do, was to draw off this rich, intensely vital, inflamed blood. And this process of depletion was kept up until the so-called buffy coat ceased to appear on the surface of the blood, which buffy coat is found, upon being chemically examined, to contain fibrine, albumen and caseine, or the so-called Proteine group, which constitutes the most important ingredient of all vegetable and animal food. After as much fibrine, albumen and caseine, or, in other words, after as large a portion of the vital constituents had been removed from the blood as could safely be done next to killing a patient, he was further reduced by constitutional treatment, low diet, purgatives and so forth, for the ostensible purpose of preventing the reproduction of the inflammatory blood. Now, any attentive observer may see from this mode of treatment, that even those who employ it, do not hold the blood directly responsible for the existing fever or inflammation; for, if they did, why should it be thought necessary to depress the constitutional action, after the blood had been reduced to the consistence of a watery fluid by repeated and copious depletions? Is not the constitution reduced for the avowed purpose of preventing the reproduction of the inflamed blood? There must, therefore, be some other cause, at work in the system which causes the increase of arterial action, the dryness and heat of the skin, in one word, the inflammatory fever; a cause not residing in the blood, but out of it, in more vital parts of the organism, upon which the circulation of the blood itself depends, and by which it is chiefly controlled and regulated. -- ----- --- -- -I --- -- -- -P------P~-o~C. I _ RELATIONS OF THE HUMAN BODY. 21 Chemical Theory. The chemical physiologist explains the circulation of the blood upon the principle of chemical affinity. According to him, the general or systemic circulation is carried on in consequence of a high affinity existing between the arterial blood and the arterial tissues, and the pulmonary circulation in consequence of a high affinity between the venous blood and the oxygen which it finds in the air-cells of the lungs; but this same affinity exists in the dead body as well as in the living, and it alone, is not, therefore, sufficient to account for the circulation of the blood, for the simple reason that it was incapable of preserving life, of which the circulation of the blood is one of the most marvellous and most beautiful phenomena. But how would the advocates of the chemical theory account, by their principles, for the phenomena of fever, and how would they proceed to treat fever, in agreement with their doctrines? Let us briefly examine what are the chemical doctrines respecting respiration and circulation, and we shall then be better prepared to understand their application to an elucidation of the theory and treatment of disease. One of the most brilliant and acute of all chemical physiologists is Dr. Draper, of the University of New York, and his doctrine respecting the circulation of the blood being admitted by many of the leading physiological writers to be true, we will consider it as a standard doctrine of the Chemical school. We are not aware that any chemical physiologist has, as yet, offered any satisfactory explanation of the office of respiration upon strictly chemical principles. Those phenomena which constitute the really vital character -~L*ll-~-~-~--------~11~~~1~---~---~-~~1 AN ESSAY ON THE ANATOMICAL of the respiratory process, the expansion and contraction of the lungs, phenomena which affect the whole organism to its outermost boundaries, have so far defied all attempts at explanation as purely chemical facts. Nevertheless, it may be said that the vital phenomena of the organism rest upon chemical and physical relations. Optical principles are embodied in the sense of sight; acoustic principles in that of hearing; mechanical principles in the construction and movements of the osseous system; chemical principles in the process of respiration. For it is in the lungs that the black or venous blood is brought in contact with the atmospheric air, and by taking up the oxygen contained in the air, is changed to arterial blood, which is indispensably necessary to the preservation and development of the body. The absorption of the oxygen is a phenomenon of capillary attraction, or, rather, the principle of capillary attraction constitutes the basis of this process; for capillary attraction alone is insufficient to account for the inmost nature of the process of respiration. Respiration is a phenomenon of life; if capillary attraction constituted the essence of the respiratory process, it would operate in the dead lungs full as well as in the living,-for, as a purely chemical phenomenon, this principle acts upon dead matter in all its force, and develops the interesting phenomenon which chemists term endosmose and exosmose,* and which is resorted to for the purpose of ex* Endosmose and exosmose are two terms derived from the Greek words, endon, within, and osmos, impulse. These terms were first used by Dutrochet, a French physiologist, for the purpose of designating the passage of fluids through organic membranes. In order that this passage may be effected, the fluids must have an affinity for the interposed membrane, and likewise for each other. Endos-._II __ ~ RELATIONS OF THE HUMAN BODY. 23 plaining the process of respiration upon chemical principles. As we said above, endosmose and exosmose is a phenomenon of capillary attraction, and may be beautifully illustrated by the following simple experiment: Take a bladder filled with alcohol, and, after making the mouth of the bladder tight so that none of the fluid can escape, place it in a vessel of water. The bladder being full of capillary tubes, the alcohol will gradually pass out of the bladder into the water, and the water, which flows more readily than the alcohol, will pass more rapidly into the bladder, and, after a short period, will accumulate in the bladder and distend it so as to cause it to burst. The introduction of oxygen into the blood takes place in a similar manner, through the delicate membranes of the air-cells. In the air-cells the blood presents itself of a deep blue color, and is then known as venous blood. From the atmospheric air it obtains oxygen, which passes through the thin membrane of which the air-cells are composed, and gives out carbonic acid gas. This operation is carried forward on a scale of great magnitude, as may be seen from the circumstance, that in a man of average size, about seven tons of blood are, in a single day, exposed to two hundred and twenty-six feet of atmospheric air. According to Dr. Draper, and the physiologists who adopt his mode of reasoning, the phenomenon which goes under the name of endosmose and exosmose, is likewise sufficient to explain the circulation of the blood. For, as we have seen in our experiment with the bladder, a constant current of the alcohol and water is kept mose generally applies to the more transmissible fluid, whilst exosmose is used for the least transmissible. An illustration of this phenomenon is furnished in the next period. 24 AN ESSAY ON THE ANATOMICAL up through the walls of the bladder, the water flowing more rapidly, because it has a greater affinity for the sides of the capillary tubes than the alcohol. From these facts, Dr. Draper has inferred the following proposition, with a good deal of ingenuity: " If two liquids meet in a capillary tube, or in a porous or parenchymatous structure, and have for that tube or structure different chemical afinities, movements will ensue; that liquid having a higher degree of affinity will move with greater velocity, and may even drive the other liquid entirely before it." Now let us apply this principle to the circulation of the blood. There is the systematic circulation, or the circulation of the blood through the whole organism, and the pulmonic circulation, or the circulation of the blood through the lungs. The arterial blood courses with the utmost facility through the arteries, in consequence of being possessed of a high degree of affinity for the arterial tissues, whereas the venous blood has little or no affinity for them; the venous blood courses with equal readiness through the lungs, in consequence of the high affinity which it possesses for the atmospheric oxygen which it meets in the air-cells of the lungs, whereas arterial blood has little or no affinity for this gas. On the same principle, Dr. Draper explains the rise of the sap, the circulatory movements in the animal tribes, and the minor circulations in the human system. Those who believe that the circulatory process depends upon the hydraulic action of the heart, are referred by Dr. Draper to the various phenomena of circulation carried on without the intervention of a heart. Thus, plants have no hearts to propel or suck up the juices, and yet these circulate in the plants. Insects are deprived of a __I__~_I__ ----~--L-- --~----------1II~-- _ RELATIONS OF THE HUMAN BODY. 25 central organ of circulation. In fishes, the systemic circulation is carried on without a heart. In coldblooded animals we observe movements in the capillaries even after the heart is cut out. In the earliest periods of foetal existence, the development of the heart takes place subsequently to the appearance of the bloodvessels. These facts show that the circulation of the blood is not sufficiently accounted for by the supposed forcing and sucking powers of the heart, and that a rational understanding of the process of circulation requires the calling in aid other principles, either physical or vital. Let us now examine whether Dr. Draper's theory of the circulation is sufficient to account for the phenomenon of fever, and whether it is capable of suggesting an appropriate method of restoring the equilibrium of the organism, in case it should be disturbed by febrile action. What are the phenomena of fever? There is, in the first place, a bounding pulse, dryness of the skin and mouth, increase of temperature, thirst, and very frequently headache, dizziness, and a variety of other symptoms, such as flushed cheeks, or alternate paleness and redness of the cheeks, appearances before the eyes, etc. Is the chemical theory capable of accounting for this bounding of the pulse, and more particularly for the heat which fever-patients experience? According to the chemical theory, animal heat is the result of the oxydation of the tissues, or of the elements of respiration which they contain. The oxydation of the elements of respiration, or the so-called non-nitrogenized bodies, results in the production of carbonic acid and water; and the oxydation of the tissues, or of the nitrogenized bodies, also designated as elements of nutrition, results 4 __L 26 AN ESSAY ON TBE ANATOMICAL in the formation of carbonic acid, water, and ammonia. But these changes or processes of oxydation do not take place without a rise of temperature; for oxydation is, so to speak, a process of combustion, although the term combustion is very improperly applied to the phenomena of oxydation which occur in the animal organism. For the combustion of carbon and hydrogen in the open air certainly leads to different results from the oxydation of the tissues in the body; the former occasions the destruction of the burnt or oxydized substances, whereas the oxydation of the tissues results in the preservation and development of the organism. Hence there exists an essential difference between the combustion of substances in the air, and the process of oxydation as carried on in the animal economy, and which chemical physiologists are likewise pleased to designate as a process of combustion. Now, if the chemical theory of the circulation be correct, it follows that, in a febrile state of the system, when the oxydizing process is carried on with greater rapidity than in a state of health, all the results of this process ought to be produced in a more striking manner; there ought not only to be an increase of heat, but also an increased development of all the other common results of oxydation, among which the production of water is one of the most characteristic. But it is well known that, in a feverish condition of the system, there is an absence of moisture; the skin is dry, the mouth is parched, the patient wants to drink all the time, the breath is dry and hot, and the urinary secretions are frequently suppressed. This heat and dryness cannot therefore be occasioned by the increased oxydation of the tissues, and must be owing to some other more --S------~L---~_ _~__ __ -I-- -I ---~- I RELATIONS OF THE HUMAN BODY. 27 general and more deep-seated cause, upon which the oxydizing process itself depends for its normal continuance. What this cause is in its inmost nature, purely chemical or physical investigations will probably never discover; but we are sufficiently acquainted with the nature and office of the various constituents of the living mechanism which the animal organism exhibits to our wondering reason, to know, that the nervous system is that portion of the visible body which enables its various parts to perform their respective functions. If these functions are not properly or normally performed, it is the nervous system that is at fault, and whatever means we apply for the purpose of restoring the equilibrium of the functions, must of necessity be brought to bear upon the nervous system as the first ostensible plane where the derangement of the animal economy begins. We cannot possibly go any farther; it is not given to our finite understanding to ascertain whether, in a case of sickness, life is affected in its inmost nature; but we need not hesitate to believe that the inmost principle of life is not affected in disease; for the inmost life-principle, or the ethereal, substantial essence of life is preserved and developed out of the eternal life-principle of God, and reason tells us that this principle can no more be disturbed or tainted than His own divine nature. What we term disease, can, therefore, only extend to the subordinate, phenomenal spheres of the animal organism, but it is not a chemical fact, and, as we have seen, cannot be accounted for upon chemical principles, although it is undoubtedly true that the operations of the vital principle are based upon chemical and physical laws. 28 AN ESSAY ON THE ANATOMICAL All the laws of Nature converge in the vital functions. Before undertaking to account for the nature and conditions of fever, let us again recapitulate the various facts which every vital phenomenon embodies. These are: first, the all-pervading, eternal life-principle which presides over every created being; which makes every created being to be what it is, and, by its presence, preserves the essential constitution of the being; this principle, being an emanation from the inmost life-principle of Nature, is, in its essence, unalterable and inaccessible to disease: secondly, the individual or individualizing life-principle constituting more particularly the distinguishing form of every being, with its inherent characteristic properties; (in the human organism the nervous system is the primary vehicle and perceptible manifestation of this principle, through which it affects every fibre of the organism, vitalises every organ and enables it to perform its appropriate function;) and thirdly, the chemical and physical relations or laws upon which the vital operations rest.as their basis and support. Let us illustrate this three-fold order of principles by a particular fact, for instance, the process of digestion. This process implies distinctly, first the existence and presence of an universal life-power which created the digesting organism, and which, after creating the organism, preserves it as a constituent portion of the universal order of Creation; secondly, the particular power of carrying on the various functions which intervene in the process of digestion; and thirdly, these functions themselves, or, if you please, their results. What are these functions? First, we have the action of the teeth and other organs of mastication, by which the particles RELATIONS OF THE HUMAN BODY. 29 of the food are first roughly divided or broken up, and simultaneously mixed with saliva. This process of comminution and the mixing up of the broken-up particles of the food, are mechanical processes embodying a vital power; afterwards the comminuted food is passed into the stomach where it mixes with the gastric juice, a viscid and slightly acid liquid. The secretion of the gastric juice from the coats of the stomach is a vital phenomenon which no chemist can imitate in his laboratory, although chemical physiologists do profess that water, acidulated with hydrochloric or acetic acid, and containing animal matter in a state of change, acts upon organized substances in the same manner as gastric juice containing animal matter in' a state of metamorphosis acts upon fibrine or coagulated albumen. But in the case of chemical physiologists, it is really proper to apply the words which Festus spoke to Paul when this Apostle pleaded his cause before King Agrippa, " much learning hath made thee mad." Although the secretion of the gastric juice is a vital phenomenon, yet the dissolving action of the gastric juice upon the food in the stomach, and the successive gyrations of the food by means of which it becomes thoroughly commingled and acted upon by the gastric juice, are, strictly speaking, so far as their material results or effects are concerned, chemical and mechanical facts, just as much so as if the food were dissolved by the gastric juice in a crucible and the mass stirred with a glass-rod. But in the crucible the gastric juice would gradually lose its dissolving power; for this juice is not a dead but a living product, and, unless it embodies in its composition an actually present principle of life, it loses its original properties, and is converted into elementary ingredients out of 4* __ _ 30 AN ESSAY ON THE ANATOMICAL which it is beyond the power of any chemist, 'by any combination of his own, to reproduce the original fluid. After the food has been sufficiently acted upon by the gastric juice and converted into chyme, it passes into the intestine, where the chyme is mingled with bile coming from the liver, and with pancreatic juice from the pancreas. The chyme is now changed to chyle, which, upon examination, is found to consist of a creamy fluid and a whey-like fluid in a state of intimate commingling, and thirdly of a red sediment. In this condition the food is prepared to pass into the blood-vessels. It would seem as though no rational being could deny that the process of digestion as I have analyzed it, contains both a vital and chemical or physical principle. For is not the comminution of the food by the teeth a mechanical fact? And is not the grinding or comminuting power of the teeth a vital fact? And yet learned men seem unable to understand each other in this respect. Some stoutly deny the existence of a vital principle, and assert that all the functions of the animal economy are chemical operations; and yet, after analyzing the blood into its constituent parts, the plasma or the fluid portion of the blood and the disk-like bodies floating in it, no chemist is capable of re-combining these parts into the original substance. And so in regard to any other vital product. Milk has been analyzed into water, butter, caseine, milk-sugar, soda and various phosphates and chlorides. But what chemist has ever succeeded in reproducing the original milk out of its constituent parts? Liebig pretends that, if the elements of urine be added to the elements of bile, they will represent the elements in the blood; but this is mere speculative theory, and he will never succeed in making _ __ _ RELATIONS OF THE HUMAN BODY. 31 blood, no matter in what proportion bile and urine may be added together. On the other hand, there are philosophers who deny that chemical or mechanical laws have anything at all to do with the operations of the animal economy. According to them everything is a strictly vital process. These so-called vitalists occupy the other extreme. They deny that there occurs a single fact of a chemical or mechanical nature in the body. According to them, even the comminution of the food with the teeth is a strictly vital process. It would seem as though any simple-minded man might easily understand, how far chemical and mechanical principles are involved in the operations of the life-principle; but men of science are generally tainted with the pride of the understanding; they are analysers, not reasoners; each knows a thing better than his brother, and they will fight for their own shadows and against the theories of others with all the fierce and exclusive spirit of bigots. To be sure, it is impossible to drawa fixed line of demarcation between the chemical and vital character of an organic process; but it is undeniable that both chemical and vital principles intervene in it. Thus the lungs exhale carbonic acid gas, which is a chemical product; urine frequently contains a distinctly perceptible excess of ammonia. And it is useless to deny that the phenomena of capillary attraction are not frequently and undeniably witnessed in the absorbent system. Thus a cow which is fed on linseed-cake, gives milk that tastes strongly of this substance; and madder is found in the bones of animals that have been fed on it. _ __~ _~ _CI~I_ _ _~ 82 AN ESSAY ON THE ANATOMICAL Circulation of the Blood. After these somewhat general, but, for our present purpose, satisfactory explanations of the differences between the doctrines of the Chemical and Dynamic Schools, or between the chemists and vitalists, as the adherents of these schools are respectively called, we are prepared to account for the phenomena which we comprise under the collective appellation of fever, in a more rational, and therefore more intelligible manner than has been done by former pathologists. Before, however, reasoning on the subject, let us endeavor to have a clear perception of the organs which are more directly instrumental in carrying on the process of circulation. If physicians should read these lines, they will please bear in mind that we are not so much writing for their own benefit as for that of intelligent laymen, who may not have had an opportunity of acquiring a sufficient amount of anatomical knowledge to profitably read a disquisition on physiology, were it ever so plain and simple. It is then, more particularly, for the benefit of laymen that we will state that the circulatory apparatus is composed of a central organ, the heart, and of two series of vessels; the larger vessels through which the general circulation is carried on, and the capillaries. We will describe each part a little more minutely. Every body knows that the heart is a muscular organ. It is situated in the thorax, surrounded by the substance of the lungs, except in front. It rests on the diaphragm below, and the point or apex of the heart is inclined to the left side and touches the walls of the thorax somewhere near the point where the fifth rib unites with its cartilage. The heart has four cavities, two of which are RELATIONS OF THE HUMAN BODY 3 termed auricles, the others ventricles. The ventricles are much larger than the auricles. The right auricle and ventricle contain the black or venous blood, and the left auricle and ventricle the red or arterial blood. We will now suppose the heart engaged in sending forth its contents, which office it accomplishes in the following manner: Commencing our description of the route which the blood follows in coursing through the system, at the left auricle, we will suppose it filled with red or arterial blood. This auricle contracts and sends the blood it contains into the adjoining left ventricle through an opening which is termed ostium venosum. This opening is provided with a valve by means of which it can be closed or opened, according as circumstances may require. It is opened by the column of blood rushing from the left auricle into the left ventricle, from which it follows, as a matter of course, that the valve opens into the ventricle. While the blood rushes into the ventricle it 'dilates, and as soon as the blood is received, the ventricle contracts and sends the blood through the aorta and its branches into the system. While the ventricle contracts, the valve which closes the opening between the ventricle and auricle, closes, to prevent the reflux of the blood from the ventricle into the auricle. This valve is called mitral valve. The orifice of the aorta is likewise provided with valves which, from their shape, are termed semilunar, and of which there are three. When the blood rushes from the left ventricle into the aorta, these valves open into the aorta; but when this ventricle dilates for the purpose of receiving the blood from the left auricle, the valves of the aorta close in order to prevent the reflux of the blood from the aorta into the ventricle. Having __ 34 AN ESSAY ON THE ANATOMICAL entered the aorta, the blood courses through every artery in the organism until it reaches the capillaries, which are a network of exceedingly fine vessels, so fine that they have to be examined microscopically. In persons with a very fine skin a considerable number of them can sometimes be seen with the naked eye on the face, hands, and on other parts. The terminal capillaries of the arterial system unite with the first beginnings of the venous capillaries, but it is a mistake to suppose, as is thoughtlessly averred by anatomical writers, who copy one from another, that the arterial blood passes into the venous system in the shape of venous blood, and, in this condition is returned to the heart. On its passage through the system the arterial blood subserves the purposes of nutrition, and those parts of the blood which the system does not require for its sustenance, are transmitted to the kidneys and other organs, and pass out of the system in the shape of urine, water, bile, etc. All such facts are substantiated by observation. By observation we know, that, when the blood-disks are old and approaching the period of disorganization, their interior is filled with a yellow substance, called hoemaphein, and corresponding to the coloring matter of the urine. And we know likewise by observation, that, as the disks grow old and disappear, new ones are formed from the plasma. There is no such a thing as old blood in the system, and the idea that the blood, courses, as it were, in a vicious circle, from the left ventricle through the arteries, thence passing by the capillaries into the veins and returning to the right ventricle by the venous system, is, upon the whole, erroneous, or requires, to say the least of it, a vast deal of modification. What the true relation of the terminal arterial RELATIONS OF THE HUMAN BODY. capillaries to the capillary beginnings of the venous system is, has, so far, remained a mystery, and our knowledge, in this respect, is exceedingly speculative. But it stands to reason, that the notion which many persons, physicians as well as laymen, entertain of the arterial circulation being intended for the purpose of conveying oxygen to every part of the system, and afterwards returning to the heart by the veins to receive a new supply of oxygen in the lungs, and again carrying it onward to its various points of destination, can only be partially true. For, the oxygen which the blood receives from the atmospheric air in the lungs, ceases to be a free substance. The arterial blood is not a chemical compound, but a living unit, which cannot be decomposed into its constituent parts without its complete disorganization being effected at the same time. And we know that a disorganizing metamorphosis is going on in the blood while it is coursing through the system, and that the animal tissues derive their constituent principles, their fibrine, albumen, caseine, gelatine, chondrine and other substances from the blood, in such manner that venous blood is not left, but that the original blood is entirely altered. Even if we do now admit that a residue of arterial blood passes from the terminal capillaries of the arterial system into the capillaries of the venous system, and returns to the heart in the shape of venous blood, this blood must be of a very inferior kind, and could subserve the purposes of life but very triflingly, if it likewise were not renewed just as the arterial blood is. And we know perfectly, that such a renewal is taking place uninterruptedly while life lasts. It is accomplished through the lymphatic system, and more particularly the thoracic duct, to whose _ __ __ _~ 36 -AN ESSAY ON THE ANATOMICAL enlarged extremity in the abdomen, called the receptaculum chyli, the chyle, or that portion of it which is necessary to the vital process, is conducted by the lacteals or absorbent vessels of the intestines; from the abdomen the thoracic duct passes into the thorax through the diaphragm, and, accompanying the aorta, ascends in front of the spinal column, and empties its contents at the junction of the left subclavian and internal jugular veins. There is another lymphatic trunk which discharges its contents into the venous system at the junction of the right internal jugular and subclavian veins. Having entered the venous system, the chyle is conducted to the right auricle and thence to the right ventricle, and1 having been thoroughly mixed in the right ventricle into a homogeneous mass, the venous blood, thus renewed and regenerated, as it were, passes into the substance of the lungs to be converted into arterial blood, and, in the shape of arterial blood is transmitted to the left auricle, thence to the left ventricle, from which it is again sent forth on its mission of nutrition through the arterial channel. This renewal of the venous blood by means of the chyle is somewhat analogous to the process of grafting in nature, by which means a new and vigorous vitality is communicated to an old and worn out trunk. Let us now resume our description of the circulation of the blood where we left off, and briefly show how the venous blood reaches its destination, which is the right ventricle of the heart. Where the arterial circulation terminates, the venous circulation commences, in the capillaries. From the venous capillaries the blood gradually collects in larger veins, until, at last, all the venous blood in the body collects in two large venous RELATIONS OF THE HUMAN BODY. 37 trunks, called the inferior and superior vena cava. The superior or descending vena cava receives all the venous blood of the upper, and the inferior or ascending vena cava all the venous blood of the lower portions of the body. Both these venous trunks enter the right auricle of the heart, the superior vena cava posteriorly, at the superior angle of the auricle, and the inferior or ascending vena cava at its inferior angle. From the right auricle the blood passes into the right ventricle through an opening termed, like the opening between the left auricle and the left ventricle, ostium venosum, and provided with a valve which opens into the ventricle, and is called tricuspid, from the three points or processes situated at the loose margin of the valve. After the blood has entered the right ventricle, this ventricle contracts for the purpose of sending its contents into the pulmonary artery. During this contraction the tricuspid valve closes the passage from the right auricle into the right ventricle, to prevent the reflux of the blood into the auricle. The contraction of the ventricle causes the column of blood to pass into the pulmonary artery,.which is likewise provided with valves precisely like those at the orifice of the aorta, and likewise termed semilunar. The column of blood from the ventricle presses this valve before it, and, on the dilatation of the ventricle for the purpose of receiving the blood from the right auricle, this valve closes again to prevent the reflux of the blood from the pulmonary artery into the ventricle. From the pulmonary artery the blood is sent into the substance of the lungs, where it is acted upon by the oxygen of the atmospheric air, and converted into red or arterial blood, which gradually collects in the four pulmonary veins, and, by them, is carried to 5 ---------- 38 AN ESSAY ON THE ANATOMICAL the left auricle, into each of whose four angles a vein enters. The pulmonary circulation offers the only instance where an artery contains venous, and a vein arterial blood, the pulmonary artery containing the former, and the pulmonary veins the latter. This account of the circulation of the blood is sufficiently explicit to be understood by every reader of ordinary intelligence, and is likewise sufficient to explain how far the doctrine which converts the heart into an hydraulic machine, and the doctrine of the chemists, according to which the heart is a passive central reservoir of the blood, are erroneous. We know, from positive observation, that the blood is propelled by the ventricles-and I may here state that the auricles act together, and the ventricles likewise-and it is this projection of the blood into the arteries which causes the pulse. With every contraction of the heart the blood is propelled, and a pulsation is experienced wherever we can place our finger upon an artery, even at the remotest point from the central organ, the heart. It is doubtful, however, whether the propelling power of the heart would be sufficient to send the column of blood through the arterial system, with its wonderful network of smaller branches, if the arterial tissue, commonly termed the coats of the artery, were not endowed with properties similar to those of the substance of the heart. The arteries are, in reality, prolongations of the left ventricle, and the muscular coat of the artery is endowed with the same kind of contractility as the muscular substance of the heart. Hence the impulse and the contractile and propelling energy of the heart are continued to the very terminations of the arterial system, and the arterial circulation-is carried on in the remotest arteries, with the __ RELATIONS OF THE HUMAN BODY. 89 same regularity and energy as in the arterial trunks nearest the heart. The chemical doctrine destroys the pulse altogether, for, according to this doctrine, the heart is like an Indian-rubber bag, and the arteries like Indianrubber tubes, which are simply designed as passive receptacles,in which the arterial blood might be pushed bodily forward by the venous. The chemical doctrine implies that there is no difference between the arteries and veins, for in the veins the venous blood is pushed forward by the arterial, in the same manner as, in the arteries, the arterial blood is pushed forward by the venous. The affinity of the arterial blood for the arterial tissue, and of the venous blood for the tissue of the veins, is undoubtedly necessary to enable the blood to course through these respective canals; but this affinity is not sufficient to explain the interesting and remarkable phenomenon of the pulse. To account for it, we have to call in aid a vital property of the heart, the contractility and dilatability of its muscular substance, and the regularly occurring contractions and dilatations of the ventricles, the former of which are termed systole, the latter diastole. Of course, there cannot be any perceptible pulsations in the venous system, because there is no propulsion of the blood going on in the veins. The question now naturally occurs: what enables the heart to contract and to propel the blood? This ability is derived from the same power from which every other organ derives its functional energy-the lungs the power to inhale and expel the air, the liver the power to secrete the bile, the stomach the power to perform the office of digestion. This is the life-principle, which the material or bodily eye does not behold in its actual form or substance, but the existence of which is an established fact, 40 AN ESSAY ON THE ANATOMICAL and of which the nervous system is the first vehicle or material development. By severing the communication between an organ and the nervous system, we destroy the power of the organ to perform its functions. By cutting the pneumo-gastric nerve, for instance, some of whose branches are distributed over the heart, others through the substance of the lungs, and others again over the coats of the stomach, we incapacitate the lungs from breathing, the heart from contracting and dilating, and the stomach from secreting the gastric juice and causing the food to perform its gyratory movements in this organ. Hence, it is the nervous system that sustains the organic power of every organ, and likewise of the organs that constitute the circulatory apparatus. Fever. Let us now enquire what takes place in common fever, and what are the particular symptoms of this disturbance. Common fever is characterized by several leading symptoms, which occur in every case. These are, for instance, a bounding pulse, thirst, dryness and heat of the skin. There may be likewise a variety of other symptoms, such as headache, dizziness, soreness, a coated tongue, foul taste in the mouth, etc.; but the violent throbbing of the pulse, the thirst, and the heat and dryness of the skin, are the leading characteristic symptoms of fever. What is the nature and proximate cause of these phenomena? When I say proximate cause, I mean their more immediate cause; for the primary or essential cause of fever is, in the present state of our knowledge, no more accessible to our understanding than the primary cause of any other form of disease. The ~-U~C --I RELATIONS OF THE HUMAN BODY. 41 proximate, or more immediate cause of fever, must reside in the nervous system. The nervous systemwhich is the chief vehicle, the primary material embodiment, manifestation or connecting link of the invisible, immaterial vital principle-has, by some particular cause, been incapacitated from performing its function of conducting the preserving, directing and harmonizing influence of the life-principle to the organs which constitute the circulatory apparatus; and, if we desire to employ suitable means for the purpose of restoring the equilibrium of the circulation, we have to bring our remedial measures to bear upon the nervous system, disembarrass the nervous system, restore its tone, its functional power, and, in proportion as this object is attained, we shall find that the blood will again circulate with the usual quiet and regularity. It is well known that the phenomena of fever are more particularly inherent in the arterial system. A common inflammatory fever is.generally induced by some external cause, exposure to a sharp wind, a current of air, wet; and these causes, from their very nature, affect in the first place the superficial or terminal portion of the circulatory system, which are the capillaries. It is here, in the capillary system, that the phenomena of fever seem to originate. The capillary circulation, which is carried on under the immediate influence of the capillary nervous system, is interfered with, because this system had become embarrassed in consequence of some disturbing influence. Whatever the real nature of this nervous embarrassment or torpor may be, we know that it is characterized by an inability, on the part of the capillary nerves, to carry on the capillary circulation. Hence the first effect of this engorged or congested con5* 42 AN ESSAY ON THE ANATOMICAL dition of the capillaries, is an increased redness of the skin, and of the temperature of the body. We have seen, in previous paragraphs, that both these conditions, the redness of the skin as well as the evolution of animal heat, depend upon the oxydation or the arterialization, as it is termed, of the venous blood. Having accounted for the increased redness and temperature, we will now try to account for the bounding or throbbing of the pulse in fever. This phenomenon is a necessary consequence of the capillary congestion. For the capillary circulation being interrupted, and the heart propelling the same volume of blood through the arterial system, it follows, as a matter of course, that the impulse of the heart must be greater and more sensibly felt, and the contractions of the heart, and the series of successive contractions continued from the heart throughout the arterial system-in other words, the pulse-must become stronger, and, under the finger, acquire that peculiar bounding or throbbing sensation. The common notion is, that, at such a period, there is more blood in the system; but the explanation which I have given shows that this is a mistake, and that as soon as the capillary circulation, which acts as a natural outlet to the general circulation, is restored, the general circulation will, of necessity, recover its equilibrium. It is clear that bleeding will not remove the nervous impediment or torpor upon which the condition of fever depends, and that this result can only be accomplished by means of some specific medicine, which possesses the power to affect the diseased nerves precisely in such a manner as will restore their free action. The first symptom of fever is a chill, or a sense of chilliness, or cold creepings or crawlings. This arises RELATIONS OF THE HUMAN BODY. 43 from the process of oxygenation of, the venous blood being more or less interfered with. The venous capillaries become clogged, the supply of venous blood for purposes of arterialization is curtailed, and the first effect of this change must be a sudden decrease of animal heat Hence the chill. If this chill were to continue beyond certain limits, the vital activity would become extinct, as certainly as no physical life can be permanently preserved by the rays of a wintry sun. Hence the chill is sooner or later followed by an opposite condition, that of heat, chiefly consequent upon arterial capillary engorgement, and an absence of counter-balancing or equilibrating moisture. We have acccounted for the chill, the subsequent heat of the skin and the bounding of the pulse; it remains yet to account for the dryness and the thirst which are always present during fever. We have seen that animal heat, or the natural temperature of the system, depends upon the oxydation of the blood-disks. But the heat which would be evolved in consequence of this process, or rather, which becomes manifest while this process is going on, would be much greater than it really is, if it were not counter-balanced by some opposite influence. This counter-balancing influence is first, the moisture permeating the atmospheric air; and secondly, the moisture which, in normal conditions of the system, is secreted by the mucous surfaces out of the circulating fluid. Now let us see what takes place during fever in regard to the moisture which covers the absorbent surfaces in health. The absorbent action of these surfaces being interrupted for the time being, the skin feels dry and hot, and hence the sensation of thirst. The interruption of the mucous A_ __ __ 44 AN ESSAY ON THE ANATOMICAL functions is owing to the same cause as the embarrassment of the capillary circulation, to wit, a depressed or torpid condition of the capillary nerves upon which the regulation of these functions depends. As soon as this torpor of the capillary nerves is removed by appropriate treatment, the functional power of the mucous surfaces will act as before, and, for a time, even with extreme energy, so that moisture will collect upon the skin, and upon the inner membranes in considerable quantity. This is what we term sweating. The equilibrium between the absorption of moisture by the external and internal surfaces and the evolution of heat in consequence of the arterialization of the blood, will be restored, and, until this restoration is effected, an unusual amount of moisture will be developed, so that, in the end, the whole amount which is secreted during the period of reaction, and the amount of heat which had been evolved during the fever, will be found to balance each other. In order that fever may result, the following conditions must necessarily occur: 1. Some external cause sufficiently powerful to embarrass or depress the nervous action upon which the venoso-arterial capillary circulation depends. 2. Congestion or engorgement of the capillary vessels, being the first symptom of organic reaction excited in consequence of the depression of the capillary nervous system. The heat, thirst, throbbing of the pulse, and the whole series of symptoms which generally accompany the vascular disturbance, are, in reality, secondary phenomena, or, as they are usually termed, phenomena of organic reaction. Capillary nervous depression and the inflammatory RELATIONS OF THE HUMAN BODY. 45 action resulting from it, may take place in any part of the body, in internal as well as external organs. Hence every organ may be.in a state of inflammation. The lungs may be inflamed, the heart, bowels, eyes, ears, brain, muscles, indeed every part of the animal organism may be inflamed. If the inflammatory action is going on at the surface of the body, the skin is generally very sensitive, sore even, and if a vital organ should be affected, the pain is sometimes very great, often agonizing. The pain is generally proportionate to the delicacy of the structure of the inflamed organ. Thus, an inflammation of the brain, eye or ear, is much more painful than muscular inflammation. But it will be perceived that, in no case, would it be rational treatment to bleed for the purpose of reducing the pulse. The inflammation of some local organ has the same effect upon the pulse as any common catarrhal or rheumatic fever, where no local inflammation is apparently present; and we ought to use the same method of combating the local inflammation that we resort to in treating any common fever. This method will be more particularly described in the subsequent pages. Delusive principles of Old School treatment. It is not inflammatory diseases alone that have been treated in an irrational manner by Old School physicians; all the leading principles of cure which have been followed by the Old School, are more or less contrary to nature. They treat disease upon the principle, that what is contrary to the disease, will cure it. This is one of their principles. The Latin formula for this principle is. " contraria contrariis curantur." According 46 AN ESSAY ON THE ANATOMICAL to this principle, if a patient be affected with diarrhoea, he has to be treated with medicines that will bind the bowels. Or, vice versa, if a patient be affected with habitual costiveness, he has to be treated with medicines that will loosen his bowels. Now, this mode- of proceeding is very unsafe. To be sure, in an ordinary case of diarrhoea, a glass of brandy and water, or perhaps a few drops of opium may stop the looseness permanently. But such would not be the case, if it were a diarrhoea of long standing. In chronic diarrhoea, the continued use of binding medicines would most probably increase the difficulty. We know that persons who are habitually costive, have to take loosening medicines all the time, if they once get into the habit of it. And hysteric ladies who are troubled with wakefulness, cannot do without their sleeping mixture, if they had once accustomed themselves to it. All such means afford only temporary relief, but they are unable to effect a complete and radical change for the better. There are, however, a great many chronic weaknesses which can be removed by judicious treatment, and, if not entirely removed, they can be so much relieved that the relief almost amounts to a cure. But the continued use of palliatives never accomplishes a permanent cure. Palliatives only hush up the disease, while the action of the palliative medicine lasts, after which the disease shows itself again with renewed intensity. The Old School principle of cure, "contraria contrariis curantur," is really and truly the fundamental principle of the palliative mode of treatment, and, as such, it is, within certain limits, a just and useful law. But it must be strictly confined to the palliative system; whenever the law of palliation is raised to the rank of a law of cure, a cure is very seldom ------------~-~-I-"`~1111^11~ ~i_~~ RELATIONS OF THE HUMAN BODY. accomplished, and, if accomplished, it is accomplished in a round-about way, with an unnecessary sacrifice of time, money, and constitutional vigor. When may palliatives be used? Under what circumstances is it proper to use palliatives? These circumstances are easily defined, provided we are willing to drop all prejudices in favor of a particular method, except in so far as it is consistent with reason and universal truth. Strictly speaking, man's whole life is'a system of palliation. Man eats to satisfy his hunger; this is, so to say, a palliation, for after a certain period, the hunger returns and has to be appeased or palliated a second time, and so on, until death. The same is true in regard to thirst, sleep, and all the other animal functions. Resting one's-self after getting tired by walking, by working, or by any other kind of exercise, is a palliation, for, after every new exercise man requires new rest. But all these means of restoring the strength and preserving the harmony of the body, are natural means, and they actually accomplish the purpose which they were intended to fulfil. Hence we might lay it down as a rule, that the use of palliatives is admissible in every case, where they really accomplish the purpose which they were intended to subserve, in a natural and pleasant manner. If we have a hearty appetite for breakfast, and have something before us wherewith to gratify it, we may partake of the proffered nourishment, if it be otherwise wholesome food, without fearing to make the appetite so much greater at dinner. If we should have a good appetite at dinner, we may gratify it a second time, and the I_ __~IICm__ ~-----------------`-----~-- -- 48 AN ESSAY ON THE ANATOMICAL result of these successive gratifications will be the preservation of the bodily strength and health. If palliatives act in this simple and beneficial manner, their use is legitimate, no matter what the nature of the palliative may be. Thus, if we feel cold, we may warm ourselves by a good fire, of course within conservative limits. And even, if some particular function should have been accidentally disturbed, and the vital powers should only require a little stimulation to recover their equilibrating influence, it is not always necessary to resort to medical treatment. A sudden fright or surprise may cause a person to faint, and, to restore consciousness, it may be sufficient to hold a bottle with cologne-water under the person's nose, or to sprinkle a little cold water on the forehead. Or exposure to dampness or a little overfatigue may have caused a derangement of the bowels, which a little brandy and water may be abundantly sufficient to remove. Under certain circumstances it may even be allowable to use palliatives that approach more closely the character of medicines. A little peppermint will sometimes afford great relief to infants when they are troubled with wind on the stomach. But let us not be misunderstood. Such means should only be used as exceptions, for if such medicinal palliatives had to be used habitually, they would, in the end, fail of affording the desired relief, and, in order to afford relief, they would have to be used in large quantities, and might affect the organism or some particular organ, the stomach, bowels or nervous system, in an injurious manner. In all such cases the trouble which the palliative was designed to quiet, is not the result of a mere temporary disturbance, but a weakness partaking of the character of disease, that may require to be treated _*--~---- - RELATIONS OF THE HUMAN BODY. 49 according to a positive and comprehensive system, comprising not only the medical treatment properly speaking, but likewise a general regulation of the patient's diet, exercise, and, as far as possible, every thing that has an influence over the bodily functions. The rational use of palliatives is likewise admissible in all cases where a cure is impossible. Expectant Method. The French physicians have started a peculiar method of treatment, which they term the expectant method, and which is, in reality, another form of the palliative treatment. According to this method, very little medicine is given. Weak infusions, herb-teas, slight expectorants, and such simple preparations, are given, and it is nature that is supposed to effect the cure. If, by this, be meant that the cure is not effected by the medicine directly and immediately, it may be said that nature performs the cure in every case. But it is well known that nature, unassisted by art, is generally powerless and insufficient to cure disease, or, if she does cure, she does it bunglingly; nature has to struggle to achieve the cure, and has to waste her strength in endeavoring to check the antagonist. Nature cannot set a broken bone, nor can she tie an artery; a clever surgeon does all this much more effectually. Therefore, all this talk about nature curing the disease requires to be taken " cum grano salis," and the boasted expectant method of the French physicians simply means, that they had lost all confidence in the heroic treatment of the old school, of which they had probably witnessed the disastrous results, and that, not having mother-wit enough to discover the true system 6 _ ~ I_ 50 AN ESSAY ON THE ANATOMICAL of the healing art, they discarded the use of medicines, and contented themselves with a few simple and inoffensive herbs, as palliatives. Counter-irritant Method. Another form of the palliative treatment, is the socalled counter-stimulant or counter-irritant treatment. This method of treatment is much more positive than the expectant method, and must have been developed out of the palliative treatment by a very simple process of reasoning. It is the palliative treatment elevated to the rank of a curative method. When it was found that a mustard-plaster, for instance, would ease a pain, when applied over the region where the pain was felt, the idea that pain could be relieved by a process of counter-irritation was readily perceived by the understanding, and was made the ground-work or basis of a whole system of treatment. If the simple counter-irritation of.a mustard-plaster, or of a pepper-poultice, did not cure, the conclusion, was that the artificial irritation was not sufficient, and that some other more powerful irritant must be applied to the skin. From a mustard-plaster the physician would resort to blistering the skin with Cantharides or Tartar-emetic ointment, and, if this was still insufficient, moxae or the red-hot iron were applied. The most horrible wounds and tortures were, inflicted upon the patient, and if the practices of the old school had not become so frightful, that all the intelligent and betterfeeling portion of humanity recoil from them in disgust, and condemn them as abominable, aberrations of professional pride and ignorance, Heaven knows how long the insane practitioners of the old school might have con __ _~ RELATIONS OF THE HUMAN BODY. 51 tinued their destructive and degrading art! But these horrors were not much longer to devastate society, and inflict endless misery and pain upon their victims. The death-knell of alloeopathic barbarity sounded when Hahnemann discovered the great truth, that the true system of medicine is just as pleasant and saving, as the old system of medicine had been repulsive and destructive of life. Yes, Hahnemann is, in more than one sense, the benefactor of his race, and long yet, after every great name in medicine shall have perished in the flood of oblivion, will his memory survive in -the hearts of a grateful and regenerate humanity. 52 HOM(EOPATHY. HOMIEOPATHY. THE HOMUEOPATHIC LAW OF CURE. WE have now arrived at the point where it becomes our duty to expound the true system of the healing art. It may certainly be supposed that the Author of life would not allow disease to invade our frames, without giving us, at the same time, the means to combat it. These means have been given to us in abundance, but the best mode of using them was first unknown to us. How could we know it, unless God revealed it to us? And if He did not see fit to give us a special revelation regarding the curative virtues of every drug, and the most appropriate mode of using it for purposes of cure, what else remained for us to do, except to discover the properties and the true use of drugs by patient investigation and experience? Indeed, this has been the road which humanity had to travel for thousands of years, before the truth in medicine was finally discovered. The development of the healing art has been marked by untold suffering, by mutilations and poisoning. It may be said, without exaggeration, that millions of human lives have been destroyed by the ignorance and barbarity of medical practitioners. And many chronic maladies, with which mankind are afflicted even at this period, eruptions, irregularities of the bowels, nervous diseases, dys _ __ THE HOM(EOPATHIC LAW. OF CURE. 58 pepsia, and a host of other troubles, are the consequences of the horrible outrages which have been perpetrated. upon the human system for a long, long series of years, by the murderous lancet and the no less murderous salivating, sweating and purging system of treatment. The most distinguished practitioners of the alloeopathic school have denounced their practice as dangerous and disgusting. Boerhaave, whose reputation extended to the ultimate confines of the known world, even to China and Japan, is said to have left behind him a large quarto volume, which was supposed to be a treasure of wisdom. This book was not to be opened until after his death. It was found to be a volume containing nothing but blank paper, except the last page, on which was found a verse in the Dutch language, the literal meaning of which is as follows: " Keep your head and feet warm, fill your stomach moderately, keep your bowels regular, and then let the doctor run." Girtanner, another eminent physician, says: "'Our Materia Medica is a mere collection of fallacious observations;" and the distinguished Hoffmann writes, in his Medicina Rationalis: "1Perpauca sunt remedia quorum virtutes et operationes certce; plurima vero infida, suspecta, fallacia, ficta;" the English of which is: There are but few remedies the virtues and effects of which are certain; most remedial agents are unreliable, doubtful, fallacious, fictitious. And yet medicine should not be a curse to mankind. Medicine should be a blessing, for its object is to heal, the sick. Surely, this is a beautiful and noble object, and if it be not worthily fulfilled, it cannot be the fault of medicine; the fault must rest with man's ignorance: of the true curative virtues of drugs, and the proper: mode of using them for purposes of cure. 6* ---~ 54. HIOMCEOPATUY. Let us examine in what manner man may have derived his first knowledge of drugs. Either God must have revealed to him this knowledge, or else it must have been acquired by experience. We know that the knowledge was not obtained by a special revelation, hence it must have been derived by observation or experience. In adapting the products of the earth to his use, man must at first have proceeded more or less indiscriminately; he could not possibly know whether a plant would be useful or hurtful to him, until he had tried it. The probability is that man, at first, behaved as children do even now in regard to the things that grow around them. If they see a pretty looking berry, they fancy it must taste well, and they will try it, not supposing that the beautiful appearance of the berry could be deceitful, and hide poisonous qualities. So it was with man. He could not know that Belladonna was a poison, until the berries had been tasted; nor could he have known that Aconite would destroy life, until this destruction had actually been accomplished. It is by the slow method of experience, that man gradually learnt to know the difference between poisonous and nourishing plants; but the application of poisonous plants to the cure of disease, was at first, not the work of experience, but of pure reason. Some first case of sickness, must necessarily have arisen among men. We will suppose it was a case of diarrhoea or fever. When this case occurred, the probability is, that the poisonous effects of various roots, leaves, fruits, or even minerals, were known. Now then, here was a series of disturbances, or poisonous effects of natural substances, and, at some later period, a series of similar disturbances came under man's observation not as.the poisonous effects of __ THE HOMCEOPATHIC LAW OF CURE. 55 drugs, but as manifestations of disease, of whose origin and mode of development he was ignorant. For.the sake of illustration, we will suppose that the stomachsickening and vomiting properties of Ipecacuanha were known, and that a case of vomiting afterwards occurred in consequence of some cause or other, not medicinal, was it not natural that man should have established a relation between the stomach-sickening virtues of Ipecacuanha and the natural stomach-sickness? And if he did, what relation must this have been? What else could it have been than that, if Ipecacuanha was capable of sickening the stomach, it must be essentially adapted to a condition of the organism of which stomach-sickness was a prominent symptom? The inference must have been that Ipecacuanha would stay the sickness, if occurring as a natural disease. To be sure, such an inference could only be drawn by a man of genius. But so it is with all new principles in science or art. It requires genius to discover them., It required genius to discover the true nature of lightning, and from its identity with the electric fluid, to draw the conclusion that the proper mode of neutralizing its destructive power, was to draw it to us, as it were, from the heavens, and to conduct it along a metallic rod into the bosom of the earth. So it was in regard to the use of drugs. It required genius to conclude, that if a drug have at all any use, it must be to cure the very diseases which most closely resembled its own subverting action upon the human organism. For, although man had no special revelation in regard to the particular uses of created things, yet he had been told this general truth, that every created thing was for some useful purpose, for " God saw every thing that he had made, and behold! it was very good." Now, inas _ I_ -------~--~ 56 IIOM(EO'ATHY. much as it was evident, that among the created things, there were.some that did not support and develop, but destroy and disturb the harmony of life, it followed, as a matter of course, that the only use for which these things could have been intended, was to restore this harmony, in case it should be disturbed by some immaterial or dynamic influence. This conclusion having once been arrived at, it was not a difficult thing to conclude further, that inasmuch as there did not exist any special revelation in regard to the particular curative virtues of the different drugs, and inasmuch as it was evidently the design of Providence, that man should become acquainted with these virtues by gradual observation and experience; the accidental discovery of the effects which any. particular drug was capable of producing in the human organism, amounted, in reality, to a positive revelation of the uses which the drug was capable of accomplishing; that one drug, for instance, was capable of curing diarrhcea, another sickness at the stomach, another fever, another headache, and so on; some particular drug for every particular morbid condition. Indeed, it is recorded, that this truth was known, even in remote periods. For in one of the works which are attributed to Hippocrates, it is stated that a "disease is cured by administering a medicine which produces a similar disease," and that "vomiting is cured by administering an emetic." These axioms embody great principles of cure. But the train of reasoning which we have offered in the preceding lines, and of which these isolated sentences are practical illustrations, was not resorted to in the first ages of medicine. In offering this mode of reasoning now, we have simply permitted ourselves to indulge in i THE HOM(EOPATHIC LAW OF CURE. 57 a species of anachronism; for it is only in our age that the exalted reason of Samuel Hahnemann was led to the discovery of the true law of cure. Humanity had to wade through ages of gross empiricism and merciless dogmatism, before the torch of medical truth shone into the dark chambers of the human understanding. In translating Cullen's Materia Medica into German, Hahnemann was struck by the statement that the extraordinary power of Peruvian bark to arrest the paroxysms of fever and ague, was supposed to depend upon some specific power inherent in the bark. Hahnemann, s:uspecting that this specific power was nothing else than a power possessed by bark to affect the human organism similarly to fever and ague, at once instituted provinigs: with bark, and found that his supposition was verified, by actual results. By taking a few grains of bark for several consecutive days, paroxysms were produced which resembled very closely the paroxysms of fever and ague. From this verification to the establishment of homoeopathy there was but one step. As Peruvian bark cures fever and ague, so does every other medicinecure its corresponding disease, in accordance with the principle of similarity; or, as Hahnemann expresses it, to cure a disease we have to employ a drug, the inherent or characteristic effects of which upon the healthy body, shall be similar to the characteristic symptoms of the disease. This is the meaning of the celebrated formula, " similia similibus curantur," or ' like cures like," a formula which acquires strength as; it spreads through the nations of the world, " vires acquirit eundo," and embodies one of the most beautiful and most beneficent triumphs: of the human reason. The formula being once dis-: covered, the difficulties to its practical application had 58 HOM(EOPATHY. to be overcome. These difficulties were great and, to a mind without love, faith or enthusiasm, they might have seemed almost insurmountable. Not so with the great discoverer of homoeopathy. He at once went to work, induced his friends and disciples to follow his example, and the art of proving drugs, or of discovering their effect upon persons in health, was the next problem which required to be solved. While in a state of perfect health they swallowed the crude drugs in sufficient quantities to develop their inherent effects upon themselves, and the action of each drug, as it developed its effects upon the organism, was watched with the most conscientious solicitude. It will be readily perceived that the accomplishment of this vast, but indispensable undertaking, required time, patient toil, and devotion. To be sure, the records of the various symptoms of poisoning, which had been collected in former works on medicine, were made available for the building up of the new medical structure; but these records were exceedingly imperfect, they only contained the gross and most material effects of the drugs or poisons; all the more delicate disturbances of the nervous system were omitted. Hence all these drugs had to be proved over again, after duly preparing the system by rigorous diet and abstention from everything that might possibly interfere with the natural and unimpeded action of the drugs; their effects were watched from day to day, and from week to week, by a number of devoted provers, and they were finally collected by Hahnemann according to a certain method, and arranged in series, the symptoms of each drug separately; first, all the symptoms which had more particular reference to the brain and mind, then those of the special senses, of the digestive organs, and so on, in THE HOM(EOPATHIC LAW OF CURE. 59 a regular series, through the various parts of the body, until a sufficient number of symptoms had been obtained by patient and careful provings, to apply the new law of.cure to the treatment of disease. It need not be told in this place, that the first attempts of Hahnemann and his disciples, to reform the practice of medicine, were crowned with the most brilliant success. Thousands of practitioners have ranged themselves under Hahnemann's standard; the new system is taught in organized colleges, it is recognized and protected 'by the State as a true principle of cure, and it is blessed as a glorious and regenerating gift of heaven by millions of grateful hearts. Since the first establishment of homceopathy by Hahnemann and his personal disciples, our Materia Medica has been considerably enlarged by devoted followers of the new school of medicine, and it is probable that the time will arrive when, thanks to the efforts of these generous explorers of the curative resources of nature, we shall be able to cope successfully with every form of disease. Having established the new law of cure, and constructed the new Materia Medica, the question of necessity arose: How shall we proceed to apply our remedies to the cure of disease? In what form, quantity and order shall we administer them? These different' points shall now be briefly examined. First, as to THE FORM of the homoeopathic medicines. According to Hahnemann, the simplest form is the best, and is best calculated to preserve the curative virtues of drugs, and to secure to them a full influence over the disease. The method of preparing homoeopathic medicines is fully described in the standard pharmacopoeas of our school, more particularly in those of Buchner and Gruner, which were originally written in German,.but ~-^-- ~ HOM(EOPATHY. have been translated into English by one of the authors of this work. It is therefore unnecessary to go more minutely into the subject here, and it will suffice to state, for the benefit of the general reader, that Hahnemann, in obedience to his general principle, and as a logical consequence of his mode of viewing disease and its relations to drugs, not only discarded the use of compound medicines, but likewise all those methods of preparing medicines which had a tendency to alter the genuine medicinal action of the drug. The only preparations which he made use of, and the only ones which are even now sanctioned by the Homoeopathic School, are alcoholic tinctures, watery solutions, and triturations, of the crude drug or of its alkaloid. The rules which Hahnemann lays down for the making and keeping of homoeopathic preparations are exceedingly minute. He directs that the mortars and pestles should be perfectly dry and polished, that all strong-tasting or strong-smelling drugs should be prepared each in a separate mortar, and even in a separate apartment; he even specifies the number of minutes during which a trituration is to be completed, including the scraping up of the triturated substance, recommencing and continuing the trituration; in one word, his instructions concerning the making of homoeopathic tinctures and triturations are so specific, that they are almost liable to the charge of pedantry, and that it is exceedingly doubtful whether they are not, at this period, considerably modified by homoeopathic practitioners and pharmaceutists. QUANTITY.-It stands to reason that Hahnemann, as he differed from old school or alloeopathic physicians in the principles of cure, should likewise differ in the essential particular regarding the quantity of the medicine THE HOM(EOPATHIC LAW OF CURE. 61 which the patient was to take. Indeed, if the medicine acted similarly to the disease, common prudence required that the smallest possible dose should be given in the first place. Of liquid medicines, the first smallest dose was of course a drop, and, indeed, we find that this was the dose which Hahnemann commenced with in his new practice. It would seem as though a medicine which had the power to produce a disturbance of the functions that resembled the natural maladyin all essential particulars, must have had a tendency to increase the symptoms of the disease, were it only temporarily, and, according to Hahnemann's statements, he indeed found that this was sometimes the case, and upon this phenomenon he constructed a partial explanation of the modus operandi of his preparations. According to Hahnemann, it is not the primary action of the drug that cures disease; this cure is effected by the reaction of the organism. Hence it is the reaction that we have to keep in view in our treatment, not the first or primary action of the drug. If, in a case of diarrhoea, we prescribe a binding medicine, such as Opium, the first action of the medicine will be against the disease, but the reaction will be against the medicine and in favor of the disease. Hence the natural disease will be strengthened by a medicine, the primary action of which is contrary to the disease. Common experience is undoubtedly in favor of this doctrine. Thus, a drunkard has to steady his trembling hands by brandy, before he is able to use them for the day's work; and the longer he has been in the habit of using the brandy, the more of it does he require. Persons who are in the habit of warming their feet over a register, have to warm them the longer the more. The bowels can be accustomed to the influence of loosen7 __ ~ __ 62 HOM(EOPATHY. ing medicines to such a degree, that these medicines lose their effect on the bowels, and that increasing quantities of medicine may be required; whereas a smaller dose was sufficient, in the beginning, to develop the cathartic action of the drug. What do these, and many other similar cases, from common experience, show? They show conclusively that, although the first effect of a drug may seem to be contrary to the disease, and in favor of the organism, yet, in the majority of cases, the reaction is contrary to the drug, and in favor of the disease. Hence, we must naturally infer that, in order to develop a suitable reaction, the primary action of the drug must be in favor of, or similar to, the disease, and the greater this primary similarity or correspondence between the remedial agent and the disease, the more contrary will be the reaction, and the more certain and permanent the cure. But these so-called medicinal aggravations not only served, in the judgment of Hahnemann, to corroborate the truth of the homoeopathic law; they led him to the discovery of important physiological and therapeutic truths. Compelled to diminish the quantity of his drugdoses, he resorted to the following method of diminishing the strength of the medicine, and at the same time, preserving'its curative virtues. He mixed one drop of the original tincture, with ninety-nine drops of alcohol, and shook the vial vigorously, first carrying the arm up and then downwards; and, in order to shake the contents of the little vial the more thoroughly, he caused the hand to alight on some elastic substance, which made it bound back with a certain force. This preparation was labelled "first attenuation." To prepare the second attenuation, a drop of the first attenuation was again mixed in a per THE HOM(EOPATHIC LAW OF CURE. 63 fectly clean and dry vial, with ninety-nine drops of alcohol, and shaken as before. And in this way the process of attenuating the medicine was carried on through a number of vials, and has recently been conducted as far as the eight thousandth, and even the ten thousandth attenuation. It would seem as though these highly attenuated medicines could not possibly have any effect, and that the medicinal power of a drug must disappear after the drug has been attenuated beyond a certain limit. It is not our business, in this place, to decide either for or against these high attenuations, but simply to relate facts as they. have actually occurred. Our duty to the reader, is therefore fulfilled, if we simply state to him, what Hahnemanni asserts with much emphasis to be true, that his mode of dividing the drug by succussion, in a successive series of vials, develops its inherent dynamic power, spiritualizes the drug so to say, and while neutralizing or removing its purely chemical, physical or grossly poisonous properties, fits it to act so much more efficiently and positively as a curative agent. Hence attenuations are likewise termed dynamizations, or potencies, potentized drugs. The doctrines of medicinal aggravations and of dynamization have given rise to a good many misconceptions in the popular mind. In regard to the former, the opinion has prevailed for a considerable period of time that no cure can be effected by homoeopathic medicines without previously aggravating the character of the disease; and this exceedingly erroneous belief has prevented many from trying the homoeopathic mode of treatment. It is certainly true that an excessive dose of a medicine which has a tendency to disturb the system in a manner per ---11-"1--~1--~^11---` 1~-~--- 61 HOMcEorATHY. 61t HOM(EOPATHY. fectly analogous to the natural disease, may produce a very unpleasant aggravation of its symptoms; but where is the necessity of administering such a dose? One of the inestimable advantages of homoeopathy is, to enable the practitioner to administer the appropriate remedy in any quantity and of any strength, even an infinitesimal portion of a drop, and to avoid even the remotest chance of unnecessarily aggravating the natural pains. For it is a mistake to suppose that the aggravation must be perceptible in order that the disease may be removed from the system. The whole doctrine of medicinal aggravations is more or less speculative; an isolated and accidental aggravation has been made the basis of a doctrine, and it will require a good deal of discussion and explanation to chase the bug-bear of aggravations out of the popular mind, and to establish the truth concerning them upon a truly philosophical basis. In regard to the doctrine of dynamization, important errors have likewise disturbed both the friends and opponents of homoeopathy. It has been supposed that the term dynamization or potentization implies an increase of power, and yet this is not so, if we have reference to the destructive or poisonous properties of the drug. Every body knows that, if we divide a grain of arsenic into a hundred parts, the one hundredth portion of a grain cannot be as powerful as the whole grain; and it is, therefore, evident that by dynamizating or develop. ing the power of their drugs, homoeopathic physicians cannot mean an increase of their destructive properties, but must mean something entirely different from what it is popularly supposed they do mean. What then is understood by the term dynamization, or potentization, if it does not mean an expansion of the inherent _I_ _ __ _ THE HOM(EOPATHIC LAW OF CURE. 65 chemical or physical properties of the drug? Let us explain. According to the. common belief, a drug is powerful when its action upon the animal organipm is of a violent and subversive nature. Prussic acid, for example, is called a powerful poison, because a small quantity of this substance is capable of destroying life. It is not in this sense that the power of homoeopathic preparations should be understood. These preparations are powerful in this sense, that they are endowed with a specific efficacy to control disease in a direct manner, not in the round-about way of the old school. Under the old school system a headache is cured by physicking the bowels, or a weakness in the bowels by sickening the stomach. Hence under homoeopathic treatment, the cure of disease is so intimately associated with the production of a violent medicinal commotion in the system, that it has become a popular prejudice that a medicine cannot cure disease except by convulsing or irritating the system in some part more or less remote from the focus of the diseased action. This is the reason why recent converts to the homoeopathic treatment of disease, on receiving a dose of medicine out of the doctor's hands, are very apt to ask the question, how will this medicine act? will it act upon the bowels, or what will it do? Such patients should be made to understand that the developmenft of these mediate or revulsive effects is not, by any means, the legitimate office.of a remedial agent. If a patient wants to get cured of colic, for instance, or of a sick headache, and he takes medicine for such a purpose, what should be the natural, direct, and therefore legitimate effect of the medicine? Common sense tells us that this should be a diminution and 7 - 66 HOM(EOPATHY. gradual disappearance of the headache. After taking the medicine, and allowing it a reasonable time to manifest its influence, the patient should feel relieved. It makes very little difference to him how this takes place, all he asks is to get better after taking medicine, and this relief must be the direct, inevitable consequence of his taking the medicine. What logical connection can there exist in the patient's mind between the relief he is in need of, and purging the bowels or blistering the skin? It is evident that the idea of relief, and the infliction of pain for the purpose of procuring it, are two facts that exclude each other as perfectly as heat and cold, or any two opposites in nature. Why then does the alloeopathic drug convulse or irritate the system? Why does it not effect a cure without producing these violent commotions or alterations which patients dread more than the original disease? For the simple reason that the al-leopathic remedial agent has no direct, immediate power over the disease, and that this revulsive or counter-irritating action is resorted to in the hope of absorbing and neutralizing, by its means, the natural irritation. This is far different in the homceopathic practice. The homoeopathic remedial agent exercises a direct, immediate, and very frequently instantaneous influence over the disease, and causes it to yield without a struggle and without the least appearance of any of those distressing medicinal symptoms that have rendered the alloeopathic treatment of disease so formidable and so destructive of life and happiness. After taking the proper homoeopathic remedy, the patient feels better; this is all he knows of the presence of the medicine in his system. There is no vomiting, no purging, no artificial sweating, and, if it were not for the suddenness _1 _ THE HOM(EOPATHIC LAW OF CURE. and the striking character of the relief obtained,; he might be tempted to believe, and indeed, he frequently does believe, and very ungratefully asserts, that he got well without any medicine whatsoever. How is this? How is it possible that a minute dose of medicine should have such remarkable curative powers? In respect to such questions the alloeopathic physician enjoys great advantages over the homoeopathic. For, if a pain in the head should disappear under the purging action of a dose of calomel or rhubarb, or a pain in the chest under the blistering influence of tartar-emetic ointment, the patient contents himself with believing that the pain was driven out by the bowels, or that the pain in the lungs was owing to bad humors which the blister had drawn out upon the skin. The alloeopathic system is filled with such grossly-material modes of reasoning; which would be found to be without the least meaning, if patients would only take the trouble to investigate the meaning carefully. They would soon find that it is beyond the common understanding to trace any logical connection between the pain in the head and the loosening effects of calomel, and that it is just as impossible, in the present state of the natural sciences, to account for the action of calomel or of any other drug, as it is to acconnt for the mysterious influence of the brain itself. Nevertheless, man who, as a general rule, is yet fond of illusions and allows his reason to be swayed by illusions, prefers an illusion, even though completely erroneous, to a transcendent, purely rational truth. And, unfortunately for homoeopathic physicians, pure reasoning has as yet to be their chief reliance in en-,deavoring to account for the action of their remedial agents. The homoeopathic physician has none of those __ 68 - HOMOEOPATHY. sensual illusions and sophisms at his command that suggest themselves to the alloeopathic practitioner in abundance. All that a patient under homoeopathic treatment experiences of the effects of the homoeopathic remedial agent, is the gradual restoration of his health; but there is no sweating, no purging, no vomiting, or any other of the violent allceopathic revulsions to which the carrying off of the morbid matter could be ascribed. Now, we trust, we are prepared to understand what homoeopathic physicians mean by the term "power," when they use it in connection with, or as an attribute of, their remedial preparations. By "power," homoeopathic physicians mean that relation between the homoeopathic remedial agent and the disease which will most directly and certainly ultimate in a cure. The method of progressive attenuations or dynamizations is believed to be the best means of exactly fitting the remedial agent to the disease, and it is in this exact adaptation to the disease that the "power" of the remedial agent over the disease resides. Various attempts have been made to account for the mode in which the remedial. agent effects the cure. Some account for it upon the principle of oscillation; regarding the morbid action as a series of oscillations in one direction, and the action of the remedial agent as a series of oscillations in an opposite direction; others account for it upon grounds suggested by the doctrine of positive and negative electricity, regarding the disease as a negative and the remedial agent as the opposite positive principle; others again explain.the modus operandi of the remedial agent upon the principle of attraction, the disease being attracted, as it were, by the homoeopathic remedial agent, which, by the peculiar process of preparation it THE HOM(EOPATHIC LAW OF CURE. had undergone, had acquired a sort of magnetic-spiritual power and, by this means, had become enabled to draw the morbid sphere which had diffused itself through the organism, into a material point, just as the point of the metallic rod will attract the electric fluid; the disease being condensed or materialized, as it were, in a mere point or ultimate molecule, the organism is, of course, freed from the morbific principle, and the material form to which the disease has been reduced, is readily expelled from the system. Any of these various processes of cure must evidently take place silently, spontaneously and without any perceptible commotion of the organism. All these different modes of explaining the action of the homiceopathic agent, are more or less speculative, but, fortunately not essential to a cure. The essential thing is to understand and admit the principle "similia similibus;" this being admitted, the smallness of the dose follows as a matter of course. And now, after the homceopathic healing art has existed for half a century, and, during this period, has spread with the most triumphant eclat over every country where science and genius are honored, we can appeal to the most brilliant cures in testimony of the efficacy of our small doses. To those who have discovered a glimpse of truth in the fundamental principle of homceopathy, we say, try the application thereof to the cure of disease and you will: not be disappointed; but be sure to select the right remedyy otherwise the small dose will have no effect. And this leads us to allude to a misapprehension which is quite current among uninformed laymetn; it is this, that homceopathy is supposed to consist in the use of small doses of medicine, and that large doses of medi 70O HO03(EOPATHY. cine are supposed to be contrary to homoeopathy. Those who have taken the trouble to read our explanations of the fundamental homoeopathic law of cure understandingly, scarcely need be shown the fallacy of the notion, that the size of the dose constitutes either the homoeopathicity or non-homoeopathicity of medical treatment. They must have understood, that it is upon the relation of the internal quality of the drug to the disease that the homoeopathicity of the treatment depends. A medicine is homoeopathic to the disease when it is capable of affecting the healthy animal organism in a manner strictly similar to the disease for which it is prescribed. This condition of similarity is the soul and spirit of homoeopathy, and wherever it is wanting, the treatrfent is not homoeopathic, no matter how small soever the dose which a physician may prescribe. On the other hand, it is evident that the medicine may be strictly homoeopathic to the disease, and yet be given in large doses. Homoeopathic physicians generally give very small doses, in order to avoid unnecessary medicinal aggravations, and because experience has shown that the so-called attenuations realize, as a general rule, the most direct and certain curative relation between the medicine and the disease; nevertheless, cases may occur where a homoeopathic physician may consider himself obliged to resort to larger doses, even to the tincture, and the treatment may, for all that, be strictly homoeopathic. It remains now to say a few words about homoeopathic globules and triturations, and we shall then have said everything that is necessary to a proper understanding of the homceopathic law of cure. We have explained, in previous paragraphs, the method of making alcoholic attenuations. This process i ________________ _ ____ _ ~_ THE HOM(EOPATHIC LAW OF CURE. 71 cannot be applied to all drugs, dry substances, metals, minerals, various kinds of roots, seeds, etc. To attenuate or potentize these drugs, the following process is resorted to: One grain of the original drug is mixed with ninety-nine grains of sugar of milk, in a perfectly dry and well polished mortar, and these two substances are then ground together for one hour in a manner which has been very minutely described by Hahnemann, and which it is unnecessary to detail here. This product forms the first trituration. The second trituration is made from the first, by taking one grain of the first trituration and mixing it with ninety-nine grains of sugar of milk, after which these two substances are ground together in a mortar, in the same manner as the first trituration. The third trituration is made from the second, in the same manner as the second from the first. There is no necessity of continuing the triturations beyond the third, except in exceptional cases, and with substances which it is very difficult to break up uniformly and completely, such as the seeds of Lycopodium. Generally speaking, the third trituration is soluble in water or dilute alcohol, and the fourth attenuation is prepared from the third, by dissolving one grain of this trituration in ninety-nine drops of, distilled water or dilute alcohol, taking good care to,shake the solution in the same manner as any other ordinary alcoholic attenuation. The fifth, and every succeeding attenuation, is prepared from the next preceding attenuation, by mixing one drop of this attenuation with ninety-nine drops of strong alcohol, and shaking the mixture as directed for the other attenuations. These attenuations should be kept in vials that had never been used for any other purpose whatsoever, nor should ever different kinds of LIII`------------------"-`------~------ - 72 HOM(EOPATHY. medicine be placed in the same vi4l. It is likewise of the utmost importance to cork the vials with care, and to use corks that are perfectly sound. To reduce a dose of medicine to the smallest possible size, and likewise for the better preservation of the medicine, Hahnemann resorted to the use of very small globules of sugar and flour, commonly termed pellets, about a hundred of which he moistened with one drop of the attenuated drug, and after having dried them carefully on a piece of unglazed and perfectly clean paper, the borders of which were slightly raised, so that the globules could be rolled about; they were enclosed in a tightly-corked vial, and in this state they were found to preserve their medicinal power for a series of years. For the benefit of those who wish to become more extensively acquainted with the particular principles of homceopathic posology, or the science of doses, we will now describe more in detail the mode of using hom.oeopathic preparations, including the size and repetition of the dose, and everything that may be of practical interest concerning the administration of homceopathic remedial agents. Our purpose is best attained by arranging our remarks under the following general heads: 1. What potencies or attenuations should be principally used? Size of doses. 2. How, or in what form, should the medicine be administered to the patient? 3. Repetition of doses. 4. Alternation of medicines. _ I ___ ___ ___ _~_~_ ___ ___ I ~J THE HOMKEOPATHIC LAW OF CURE. 73 WHAT POTENCIES OR ATTENUATIONS SHOULD BE PRINCIPALLY USED? SIZE OF DOSES. This question has caused a good many disputes in the homoeopathic ranks. Some physicians have strenuously contended for the higher and highest; others, on the contrary, for the lower and lowest attenuations. Many physicians, and these, it is to be hoped, constitute a majority of the profession, permit themselves to use the whole scale of preparations, from the tincture up to the highest attenuation. The division of practitioners into high and low dilutionists is a most absurd arrangement. It may be asserted as an established fact, that a cure may be effected, in every case where a cure is possible, with the first twelve attenuations of the suitable medicine. It cannot be shown, by any experimental evidence in our possession, that it is at all necessary, for purposes of cure, to attenuate drugs beyond the twelfth dynamization. The tendency of the age seems to be, to use the lower attenuations in preference to the higher. The size of the dose may depend upon a variety of circumstances-upon an idiosyncratic susceptibility to the action of particular medicines, upon the character and duration of the malady, upon the natural sensitiveness of the patient to medicinal action, and upon other circumstances. In some patients, a few drops of the strong tincture may be required to effect the largest amount of good in a given case, whereas a few globules of a tolerably high attenuation may be amply sufficient in other cases. After the sixth attenuation, the difference between subsequent attenuations is very trifling indeed. It is even doubted, by many of the most experienced and intelligent practitioners of our school, whether such a difference is not altogether imaginary. Hahnemann was very 8 __.__~~___ __ __._ ~ 74 HOMOEOPATHY. gradually led to the adoption of the higher attenuations; some of his most brilliant cures were achieved in the first years of his homoeopathic career, when he operated altogether with comparatively massive doses. As a general rule, homoeopathic physicians prefer small doses, or the higher attenuations, in most chronic cases, and likewise in the first stage of acute fevers; larger doses may be required at a later period of an acute disease, or if disorganizations threaten to develop themselves, or have actually set in. In the course of this work, the dose will always be indicated for every particular disease. In the meanwhile, it may be expedient to indicate a few general rules, by which those who prescribe homoeopathically may be guided in determining the size of the. dose. As a general rule, we resort to the lower preparations in the treatment of all diseases that run a rapid course, or which, unless speedily checked, would soon lead to disorganizations, or to the destruction of tissues. In this rule we not only include acute diseases, properly speaking, but also chronic diseases of great intensity and affecting the general organism in a dangerous and disorganizing manner. Starting from this position, we prefer the lower preparations, 1. In acute fevers, with or without local inflammations; 2. In remittent fevers, with local inflammation; 3. In intermittent fevers, and other intermittent diseases of an acute character, such as fever and ague, various forms of inflammatory neuralgia, etc.; 4. In chronic diseases that have a tendency to terminate in disorganizations, such as syphilis, tuberculous and scrofulous diseases, etc.; i-II _ __ I_ I I __ --~---111 -1 --_----1I1 I - - - THE HOM(EOPATHIC LAW OF CURE. 75 5. In such nervous diseases as will readily terminate in the destruction of parts, or in a permanent derangement of the functional powers of the affected part; such as various forms of acute nervous irritation, spinal irritation, seated or shifting congestions, spasms, convulsions, apoplexy, etc. 6. In actual disorganizations, suppurations, ulcerations; such as blennorrhoea of the lungs, uterus, vagina, phagedenic ulcers, schirrus, enlargements of organs, etc. We repeat that, as a general rule, it is safe to employ the lower attenuations in the treatment of these diseases. We say, as a general rule; for, in a number of cases of these very diseases, the middle or higher attenuations may be more conducive to a speedy and permanent cure. -It is utterly impossible to furnish rules that will prove safe and invariable guides to the beginning practitioner; in spite of rules, he will soon feel compelled to rely upon his own powers of observation, his own judgment, and to pursue a course opposite to the one that was pointed out to him in the books. Physicians who practice in the same families from year to year, enjoy great advantages over the beginning practitioner, as respects the dose which should be prescribed under certain circumstances. They are afforded frequent opportunities of studying the constitution of their patients, and the character of the diseases to which the families are most liable, and hence they are better able to judge, by the apparent phenomena of the disease, to what extent the internal organism is affected, and how much medicine it will require to make a curative impression on the disease, and whether the same medicine should be continued after this first impression is obtained, or whether another medicine should be substituted for, or given in alternation with it. The i76 HOMCEOPATHY. beginning practitioner, not having yet enjoyed these advantages of steady observation, has to steer his course, in respect to doses, with great caution, though even in his case the difficulties are by no means overwhelming, provided he enters upon the practice of his profession with a full knowledge of the pharmacodynamic virtues of our drugs, and of the various observations made by reliable practitioners, at the bedside of their patients, regarding the efficacy of the various attenuations of our remedial agents. It being the legitimate right of every practitioner to deduce rules of practice from the clinical observations he is enabled to make, the student of homoeopathy must expect to find a good deal of speculative reasoning mixed up with sound practical teaching, and to see one class of practitioners attack the statements of another class, sometimes with a good deal of bitterness of feeling. What is the student of homoeopathy to do in the presence of these apparently perplexing circumstances, these contradictory statements and inferences? To the intelligent student there is but one way left, and this is to hear every side, to listen to every opinion, and then to judge for himself, and pursue a perfectly independent course. We have named various classes of diseases, in which the lower attenuations seem to be preferable. This preference, however, is by no means absolute. The beginning practitioner should have some positive rules to set out with in his career; and the general propositions expressed in the preceding paragraph, are intended to subserve this purpose. There is scarcely a single rule in regard to the administration of drugs that does not require some modification in particular cases. Let us take an acute disease, pleurisy, we mean the _ THE HOM(EOPATHIC LAW OF CURE. 77 acute form, characterised by synochal fever, stitches in the side, excessive painfulness to the touch, oppression of breathing, racking cough with bloody sputa, etc. In many cases one or two doses of the thirtieth potency of Aconite will suffice to effect a radical cure; in other cases, on the contrary, the same disease, with apparently the same symptoms, will require repeated doses of the tincture, provided we mean to do the patient justice, and cure him according to the principle of Celsus, " cito, tute et jucunde':" Or, let us take a case of inflammatory rheumatism, for which we will suppose Aconite to be the true remedy. Do we not know that many severe cases of articular rheumatism have been cured with the middle potencies of Aconite in an incredibly short space of time, and that other cases, on the contrary, had to be treated with large doses of the tincture? As far as we are personally concerned, we can answer these questions in the affirmative with an impartial and truth-loving mind. Some cases of neuralgia will yield to the higher potencies of Aconite as by a charm, other cases require the use of strong doses of the tincture, and even an outward application of the drug. In many sections of our country, fever and ague is a prevailing disease. Some attacks will yield perfectly to a few globules of the thirtieth potency of Ipecacuanha, others have to be treated with Quinine in substance, others again are readily controlled by a few globules of the thirtieth potency of Cinchona; whereas, in thousands of cases Arsenic has to be given in doses of one-fifth of a grain. As regards chronic diseases it is generally supposed that the higher attenuations are preferable to the lower. This is true in many cases, but in other cases it is not 8* _I_~ _ __ __~I__ _ ~ __ 78 HOM(EOPATHY. true. The itch has frequently been cured with the higher attenuations of Sulphur and Miercury, but there are likewise cases that require the use of massive doses of Sulphur, and even the application of the sulphur-ointment. The lower attenuations are likewise preferable in all chronic diseases that threaten to terminate in the destruction or disorganization of tissues, extensive suppurations, ulcerations, congestions, etc. Even in purely nervous diseases, hysteria, hypochondria, mania, etc., it may sometimes be necessary to resort to the lower attenuations. It is not only proper, but frequently necessary to commence the treatment of these diseases with the middle or higher attenuations; but, if the same medicine should have to be used for a long time in succession, it may become necessary to use the lower preparations, though it may sometimes be of advantage to the patient to interpolate a dose of the higher preparations of the same substance. In some cases it is useful to employ the lower and higher attenuations of the same drug in alternation. In chronic eruptions, the middle or higher attenuations may be resorted to first, to be afterwards followed by the lower, if necessary. Persons who have never taken homoeopathic medicines, are more easily impressed by them than others who have already been under homceopathic treatment. This is particularly true in regard to inflammatory diseases, where, after a protracted alloeopathic treatment, a single dose of some higher potency of Aconite will sometimes relieve the patient as by enchantment. This remark applies likewise to organs that are acted upon for the first time by a certain medicine, which had been given to the same patient for diseases affecting other organs. For instance, the patient may have taken so much mer THE HOM(EOPATHIC LAW OF CURE. 79 cury, even in homoeopathic doses, for certain affections of the liver, that this organ refuses to receive any further impression from that agent; but, supposing he should be attacked with sore throat, and, for the first time should take mercury for this affection, provided, of course, that mercury is the specific remedy, the action of the medicine will be speedily perceived by the diseased part. So with any other drug. Affections of the larger nervous trunks require, as a general rule, to be treated with massive doses of the specific remedy. The rule seems to be, that the more central the diseased nervous mass, the more delicate should be the medicinal influence that is brought to bear upon it, of course within certain limits. Some portions of the nervous system may, for particular affections, have to be acted upon externally, by friction, endermatic application of the suitable remedial agent, etc. Even the poultices which we apply to inflammatory swellings, abscesses, etc., may be referred to as illustrations of this general principle. Physicians are frequently called upon to relieve their patients of drug-symptoms. The excessive use of mer. cury, for instance, may have caused an habitual tendency to salivation, inability to bear the least exposure to a current of air, to dampness, etc., bone-pains, costiveness, derangement of the liver. All such medicinal diseases have to be treated by suitable antidotes, or by the higher preparations of the same drug, or by the wet pack. The cold-water treatment will be found admirably adapted to such conditions. In order to facilitate the determination of the size of the dose as much as possible, we will terminate this paragraph for the convenience of laymen and beginning _ __ _1_11__ 80 HOMCEOPATHY. practitioners with the following general resume of practical rules: 1. Use the lower preparations in acute catarrhal and rheumatic fevers with or. without local inflammations; in acute gastric and bilious fevers. 2. In all chronic diseases with tendency to disorganizations, in extensive suppurations and ulcerations. 3. In all nervous diseases with tendency to disorganizations, such as spasms, convulsions, epileptic fits, etc. 4. In acute congestions of the; brain, thoracic and abdominal viscera. 5. In acute diseases which run a rapid course and are disposed to terminate fatally, such as cholera, apoplexy, inflaimmation of the heart, stomach, etc. 6. In a great many cases, where the medicine has to be continued for a long time, it may be expedient to use it in gradually increased doses. Use: the middle and higher attenuations: 1. Insequelaeof acute affections. 2. In chronic eruptions and other diseases without tendency to disorganization. 3. In purely nervous affections, such as vertigo, hysteria, hypochondria, without tendency to disorganization. 4. In all cases, where a certain drug had been used to excess, and where the same medicine is again indicated by the symptoms. 5. In all diseases, where the more central portions of the nervous system, seem to be involved, as in typhus cerebralis, delirium tremens, etc. 6. In a great many cases, where the diseased part is for the first time acted upon by the homceopathic agent. We may be pardoned for alluding once more to the THE HOMEBOPATHIC LAW OF CURE. 81 bitter strife which has been waged for years past by the respective adherents of high and low potencies, but more particularly by the so-called high against the low dilutionists. Such a course of conduct is not justified by Hahnemann's own antecedents. There was a period when Hahnemann considered it necessary to use very large doses; he states expressly that, in some cases of sickness, large doses were absolutely required to effect a cure. In the epidemic influenza of 1798, Hahnemann used Camphor as the specific remedy. He relates his success, in the treatment of this dangerous epidemic, in the following words (see Hahnemann's Lesser Writings, published by W. Radde, 322 Broadway, New York, p. 336): " Camphor surpassed all the expectations that could have been formed of it; it was efficacious, and, I may say, specific, in all the stages of the disease, accompanied or not by fever, especially when it was given as early as possible, and in large doses. A large number of patients recovered by its use in the space of four days, in spite of the gravity of their symptoms. "At the commencement, I was very cautious in its use, and did not give to adults above from fifteen to sixteen grains a day, in almond-milk; but I soon perceived that, in order to produce a speedy recovery, it was necessary to give, even to weak subjects, thirty grains, and to more robust individuals, forty grains in the twentyfour hours. The favorable result was never long delayed; the constipation ceased; the bad, or at least the bilious taste, rapidly went off, together with the nausea and discomfort; the weight and pain in the head diminished from hour to hour; the febrile rigor was smothered in its birth; the heat diminished, and in those cases L __ ____ _I__ ______ _ I_ I_ I _ 82 HOMIEOPATHY. where there had been no perspiration, or where it had been abundant, there occurred a general mild diaphoresis, with diminution of all the drawing, tensive pains in the external parts. The strength soon returned, along with appetite and sleep; the despondency changed to hope, and the patient recovered his health without a drawback." We might refer to a number of other instances from Hahnemann's own practice, to justify the use of large doses; but this seems a mere waste of ink and paper. The chief object, in prescribing a medicine, is to effect a cure, and every physician is entitled to the privilege of using his own discretion regarding the dose by means of which this object is best accomplished. In a very large number of cases, small doses are undoubtedly sufficient to effect a cure. If a patient had been frequently bled for pneumonia or some other inflammatory disease, and he is transferred to the hands of a homoeopathic physician in a low state, small doses of medicine are undoubtedly preferable to large ones. A large dose of Aconite, for instance, in case this medicine should still be indicated by the existing inflammatory symptoms, might produce unpleasant medicinal effects, such as dyspnoea, palpitation of the heart, anxiety, violent throbbing of the pulse. A higher attenuation mright produce the desired relief without any of- these distressing aggravations. Repetition of the Dose. In the earlier periods of homoeopathy, it was thought proper, by Hahnemann and his disciples, to give but one dose, and to watch its effects before administering a sec THE HOI(EOPATHIC LAW OF CURE. 83 ond dose of the same medicine. This method, however, has been abandoned by most homoeopaths. It would be impossible to watch the effects of a single dose in every case; physicians who have a large practice could not do their patients justice, if this rule were a fundamental principle in the homoeopathic treatment of disease. Some writers apprehend very unfavorable consequences from an unnecessary or untimely repetition of the dose. These apprehensions are very much exaggerated, and, in most cases, unfounded. If the medicine produces a favorable result after one, two or three doses, common sense tells us that it is unnecessary to use the remedy as frequently as before. Instead of giving it every two, we give it every four or six, hours, or even less frequently. It stands to reason that, as long as the patient continues to feel better, the medicine may be discontinued. In a case of fever, for instance, where a dose of Aconite produces perspiration; with a feeling of ease, it would be ill-advised to repeat the medicine as long as the perspiration and the feeling of ease continue. If the improvement ceases or begins to be less marked, the medicine may be resumed, In all cases it would be injudicious to repeat the dose more frequently than is required by the condition of the patient; but in this respect, as well as in respect to the size of the dose, all pedantry should be avoided, and no practitioner should suppose that, because it may suit his taste or genius to give but one dose of medicine every eight or twelve hours, it might not sometimes be to his patient's advantage if the medicine were repeated every two or three hours. Every physician will have to depend more or less upon his own judgment in regard to the repetition of the dose; in the absence of rules derived from his own personal observation and ~_ __ 84 HOMIEOPATHY. experience, the beginner may avail himself of the following general suggestions: 1. In acute fevers, with or without local inflammation, repeat the dose every hour, or every two or three hours, according as the violence of the symptoms may seem to require. 2. In chronic diseases, with tendency to disorganizations, repeat the dose three or four times in the twentyfour hours. 3. In extensive or deep-seated suppurations and ulcerations, repeat the dose three or four times a day. 4. In acute spasms and convulsions the dose may be repeated every ten or fifteen minutes; if the spasms recur at intervals of weeks or months, the specific remedy may be repeated twice a week. 5. In acute congestions, such as congestion of the brain, lungs, liver, etc., the dose should be repeated every hour, or every two or three hours, according as the intensity of the pain, or the extent of the danger, may require. 6. In cholera, inflammation of the heart and stomach, apoplexy, acute paralysis, or any other acute disease, which runs a very rapid course, and is disposed to terminate fatally, the medicine may be repeated every five, ten or fifteen minutes, until a favorable reaction sets in. 7. In the sequele of acute affections the medicine may be repeated three or four times a day. 8. In chronic eruptions give the medicine once or twice a day, or in. very chronic cases, once or twice a week. 9. In nervous affections, without tendency to disorganizations, such as vertigo, hysteria, hypochondria, I _ _ ___ THE HOM(EOPATHIC LAW OF CURE. 85 local spasms, etc., give the medicine three or four times in the twenty-four hours. 10. In acute diseases of the higher portions of the nervous system, the medicine may be repeated every half hour, or every hour, or even every two hours, according as the symptoms are more or less threatening. In simple typhus cerebralis, for instance, or in meningitis, in delirium tremens, or even in acute hydrocephalus, we would advise to give the medicine every two hours, although we are persuaded that it may be safely given every hour, until the pain is mitigated and a reaction has commenced. Alternation of Medicines. Experienced practitioners are not fond of using many kinds of medicine. Homoeopathic beginners who are not yet thoroughly acquainted with their Materia Medica, are very apt to commit the great mista'ke of changing their medicines too frequently. Some physicians give a new medicine as often as they visit their patients. We have known physicians who used half a dozen different medicines in a case, where an intelligent and well-informed practitioner would have contented himself with one or two. These frequent changes of medicines are all wrong, and they betray an ignorance of the true action of our drugs or a want of faith in their efficacy. In many diseases it is, of course, necessary to employ different remedies; but there is scarcely a disease, even the higher forms of typhus, which cannot be effectually controlled by at most three or four remedies. In a number of diseases, where many physicians are in the habit of prescribing several different medicines, a single remedy is frequently sufficient to effect a radical 9 __ 86 HOM(EOPATHY. and permanent cure. In simple inflammatory diseases, for example, physicians generally commence the treatment with a dose of Aconite, and as soon as the fever abates and signs of reaction set in, the Aconite is abandoned and a dose of Bryonia, Belladonna or some other medicine substituted. This may all be very well in some cases, but it is decidedly wrong to make this a rule; for in many cases the probability is that a second dose of Aconite, given at a suitable interval from the first, would have achieved the cure much more speedily and thoroughly than any other two, three or half a dozen medicines could have done. There is another custom which has been introduced into the practice of Homoeopathy by recent practitioners, and is unfortunately carried to so great an extent that it amounts to a positive abuse; we allude to the habit of alternating several medicines at one and the same time. Some physicians use as many as four different remedies at one period. This is certainly a great mistake, although patients will, of course, get well under such a treatment as well as under any other mode of homoeopathic practice. But it would seem as though physicians who have acquired a proper knowledge of the curative resources of their Materia Medica, could not possibly resort to the simultaneous use, in alternation, of three or four remedies. This method of alternation has originated, in a great measure, in a false conception of what should be understood by the term "similarity." It has been supposed that this term implies an exact reproduction, in our provings upon the healthy organism, of the morbid symptoms which we desire to cure. Now, every intelligent observer at once perceives that similarity, as understood in this technical sense, is impossible. For THE HOM(EOPATHIC LAW OF CURE. 87 we have not yet succeeded, and probably shall never succeed, in producing the exact symptoms of pneumonia, pleurisy, inflammation of the brain, typhus, or any other disease. Hence it is not by this merely external or symptomatic resemblance that the homoeopathic similarity of a drug to the disease should be measured. This similarity has reference to the essential morbid condition; it may exist, even though the symptoms, as recorded in the Materia Medica, should not comprehend the full series of morbid phenomena which characterise the particular case before us. The very expression "homceopathy," refers, not to the technical symptoms, but to the disease; homoeopathy means " similar disease," and by disease we understand any state or condition of the body which is not a state of health. Disease is not anything positive; health is a positive state, characterised by definite functions and appearances, and resulting from, and supported by fixed laws; but disease is merely a negative state or condition of the organism, an absence of health. Hence the symptoms which characterise the disease, are, properly speaking, the symptoms by which we recognise an absence of health. How far this absence extends, or the degree of the disturbance, can only be determined by a comparison of the morbid with the healthy state. This shows that disease is a relative condition; that it is something only, when compared with a state of health, and that, without a knowledge of the normal physiological functions, it is utterly impossible to determine the true meaning and character of disease. Hence the symptoms of a disease imply, in reality, an abnormal alteration of the primary or normal physiological state, and just as much as it is the legitimate province of the human reason to investigate the 88 8HOM(EOPATHY. character and connection of the physiological phenomena, just as much it is the undoubted privilege and office of reason to determine the true meaning and relation of the pathological symptoms, or the symptoms by which we recognize a disturbance of the normal physiological condition of the organism. To prescribe for symptoms without reference to the physiological functions, would be tantamount to confounding a dead with a living body. It would be prescribing for shadows, and such a mode of prescribing would be, as the late Dr. Hufeland very correctly observed, the grave of Medicine. Any dunce might be a physician, provided he is able to read and write, and knows an eye from a toe-nail. The symptoms of a disease should be viewed as the phenomenal manifestations of an internal condition of the system. It is only when symptoms are viewed superficially, without reference to their internal unity, that they seem disconnected, and that more than one medicine seems to be required at one and the same time for their removal. In his Organon, Hahnemann proposes that a general record of the symptoms, as stated by the patient, be taken according to a certain order, and that from among the drugs, the provings of which are recorded in our Materia Medica, the physician select one whose symptoms resemble, as nearly as possible, the symptoms of the disease. This method has given rise to abuses. If one remedy does not suffice, some practitioners will select two, in order to make sure that the symptoms of the disease are "covered," as they term it, by the remedies. Physicians who proceed in this manner seem to ignore the fact that diseases are disturbances of the organism, and that the symptoms simply reveal the nature of these disturbances to those LI____ _ __ THE HOM(EOPATHIC LAW OF CURE. 89 whose intelligence enables them to interpret the phenomenal signs of diseases. There are circumstances where the alternate use of two medicines may not only be excusable, but necessary. Sometimes the symptoms are so obscure, that it is difficult to tell which of two remedies is indicated; or a physician in large practice may be unable to watch the effects of his remedies as closely as he would wish. Under these circumstances, it may be advisable to prescribe two medicines in alternation. In a case of injury, for instance, we may prescribe Aconite and Arnica in alternation; in a case of pneumonia, Aconite and Phosphorus; in a case of erysipelas, Aconite and Rhus tox. But let us avoid the abuse of this mode of practice. Compounding several medicines into one is not allowable according to Hahnemann. This practice is even condemned by many alloeopathic physicians, one of whom, Marcus Herz, expresses himself as follows, in the second volume of Hufeland's Journal, page 33: "When we wish to remove inflammation, we do not employ either nitre, sal ammoniac or vegetable acids singly, but we usually mix up several antiphlogistics, or use the whole of them together at the same time. If we have to contend against putridity, we are not content with administering, in large quantities, one of the known antiseptics, cinchona, mineral acids, arnica, serperttaria, etc., to attain the object we have in view, but we prefer mixing up several of them together, having a greater reliance upon their combined action; or, not knowing which of them would act most suitably in the existing case, we accumulate a variety' of incompatible substances, and abandon to chance the care of producing, by means of one or the other of them, the relief we designed to (.^. I _I 90 HOM(EOPATHY. afford. Thus it is rare that, by the aid of a single medicine, we excite perspiration, purify the blood, dissolve obstructions, provoke expectoration, or even effect purgation. To arrive at these results, our prescriptions are always complicated; they are scarcely ever simple and pure: consequently they cannot be regarded as experiments relative to the effects of the various substances that enter into their composition. In fact, we learnedly establish, among the medicines in our recipes, a hierarchy, and we call that one the basis to which we (properly speaking) confide the effect, giving to others the names of adjuvants, corrigents, etc. But it is evident that mere arbitrary will has, for the most part, been the occasion of such a classification. The adjuvants contribute as well as the basis to the entire effect, although, in the absence of a scale of measurement, we cannot determine to what degree they may have participated. The influence of the corrigents over the virtues of other medicines, likewise, cannot be wholly indifferent; they must either increase or diminish them, or give them another. direction. The salutary change which we effect by the aid of such a prescription, ought then always to be considered as the result of its whole contents taken collectively, and we can never come to any certain conclusion upon the individual efficacy of any one of the ingredients of which it is composed. In short, we are but too slightly acquainted with that which is essential to be known of all medicines, and our knowledge with regard to the afinities which they enter into, when mixed up together, is too limited for us to be able to say, with any degree of certainty, what will be the mode or degree of action of a substance, even the most insignificant in appearance, when introduced into the human body, combined with other substances." THE HOMCEOPATHIC LAW OF CURE. 91 Examples of Homoeopathic Treatment taken from Old-School Practice. There are many medicines used by old school physicians which have acquired the name and reputation of specifics. These medicines cure certain diseases in a remarkably prompt and efficient manner. Whenever these diseases occur, the medicines, which are reputed as specific remedies against them, are expected to cure them without fail and as a matter of course. Hahnemann has compiled, in his Organon, a very large number of cases of disease cured by the administration of specifics; be shows that they exercise their specific curative action in consequence of their being homoeopathic to the disease. For the benefit of our readers, we will subjoin some of the most interesting of these cases of specific homoeopathic treatment by old school physicians. The English sweating sickness, which first exhibited itself in the year 1485, and which carried off in the commencement, ninety-nine patients out of a hundred, could not be subdued until such time as they had learned to administer sudorifics to patients. Since that time, as Sennertus observes in his work, " De febribus, IV. chap. 15," few patients died of it. A case of dysentery which lasted several years, and against which every other medicine had been tried without success, was, to the great surprise of Fischer, in Hufeland's Journal, Vol. X., p. 127, cured in a speedy and permanent manner by a purgative administered by an empiric. Among the symptoms produced by the use of tobacco, vertigo, nausea and anxiety, are the principal. Whereas, Diemerbroeck, in his Treatise on the Plague, published at Amsterdam, 1665, p. 273, informs us that, when 92 HOM---E0PATHY.-~ 92 HOM(EOPATHY. attacked with those very symptoms of vertigo, nausea and anxiety, in the course of his close attendance on the victims of epidemic diseases in Holland, he removed tkma by the use of the pipe. According to Murray, oil of aniseed allays pains in the stomach and flatulent colic caused by purgatives; whereas, J. P. Albrecht has observed pains in the stomach produced by this liquid; and P. Forestus, violent colic likewise caused by its administration. Hoffmann praises the efficacy of millefoil, or yarrow, in various cases of hemorrhage; and Stahl has found this plant useful in excessive hsemorrhoidal flux; Ouarin and other physicians have cured with it haemoptysis, and Thomasius uterine hcemorrhage. Jalap, according to Muralto, creates gripes of the stomach, with great uneasiness and agitation. Wedel praises its efficacy in allaying the gripes, restlessness and screaming, which are so frequent in young children, and restoring them to tranquil repose. Senna, according to Murray and Hoffmann, occasions a kind of colic, and produces flatulence, agitation of the blood, sleeplessness. Detharding cured with its aid patients afflicted with violent colic and sleeplessness. Stcerck knew that clematis produces a psoric eruption over the whole body, and yet he cured with it a general chronic humid, phagedenic and psoric eruption. According to Murray, euphrasia cures bleareycdness and a certain form of ophthalmia, and yet Lobelius remarked, that it possesses the faculty of exciting a kind of inflammation of the eyes. The rhus toxicodendron and radicans produce pimples which gradually cover the entire body; Dufresnay cured with Rhus various kinds of herpes. _C~ ~ THIE IIOM(EOPATHIC LAW OF CURE. 93 Dulcamara produces similar affections to those which arise from colds; see Carrere's Treatise on the Properties of the Bitter-Sweet, and yet this author informs us that he has cured with this plant the most violent diseases emanating from colds. Stramonium excites a singular kind of delirium, convulsions, and involuntary movements of the limbs; see Crueger, Boerhaave and others.. Sydenham, Boerhaave and others, have cured with it these very same diseases. Ipecacuanha excites hemorrhage and produces spasmodic asthma, according to Baglivi, Murray and other eminent observers. And yet it cures these diseases most effectually, as was known to Baglivi, Murray, Geoffrey and others. Belladonna causes symptoms which resemble hydrophobia, amaurosis, madness and melancholy, as is related by a number of allceopathic writers, and yet it frequently cures these very same diseases, as stated by Buchholz, Henning and others. Schenkbecher would never have succeeded in curing a vertigo of twenty years standing with hyoscyamus, if this plant did not possess the power of creating an analogous affection. Spirituous wines, administered in small doses, have cured fevers that were purely inflammatory. Asclepiades, on one occasion, cured an inflammation of the brain by administering a small quantity of wine. In a fever, attended with coma, where the patient deprived of speech, lay extended, the eyes open, the limbs stiff, the pulse small and intermittent, the respiration disturbed and stertorous, Opium was the only substance which Hoffman saw produce any good effects; and yet, according to the report of Delacroix, Rade 94 HOM(EOPATHY. macher, Sauvages and others, it produces these very symptoms. Lead produces the most obstinate constipation, and even the iliac passion; and yet Sydenham and others cured these very same diseases with lead. Mercury produces inflammation and swelling of the inner parts of the mouth, ulceration of the mouth, aphthae, etc., and yet all these conditions are removed by mercury, as stated by Hamilton, Hoffmann, and others. Frozen sour-krout is frequently applied to a limb that is recently frozen, or sometimes it is rubbed with snow. A cook who has scalded his hand, exposes it to the fire at a certain distance, without heeding the increase of pain which it at first occasions, because experience has taught him that, by acting thus, he can, in a very short time, perfectly cure the burn, and remove every feeling of pain. Others apply a substance to burns which excites of itself a similar feeling of heat, that is to say, hot alcohol or the oil of turpentine. Laborers who work in the fields under a scorching sun, will not drink cold water when the heat of the sun or the fatigue of hard labor have brought them into a feverish state; they are well aware of the danger that would ensue, and they know that their parched mouths cannot be effectually moistened with water, but that a little brandy will accomplish this, and will, moreover, diminish the heat and lassitude which oppress them. In Hahnemann's Organon, pages 60-90, from which the foregoing cases are extracted, the curious reader will find a large number of exceedingly interesting illustrations of the homoeopathic method of cure taken from Old School practice. - `-R---~ --~-------~I-I' HYGIENE. 95 HYGIENE. BY hygiene we understand, properly speaking, the science of the preservation of health. The regulation of all those influences in society that have a tendency to affect man's physical well-being, appertains to the province of hygiene. E-ducation, our system of labor, street cleaning, ventilation, the lighting, warming and construction of our houses, the draining of swamps and marshes, the condition of our markets, the quality and preparation of food, exercise, clothing, and many other subjects, constitute the legitimate sphere of hygiene. But in a popular work of this kind, the limits of which are necessarily confined, it would be impossible to treat of all these subjects in a comprehensive manner. Those who are desirous of being more familiarly acquainted with such interesting matters, will have to consult works where these subjects are treated in detail; all that the limits and object of the present work will allow us to. do, is to communicate to the reader a few useful hints relative to diet or food and drink, exercise, clothing, ventilation, bathing and the use of water for medicinal purposes generally. Let us begin our remarks with Diet, There exist all sorts of opinions and doctrines regarding the food which a man should consume, and the mode of preparation that the food should be subjected 96 IYGIENE. to previously to being introduced into the stomach for its preservation and development of the organism. Some teach that man should confine himself exclusively to the use of vegetables; others, that he should eat every kind of fruit and vegetable raw, without any preliminary preparation by the various processes of cooking; others maintain that man should avoid every kind of spirituous beverage, and drink nothing but water. A long list of opinions and theories might be adduced concerning the best mode of dressing, exercising and so forth; but with all these diversified opinions we have nothing to do in this work, and our duty is fulfilled by simply affording the reader such suggestions concerning the principal subjects of hygiene, as are conformable to plain common sense. It would seem, however, beyond controversy that the food which man consumes, generally requires to undergo some preparatory process of boiling, cooking, roasting and the like, before it can be adequately assimilated by the human organism. A great many substances contain in their crude state acrid principles which are either injurious to the human organism, or impede the process of assimilation; and the various processes of cooking are required to destroy or remove obstacles of this nature. Take, for instance, a vegetable which is one of the greatest blessings that Providence has bestowed upon us-the common potato. In its crude state this eminently useful and salubrious vegetable contains a quantity of tannin which, if introduced into the stomach, would prove exceedingly detrimental to this organ, and would greatly embarrass the process of digestion. By cooking the potato, this deleterious principle is entirely removed, and the feculent matter which constitutes the truly nutritious principle HYGIENE. 97 HYGIENE. 97 of the potato, is not only retained, but it is presented to the stomach in such a form as renders the process of assimilation an easy and pleasant business. Or let us take fruit, a fine luscious peach, a juicy pear or apple, the very thought of which causes our hearts to rejoice. It would seem as though these beautiful productions of nature need not undergo any previous preparation to be fit for use. And yet they do in a number of cases. For these delicious fruits frequently contain acrid and acid principles which are exceedingly unpleasant to the stomach, interfere with the secretion and the solvent power of the gastric juice, with the suitable absorption of the bile by the liver, and disturb the general harmony of the organism in a variety of ways. By cooking these fruits, the nocuous principles are neutralized or removed. It is a mistaken notion to suppose that a state of nature consists in eating every thing raw, going naked as some have actually proposed, or browsing like cattle on the fields. This is the nature of the brute; but the nature of man requires a far different and higher order of existence. Man is essentially a rational being, and one of the highest offices of human reason consists in properly cultivating the soil, perfecting the productions of the soil and adapting them to the varied wants of our nature. The art of cooking or preparing the food fot use, is one of the most useful and essential branches of human knowledge, which it would be desirable that every young woman should be thoroughly acquainted; with. When a great chemist, like Liebig, does not con-. sider it unworthy of his genius to discover a new and better 'mode of making soup, surely no young lady need be ashamed of acquiring a thorough knowledge of the art of cooking. How much more useful and agreeable 10 9S HYGIENE. _ 93 HYGIENE. this knowledge would be to her than the flippant and useless trash with which her brains are burthened in our fashionable boarding-schools and.academies. When the art of cooking shall be thoroughly and universally understood, we shall no longer hear thousands of mortals complain of dyspepsia, flatulence, and the like; we shall see new health and vigor infused into all classes of society, and the various dyscrasias or chronic taints which now desolate man's fair habitation and undermine the health of his body, will gradually disappear. It is contended by some, and more particularly by the adherents of Graham, that meat should not be used by man, and that he should confine himself exclusively to the use of vegetables and fruit. It is doubtful whether such a system can as yet be universally adopted. The time may come, when man's nature may be so universally refined, that nobody may be willing to slaughter a domestic animal, to hunt a deer or catch fish with a hook. And when this time shall have come, it is more than probable that then the human organism will not require any animal food for its sustenance and support. But in the present condition of society and of this globe, we could not possibly get along without animal food. If every body now living would at once discard the use of animal food, and confine himself to the use of vegetables and fruit, an universal state of starvation would ensue; for there would not be a sufficiency of vegetable food to satisfy the demands of, our own country, much less of the population of the whole globe. The existing poverty of the globe is one of the principal, and probably the principal objection to the introduction of a strictly vegetable diet in all families and countries. Man would consume immensely more _ L __ I_~ __ HYGIENE. 99 vegetables than he now does, and if every spot of the globe's surface were cultivated, it is not probable that, with our present means of producing, we should be able to make the surface of the globe yield enough to satisfy the wants of all its inhabitants. Vegetable diet is undoubtedly superior to animal diet. But man was not at first a consumer of vegetables. So far as we know, man began with eating his own species, and the beasts of the forest and the prairie. The use of vegetable productions was first resorted to, when man practised agriculture. The agricultural tribes were superior to the hunting tribes in social government and the cultivation of the arts and sciences. The character of the hunting Nomad was fierce, roving, and blood-thirsty, and the flesh of his booty was indispensable to satisfy the craving of his savage hunger. The first cultivators of the soil were less blood-thirsty than the Nomad tribes; but they were hard and unfeeling men, without refinement, though content to feed on the grain which the rudely-worked soil had yielded them. Theirs was a life of toil; the primitive plough afforded but a scanty assistance to the hand of man, and the struggle against Nature, in which the primitive ploughman was constantly engaged; the constant exposure to the inclemencies of the weather; the brutalizing company of his oxen, and the use of his coarse implements, hardened the heart of the husbandman, or, if it was not naturally hard and cruel, its kindly feelings had no scope of development, and the first notions of urbanity were of the rudest and most restricted kind. Gradually the cultivation of vegetables was introduced, and, with it, a higher state of social refinement. And it may safely be asserted, that social culture will 100 HGIEN 100 H YGIENE hereafter go hand in hand with the cultivation and use of vegetables, flowers and fruit. The degree of cultivation to which a nation has attained, will be measured by the quantity and beauty of the grain, vegetables and fruits which it produces and consumes, by the degree of scientific perfection which the art of preparing vegetables and fruits for use has acquired arrong the people, and by the degree of attention and universality with which this art is practised. It should be the duty of every statesman to encourage the cultivation of vegetables and fruits as one of the best means of spreading and consolidating refinement and happiness among his fellow-beings; the time may then arrive, when we 3hall be satisfied to drink the milk of our cattle, instead of eating their flesh; to relish a hen's egg, instead of destroying her little flock; and to admire the beauty and gracefulness of a stag, instead of hunting him down with a pack of bloodthirsty hounds, and gloating over his bleeding entrails. But, although this millennial period of social refinement seems yet far off, owing to the positive poverty of the globe and the scarcity of vegetable productions, which would soon compel us, if we would all at once discard the use of animal food, to resume it with renewed greediness and delight; yet it is not necessary that man should, on this account, be an essentially carnivorous animal. A vegetable diet has undoubtedly a refining influence on man, and no truly educated man will ever be seen stuffing himself with quantities of almost raw and bleeding beef, as thousands are in the habit of doing. This is a horrible custom, and every physician should exert his influence to banish the taste for, and the excessive use of, rare meat, from among the families where he attends. The use of fat, which so many persons are so fond of, is HYGENE 101_ HYGIENE. 101 decidedly coarse and vulgar. Sound, properly-cooked meat may be allowable; but the quantities of fat, and of fat gravies, that some people are in the habit of loading the stomach with, are sickening and exceedingly injurious to health. Would that the time were not far distant, when no person who lays claim to refinement and education will besmear his lips with fat meat, gravy, or even with the least injurious of all kinds of fat, fresh and sweet butter. I am not prepared to assert that the use of butter will ever be abandoned, no matter what degree of culture a nation may have acquired; but the abuse of this mild fat is unjustifiable, and implies a want of aesthetic culture. In the present condition of society, and of the globe which we inhabit, the use of meat, vegetables and fruits is not only allowable, but necessary. It is impossible to say how much of each of these different articles a man should consume. It stands to reason that this proportionate quantity depends a good deal upon a person's constitution and mode of life. Persons who take a good deal of exercise in the open air can eat more meat than others who lead a sedentary life; and, in regard to sex, a man can bear heartier food than a woman. It is painful to see a man fill his stomach to excess, but a womanglutton is disgusting; she is a disgrace to her sex. As a general rule, it is sufficient that we should eat meat once a day'; but hard-working men, laborers in the field, sailors, and, in general, individuals who are frequently exposed to the stimulating influence of a fresh and bracing atmosphere, and who are obliged to undergo a good deal of physical fatigue, may require meat twice and even three times a day. But before swallowing it, it should be properly chewed and mixed with saliva; the 10* 10 HYGIENE._ _ 102. HYGIENE. habit, which a great many persons have, to eat fast, and resume their work as soon as the last morsel of food is swallowed, is, in a great measure, the cause of dyspepsia, with which so many individuals seem to be affected. Everybody, even the meanest laborer, should have one hour to eat his meal, whether breakfast or dinner. Any violent exercise, even rapid walking, should be avoided immediately after a meal. After eating, it is well to remain quiet for half an hour, either in a sitting or a recumbent posture; this will allow the food time to settle, whereas, if we take violent exercise without this interval of rest, the stomach will feel oppressed and sometimes even as if filled with stones. In order to increase the solubility of the meat in the gastric juice, it it is proper to drink a moderate quantity of water during a meal; it is not necessary to drink more than a person naturally requires, nor is it possible to determine the quantity which everybody should drink, some requiring more, others less; but it is a mistaken notion to suppose that water must not be touched during a meal. I would not advise anybody to inundate the stomach, but, on the other hand, it should be well understood, that water is not a poisonous liquid at any time and under any circumstances, and that if the use of water be productive of evil results, it is not the water that should be accused of the mischief, but the circumstances under which it was used. Water may be freely drank during a meal, provided a few very simple rules are observed, which common sense will suggest to every person that is possessed of but a moderate share of this invaluable commodity. Among these rules the principal one is, not to drink water at the very moment when we are eating fat or gravies; for the effect of cold water upon the fat will HYGIENE. 103 be to cause it to coagulate, and to produce sickness at the stomach. The coagulated fat does not digest in the stomach; it passes out of the stomach in a perfectly undigested condition, and it is not till the pancreatic juice acts upon it, that the fat is dissolved. It was but recently discovered, by a French physician, that this process of solution takes place in the duodenum. This shows that it is important to prevent the coagulation of the fhtty matter in the stomach, for. its solution by the pancreatic juice must, of course, be facilitated by its being presented to the action of this fluid in a liquid form. Another rule is, not to drink an excessive quantity~ of water at one draught, lest the stomach should be unduly distended; for everybody may easily comprehend that an over-distended stomach would, in a measure, be deprived of the power to contract and effect the gyratory movements of the food, which are absolutely necessary to a proper performance of the process of digestion,. Without these gyrations, the food,would not he suitably commingled.with and acted upon by the gastric juice, and the process of digestion would not be adequately performed.; In some countries it is the fashion to take the principal meal after the day's labor is ended. This is undoubtedlya good method., provided.the last meal is not postponed. too late; hbut only few, comparatively speaking, can avail themselves of this advantage. Most people have to; take their dinner in the miiddle of the day, and have to cbntinue'their work afterwards;. and this would not be attended with any material injury, provided a sufficient period of rest is. enjoyed after the meal tq allow the food. to settle.- It should likewise be remarked, that it is-not well to eat a copious meal immediately after a very fatiguing exercise or work; if pos _ __ I_ ~___ __ _ 104 HYGIENE. sible, the body should first be allowed a little rest before the meal is eaten. It is well known, even by those who do not make such subjects their particular study, that some articles of food are more easily digested than others. This has been observed by ocular demonstration in some individuals whose stomachs could be'seen into through fistulous openings, and who afforded physiologists an opportunity of watching the time it required for the gastric juice to accomplish the solution of particular substances introduced into the stomach. In this way it was discovered, that in order to digest the following list of substances, the time which is appended to each particular substance, was required by the gastric juice to dissolve or digest it. Hrs. Min. Rice,.....................boiled,........ digested in......l Pig's feet, soused,.......... "........ Tripe, soused,.............. "......... Eggs. whipped,........... raw,......... Trout, salmon, fresh,a..... boiled,........" " ".....fried,........ Apples, sweet,............ raw,........... Venison-steak,............. broiled,....... Brains,.................boiled,....*... Sago,.................*........ "..... Tapioca,------- -.-- "........ Barley,............,................ Milk.................... "........ Liver, beefs, fresh,......... broiled,........ Eggs, fresh,.............. raw,........... Codfish, cured, dry,........boiled,........ Apples, sour,...raw,......... Cabbage, with vinegar,..... "......... Milk..................... "......... Eggs, fresh,. o.............roasted,..............1.......1 1.....1 30 "......1 30....... 30 1......1 30.......1 35 S.......1 45 "......1 45 S.......2 S......2.......2.......2 "......2 15.......2 15; ~.~-- pl~~-~rx~9~r~~r'~l~-~r.~----- HYGIENE. 10 MIrs. Min. Turkey, wild-..........roasted,. digested in...... 2 18 It domestic........ boiled 66602 25......... roasted,....... 2 30 Gelatine,..,,.ease o..boiled..............2 30 Goose...........roasted,,. a*a 0.... 2 30 Pig, sucking23...30 Lamb, fresh............... broiled,...,2 30 Beans, pod,.... 6,........a boiled,.........."...*2 30 Cake, sponge,......DAr!1.9...baked, *aa*2 30 Parsnips,., 0 09 0 a 0 a 0boiled,. 0 0 0 0 a a 0 a e 2 30 Potatoes, Irish,...e..?..v. roasted,......*.a.".a......2 30 0 00 00 0.baked,. a a a's 0,0 a *2 30 Cabbage, head,.......... raw,.............2.30 Spinal marrow,....... boiled,.. 2 40 Chicken,....a..a........ 0fricasseed,,. 0.0 02 45 Custard,., 0 0 0 0 0 a...baked,. a a 0 0 i a e a 9 2 45 Beef,..................boiled,. 2 45 Oysters..............raw........... 2 55 Eggs,......oft boiled,... 3 Beef, fresh, lean,' rareea.. roastedge e o. v i eo 3 Beef-steak, a W 6.1.broiled,. 9 0 0 0 0.3 Pork, salted............raw,.3. 3..6.. 0 a 91 e e a.stewed,. a a -0 0.03 Mutton, fresh,.... --00 1..0broiled,.. as a a 0.3..........boiled,. a a 0 0 #a9eae3 Chicken-soup 3... a00000 4 0aa*aa* Dumpling, apple,.... 0 0 0.....0 *a0 **s3 Oysters,....see......**e e.....roasted,.. * a e3 15 Pork-steak.......00....,broiled,... 0 3 0 0 a 315 (( salted,...... 060 smeso* 94 0 0 0 a 00 3 1..o saltd 3 15 MXutton........,,...,....roalsted )~~~ ~~~3 15 Bread, corn............ baked,.3... se 9 eooo315 Carrot,.,..............0.boiled',3. r0&00eae315 Sausage,.............*so**...broiled,.... 0...o P3: 20 Flounder,.I0...........fried. "... 0 ese.3 30 Oysters.............a.stewed 3 30 Beef................. boiled... It e 9 ~e~*3 30 Butter,........... *0 0.. melted,. aa ea*ee3 30 106 HYGIENE. Hrs. Min. Cheese, old...............raw.......... digested in......3 30 Bread, wheaten, fresh,..... 0baked,......... * ".....3 30 Turnips,.................. boiled,..... "......33 30 Potatoes, Irish,........... "............3 30 Eggs,.-...-................hard boiled,... ".... 3 30 ".................fried,......... "...3 30 Green corn and beans,..... boiled,................3 45 Beets,.......................... "......3 45 Salmon, salted,... "."..... Beef,................fried,...... ".....4 Veal....................broiled,...........4 Fowls, domestic,...........boiled,........ "......4......... roasted,....... "..4 Ducks, " 0 'I..... 0* It 0aaa 4 Ducks, ",........... "....... "......4 Heart, animal,.............fried,......... a......4 Beef, old, salted,........... boiled........ "......4 15 Pork, "......s.. fried......... "......4 15 ".........boiled,....... ".....4 30 Veal,.....................fried,......... "..... 4 30 Ducks, wild,...............roasted....... "......4 30 Suet, mutton,.............. boiled,........ "...... 4 30 Cabbage, with vinegar,..... "......... "......4 30 Suet, beef,................ "....... "......5 03 Pork, fat and lean,........roasted,....... "......5 15 Some excedingly interesting facts may be gleaned from this table, by the reader. He will be astonished to find that soft-boiled eggs are much less digestible than boiled beef or raw oysters; and yet the figures in the table must convince him, that this is a fact. Most people fancy that a soft-boiled egg is easily digested, that it cannot hurt any body, and may therefore be safely given to a patient who is. recovering from some acute disease.- This table shows that this universally prevailing opinion is erroneous, and might und'er certain circumstances, be productive of great' mischief. But in order to use this table with advantage, another table HYIEF 107_ HYGIENE, 107 is required, showing the quantity of nutrient matter which is contained in particular kinds of food. Various chemical physiologists, such as Carpenter, Dulong, Liebig, etc., have analyzed some of the principal articles of food in common use, and, taking human milk as the standard of comparison, they have obtained the following results regarding the nutritious quality of the various kinds of food mentioned in the subjoined table. Vegetable Food. Rice,.................... 81 W heat,...............119-144 Potatoes................ 84 Carrots................... 150 Turnips,.................. 106 Brown bread,........... 166 Rye,.......06 Peas.................. 239 Maize,...............100-125 Lentils,.................. 276 Barley,................ 125 Mushroom,............. 289 Oats.................... 138 Beans,................... 320 White bread,............ 142 Animal Food. Cow's milk,............... 237 Oyster,.............. 305 Yolk of eggs............. 305 Cheese,................ 331-447 Eel, raw,................ 434 Eel, boiled,.............. 428 Mussel, raw,.............. 528 " boiled,............ 660 Ox-liver, raw,............. 570 Pork-ham, raw,..........539 " boiled,......... 807 Salmon, raw,..a........... 776 " boiled,........... 610 Portable Soup,.......... 764 White of egg,............ 845 Crab, boiled,.............. 859 Skate, raw,............. 859 " boiled,............ 859 Herring, raw,........... 910 " boiled,............ 808 " milt of,.......... 924 Haddock, raw,............ 920 " boiled.......... 816 Lamb, raw,.............. 833 Mutton, raw,.............. 773 " boiled,.......... 852 Veal, raw,............... 873 Flounder, raw,............ 898 (" boiled,........ 954 Pigeon, raw,.............. 756 " boiled........... 827 Yeal, boiled,.............. 911 Beef, raw,................. 880 Sboiled,.............. 941 Ox-lung,................ 931 I _ _ _ __ __ _____I_~ _ 108 [YGI1STE 108 IHYGIENE, Comparing these two tables with each other, it will be perceived that a certain quantity of boiled mutton will introduce into the human system, in the space of three hours, 852 parts of nutritious matter, whereas a similar quantity of boiled beef, will introduce 941 parts of nutritious matter in the space of two hours and fortyfive minutes. Whence it follows, that a smaller quantity of boiled beef is required to nourish the body as much as a quantity of mutton would do. Or let us compa1e oysters with the yolk of an egg. The first table shows that a raw oyster is digested in two hours and fifty-five minutes, and a raw egg in two hours, including the yolk and the albumen. The second table shows us that a raw oyster contains 805 parts of nutritious matter, and an egg, including the yolk and the albumen, 1150 parts; whence it follows that a raw egg is not only much more easily digested than an oyster, but conveys to the human system very nearly four times the amount of nourishment in a shorter space of time. If such physiological tables regarding the digestibility of the various kinds of food, and the amount of nutrient matter which each particular kind contains, are carefully constructed, they may be. of great value for purposes of health, fattening, and the like; they will teach us the usefulness or hurtfulness of various aliments used by man; they will eminently contribute to remove prejudices in favor of, or against particular kinds of food, and to construct the ar.t.of cooking upon a truly scientific basis. Among these prejudices there is one that deserves particular mention; it is this, that rare beef is more easily digested than beef that is properly cooked. Now, what do our tables show? The first table shows that it requires three full hours HYGIEE. 10 HYGIENE. 109 to digest rare beef, and but two hours and forty-five minutes to digest boiled beef; and the second table shows, that raw beef contains but 880, and boiled beef, on the contrary, 991 parts of nutrient mattter. Hence, boiled beef is not only more nutritious, but it is likewise more easily digested than rare or raw beef, which amounts nearly to the same thing; the very contrary of what many persons believe. It is supposed that meat, which is properly roasted, contains more nutrient matter than boiled meat. In boiling meat, the albumen, which is a constituent part of the meat, is dissolved out of it by the action of the water; whereas, it remains when the meat is roasted. This seems plausible, and persons who pay proper attention to the influence which particular kinds of food and particular modes of preparing the food, have upon their digestive organs in particular, and, by sympathy, upon the general organism, can easily determine for themselves, how a particular kind of animal or vegetable food should be prepared, in order to fulfil to them its purpose of nutrition in the most pleasant and complete manner. Most persons, in the present state of social culture and refinement, have a general, and, for hygienic purposes, sufficient knowledge of the digestibility and nutritious quality of the food in common use, nevertheless it may. not be amiss to review briefly the opinions entertained by physiologists about the various kinds of food which are most commonly used by the generality of mankind. Fat is an exceedingly indigestible article of diet, and is the more injurious the warmer the climate in which those who eat fat, reside. Fat contains a large amount of carbon and is therefore necessary to persons who 11 ~I 110I HYGIENE. inhabit cold regions. They require a considerable amount of carbon to keep up the normal temperature of the body. The carbon in proportion as it is acted upon by the oxygen of the atmospheric air, becomes the basis of the animal heat which prevades the whole interior of the organisnh; or rather, this process of oxygenation, or combustion, as chemical physiologists are pleased to term it, enables the vital prinbipal to evolve the required temperature of the living organism, just as-vigor and growth are evolved out of the digestive process which is going on in the stomach. The colder the climate the mnore carbon is required by the organism to serve as a basis to the operations'of the vital principle for the evolution of animal heat; and vice versa, the warmer the climate, the less carbon is required to keep up, the temperature of the system. For these reasons the Greenlander delights irn his fish-. oil, which is richly freighted with carbon, whereas the inhabitants-of the torrid zone prefer fruits and watery productions. JBeef and mutton are eminently nutritious, and,, as we have een from 6our tables, easily digested. Hence these two kinds of meat are, more than any other, suitable to per'sons whose digestive organs are not very strong, or who are more or less liable to dyspeptic attacks..Venison is likewise eminently nutritious and can be readily digested even by delicate stomachs. Eggs are very nutritious, and, if eaten raw, soft-boiled, whipped or fried, are of easy digestion; hard-boiled eggs are not so: readily digested, and should not- be used by persons with weak stomachs or of siedentary habits. Veal is nutritious, but is not easily digested, especially _1GEE.Il IRYGIENE..1! when young. It should be avoided by dyspeptic persons. Lamb, if not too young, is allowable. SPoultry is generally supposed to be easily digested; but this opinion is not founded on experience. Wild fowl, such. as pheasants, partridges, prairie-hens, etc.,.are not objectionable; but domestic fowl is objectionable in many respects. The flesh of tender chickens and: turkeys is not so very difficult to digest, but duck and goose is pretty heavy meat, and will not do for persons with weak stomachs. Roasted poultry is preferable to boiled. It may be eaten with gravy composed of the juice of the meat, but all exclusively fat gravy should be strictly avoided. Pork is the least digestible of all meats; but with most people it is a favorite -dish, especially ham and fresh roast pork. Those who use it should eat as little of the fat as possible. Bear's meat is sometimes very tender and many persons consider.it a delicate dish. It is exceedingly nutritious and should only be eaten in moderate quantity..Ifeat soup is relished by m6st people, and, if: properly prepared, it is undoubtely a very excellent and- palatable dish. But the a:art of.making, a good soup is not.generally understood. Good soup should contain the nutritious principle of the meats, bixt! the fat sould be skimnmed off with the greatest care. Many persons entertain, even at this day, thel foolish: notion. that.-,eating fat makes people fat. This is a great and lamentable mistake. Fat: subserves the purpose of.develbping animal heat, especially in the colder climates, but it is not by'any means conducive to nutrition; the ultimate result of the decomposition of fat in the human body, are carbonic 112~_ HYIEE 112 HYGIENE. acid gas and water, and very little of the essential principle of fat is assimilated by the organism. Fish is generally digestible, except the oily kinds of fish without scales. Oysters are easily digested when eaten raw; stewed oysters are rather heavy, nevertheless, oysters, even if eaten raw, do not agree with all persons, and, in some cases, oysters are known to have caused serious attacks of indigestion. Clams are indigestible; clamsoup is less so. Lobster, and every kind of shell-fish, require a sound stomach to digest them with ease. In the hot season lobster and oysters should be avoided or, if eaten, should be eaten only when perfectly fresh. Among vegetables the following may be eaten safely by any body, even by persons with weak stomachs: rice, hominy, arrow-root, sago, tapioca, and farina; all these vegetables are both nutritious and digestible. Oat-meal agrees with many persons, and is particularly relished by little children. Barley is eminently nutritious and digestible. Flour is universally used as an article of diet, and is, in many respects, indispensable. We use it for a variety of purposes, the principal of which is to bake it into bread. Fresh bread is not near as easily digested as bread,that is about a day old. All bread should be thoroughly baked, and all the water should be carefully evaporated during the baking. Nor should any sour flour be used, or mixed up with sweet flour, as many bakers are in -the habit of doing, to the great detriment of the consumers. In many parts of the country, flour is cooked with milk into a soup or pap. This species of farinaceous diet is very heavy, and persons who use it. a good deal, espe HYGIENE 113 HYGIENE,.1.3 cially in connection with pork, become finally subject to all sorts of annoying eruptions. Buck-wheat is extensively used by our people. BIuekwheat cakes are eaten all over the country. But they are heavy, especially when eaten with a quantity.of butter, as is generally the case; if eaten with molasses, they are much less hurtful, although persons with weak stomachs should avoid them altogether. Potatoes, in order to be wholesome and of easy digestion, should be mealy, not watery. If roasted or baked, they are more easily digested than when boiled. Sweet potatoes are less digestible than the common Irish potatoe. Beets are a very nice relish, but they belong to- the class of food which chemists term respiratory or nonnitrogenized, which is ill-adapted to purppses of nutrition. SCarrots, turnips and cabbage seem to haye a tende.ncy of causing flatulence, and should therefore be avoided by all who are troubled by it. Asparagus is a very palatable vegetable, but it sh.ould,be avoided by those whose urinary apparatus is not in perfect- order. Tomatoes are a favorite vegetable of all classes-in our country. People eat them stewed with a little butter and sugar, or in the sha;pe of a salad, seasoned with vinegar, oil,- mustard and pepper.' If eaten ini oderation, and not by persons who, for exceptional: reasons, have, to deprive themselves of this relish; they will not, as a general rule, do any harm. They may.be said to be a wholesome and exceedingly pleasant. vegetable. QGreen peas and caulfl'ower are most delicious yegeta11* 114 HGIENE 114 HYGIENE. bles, and, as a general rule, can be eaten with impunity by every body. Lima.beans are nutritious, and, if fresh, not very heavy. Green beans contain very little nourishment, and cause flatulence. Dried white beans and peas are very nourishing, but heavy. Relishes, such as cold-slaugh and celery, had better be avoided by those who are obliged to pay strict regard to the condition of their digestive apparatus. Spices and stimulants, such as pepper, mustard, catsup, horse-radish, cloves, cinnamon, and the like, should be used moderately, and only by persons whose digestive organs are pretty sound. Coffee is an exceedingly pleasant beverage, especially at breakfast, and is so universally used and liked, that it would seem up-hill work to condemn it. Hahnemann has written a most interesting essay, showing all the pernicious effects of this beverage upon the nervous system. Even if we admit that his statements and inferences are somewhat exaggerated, yet there is no doubt that the habitual use of strong coffee weakens the nervous system and impairs more or less the digestive functions. Persons who use strong coffee for breakfast, generally experience a sensation of emptiness or hollowness in the prsecordial region three or four hours after taking the coffee, and they require some stimulating drink, such as brandy, to fill up the vacant spot. In this way coffee-drinkers gradually incline to the use of ardent spirits. Nevertheless, a little coffee at breakfast is allowable, provided persons do not experience any positively injurious effects from it. To preserve the HYGIENE. 116 HYGIENE. 115 aroma of coffee, it should be roasted in small quantities and not ground until we wish to use it. Coffee diluted with water is not a palatable drink; if we use coffee at all, it should be made strong enough to contain all the delicious flavor of coffee; it may be weakened with milk or cream. Tea is likewise so commonly used that it would seem foolish to condemn it. And, if used in moderation, and not too strong, it is not injurious, although there may be persons in whom it will cause palpitation of the heart, nervousness, wakefulness, and other unpleasant symptoms. All such persons should, of course, avoid this otherwise very pleasant beverage. Black tea is preferable to green, which contains a good deal of tannin. Chocolate or cocoa is a very excellent beverage, provided chocolate is used as is free from fatty matter. Persons with very weak stomachs might perhaps find it very difficult to digest this beverage. To all such individuals I recommend the cocoa-shells, which can be obtained of the manufacturers of chocolate. Care should be taken to have them fresh, as the old shells are very insipid. Instead of boiling them at once, for an hour or half an hour, I advise all who wish to use them, to first steep them in warm water before boiling them. Boiling milk should be added at the moment of using them. This beverage may be sweetened with sugar to suit one's taste. Spirituous liquors are generally condemned as improper and hurtful beverages. The conversion of grain into alcoholic liquor is undoubtedly an abuse, and it is my opinion that this branch of industry, if it cannot be indicted as a nuisance, should be discouraged by all 116~~ HYIEE 116 HYGIENE. those who have the elevation and the happiness of their fellow-beings at heart. To a pharmaceutist, alcohol is indispensable, and a little good brandy is a most useful medicine under certain circumstances. To the laborer in the field, exposed to a scorching sun, a little brandy in a quantity of water, is sometimes absolutely necessary to refresh his parched and burning mouth. But to use brandy at all hours, during and between meals: in and out of company, is decidedly injurious and degrading. Wine is, of course, less objectionable than brandy, provided it is genuine, and not adulterated with dye-stuffs, litharge and the like, as most wines that are sold in the bar-rooms and.groceries are; but even wine should be used discreetly,,.and only at times, or to promote social mirth. It is a great mistake to unite wines and brandies under the same sweeping condemnation.. Wine is the natural product of the grape, and those who wish'to be convinced 'that wine-drinking people can be an industrious and sober class of men, need but visit the vine-.growing countries of Europe, the South of France, the banks of the Rhine, Moselle, Neckar; wine is the common beverage of the people in all wine-growing districts,; wine is drank at breakfast,. dinner, supper, and yet' those' people enjoy good health, look; hale and hearty, live to a good old age, and are habitually sober, and what is a most excellent si-gn in their favor; remarkably industrious.. The best mode of breaking down the brandy-distilling business, is to encourage the growth of the grape, and the use of pure, wholesome wine. A stimulant universally used by all civilized-nations is Beer. Some kinds of beer are heavy, and contain bitter stuffs, such as hops, quassia, etc. These:are objectionable. A pure malt-brew, with the slightest O,J HYGIENE. 117 admixture of hops, to prevent decomposition, is generally allowable. I am not aware that the moderate use of this kind of beer is attended with any unpleasant effects, although there may be individuals who are unpleasantly affected by it. Light beer is decidedly less injurious, and generally more pleasant than cider, which is not objected to on the score of temperance. Some persons seem to derive a good deal of strength from the moderate use of light beer at dinner, and physicians have been in the habit of recommending it to nursing females. For many persons the best plan is undoubtedly to do without any of these stimulating drinks, and to confine themselves exclusively to water. Among the stimulants which are likewise used all over the inhabited globe, tobacco holds an eminent rank. The productions of the earth are generally adjusted to the existing wants of her inhabitants, and to the degree of culture to which they have attained; and as long as tobacco is grown and used, the probability is that this plant is for the time being, necessary to the human race, and that it fulfils uses which are suggested by the existing condition of humanity. Man requires to be stimulated more or less; the love of excitement, is one of the constituent principles of his nature, and a state of excitement seems to be indispensable to health. To be sure, this excitement should be gratified by natural means, by our common pursuits in life, by our business, study, labor; and whenever man is devotedly fond of the occupations he is engaged in, they will generally prove adequate to satisfy that craving for stimulation or excitement, which seems to be one of the forms or conditions of human happiness on earth. But it is well known that labor fatigues, instead of refreshing the mind 118 HYGIENE. 118 HYGIENE. and invigorating the body; after having been worn. out by toil, man seems to require some artificial stimu.lant, which, to be, sure, is a, poor substitute for the positive and exalting pleasure which he should derive from his intercourse with fellow-men,: from scientific or industrial pursuits. Tobacco is one of those artificial stimulants, which Providence has furnished us with, and which man will undoubtedly use, and it seems to me, has a right, to use, until the actual delights and refinements of social life shall supersede the necessity of using this weed. Although it is well tb condemn the use of tobacco, yet the philosophical physician has another duty to fulfil which is far higher than to indulge in indiscriminate and: sweeping condemnations of all artificial stimulants. This higher duty consists in devising means to lessen the burden of labor, render it more attractive and-refining; and deprive it of its present deleterious influence. At the same time it may be shown that artificial stimulants, and especially such narcotic stimulants as tobacco and brandy, are deceitful friends, and that the stimnulation which they afford, wastes the vital' energies of the system, impairs the mental faculties, and frequently reduces man to the condition of a brute.. Of all stimulants, tobacco seems to be the most offensive, and, I think, quite as injurious to health as brandy or any other stimulant. The alkaloid of tobacco, nicotine, is a deadly poison, and even the common tobaccojuice may prove fatal'if introduced into the intestinal canal. Chewing is a most loathsome practice, and it is no wonder that so many persons complainof weak stomachs, wind on the stomach, etc., when we consider the immense number of male persons who chew their quid. The immoderate use of tobacco, whether chewed or HYIEE 11 HYGIENE.o 119 smoked, is the cause of a good many nervous derangements, and the relinquishment of this unwholesome weed would undoubtedly be attended with the most beneficent consequences to the moral and intelleQtual elevation, health and happiness of our race. *-- *- * * * "* It is impossible to give such general rules, in regard to diet, as will prove infallible guides to everybody, in the selection of those things which he should eat,or drink. Intelligent persons endeavor to.find out what agrees with them best, and this should be used in preference to other articles of diet. It is bad policy to force any'kind of food on the stomach. In former times, it used to be the fashion of parents to compel their children to eat what was put on the table, no matter whether the child had an aversion, to the thing or not;.nor was the child allowed to leave anything on the plate, even if the appetite was perfectly satisfied. Such. foolish practises no. longer exist, for most parents are reasonable enough to be aware of the injury which this unnatural mode of forcing food upon the child's stomach inflicts upon the health of their offspring. Nor is it probable that, in proportion as.mSankind become more refined, they will eat as much as they have done. It is positively frightful, what aWr,:enotmous quantity of food some persons can consume. And it is a mistake to suppose that excessive eating is not just as injurious as the ~abiuse of ardent spirits. Few persons are aware: of the influence of diet on the general health. Regularity in diet, and the moderate use of wholesome food, are sufficient to remove many kinds of chronic dyscrasias; there is reason to believe that:some of our most destriuctive chronic 120 HYGIENE.-~- ~ 120 HYGIENE. disorders will gradually be extirpated by regular diet, the use of water, proper ventilation, exercise in the open air, and such general hygienic means. In Hufeland's "Art of Prolonging Life," a case of longevity is mentioned, which beautifully illustrates to the reader the restorative influence that regularity and moderation in diet are capable of exercising, over the sinking vitality of an exhausted organism. A German Count had so completely ruined his constitution by habits of dissipation, that it was supposed, by the best physicians of his time, that he could not live more than a month longer. An Italian physician finally informed him that he might perhaps preserve his life for some time by the strictest diet and abstemiousness. The Count was then forty-two years old; he contented himself with the daily use of a few ounces of bread and potatoes, and a quart of water; his health became restored, and he lived without a day's sickness to the remarkable age of ninety years. For the convenience of the patient, we will furnish him with a synopsis of the aliments which are either allowed or prohibited while under homoeopathic treatment. The rules here laid down are to be understood with reference to the medicine, the action of which is impaired or neutralized by certain kinds of food or drink. On the other hand, it may be perfectly proper for the patient to partake of a certain kind of food, so far as the medicine is concerned, but the use of this food might be highly improper with reference to his disease. Hereafter, in speaking of the treatment of acute diseases, the diet which should be followed during the treatment HYINE 2 HYGIENE. 121 will always be indicated. In chronic cases, such as chronic eruptions, nervous debility, hysteria, and such like diseases, and in all chronic affections which leave the digestive functions unimpaired, the patient may select, from among the following list, whatever is most grateful to his appetite, provided that the use of this particular dish does not in any manner inconvenience the organism. Aliments Allowed. Soup or broth, made from the lean of beef, veal, or mutton; to which may be added, rice, well-boiled sago, tapioca, vermicelli, farina or macaroni, pearl-barley, and sometimes carrots, young peas, or cauliflower, seasoned merely with a little salt. Also chicken-soup. Mutton and beef, boiled, roasted or baked, fresh or smoked tongue, lean ham, or also lean pork, if it does not otherwise disagree with the patient. Venison, wild fowl, and any kind of game, when tender, but not when too old; it may be used roasted, broiled, stewed or steamed. Turkeys, chickens, pigeons, larks, rabbits. Fresh scale fish, such as shad, smelts, trout, cod, haddock, mullet, perch, turbot, flounders, broiled or fried; when fried, only the white meat should be used, and the outer skin rejected. Oysters may be eaten in every style, but without spice; stewed oysters are less allowable than raw or broiled. Fresh, sweet butter and cheese; raw, whipped, softboiled or fried eggs; if eggs gripe the bowels, they should not be used. Well-baked wheat or rye bread, at least one day old; and biscuit without soda, salaratus, and the like. 12 122 HYGIENE. Puddings, dumplings, or noodles, of wheat, arrowroot, Indian, rice and oatmeal, not too heavy, fat or spiced. Macaroni, without cheese, simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. Arrow-root, tapioca, farina, hominy, sago, julep, oatmeal, and the like, are allowable. Milk, boiled or fresh, fresh whey, buttermilk, which may be sweetened with a little sugar. Common potatoes, sweet potatoes, turnips, carrots, tomatoes, parsnips, cauliflower, salad without vinegar, spinach and green peas, beans, rice, hominy, pearl-barley, dried peas or beans. Fruit, such as baked, stewed, or preserved apples and pears, also gooseberries, raspberries, whortleberries, dried currants, fresh, sweet or slightly tart apples, peaches, strawberries, or any other kind of fruit which is not acid, and is perfectly ripe, either fresh or preserved. Water, either pure or sweetened with sugar, currant jelly, raspberry or strawberry syrup, toast-water. Gruels, made of barley, oat-meal, farina, rice, dried fruit. Chocolate, without spice, not too strong, with milk and sweetened with sugar. Also the plain cocoa, or cocoashells. Tea, black tea, but not too strong. Salt and sugar may be used, but moderately. Icecreams flavored with some non-medicinal substance, such as strawberries, and ice may be used in moderation. I - - -- " --- --a --W I~~~I I~----I~ HYIEE 123 _ _ HYGIENE. 123 Aliments Prohibited. All kinds of rich and seasoned soups, such as turtle, and mock-turtle soup; ochre-soup, etc. Pork, bacon, calf's head, young veal, duck, goose, sausages, kidney, liver, tripe, smoked or salted meats and fish; old, rancid butter and cheese, lard, terrapins, fish without scales, eels, lobster, crabs, clams; clam-soup is sometimes allowable. Fat is decidedly inadmissible, except fresh, sweet butter; food prepared from the blood of animals, should be rejected. The flesh of young animals, such as veal, very tender lamb, etc., should be avoided. Fat gravies, sauces, drawn butter, fat hashes and the like, are prohibited. SVegetables, such as cucumbers, celery, onions, radishes parsley, horse-radish, leeks, thyme, garlic, asparagus; and every description of pickles and spices, such as red or Cayenne pepper, mustard, vinegar, catsup, cold-slaugh, nutmeg, cinnamon, cloves, vanilla, laurel-leaves, bitter almonds, allspice, coriander, fennel, anise, coffee, green tea, spiced chocolate, etc., should be avoided. Rich or highly-seasoned made dishes. Pastry of all kinds, whether boiled, baked or fried. Almonds and nuts of all kinds, chesnuts, filberts, walnuts, etc. Spirituous liquors, such as brandy, rum, whiskey, gin, etc. Cordials, mineral waters, mead, spruce beer, sodawater, porter, ale, and all acid wines and most other wines. While the patient is under homoeopathic treatment, all aromatic salves, pomatums, hair-washes, waters, smelling-bottles, etc., should be avoided; also all kinds 1_ HYGIENE.1 121: HYGIENE. of perfumery, musk, cologne-water, aromatic tooth-powders. Nor should the patient, behind his physician's back, keep up old habits contracted under alloeopathic treatment, such as using a cathartic now and then, or a sleeping mixture, or anodyne. Patients who have for years been in the habit of using certain stimulants, should not be deprived of them all at once, except this can be done without producing a sudden revolution in their system; all such stimulants, unless they should have an immediate poisonous or otherwise deleterious effect upon the system, should be discontinued cautiously and gradually. Several articles have been mentioned among the prohibited aliments which it may be proper to use under certain circumstances. Some patients, for instance, cannot do without a little weak coffee for breakfast; others must have now and then a little brandy and water, others a little wine, beer, etc., before using such articles the patient should confer with his physician; and we advise the physician not to be over-strict or pedantic in such matters; if the patient should not appreciate the propriety of observing a strict diet, our advice to the physician is, to get along with the patient as well as he can; for such patients might soon get tired of homoeopathic treatment; whereas, with a little patience and accommodating direction, they may be found willing, after once perceiving the first good effects of the treatment, to conform more rigidly to a strict homoeopathic diet. In acute cases the physician has no trouble in regulating the patient's diet; for the patient is not only willing and anxious to make every sacrifice, in. order to get rid of his pains; but he seldom cares for anything that interferes with the treatment. HYGIEE. 12 HYGIENE. 125 Exercise. The most natural and healthful kind of exercise would be a variety of pleasant and useful occupations, both in the house and open air. But inasmuch as scarcely any one is favored with this advantage, it is necessary to devise for many persons a system of artificial exercise, or exercise carried on for the purpose of affording the various members and viscera of the body an opportunity of being appropriately stimulated by motion. A complete medical system the so-called movement-cure has been recently constructed upon the theory of exercise, but its advantages are not yet sufficiently tested to justify an unqualified recommendation of such an invention in a popular work like this. Exercise is a thing of common sense, and an elaborate disquisition does not seem to be required, to convince the reader of the importance and best mode of exercising the various parts of the body in a variety of ways; for it is upon this variety that harmony and health depend. Nevertheless, a few remarks on the subject of exercise do not seem to be out of place. A very common kind of exercise is walking. This is better than no exercise at all, but it is by no means the best mode of exercising the body. It is a fatiguing kind of exercise, and some of the most important parts of the body remain inactive, while other parts, particularly the lower extremities, have to do all the work. However, a walk in company with some interesting friend, and more particularly in the country, where we can inhale the balmy and invigorating air of nature, is pleasant and useful. Riding on horseback is a very excellent exercise, 12* 126 HYGIENE._____ 126 HYGIENE. especially for dyspeptic persons. This kind of exercise is not fatiguing, and the abdominal organs are kept in a pleasant and healthful state of excitement by the movements of the horse. An early ride in the country is an admirable.means of stimulating the appetite and invigorating the whole system. Dancing is not objectionable, provided it is carried on properly and moderately. Dancing half the night, as is frequently the case in the fashionable world, is decidedly objectionable. But it is not necessary, on that account, to condemn dancing altogether. Various kinds of stage dancing, and tours deforce are improper and unnecessary; but a single galopade, a quadrille, a Virginia reel, and even a waltz may be enjoyed with benefit, both as respects.health and gracefulness. Fencing is an excellent mode of exercising the chest and extremities; but care should be taken to practice with both arms, and not with the right arm exclusively; for this partial exercise with the right arm is apt to give the right side of the chest an undue development, and to impoverish the left lung. Exercising with the dumbbells, wrestling, boxing, bowling, swimming and other bodily exercises of this character, are decidedly beneficial. Sawing and splitting wood, digging, hoeing and various other mechanical exercises which are at the same time productive of useful results should be encouraged. Gymnastic exercises have been reduced to a regular system. In the German Schools gymnastics is taught and practiced upon scientific principles. Both girls and boys may indulge in this kind of exercise under suitable teachers. _ _~II_ HYGIENE. 127 Some kinds of exercise are more or less objectionable, such as rocking in a cradle, swinging, and any kind of exercise which has a tendency to cause dizziness. Even riding in a carriage may be objectionable on this account. The harmonious development of the body should be one of the main objects of 'education. But the body is very little cared for in the schools as at present organized. All that is done for children, is to let them out into the open air for a few minutes, for the purpose of jumping about in the beautiful confusion, and filling the air with their discordant noises; but the greater part of the time they are confined to gloomy halls, and compelled to maintain a most oppressive and unnatural silence, and their eyes are riveted on the black-board or Primer, while their buoyant little hearts are panting after play and liberty. What a blessing it would be to children, if our schools were surrounded with blooming, fields and gardens, where the children could be initiated in a knowledge of agricultural and horticultural pursuits, and if work-shops were included in the school-house, where the use of tools could be taught, and the powers of the child, not only be naturally and delightfully, but also usefully, developed. Does not this seem the natural mode of educating children? What an immense work is here yet to be done! What a beautiful and truly heavenly charity our philanthropists might bequeath to future generations, if they would realize a system of education that should result in the perfectly healthful and harmonious development of the juvenile body. It is well that everybody should take some kind of exercise, if his daily pursuits confine him to the house and a sedentary mode of life. The question then comes 128 HYGIENE 128 HYGIENE. up, is it proper to take exercise in anykind of weather, at any hour, or under any circumstances? Some persons fancy that we must accustom the body to any kind of exposure; their idea is that the body can be hardened as it were, the same as you harden steel. But this seems a great mistake in the sense in which this pretended process of hardening is generally understood. The human body is not made for rough winds, cold, wet, and all the other inclemencies of the weather, and no system that we can devise will ever succeed in habituating the human body to abnormal influences. To be sure, we may succeed in distorting the body, of which the foot of a Chinese lady is a striking and shocking illustration; but no human body will ever bear a cold draught of air, or a chilly and soaking rain, with the same pleasurable sensations as are excited by the balmy zephyrs of spring or the cheering rays of an autumn sun. It may be advisable, in the universal disorder and confusion of society, to devise means of resistance against the disturbing influences of atmosphere and climate to which we are so frequently exposed; but an atmosphere of malaria, sudden alternations of oppressive heat and raw dampness, cold blasts from the North or North-east, wet clothes, damp sheets, are not adapted to the susceptibilities of the human organism. If man could become inured to the disturbing chemical and physical influences of the atmosphere he lives in, why should so many millions of human beings die of consumption, of rheumatic inflammations, fevers? Why should so many millions among those who are not destroyed by disease, be constantly suffering with cold, rheumatism, soreness, lameness, weaknesses of every name and description? All this misery results from atmospheric disorders, exposure __ _ _I _~ _IYlr_~r~ HYGIENE. 129 HYGIENE. 129 to cold winds or rain, and from various other causes, over-work, insufficiency of food or raiment, damp dwellings, deficient ventilation, and the like. Let those who choose take their customary exercise, rain or shine; but this is a species of monomania which no reasonable being should imitate. If we wish to take exercise, it should be in fine, dry weather-cold, if you please, but dry and not windy; or, at any rate, we should not be exposed to the wind. Nor is it well to be out late in the evening, when the air is damp and chilly, or early in the morning, especially in parts of the country where a thick fog rises every morning; the air is not healthy until this fog has been dispelled by the sun. And if we should be at all caught in the rain, or get our feet wet, it is important to change our clothes as speedily as possible, not to omit the underclothes, drawers, shirts, and so forth, and, above all things, to put on dry stockings; thousands of lives have been destroyed by wet stockings, and it is cruel in the extreme to make light of such important matters. Exposure to the hot rays of the sun, as everybody knows, is likewise extremely injurious, and, in many cases, productive of fatal results. Clothing. The object of clothing is various; but the principal ends which we desire to accomplish by clothing our: bodies is, first, to protect them from unpleasant and injurious atmospheric influences, and secondly, to beautify. them. Those who condemn fashion as an useless encumbrance, have no sort of conception of the destiny of the human race, and of the ennobling and elevating influence 130iC HYIEE 130 HYGIENE. which beauty exercises over the human mind. The most beautiful and the most highly refined nations are those where fashion has acquired the highest and most universal development. Fashion is to the human body what accomplishments are to the mind. To be sure, the demands of fashion may become oppressive, and there may be ridiculous fashions. The study of fashion, and the reducing it to rational and testhetic principles, constitute a perfectly legitimate and interesting exercise of the human mind. Protection from the inclemencies of the weather, from cold, wet, etc., is another important object of clothing. The principal materials, out of which the stuffs which we use for clothing are made, are linen, cotton and wool. Linen and cotton are chiefly used in warm climates or seasons; wool, being a bad conductor of heat, or, in other words, preventing the heat which the vital principle develops in the organism, by means of the oxydation of the tissues, is most appropriate in cold climates or seasons. Furs are likewise a desirable article of clothing in cold weather, and our ladies consider them indispensable, both on the score of beauty and protection. Linen is the coolest kind of raiment, and is therefore particularly pleasant in warm summer-weather; but, being a rapid conductor of heat, or, in other words, allowing the animal heat engendered in the organism to escape with considerable rapidity, linen is not advisable to persons who perspire a-good deal and readily; for they must necessarily experience an unpleasant sensation of chilliness, and, if they should be disposed to rheumatic attacks, this would be an additional reason why linen under-clothes should be avoided. Under such circumstances, it would be advisable for HYIEE 131 ___ HYGIENE. 131 such persons to wear cotton instead of linen shirts in the summer season; and, in the winter season, they might wear a flannel shirt on the bare skin, and either cotton or linen over it. White or red flannel may be used, which ever feels most pleasant to the skin. As regards the amount of clothing which a person should put on, this depends altogether upon the season, climate, and upon the constitutional state of a person's health. In cold and damp weather we should, of course, be clad more warmly than in warm and dry weather. In variable climates it is a good plan to uniformly dress warmly. It is a mistaken notion that the body can be accustomed to cold and piercing blasts, and, if we sometimes see poor children walk bare-foot in mid-winter, without succumbing at once under such a terrible exposure, this is no reason why we should consider a state of comparative nudity a proper mode of existence. It is not, and it is a great shame that such instances of exposure and want should be witnessed in our boasted civilization. To be sure, the body should not be overburthened with clothing, but it should be sufficiently covered in all seasons, not to feel chilly. Consumption, chronic weaknesses, bronchitis, rheumatism and a variety of troubles proceed, in a measure, from the exposure resulting from a deficient supply of clothing. The habit of keeping certain parts of the body, such as the face, hands, etc., uncovered, diminishes the sensitiveness of these parts to the influence of cold. We know that our hands are capable of bearing a good deal of exposure to cold before they feel chilly; and this kind of exposure does not seem to affect the general health. This remark likewise applies to the face. It is quite probable that other parts of the human body might t32~ HYGEN 132 HYGIENE be thus exposed without detriment to a person's health. Most women, for instance, wear their necks almost bare, and yet they do not seem to suffer any the more on that account from bronchitis, sore throat and similar diseases. Men who have been in the habit of keeping their necks Swrapt up in cravats and stocks, could not afterwards expose these parts without running very great danger of contracting some serious inflammation. It is from the earliest infancy that all such natural and reasonable habits of exposure have to be acquired; after the body is trained to certain artificial influences and modes of living, it is difficult, and sometimes impossible to relinquish them. As regards the style or fashion of clothing, the physician has to deal with these things only in so far as they interfere with health and comfort. All clothes should be made to fit the body, not in the Chinese fashion, by which the feet is made to fit the shoes. Tight clothes have been the means of doing a vast deal of injury to the body. Tight lacing, for instance, has caused pulmonary diseases, dyspepsia; tight shoes distort the feet, they cause corns; and other unpleasant disorders. There are cases of convulsions recorded in medical works, which were induced by tight shoes or boots; and a case has been quite recently reported in the public newspapers, where a young gentleman had so injured one of his feet by wearing tight boots, that it had to be amputated. All such consequences can easily be avoided. It is not only tight shoes that are objectionable, but *the soles should not be too thin. Our ladies are very fond of wearing gaiters with thin soles, paper-soles as it were. This may not be so very objectionable in warm summer-weather, but- it is decidedly so in the winter UYIEI_ 133 HYGIENE. 133 season, or when the stones are wet. In such a climate as ours, India rubber shoes seem to be indispensable, and I do not believe that they do any injury, provided the soles are not too thick, and the shoes are taken off as soon as we enter the house. All sudden changes in the amount of clothing we put on should be avoided. Serious and even fatal consequences may result from them. The substitution of a light for a heavy cravat may cause a distressing attack of quinsy or bronchitis; or replacing thick by thin drawers may be the means of bringing on an attack of rheumatism or acute fever. The more changeable the climate, the more cautiously should all changes in the amount, thickness and nature of the clothes we wear, be effected. In leaving off our winter-clothes, and substituting summer-clothes in their stead, we should never be in too great a hurry. The most prudent plan is to wear the winter-clothes until the warm spring-weather has fairly set in; and if the spring should be damp and chilly, we had better hold on to our overcoats until summer. The summer-clothes should be abandoned as soon as the evenings become cool; even if we do not dress for winter, yet it is prudent, and indeed necessary to put on warmer clothing than during summer, and to resume our flannel and woolens. Ventilation. The subject of ventilation has excited a good deal of interest in modern times. Formerly it was altogether neglected or not thought of. Cities constructed in the old Roman fashion, would be thought uninhabitable by our people. The streets were narrow and crooked, and 13 '34 ilYGIENE. 134 HYGIENE. flanked on each side by high houses with small windows and low ceilings. And to shut out the last breath of pure air, the city was surrounded by high walls,around which ditches were dug filled with stagnant water, and breeding pestilential malaria and disgusting vermin. How differently are the cities constructed in our own beautiful free land! In crowded places like New York and Philadelphia, the air is almost as pure as in the country. In laying out our cities, a proper system of ventilation is never disregarded. The breeze has a clear sweep from one end of the city to the other, from north to south, and from east to west. And our cities are not shut up within high walls and marshy ditches, as was the case in former times, and is the case even now with many cities of the first order on the European continent. Our houses, how much more convenient are they than the houses of our forefathers used to be! They are better lighted, the rooms are more spacious, and we have the means of ventilating them in a suitable manner. Not enough has been accomplished in this respect; thousands of poor families live yet in dark and gloomy apartments filled with foul air, and scarcely ever illumined by the cheering rays of the sun. But these defects could easily be remedied, if the State chose to do its duty to all citizens. The State has a perfect right to regulate the architectural arrangements of the cities for the purposes of health, comfort and safety; the construction of ill-lighted, ill aired, damp dwellings, and more particularly rear-dwellings, should be made a penal offence. Wherever ventilation is suitably cared for, the danger of epidemic disease is much less than in districts, where the emanations from the stagnant marshes are allowed to hover 'over the land, and where foul air HYGIENE. 135 HYGIENE. 135 is allowed to collect in the streets and houses. Ventilation has been reduced to scientific principles by modern architects and physiologists, but a good many erroneous notions seem as yet to prevail in reference to this subject. Thus most people confound ventilation with a current of. air. They fancy that a current of air is equivalent to fresh air. They will open doors and windows, especially in warm weather, for the purpose of letting in a constant supply of fresh open air, and being fanned by the refreshing breeze. On entering an omnibus, the first thing they think of, is to let down all the windows and establish half a dozen different currents of air. These persons do not seem to be aware that there is a vast difference between ventilation for the sake of health, and a current of air for the sake of a momentary cooling of the skin. And if reasonable men, physicians or other professional men, who study the best means of preserving the health and prolonging the lives of their fellow-beings, tell them that a draught of air may, under certain circumstances, be the cause of some fatal disease, such warning is disregarded and even ridiculed. And yet the truth is, that a draught of air is a kind of exposure that is probably productive of as much disease as any other of the thousand causes that are constantly at work in undermining health and destroying life. The fact that air in motion is much more sensibly felt, and is much colder than air of the same temperature when still, might suffice to convince people that a draught of air affects the skin differently from still and quiet air. When the air is perfectly still, the animal heat which the body engenders, irradiates very slowly, and the body remains warm, whereas if the body were exposed to the same air in motion, the heat 136 HYGIENE. of the body would irradiate very speedily, and a sensation of coolness, coldness or chilliness would be experienced. Capt. Parry, the well-known explorer of the Arctic seas, relates that while exposed to a temperature of fifty-five degrees below zero, the hands could remain uncovered for a quarter of an hour without experiencing any pain, so long as the air was still; whereas acute pains would be experienced almost immediately after exposing the -bare hands to air in motion, dr to a fresh breeze when the thermometer was down only to zero. In the winter season we have frequent opportunities of observing the difference between air in motion and a perfectly still air. While the air is perfectly still, water may be exposed to a considerable degree of cold without freezing; whereas, it will freeze almost immediately as soon as the air begins to stir. Are not these facts sufficient to account for the -bad effects of a draught of air? Those portions of the skin which are exposed to the draught give off their heat much more rapidly than the parts which are not exposed. The immediate effect of this irregularity must be a disturbance of equilibrium, a sense of chilliness, followed by the opposite sensation of heat. This is a condition which we usually term fever, and which may be characterized by local inflammation or congestion. The heat and inflammation are, so to say, phenomena of reaction; for, if the chilliness continued or went on increasingly, the probability is, that the individual would perish sooner or later. But, if the vital forces have sufficient power to rally, they will endeavor to overcome the depression of the animal temperature. This relative effort of the vital forces is characterized by a sensation of heat. A phenomenon of this kind should convince all intelligent persons of 111-~~-111~1--, . __... HYGIENE.----- 137 HYGIENE. 187 the injurious effects of a draught of air, and of the radical difference existing between such a draught and a properly arranged system of ventilation. In ventilating our apartments, it is therefore of the utmost importance to proceed in such a manner that the draught is not immediately perceived. Rooms should be ventilated while the inmates are absent. Sick-rooms require to be ventilated more frequently than common apartments; but care should be taken that the draught never strikes directly upon the patient. Some kinds of sickness require more ventilation than others. In smallpox, ship-fever, cholera, a constant draught should be kept up, if possible, besides suitable means being employed to neutralize the miasmatic emanations, which is best accomplished by burning a little chloric ether, or placing vessels with chloride of lime in the corners of the room. If exposure to a draught of air be more or less dangerous at all times, and under all circumstances, the danger must be so much greater when persons expose themselves to a draught while over-heated by exercise, running, dancing, and the like. While thus exposed, all the pernicious consequences which a draught of air is apt to entail, develop themselves much more certainly and vehemently; the animal heat, on the exposed parts, is carried off with undue rapidity, the equilibrium of the temperature is violently disturbed; the nervous action, owing to the sudden transition from a state of high excitement to the opposite state of depression, is functionally impaired, and a violent fever, which is sometimes accompanied by serious local inflammation, is the unavoidable consequence of this indiscreet and highly reprehensible exposure. In crowded assemblages, thea13* 13S HYGIENE. 188 HYGIENE. tres, concert and ball rooms, this process of cooling is frequently resorted to by thoughtless and giddy girls. Over-heated by the dance, with a flushed brow and the neck and shoulders covered by moisture, which is the necessary result of the oxidyzing process which is constantly going on at every point of the animal economy, these imprudent creatures will rush to the open window to be fanned by the cooling breeze, forgetting that they are courting death, or receive the germs of some slow disease, which mars all their earthly joys, destroys their usefulness, and consigns them to a premature grave. Avoid a draught of air at all times and under all circumstances! This is our advice to young and old. Those who ridicule this kindly-meant advice, are ignorant of the laws that preside over the preservation of health; in their limited sphere, seemingly trifling exposures of this kind may do as much mischief to individuals, as a devastating plague does to cities and nations. On the use of Water. Water is used for various purposes, the principal of which are cleanliness, cooling, drinking and the restoration of health. We will briefly consider each of these different uses. CLEANLINESS. In former times the use of water as a means of cleanliness was not near as commonu as at present. Even in our enlightened age, there are, comparatively speaking, few persons of really clean habits. Persons who wish to keep themselves clean, should wash all over, at least once every twenty-four hours; but how few are there who will really take this trouble. HYGIENE. 139 And yet, one general daily ablution should not be con sidered a trouble; it does not require more than a few minutes to accomplish this process. Poor people may not have the requisite supply of water handy for a whole family, and this is really an objection; but if one general ablution a day be necessary to health and cleanliness,and among the poorer classes this necessity is evidently much more urgent than among rich people who are not near so much exposed to dirt and dust as the laboring classes,-it should be the duty of the State to provide for a convenient supply of water for every family, especially in crowded cities. In such cities as New York and Philadelphia, it should be a penal offence to construct houses without a bathing apparatus for every family. Landlords who build tenant-houses, are perfectly indifferent, with a few exceptions, to the comforts of their tenants; all they care for, is to grind out of their poor tenants all the money that can be extorted by hook and by crook. Why then should not the State interfere, and regulate the construction of houses, and more particularly of tenant-houses, with a view to comfort, health and safety? All talk about individual rights is sheer nonsense, whenever the enjoyment of a right is separated from a sense of the social obligations which a just appreciation and perception of Christian charity imposes upon all the members of a civilized community. The higher the freedom which we enjoy, the more we should be concerned about the welfare and happiness of our fellowbeings; and hence it is in a republic like ours, that the government of the State should look upon the protection.and regulation of the social interests of its citizens, as its highest and most sacred duty. Some persons seem to have a mortal fear of cold 14 HYGIENE.~~-~~~ 140 HYGIENE. water. They fancy that the least contact with cold water, will give them a cold, or cause some other dreadful malady. But they are greatly mistaken. With few exceptions, which will be alluded to by and bye, when we treat of'the therapeutic uses of water, almost any body may use cold water for a general ablution every morning; all that is required to be considered, is the temperature of the room, which should not be too low, although even this is not objectionable to most persons. Another circumstance to be considered, is to lose no time in washing. Dash the water boldly on the body, either with the hands or by means of a wet towel,beginning at the face, neck and chest, and gradually proceeding downwards, not omitting the feet and head; then take a few towels and rub all over, until the skin is perfectly dry and a glow is felt on it. The whole process may be accomplished in from ten to fifteen minutes, and this is not too great a loss of time considering the comfort which we experience after such an ablution; not to mention the elevating influence which the consciousness of cleanliness exercises over the mind. All classes and ages require such a general ablution once every twenty-four hours, but more particularly children and females. The vegetative life of these two classes of beings is much more active than that of males, and the vegetative functions are essentially facilitated by frequent ablutions with cold water. A dirty-looking man is, in all conscience, a pitiable sight; but a dirty-looking woman is positively revolting. Nature seems to have implanted this instinctive aversion. to dirty, slovenly women in our breasts. And children, these loveliest of all the creatures of the Divine goodnes and wisdom, how sadly are our hearts -- - ~-~--LII--~-~---^ HYGIENE.________ 14 HYGIENE. 141 moved by the sight of a poor-looking, dirty, ragged child! And, on the contrary, what a delightful and soul-quickening aspect is the fair form of a neatlydressed, clean and fresh-loooking little boy or girl! Would that the time might soon arrive, when all parents shall have the means and the desire to keep their children clean and neat; for this will be the beginning of their increase in wisdom and in favor before God and men. COOLING. In speaking of ventilation, the ill-effects of a cooling draught of air have been pointed out These remarks apply more or less to water. It would be decidedly wrong, and might be attended with dangerous and even fatal consequences, to drink cold water while the system is heated and the perspiration trickling down the cheeks. We sometimes hear of persons dying quite suddenly in consequence of drinking ice-water, while over-heated. Some persons imagine that this sudden death is owing to the fat in the system coagulating by the contact with cold water. This is a vulgar and senseless prejudice. For the fats in the body are just as solid when the body is warm as when it is cold; but the sudden transition from an excessive heat to the opposite temperature, paralyses the nervous action, and it is this sudden transition of the nervous action which is the cause of death, or, rather which constitutes death. We know from physical phenomena that any sudden transition from heat to cold or from cold to heat produces essential changes in the constitution of substances; that this sudden transition is capable of destroying the cohesion of parts, altering the essential qualities of many substances, imparting new qualities to some, and destroying the original qualities of others. Why then should ~-C 142 DRINKING WATER. not the nerves, these delicate and highly susceptible vehicles of life, which we know are subject to the chemical and physical influences of the atmosphere, be organically affected by sudden and violent transitions? We know that they are, both in the moral as well as in physical order, and that their functional power mny be, and frequently is, suddenly and permanently interrupted by sudden changes. Cold draughts should therefore be avoided while the system is heated. The only cooling process which it may be proper and safe to enjoy, while the system is heated, is to wash one's face with a little fresh cold water, or to dip the fingers into a basin filled with this liquid. And if the heat which we experience, should be excessive, we may moisten our tongue and lips with a little brandy and water, gradually increasing the quantity, until the skin feels cool and dry, and it is safe to take a full draught. What has been said of water, applies with equal force to ice. The habit of chewing pieces of ice, which our children and ladies are so fond of indulging, is a very bad one, and should not be encouraged. If it have no other pernicious effect, it is certainly injurious to the teeth, and these are too important to be sacrificed by childish and reprehensible practices. DRINKING. Water is man's natural drink, and it may be used freely for the purpose of quenching one's thirst. Good water should be without taste, smell and color, and if such water cannot be obtained naturally, it should be filtered before being used. Water may be drank at any time, except when the system is heated. Some persons.imagine that the digestion is hindered by water being drank during a meal. This is a mistake. We neel not fall into the other extreme, and make it a point HYGIENE. 143 to drink water when we are not thirsty; but whenever we experience a natural desire for water, we may gratify it, although bounds of moderation may be observed in doing so. By over-distending the stomach with water, the contractility of the muscular coat might be impaired, and the gyrations of the food which are essential to its being thoroughly mixed with, and acted upon by the gastric juice, might take place more slowly in consequence, and the whole process of digestion nwight be impeded. But it is perfectly proper to drink a moderate quantity of water during a meal, and it would be wrong to leave a desire for it ungratified. This subject has been spoken of more in detail in the article on diet, and it is therefore unnecessary to go into any further developments here. In regard to drinking, the best rule always is to drink when we are thirsty, and to drink as much as we require to quench the thirst. In warm weather it is allowable to cool the water with a little ice. If we should have been exposed to the sun's rays, and be over-heated and covered with perspiration, it is advisable to mix a little brandy with the water. If pure water should not be accessible, and we should have to use rain-water, or stagnant water from ponds and marshes, the water should be filtered before it is drank, and if it should contain a good deal of decayed vegetable matter, it is necessary to boil and filter it, before it is used, for the purpose of destroying the decayed matter or, at any rate, rendering it innocuous. Such water should likewise be mixed.with a little wine or brandy, or if this should not be handy, we may acidulate it with a little lemon-juice or vinegar. Very hard water, containing a good deal of calcareous earth in solution, or water to which we are not yet habituated, h/--~------------- 141 MEDICINAL PURPOSES OF WATER. is apt to derange the bowels and cause other inconveniences. Such water should be mixed with a little brandy, by means of which the disturbing properties will be neutralized. MEDICINAL PURPOSES. Water is used by many physicians for the treatment of disease. The use of water for medicinal or therapeutic purposes has been reduced to a scientific system, which is universally known as the water-cure system, or the hydropathic system of cure. This system was invented by a German farmer, Priessnitz, and is now practised in every civilized country. The curative powers of water are undoubtedly very great, but they are not, by any means, unlimited, and it is a great mistake to suppose, as some hydropathic physicians do, that water, is a panacea for all diseases. We look upon the origin and development of the water-cure method of treatment as an organized reaction against the long and inexplicable neglect that mankind, and more particularly physicians, have been guilty of towards water. There was a time when even the parched lips of a fever-patient would be refused a drop of water. Any quantity of hot wines, spiced and hot lemonades were permitted; but a drop of water was considered poisonous, and Heaven knows how many millions of human beings may have been suffered to perish by ignorant and prejudiced physicians, for the want of a cooling drink of water. Heaven be praised, these periods of horrible and barbarous darkness have passed away. We know now that cold water is not only not injurious, but that it is an allowable comfort to fever-patients, that it is endowed with curative virtues, and that, where it does not cure, it will facilitate the action of suitable specific medicines, and will reduce an HYGIENE. 145 HYGIENE. 145 otherwise long, tedious and expensive cure to a comparatively short, easy and not very dangerous process of treatment. In a work of this kind, the reader will not expect to find a detailed description of the water-cure treatment; but the principal operations which occur in every hydropathic institute, will be briefly described. Henceforth Hydropathy and Homoeopathy are indissolubly united. There may yet be a few homoeopathic physicians who rail at the good farmer Priessnitz; but these men do not progress with the times, no more than hydropathic physicians do, who do not appreciate the invaluable truths of Homoeopathy. How ridiculous it would be for an hydropathic physician, to underrate the curative virtues of Aconite in inflammatory diseases, or to undertake to cure an inflammation with water alone, without the use of Aconite; and, on the other hand, how much injustice would be done to a fever-patient under homoeopathic treatment, if water, whether cold or tepid were not used in his case. What homoeopathic physician would be barbarous enough to deprive a patient attacked with a hot fever, of the soothing effects of an ablution with tepid water? Every homoeopathic physician should therefore avail himself of the use of water as a therapeutic agent, were it only for purposes of palliation; and, on the other hand, every hydropathic physican should be thoroughly acquainted with the immense resources of the homoeopathic healing art, and should not be ashamed of availing himself of the homoeopathic Materia Medica, which might be done almost in every case, and especially in acute cases, with signal effect. In a great many chronic cases, especially in chronic eruptions, the itch and its sequelae, herpetic eruptions and the like, water alone may be sufficient, 14 14f BATING 146 BATHING. although even in such cases a properly chosen and properly administered homoeopathic drug will shorten and facilitate the cure. Under the united influence of Homoeopathy and Hydropathy, these beautiful and immortal twin-sisters of the healing art, the germs of disease will gradually be eradicated from the human organism, and this body will again become what the Saviour called it, "a temple of God." A great many hydropathic physicians account for the curative effects of water upon the principles of the humoral school. But this is wrong, and homoeopathic physicians especially would have to reject this course and exceedingly material mode of explanation. In his Organon, the immortal founder of Homoeopathy has given the quietus to the. illusions of the humoralists, and no hydropathic physician who professes to believe in, and practice Homoeopathy, should undertake to build his mode of treatment upon such a frail basis. It is the nervous power that is primarily affected by the water, and it is by regulating or rather stimulating the nervous action, that water operates a cure. We will now proceed to describe some of the principal operations of water as a curative agent; in the course of this work we shall not fail, wherever it seems necessary, to point out the particular mode of using water in particular diseases. Bathing. This is an amusement, a luxury rather than a means of cure, although the process of bathing is frequently resorted to for remedial purposes. Sea-bathing especially, is recommended for a number of nervous diseases, HYGENE 147I__ ~ __ I_ _ HYGIENE. 147 hysteria, epilepsy, weakness, etc. For very weak persons, sea-bathing is frequently too stimulating and causes prostration, diarrhoea, a loss of appetite. If sea-bathing could be indulged in without exposing one's-self to the stimulating effects of the sea-air, it is probable that even weak and nervous individuals might be benefitted by a surf-bath; but the sea-breeze has to be endured, and its effects are too bracing for many constitutions. For thousands of healthy persons, a bath in the sea or in some lake or river, is a source of great enjoyment, and has a tendency to invigorate their constitutions. All that is required to secure all the best advantages of a bath in the flowing water, is to observe certain very simple rules which every man's common sense is abundantly sufficient to suggest. Thus it is plain that we should not go into the water, while the body is hot and the skin covered with perspiration; nor should we, on the other hand, go into the water, while the body feels cold or chilly. In the former case, the sudden transition from heat to cold might cause such a violent shock in the nervous system, that all vital reaction might become paralyzed; and, in the second case, the existing depression of the nervous energy might be greatly increased by the bath. It would likewise be highly improper to bathe in the open -air when the air is raw and damp; this kind of exposure might prevent a reaction of the nervous energy against the depressing effects of the bath. There are persons that can bathe during any state of the atmosphere, without injuring themselves; but their example cannot be imitated as a rule. After the bath it is well to take a little moderate exercise, which may be gradually increased. The best time to bathe is towards evening, 1_ BAHIG 146 BATHING. an hour or two before supper, or three or four hours after breakfast. While in the bath we should not remain quiet, but splash about as much as possible. Fortunate are those who know how to swim, for this is undoubtedly the best kind of exercise in the water. The proper mode of taking the bath is to dash into the water at once, without temporising, and to plunge in with the whole body. Going in gradually and allowing the water to rise from the feet upwards, causes a.momentary congestion to the lungs and brain, and may occasion oppression of the chest, headache and other troubles. Persons who bathe in the surf, should not expose themselves to the danger of being carried away by an undercurrent; the great benefit of sea-bathing consists not so much in the effect of salt water upon the body, but in the electrifying shock of the waves. Half a dozen full waves are sufficient to insure all the good effects which can be derived from sea-bathing. In receiving the shock of a full wave, it is not well to stem the body against it with a view of resisting the wave; for if the wave should be powerful, it might knock the bather down with great force and injure him severely. There are instances where limbs have been fractured by the shock of a wave. The best method is to yield to the impulse of the wave, and allow one's-self to be carried along with it; even if one should fall, this will not result in any further inconv.enience; for the surf rolls back again immediately, and leaves the bather on the dry beach. A bath in the open air can only be enjoyed at certain periods of the year, and, if we wish to bathe at a time when a bath in the open air is impossible on account of the weather or temperature, we have to content ourselves HYIEF 14 HYGIENE. 149 with a bath in a tub constructed for this especial pur. pose. Bathing-tubs are so common and so well known that it is unnecessary to describe them. But it may not be unnecessary to advert to a circumstance which might be productive of serious inconvenience under certain circumstances. Bathing-tubs are generally lined with tin-sheeting, which is apt to chill the feet when they are exposed to it. To prevent this- chilling effect, a piece of flannel should be spread on the bottom of the tub, or else a pair of slippers should be put on before one enters the tub. The water in the tub should not be above blood-heat, say from 90~ to 92o F. In the summer the common temperature of the water is sufficient. Even in taking a bath in such a tub, we should at once dash some water over the chest and shoulders, in order to prevent a determination of blood to the chest and head. Immediately after leaving the bath, the skin should be rubbed with a large towel, and afterwards with a coarse towel, in order to restore or facilitate the reaction in the capillary system. It is a good plan, while in the bath, to rub the body with a pair of horse-hair mittens or a flesh-brush. Persons subject to asthmatic attacks, rushes of blood, fainting spells, palpitation of the heart, should not take the full bath without the advice of an intelligent physician. SWEATING. This is an important operation in the hydropathic treatment, and may be productive of extremely beneficent results. This process is resorted to when we wish to stimulate the nervous energy, counteract or remove the injurious effects of medicinal substances, clear the skin of eruptions; it is an important auxiliary in the hydropathic treatment of acute fevers, acute and chronic inflammations, rheumatism, gout, etc. 1.4* 150 SWEATING. A woolen blanket is spread on a cot, upon which the patient lies extended, with the lower extremities in close contact and the arms close to the body. A vessel may be placed between the thighs for the purpose of receiving the urine, in case the patient should have to pass any while packed. One side of the blanket is then raised and wrapt round the patient's body, taking care to apply the blanket close to the skin under the arms, at the feet, etc.; this being accomplished, the other side of the blanket is grasped firmly and pulled toward the opposite side. The patient, thus wrapt up, is covered with a sufficient number of blankets to excite perspiration. The mouth and nostrils should be left free, but the neck and sides of the head should be carefully included in the packing. While thus packed, the patient may drink much cold water, not a quantity at once, but small quantities at short intervals. This will promote the sweating. Some persons begin to sweat after the lapse of an hour, others require several hours. It is difficult to say how long a person should be allowed to sweat; some may sweat for an hour, or for two, and even more hours. This sweating can be carried on to such an extent that the sweat will trickle through the mattress, and basinfuls of sweat may be collected under the bed. In acute bilious and rheumatic fevers, a prodigious amount of sweat is sometimes secreted. But this sweat differs greatly from the sweat with which the skin is covered in hot summer weather, after some violent exercise. The sweat excited by the dry pack leaves the circulation perfectly quiet, nor has the nervous system been strained to produce the sweat. The large amount of animal heat which had been accumulated in the blankets, cannot fail to meet, in the large quantities of water which the patient HYGIENE. 151 HYGIENE. 151 had drank, a counterbalancing influence; the vital principle, which is ever busy in restoring the normal temperature of the system, avails itself of the water for the purpose of cooling down the artificially-excited heat, and the only way in which this object could possibly be accomplished, is by converting the water into a copious flow of perspiration. This will of course accumulate upon the skin, and, in penetrating to the skin, will become impregnated with the impurities pervading the organism. We know that solid mercury has been discovered in this artificially-excited perspiration; the odors of various medicinal substances, such as Valerian, Turpentine, Iodine, Musk, Asafoetida, are sometimes strikingly perceived; not unfrequently the sweat has an urinous smell; and the color is likewise found altered, but generally red and yellow, although a darkish brown or blue color has likewise been noticed. Now let us see what is the state of the patient. The internal organism perfectly cool, and only the skin in a high state of sensitiveness, and covered with an artificially-excited perspiration. While in this state, the patient, provided he has perspired sufficiently, is raised on his feet, the blanket is suddenly thrown off, and he steps with both his feet into a tub full of cold water; at the same time a dripping sheet is quickly wrapt around him, not omitting the head, and he is rubbed off until the sheet is quite warm; he then steps out of the tub, and is wrapt in a dry sheet for the purpose of being dried, after which the patient may be rubbed for a few minutes with a fleshbrush, a coarse towel, or a horse-hair mitten. Those who prefer it, may jump into a bathing-tub filled with cold water, care being taken that no time is lost between the moment of throwing off the blanket and the mo i I ------- - - - -- _ ~ __ ~1_1~ _I I 152 - SWEATING. ment of washing with the cold water. This sweating process may be repeated once a day, or once every other day, and afterwards still less frequently, as the patient improves. The sweating should be carried on in a room that has a good supply of fresh, pure air. As soon as the sweat begins to break out upon the skin, the windows may be let down a little, for the purpose of letting in the open air. But this air should never strike directly upon the patient. The patient should never be directly exposed to a draught of air, and more particularly of damp and raw air; water-cure physicians who advise the contrary, are ignorant of the first principles of physiology, and should not meddle with the difficult and responsible exercise of the healing art. Nor should hydropathic physicians be so grossly ignorant of, and indifferent to the advantages which their patients who have to undergo the sweating process, might derive from Homoeopathy. Every hydropathic physician should know that in a case of inflammatory rheumatism, for instance, the sweating, which, with the ordinary packing process, might not come on undertwelve or even twenty-four hours, during which period the patient may suffer great distress, will be brought about with the assistance of a few globules of Aconite after the lapse of half an hour or hour. We have seen patients in hydropathic institutions who were laboring under a severe attack of acute articular rheumatism, packed in blankets, in a room with all the windows and doors wide open, day and night, and half a dozen draughts blowing upon the-patients, while a sharp wind was stirring and the rain coming down in torrents. No wonder that such patients get worse instead of better; that no sweat would make its appearance, and that, if it HYGIENE. 153 HYGIENE. 153 did show a tendency to break out, it was immediately checked again by this monstrous and foolish exposure. In one of these cases the patient had been confined to his cot and blankets for a week, without the least improvement being effected in his condition; the shoulder and wrist-joints were so stiff, swollen and painful that he was unable to stir. We were sent for. The first thing we did was to close the windows, leaving only one of the corner-windows open at the top, in such a manner that no draught could reach the patient. He complained of burning thirst in spite of the quantity of water he had been drinking, and his skin was dry and hot, with a hard bounding pulse. We gave him a little Aconite during the night, and called again next morning. On entering the room; he extended his hand, shook his arm in the air, and said: "Doctor I am well, your Aconite has cured me." He had perspired copiously all night, and in a few days he was able to leave his room. Individuals with enfeebled or impoverished constitutions cannot undergo this process of sweating. The object of this operation is to stimulate the vital reaction, and, unless the vital energies are organically unimpaired, the depressing effect of the cold bath or of the dripping sheet cannot be overcome sufficiently to benefit the organism. In some the vital reaction is so reduced that a simple ablution with cold water proves too depressing in its effects upon the organism; such individuals should substitute tepid water for cold, and the temperature of the water should be diminished gradually, until cold water can be borne. If the vital reaction is sufficiently strong, the colder the water the more the organism will feel stimulated by it. The degree of vital reaction may be measured by the glow which is experienced on the -i ~~-~ 154 - 1 SWEATING. skin immediately after applying the water; wherever this glow is not felt, there is a deficiency of reaction, and the patient is not in a condition to go through the sweating operation. Intelligent water-cure physicians sometimes allow patients to remain at their institutions for a certain period before any real water-cure treatment is commenced. All such institutions should be situated in perfectly healthy regions, where the patients have an abundance of opportunities for walking and riding, and where a refreshing and invigorating air can be inhaled on the mountain-tops. Fresh air, diet and regular exercise are sometimes indispensable preliminaries to the cure, and debilitated individuals should be adequately prepared by strictly hygienic means, before the more energetic operations of Hydropathy are resorted to. After dressing, the patient may take a little gentle exercise, or, if he should feel tired, he may lie down and take a little nap, which will frequently prove refreshing. The appearance of the sweat is sometimes facilitated by spreading a linen sheet that had been dipped in cold water and then wrung out, over the blanket and wrapping it, together with a blanket, round the patient. Care must be taken to apply it closely to every part of the body. A wet sheet without a sufficient amount of woollen blanketing to prevent evaporation and the irradiation of animal heat, is decidedly objectionable. Sweating is an excellent remedy for a great many chronic eruptions, such as the itch, tetter, saltrheum, etc., or medicinal cachexias, etc. It has to be used discreetly, lest excessive sweating, should disturb the normal action of the skin. In acute eruptive diseases, such as small-pox, measles, scarlet-fever, the wet-sheet may favor the development of the eruption HYGIENE. 155 HYGIENE. 155 and help to bring it out again after a sudden retrocession. Plunge-bath. The plunge-bath is intended to stimulate the vital reaction, and it is a very efficient means of stimulation, wherever it can be safely employed. It may be used without previous sweating, but it is particularly effective when used immediately after leaving the pack, with the skin in a high state of sensitiveness and covered with perspiration. Patients should not remain in the plunge.bath longer than a few minutes. Those who cannot take the plunge unassisted, may be suddenly lowered into the bath on a blanket, which is let down into the water suddenly by means of pullies or some other arrangement. The plunge-bath is applicable in acute nervous fevers, typhus, yellow-fever, ship-fever and the like. Some years ago a yellow-fever patient, in a fit of raging delirium, jumped out of the window into a basin full of water, and was drawn out free from fever; shortly after, he left the hospital cured. We need scarcely remark, that individuals suffering with organic affections of the lungs and heart, spinal weaknesses, vertigo, rushes of blood to the brain, chronic deafness or ophthalmia, should not use the plunge-bath. Shower-bath. This is so commonly used in almost every family, that a particular description may safely be omitted. In cities like New York and Philadelphia, where every properly constructed house is supplied with water in almost every story from the magnificent public water 156 SHOWER-BATH. works of these places, a shower-bath is a fixture in the bath-room. The shower-bath is intended to stimulate the vital reaction, and should not, therefore, be used by debilitated, asthmatic individuals, or by persons who are affected with organic diseases of the lungs or heart. The shower should never be allowed to fall directly on the weak spot. For instance, a person affected with chronic deafness or ophthalmia, should never receive the shower on the head, neck or shoulders, for the reaction would invariably be characterized by an aggravation of the original affection. In all such cases the shower should be allowed to fall on the lower extremities, and more particularly on the soles of the feet, or perhaps on the lowest portion of the spine. In this way the shower might act as a derivative, and diminish the pressure of the blood upon the auditory nerve, and lessen the congested condition of the eye. Upon persons in health, or who wish to strengthen themselves, the shower-bath acts as a very pleasant, and exceedingly refreshing stimulant. It may be taken early in the morning, immediately upon rising from bed. The shower may be adapted to a person's feelings, by using a plate with large or fine holes. Accordiing to our experience, the best mode of showering is to receive the stream first on the lower extremities, and after they are well showered, to gradually let the shower rise towards the head. Every side of the body should be in turn presented to the falling shower, and, while the shower is falling, we may rub the skin as much as possible with our hands, a horse-hair mitten, or a stiff flesh-brush. After the whole body has been showered in this way, we may then shower more particularly, such parts as require extraordinary stimulation, allowing the shower to HYGIENE. 157 HYGIENE. 157 fall either directly on the weak spot, or to act indirectly by being made to fall upon some opposite part, for instance, upon the soles of the feet, if the superior organs are affected, or upon the head and neck, if we wish to remove congestions of the abdominal viscera, the lower portion of the spinal column, the uterine apparatus, etc. An intelligent physician will have to decide whether the shower can be allowed to fall directly upon the affected organ. The Douche. This is a sort of concentrated shower-bath, and one of the most energetic, and, to those who have once got used to it, one of the most grateful appliances of the *water-treatment. It is a stream which is allowed to come down from a sufficient height through a tin tube of from one to two, or even three inches in diameter. All the precautionary rules which have been prescribed for the shower-bath, apply with equal force to the douche. The douche is principally used for the removal of congestions, the dispersion of rheumatic, arthritic swellings, which require to be douched considerably for this purpose; for the more speedy suppuration of glandular indurations, etc. The douche may be repeated once or twice a-day, but never on a full stomach. The douche should never be allowed to fall on the stomach, pit of the stomach and chest, nor perpendicularly on the head; the bowels may be douched moderately. After the douche it is well to take active exercise. These are what might be termed the general applications of water for curative purposes, although a showerbath and the douche are likewise more or less local in 15 158 SITZ BATH. their action. The purely local applications of water are; the partial bath, the wet-bandage, and injections. Partial baths. The partial bath is applied both for palliative and curative purposes. It is used to relieve pain, remove congestions, etc. We distinguish the Drop-bath. A single drop is allowed to fall from a certain height for the purpose of scattering an induration or bringing it to a head. In some of the lunatic asylums of Germany, the drop-bath is sometimes resorted to as a cure for craziness. The water should be quite cold and fresh. The Sitz or sitting-bath. These baths may be used for various purposes, for instance, as derivatives for the purpose of removing congestions from the superior organs; they are an excellent palliative for piles, soreness of the anus; they stimulate the digestive apparatus, strengthen the genital organs, soothe the existing irritation of the nervous system, and are sometimes a cure for neuralgia of the face, etc. If, at first, patients cannot bear the water cold, it may be used of a temperature of from 900 to 92~ F. But little by little the patient should accustom himself to use the water cold, and even as cold as ice. While in the bath, the skin should be rubbed with the hand, or with a horse-hair mitten, and more particularly the bowels, in a circular fashion. Sometimes it is neces HYGiENE. 1&9 HYGIENE. 159 sary to remain in the bath, until the parts have become quite numb; the reaction will then be so much greater and beneficent. If the common sitting-tub is used for the bath, the interior should be covered with flannel or with a blanket, to prevent the chilling contact of the tin-sheeting. After the bath, the patient should take active exercise for the purpose of facilitating the reaction towards the skin. Such local baths should be taken in a room of a middle temperature, say about 60~ or 65~ F. Those parts which are not in the water, may be covered for the time being with a blanket or shawl. Some persons are so sensitive that they cannot sit in the water at once, but have to be prepared by first washing the lower part of the back and bowels with cold water, and rubbing these parts for some time with a wet towel; after which they summon the necessary courage to sit down in the bath. The Foot-bath. This is likewise used as a derivative for headache, congestion about the superior parts, etc. In order to fulfil this purpose, the bath should be used cold. Another mode of using the foot-bath, is to use warm water to the feet, and to apply at the same time a towel soaked with cold water to the head. A warm foot-bath, without the counter-acting cold applications to the head, does not fulfil the desired object. And this,is quite natural. For it is the reaction, not the first or primary action, that constitutes the curative effect. The primary action of a cold foot-bath is to increase the determination of blood to the superior organs; but this primary action soon ceases, and the secondary or re-action sets in which ~_~I ____ 160. WET BANDAGE. is always opposed to the primary action, and, in this instance, would be the opposite of a determination of blood to the head, hence a diminution or removal of the cerebral congestion. There are a variety of other partial baths which are used in hydropathic treatment, such as the head-bath, eye-bath, hand-bath, etc., the object of all of which is to remove congestions, alleviate pain, etc. The head-bath is quite common, and consists in dipping the head into a basin full of water, or, which is more convenient, extending one's-self on a mattress lying on the floor and lowering the head into a basin with water placed close to the mattress. Females may tie up their hair in a knot and cover it with an oil-silk cap, although the great dread which most females have of wetting their hair, is altogether unfounded. All such partial baths may be repeated a number of times in the course of the day, provided they are either taken an hour or two before, or three or four hours after a meal. The wet bandage. This is another favorite mode of using water for curative purposes. It may be applied in various ways, in acute as well as chronic diseases and weaknesses. In acute inflammations, besides and general treatment for sweating, wet bandages may be applied to the inflamed parts in such a way that all sudden evaporation is rendered impossible. The wet bandage should consist of half a dozen thicknesses of linen, which should be dipped in very cold water, ice-water in the summer-season, and, having been gently pressed to prevent the dripping, they are placed on the inflamed part, and a piece of dry ___ WET BANDAGE. 161 flannel tied over them to prevent all sudden evaporation. As soon as the bandage feels warm, it should be replaced by another bandage soaked with cold water. This changing must be kept up steadily; a bandage that has got warm, must not be allowed to remain on the part, for this would not only increase the pain, but might likewise prove injurious. The reduction of the inflammation is only possible by exciting a series of successive reactions in the diseased part or organ. These local applications may prove of great benefit in acute inflammations of external as well as internal parts, muscles, nerves, membranes, the brain, lungs, bowels, etc. Cold water should be drank freely while the general and local treatment is going on. Some persons are in the habit of wearing a wet bandage all the time, in order to stimulate or strengthen debilitated organs; some wear the bandage over the chest, others over the bowels, etc. To prevent evaporation, one or two thicknesses of flannel should be tightly drawn over the bandage, and the bandage should be moistened with fresh, cool water, every five or six hours at least. Sometimes such a bandage irritates the skin, and brings out an eruption which proves a relief to the subjacent organs. No such applications should be made, except with and by the advice of an intelligent and experienced physician, not merely a water-cure physician, but a physician who is fully acquainted with the rationale of water-cure treatment and the nature of disease, and of the physiological functions of the organism. A warm wet bandage, for which purpose we should use flannel instead of linen or cotton, is sometimes very soothing when there is spasmodic or colicky pain. The application should be renewed as soon as the water begins to feel cool. 15* 162 HqIENE 162 HYGIENE. Injections. Injections of warm and cold water are used for various purposes and affections. An injection of tepid or even cold water, sometimes proves an excellent means of quieting the nervous system. Persons who are habitually costive, may use an injection of cold water every day, half an hour or so after breakfast. This will never do them any harm; it may prevent a good deal of distress and may gradually induce a regular action of the bowels. Persons who are afflicted with piles, may do well to use an injection every morning after breakfast. Females who are troubled with uterine weaknesses, prolapsus, leucorrhoea, etc., may likewise use cold waterinjections by the rectum with advantage. They may be accompanied by similar injections into the vagina and uterus. To inject the vagina, a syringe should be used that is closed at the end and provided with a number of fine side-holes. - ~---~--~-ly-~0~ -~ --- IrY -~ --- ~--- A CHAPTER ON GENERAL DIAGNOSIS; OR, EXPLANATION OF THE PRINCIPAL CHARACTERISTIC MORBID SIGNS, OR PHENOMENA, WHICH OCCUR MORE OR LESS IN EVERY CASE OF DISEASE. THE whole science of practical medicine reduces itself to these two questions: What ails a patient? and, secondly, what means have to be employed to cure him? The first question implies a knowledge of all the various diseases that mankind are subject to, and the second a knowledge of the remedial agents that Nature has furnished us against disease, and of the curative virtues inherent in every particular medicine. Hence, in order to obtain this knowledge, it would seem as though a person ought to study medicine as a science, by attending lectures, visiting hospitals, dissecting dead bodies, and the like. And this is, certainly, indispensable to a man who does not mean to content himself with the practice of medicine for a mere livelihood, but who has the highest interests of medicine at heart and is anxious (163) __ __ 164 ON GENERAL DIAGNOSIS. to perfect it as a science. But there are thousands of intelligent persons, mothers, fathers, guardians, teachers, who are frequently called upon to give advice in a case of sudden indisposition, or when no physician is at hand, or when the patient is too poor to pay for medical advice. And it would seem an inconsistency in Divine Providence to implant the desire of relieving our fellow-beings of pain, in our hearts, and render the means by which this relief is most adequately accomplished either inaccessible, or, at any rate, so difficult of access that they become comparatively unavailable. It may therefore be inferred, that if the cure of disease has been heretofore as obscure and difficult a business as it certainly has been, this cannot have been owing so much to the intrinsic difficulty of the business of curing, as to the imperfect manner in which it was taught; to the extraneous difficulties with which the art of curing was surrounded; to the dogmatic mysticism and the paraphernalia of erudition with which this art was cloaked; and to the positive prohibitions, by the State, of practising the art, unless it had been acquired in the regular fashion, or in accordance with the routine which the State had sanctioned. In this way, the art and business of curing became the exclusive property of a privileged class, and served to feed man's vanity, and pamper man's cupidity, rather than to alleviate his pains. But the progressive emancipation of humanity from prejudice and error, which has been so signally directed by Providence in all the departments of science and art, has likewise extended its beneficent influence over the healing art; what was, a century ago, looked upon as the mysterious and magical arcanum of privileged minds, has now become a popular acquirement. The spirit of __ ON GENERAL DIAGNOSIS. 165 progress has effected the same reform in the healing art, and in the means of acquiring it, that has taken place in the study of everything else which is of interest to the human mind. Formerly, it took years to study a foreign language, now it takes so many months. Formerly, a knowledge of Latin and Greek was indispensable in order to become a physician; now, a knowledge of one's mother-tongue is sufficient to acquire a pretty thorough initiation into all the mysteries of the healing art. The invention of the steam-engine required transcendent genius, but the management of the steam-engine has become a popular branch of industry. The progressive development and reformation of medicine require the highest order of mind, and pre-suppose a comprehensive knowledge of all the natural sciences; but the actual exercise of the healing art may, within certain limits, be rendered accessible to all persons endowed with a moderate share of intelligence. It may safely be asserted, that physicians who have once entered upon the exercise of their profession, cease to bother their brains with the anatomy of the sphenoid bone; they reduce, each according to his own taste and judgment, the practice of the healing art to a very simple and convenient routine. Such facts go to show that the practical good of medicine may be studied by anybody endowed with ordinary intelligence. We will try to show our readers, as lucidly and concisely as possible, how they have to proceed in order to become acquainted with the nature of the patient's malady. A particular description of the various diseases, and more particularly of the eruptive diseases, such as variola, measles, scarlet-fever, etc., will be given in the course of this work,-and we advise all those who desire to acquire proficiency in the management of dis 166 ON GENERAL DIAGNOSIS. eases, not to content themselves with reading over a particular paragraph or chapter, in proportion as it may be needed for special emergencies, but to study and re-study this work regularly; for the more general and coherent knowledge of diseases, which will be thus acquired, will sharpen the faculty of accurately discerning the character of a particular case. But there are general diagnostic signs with which persons, who wish to prescribe for their sick fellow-beings intelligently, should be acquainted, before they enter upon the study of the special diseases. With a little attention, the reader will not find it difficult to acquire a knowledge of these general diagnostics. Let us proceed to describe and interpret them. For the sake of preventing confusion, and of facilitating a survey of the grounds upon which we stand in trying to prescribe for a patient, we will arrange the general diagnostic signs' under the following heads: 1. Fever, condition of the pulse, periodical recurrence of the paroxysms of fever, or else uninterrupted continuance of the fever, with or without exacerbations at particular periods. 2. Condition of the secretions, sweat, alvine evacuations, urine. 3. Condition of the brain and nervous system. 4. Condition of the patient's spirits, mental faculties. 5. Condition of the gastric functions, appetite, thirst, appearance of the tongue, taste, absence or presence of nausea, vomiting, etc. 6. Color of the skin, eyes, etc. 7. Nature of sleep, dreams, etc., and the phenomena experienced during sleep. 8. Pain; nature, locality and duration of the pain, its FEVER. 16 FEVER. 167 permanent continuance, or its disappearance and recurrence at regular periods. 9. Condition of the chest, cough, expectoration, oppression, pain, etc. 10. Condition of the spine, shape, soreness, etc. 11. We may inquire, whether the particular disease which we are called upon to treat, is hereditary in the patient's family, or whether there are any other hereditary diseases in his family. The patient's temperament, age, sex, and general occupation should likewise be considered, and our examination modified accordingly. We will now proceed to a more detailed examination of some of these subjects. 1. Fever. This is such a common and universally-prevailing disturbance that there is hardly any person that is not able to decide whether a person has fever or not. Common fever is generally distinguished by various phenomena which are uniformly present. These phenomena are a hot and dry skin, the heat being generally preceded by a chill or a sense of chilliness or coldness; a full, hard, bounding, pulse; a dry mouth and thirst, dark-red urine and generally a coated tongue. If the fever is very violent, the cheeks are more or less flushed, the skin has a darker, generally reddish tinge, and there may be other symptoms present, such as dizziness, headache, palpitation of the heart, etc. Sometimes the fever is very slight, and most of the above-mentioned symptoms may be present, although so slightly that only the practised and attentive eye of a careful observer is able to perceive them. In very nervous or hysteric 16.8 ON GENERAL DIAGNOSIS. females, symptoms resembling those of fever, will sometimes make their appearance; they will feel alternately chilly and flushed, the pulse may be irritated; there is, as they term it, a sort of inward fever; the skin is dry, the mouth parched, they feel thirsty and want to drink a good deal, and the urine may have the same dark appearance and strong odor that it has in genuine fever. Such symptoms should not be confounded with fever; they can be readily distinguished from real fever by their irregular, more or less capricious appearance and disappearance, whereas the fever symptoms run a regular, steady course, until sweat breaks out, after which the skin cools off, the pulse becomes softer and slower, the urine deposits a sediment consisting of whitish flakes, the mouth becomes moist, and the accessory symptoms gradually disappear. Full-grown persons seldom become delirious during a common catarrhal or rheumatic fever, unless they should be constitutionally subject to rushes of blood to the head; children, however, are very apt to be flighty during an attack of fever, especially in the night. The leading phenomena of fever, chill, heat, dryness of the skin and thirst, are present in every fever, but their relative duration and intensity vary. In simple fever these phenomena develop themselves in the course of twenty-four hours. A sudden and very severe chill generally is indicative of fever with congestion or inflammation of some important organ. A continuous dry heat after the chill points to a deep-seated disorder of the higher portions of the nervous system. A chill followed by burning fever and copious and debilitating sweats denotes tubercular disease. In this case the chill recurs more or less regularly every twenty-four FEE 169I~ ~ FEVER. 169 hours. In some forms of tubercular disease the chill and fever may be slight for a long time, especially among children, whose general health sometimes seems to be so little disturbed, even when the brain is the seat of the affection, that the existing symptoms would seem to be satisfactorily accounted for by the supposition of worms. A chill which is ushered in by a drawing in the bones, a desire to stretch one's-self, to be near the warm stove, and which is characterized by coldness of the hands and feet, blueness of the finger-nails, goose-flesh, and which is moreover accompanied by a variety of secondary symptoms, such as violent thirst, palpitation of the heart, dizziness, vomiting, colicky pains, headache, etc., is indicative of fever and ague, particularly when occurring in a region where this malady is endemic. A chill followed by burning heat, with stupor or a drowsiness bordering on stupor, and sometimes spasmodic symptoms, points to some approaching eruption, the character of which will depend upon a variety of other symptoms. Partial chills and cold spots denote a derangement of the nervous functions. The thirst in fever is caused by the inability of the secreting surfaces to furnish moisture. The amount of thirst must, therefore, be proportionate to this inability. And while this inability lasts, it is eminently proper to supply the deficient moisture by suitable artificial means, such as drinking cold water, sponging the skin with tepid water, etc. How cruel it would be to refuse a fever-patient plenty of cold water, if he has a desire for it. Sweat being one of the secretions, the reader is referred for appropriate observations on this subject to the chapter on the secretions; and the various kinds 16 _ _ __ _ _ _ 170 ON GENERAL DIAGNOSIS. of fever, so far as the origin and meaning of their names are concerned, will be found mentioned in the last section of this part of the work. A most important phenomenon in fever is the pulse. The pulse of a healthy adult person is generally from seventy to seventy-five beats a minute, although this is by no means an invariable rule; for there are adults who apparently enjoy good health with a pulse usually down to thirty-five and even thirty, and, on the other hand, others with a pulse up to ninety. The pulse of children is generally quicker than that of adults, and the normal pulse of infants frequently is from one hundred to one hundred and twenty. During a fever the pulse is always more or less altered. A quick, hard, full, bounding or throbbing pulse shows that the fever is of an acute, inflammatory character. A sluggish, full and heavy pulse shows that the nervous energy is not sufficiently active and requires to be stimulated by treatment. A thin, 'quick, wiry pulse indicates debility; it may naturally result from the inflammatory quick, full and bounding pulse, and frequently does result from it, if the fever is allowed to run its course unchecked, and the vital energy becomes more and more prostrated. A thin, scarcely perceptible pulse, with coldness of the extremities or of the skin generally, and accompanied by acute crampy or colicky pain, indicates a sudden attack or acute congestion in the part where the pain is felt. An intermittent pulse indicates disease of the heart; and, if it occurs towards the termination of an acute __^_ ~ ~ I~ER 171__1__I___ ____ __ 1__1__ 1 _I ___ FEVER. 171 sickness, it indicates exhaustion of the vital energies and approaching dissolution. A fine, wiry, readily-compressible pulse in fever, is a very bad sign, and frequently denotes approaching death. An unequal, irregular pulse denotes an abnormal action of the nervous system; so-called nervous people, females affected with hysteria, are very apt to have such a pulse; in nervous diseases such a pulse is likewise met with, especially in nervous disorders depending upon cerebral derangement. A slow, irregular and intermittent pulse generally indicates a sinking of the cerebral action. A sudden change of the pulse from quick to slow in cerebral inflammation indicates incipient effusion. An increasing rapidity of the pulse in fever denotes aggravation of the disease. A changeable pulse in fever is an unfavorable symptom, and shows that the nervous system is considerably involved in the morbid action. There are a good many varieties of the pulse, the most important of which have been mentioned in the foregoing list. It seems to be an easy business to feel the pulse, and, by the condition of the pulse to obtain an appreciative knowledge of the condition of the patient; but the pulse is by no means as easy a test as some imagine; it is not always an infallible indication, and a good deal of experience, acute observation and delicacy of touch are required, to appreciate this highly important and interesting diagnostic sign at its full value. The pulse may be felt, wherever an artery is so near to the surface of the body, that its throb may be distinctly felt; the most convenient locality for feeling the pulse L_---3---~-~~UI-P- --- I^-- - ~ PI-I-~- --II-~~i~~L-~Y~~-- I~-~-IP~-~I---P--~~---. 172 ON GENERAL DIAGNOSIS. is at the wrist, near the outer edge of the radius, the larger of the two bones in the forearm; the operation is performed by placing the index and middle fingers close together upon the region of the pulse, just above the sharp bony prominence or process at the outer side of the lower extremity of the forearm, and pressing gently until the throbbing of the pulse is distinctly felt. A short interval should be allowed to elapse before we begin to count the beats, for obvious reasons, the principal of which is, that patients are generally a little excited when they first see their physician, or begin to talk about their sickness. In order to be perfectly sure of the condition of the pulse, we ought to keep counting for a couple of minutes, and even feel the pulse of both wrists. This is sometimes required on account of the radial artery being covered by a tendon, in which case the pulse would, of course, become imperceptible. It need scarcely be remarked, that the value of the pulse as a diagnostic sign depends upon the condition of the pulse during a state of health. If a person's pulse, for instance, is habitually from 45 to 50 beats in the minute, that same pulse, if it should rise to 70, might indicate a pretty high state of fever; and so in the case of infants, a pulse of 140 beats migl4 indicate a common degree of fever, whereas such a pulse, in the case of adults with a natural pulse of 70 beats, would indicate a most dangerous condition of fever. 2. Pain. Pain is a very important diagnostic sign. When accompanied by fever, it is generally indicative of congestion or inflammation of the part where the pain is PAIN.~1 ~ 1 173 PAIN. 173 located. In such a case it is of the highest importance to ascertain the. exact locality of the pain, in order to know what particular organ is affected, for the treatment may have to be shaped accordingly. Thus, if the lungs are the seat of the congestion or inflammation, the treatment may be quite different from what it would be, if the bladder or kidneys were affected. Again, the nature and degree of the pain are likewise of the utmost importance as regards the treatment to be pursued. An acute pain with fever, especially when of a cutting, pricking, lancinating character, aggravated by the least pressure, motion, or attempt at drawing a long breath, with heat and soreness in the part, generally denotes inflammation; if it be not so much an acute lancinating or pricking, but an aching pain, a sort of painful pressure, with soreness, sensitiveness to contact, or a feeling of distention, or fulness, etc., we diagnose congestion, which may be looked upon as an inferior degree of inflammation, and generally requires the same kind of treatment. A congestion or inflammation of some external organ is readily known. Any body knows, for instance, whether the eye is inflamed, although, in common parlance, an eye is frequently called inflamed when it is simply a sore or weak eye- for, as has been stated before, congestion and inflammation, which non-professional men do.not always know how to distinguish from each other, and which, indeed, do not always require to be distinguished for practical purposes, are always accompanied by a remittent fever, characterized by regularly-recurring morning or evening exacerbations. Inflamed muscles are readily distinguished by the acute pain, swelling, heat and redness of the parts. When glands become inflamed, they are swollen, red, sore, and 16*. --- --- ---- S 174 ON GENERAL DIAGNOSIS. a throbbing pain is felt in the swelling. Congestion of the lungs is characterized by oppression, soreness, difficulty of breathing, a racking, spasmodic cough. If the congestion amounts to inflammation, the cough is accompanied by an expectoration of a muco-sanguineous substance, technically termed " rusty sputa;" the oppres sion and agony of breathing are sometimes distressing, especially when the patient attempts to lie on his back; and when these symptoms are accompanied by a sharp, shooting, lancinating, stitching pain, which is aggravated by the least attempt at taking a long breath, this symptom shows that the serous covering of the lungs, termed pleura, is inyolved in the inflammation. In such inflammations the external parts corresponding to such internal inflamed organs, are likewise sore and sensitive to pressure. Most persons have heard of such a thing as pleurisy, but not all have a correct idea of the nature of such a trouble. Pleurisy is an inflammation of the pleura or the serous sac enveloping the lungs and lining the walls of the thorax. This inflammation is characterized by an acute, stitching pain, great distress of breathing, soreness to the touch, racking cough, with bloody expectoration, symptoms of cerebral disturbance. If the pain is seated in the air-passages or bronchia, and is of a stitching or shooting nature, with sensation as if the inhaled air were passing over a raw surface, which feels as if cut with a sharp knife, while the air is passing over it: it is an inflammation of the air-passages that we have to contend against. An acute, stitch-like or burning pain in the right side, under the false ribs, shooting to the breast-bone, the right shoulder blade and the top of the shoulder, accompanied with sensation of numbness or stinging in the right arm, and PAIN 175 PAIN. 175 a short, dry, hacking cough, and inability to draw a long breath: such a group of symptoms points to inflammation of the convex or outer surface of the liver. But if the pain is less acute, and resembles a sensation of painful pressure, accompanied by a jaundiced color of the skin and face, orange-colored urine, hard, whitish or gray stools: the inflammation affects the inner or concave side of the liver. An acute, lancinating pain in the brain, with soreness, inability to keep the head erect, and sometimes:accompanied by delirium, denotes an inflammation of the meningeal membranes, or the covering membranes of the brain. If the substance of the brain is affected, the pain is more of an aching character. A pressing, stitching pain in the side, near the lower third of the back, shooting to the bladder along the ureters, (along both ureters, provided the pain is felt on both sides of the back,) points to inflammation of the kidneys, in which case the secretion of the urine is either totally suppressed, or its discharge is difficult and painful; the urine is of a high color, the testicle of the affected side is drawn up, swollen and painful; the whole lower limb of the affected side is sometimes numb and spasmodically affected, and there are symptoms of sympathetic irritation, such as nausea, vomiting, colic, ineffectual straining, etc. If a burning pain be experienced in the region of the bladder, with swelling, heat, tenseness and painfulness to contact of the external parts, with red and hot urine, which it is either difficult or impossible to discharge: an inflammation of the bladder may be safely inferred from such symptoms, especially if symptoms of sympathetic constitutional irritation, such as hiccough and vomiting, are present, and the patient, after dreadful urging, passes only a few L -. ~ ~ ~ __~ _ ___ _ ~___1_11~ _~__ __ 176 ON GENERAL DIAGNOSIS. drops of blood instead of urine. A pressing and stitching pain in the region of the spleen, with swelling, pain to pressure, vomiting of blood, denotes inflammation of the spleen. A painful pressure in the region of the heart, with anguish, fainting, coldness of the extremities, and a small, unequal, quick but soft pulse, always points to inflammation of the heart. When the lower part of the abdomen is tense, tumefied, painful to the touch, with heat and pain in the vagina, painful emission or complete suppression of the urine, tenesmus and constipation, and sympathetic irritation of the stomach, characterized by hiccough, vomiting, etc., we may rest assured that the womb is the seat of the inflammation. A burning, pricking or shooting pain in the region of the stomach, with swelling, heat and tension of this region, throbbing, nausea, vomiting, intense thirst, spasmodic hiccough or singultus, sobbing, anguish, great prostration, excessive sensitiveness of the region of the stomach to contact, coldness of the extremities, foul tongue, which is red at the tip and round the edges; small, remittent pulse, sunken features, constipation or diarrhoea, spasms and convulsions: these symptoms denote inflammation of the lining membrane and submucous coat of the stomach. A burning, pricking pain in some particular spot of the abdomen, most frequently in the region of the navel, with heat and tympanitic distension of the abdomen, anxiety, thirst, vomiting, small and contracted pulse, with excessive sensitiveness of the abdomen to contact or pressure, is a sure indication of inflammation of the bowels. Pain need not necessarily be accompanied by fever, although it is probable that every acute pain produces some alteration in the pulse. The most acute and PAIN, 177 agonizing pains are the so-called neuralgic pains or tic-douloureux. They come and go sometimes quite suddenly; thinking of them sometimes brings them on, and they disappear if the patient's attention is diverted by some interesting circumstance, conversation, etc. It is not, however, the mere fact of thinking of the pain that excites it, but the fear which the thought of the pain raises in the patient's mind; fear, it is well known, exercises an immense influence over the nervous system, and is perfectly able to excite distressing pains to which particular portions of the nervous system are constitutionally liable. Such neuralgic pains are of an inflammatory character when there is fever; the part where the pain is located, is exceedingly sensitive to contact, swollen, red, hot; the pain is throbbing, lancinating, burning, sticking. Neuralgic pains are of every imaginable variety, cutting, darting, lancinating, stinging, boring, jerking, screwing, tearing, sensation as if a hot iron were plunged into a part, pecking, pressing, splitting, twisting, etc. The acuteness of the pain depends also upon the natural sensitiveness of a part. Thus a certain amount of inflammation in the eye would be much more distressing and painful than a similar amount of inflammation in some external muscle. Pain is not always accompanied by any visible alteration of the affected part. There is a species of rheumatism which modern pathologists have termed nervous rheumatism. The pain in this disease is of the most distressing and frequently agonizing nature, burning, throbbing, lancinating, excoriating, aching, pressing, and yet there is no visible change of any kind, no change of color; the parts bear a considerable amount of pressure, the pain is sometimes eased by pressure, and __~ I I_ _I_______ __ Ill_---YII-- 178 ON GENERAL DIAGNOSIS. a. trifling amount of swelling is frequently all the change that is perceivable. An intensely acute, agonizing, burning, stitching, or hard-aching, tearing pain, when accompanied by delirium, excessive prostration, a tongue thickly coated with a brown or blackish fur, and by a vacant or staring gaze, denotes the approach of typhus. This is, in reality a general constitutional malady, although we are in the habit of distinguishing the disease by the name of the organ where the pain was originally located. Thus, as we say, infla.mmation of the brain, so we say typhus of the brain, or typhus cerebralis; typhus of the lungs, or typhus pulmonalis; typhus of the bowels, or typhus abdominalis; typhus of the liver or typhus hepaticus. Pain which reappears at a certain spot or in a certain region, in consequence of the least exposure to some disturbing cause, denotes organic debility of the affected part, and is a strongly presumptive indication of some disorganization developing itself in this region. The sudden disappearance of an acute pain, during fever, with wiry or collapsed pulse, increase of prostration, loss of consciousness or sometimes a transfigured expression of-the countenance, points to incipient mortification. Some individuals are more sensitive to pain than others. Some persons cheerfully bear an amount of pain which would produce fainting and convulsions in others. This shows that -pain is essentially a nervous phenomenon; that the absolute amount of the pain may not depend upon a man's volition, but that its relative intensity does, and that the character of the pain has, therefore, to be determined and measured by all those various influences which possess the power of modifying ____ ~__ SECRETIONS-SWEAT. 179 the pain such as temperament, condition of the interior principles of the soul, religious enthusiasm, and perhaps a constitutional insensibility to pain. The amount of pain is not always proportionate to the dangerous character of the disease. An aneurism of the aorta may exist without any great pain, whereas the simplest lesion of an apparently insignificant twig of some sentient nerve, may be the means of causing the most agonizing suffering. 3. Secretions. a. SWEAT.-Every healthy person sweats more or less. The secretion of sweat is a vital operation which seems to be based or depend upon the oxydation of the tissues as chemists term it, or upon the assimilation of food to the different organs of the body. In a perfectly healthy condition of the system, sweat is a clear, colorless, inodorous liquid, of a slightly saltish taste, and of the temperature of water, when exposed to the rays of the sun in the summer season. But sweat is almost always more or less altered. This may be owing to a variety of causes. The circumambient atmosphere, for instance, may not be perfectly pure, or sweat may become mixed up with heterogeneous particles which it finds collected on a person's skin, or it may become altered in consequence of impurities in the system which become incorporated with the moisture secreted on the inner surfaces, and are gradually carried forward towards the skin, and finally deposited upon this organ. These morbid alterations of the sweat are of great and immediate interest to the physician. In simple inflammatory fever the amount of sweat is L_ __ 180 ON GENERAL DIAGNOSIS. proportionate to the intensity of the fever. Persons may have to change their linen half a dozen times in one night, before they cease sweating. As soon as the sweat begins to break out, as the phrase goes, the fever decreases, the patient feels more comfortable, the pains and soreness gradually disappear, and a feeling of strength returns into the languishing organism. During fever, when the languishing mucous sufaces find it very difficult to secrete the necessary amount of moisture, we should provide a reasonable supply of artificial moisture for the patient's use, by giving him plenty of cold water to drink, and keeping the sick room cool within conservative bounds. In twenty-four hours after the first appearance of the fever, sweat should set in, even without any medicine having been given. If no sweat appear, notwithstanding the patient had taken some suitable medicine, we may conclude that the nervous system is deeply involved in the disease, and that typhus may be developing itself. Night-sweats, when. occurring habitually, denote debility, and, if accompanied by chills and fever, they are indicative of a hectic or consumptive condition of the system. In such a case, there are generally various other symptoms pointing to this state, such as loss of appetite, or else a voracious appetite, cough with oppression, pain and expectoration of a frothy, purulent or sanguineous substance, emaciation, prostration, etc. Partial or local sweats denote a deranged condition of the nervous system, or a weakness of the organs covered by the perspiring surface. It is of great importance to note the color, smell and consistence of the sweat. These indications are sometimes indispensable to a proper appreciation of the con ALVINE EVACUATIONS. 181 dition of the patient, of his chances of recovery, and of the remedies which should be used in his case. Thus, sour sweat may be indicative of a congestion of the mucous surfaces, and more particularly of the mucous membrane of the liver; it often points to mercury as a specific remedial agent. A foul, offensive sweat in fever is supposed to point to the putrid character of the disease. A cold, clammy sweat, in fever, indicates a high degree of prostration of the vital reaction. Sweat which leaves a greenish-yellow stain on the linen, indicates an inability, on the part of the biliary apparatus, to effect a perfect secretion of bile from the blood. Some persons sweat quite readily, others scarcely ever, even after violent exercise. If sweat breaks out after every little exercise, it denotes weakness. Some persons have a very dry skin, which may be owing to a constitutional torpor or embarrassment of the cutaneous nerves. b. ALVINE EVACUATIONS.-We have to note both the quantity and quality of the alvine evacuations. Habitual costiveness generally depends upon a torpid condition of the liver. It may likewise be owing to weakness of the lower portion of the spinal column. Constipation may be a symptom of deficient innervation or consumptive decline. It is generally present in inflammation of the bowels, although diarrhoea may likewise exist in.a very high state of inflammation, when the vital reaction is exceedingly low, or mortification is developing itself. In all such cases, it would be the height of folly to use cathartic or drastic medicines to move the bowels. Such treatment would only tend to increase the patient's weakness, and in many cases, and more particularly in inflammation of the bowels, the 17 ___ 182 ON GENERAL DIAGNOSIS. disease which might perhaps have been cured by the use of appropriate specific medicines, might be rendered incurable by the violent action of drastic medicines. In a case of fever, the state of the bowels depends a good deal upon the constitutional condition of the patient. With some the bowels become torpid during fever, even a common catarrhal fever; with others, diarrhoea sets in. In all such cases, we need not trouble ourselves either about the constipation or diarrhoea. All we have to do is to remove the fever by the medicine which may be indicated by the totality of the symptoms, and by the constitutional taint or idosyncrasies of the patient, and the constipation or diarrhoea will disappear of themselves. It would be perfectly amusing, if a laugh were otherwise compatible with the misery of a human being, to see the futile efforts which alloeopathic physicians sometimes make, in a case of simple fever, to open the bowels. First a dose of rhubarb is given, without any other effect than to distress the patient. After the rhubarb comes perhaps a blue pill, likewise without the least effect. Next they resort to a good dose of castoroil; this will sometimes remain inactive. Now some drastic medicine, jalap, colocynth, etc., is crammed down the patient's throat, all without effect. In the meanwhile the patient's distress has become very great; the bowels are distended like a drum, and a state of mortification is apprehended by the affrighted patient and his friends. A homoeopathic physician is sent for. He at once perceives the cause and nature of the trouble. He sees that the bowels could not possibly be acted upon while the fever rages. For he knows that fever is essentially a nervous phenomenon, and unless the torpor or depression of the nervous system is removed by specific CIY~LIIII~L~--L- - _ ~ ALVINE EVACUATIONS. 183 internal treatment, there cannot be any vital reaction of sufficient strength to overcome the torpid condition of the bowels. Hence, he prescribes a dose of Aconite, which he knows to be an infallible specific for this condition of the nervous system, and in a very short time the medicine begins to show its salutary effects. The patient begins to perspire, and now a perfect flood of diarrhoea sets in; the patient feels easier, and the family exclaim: " Well, after all, if we had waited a little longer, the medicines would have acted;" for they cannot imagine that it is the globule of Aconite that enabled the alloeopathic purgatives to act, and that this enormous purgation was a perfectly useless infliction. In this way the alloeopathic doctor gets the credit for the good which the homoeopathic specific actually accomplished. On the other hand, if, during an attack of fever, the bowels should be loose, Opium and brandy are sometimes crammed into the patient without any permanent effect. The dose has to be renewed from time to time, and the patient is positively drugged with Opium. In the mean while, the fever runs its course. All this dosing with Opium is entirely unnecessary; if the fever were specifically acted upon, as it is under homoeopathic treatment, the diarrhoea would disappear without the least difficulty, and without causing the patient the least inconvenience, except for the few hours that it lasted. For a homoeopathic physician does not pretend to be a magician, and to remove diseases by a sleight of hand. A little time is always required, but some persons are wonderfully unreasonable; they are perfectly willing to be butchered and poisoned for weeks by allceopathic physicians,-this, they know, is unavoidable, it is fate, and they submit without murmuring,-but of a homoeo -~ _T 184 ON GENERAL DIAGNOSIS. pathic physician they expect to be cured in the twinkling of an eye; a single globule must do the job, and, if their expectations are disappointed, they send the poor homoeopathic doctor about his business as a humbug. To be sure, such patients are no great loss to our practice, and they are, fortunately, few and far between-rari nantes in gurgite vasto-but it is unpleasant to meet such treatment in a single instance, and to throw the precious and invaluable pearls of Homoeopathy before positive swine. Green or blackish diarrhoeic stools generally point to derangement of the biliary organs. Gray or clay-colored stools denote an absence of bile from the excrementitious matter. A serous diarrhoea may be owing to an undue irritation of the pancreatic gland, The offensive smell of the alvine evacuations may be owing to various causes. It may result from the presence of foul bile, or may be an *indication of a general typhoid or putrid condition of the system. The value of such symptoms depends upon the co-existing general symptoms of constitutional disturbance. All such phenomena of the alvine evacuations point to particular remedies which are appropriate to the general disturbance; and a Repertory may have to be consulted to ascertain what particular medicine is indicated by the particular smell, color or consistence of the stools. c. URINE.-The urine is another important secretion, the character of which has to be carefully inquired into by the physician. The specific gravity of urine is a trifle more than that of water, and the specific gravity of the urine of females exceeds that of the urine of males. According to the analysis which Berzelius and Lecanu have furnished. of urine, this fluid is composed of a URINE. 185 URINE. 185 number of substances, the principal of which are water, urea and uric acid. Lactic acid is another constituent of the urine, besides which it contains phosphates of lime and magnesia, phosphates of soda and ammonia, sulphates of potash and soda, common salt, etc. Urea is an inodorous body; it has a cooling taste and a neutral reaction. Uric acid is found in the urine of all carnivorous animals. Birds and reptiles void it with their excrements, and on some small islands of the South Sea, on the coast of Peru, the birds which inhabit these islands, have deposited it in such quantity, that it has become an article of commerce, and is exported by the Peruvian government under the name of Guano. It is used as manure. In many diseases, uric acid is generated by the organism in abnormal quantities, and constitutes the base of gouty concretions, and of various forms of vesical calculus. The urate of ammonia, which is the material of the white excrements of birds and serpents; and the urate of soda, which constitutes the basis of arthritic concretions, are some of the principal salts of uric acid. The changes which occur in the composition of the urine, furnish valuable indications to the pathologist in diseases of the urinary and digestive organs. A great many substances, which are taken into the circulation and cannot be assimilated by the tissues, are eliminated by the urine, either in their original or in a modified shape. Some organic bodies, such as the oil of turpentine, are decomposed, and the excreted products impart to the urine a peculiar odor; the oil of turpentine, for instance, imparts to urine the odor of violets. Most coloring matters are carried out of the system by means of the urine. Mineral acids, alcohol, camphor, and most 17* j 186 ON GENERAL DIAGNOSIS. metallic salts, affect the urine so slightly that a change is not sensibly perceived. In disease, the urine undergoes a variety of important and significant changes, which it is of the utmost importance that a physician should be acquainted with. These changes affect both the quantity and quality of the excreted urine; its color, smell, consistency, sediment. In inflammatory fever, for instance, the urine is generally red, and deposits a brick-dust sediment at the bottom and on the sides of the vessel. Sometimes the secretion of urine is considerably diminished during an acute fever, althougL there may be a good deal of urging. A yellow-looking urine denotes the presence of bile in the urine. The urine sometimes has a bloody tinge, from which an admixture of blood may be inferred. Or there may be pus in the urine, which indicates suppuration of. the mucous membrane of the urinary apparatus, urethra, bladder or kidneys. The pus sinks to the bottom of the vessel. A watery urine which is passed in frequent succession, indicates a spasmodic condition of the nervous system. Nervous or hysteric females generally pass much urine. The color, smell and consistence of the urine, and the sediment which it deposits, should be carefully noted. There is a species of urine which physicians term " opalescent" urine. This is distinguished by a greasy pellicle floating on the surface of the urine, and shining with a variety of colors. Opalescent urine indicates a disordered condition of the nervous system rather than any particular local affection of the urinary organs, unless it be weakness. In some diseases, the quality of the urine is considerably altered. In typhus, urine frequently has an acid reaction, which is a bad symptom. In Bright's URN. 8 URINE. 187 disease or granular degeneration of the kidneys, also termed albuminuria, the urine contains a quantity of albumen, showing that a process of suppuration is going on in those organs. In diabetes mellitus, the urine is sometimes voided in enormous quantities, and is found to contain grape-sugar and but little urea or uric acid, although the amount of urea contained in the whole quantity of urine that is passed in twenty-four hours, is equivalent to the normal quantity of urea formed by the healthy system in that space of time. Milk has been detected in the urine, even of males. In jaundice, the coloring matter of the bile passes into the urine. A blue substance has been discovered in the urine, imparting to it a blue color. In the case of a child a peculiar black matter was observed in its urine. In many states of the system, and particularly in arthritic rheumatism, uric acid is found in abundance, and precipitated in the form of crystals, the urate of ammonia. Arthritic concretions in the joints consist chiefly of the urate of soda. There are conditions of the system where, instead of urates, phosphates are deposited by the urine. There is this difference between the phosphatic and the uric acid deposites, that the uric acid deposites are soluble in alkalies and insoluble in dilute acids, whereas the phosphates are insoluble in alkalies and soluble in dilute acids. The phosphatic salts may, however, be decomposed by alkaline liquors. Urinary calculi consist of uric acid and salts, such as the urate of ammonia, the phosphate of lime, etc. A whitish, cloudy sediment deposited by the urine shortly after it is discharged, and floating about in it, generally is indicative of a favorable change in the disease. _~ I i 188 ON GENERAL DIAGNOSIS. Condition of the Brain and Nervous System. Dizziness may be owing to a momentary rush of blood to the head, as it is termed, in which case the attack will soon pass off again without any further trouble. Frequently recurring attacks of dizziness, especially when setting in quite suddenly, or from the least exposure to the sun's rays, denote constitutional cerebral irritation or even incipient cerebral disorganization, especially when accompanied by an irregular, intermittent pulse. Frequent turns of slight dizziness may likewise indicate a general debility of the nervous system, and consequent irregularities of the circulation. In some persons, dizziness is a sympathetic condition of the brain, and depends upon some primary irritation of the stomach. Persons who are troubled with piles or liver complaint, are likewise subject to atttacks of dizziness. Permanent dizziness may be the result of insolation or exposure to the hot sun; it may likewise be an accompaniment of irritation or organic disease of the heart. Delirium is generally a symptom of some deep-seated constitutional disturbance. Delirium with pain in the head, may point to typhus. In this case the delirium is generally accompanied by picking at the bed-clothes, grasping at flocks in the air, etc. The delirium may be of the muttering or of the violent furibond kind. Delirium is generally present in every disease characterized by very acute fever and intense pain. It is therefore unnecessary to dwell upon this symptom at greater length. It is sufficient to observe that the pathological importance of delirium depends principally upon the co CONDITION OF THE BRAIN, ETC. 189 existing phenomena of constitutional disturbance, and upon the natural condition of a person's nerves. Some patients, particularly hysterical females and children, become delirious when there is but an ordinary degree of nervous and vascular irritation. This kind of delirium is of very little consequence and need not frighten anybody. Nor is the violence of the delirium a criterion of its dangerous character. For a raging delirium may arise from a simple irritation of the cerebral nerves, which may sometimes be subdued without difficulty, whereas the low, muttering, incoherent delirium denotes great prostration of the vital reaction, or even approaching dissolution. Spasms and convulsions are likewise a symptom of equivocal value. Spasms may be of a purely nervous character, in hysteric females, in children affected with worms, during the period of dentition; or they may be induced by some sudden emotion, by the sight of particular animals or substances which excite our fears or against which we feel an idiosyncratic aversion or horror; the sight of blood, for instance, throws many persons into a spasmodic fit. But all such spasms are more distressing in appearance than in reality, and generally pass off again without any other treatment than a soothing stimulant, sprinkling with a little cold water, smelling of a little cologne-water or spirits of hartshorn. Acute eruptions such as variola, scarlatina, etc., are frequently ushered in by spasms, which cease as soon as the eruption has made its appearance upon the skin. Spasmodic symptoms sometimes run into inflammation, and, on the other hand, an inflammation sometimes leaves behind it a spasmodic irritation, especially, however, under alloeopathic treatment; for under the horneo __ ~ ~ ~ __ 190 ON GENERAL DIAGNOSIS. pathic treatment the nervous equilibrium which is disturbed during the inflammatory process, is restored at the same time as the inflammatory action is subdued. Spasms are: sometimes the forerunners or the commencement of a typhoid state. If spasms set in during the course of some acute inflammation, they generally denote the setting in of effusion, and, in such a case, the violence of the spasms seems to depend upon the importance of the affected organ. Convulsions in children frequently denote pressure of the blood on the brain and require to be treated with medicines that have a tendency to equalize and quiet the circulation, such as Aconite, Belladonna, etc. These medicines act directly upon the brain and nerves, and restore the harmony of their functions, the disturbed condition of which is unavoidably and primarily followed by a derangement of the circulation, characterized by congestion, inflammation, etc. The restoration of the nervous equilibrium is necessarily followed by a return of the normal.condition of the circulation, Condition of the Mind and Spirits. Depression of spirits is natural with many people. Wherever it is inherent in the temperament, it cannot be considered as an indication of disease. A melancholy state of the mind may indicate disease of the heart. In such a case, persons are generally brooding over their condition; the idea of their disease haunts them like a spectre. A deranged condition of the mind may depend upon organic disease of the brain, an impoverished state of the cerebral substance. Lesions of the nervous system, or __ CONDITION OF THE GASTRIC FUNCTIONS. 191 permanent irritation of some portion of the nervous system, may lead to loss of innervation and derangement of the mental functions. Long-continued nervous disorders, such as epilepsy, chorea, etc., gradually impair the mental powers, and may lead to positive idiocy. Loss of memory may be induced by a stroke of the sun, and is sometimes the result of severe nervous diseases, Fitfulness, sudden changes of spirits from sad to cheer, ful, and vice versa, are frequently a sign of hysteria. A quiet sadness, a disposition to sit alone, pensive and brooding, are likewise peculiar to hysteric females. Girls, at the age of pubescence, are sometimes attacked with this kind of melancholy. The long-continued practice of onanism is apt to affect the spirits of both boys and girls; they become shy, seem to be absorbed in reveries, from which they start up suddenly with an expression of wonderment and confusion, or of anxiety and fear, mixed with an appearance of guilt, as if they had committed some criminal act, the discovery of which might expose them to shame. Condition of the Gastric Functions. In this direction we have to consider the appearance of the tongue, the patient's appetite, thirst, taste, absence or presence of nausea and vomiting, the manner in which food acts upon the stomach, the condition of the reproductive or assimilative functions, etc, a. TONGUE.-A foul tongue is quite common, and many persons are affected with it all the time, especially early in the morning. It indicates an irritation of the nerves of the stomach, which may not be characterized _ ~ _ _ 192 ON GENERAL DIAGNOSIS. by any other unpleasant symptom, although a foul tongue is generally accompanied by a foul taste in the mouth, especially before breakfast. In fever, even a common catarrhal fever, the tongue is always more or less coated. But if the coating should consist of a thick white or yellowish fur, this would indicate the gastric character of the fever, and would show that the gastric functions are particularly involved in the disturbance. A dry, cracked tongue, which peels off in patches, and looks quite red underneath, denotes a condition of debility of the nerves of the stomach. A thick, brown coating on the tongue, with excessive dryness of this organ, or a sensation as if the tongue were made of leather, with a parched and glazed appearance, and roughness like a cat's tongue, denotes typhus, in which case symptoms of cerebral derangement, such as delirium, catching at flocks, etc., will be present. A return of moisture on the tongue, during fever, is a good symptom. In some very acute and even fatal diseases, the tongue may not seem to be much changed. In the last stage of tuberculous consumption, the coating on the tongue is apt to disappear, and to make room for an inflamed appearance of this organ. A pale-looking tongue may denote prostration of the vital reaction, an impoverished condition of the reproductive sphere, etc. A cold tongue is indicative of great depression and approaching extinction of the vital energies, as in Asiatic cholera. :Stuttering is frequently an organic defect, but it may Jli'kewise be a symptom of acute nervous irritation, as in TASTE. 193 TASTE. 193 delirium tremens, in which case the stammering is occasioned by a trembling of the tongue. APPETITE AND THIRST.-A fitful appetite points to nervous derangement of the stomach. A ravenous appetite in children frequently indicates worms; it may likewise characterize a state- of consumption or atrophy. Hysteric females sometimes have an appetite, or rather a capricious desire for strange things, such as chalk, charcoal, soap, etc. In the course of some acute disorder, patients sometimes all at once are seized with an appetite for some particular food, which, according to common observation, would seem injurious to them; thousands of patients have been cured by being allowed to partake of the thing craved. Thirst generally indicates fever; but some individuals are troubled with excessive thirst without having fever. Persons who have a tendency to become fat, generally have to drink a good deal of water. To them water is nourishment, and it helps to keep the animal temperature at a normal point, which otherwise would become excessive. In disease, the thirst is frequently altered. In some fevers, patients have a desire for particular drinks, such as lemonade, beer, etc. In some diseases the thirst is intense, as in fever and ague, inflammation of the bowels, etc., and it should be satisfied without stint. Taste. Loss of taste indicates a torpid condition of the gustatory nerve, or a peculiar irritation of the stomach. In such a case all things may taste alik6. A bitter taste generally denotes a derangement of the bilious 18 ON GENERAL DIAGNOSIS. 194 functions. An acrid taste indicates a very high state -of nervous derangement of the stomach. A sweetish taste is sometimes the forerunner of haemorrhage; a saltish taste may likewise point to some pulmonary disorder, in which case other more decisive symptoms will of course be present. Nausea and Vomiting. This may be the result of a simple overloading of the stomach, or of having partaken of something that does not agree with the stomach. Habitual nausea, when relieved by eating, results from an irritated condition of the nerves, and capillary congestion of the stomach. In particular conditions of the female system; for instance, in the commencement of pregnancy, or in particular hysteric conditions, nausea is an ordinary symptom. Habitual spitting up of food after eating may be owing to nervous irritation of the stomach,,or to schirrous disorganization of this organ. Vomiting is likewise present in many acute diseases, acute derangements of the liver, inflammation of the stomach, etc. It may likewise exist as a sympathetic symptom in inflammation of the womb, kidneys, bladder, etc. The pathological value of vomiting, has, in all such cases, to be determined by the accompanying symptoms, and by the nature of the substances which are discharged from the stomach. If bile is discharged, it is evident that the secretion of this fluid is not properly performed by the liver. If. blood is thrown up, we may trace it to the stomach; if the vomiting of --~5--~I~~~~-Y~-~UICI~~~~~ll~~IL--- ~-----_-~a ---------s~- ---~---- -~----nru--LII^---~ --~ - COLOR OF THE SKIN, EYES, ETC. 195 blood is accompanied by spasmodic cough, to a tuberculous condition of the lungs. If the vomited substances consist of excrementitious matter, we may diagnose intussusception of the bowels, strangulated hernia, etc., according to the accompanying symptoms. Color of the Skin, Eyes, etc. The color of the skin is considerably altered in some diseases, and the character of the disease may be in a measure inferred from such alterations. A bluish tint points to organic disease of the heart. A yellow color of the skin indicates affection of the biliary organs. In Asiatic cholera the skin has a bluish tint, and looks shrivelled like the skin of a person who has been washing with warm soap-suds. The skin may exhibit various other alterations of color, greenish, blackish, livid, etc. A good deal of color in the face is not always a sign of robust health; it generally indicates an irritable condition of the nervous system, or a tuberculous diathesis. Paleness of the skin may indicate a deficiency of the reproductive energies. In connection with the color of the skin we should not overlook its temperature, the feel of the skin, the eruption which may have broken out. In some persons the skin is habitually cold and clammy; this may be nervous debility without any other disease. Others have an habitually dry skin, which may likewise be owing to a want of action of the cutaneous nerves. Such persons are apt to complain of an inward fever. 196 ON GENERAL DIAGNOSIS. Sleep. The phenomena of sleep are interesting. Natural sleep, when occurring during disease, is always looked upon as a favorable sign. Drowsiness, shortly after eating, provided it is not the result of a natural want of sleep, is generally indicative of a weak and deranged condition of the digestive functions. Nervous females who are troubled with a determination of blood to the brain, are subject to attacks of unconquerable drowsiness. Drowsiness of infants and children, when attended with a sort of stupor, shows that there is pressure of the blbod on the brain. In fever, drowsiness points to a similar condition of the brain. Drowsiness with apparent loss of consciousness, may be caused by effusion into the cavities of the brain. In such a case the pupils will be found dilated, and insensible to the light, although an opposite condition of the pupils may occur at first. A deep, comatose sleep, with stertorous breathing, may indicate an apoplectic condition of the brain. Constant wakefulness indicates a high state of nervous irritability. The position of the body, during sleep, should not be left unnoticed. A tendency of the body to settle down towards the foot-board of the bed, indicates debility. In typhus, such a phenomenon indicates an excessive sinking of the vital reaction. The nervous phenomena which occur during sleep, are of great importance. The grating of the teeth, C 1_1 _~1__11 _1_ _ __ _I___ ______ I CONDITION OF THE CHEST, ETC. 197 which is so peculiar to children during sleep, may indicate the presence of worms; or, in meningitis, it may point to incipient effusion in the brain; or it may simply denote nervousness. If children draw up their legs during sleep, if their sleep is uneasy, and interrupted by cries, we may infer the presence of colic. Persons who are troubled with rush of blood to the brain, or who are very nervous, are generally subject to dreaming. Condition of the Chest, Cough, Expectoration, Oppression, Pain, etc. Cough is an extremely important item in examining our patient. We should inquire into the origin, character, duration and intensity of the cough; into the character of the expectoration accompanying the cough, whether it is easy or difficult, slimy, purulent or bloody, etc.; into the accompanying pains, and the general phenomena of constitutional disturbance. A cough without any symptoms of constitutional irritation may be a simple catarrhal irritation of the lining membrane of the air-passages or lungs. If accompanied by fever, oppression, acute aching pain in the chest, either at one spot or all over the chest, congestion is evidently present. If these symptoms are accompanied by bloody expectoration, we may infer that there is inflammation. An expectoration of pus with the cough may either be owing to suppuration of the mucous membrane, or to the presence of an abscess. If to the latter, the pain and 'the expectoration are distinctly traceable to this disorganization. Attacks of profuse discharge of blood from the lungs with chills and fever, agony of breathing, intense pain, inability to lie down, 18* 198 ON GENERAL DIAGNOSIS. are unmistakeable signs of tuberculous disorganization. A mere oppression on the chest, without fever, may be a purely nervous phenomenon, of the character of asthma. The nature of the respiration should not be overlooked. In congestion and inflammation of the lungs, the breathing is of course impeded, sometimes accompanied with great agony. In organic disease of the lungs, the breathing is short and superficial, and the pulse correspondingly accelerated. If the breath is hot, this is an additional evidence of inflammatory action; if cold, we may infer from this coldness a sinking of the vital reaction. A foul breath denotes nervous derangement of the stomach and perhaps of the biliary organs. It may, however be induced by an unclean condition of the mouth, and likewise by a tuberculous state of the lungs. In some females the breath becomes offensive at the appearance of the menses. The noises or murmurs in the chest should likewise be considered. A very common murmur is a rattling sound, similar to that which is produced by blowing air into water or soap-suds. It is produced in a. similar manner by the passage of the air through the mucus contained in the air-passages. This rattling may be a fatal symptom when occurring towards the end of an acute disease and accompanied by a general sinking of the vital reaction. A wheezing or whistling sound may indicate a spasmodic condition of the air-passages, and a tenacious condition of their lining membrane. A crepitating or crackling sound is indicative of effusion into the air-cells and is likewise produced by the passage of the air through the exuded substance. If the inflammation of the lungs should go on without improvement, the inflamed lung would assume the con CONDITION OF THE CHEST, ETC. 199 sistence of liver or become what is technically termed hepatized. In this condition the substance of the lungs is impermeable to the atmospheric air, and all communication between it and the hepatized portion of the lungs is, of course, interrupted. The respiration in this portion of the lungs is then confined to the larger bronchial tubes, provided they are not likewise closed, and this bronchial respiration is likewise characterized by a peculiar murmur. A knowledge of these various sounds or murmurs is exceedingly important to a proper appreciation of the extent and character of the pulmonary disease. The study of these sounds has become quite a science, which goes by the name of auscultation and percussion. An investigation of these sounds is facilitated by a tubular contrivance known as the stethoscope. In examining the chest, we may likewise have to investigate the condition of the heart. This condition is likewise revealed by the sounds of the heart, in conjunction, of course, with the subjective symptoms, such as pain, and the like. In the normal condition of the heart, two sounds are distinctly perceptible. The first is a dull and lengthened sound, the second, sharp and quick. These two sounds follow each other in rapid succession, after which a short interval occurs, when the sounds are heard again. The dull, lengthened sound is synchronous with.the contraction, the sharp and quick sound with the dilatation of the ventricles. When the ventricles contract, the blood rushes through the orifices of the aorta and pulmonary artery; this rushing of the blood partially causes the first sound, which is in a measure completed by the flapping of the auriculo-ventricular valves, a description _ _ I ~I__ __ _ __ _ _ I_ I 200. ON GENERAL DIAGNOSIS. of which has been given in the chapter on physiology and pathology. The second sound is caused by the flapping of the semilunar valves at the orifices of the aorta and the pulmonary artery. These sounds are more or less altered in disease; so is the impulse of the heart, by which we understand the mode in which the point or apex of the heart strikes against the walls of the thorax. A violent beating of the heart against the walls of the thorax, with anguish and fainting fits, and a small, feeble and contracted pulse not synchronous with the beats of the heart, point to hypertrophy and dilatation of the ventricles. The quick and sharp sound caused by the flapping of the semilunar valves, must necessarily lose its resonnance when the valves have become disorganized by disease, such as adhesions, ossification, insufficiency. And if the valves are not sufficient to prevent the reflux of the blood into the aorta or pulmonary artery from the ventricles during their contraction, this reflux gives rise to a peculiar murmur which is described as a bellows' sound, even by patients who are not acquainted with the technicalities of pathology. The heart is enveloped in a serous membrane, which is a shut sac and is called the pericardium. This is liable to inflammation, the Eame as all other serous membranes in the body. If this inflammation be not speedily arrested, serum will exude from this membrane, and in proportion as this fluid accumulates, it is evident that the sounds of the heart must become fainter and finally scarcely peceptible; hence, if, on examination, we should find that the sounds of the heart are very feeble, and the subjective symptoms cause us to suspect L V~I~ L~Ili~l~~ a CONDITION OF THE SPINE. 201 disease of this organ, we may infer that effusion into the pericardium has taken place. Again in pericarditis, after the serum has begun to exude and more particularly after it has acquired a certain degree of consistence on the surface of the heart, the motion of the heart occasions a peculiar friction-sound. Hence, from the perception of this friction-sound we may infer, in disease of the heart, that the pericardium or surrounding serous membrane is inflamed. In a popular work of this kind we cannot go into any further details concerning the sounds of the heart; those who feel anxious to acquire a more extensive knowledge of this subject, will do well to study special treatises on auscultation and percussion where the physical signs, as all these sounds and murmurs are called, are fully explained. Condition of the Spine. The spine has an important bearing upon the rest of the bodily organs. From the spinal marrow proceed a number of important nerves, nerves of motion and nerves of sensation, and if these nerves become diseased or injured, the functional life of the organs to which such nerves go, and over which they are distributed, correspondingly suffers. Thus, if the motor nerves are injured, the motive power "of the organs over which such nerves ramify, must be impaired or perhaps completely suspended; and if the sentient nerves are affected, the sensations are disturbed, so that there may either be a complete suspension or an excess of sensibility. In order to discover the real condition of the spinal marrow, we have sometimes to make a very accurate and minute _~_~_I _ __ __ __ ____ 202 ON GENERAL DIAGNOSIS. investigation over the whole length of the spine, by pressing with the point of the finger between each two adjoining vertebrae; if the spinal marrow is irritated in any particular spot, the patient will experience pain on pressure, which is sometimes so acute, although he may not have been aware of it previously, that he shrinks back from the pressure quite suddenly. The spinal affection may likewise be seated in the bones, in which case the vertebrae will feel sore when pressed upon. Spinal irritation, as it is termed, is very difficult to cure, and all that can be accomplished in most cases, is to give relief. But even this is a great boon in such a condition which is so frequently the cause of acute and lifelong suffering. Names of diseases. In medicine it may perhaps be more truly asked than in any other department of human interests: what is in a name? Names have been all-important in this science, so important that they came very nearly supplanting the substance. A name, after all, is a mere shadow, and although it may be interesting to be able to call a thing by some particular name, yet it must be admitted that this name is only truly important when it calls to mind the exact nature of the thing, its shape, color, smell, in one word its essential properties. It cannot be said that names of diseases have always been chosen in strict correspondence with the real nature of the malady, which was in a measure owing to the fact that the real nature of the malady was not known. But- names exist; they are in universal use, even by homceopathic physicians, who have not yet succeeded, either from indiffer _ ~ THE NAMES OF DISEASES. 203 ence or a want of knowledge and boldness, in reforming the existing nomenclature of pathology from the standing-point of their own principle of cure. It is therefore indispensable, for the present, to have a knowledge of the current names of diseases, to comprehend the meaning and origin of these names, and to acquire the habit and faculty of using them understandingly. We will therefore examine them a little more closely. The names of diseases have been derived from various sources. Some affections derive their names from the names of pathologists who have furnished the first accurate description of the disease. A certain disease of the kidneys is termed, for instance, Bright's disease of the kidneys, because Bright was the first to give an exact description of it. Other diseases derive their names from the peculiar shape or color of the eruption which characterizes them; such diseases are, for instance, small-pox, scarlet-fever, etc. Fevers derive their qualifying names from a variety of conditions and circumstances, and it will be found interesting to examine the reasonableness and meaning of these technical appellations. Most of these names are of Greek, and very few of Latin origin; a few single names are taken from the French language, such as tic douloureux. Gastric, for instance is derived from the Greek word gaster, which means the stomach. Rheumatic, comes from the Greek word rheuma which means a cold. Pneumonia, is derived from the Greek pneumon, which signifies lungs. And so most other names. The termination in itis, affixed to the Greek name of the part, is indicative of inflammation. Pneumonitis, for instance, means inflammation of the lungs. Peritonitis, inflammation of the peritoneum, or serous mem 204 GENERAL DIAGNOSIS. brane of the bowels. Gastritis, inflammation of the stomach. Encephalitis, inflammation of the encephalon or substance of the brain. Meningitis, inflammation of the meningeal membranes, or membranes enveloping the cerebral substances. Pleuritis, inflammation of the pleura. The termination in algia, indicates pain or a painful condition. Neuralgia, for instance, means a painful condition of the nerves. Odontalgia, a pain in the teeth, toothache. Gastralgia, a painful condition of the stomach. But most of these names have a more or less technical or conventional meaning, differing from the literal translation of their constituent elementary parts. A very common termination is the termination in ia, which has several meanings. It may mean, for instance, inflammation, as in pneumonia, which stands for inflammation of the lungs, or ophthalmia, inflammation of the eyes. This termination likewise indicates a general morbid condition, as in hemicrania, which stands for a morbid condition of one side of the cranium; or hemeralopia, which stands for a peculiar morbid condition of the sense of sight. The termination'in osis is likewise a very common termination, and generally indicates an inflammatory condition. Neurosis, for instance, means an inflammatory condition of the nerves. Rheumatosis, a rheumatic inflammatory condition. There are various other terminations, such as agra, which stands for a gouty condition, as in podagra, gout of the feet; chiragra, gout in the hands; coxagra, gout in the hips; or ace, which stands for putrid disorganization, as in arthrocace, putrid condition of the joints; stomacace, putrid condition of the mouth. These are NAMES OF DISEASES. 205 the principal names and terminations, and it now remains for us to give the rationale of the medical nomenclature. We will select fever as an appropriate subject whereby we may illustrate our reasoning. A common catarrhal fever is not generally accompanied by pain, and sometimes terminates, in the course of twenty-four hours, in a more or less copious perspiration. But when a catarrhal fever continues for several days and nights in succession, it is accompanied by more or less inflammation. Generally speaking, the phenomena of fever run their course in twenty-four hours. This is a simple, uncomplicated catarrhal fever. Such a period of twenty-four hours might be called a typical period. If a fever should last longer than twenty-four hours, we may consider the duration of the fever as a successive series of typical periods. Each period is distinguished from the next following, and presents a return of the original phenomena of fever, in their regular order of succession,-first a chill, then the heat, and lastly the sweat. These regular and successive returns of the fever are generally termed exacerbations, and from the period of the day when they occur, they are either morning or evening exacerbations. Most exacerbations occur in the evening, although morning or forenoon exacerbations are not, by any means, unfrequent. Fevers, composed of two or more regularly-recurring exacerbations, are termed remittent fevers. Such fevers are generally accompanied by congestion or inflammation of particular external or internal organs. Almost any organ or viscus of the body is liable to such an attack of congestion or inflammation. In a simple rheumatic fever, there may be no important internal or external organ involved, and the congestion may reside in the 19 206. ON GENERAL DIAGNOSIS. cutaneous and muscular coverings of the body. There may be no acute pain in any particular spot, but the whole skin may feel more or less sensitive and sore, the joints may feel weary and unyielding, like those of an old man; the eyes may be sensitive to the light, the brain may be jarred by noise; there may be buzzing in the ears, and various other symptoms of a determination of blood to the brain, not to repeat the other phenomena which are commonly present in fever. If other organs are affected with congestion or inflammation, there are various symptoms by which such a condition can be ascertained without difficulty. One of the principal general diagnostic signs of congestion, and more particularly of inflammation, is pain, which the reader will find more minutely referred to further on. A fever, accompanied by inflammation, is termed inflammatory, though it must not be inferred from this that, in order to constitute inflammatory fever, the inflammation must be centred in any one particular organ. There are fevers whose typical periods are distinguished by perfect intermissions; such fevers are termed intermittent.. The difference between intermittent and remittent fevers is, therefore, two-fold in remittent fevers the intermissions are imperfect, and the fever continues more or less all the time; whereas, the intermissions of the other class of fevers are perfect, and are characterized by a complete absence of fever symptoms. The second characteristic difference between remittent and intermittent fevers consists in this, that remittent fevers are accompanied by symptoms of fixed local or general congestion or inflammation, upon whose presence the remittent or continnuous character of the fever seems to depend; whereas, an intermittent fever has none of these symptoms of seated NAMES OF DISEASES. 207 congestion or inflammation, except during the actual paroxysm, at the termination of which they generally disappear. Congestions, such as occur during a paroxysm of intermittent fever, are characterized by various kinds of pain, colic, pains in the spinal marrow, cerebellum, headache, vomiting, palpitation of the heart, etc. Fevers accompanied by congestion of.particular organs, might be termed congestive fevers, and according to the character of their typical periods, such fevers may either be congestive remittent, or intermittent fevers. When a particular organ is the seat of the congestion, the fever generally goes by this name, as: congestion of the brain, lungs, liver, bowels, etc. Fevers are likewise named by the functions which are more particularly disturbed during the fever. Thus we term a fever bilious, when the secretion of bile is principally affected, whence it may be seen that a congestion of the liver and a bilious fever may be two different names for a similar derangement; in the former case the derangement would derive its name from the organ which is the principal seat of the disease, and in the latter case from the functions which are more particularly altered or disturbed by the morbid action. Or some other part of the biliary apparatus, the gall-bladder, for instance, which is attached to the inner surface of the liver, may be the seat of the congestion, in which case the symptoms might likewise correspond to the condition which we term bilious fever. Or a fever may derive some particular name from the tint which is communicated to the skin during the course of the disease. An alteration or interruption of the secretion of bile, and more particularly an impaired condition of the gall-bladder itself, generally results in the imparting a yellowish tint to the 208 ON GENERAL DIAGNOSIS. skin, even to the whites of the eyes; whence such a condition derives the particular name of jaundice. Hence congestion of the biliary apparatus, bilious fever, jaundice, mean more or less the same thing, and the difference resides in the perceptible effects, more than in the essential features and principles of the disease. When the gastric functions are principally affected during the fever, we call it a gastric fever. Others might term it a congestion of the lining membrane of the stomach, and they might probably mean the same thing; in the former case the name refers to the disturbed functions, in the latter to the anatomical seat of the disease and the pathological alteration which has there taken place. There are various other kinds of fever, which all derive their names from the character of their typical periods; from the functions which are particularly disturbed during the fever; from the organs or tissues which are the seat of the diseased action; from the changes of color which take place on the skin; from the nature of the altered secretions; from the nature and degree of the pain which characterizes the fever; and from its natural duration. Thus we have yellow and scarlet fever, with reference to the color of the skin; black vomit, with reference to the secretions; gastric and mucous fever, with reference to the functions and tissues involved in the derangement; acute and chronic fevers, with reference to duration and intensity; typical fever, from its being distinguished by typical periods or stages, of one, two and more weeks. From the foregoing developments, the reader must have seen that names of diseases are more or less arbitrary and conventional, and that they do not constitute safe guides in the treatment of disease. Unfortunately, IYr NAMES OF DISEASES. 209 the public mind is still enslaved by names, and patients consider themselves half cured, if the doctor can only name their disease. And yet it is evident that a physician may be unacquainted with the current names of diseases, and nevertheless, have a very clear and accurate perception of the patient's trouble, and which is by far the most important thing to a patient, know precisely what medicine, and what use of it, will effect the speediest and most thorough restoration of his health. Names, however, are not immaterial; if properly applied and properly representing the disease named, they may be very useful auxiliaries in the study of medicine. But to attain this end, a complete revolution in the nomenclature of diseases will have to be effected, and our existing definitions of some of the fundamental disturbances of the system will have to be modified or re-made. With fever, for instance, most physicians, even homceopathic physicians, associate the idea of a more exalted vitality, whereas, fever indicates in reality a depression of the vital forces, and, under specific homoeopathic treatment, is cured by such medicines as have a tendency to depress instead of exalting or rousing the vitality. Such medicines are, for instance, Aconite, Arsenic, Camphor, etc. Most of the old standing names in medicine, are derived from illusory appearances, and do not seem to have the slightest relation to the substantiate or essential state of the vital principle. The term hydrothorax, for instance, simply means that there is water in the chest, but it does not allude to the fact that this effusion of water is simply the most ultimate development of some prior morbid condition, and that this very disease, hydrothorax, may exist without any effusion having as yet set in. Or let us take a very common 19-* 210 ON. GENERAL DIAGNOSIS. disease among children, hydrocephalus, which means; water in the head. But an effusion of serum in the cavities of the brain, is likewise the very last development of a previously-existing morbid condition, which is, in all respects, the essential disease, even though no effusion should yet have taken place. If these names were used for the sake of convenience, and the philosophy of their meaning were properly attended to, there would be no difficulty in agreeing, both on the name and on the treatment which should be associated with it. But, in the present condition' of medicine, names are, unfortunately sounding illusions rather than positive indications of disease, and are, generally speaking, worth no more than the fantastic symbols which are supposed to represent the worth and dignity of a nobleman. --d~~ - e____~-CI ----p--, _p_~~~k__ I~------~-QIP--l ~---U - _ __ SPECIAL THERAPEUTICS; OR, SPECIAL TREATMENT OF THE DISEASES AND INJURIES DESCRIBED IN THIS WORK. PART I. Diseases of the Mind. IT would seem as though no material medicine can reach the mind, and yet we know that this is possible. Otherwise how could the mind be disturbed by excessive quantities of certain poisonous drugs? How could Belladonna, for instance, transform a sane man into an apparent maniac, or how could alcohol call up before the imagination the illusory sight of vermin or monstrous phantoms? It is not the mind itself, in its essential principles, that is affected by the drug, but the mental alteration is produced by modifying the nervous receptivity in such a way that the action of the mind upon the nerves is disturbed somewhat similarly to the two-fold effect of the sun's rays, which, if acting upon suitably combined physical elements, produce beautiful forms and delightful aromas; whereas the same rays, if acting upon animal matter in a state of decomposition, fill the air with poisonous and loathsome odors. (211) 212 SPECIAL THERAPEUTICS. For the sake of simplifying our remarks regarding the treatment of mental affections, we will consider first the disorders pertaining more particularly to the emotive sphere, and secondly, those appertaining to the intellect. In regard to the former, the principal disturbing causes are: disappointed or excited passion, mortification, insult, anger, grief, unhappy love, sudden bereavements, great losses in business, and so forth. The principal medicines which cover almost all the morbid phenomena produced by these various causes, are: ACONITE, OPIUM, IGNATIA, CHAMOMILLA, COFFEA and STAPHISAQRIA. Other medicines, less frequently required, are: Belladonna, Hyoscyamus, Pulsatilla, Nux vomica, Causticum, Colocynth, Bryonia, Lachesis and Phosphoric acid. Particular Indications. ACONITE is indispensable when the following group of symptoms is presented either in part or in its totality: chills and fever, congestion of blood to the brain, a very feeble, compressible pulse with apparent loss of consciousness, the motions of the heart are scarcely perceptible; or else the pulse is full, strong and throbbing; the patient is delirious, or there is great nervousness, trembling all over, even spasms and convulsions, moaning, sighing, breathing, furred tongue. These and similar symptoms are generally the result of some sudden fright, fear, surprise, or any other sudden shock upon the nervous system. DOSE.-Dissolve one drop, or six globules in a tumblerful of water, and give to full-grown persons a tablespoonful every two or three hours, to children only a dessertspoonful. If a decided reaction should become perceptible after the first dose, do not give a second dose until the improvement seemns to remain stationary. DISEASES OF THE MIND. 213 OPIUM is indicated by a comatose condition, from which the patient is roused with difficulty; the tongue is somewhat furred. Such symptoms may set in after a gross insult, sudden terror. DOSE.-The same as directed for Aconite. ACONITE and OPIUM may have to be given in alternation, if the symptoms seem to indicate their combined use. In this case each medicine is to be prepared in solution separately, as directed above, and either the Aconite or the Opium is to be given first, according as the symptoms indicate. more particularly one or the other of these two medicines. The doses may be alter. nated every two hours, until a decided improvement becomes manifest. IGNATIA is an admirable medicine for the injurious effects of grief, especially if the digestive functions have become impaired in consequence, and if the patient is inclined to melancholy, seclusion, taciturnity, and complains of fluttering about the heart, wakefulness, pricking and a sense of hollowness in the preecordial region. DOSE.-One drop, or from four to six globules in a tumblerful of water, a small tablespoonful to be taken three times a day, one hour before each meal; or, if the patient prefer, two or three globules dry on the tongue, either early in the morning before breakfast, or a few hours after supper. This medicine may have to be used for a longer period, in which case a dose should only be taken every two or three days, and one day after every third dose, a dose of Aconite, provided the patient is of a full habit of body, subject to rushes of blood, sudden flashes of heat, etc. CHAMOMILLA may be required after a violent fit of anger, chagrin, insult to one's feelings, especially when the following symptoms occur: bitter, foul taste in the mouth, yellow-coated tongue, headache, nausea and vomiting of bile, shivering followed by heat, yellowish tint of the skin, and other symptoms characteristic of bilious derangement. 214 SPECIAL THERAPEUTICS. DOSE.-One drop, or two or three globules, dry on the tongue, may be sufficient to remove the whole group of symptoms; if another dose should be required, four globules, or one drop may be dissolved in a tumblerful of water, and a small tablespoonful given every three hours, or every six hours, if a favorable change should take place. COFFEA is an excellent medicine to allay a violent nervous excitement, produced by sudden joy or likewise by intense pain in consequence of severe labor in childbirth or some trying surgical operation. DOSE.-One drop or from three to four globules dry on the tongue, which dose may be repeated in six hours. But if severe pain should be the disturbing cause, the best way to give the coffee, is to prepare a strong decoetion of two ounces to a cup of water, and give half a teaspoonful of this preparation, sweetened with sugar or not, according to the patient's taste, and repeat it every five or ten minutes, until the spasmodic irritation is allayed. This mode of using the coffee will allay even traumatic convulsions. STAPHISAGRIA is useful in removing the ill effects of anger, arising from unmerited insult. A characteristic indication for the use of this medicine is, when the patient pushes everything that is offered to him, or that is before him, away from him. DOSE.-The same as indicated for Chamomilla. It is a matter of course that, in order to make these medicines effective, the existing cause has to be removed first. It cannot be expected, for instance, that the physical consequences of an unhappy or unrequited love can be effaced by medical treatment, so long as the love itself continues. The only remedy, in such a case, may be the gratification of the affection. Nor must it be supposed that the effects of barbarous moral treatment which a superior may inflict upon an inferior, can be removed by medicine, if the treatment should be persisted in. It is likewise proper to advise those who wish to practice our art, that they should not fall into the habit of prescribing certain medicines for the ill i DISEASES OF THE MIND. 215 effects of grief, others for the effects of jealousy or anger, others again for some other passion. The proper method to pursue is to study the symptoms which appertain to each medicine respectively; and, if the medicine be distinctly indicated by the symptoms, it will remove them effectually, no matter whether they had been occasioned by a sudden fit of jealousy or a sudden surprise, or insult, grief or any other cause. The other medicines which have been mentioned at the commencement of this paragraph may be required as follows: Belladonna, if Aconite and Opium should prove ineffectual, for violent starting, cries as if from rage, glistening eyes, spitting, spasmodic twitching or convulsions, inability to swallow liquids, delirium. DOSE.-One drop, or six globules in a tumblerful of water, a small tablespoonful every three hours, until an improvement sets in; if no improvement should set in after the second or third dose, it may be necessary to give Hyoscyamus, in the same manner as Belladonna. Bryonia may be required by shivering over the whole body, loss of appetite, nausea, vomiting, stitch in the pit of the stomach on making a false step, etc. DOSE.-Same as Belladonna. Colocynth, for violent cramps in the stomach, sensation as if the bowels were ground between stones, violent vomiting of bile, excessive restlessness and sleeplessness. DOSE.-One drop, or six globules in a tumblerful of water, a small tablespoonful every two hours, until an improvement sets in. Phosphoric acid, Lachesis and Causticum are more particularly indicated by the chronic character of the symptoms; the Phosphoric acid by a hectic state, or a state of decline, with fever-flushes and night-sweats, falling out of the hair, listlessness, etc.; Causticum by spas ~C~C--~~~---------~----------------~ 216 SPECIAL THERAPEUTICS. modic symptoms, and more particularly epileptiform spasms. In such chronic cases, the patient ought not to have more than three or four globules, or one drop, dry on the tongue, every two or three days, night or morning. Hypochondria This is not a very painful, but a very distressing affection, and indicates a very deep-seated and general derangement of the nervous system. The abdominal functions seem to be particularly out of order. The digestive functions are likewise deranged; and the spirits are generally depressed. Hypochondriac patients are constantly thinking of themselves and of their pains, and, what distresses them most, is the thought that people will not believe they are sick. Hypochondria is sometimes the precursor of sinking innervation, marasmus, or consumption of the bowels. The treatment should be both general and local. In this affection, the judicious use of cold water may prove of great benefit. Gentle shower-baths on the head may prove beneficial, provided the condition of the superior organs does not counterindicate them, for which the reader is referred to the chapters on the use of water. Daily ablutions and friction may likewise be employed, and a wet bandage may be permanently applied to the bowels. The patient should abstain from stimulants of any kind: coffee, tea, wine, beer, brandy, and the like, should be avoided, but fresh cold water may be drank in abundance, even during meals. He may pursue gymnastic exercises, under proper tuition; but one of the best kinds of exercise for such patients is a ride on horseback, once or _ j _ i I HYPOCHONDRIA. 217 twice a day, in a bracing, but not windy or raw atmosphere. The most regular habits of body are strictly to be enjoined. Among married persons, sexual intercourse should either be, entirely avoided, provided it is attended with a sensation of exhaustion, or if the peculiar pains and distresses of the patient are aggravated in consequence; at all events, sexual intercourse should be enjoyed with the most rigorous moderation. Perfect abstemiousness is very frequently the cause of hypochondria, if unmarried young men are strongly stimulated by the sexual passion, and, from religious scruples or from an innate sense of purity, shun sexual intercourse as something sinful and degrading. Physicians are frequently called upon to advise young men so situated. It is a most trying position for a pure-minded and conscientious practitioner. If the young man is too poor to marry, or has not succeeded in meeting a woman to whom he could unite himself in marriage, we would say to this young man: Do not blunt your inward sense of propriety for the sake of a purely physical gratification of the sexual passion. Abide your time; cultivate the inner sense of virtue and purity; and from such culture you will not only derive a justness of perception, that will enable you to select more accurately a partner for life, but you will likewise spread around you a halo of goodness and loveliness that will point you out to a pure womaoi as an object worthy of her love. If the mere satisfaction of the carnal passion, even for the avowed purpose of benefitting one's health, were in accordance with the wisdom and justice of God, how comes it that society is so universally and unqualifiedly opposed to it in the case of women? Women are subject to the same sexual desires as men, yet they would perish rather than 20 -I I IIY-~- --~I -- - _ -21.8 SPECIAL THERAPEUTICS. to indulge in sexual delights, divested of love and irinocence. To be sure, it is a miserably arranged society, where young people are reduced to the horrible dilemma of either destroying their bodily health, or losing their peace of mind; and where, moreover, daily example, a false system of education, the excitements and allurements of fashion, and, alas, the intrigues of selfishness, unite their almost irresistible influences against the development and enjoyment of pure love. But this does not justify the degrading practice of visiting haunts of prostitution; and we consider it disgraceful and criminal, on the part of physicians, to encourage such habits among their patients, even in a medicinal point of view. We doubt whether health is at all benefitted by the enjoyment of sexual intercourse which is.not desired by true love. It is love that imparts to it the magnetism which exalts and electrifies the bodily sense, and without which the quieting of the sexual appetite is more than counterbalanced by the degrading afterthoughts, which the illegitimate gratification of this passion calls up in every mind, where the exercise of reason has not been entirely superseded by a mere brutish instinct. Nevertheless, let us remember that charity covereth a multitude of sins. It is no man's business to lay down the law for all without regard to temperament or to the impulses inherent in the very organization of the being. The sexual passion is an irresistible instinct of human nature; if this society is so miserably deficient in legitimate opportunities of gratifying the demands of this ever active, and in itself perfectly good and useful principle, society must bear the consequences of its own unrighteous folly; in spite of the statute-book, and of - THERAPEUTIC INDICATIONS. 219 the teachings of morality, the individual man will resort to such arrangements as may seem conformable to his own conscience. Advise as you will, moralize as you will, the wise physician is aware that the mighty cravings of the sexual passion will overrule all counsels and lead man to do that which abstract morality must ever condemn. Therapeutic Indications. Among the medicines which are particularly useful in this affection, the following are probably all that will do the patient any essential good..Aconite, for abdominal congestions characterized by fulness, distension, constant urging to stool or continual pressure on the bladder; depression of spirits, apprehensions of sickness and death, palpitation of the heart, fulness about the head, dizziness, rush of blood to the head, sense of chilliness; uneasy, changeable pulse, or heavy, slow, sluggish pulse; uneasy sleep, heavy dreams, nightmare, constipation or irregularity of the bowels, red urine having an offensive smell, or opalescent urine. DOSE.-One drop, or from three to four globules, morning and evening, dry on the tongue. PULSATILLA: foul taste, sense of shivering; coated, slimy tongue; looseness of the bowels, sour vomiting, especially at night; this medicine is particularly indicated, if fat meat disagrees with the patient or aggravates his sufferings; upon patients of a week disposition this medicine is supposed to have a particularly good effect. DOSE.- The same as for Aconite. Nux VOMICA: constipation, or frequent urging to stool; disposition to piles; irritable, irascible temper4 ( I ~ ~.220 SPECIAL THERAPEUTICS. the patient is troubled with heartburn, spasmodic vomiting; he cannot drink coffee or spirits without aggravating his distress; or his ailments had been originally brought on by abuse of coffee and spirituous beverages, or by suppression of the piles. DOSE.-One drop, or three globules dry on the tongue at night on retiring, DIGITALIS: an excellent remedy; the functions of the liver are very torpid, the stools are hard, dry, of a claycolor and the patient is troubled with frequent urging to urinate; he likewise complains of irregular action of the heart, intermittent pulse, etc. DOSE,-The same as for Nux. MERCURIUS VIVUS: Constipation, the alvine evacuations look dry, or slimy, dark-brown or greenish, in incoherent balls; they take place at irregular periods; the urine has a strong ammoniacal odor, and looks yellow as if containing bile; ptyalism, tight feeling in the hypochondria, distention of the bowels. DOSE.-The same as for Aconite. SULPHUR is an excellent remedy for hypochondria when arising from a haemorrhoidal disposition, with sensation of rigidity in the lower part of the back as if it would break; sensation as if something would press out of the rectum, frequent desire to urinate or inability to retain the urine, especially at night; depression of spirits. DOSE.-One drop, or three globules morning and night, dry on the tongue. This remedy may be given in alternation with Nux vomica, especially when hbmorrhoids are present, giving one drop or three globules of Nux one night, and one drop or three globules of Sulphur on the night following, and so on alternately, until the patient feels better. As soon as an improvement takes place, a dose of medicine should be given every two or three days only. CALCAREA CARBONICA may be tried if the patient is scrofulous, subject to glandular swellings, sore eyes, debility, etc. hYTRA 221 HYSTERIA. 221; DOSE.-A powder, as much as will cover a five cent piece, every night, or. every other night, dry on the tongue. This medicine is frequently giveli in alternation with Sulphur, giving the above mentioned lose of Sulphur one night, and a dose of Calcarea the next, aind so on alternately until an improvement takes place. CARBO VEGETABILIS, if the patient complains of costiveness, heartburn, acidity of the stomach, bloating of the bowels and hypochondria. DOS'.-A powder every night, dry on the tongue, of the size indicated for Calcarea. Hystdria. This condition.of the female system corresponds in a great measure with the hypochondria of males. Hysteria is not an imaginary derangement removable by a mere act of the will; it is a deep-seated and universal- disturbance of the nervous system, which may, however, be chiefly perceptible in the sexual sphere, whence the name hysteria, from the Greek word hysteros, the womb. Hysteric derangements are so varied that they may simulate almost any morbid condition. Hysteric females may go into decline without being consumptive; they may complain' of inflammation of the womb, bowels, stomach, etc., and yet there may be no inflammation; they may act like crazy persons, and yet be perfectly sane. The symptoms are sometimes so evanescent and variable that it seems difficult and even impossible to pursue a definite course of treatment. In no disease the abuse of medicine is more prejudicial 'than in hysteria. In this disease the middle and higher preparations of the homceopathic specific remedy seem, as a general rule, more suitable than the lower. Chronic hysteria may lead to disorganizations of internal organs. Medical treatment is frequently unavailing in this disease; geneial 20* 222 SPECIAL THERAPEUTICS. hygienic means, perfect regularity in diet, frequerit changes of air, exercise on horseback, in some cases a sea-voyage, and almost always the judicious use of cold water, daily frictions with cold water, the use of the shower-bath and even the douche on parts which are free from congestion, are, in many cases, the only means which will afford relief. Among the medicines those which have been recommended for hypochondria, will likewise be found available for hysteria, to which -may be added the medicines recommended for irritation of the spinal marrow, to which chapter the reader is refei-red, and a few remedies which seem to 'exercise a characteristic curative influence on the various organs of the female sexual apparatus, such as: PLATINA, for excessive titillation in the womb, with tendency to flooding. SEPIA, for vascular excitement, with fluttering of the heart, costiveness, pressing in the uterus, violent stitches in the pudendum, soreness of the vagina and labia, etc. PHSPHORUS may be required for the great nervousness of the patient, with oppression on the chest, tendency to cough, expectoration, etc. DOSE.-A dose of these three medicines may be given every twelve hours, one drop, or three globules dry on the tongue. The Phosphorus may have to be alternated with Aconite, in which case Aconite should be given first, one dose, and six hours after, Phosphorus, and so on alternately, one dose every six hours. ACONITE is an admirable remedy for the spitting up of food after a meal, with which.so many nervous females are troubled, especially when accompanied by a sour stomach. DOSE.-One drop, or three globules every twelve hours, dry on the tongue. This medicine is a great remedy in the various forms HYSTERIA. 223 HYSTERIA. 223 of hysteria, more particularly, if the patients complain of the following symptoms: Dizziness, rush of blood to the head, fulness and heat about the head, with soreness; sensitiveness of the eyes to the light, scintillations, appearances of color. Noises in the ears, humming, whizzing. Sensation as if a ball would rise in the throat, causing a feeling of spasmodic constriction, and sometimes accompanied by flow of water from the stomach. Fitful appetite; at times the appetite is ravenous, and at other times the appetite seems entirely gone, or the patient may experience a desire for strange things, uncommon kinds of food, or at uncommon hours. Coated tongue, abnormal taste, sour, bilious; thirst; the tongue looks cracked, parched. Spitting up of food, with flow of alkaline or acid water from the stomach. Irregularity of the bowels, costiveness or diarrhcea, or alternate costiveness and diarrhoea. Red urine, with lateritious sediment and strong ammoniacal odor; or watery urine, which is discharged frequently and in copious quantities. Soreness in the region of the womb, dragging pains; suppression of the menstrual discharge; or painful menstruation, with scanty discharge; or profuse and frequent menstruation, with excessive nervousness and prostration.. General debility, oppression on the chest, anxiety, palpitation of the heart, pain in the back, creeping chills followed by flashes of heat; inward fever (by which many people designate a sensation of heat on the inner surfaces). Disturbing dreams, etc. ___._ 22$ SPECIAL THERAPEUTICS. DOSE.-Six globules of Aconite may be dissolved in twelve tablespoonfuls of water, and a tablespoonful of this solution may be taken every six hours, until a decided improvement sets.in, after which, the medicine may be continued morning and evening, for some time longer. We advise the patieit to discontinue, all treatment every few weeks, for a week or fortnight, and not to resume the. medicine until an increase of suffering renders this necessary. Diet and Regimen: The successful treatment of hysteria implies the use of other means beside medicinal agents. Social influences of the right sort are particularly desirable. The company of intelligent and pure-minded male friends will be found of great use. A change of locality is likewise attended with good results. Traveling, cheerful countenances and" pleasant surroundings, will sometimes do more towards the cure of hysteria, than the best selected therapeutic agents. If the sexual passion is the main cause of the trouble, the influence of a pure and true love will alone be able to effect a radical cure. If hysteria results from the accidental suppression of the menstrual discharge, it has to be restored by the means indicated for menstrual suppression and irregularities. Exercise in the open air, active work in the field and garden, is eminently serviceable to such patients. Anything that has a tendency to excite the nerves, had better be avoided, unless some idiosyncratic or otherwise exceptional condition of the system should require the use of stimulants, such as tea, coffee, beer, wine, or other alcoholic liquors. The patient will have to indulge in such food as agrees with the appetite, the tone of the stomach, or with other preferences. As. a general rule small quantities of simple but nourishing food are advisable. Everything that causes flatulence, oppression, derangement of the bowels, may have a tendency to increase the nervous depression, and had better be strictly avoided. Fresh MELANCHOLIA. 225 air, and more particularly bracing mountain-air may tend to harmonize the irregularities of the nervous system. Surf-bathing, or even the stimulating action of the sea-air may exercise a beneficial influence, provided other constitutional tendencies are not opposed to the use of such means. Hysteria being a condition ot the system, where particular organs may be more or less irritated, the hygienic treatment will.have to. undergo corresponding modifications. If the lungs are involved, bracing country-air, plenty of exercise in the open air, good milk-diet, together with a careful avoidance of every thing that might irritate the lungs, will prove useful means of relief. If the digestive faculties are weak, a ride on horseback, working in the garden, the use of tender beef and mutton in moderate quantities, stale bread, rice, farina, and such vegetables as do not naturally disagree with the patient; and, if the bowels should be inclined to be costive, injections of cold water half an hour after breakfast, will be found adequate means of assisting the medical treatment. It is hardly possible, in a disease of such Protean forms as hysteria, to indicate hygienic measures adapted to every case; such patients are not disposed to try their skill upon themselves, nor will they be willing to trifle with the welfare of a friend; as soon as their stock of advice is exhausted, they will, as they should, apply to a physician. _ ~i ~~ 226 SPECIAL THERAPEUTICS. and hysteria, and the bad effects of sudden emotions, disappointments, etc., we may have to use: AURuM, when the lowness of spirits is characterized by a desire to destroy one's-self. DOSE.-A powder of the size of a five cent piece every morning and night, dry on the tongue. ARSENIOUM, when characterized by despair for one's salvation. DOSE.-Same as for Aurum. BELLADONNA, when the following symptoms prevail: lear of ghosts, double vision, motion of being elevated in the air by means of a wire, or when the patient is diffident and shy, and desires to look at the light, or, when the melancholy is accompanied by spasms in the organs of deglutition or bladder; or in the case of females, during and after confinement, when resulting from derangement o~f the sexual functions. DOSE.-One drop, or three globules every twelve hours, dry on the tongue. HELLEBORE, for silent melancholy and grief. May be alternated with Aconite or Ignatia. DOSE.-One drop, or three globules every twenty-four hours,, and, if alternated with either Aconite or Ignatia, give an alternate dose every twelve hours. HYosCYAMXS, for melancholy from fright, especially in females, if the menstrual discharge had been suppressed in consequence of the fright. In this case it may be alternated with Aconite and Pulsatilla, the dose.being the same as indicated for Hellebore. Nux VOMICA, if the melancholy results from suppression of the haemorrhoidal discharge, from sedentary habits, abuse of coffee and ardent spirits, etc. DOSE.-One drop, or three globules every night, dry on the tongue. PULSATILLA. This medicine is eminently adapted to _ _. ___ ~~ __ MANIA. the female system, and, in this disease, it is indicated when there is anxiety, sleeplessness, headache, cardio algia, pain in the small of the back, suppression of the menses. BOSE.-One drop, or three globules, dry on the tongue, every third morning before breakfast. This medicine is likewise indicated during pregnancy, when the mind is absorbed in taciturn reveries, the patient folds her hands across her lap, utters foolish things; the arms and'lower limbs ache, she cannot sleep. DOSE the same. STRAMONIUM: the patient converses with spirits, sees frightful visions, moves his hands as in chorea, the bowels are distended and constipated, with circumscribed redness of the cheeks. DOSE.-One drop, or three globules in a tumblerful of water, a small tablespoonful every six hours, until an improvement takes place. SULPHUR has been successfully used in melancholy with despair of salvation. DOSE. - Same as for Arsenic. Mania. It would be vain to attempt to give full details in a, popularwork of this kind concerning the treatment of mania, which disease is frequently incurable, resulting as it frequently does, from some cerebral disorganization, or from general atrophy of the nervous system. All we can do in this place is to indicate some of the leading remedies or this derangement. The dose being the same for all, it will be found indicated at the end. AcoNITE: violent rush of blood to the head, vertigo, the patient is inclined to fall, fancies he is persecuted, apprehends death, imagines he is some strange personage, sees all sorts of fanciful things, a strange scenery, strange men, etc. - ----------- i~- ------ ----L L 228 SPECIAL THERAPEUTICS. BELLADONNA: loss of reason; the patient laughs and sings, whistles, smiles, quarrels, runs through the street naked, claps his hands, or sits behind the stove, talks nonsense, about dogs, etc. VERATRUM: he sings and whistles; also with anguish, restlessness, delirium, melancholy; or for chronic mania, with costiveness, vertigo, anguish of death, delirium; or he does not know his own relatives, or looks red, does not want to leave his bed, laments without apparent reason, takes no food, is sleepless; or he claps his hands and coughs; she pretends she is in labor; she kisses everybody previous to the menses; he pretends he is deaf and blind, a prince or hunter. HYoscYAMUS: absurd laughter, ridiculous gesticulation; uses improper words, wants to travel, to officiate at mass; he turns furiously against those who oppose him; divulges secrets; mutters, gropes about, bites his shoes and eats them; feels of his head, face, nose, of the bed-clothes; exclaims that objects will fall; fears that he will be bitten by some animal; acts as if he were cracking nuts or chasing peacocks, etc. STRAMONIUM: Acts like a person in ecstacy, dances, laughs, sings, acts as if he were spinning; or breaks into a rage; dances in the church-yard at night; does not recognize his own family, and stamps with his feet, or carries his hands about as if he would grasp at something; talks nonsense and then excuses himself; he grasps at the air, crawls about his bed; imagines he will be roasted and eaten; kneels down and stretches his arms, etc. OPIUM: He feels exceedingly merry and happy; or rolls over the floor and does not know his own family; with protruded inflamed eyes; or with furious delirium, ~1ANIA. 229 MANIA. 229 starting as if in affright, confused talking, and furiously grasping the hands of those near him; he talks about demons and masks by which he fancies himself surrounded; or about former events, with the eyes open, as if dreaming; evinces a disposition to be cruel..MERCURIUS: When walking he is disposed to seize people by the nose; is disposed to weep while acting foolishly; heats the stove in the middle of summer, places candles in one corner-of the room and boots in another; or she uncovers herself at night, tosses the straw of the mattrass about the room, licks up her own saliva, laps up cow-dung and mud, puts little pebbles into her mouth, etc. Those who desire to have a thorough knowledge of the various mental derangements which can be cured by homoeopathic preparations, are referred to our Repertory, where a pretty complete list will be found, under some appropriate head, on the first sixty pages of the work. DOSE.-Of any of the foregoing medicines, one drop or three globules of the appropriate remedy every twelve hours, dry on the tongue, until an improvement has set in, after which the medicine may be given once every other day. DIET: In all mental diseases, if the bodily health of the patient is otherwise perfect, the diet need not be restricted, unless such restriction should be demanded by the treatment of the mental disorder. If the bodily health is imperfect; if the bowels are deranged, or if the nervous functions are very much disturbed in particular directions, the diet will have to be regulated agreeably to these abnormal conditions. Hence it is impossible to lay down special rules of diet, to meet particular emergencies. 21 L~ __ 230 SPECIAL THERAPEUTICS. Homesickness. Homesickness cannot be removed by medicine. The longing for home is not a disease but a desire of the soul which can only be appeased by gratification. The functional derangements resulting from this unsatisfied longing for the scenes of one's childhood, the home of one's friends and parents, may have to be treated with -medicine. Among the remedies which have been indicated for the various mental derangements the reader will undoubtedly find some medicine that will suit his case. Loss of Memory. This is frequently the consequence of some acute cerebral disease, inflammation, typhus, sun-stroke, sexual excesses, etc. But loss of memory may likewise be owing to other causes, such as exposure to the sun's rays, determination of blood to the brain, etc. It may be treated with the following medicines: CUPRUM METALLICUM: For absence of thought BELLADONNA: Forgetting things which one had just intended to do. CAMPHORA: Loss of memory after a tetanic fit, with loss of consciousness and vomiting. ACONITUxM: For loss of memory caused by exposure to the rays of the sun; or for lost faculty of remembering dates; or he forgets the end of what he is writing. STAPHYSAGRIA: For forgetting immediately what one had been reading or thinking, or was going to think of. Nux VOMICA: For making mistakes in speaking, or in quoting weights and measures. CONSEQUENCES OF GRIEFS, FRIGHTS, ETC. 231 MERCURIUS: Does not hear the questions asked, cannot remember what he has been reading; or forgets the latter part of a phrase while uttering the first part; entire loss of the memory of names. MosoCHUSs: He forgets the very place where he happens to be. ANACARDIUM: Weak memory with dulness of the senses. DOSE.-Of these different remedies, the patient may take one drop or three globules, morning and night, dry on the tongue. Consequences of Grief, Fright, Anger, Mortification of One's Feelings. The principal remedies by which the consequences of these violent concussions of the moral system may be successfully met, are Aconite, Opium, Ignatia, Chamomilla, Staphysagria, Coffea. Aconite, for the consequences of fright, chill, fever, palsy, palpitation of the heart, tremor, collapse of pulse, etc. Mix six globules in ten tablespoonfuls of water, and give a small tablespoonful every hour. Aconite is likewise an excellent remedy for the effects of violent agitations of the nervous system, produced by excitement of feeling, altercations, etc. The dose is the same as before indicated. Coffea is indicated for the consequences of excessive joy, when the nervous system seems unhinged by excessive mobility, a sort of mercurial restlessness, nervous wakefulness. Dose the same as for Aconite. If Coffea should not be sufficient, we may give Opium, more particularly for excessive wakefulness, especially if the wakefulness seems superinduced by an extremely lively fancy, with a host of pleasant ideas I 232. SPECIAL THERAPEUTICS. and visions crowding upon the mind. Same dose as for Aconite. Ignatia removes the effects of silent grief and melancholia, more particularly if the digestive system is affected; the patient complains of a gone feeling in the pit of the stomach, and a pricking sensation in this region. Give three or four globules morning and night, dry upon the tongue. Chamomilla is an excellent remedy for the consequences of anger, if the bilious symptoms predominate; the patient looks sallow, complains of stinging headache, the tongue looks coated white or yellowish, the patient feels sick at the stomach, vomits up bile; the skin feels dry, feverish, with occasional chilly creepings. Dissolve six globules in a tumblerful of water, and give the patient a small tablespoonful every two hours, until a decided improvement sets in. If the fever symptoms are strongly developed, Aconite may be given instead of Chamomilla, to be administered in the same way as Chamomilla. Or a few tablespoonfuls of a solution of Aconite may be given first, and, after the patient has begun to perspire freely, a dose of Chamomilla may be administered, if it should seem necessary, or else the Aconite may be continued at longer intervals, until the patient is quite well. Opium may be given under these circumstances, if the patient is very drowsy, and can only be roused with difficulty; to be given in the same way as Chamomilla. Staphysagria is generally recommended, if the patient inclines to push every thing away from him. A few pellets may be given every six hours. We have very little confidence in the good effects of this drug in affections resulting from any of the above mentioned causes. FAIUE TC 3 FATIGUE, ETC. 233 Upon looking carefully at the existing symptoms, one of the other medicines named in connection with Staphysagria, will be found much more appropriate. Diet: The diet in all these cases will have to be modified agreeably to the physical condition of the organism. Articles of diet which disagree with the patient, and disturb the action of the drug, have to be avoided. Under some circumstances, in states of debility, for instance; or if the stomach should feel faint and exhausted, the moderate use of stimulants, a little lager-beer, Bourbon-whiskey, etc., may be perfectly.admissible. Fatigue, Consequences of Excessive Physical or Mental Exertions, Watching. Over-exertion, excessive walking, working or watching, may occasion a feeling of prostration, unconquerable lassitude, soreness and aching in the joints, inability to sleep. The best remedies for this condition are ARNICA, taken internally, one drop or six globules in a tumblerful of water, a tablespoonful every two hours, if the patient feels weary and sore as if bruised. ACONITUM, if the prostration is accompanied by congestion about the brain, headache, dizziness, loss of appetite, diarrhoea, nervousness, wakefulness. DOSE.-Same as Arnica. COFFEA, if the sense of exhaustion and wakefulhess have been caused by over-watching, In this case, it is eminently proper to alternate the Coffea with Aconite, one drop or six globules of each in separate tumblers full of water, a tablespoonful every two hours, giving first the Aconite, next the Coffea, and so on, alternately, 21* .-..~. ---~--~.. __ 234 SPECIAL THERAPEUTICS. until the patient is refreshed by sleep, and a pleasant moisture makes its appearance on the skin. China is another excellent remedy for the consequences of over-exertions of the body, more particularly, if the patient has lost all appetite, feels weak, the joints are painful, there is tendency to coldness or chilliness, followed by occasional flashes of heat, the bowels are inclined to be loose, and the spirits feel rather depressed. One or two drops or from six to ten globules may be dissolved in a small tumblerful of water, of which a tablespoonful may be taken every three hours; if the fever should be considerable, Aconite may be used in alternation with China, to be administered as the China, in alternate doses with this agent every two hours. Regimen: Sponging with tepid water, in which a tablespoonful of brandy or a little bay-rum is mixed, often proves exceedingly refreshing to persons who have become exhausted in consequence of physical exertions. The moderate use of a stimulant may likewise be beneficial. A teaspoonful of brandy in a glass of water, or a glass of lager-beer diluted with water, if necessary, may be taken in small -quantities, say three or four tablespoonfuls at a time, to be repeated every few hours. The diet is to be simple, but, if the patient's appetite should require it, more nourishing, consisting of broth, small quantities of beef-steak, mutton-chop, etc. Over-heating, Insolation, Exposure to the Sun's rays, Sunstroke. This kind of exposure, during a walk, or during work, may occasion a severe feverish condition, characterized by symptoms of inflammatory fever, and incipient OVERHEATING, INSOLATION, ETC. 285 cerebral inflammation. It may occasion chills, followed by heat; severe headache, throbbing in the head, dizziness, loss of consciousness, red and glowing face, parched mouth, intense thirst, prostration. This condition requires ACONITUM, one drop or six globules in a tumblerful of water, a tablespoonful every hour, until better. Indications: violent headache, throbbing pain, dizziness, flushed face, stupefaction, nausea or vomiting, shivering and feverishness, thirst, coated tongue, etc. This remedy may be alternated with BELLADONNA, if the front part.of the head is principally affected; the brain feels heavy, especially on stooping, with pain and dartings through the forehead; the eyes look sore, inflamed, are sensitive to the light; the patient feels as though he would lose his senses. DOSE.-Mix one drop or six globules of each medicine in a separate tumblerful of water, and give the patient a tablespoonful of Aconite, to be followed in one hour by a tablespoonful of Belladonna, then again the Aconite, and so on alternately, until the patient begins to perspire, and to be otherwise relieved, after which, the intervals may be lengthened to two or three hours. DIET.-The patient may be allowed ice-water, but cautiously; at first it is best to give him teaspoonful doses of a mixture of brandy and water-six drops of brandy to a teaspoonful of water-until the mouth remains moist; gradually the quantity of brandy may be lessened, and finally abandoned altogether, giving the water pure and fresh, and lastly ice-water. If important cerebral derangements should occur, the reader will find under inflammation of the brain, and under typhus and typhoid fever, all the medicines he may require to use ~~I 236 SPECIAL THERAPEUTICS. Apparent death. Asphyxia. A variety of causes may induce a condition of the system resembling death. This kind of apparent death is a temporary suspension of animation, which has caused many persons who were only apparently dead to be consigned to their graves for dead. Let us examine a little more in detail the treatment which should be pursued in order to restore such patients to life. In a popular work.like the present, it seems inexpedient to enter into learned disquisitions concerning the various opinions advanced by authors, as regards the mode in which a temporary suspension of animation gradually results in the destruction of vitality. It seems generally conceded, by all physiologists who have examined.the subject, that the suspension of respiration, and the consequent arrest of the oxygenation of venous blood, are the immediate causes of death. In all persons who die asphyxiated, the right ventricle and the pulmonary artery are found full of black blood after death, whereas the left ventricle is found empty. This cannot be otherwise. If respiration is arrested by external mechanical causes, such as submersion in water, strangulation, spasmodic closing of the glottis in consequence of the irritating action of some noxious, irrespirable gas, the oxygenation of the venous blood in the pulmonary capillaries ceases; hence, the supply of aerated blood, in the arterial capillaries of the lungs, ceases likewise, and the left cavities of the heart must necessarily remain empty. The first object, therefore, in all cases of asphyxia or suspended respiration and circulation, should be to APPARENT DEATH-ASPHYXIA. 237 restore the action of the lungs. In order to accomplish this purpose, we place the patient upon a mattrass, in a recumbent posture, with the lower limbs extended, the head raised, and the arms resting naturally alongside the body. After having cleared the nostrils and mouth from whatever impurities might obstruct the passage of air from and to the lungs, we then resort to the various processes which have been found most efficient in restoring the irritability of the pulmonary tissue. These processes are 1. Friction. 2. Galvanism. 3. Insufflation. Friction may be made with the hand, previously warmed, or with a piece of warm flannel, or even with a soft brush, provided it does not excoriate the parts. Galvanism is applied by means of an electro-galvanic battery of ordinary size. A galvanic current is passed through the diaphragm, by applying one pole to one side of the thorax, in the region corresponding to the insertion of the diaphragm, between the eighth and ninth rib, and the other pole to the opposite side of the thorax, in the same region. Immediately upon closing the circle, the diaphragm will contract, and the lungs become filled with air. This air is expelled again by interrupting the circle, and making gentle pressure upon the abdomen. After the expulsion of the air, a second inspiration is effected, then again an expiration, and so on, from eighteen to twenty inspirations and expirations in a minute. The effect of this artificial respiration, if continued a sufficient length of time, will be the oxygenation of the blood contained in the pulmonary capillaries, and the resuscitation of the suspended vitality of the lungs. Insufflation, if properly carried on, is a most L 238 SPECIAL THERAPEUTICS. efficient means of restoring the functional power of the pulmonary tissue. The process of insufflation may be accomplished in various ways: by inserting the point of a pair of bellows in one nostril, and, while the other nostril and the mouth are held closed, blowing air. into the lungs at the rate of eighteen or twenty strokes per minute. This should be done very gently, lest the pulmonary vesicles should be torn, if the air rushes in with too much force. After every stroke of the bellows, the air has first to be expelled from the lungs, before fresh air can be introduced. The expulsion of air is effected by compressing the thorax from side to side, and, at the same time, making gentle pressure upon the abdomen with the flat hand, placing it upon the anterior wall, and turning it slightly upward while pressing upon the part. Another mode of effecting insufflation is by applying one's mouth to the open mouth of the patient, whose nostrils have to be carefully closed during the operation, and breathing air into his lungs. In order to be sure of the success of the operation, it is important, while the air is blown into the lungs, to press upon the cartilaginous prominence in front of the neck, commonly known as Adam's apple; otherwise the air might rush into the stomach, instead of entering the lungs. The expirations are effected in the same way as during the previous operations. Air may likewise be blown into the lungs through a silver tube, the bent end of which is introduced into the larynx. This is readily accomplished by pressing down the tongue with the finger as far as the root, by which means the epiglottis is raised, and the canula slides into the larynx without any difficulty. The finger may be used as a guide for the introduction of the instrument. The usual precautions, of closing __ APPARENT DEATH.-ASPHYXIA. 239 the nostrils and mouth of the patient during the operation, should.not be neglected. In all cases of asphyxia resulting from the operation of causes which prevent a sufficient supply of oxygen from penetrating to the pulmonary capillaries, it is of importance to secure to the atmospheric air free access to every part of the cutaneous surface. For this purpose we strip the body as soon as convenient after it is taken out of the water, or freed from the rope or from whatever obstacle may have caused the patient's apparent death, and we then expose him to an atmosphere of from 600 to 650 F. At the same time we may assist these mechanical efforts to save the patient's life, by preparing a mixture of five drops of the concentrated tincture of Aconite-root in four tablespoonfuls of water, of which a few drops may be dropped upon the patient's tongue every few minutes. The philosophy of this proceeding is very simple. There is no remedy in our Materia Medica which is endowed with the same specific power as Aconite, to stimulate the paralyzed energies of the peripheral nervous system, more particularly if this paralysis results in sanguineous engorgement of the paralysed part. Hence, in all cases ofasphyxia, Aconite is an appropriate accompaniment of the mechanical measures employed, and will materially contribute to rouse the dormant circulation and to prevent dangerous congestions of internal organs. After the patient has become fully roused to consciousness, we may prescribe such remedies as may seem indicated by the symptoms, but Aconite will be found sufficient in most cases. After consciousness is fully restored, this medicine may be continued in half tablespoonful doses of a mixture of one drop of the concentrated tincture of the root in half ~c ~ 240 SPECIAL THERAPEUTICS. a pint of water, a dose every hour or two hours, gradually lengthening the intervals as the patient continues to improve. If symptoms of violent cerebral congestion develop themselves, with delirium whether bland or furious, Belladonna may be given, one drop or six globules, in ten tablespoonfuls of water, a dessertspoonful every fifteen or thirty minutes, until an improvement takes place. If the patient inclines to be comatose, Opium may be substituted for Belladonna, to be administered in the same manner. It is proper to give Aconite and Belladonna, or Aconite and Opium in alternation. Apparent Death from a Fall. In this case a surgeon has to examine, whether any bones are broken or other injuries inflicted upon the patient. In the meanwhile, until the arrival of a physician, the patient should be gently and carefully laid upon a soft mattrass, and a drop of the concentrated tincture of Aconite root should be mixed in six tablespoonfuls of water, of which mixture from ten to fifteen drops may be introduced into the patient's mouth every few minutes, until the pulse begins to reappear, after which the medicine may be continued at longer intervals. In many cases of this kind the patients may not meet with any bodily harm, but the signs of life may have become suspended from the violent shock which the nervous system may have received in consequence of the fright and the mechanical concussion. After consciousness is fully restored, the Aconite may be continued in teaspoonful doses in alternation with six globules of Arnica in a small tumblerful of water, in half tablespoonful doses, an alternate dose every two hours, or j APPARENT DEATH FROM HUNGER, ETC. 241 until a surgeon takes charge of the case. If the patient is able to move his limbs easily and without pain, and if he expands the thorax readily and completely, without experiencing any pain in the region of the ribs, we may rest assured that there is neither fracture, nor dislocation. Bruised parts are to be fomented with a solution of from thirty to forty drops of the strong tincture of Arnica in a cupful of water; a linen compress may be dipped in this solution and applied to the bruise. A dry bandage of sufficient thickness should be tied over the wet compress. This compress should be moistened with the solution every two or three hours. Apparent Death from Hunger, Starvation. Administer small injections of tepid milk every fifteen minutes; or, if no milk should be at hand, moisten the patient's tongue with a drop of diluted wine. Repeat this every five minutes, until the patient shows decided symptoms of life; then give a few drops of beef-tea, every few minutes, and gradually increase to teaspoonful doses. A cupful of beef tea may be consumed in about two hours. After the patient has slept soundly, a more copious meal may be given, but no meat, except the juice of it, for a day or two. If symptoms of cerebral irritation or inflammation of the bowels, diarrhoea, etc., should set in, the reader may consult the chapters that treat of these diseases respectively. Aconite and China will be found main remedies; they may be used in alternation, one drop or three globules dissolved in water, every two hours. Belladonna may be resorted to, for the purpose of combating cerebral disturbances characterized by delirium, stupor, etc.; give one drop or three globules, dissolved in water, every two hours. 22 SPECIAL THERAPEUTICS. 242 Apparent Death by Strangulation. For this species of death medical aid is not sought, unless the patient attempted to commit suicide or became suspended by accident. If the cervical vertebrae had become dislocated and the spinal cord had been pressed upon in consequence, the patient generally dies before anything is done for his relief. Nevertheless, until a physician is sent for, the patient's neck and breast may be uncovered and exposed to the air near an open window. He may likewise be fanned, and the above mentioned method of resuscitatipn, viz.: tie application of a galvanic current to the diaphragm and the process of insufflation, may at once be resorted to. Care should be had to place the patient in a recumbent position, with the head and shoulders slightly raised and bent forward. In this position, the lungs act with" the greatest ease, provided their functional power can be restored. Aconite may be employed in the manner advised in the article on general asphyxia. After the function of respiration is fully restored, the use of Aconite may be continued for some time, one drop in half a pint of water, of which mixture a dessertspoonful may be given every half hour, and finally every hour or two hours until the patient can dispense with all further medication. Apparent Death by a Stroke of Lightning. Some propose to place the patient, in a half-sitting and half recumbent posture, into a recent excavation in the ground and cover him with the fresh earth, with his face turned towards the sun, until he begins to revive. II _ APPARENT DEATH BY DROWNING. 243 Others advise to expose him to a current of fresh cool air, and to sprinkle his neck, face and breast with cold water. If the body is cold, brisk friction with warm flannel, or a horse-hair mitten, should be instituted and sedulously kept up. Artificial respiration, as described in the preceding paragraphs, may likewise be resorted to. ' The. olfactory nerves may be, at the same time, stimulated with the emanations of the concentrated tincture of the root of Aconite by holding a vial filled with it under one or both nostrils. As soon as animation is restored, ACONITUM and Nux VOMICA may be given internally, one drop or six globules of each, dry on the tongue, in alternation, a dose every half hour, beginning with the Aconite, and continuing the medicines until the patient seems well enough to do without any. The intervals should be gradually lengthened. Apparent Death by Drowning. Formerly such patients fared hard, indeed. They were placed on their heads to let the water flow out of their mouths; they were rolled on casks, trampled upon, laid in the sun, etc. The present treatment of such cases is more humane, for we know that such patients do not die from the quantity of water which they swallow, but from suffocation, from paralysis of the brain and lungs. How important, therefore, that they should be handled with the greatest care, in order not to extinguish the feeble glimmer of life that may still be glowing. The first thing to be done is to carry the body, with the head and shoulders slightly elevated, into a room, the temperature of which is agreeable to the season. In 244 SPECIAL THERAPEUTICS. the winter-season, or in cool and damp weather, the room must be heated by a fire; in the warmer seasons of the year no fire is required. Let the patient have as much fresh air as can be afforded consistently with the season and the state of the weather. In the summerseason the windows may be opened, and the patient be extended upon a mattrass close to the opened windows. In other seasons, fresh air may be permitted to enter, but in such a manner that the patient, who is stripped of his clothes, cannot possibly get chilled. The body having been stripped, it is dried, all impurities are removed from the mouth and nostrils, and the various methods of resuscitation which have been detailed in previous paragraphs, are at once resorted to. Artificial respiration will be found of the greatest use and importance. The head and shoulders should always be slightly raised, and every obstacle that might interfere with the free expansion of the thorax, must be carefully removed. The tincture of Aconite should likewise be used in the same manner as has been indicated in the preceding paragraphs on asphyxia. The tincture may be held under the nostrils, so that its emanations may irritate the nerves distributed over the Schneiderian membrane; and it may likewise be applied to the tongue in the manner indicated above. This mode of treatment is not recommended in other homoeopathic treatises, where Carbo vegetabilis, Lachesis, and other drugs are mentioned as the most appropriate under such circumstances. But it is time that our science should be, what it really is in Nature, based upon fixed principles, and that this everlasting copying of one author from another should cease. In all conscience it has been carried on long enough; this habit of copying one from another, has APPARENT DEATH. BY DROWNING. 24:5 injured Homoeopathy, which should be an object of universal regard, in the eyes of those whose minds do not enjoy the intuitive perceptive power, which enables others to behold truth even through the darkening mists in which she is often veiled by the perversions of her professed advocates. If a body is taken out of the water, and there are no unequivocal signs of death, we should at once proceed to employ every possible means in our power to resuscitate the vital spark. There are instances on record, where several hours' unremitting exertions were required, before animation was restored. As a general rule, a few minutes' complete submersion under water will prove sufficient to extinguish life. After a quarter of an hour, recovery is not very common; after half an hour, it may be considered hopeless. The longest period that a person whose life was saved, has been under water, is three-quarters of an hour. Several cases of this kind are recorded in the Reports of the Royal Humane Society of London, and of the Establishment for the Recovery of Drowned Persons of Paris. It is proposed by some to place the patient.in a warm bath as soon as he is taken out of the water; but this is not advisable on account of the free access of atmospheric air being precluded by such a proceeding. As soon as signs of returning animation become apparent, bottles of warm water may be put to the feet, and hot sand-bags may be laid alongside the patient's body. The extremities and abdomen may be rubbed with warm flannels. If the patient is completely resuscitated,. we may then begin to cover him with a light blanket well warmed, and finally place him in a comfortable bed. If any internal treatment is required, a few glo22* 246 SPECIAL THERAPEUTICS. bules of Aconite in eight or ten tablespoonfuls of water, a spoonful every half hour or hour will be found sufficient in all ordinary cases, where symptoms of congestion and the pains incident to this condition, are the only indications that require to be combated by treatment. Of all the forms of asphyxia, death by drowning seems to be the least painful. This may be inferred from the testimony of those who, after suffocation had already taken place, were eventually saved. An interesting case illustrative of this condition of the human mind immediately after suffocation by drowning, is that of the late Capt. Beaufort, of the English Navy, who describes his experience in the following letter to Doctor W. Wollaston, which, for its composition and style, and still more for the subject of which it treats, is deserving of the most attentive perusal. This letter was originally made public in the Autobiography of Sir John Barrow, Bart., and is inserted here from Professor Bush's New Church Repository and Monthly Review, January Number, 1849. " Dear Doctor Wollaston:-The following circumstances, which attended my being drowned, have been drawn up at your desire; they had not struck me as being so curious as you consider them, because, from two or three persons who, like myself, had been recovered from a similar state, I have heard a detail of their feelings, which resembled mine as nearly as was consistent with our different constitutions and dispositions. "Many years ago, when I was a youngster on board one of His Majesty's ships in Portsmouth harbor, after sculling about in a very small boat, I was endeavoring APPARENT DEATH BY DROWNING. 247 to fasten her alongside the ship to one of the scuttlerings; in foolish eagerness I stepped upon the gunwale, the boat of course upset, and I fell into the water, and not knowing how to swim, all my efforts to lay hold either of the boat or of the floating sculls were fruitless. The transaction had not been observed by the sentinel on the gangway, and therefore it was not till the tide had drifted me some distance astern of the ship that a man in the foretop saw me splashing in' the water, and gave the alarm. The first lieutenant instantly and gallantly jumped overboard, the carpenter followed his example, and the gunner hastened into a 'boat and pulled after them. "With the violent, but vain, attempts to make myself heard, I had swallowed much water; I was soon exhausted by my struggles, and before any relief reached me, I had sunk below the surface, all hope had fled, all exertion ceased, and I felt that I was drowning. " So far, these facts were either partially remembered after my recovery, or supplied by those who had latterly witnessed the scene; for during an interval of such agitation a drowning person is too much occupied in catching at every passing straw, or too much absorbed by alternate hope and despair, to mark the succession of events very accurately. Not so, however, with the facts which immediately ensued; my mind had then undergone the sudden revolution which appeared to you so remarkable, and all the circumstances of which are now as vividly fresh in my memory as if they had occurred but yesterday. "From the moment all exertions had ceased-which I imagine was the immediate consequence of complete suffocation-a calm feeling of the most perfect tran 248. SPECIAL THERAPEUTICS. quility superseded the grievous tumultuous sensationit might be called apathy, certainly not resignation, for drowning no longer appeared to be an evil-I no longer thought of being rescued, nor was I in any bodily pain. On the contrary, my sensations were now of rather a pleasurable cast, partaking of that dull but contented sort of feeling which precedes the sleep produced by fatigue. Though the senses were thus deadened, not so the mind; its activity seemed to be invigorated, in a ratio which defies all description-for thought rose after thought with a rapidity of succession that is not only indescribable, but probably inconceivable by any one who has not himself been in a similar situation. The course of those thoughts I can even now in a great measure retrace-the event which had just taken place -the awkwardness that had produced it-the bustle it must have occasioned (for I had observed two persons jump from the chains)-the effect it would have on- a most affectionate father-the manner in which he would distlose it to the rest of the family-and a thousand other circumstances minutely associated with home, were the first series of reflections that occurred. They took then a wider range-our last cruise-a former voyage, and shipwreck-my school-the progress I had made there, and the time I had misspent-and even all my boyish pursuits and adventures. Thus travelling backwards, every past incident of my life seemed to glance across my recollection in retrograde succession; not, however, in mere outline, as here stated, but the picture filled up with every minute and collateral feature; in short, the whole period of my existence seemed to be placed before me in a kind of panoramic review, and each act of it seemed to be accompanied by a con APPARENT DEATH BY DROWNING. 249 sciousnesss of right or wrong, or by some reflection of its cause or its consequences; indeed, many trifling events which had been long forgotten, then crowded into my imagination, and with the character of recent familiarity. " May not all this be some indication of the almost infinite power of memory with which we may awaken in another world, and thus be compelled to contemplate our past lives? Or might it not in some degree warrant the inference, that death is only a change or modification of our existence, in which there is no real pause or interruption? But, however that may be, one circumstance was highly remarkable: that the innumerable ideas which flashed into my mind were all retrospective; yet I had been religiously brought up-my hopes and fears of the next world had lost nothing of their early strength, and, at any other period, intense interest and awful anxiety would have been excited by the mere probability that I was floating on the threshold of eternity; yet, at that inexplicable moment, when I had a full conviction that I had already crossed that threshold, not a single thought wandered into the future-I was wrapt entirely in the past. " The length of time that was occupied by this deluge of ideas, or rather the shortness of time into which they were condensed, I cannot now state with precision, yet certainly two minutes could not have elapsed from the moment of suffocation to that of my being hauled up. " The strength of the flood-tide made it expedient to pull the boat at once to another ship, where I underwent the usual vulgar process of emptying the water by letting my head hang downwards, then bleeding, chafing, and even administering gin; but my submersion had 250 SPECIAL THERAPEUTICS. been really so brief, that, according to the account of the lookers-on, I was very quickly restored to animation. "My feelings, while life was returning, were the reverse in every point of those which have been described above. One single, but confused idea-a miserable belief that I was drowning-dwelt upon my mind, instead of the multitude of clear and definite ideas which had recently rushed through it-a helpless anxiety, a kind of continuous nightmare, seemed to press heavily on every sense, and to prevent the formation of any one distinct thought-and it was with difficulty that I became convinced that I was really alive. Again, instead of being absolutely free from all bodily pain, as in my drowning state, I was now tortured by pain all over me; and, though I have been since wounded in several places, and have often submitted to severe surgical discipline, yet my sufferings were at that time far greater, at least in general distress. On one occasion I was shot in the lungs, and after lying on the deck at night for some hours, bleeding from other wounds, I at length fainted. Now, as I felt sure that the wound in the lungs was mortal, it will appear obvious that the overwhelming sensation which accompanies fainting must have produced a perfect conviction that I was then in the act of dying. Yet nothing, in the least resembling the operations of my mind when:drowning, then took place; and when I began to recover, I returned to a clear conception of my real state. "If these involuntary experiments on the operation of death afford any satisfaction or interest to you, they will not have been suffered quite in vain, by "Yours, very truly, L F. BEAUFORT." _~ APPARENT DEATH BY FREEZING. 251 Apparent Death by Freezing. Persons who are exposed to severe cold in the open air, for several consecutive hours, may freeze to death. At first they feel drowsy, and if they yield to this almost irresistible desire for sleep, they inevitably perish. Hence it is of vital importance that this desire should be resisted. If the patient is accompanied by other persons, they should keep him awake, even if violence has to be resorted to. The moment the patient lies down to rest, he is sure to lose his life by the cold. But what is to be done, in case such persons are met with in a state of apparent death? Let us detail the measures which should be adopted for their resuscitation. Such patients have to be handled with care, lest their stiffened limbs should break. The patient should be carried into a cool room, where he is not exposed to the least current of air. There he is to be laid upon a mattrass, in a half raised position, and covered with snow to the height of several inches, leaving only the eyes and mouth free. As the snow melts, it should be replaced with fresh snow. Or, if no snow is to be had, prepare a bath of the temperature of water at the freezing point, and place the patient in the bath for several minutes; or, which is still better, wrap. him in blankets that had been dipped in icy-cold water, and moisten them every few minutes with ice water. The blankets should be wrapped all round the patient carefully, and touch every part of the body, leaving only the nostrils and mouth free. After the rigidity of the limbs is entirely removed, consciousness restored, and the patient feels warm, we 252 SPECIAL THERAPEUTICS. may undress him, by cutting the clothes from the body if necessary. The patient should then be dried, laid in a perfectly dry bed, and covered up well. At the same time we give him ACONITUM, one drop or six globules in a tumblerful of water, a small tablespoonful every hour, until the drowsiness and pain have disappeared, and perspiration has set in. The patient may occasionally be given a teaspoonful of coffee, or a few drops of a mixture of onefourth wine and three-fourths water, if he should desire it. He should stay away from the fire for a long time after his health is considered restored. If this treatment does not restore the patient's life and health, we may be pretty confident that no other known treatment will. Frozen limbs are likewise treated with snow or ice-water, and the internal use of Aconite, as shown above. Apparent Death from Noxious Gases, Foul Air, etc. It is known to every body that a sufficient supply of pure atmospheric air is indispensable to the preservation of life. Atmospheric air is a compound of several gases, some of which, in their separate form, are either totally unfit for purposes of respiration, or else act too intensely and therefore cause too rapid a waste of the vital tissues. The principal constituents of atmospheric air are oxygen and nitrogen, a very small quantity of carbonic acid gas and aqueous vapor. In the day-time the plants give out oxygen, and carbonic acid is exhaled from the lungs. During the night, a small quantity of carbonic acid is likewise given out by plants, which accounts for the injurious effects that are often caused by plants, if left APPARENT DEATH FROM NOXIOUS GASES, ETC. 2533 in a bedroom over night. Carbonic acid being heavier than atmospheric air, it must necessarily collect at the bottom of a well, or constitute the lower stratum of the air in a room. It is an irrespirable medium, and extinguishes the vital spark almost immediately. Hence laborers who have to descend to the bottom of a well, first lower a lighted. lamp in order to ascertain whether it will burn. If the flame is not extinguished, this is a sure sign that no carbonic acid has collected at the bottom, and that the air there contains a sufficient amount of oxygen to support life. Carbonic acid constitutes the choke-damp of the coal mines. The so-called ftir-edamp, which is an inflammable gas, consists of carburetted hydrogen. In some volcanic regions this choke-damp issues in grreat quantities from fissures in the rocks; it is generated in great abundance in the celebrated dog's grotto at Naples, so called from the number of dogs that have perished in it. In treating patients who had become asphyxied by inhaling carbonic acid gas, we have in the first place to strip them of their clothes, in order that. the air may have free access to the skin. They should be fully exposed to currents of cool air, and their faces and chests bathed with cold water, until the respiratory movements reappear. Frictions over the chest are likewise advisable and ammonia may be held to the. nostrils. The mixture of the concentrated tincture of Aconite-root' and water, which has been recommended in other forms of asphyxia, may likewise be applied to the patient's tongue in this instance. After the breathing is restored, a few drops of Aconite third attenuation, may be mixed in ten tablespoonfuls of water, and the patient may be given a tablespoonful of this mixture every hour or two, until all 23 254 SPECIAL THERAPEUTICS. signs of congestion on the lungs have been effectually removed. Asphyxia of New-born Infants. Children are sometimes born without any apparent signs of life, although the movements of the fetus had been distinctly felt by the mother until the moment of its birth. This may be owing to several causes, the principal of which is strangulation by the chord during the descent of the fetus, or prolapsus of the chord and consequent pressure upon this organ by the descending fetus. Either of these causes is sufficient to destroy the life of the child; but, if the child is still-born, and we had every reason to believe that the child was a living child previous to its birth, we should use every exertion to resuscitate it. If the pulsations in the chord continue after birth, it may be advisable not to sever the chord, and to endeavor to reanimate the child by resorting to the various processes, such as friction, artificial respiration, electro-galvanism, which we have fully explained in previous paragraphs. But, if the pulsations in the chord have entirely ceased, it is useless to preserve its integrity; it may be cut at once, and it may even be advisable to let a teaspoonful of blood flow out of the fetal extremity of the chord. We should not despair of saving the little being, even if we have to work for several consecutive hours. Do not forget the tincture of Aconite, which we have recommended in the former paragraphs on asphyxia; in this instance as in most other forms of asphyxia, Aconite proves the most powerful exciter of the paralyzed vitality, if symptoms of sanguineous congestion constitute the leading patho FEVER. 25 FEVERS. 255 logical feature in the case. It may be of the utmost importance to continue the use of Aconite for some time, even after resuscitation is completed. A few pellets may be placed upon the child's tongue every two or three hours. Sometimes our best efforts of inflating the lungs, remain unattended with success. External means of exciting the respiratory muscles to contract, may be of great use. For this purpose, the accoucheur may fill his mouth with cold water, and, having held it there for a few seconds, may eject it against the anterior wall of the child's chest. Instead of water, some accoucheurs prefer using brandy. Diet and Regimen: In all cases of asphyxia, after the patient is fully resuscitated, it is perfectly proper to accompany the medical treatment, if any should seem required, by the use of alcoholic stimulants in quantities suited to the case, whenever the patient expresses a desire for them, and the existing exhaustion should seem to render the use thereof advisable. With a returning feeling of strength and health, the patient may resume his usual mode of living. Fevers. In the Introductory Essay on Physiology and Pathology, we have endeavored to explain the nature of fever and of the various phenomena which characterize this condition of the system, the chill and subsequent heat, the dryness and thirst, and the bounding of the pulse. We have shown that the proximate cause, or more correctly speaking, the first beginning of fever, consists in an irritation of the capillary nervous net --? 256 SPECIAL THERAPEUTICS. work; that this irritation leads to congestion of the capillary vessels, which, in its turn, causes the apparent tumult in the larger vessels of which the bounding of the pulse is the most characteristic symptom; and that the dryness and heat of the skin are principally owing to the impaired power of the mucous surfaces, to absorb moisture from the vital fluids of the organism. This last mentioned fact accounts for the necessity of keeping the room, where the fever-patient is confined, cool, of course within proper limits, say of a temperature of from 45 to 50 degrees F., giving the patient as much cold water to drink as he likes, and sponging him every now and then with tepid water. We will now proceed to a more detailed description of the treatment which is to be pursued in the various kinds of fever, premising once for ever in regard to diet, that the patient should be allowed as much fresh cold water as he craves, and that the diet should be light and not stimulating; light black tea, gruels, farina, arrow-root, a little toast, and such kinds of food, being the most appropriate. If any special remarks have to be made concerning diet, they will be found in their respective places at the end of the chapters treating of the particular diseases to which such remarks have reference. Simple Irritative Fever. This derangement may be induced by various causes, a cold, fright, a little gastric derangement. All the symptoms are slight, a little chilliness or only a sense of coldness followed by warmth, slight thirst, a sense of weakness or weariness, impaired appetite, perhaps a little headache, dulness or tight feeling -about the head; --~-~~-~11111~~----~11111~--- 1 CATARRHAL FEVER, ETC. 257 the urine is more deeply colored,,and the bowels may likewise be out of order one way or the other. Give ACONITUM, one drop or six globules in a tumblerful of water, a tablespoonful every three or four hours. A few doses are generally sufficient to quiet the pulse and restore the normal action of the skin. Catarrhal Fever. This" is a simple irritative fever, which requires the same treatment as the last-named derangement, in addition to which it may be necessary to give MEROURIUS, one drop or six globules in a tumblerful of water, a tablespoonful every three or four hours, when the following symptoms occur: chilliness or sense of coldness, with or without goose-flesh, warmth in the palms of the hands, flashes of heat, or alternate flashes of heat and sweat, which sometimes has a sour smell; bilious-looking urine, which may have a strong, ammoniacal odor; tongue slightly coated, profuse flow of saliva, yellowish color of the face and skin, constipation or diarrhoea, thirst. The patient likes to be near the fire, whereas, if Aconite is indicated, he prefers a cool room, and keeps away from the fire while the fever lasts. Inflammatory or Synochal Fever. The pure synochal fever has pretty much the same symptoms as the simple irritative or catarrhal fever, except that they are more marked and sometimes ac companied by striking phenomena of consensual dis. turbance of the organism. The chill and fever are more 23* 258 SPECIAL THERAPEUTICS. violent, the heat lasts.longer, the thirst is more intense, the tongue more furred, and the fever is frequently attended with sickness at the stomach, vomiting, headache, and even delirium. In children the determination of blood to the brain frequently induces twitchings and even spasms. Give ACONITUM for these symptoms, a few drops or six globules in a tumblerful of water, a tablespoonful every two hours until the sweat breaks out, after which the intervals between the doses may be lengthened to four hours. This is the only medicine which need be taken for this kind of fever, and, if such symptoms as diarrhoea, headache, and so forth, should not speedily disappear under the use of the globules, we would recommend, instead of changing the medicine for some other, to substitute the tincture of Aconite-root for the globules; the tincture will be found perfectly adequate to the case, much more so than another medicine. One drop of the tincture may be mixed in a tumberful of water, a tablespoonful to be given every two hours until an improvement sets in, after which a few more doses may be given every four hours. Diet: In regard to diet and regimen, we would repeat what has been suggested in the paragraph on simple irritative fever: that the patient should content himself with the simplest kind of nourishment, cold water, tea and toast, gruels, simple jellies, etc. If the bowels are deranged, everything that has a tendency to keep up this irritation, must be avoided. ~ ~ ~ _, I GASTRIC FEVER. 259 Gastric Fever. In the chapter on 'l names of diseases," the origin of this and other fever-names has been abundantly explained. This is a fever which, beside the usual phenomena occurring during fever, and which have been described in speaking of simple irritative fever, is characterized by peculiar symptoms of derangement of the gastric functions, accompanied by symptoms of irritation of the intestinal mucous membrane, such as bright redness of the edges and tip of the tongue, thick, white, yellowish or brownish coating of the tongue, nausea and vomiting of food or bile, sense of fulness and distension of the region of the stomach, costiveness, or at a later stage of the disease, foul-smelling evacuations, dizziness, headache, prostration. Generally the abdomen is soft. In this disease the pulse, although quick, is not hard and bounding, but rather soft, and sometimes irregular. The disease may be caused by exposure to a draught of air, sudden checking of the perspiration, over-eating, indigestible food, or food which does not agree with a person, etc. This disease generally runs a typical course. Very mild forms of gastric fever may terminate in recovery in twenty-four hours. More obstinate cases may get well in three or seven days. If the fever should assume a torpid character, it may last from two to three weeks, before perfect recovery is established. Under homoeopathic treatment gastric fevers are easily managed; under allceopathic treatment they may not only prove obstinate, but even dangerous diseases, ~L-ULCIII-4C-~-r~-~I-~~I~ 260. SPECIAL THERAPEUTICS. assuming a typhoid character, with tympanitic distension of the abdomen, parched and shrivelled appearance of the tongue, coldness of the extremities; small, feeble, filiform pulse, torpor, muttering delirium, involuntary evacuations from the bowels and bladder. If diarrhoea is a prominent symptom in gastric fever, the prospect of a speedy and thorough cure is less favorable than if the bowels are constipated. This may be said to be the case in all fevers. Even allceopathic physicians admit that this fact is substantiated by common experience, and yet they will persist in the foolish practice, if the bowels are confined during fever, of assailing them with cathartic and drastic medicines, thus destroying, in obedience to some obscure theory, one of the signs of a favorable prognosis, and substituting in its stead, by -violent and artificial means, an indication avowedly unfavorable and often dangerous. How often are homoeopathic physicians called upon to remedy the consequences of this disastrous system of medication! An incontrolable diarrhoea has to be arrested; an inflammatory irritation of the bowels has to be subdued; and sometimes the bowels become surcharged with the abominable compounds, the castor-oil, the rhubarb, the calomel and jalap, which work about in the intestinal canal without the torpid fibre being able to expel the mass. How magically will a single drop of the third or fourth attenuation of Aconite relieve the distressed patient from his embarrassment! The Aconite will speedily restore the contractile power of the fibre, and the contents of the bowels will be expelled, to the great comfort of the sufferer. It seems hardly necessary to remark that the patient should confine himself to the simplest diet, tea and toast, PARTICULAR INDICATIONS. 261 rice or barley-gruel, cracker-soup, etc., until the fever is fairly subdued and the symptoms of gastric irritation have subsided. Gradually a little broth with rice, farina, sago or barley may be taken, but without any fat; and if the tongue is quite clean and the alvine evacuations have assumed a natural color, meat-diet consisting of tender beef and mutton, may be gradually but very cautiously resumed. Relapses from over-eating may prove exceedingly troublesome and even dangerous in this disease, particularly if the disease is more or less prevalent and threatens to become epidemic. The principal remedies for this disease are ACONITUM, BELLADONNA, NUX VOMICA, PULSATILLA, BRYONIA, MEROURIUS VIVUS, IPECACUANHA, ANTIMONIUM CRUDUM, TARTARUS EMETICUS. Particular Indications. ACONITUM, for fever with quick and soft, rather swelling pulse, thirst, frontal headache, nausea, vomiting of bile, bloating of the pit of the stomach, tenderness of the epigastrium, sense of tension around the epigastric region, bitter taste, foul eructations, diarrhoea or costiveness, turbid urine. DOSE.-A few drops, or six globules in a tumblerful of water, a small tablespoonful every two hours, until relief is obtained, after which a few more doses may be given every four hours. BRYONIA: If Aconite should not afford much relief, and if the bowels are very costive, and the patient experiences a stitch in the pit of the stomach when making a wrong step. This medicine may be given after the Aconite or in alternation with it, in which case an alternate dose of medicine should be given every two hours. ~CI-----~-~-- 262 SPECIAL THERAPEUTICS. DOSE.-If Bryonia is given alone, the same as Aconite; if in alternation with Aconite, an alternate dose of each of the same quantity, every two hours giving the Aconite first. BELLADONNA: If the cerebral symptoms are very prominent, such as dull headache all over the head, or intense frontal headache as if the head would split, with sensitiveness of the eyes to the light, delirium, thick brown coating on the tongue, intense thirst, very dry mouth, and throat, drowsiness with starting, etc. DOSE.-Same as Aconite, until the cerebral symptoms seem subdued. NUx VOMICA: When there is little or no fever, but spasmodic vomiting, constipation, stinging sensation in the bowels, with great sensitiveness to the touch, acrid heartburn or risings. DOSE.-Same as Aconite. PULSATILLA, for bitter or foul taste; bitter, foul or sour eructations, vomiting of a sour phlegm, whitecoated tongue, diarrhoea or constipation, sense of coldness or shivering, headache. This medicine is particularly useful if the derangement is caused by eating fat pork, ices or fruits. DOSE.-Same as Aconite. MERCURIUS VIVUS, for white-yellowish coating on the tongue, giddiness and headache, as if the brain felt sore or would split; vomiting of bile, well marked evening exacerbations with chill and fever, violent thirst, constipation, or hard, dry, dark-brown fieces in lumps, or deepred soft stools or diarrhoea, yellow-colored urine or else copious watery urine, ptyalism, distension of the bowels, sense of warmth in the bowels; the pulse is soft, but quick. DOSE.-Same as Aconite. IPECACUANHA: For spasmodic vomiting of mucus, especially at night, with colicky pains in the bowels, GENERAL REMARKS, ETC. 263: especially when of a spasmodic nature as if the fingers were spread over the bowels and pressed in; stinging headache, white-coated tongue, diarrhoea. DOSE.-Same as Aconite. ANTIMONIUM CRUDUM, and TARTARUS EMETICUS: If the vomiting is exceedingly severe and spasmodic, with diarrhoea, loathing after eating, although the food may be relished, sensation as if a stone were laid across the bowels, with chilliness and watery diarrhoea; empty or putrid eructations; rising of a sour or saltish-watery fluid into the mouth; also colic as if the bowels would be cut, or tearing and pinching colic, meteorism. All such symptoms indicate more particularly Tartarus emeticus. D)OSE.-Dissolve one grain of the first trituration in a tumblerful of water, and take a dessertspoonful every two hours, until a decided improvement takes place, after which the medicine may have to be continued every four hours, or another remedy may have to be given. General Remarks about the Medicines and Diet. Scarcely a case of gastric fever occurs which cannot be cured with one or two medicines, one of which is generally Aconite. If the Aconite should be decidedly indicated, and the globules do not seem to produce the desired effect, then do not hesitate to use the tincture, one drop in a tumblerful of water, a small spoonful every four hours. In regard to diet, we repeat that it should be quite light, a little weak tea and toast, farina, gruels, rice, no raw fruit; even stewed fruit should be used very moderately and only during recovery. When the disease is fairly conquered, the patient may be treated to a little beef-tea, oyster broth without the oysters, and gradually he may resume heartier food. ~h/----~,~,'-----~----~------- 264: SPECIAL THERACEUTICS. Mucous Fever. Pathologically speaking there is very little difference between gastric and mucous fever, except that in mucous fever, the irritation of the mucous membrane extends not only over that portion which lines the intestinal canal, but very frequently involves the mucous lining of other organs, the urinary and sexual and even the thoracic organs. This fever may be much more obstinate and insidious than a purely gastric fever. At first its character may be more or less intermittent, but it soon assumes the remittent type. It runs an indefinite course; from a few days it may run on until weeks elapse before the patient's health is fully restored. As an epidemic, it often proves destructive to life, and shows a disposition to assume the character of typhus, with muttering delirium, buzzing in the ears, cloudiness of the head, stupefaction, hardness of hearing, subsultus tendinum (twitching of the tendons,) grasping at flocks. According to Schcenlein, the typhoid form of this fever is frequently distinguished by the breaking out of a whitish rash " consisting of fine, pellucid vesicles which are sometimes hardly perceptible to the eye, and the existence of which, upon the abdominal walls, is often recognized only by the roughness which the hand experiences in passing over the abdomen. The rash is preceded by profuse fetid sweats of short duration, affording no relief to the patient, and unaccompanied by any diminution of the fever or heat. " This condition is accompanied by symptoms of subacute peritonitis; the patients complain of slight colicky pains, either with constipation or slimy diarrhoea, and a __ MUCOUS FEVER. 265 feeling of numbness in the lower extremities, attended with occasional paroxysms of violent fever. Instead of miliaria, but less frequently, aphtha sometimes make their appearance. It is preceded by a fetid, sometimes cadaverous, smell from the mouth, vivid redness of the gums and buccal cavity, and by incipient ptyalism. In some cases, the whole of the abdominal mucus membrane is invaded by the aphthous exulceration, in consequence of which, tenesmus and shred-like evacuations set in." As soon as the remittent type of the fever is fully developed, we have all the symptoms which usually characterize inflammatory fever: burning heat and dryness of the skin, tense and hard pulse, red-colored urine. At the commencement of the disease, the patient feels chilly towards evening; in the night the skin feels dry and burning, the pulse is full and irritated. Towards morning there is a remission of the fever-symptoms. The prostration and frontal headache continue during the day. The intermissions cease after a while, and the fever becomes remittent, or even continuous. The gastric symptoms are very fully developed in this fever. The patient loathes all food, the stomach is distended, a feeling of oppression is experienced, which frequently results in retching and vomituritions. The coating on the tongue differs in the different stages of the disease. At first it is whitish or grayish-white, more or less thick, but sometimes very superficial. The tip and edges of the tongue are dark-red, having the appearance of raw flesh. At a later period, when the coating disappears, the whole tongue has this dark-red appearance, or looks as if covered with a coat of varnish. At first the tongue is moist, but becomes dry afterwards. This dryness is particularly marked in the evening. The 24 266 SPECIAL THERAPEUTICS. taste in the mouth is disagreeable, and the mouth feels as if filled with phlegm, which is often hawked up in long, ropy threads. During the first week, the bowels may be costive, but, at a later period, the patient may have several evacuations a day, consisting of undigested food, tenacious mucus, bilious matter, and fragments of worms. In the case of females, a tenacious, ropy mucus may even be discharged from the vagina, and the urine may likewise deposit a slimy sediment. If the disease ispermitted to run a natural course, it may last from one to six and more weeks. Under homceopathic treatment, the patient is never confined for more than one or two weeks. The remedies which have been indicated for gastric fever, may likewise prove applicable in this disease. Aconite is invariably resorted to, if the fever is high, the skin hot and dry, the pulse hard, full, jerking, tongue thickly coated, urine fetid, dark-red, and depositing a sediment; the patient is inclined to feel sick at the stomach, he complains of headache, looks flushed and sallow, feels very much prostrated. A drop or a few globules may be dissolved in a small tumblerful of water, and the patient may take a small table-spoonful of this mixture every two hours, until relief is obtained by copious perspiration, after which the medicine may be discontinued for a few hours, and afterwards resumed again every four or six hours, if the fever should continue. Mercurius vivus will prove useful, if the patient looks sallow, wants to drink all the time during the fever, the tongue has a dirty-yellowish or greyish coating upon it, the bowels are costive, or else the patient is troubled with a debilitating, excoriating, offensive diarrhoea; the -L~llll SPECIAL THERAPEUTICS. 267 urine has a strong, fetid odor, and a deep-yellow color, leaving a stain on the linen, and depositing a deep-red sediment. The appetite is completely gone, the patient complains of oppression in the pit of the stomach, and the patient feels particularly uncomfortable at night. The medicine is to be administered in the same way as Aconite. Arsenicum may be of great use if the fever is very high, the skin is burning hot, the patient complains of agonizing headache, the tongue is thickly coated, looks foul, the patient wants to drink all the time, little at a time, lest he should be made sick at the stomach; there is an expression of distress in the sallow-looking countenance; the patient complains of precordial anxiety, is exceedingly weak; the bowels are either costive and inclined to be tympanitic, or else the patient is troubled with a very offensive, watery or slimy, prostrating diarrhoea. This medicine should be given like the preceding one. If Arsenic should fail to afford the desired relief, and the fever is characterized by distinct intermissions (which is likewise a characteristic indication for Arsenic), we may try China, to be given like the preceding medicines. Pulsatilla is likewise useful, particularly if the patient is troubled with retching and vomiting of sour, acrid mucus at night. The bowels incline to be loose. A drop or a few globules may be given every four or six hours. The indications for Ipecacuanha, Bryonia and Nux vomica, are the same as those which have been given in the chapter on gastric fever, pages, 261, 262. If the typhoid stage should supervene, we have to 268 BILIOUS FEVER. resort to the remedies which will be found indicated further on, in the paragraphs on typhus. Diet: In regard to diet we have nothing to add to the remarks which have been very fully made in the preceding chapter on gastric fever. What has been said there, is likewise applicable to this disease. Bilious Fever. There is no essential difference between a bilious fever and the gastric or mucous fever above described; a gastric fever becomes a bilious fever, if the bilious symptoms predominate, showing that the irritation of the mucous surfaces has invaded the biliary apparatus. In this case the fever is more intense and assumes the character of a truq inflammatory fever, with a.full, hard, quick and throbbing pulse, very dry and burning skin, excessive thirst, desire for acidulated drinks, though not in every case; the countenance has an earthy, livid, somewhat jaundiced appearance, which is at times mingled with dark flushes; the coating on the tongue is at first of a pale-yellow color gradually changing to a deepbrown; the patient complains of a racking headache, with shooting pains in the forehead; he vomits up bitter bile; the epigastric region is bloated and sensitive to the touch, the abdomen is distendedi the bowels are either torpid, or else a foul-smelling, dark-brown or greenish diarrhoea is present; the urine has a deepbrown color, and sometimes looks almost black; the patient complains of excessive heat, and sometimes of a burning pain in the bowels and region of the liver. The first fever-paroxysm generally sets in with a _ __.__ BILIOUS FEVER. 269 violent chill, after which the fever makes its appearance. For some days, and, in some cases, during the whole course of the disease, this chill is experienced every day, generally towards evening, and is invariably followed by an exacerbation of the fever-symptoms. The pulse, during the fever, is always full and bounding, but sometimes intermittent, and even a double pulse (pulsus dicrotus), where one beat of the pulse seems to be divided in two. The character of the fever differs more or less, according to the constitution of the patient, the ruling type of disease, and other causes. It may be highly inflammatory, or simply erethic, with moderate heat and a moderate degree of vascular excitement, or the character of the fever may be torpid, with all the symptoms of typhus, muttering delirium, picking at the bedclothes, grasping at flocks, twitching of the tendons, frequent, small, and intermittent pulse, collapse and alteration of the features, livid complexion, dry, brown, and even blackish coating of the tongue, excessive prostration, rapid emaciation, foul, more or less involuntary evacuations from the bowels, fetid, black-looking urine. The disease may last from one to two and even six weeks; the milder forms of this fever generally run their course in one or two weeks, and very frequently in three or four days; if typhoid symptoms supervene, the fever may last three, four andrgven six weeks. In this fever the same medicines may be used which have been recommended for gastric and mucous fever; the main remedies, however, in most cases, will be found to be: Aconitum, Bryonia, Chamomilla, Arsenicum, Mercurius vivus, China, Pulsatilla, and in the typhoid form 24* 270 SPECIAL THERAPEUTICS. the medicines which are recommended for typhus generally. Aconitum is administered, if the pulse is full, hard, bounding, the skin is hot and dry, the fever sets in with a chill; these symptoms are characteristic indications for Aconite in every fever. DOSE.-A few drops, or ten globules to be mixed in about ten tablespoonfuls of water, of which solution the patient may take a small tablespoonful every hour, until an improvement is effected, after which, the medicine may either be continued at longer intervals or, if necessary, another remedy may be selected. Arsenicum should be given, if the pulse is rapid, hard, full and bounding, the headache is excessive, the face looks sallow, or of a dark jaundiced appearance; the patient is obliged to vomit up bile every now and then, with excessive retching, nausea, and attended with a feeling of agonizing anxiety; the skin is burning-hot and dry, with coldness of the lower extremities, excessive restlessness, unquenchable thirst, prostration, evening and night exacerbations, delirium, constipation or foul diarrhoea, fetid urine which looks very dark. DOSE.-The same as Aconite; these two medicines may be given in alternation, a tablespoonful every hour. iMercurius vivus: Evening exacerbation, chilliness, followed by fever, excessive thirst, dry and yellowish or grayish-coated tongue, sickness at the stomach, headache, dizziness, constipation, or else loose bilious stools, deep-yellow or brown urine having a fetid smell or sometimes smelling like burnt sugar. DOSE,-Same as Aconite. Chamomilla: This medicine is especially useful, when the attack is caused by unpleasant emotions such as anger, mortification in consequence of an insult. It is particularlarly indicated by the following symptoms: REMARKS ON GASTRIC AND BILIOUS FEVERS. $71 soft and quick pulse, jaundiced color of the face, agooizing headache, red and hot countenance, violent thirst, bitter taste in the mouth, frequent bitter eructations, retching, vomiting of bile, bloating of the pit of the stomach, twisting and griping pain in this region, offensive, bilious stools, oppression of the chest, burning heat of the body. DOSE.-Six globules in a tumblerful of water, a tablespoonful every two hours, until relief is obtained. The indications for Bryonia, China, Nux vomica and Pulsatilla have been given under gastric and mucous fever, to which the reader is referred. General Remarks about the course of Gastric and Bilious Fevers, the Diet and Treatment to be pursued in these Diseases. Gastric and bilious fevers run a certain course before recovery is effected. Ordinary cases may complete their course in three or four days; but such fevers may likewise las. tfrom one to two and even more weeks, and may finally assume typhoid character, in which case the probability is that the fevers were disposed from the commencement to run into this form. The course of these fevers may be considerably shortened by judicious treatment. In regard to diet, it should be observed that the patient may drink as much cold water as he likes, and if the skin is very hot and dry, sponging the skin with tepid water is exceedingly soothing. The diet should be light and stimulants should be strictly discarded. Gruels, tea and toast, hominy, toast-water, and if otherwise admissible, apple-sauce, baked apples, stewed prunes, and the like, may be taken by the patient. During recovery beef-tea, chicken-tea, broth, and gradu ____ ~---_-~~------------D--~ _ I ~I 272 SPECIAL THERAPEUTICS. ally a little meat, roast mutton, beef, etc., but no fat or raw fruit, should be selected. The first medicine to begin the treatment with, is, in almost all these cases of fever, ACONITE, and this medicine should not be discontinued until we feel sure that all the good has been obtained from it which it is capable of accomplishing; we may have to recur to this medicine again and again in the course of the disease, after other medicines have been used. A second medicine, with which the treatment has to be commenced in some cases, is MERCURIUS, especially if we know from our previous knowledge of the patient's system, that Mercurius is a medicine generally adapted to his condition and to the derangements to which it may be liable. ARSENICUM should commence the treatment, if the attack sets in with excessive prostration, tendency to stupor, delirium, deep flushes in the face, dark sallow complexion, anguish. OPIUM may have to be given in this disease, if the brain seems to be considerably involved, and a comatose stupor is developing itself, with sour vomiting, bloating and redness of the face, glistening eyes, staring, dilated or contracted pupils which are almost insensible to the light. Half a dozen globules may be dissolved in a tumblerful of water, and a tablespoonful may be given every hour until the coma is effectually relieved. If necessary a drop of the tincture may be substituted for the globules, to be used in the same manner. Aconite, Arsenicum, Chamomilla, and Mercurius will generally be found sufficient to control almost any case of bilious fever. - --------~L~--- ~ i~____~ CONGESTIVE FEVER, 278 Congestive Fever. This species of fever is principally met with in warm, newly settled countries. It sets in with a sudden attack of vertigo and headache, faint feeling and debility, nausea, vomiting, chill followed by heat and thirst. Gradually the symptoms get worse, the fever-heat becomes more burning, the headache agonizing, the brain feels as if it were on fire and would fly to pieces, or as if a red-hot iron band surrounded the head; and the sensitiveness to light and noise is so excessive that the slightest vibration, even from a person walking about in the room, excites the most intense suffering. The bowels are constipated and the urine is highly-colored. There is a regular exacerbation every day, generally a few hours after the sun is up and begins to rise in the heavens. The evenings are more comfortable, but the patient is deprived of sleep, and wants to drink all the time. Every attack terminates in profuse perspiration. The fever runs a natural course of.about nine days, after which it gradually abates. This disease is generally treated with massive doses of calomel by allceopathic practitioners, and thousands of otherwise healthy and vigorous constitutions are destroyed by this murderous practice. This fever is really a derangement of the biliary functions, and might very properly be termed an acute bilious remittent fever. The intense burning heat in the brain and the horrible agonizing headache are caused by the irritating presence of bile in the cerebral tissues. This disease is combated in homoeopathic practice by the following medicines: Aconite, Belladonna, Ipecacu- 1-~.......... C~ --- 274 SPECIAL THERAPEUTICS. anha, Mercurius, Arsenicum, Quinine, and the use of cold and tepid water. ACONITE may be given at first when the first attack, vertigo, headache and vomiting, with chill and fever set in. DOSE.-A few drops, or six globules in a tumblerful of water, a tablespoonful every two or three hours. If this medicine should produce a marked improvement, and the next attack be considerably less, the Aconite may be continued; but if a change of medicine should be required, one of the following medicines may be given: BELLADONNA, when there is excessive sensitiveness to light and noise, burning heat in the brain, severe thirst, glowing redness and swelling of the face. DOSE.-Same as Aconite. IPECACUANHA, if there is much vomiting of phlegm and bile, and the attacks are more evidently of a typical nature, consisting of a distinct chill, followed by heat and thirst, and lastly profuse sweat. DOSE.-Same as Aconite. ARSENICUM, if Belladonna should not seem to afford the desired relief, and for the same symptoms as Belladonna; when there is, moreover, excessive and agonizing vomiting of bile, and great prostration, with burning thirst. DOSE.-Same as Aconite. MERCURIUS, when, beside the usual symptoms, the epigastric region is bloated, the sweat smells sour, and the attack was preceded for some days by an acrid, bilious, bloody diarrhoea; the alvine evacuations are either suppressed, or else soft and of a deep-yellow or brown CONGESTIVE FEVERS. 275 color, or hard; the urine looks deep-yellow, and has a strong, fetid odor, DOSE.-Same as Aconite. QUININE is undoubtedly an excellent remedy for this disease when, as was stated under Ipecacuanha, the symptoms indicate a typical course, and every attack is ushered in by a violent chill, with intense thirst, and followed by burning heat, excruciating headache, and lastly profuse sweat. DOSE.-Begin with the first trituration of Quinine, decimal scale; and give a powder of the size of a five cent piece, dry on the tongue, immediately after the sweat has begun to break out, repeating the dose every two hours. If the next attack should be considerably modified, continue this treatment until the fever is effectually subdued; but if no impression is made upon the disease, and quinine should still be indicated, do not hesitate to use the quinine in substance, giving a grain of Quinine at a dose, every two hours, and commencing as soon as the sweat begins to appear. Allow the patient the free use of cold water, and promote by this means the perspiration. Physicians who have never treated this fever, cannot form a just idea of its vehemence. In some parts of our country it is dreaded as much and even more than yellow fever. We have seen and treated this disease in its most horrible forms on the prairies, and we can therefore assert from experience, that it requires a definite mode of treatment, and more particularly that the use of Quinine in substance is sometime indispensable. The heat in the brain, and the headache are no counter indications to Quinine. The use of water, in this disease, is sometimes invaluable. The sweating process, as described in the hydropathic portion of this work, should be employed twice a day. We assure the reader that it is a most important auxiliary of the homoeopathic treatment of this dreadful affection. For diet and general hygienic management, we refer the reader to the articles on Gastric, Mucous and Bilious Fevers, s I - -1 276 SPECIAL THERAPEUTICS. Intermittent Fevers. Fever and Ague. These fevers constitute a peculiar class of nervous affections, and are distinguished by paroxysms of chills, fever and sweat, and perfect intermissions, or periods of apyrexia or absence of fever. Generally, the paroxysms return at regular periods, sometimes every twenty-four hours, in which case the fever is termed quotidian; or every forty-eight hours, in which case the fever is termed tertian; or every seventy-two hours, to which form the appellation of quartan is given. There are a few cases where the paroxysms have been known to return every seven days; or two paroxysms may take place within each of the above-named periods of time, in which case the fever is designated as double quotidian, double-tertian, double-quartan, etc. A fever is said to have double paroxysms, when every third paroxysm is similar in regard to time, violence and duration. Intermittent fevers are also termed fever and ague, because every paroxysm is composed of a chill, followed by heat and sweat. We will now mention some of. the principal medicines which have been used and recommended for intermittent fever. As a general rule, it is best to give the medicine after the fever-heat begins to subside and the sweat has broken out upon the skin. These fevers are not always cured so very easily, especially in recently-settled countries, or in districts where they are endemic diseases, in consequence of the malaria with which the air is impregnated. These malaria generally emanate from the immense quantities of decayed vegetable matters floating upon the surface of rivers and stagnant water, or constituting the superficial _ ~ ~_~ _ ~__~ 1_~_~_____ _ _ i ~ ~ __i INTERMITTENT FEVERS, ETC. 277 black soil of the country. Moreover, the paroxysms are not always clearly marked from the first, and a few paroxysms have to be allowed to escape before the character of the disease becomes apparent beyond a doubt. Such fevers are very frequently attended with symptoms of congestion, or even inflammation, such as pain in the back, headache, toothache, congestion of the lungs, colic; and with nervous symptoms, such as palpitation of the heart, depression of spirits, trembling. It may likewise be proper to inform the uninitiated reader that, during the period of the prevalence of fever and ague, it may happen that a person is attacked with some isolated symptom of pain-for instance, a peculiar condition of the brain, denoting a state of congestion; or a distressing pain in the back, for which the usual treatment seems to be insufficient. If these pains break. out at regularly recurring intervals, thereby "revealing a certain typical character, the probability is that these pains are vicarious manifestations of the prevalent epidemic, and will therefore have to be treated as the original disease, with the remedies which have proved specific for it. After these preliminary remarks, we are prepared to furnish the symptomatic indications of the various medicines which have been employed for fever and ague with more or less success. The principal remedies for fever and ague are the different preparations of Peruvian bark, the principal of which is the alkaloid, known under the names of Quinine, Sulphate' of Quinine, Chininum sulphuricum. A great many homceopathic physicians seem averse to the use of this drug; but in our country the use of Quinine is indispensable. In those parts where intermittent 'fevers are prevalent, in the South, West, and Southwest, 25 _ ~ ___ 278 SPECIAL THERAPEUTICS. it would be utterly impossible to get along without Qui nine. Physicians who would undertake to cure fever and ague without Quinine, would injure their practice by jeopardizing the lives of their patients. All intelligent homoeopathic practitioners are fully aware of this fact, even those who use the high potencies. We can assert in all fairness, from our own and other physicians' experience, that even in our part of the country, many fever and ague patients leave their phy. sicians, or send for allceopathic physicians, because week after week elapses, under the use of the globules, and no impression is made upon the disease. This is all wrong, and no physician should be so far blinded by prejudice, or even by the dazzling authority of Hahnemann's example, as to expose himself to unnecessary disappointment and the loss of influence, time and money, by sacrificing his patients to a baseless abstraction. We therefore recommend Quinine, not only as a proper, but as an indispensable remedy for fever and ague, and offer the following advice concerning the DOSE.-Give one grain of the first trituration, every two hours, until shortly before the time when the second paroxysm is repeated. If it should not come on, then discontinue the medicine for the time that the first paroxysm lasted, and then resume again for another day. Intermittent fever having a greatinclination to reappear on the seventh, fourteenth, twenty-first, twenty-eighth, and forty-second day, it is of great importance to repeat the last medicine during one paroxysmal term, or for about twenty-four hours previous to each of the above named periods. If the next paroxysm should break out in a much milder form, continue the same preparation until the fever is entirely subdued. But if the next paroxysm should be more violent than the previous one, then resort to the Quinine in substance without any hesitation, and give it in grain doses, one dose every two INTERMITTENT FEVERS, ETC. 279 hours, and if the paroxysms should be of the quotidian type, repeat the dose every hour. The Quinine may either be given dry on the tongue, mixed with sugar, or else each powder may be dissolved in a little alcohol, and then mixed with a spoonful of fresh water and sweetened with sugar or some gum syrup. It is sometimes necessary to give from twelve to fifteen grains of Quinine between two successive paroxysms in order to prevent their recurrence. If patients desire it, it is perfectly proper to try first the globules of Cinchona or China as homceopathic physicians term it, dissolving six globules in a tumblerful of water and giving a tablespoonful every two hours. This is frequently sufficient, or the tincture of Cinchona may be tried, one or two drops in a tumblerful of water, a tablespoonful every two hours. Either of these preparations has cured fever and ague, but the Quinine is undoubtedly the most reliable. The symptoms by which either Cinchona or Quinine is characteristically indicated, are: a drawing in the bones, desire to stretch one's-self, coldness, shivering or chill, with or without shaking, chattering of the teeth, blue nails, excessive thirst during the cold stage and continuing during the heat and sweat; coldness of the extremities, sickness at the stomach, vomiting, oppression, congestion of blood to the head, heat all over, with flushed face, dizziness, headache, especially in the back part of the head, throbbing in the head, palpitation of the heart, pappy, doughy taste in the mouth, colicky griping pains in the bowels, pain in the spine, bloating of the epigastric region, and even of the region of the liver, prostration, constipation. Sometimes the attacks commence with a ravenous appetite, . ---~ 280 SSPECIAL THERAPEUTICS. sneezing, and other accessory symptoms, which, in children, may simulate worm symptoms. IPECACUANHA is another important remedy for fever and ague, and is given by many homoeopathic phy. sicians in most cases, a few doses after the paroxysm, and before the Quinine is commenced; or it is given alternately with the Quinine, giving two doses of Qui.nine in succession, and the third dose a dose of Ipecacuanha, then again the Quinine, and so. on. It is principally indicated by vomiting, chills followed by fever, oppression on the chest, repugnance to food, thickly-coated tongue and various other symptoms of gastric derangement. DOSE.--A few drops, or six globules in a tumblerful of water, a tablespoonful every two hours. ARSENICUM is indicated by excessive prostration accompanying the paroxysm and setting in suddenly; excessive anxiety, oppression, palpitation of the heart, violent vomiting of bile followed by great exhatstion, burning heat after the chill, intense thirst. In many of our Western States, patent fever and ague pills are sold in immense quantities. Most of them contain Arsenic and very speedily arrest the feverparoxysms. If Quinine does not succeed in effecting this result, Arsenic will generally prove adequate-to this task. In most cases it will be found necessary to use this drug in doses of one-hundredth and even onetwentieth of a grain. We have known case after case where one-tenth of a grain was prescribed with success and without any inconvenience to the patient. It is not advisable, however, that lay-practitioners should venture upon this species of heroic treatment. We would advise them to first try Arsenic in the dose indicated for Ipe. iY_ INTERMITTENT FEVERS, ETC. 281 cacuanha; if this should fail, and the medicine is still indicated, larger doses may be resorted to. Nux VOMICA is given for the following symptoms: chilliness, heat with headache, nausea, tingling in the ears. Or, internal heat at night, external chilliness, dryness of the mouth and loathing of drinks. Or, chilliness with blue nails, followed by long-lasting heat, and accompanied with violent thirst and stitches in the temples. Or, slight chilliness followed by heat and thirst, headache, vertigo, red face, vomiting, dark urine, pain in the chest; partial sweat after the heat. Or, fever with vertigo, anguish, chills, delirium, distension of the stomach. Or, intermittent fevers characterized by a sense of paralysis in the commencement of the fever. Or, intermittent fevers with stitches in the side and abdomen. DOSE.-Same as Ipecacuanha. Eupatorium perfoliatum, or boneset, is an excellent remedy for fever and ague. This remedy was used as a specific remedy for a peculiar epidemic which raged in this country half a century ago, more particularly in the State of Pennsylvania, and which, from the pain in the bones that was constantly present in this disease, was termed break-bone fever. Copious perspiration was a frequent attendant of the fever, in spite of which boneset, which excites perspiration, was given. We find it stated in the first volume of the Transactions of the American Institutes of Homoeopathy, that "this herb is one of the remedies, and perhaps the principal one employed by the aborigines of this country, in the treatment of intermittent fevers, and hence another of the 25* 282 SPECIAL THERAPEUTICS. common names by which it is known among us, agueweed, which corresponds to the Indian name." "In miasmatic districts, along rivers, at fisheries, on marshes and their several neighborhoods, where intermittent and remittent fevers have prevailed epidemically, the Eupatorium has been a favorite remedy with the most successful practitioners, as well as a deservedly popular one in the hands of the people, very often superceding the necessity of calling in medical aid, especially where such aid could not readily be obtained." A few drops of the tincture of Eupatorium may be mixed in a small tumblerful of water, and the patient may take a tablespoonful of this mixture every few hours. A favorite mode of prescribing Eupatorium is in the shape of a tea, of which a small cupful may be drank two or three times a-day. These are the principal remedies for fever and ague. The following medicines have likewise been used with more or less success. The dose for all these medicines is the same as indicated for Ipecacuanha. ANTIMONIUM CRUDUM: When gastric and bilious symptoms prevail, such as nausea, vomiting, bitter taste in the mouth, and little thirst, or even when these symptoms exist during the apyrexia. ARNICA: For chills followed by heat, thirst during the chill, the patient drinking a good deal; during the hot stage the patient likewise feels thirsty, but drinks little. BELLADONNA: Slight chills, no great heat of the skin, then sweat, or, not much chilliness, but a good deal of dry heat, without thirst, or when there is no thirst either during the chilly or hot stage, or when the chills come INTERMITTENT FEVERS, ETC. 283 in the forenoon and the heat in the afternoon; or, when there are several attacks of fever during the day, chills followed by general heat, and then sweat without thirst; or, when the chills come in the night followed by heat and sometimes vertigo and thirst; or, when the whole nervous system is exceedingly irritated. BRYONIA: Chills, heat, then sweat, thirst only during the whole stage; or, when the cold stage prevails; or when the fever is accompanied with stitches in the side and abdomen; constipation. CAPSICUM: General heat and sweat without thirst; then chills, shaking, chattering of teeth, coldness of the whole body, anxiety, uneasiness, inability to use one's senses, intolerance of noise; thirst only during the cold stage; no thirst during the hot stage. CARBO VEGETABILIS: Violent tearing in the teeth and bones, followed by a cold sensation pervading the parts; then heat in the head, a little thirst, lastly sweat and swelling in the region of the stomach. CAUSTIOcu: Chills, heat with violent pain in the joints, cutting pain in the back. CHAMOMILLA: Fever, with gastric or bilious symptoms, burning cheeks, starting during sleep, great heat which lasts a long while, with thirst. CINA: Fever, with vomiting and ravenous hunger, or hunger only during the apyrexia. CoccULus: Fever, with obstinate constipation and spasms of various kinds, especially of the stomach. MEZEREUM: Chills accompanied with asthmatic contraction and tightness of the chest in front and behind; or, the cold stage is characterized by dryness in the back part of the mouth, with accumulation of saliva in the forepart, without any desire for drink. -~~.-- r I 2841 SPECIAL THERAPEUTICS. DIGITALIS: redness and heat of the face, with chilliness of the remainder of the body. FERRUM: Congestion of blood to the head; distension of the veins; bloat around the eyes; pressure at the stomach and in the abdomen after a slight meal; asthma caused by distension of the bowels; vomiting of the ingesta; paralytic weakness. HELLEBORE: Burning heat over the whole body, especially about the head, accompanied with internal chills, without thirst; can only drink little at a time. HYOSCYAMUS: Quartan fever with dry cough at night; or, when the coldness is the prevailing symptom, with pain in the back; or, burning heat of the whole body, with much thirst, foul taste and a quantity of phlegm in the mouth. IGNATIA: Fever-pains which can be relieved by external warmth; or, heat of some parts and coldness of others; or, thirst only during the cold stage; or, chills with thirst, followed by heat with icy-cold feet. LYCOPODIUM: Shaking paroxysms, with icy-coldness, accompanied with drawing through the whole body; then sleep, and sweat on waking. Tertian fever, with sour vomiting; puffiness of the hands and face after the chills. MERCURIUS: Alternate heat and sense of coldness over the whole body, with failing of strength; or, heat and chilliness continually intermixed; when out of bed the patient feels chilly, when in bed he feels hot; or, excessive palpitation during the sweating stage, the sweat having a fetid or sour smell. NATRUM MURIATICUM: Chilliness followed by heat and excessive headache, as if the head would burst; or, chilliness followed by heat, accompanied with obscura --C--~l~~~l~-~llllll~-~11~~--~1~ INTERMITTENT FEVERS, ETC. 285 tion of sight, stitches in the head, thirst, little or no sweat. NITRIC ACID: Chilliness, heat and violent sweat; no thirst in either stage. OPIUM: Fever with stupor, snoring with the mouth open, twitchings of the limbs, and burning heat of the sweating body. PHOSPHORUS: Chilliness followed by heat and thirst, accompanied by internal chilliness, or else heat and thirst, accompanied by internal chilliness, or else heat and sweat, followed by chilliness and imparting a sense of coldness to the hands when touched by them; the chilliness being again succeeded by heat whilst the external coldness continues; the presence of diarrhoea is a characteristic indication of Phosphorus. PHOSPHORIC ACID: Chills, followed by an excessive dry heat; or, chills, followed by heat in the face, dryness of the mouth, and stinging pain in the throat when swallowing. PULSATILLA: Chilliness followed by heat and drawing in the bones, thirst only during the hot stage. Or, vomiting of mucus in the commencement of the cold stage, absence of thirst in the hot and sweating stage, mucous diarrhoea during the apyrexia, with nausea and want of appetite. Or, shivering followed by burning heat with thirst, startings when on the point of falling asleep, violent pains resembling labor-pains, soreness of the whole body, and watery diarrhoea. RHUS TOXICODENDRON: Chilliness with thirst, general heat, with livid complexion, sweat after the warm stage, the sweat being preceded by tearing in the left lower limb, pain in the small of the back and right lower 1 _ I 286 SPECIAL THERAPEUTICS. limb. This remedy is also indicated by nightly diarrhoea and cutting pains in the bowels. SABADILLA: Chilliness, sweat, which becomes very profuse. Or, when a dry and convulsive cough prevails during the cold stage, the chilliness being divided off into paroxysms. SAMBUCUS: Chills followed by heat, and profuse sweat during and after the hot stage, or exhausting sweats during the apyrexia. SPIGELIA: Fevers, where some parts are affected with a feeling of heat, and others feel cold to the touch. Or, when a badly-smelling sweat breaks out during the hot stage all over the body, and lasts all night. STAPHYSAGRIA: Fevers consisting only of the cold stage, without thirst or subsequent heat. Tertian fevers, with symptoms of scurvy, putrid taste in the mouth, bleeding gums, want of appetite and constipation. SULPHUR: Internal heat and redness of the face, simultaneously with chilliness; weary and bruised feeling in the limbs accompanied with great thirst, afterwards sweat all over the body. Or, heat mingled with chilliness, and accompanied with continual palpitation of the heart. Or, chilliness, exaltation of the fancy, and lastly, heat and profuse sweat. Or, chilliness which cannot be relieved by the warmth of a stove. VERATRUM: Fever consisting merely of the cold stage. Or, coldness with internal heat, dark urine and cold sweat. Or, nightly chills with violent pain in the small of the back. Or thirst, with alternate chilliness and heat; afterwards heat with unquenchable thirst, delirium, redness of the face, and constant slumber; finally, sweat and paleness of the face. DIET:. The patient should be allowed to drink as TYPHOID FEVER, ETC. 287 much cold water as he pleases; if he should crave acidulated drinks, such as a weak lemonade, or a little currant-jelly mixed in water, they may be given. Use spare diet, no meat, although broth may be taken during the apyrexia. The bowels should be kept open either by using such food as will move them naturally, such as apple-sauce, stewed prunes and the like, or by means of injections of tepid water. An injection may be used every day. If the bowels are allowed to remain bound, a relapse is very apt to take place. To these remarks regarding the treatment of fever and ague, we would append a few words of advice concerning the management of the chilly stage. Some of the most experienced physicians in the Western and South-western States, where the marsh-intermittents frequently terminate fatally in consequence of the violent cerebral congestion which characterizes the cold stage, are in the habit of giving Aconite during this stage, in order to counteract this overloading of the brain and avert the danger of apoplexy. A few drops of the tincture may be mixed in about ten tablespoonfuls of water, of which the patient may take a tablespoonful every fifteen minutes, or every half hour until a favorable reaction seems fully developed, after which the Aconite may be discontinued until the next chill, if it should arise. Typhoid Fever, Malignant Remittent Fever. This fever is a species of remittent fever arising more particularly from an irritation of the medullary substance. It is characterized by distinct exacerbations, which generally occur in the evening. This fever is r~--------------------~--------- __ 288 SPECIAL THERAPEUTICS. frequently mistaken for typhus; but it is not true typhus; hence the remedies which are our chief dependence in typhus, are not always 'appropriate in this disease. The attack sets in with a chill, followed by a dry heat and debility; the patient complains of a feeling of sickness, and malaise all through his frame. The first invasion of the disease is generally accompanied with a sense of apprehension and anxiety. The symptoms which characterize this fever, indicate a disturbed condition of the circulation and of that portion of the nervous system upon which the circulation seems more particularly to depend. Hence there is generally a sense of weight, fulness or oppression in some organ. If in the brain, it is generally in the small brain or cerebellum, at the occiput, and is attended with a sense of aching pain. If in the lungs, the oppression is accompanied with dyspnoea, anxiety, and frequently with palpitation of the heart. The irritation may localize itself in the cerebral nerves or in some portion of the spinal column, generally in the lower or upper, but sometimes also in the middle portion, in which case the organs which receive their sentient and motor powers from those diseased portions of the spinal marrow, are likewise affected, and experience corresponding functional derangements. If the cerebral nerves are the chief focus of the irritation, the patient will.be troubled with drowsiness, vertigo, frothing at the mouth, deafness, dimness of sight, or impaired condition of some other special sense; if the spinal nerves are the seat of the disease, the patient experiences oppression of breathing, anxiety, palpitation of the heart, weight and fulness at the stomach, constipation, difficulty of voiding the urine. _~~~ _____~ TYPHOID FEVER, ETC. 289 The tongue is not as thickly or as darkly coated as in typhus, nor has it generally the same dry, leathery, glazed, raspy feeling which we observe in typhus; there is very little, if any, delirium, but the patient frequently looks frightened, gloomy or melancholy. Prostration and gradual wasting of the flesh are prominent symptoms. The pulse is at first rather full and bounding, but soon changes to a soft and quick pulse, and, as the disease progresses and develops its typhoid: form, symptoms of decomposition of the fluids manifest themselves and the pulse becomes wiry and more rapid. In the highest development of the disease the alvine discharges assume a putrid character and have an offensive smell, the urine becomes very dark, blackish and fetid, the skin is cold and clammy, the gums and nose discharge a blackish blood, and death gradually takes place from paralysis. This disease may be considered. as the type of those diseases which the humoral pathologists set down as diseases of the blood. Acute influenza, cholera, the black vomit and yellow fever, when assuming a rather chronic type, exhibit a train of symptoms strictly resembling the typhoid fever, which forms the subject of this article. Experience and a careful analysis and comparison of the morbid phenomena with the physiological action and manifest effects of the ACONITUM NAPELLUS, have confirmed us in the belief that this drug, which, to employ a technicality of the humoral pathologists, is really and truly the specific remedy for their so-called diseases of the blood, is one of the leading remedies for typhoid fever. It has never failed in our hands to produce striking curative results in this disease; in most cases all that we have found necessary to use besides 26 290 SPECIAL THERAPEUTICS. Aconite, was fresh air and water, either cold or tepid. The treatment may be commenced with the third attenuation of Aconite, dissolving half a dozen globules or a few drops in a tumblerful of water, a tablespoonful three or four times a day. If copious perspiration should soon set in, two or three doses a day are sufficient. If the local symptoms, however, such as weight, fulness, oppression, aching pain, should be very troublesome, we at once resort to the tincture of Aconite, using in this disease, invariably, the concentrated tincture of the root, one drop, or, if this should cause sickness at the stomach or make the patient nervous and restless, half or even quarter of a drop, in a tumblerful of water, a tablespoonful four or five times a day until relief is obtained. The concentrated tincture from the root is absolutely necessary in this disease; this tincture contains the active resinous principle of Aconite intensified as it were, and will meet the character of the existing disturbance of the nervous functions and the consequent alteration of the blood. In conjunction with the use of Aconite we have the patient sponged from head to foot three or four times a day with tepid, or, if it should feel pleasant to him, cold water, taking care to have fresh and perfectly dry linen put on him after every washing. The room where the patient is confined, should likewise be properly ventilated, in such a manner, of course, that the patient is in no wise exposed to the draught. Nor should the room be too warm; from forty to forty-five degrees F., is a sufficiently high temperature in this kind of fever. With this treatment the disease may last from one to three weeks; but it runs, comparatively speaking, a mild course, and, if the patient's diet, which should be per TYPHOID FEVER, ETC. 291 fectly simple and free from all stimulants, be properly attended to, and he be not disturbed by conversation or any other kind of improper excitement, there is every chance that he will recover without any subsequent derangements or debility. Cases, however, may turn up in which the Aconite is only partially useful. Such exceptional cases may require: MERCURIUS VIVUS, VERATRUM, ARSENICUM, ARNICA, BRYONIA, BELLADONNA, or RHUS TOXICODENDRON. MERCURIUS VIVUS may have to be exhibited, if the patient complains of intense pain in the back part of the brain, and feels so cold that he requires the room to be heated by fire, even in hot summer, and the least decline of the temperature of the room makes him feel chilly. The weakness is not so great, but the bowels are quite torpid, the urine has a deep-yellow color, the tongue is coated with a dirty-looking, whitish-gray mucus, the patient looks sallow, and the sweat smells sour. DOSE-Six globules in a tumblerful of water, a tablespoonful every two or three hours; instead of the globules a few drops of the liquid attenuation may be given. VEBATRUM may be given with advantage, if the patient complains of coldness without desiring an increase of temperature, and of pain in the bowels, as though they were tied up in a knot. DOSE.-Same as Mercurius. ARSENICUM may be resorted to in case the symptoms of disorganization of the fluids, such as foul discharges from the bowels and bladder, bleeding of the gums, coldness of the skin and clammy sweat, should develop them-.elves in a more marked manner: DOSE.-Same as Mercurius. 292 SPECIAL THERAPEUTICS. RHUS TOXICODENDRON is indicated by the same symptoms as Arsenic, if symptoms of paralysis, numbness, etc., supervene. DOSE.-The same as Mercurius. ARNICA is indicated by foul taste in the mouth, thick, dirty coating on the tongue, eruption of little boils in various parts of the body, feeling of soreness all over the skin. DOSE.-Same as Mercurius. BRYONIA may be required when the gastric symptoms, such as sense of tumefaction and fulness in the epigastric region, bitter taste in the mouth, yellowish or brownish coating on the tongue, bitter eructations, bitter vomiting of bile and water, are predominant. DOSE.-Same as Mercurius. BELLADONNA corresponds more particularly with cerebral symptoms, or with symptoms indicating a derangement of the cerebral functions, such as distressing headache, incipient delirium, staring look, stupor, or excessive wakefulness, etc. DOSE.-One drop, or three globules dry on the tongue, every six hours, until a decided improvement in the condition of the brain becomes manifest, when the Belladonna may have to be replaced by some other remedy. Belladonna is seldom required in strictly typhoid fever. Gastric, mucous, or bilious fevers, frequently assume a typhoid form, and this is commonly denominated the typhoid stage of these fevers. Whenever this occurs, the typhoid character most probably existed from the very commencement of the disease, and, instead of simply being a gastric or bilious fever, the disease should have been set down as true typhoid fever, characterized by a more prominent development of the gastric or bilious symptoms. The remedies indicated for typhus will be found adapted to such conditions. TYPHUS FEVER. 293 DIET.-The diet should be sparing, and extremely simple; typhoid patients have no appetite for anything, except during convalescence, when the appetite sometimes becomes ravenous. At such times they should be cautious, and not at once indulge in hearty food or overload the stomach. For a week after recovery, the patient should content himself with broth without fat, hominy, light vegetables, such as cauliflower, potatoes, roast or baked apples, pears; he may likewise eat a little roast meat once a day, and gradually, in the second week, he may return to his customary diet. Typhus Fever. This disease, which is well known even to laymen, involves more particularly the functions of the higher or interior portions of the nervous system. Ttyphus is distinguished by the characteristic property of running a definite course, consisting of typical periods or stages, from one to two, three, four or six weeks' duration. This fever cannot be cured, in the same sense as we cure an inflammation; if the fever has once entered upon a typical period, it will run to the end of it, even if the treatment should be perfectly adapted to the nature of the disease, and the remedies which we use should exercise a specifically curative influence. There are varieties of typhus which derive their names from the principal locality or focus of the disease, or from the character of the malady itself. Thus we have cerebral typhus, if the brain seems to be principally involved; pulmonary typhus, if the lungs are the chief focus of the disease; hepatic typhus, if the liver, and abdominal typhus, if the bowels are principally affected. 26* 2941 SPECIAL THERAPEUTICS. On. the other hand, we have inflammatory typhus, if the fever has the inflammatory character; stupid typhus, if the character of the disease is stupor; torpid typhus, if torpor or paralysis is the characteristic feature of the disease; putrid typhus, if symptoms of decomposition of the animal fluids are prevalent; petechial typhus, if, in the course of the disease, petechiae, or spots arising from the extravasation of a dark, disorganized blood into the subcutaneous cellular tissue, make their appearance upon the skin; and so we may have malignant or epidemic typhus, hospital or jail-typhus, ship-typhus, or ship-fever, and various other denominations of typhus, all of which, are more or less characterized by similar symptoms, and require a more or less similar mode of treatment. Typhus may be induced by various causes, but it is more particularly engendered in crowded, ill-ventilated, filthy localities, on ship-board, in hospitals or crowded districts situated in damp and hot regions, where miasmatic exhalations are abundantly developed by the action of the sun's rays. It may likewise result from sudden and great 'exposure, as from throwing off one's coat while in a state of profuse perspiration, and exposing one's-self to a keen draught. The constant use of bad water and vitiated food may likewise give rise to this disease. Typhus does not set in all at once in all its fury. At first it may look like a catarrhal or rheumatic fever, with pain in the bones and joints, sore throat, swelling of the parotid or submaxillary glands, excruciating headache, etc.; although patients sometimes experience from the first a peculiar sense of prostration and feeling of sickness which foerbode the approach of some serious TYPHUS FEVER. 295 malady. Moreover the paroxysms of chills and heat are more frequent, more marked and irregular than in a common rheumatic fever. Very speedily we are made aware of the true character of the disease in consequence of the obstinate continuance of the supposed catarrhal or rheumatic symptoms, and the gradual supervention of nervous phenomena, such as impaired consciousness, drowsiness, acute pain, restlessness, spasmodic twitchings, increased thickness and darker color of the coating on the tongue, tenderness of the ileo-coecial region, loss of strength, incipient delirium, all of which symptoms develope themselves very rapidly and with increased energy as the disease progresses. In the second stage of the disease the nervous symptoms are developed in all their intensity; furious or muttering delirium, spasms and even convulsions, picking at the bedclothes, grasping at flocks, optical illusions, or illusions of the imagination, constant wakefulness, wasting of the tissues, strong-smelling urine like the urine of horses; in the third or torpid stage symptoms of paralysis and decomposition of the fluids develope themselves, such as entire loss of consciousness, inability to void the urine, depression of the lower jaw, dribbling of the saliva, settling down towards the foot-end of the bed, digging with the head into the pillow, rolling of the eyeballs upwards and sideways, cold and clammy perspiration, miliaria, paralysis,- ulceration of the bowels, involuntary offensive discharges from the bowels, or discharges of black blood, and gradual extinction of the vital powers. In describing the treatment of typhus it will not be necessary to mention each variety of typhus in particular, as the same remedies may be required in each; it will be sufficient to give an accurate account of the _ ~ __ 296 SPECIAL THERAPEUTICS. symptoms by which the various remedies required in typhus are indicated; by this means the selection of a suitable remedy for particular groups of symptoms will be made quite easy to lay-practitioners as well as to professional attendants. But, before detailing the treatment, let us caution the reader against the abuse of medicine in this disease. Three or four doses of the appropriate medicine in the course of twenty-four hours are amply sufficient; for, as we remarked above, the course of the disease cannot be arrested by the medicine until the typical period has reached its natural termination; all the good that the medicine can do in the mean while, is to control the disease sufficiently to prevent its running into another stage, and this control can be effectually exercised by a few doses of the specific remedy as well as by unnecessarily repeated medication. It is wrong to suppose that the medicine has to be changed frequently. It is doubtful whether more than three or at most four medicines are required to cure the most complicated cases of typhus. For the sake of facilitating the selection of a remedial agent in this disease, we will endeavor to arrange the different remedies which are generally used in typhus, according to the various varieties to which each series of remedies more particularly corresponds. For Cerebral typhus: Arnica, Belladonna, Bryonia, Hyoscyamus, Opium, Rhus toxicodendron, Stramonium, Muriatic acid, and thesweet spirits of nitre. For, Pulmonary typhus: Arsenicum, Belladonna, Phosphorus. For, Hepatic typhus: Arsenicum, Belladonna, Bryonia, Rhus toxicodenaron. For SYMPTOMATIC INDICATIONS. 297 Abdominal typhus: Arsenicum, Belladonna, Calcarea, Lycopodium, Nitric acid. The reader should, however, understand that this classification is not complete, nor, indeed, strictly correct; for remedies which are arranged under cerebral typhus, may have to be used for abdominal typhus, and vice versa. This classification is the best we could offer, and it may perhaps fulfil the object for which it was intended. Symptomatic Indications. BELLADONNA is indicated by the following symptoms: headache as if the brain were stunned, or above the orbits as if pressed ihto a smaller space, and obliging one to close the eyes; pressure in the head, here and there; continual sensation as if the whole brain were forcibly dilated; violent throbbing in the brain, terminating in painful stitches; or dull stitches darting through the brain in all directions; vertigo, objects seem as if balancing to and fro; or vertigo with trembling of the hands and oppressive anguish; optical illusions, such as seeing ghosts and insects; or loss of consciousness with stupor; anguish about the heart, with flushed and bloated countenance; restlessness; the patient utters incoherent words and phrases; prepares for leaving for home; talks about wolves, dogs, bulls, etc.; or he is beside himself, as if in rage; or he talks like a maniac, with staring and protruding eyes; at times the delirium is merry and muttering, at others violent and furious; the patient exacts things with uncontrolable headstrongness, and becomes enraged and howls when refused or when the demands are not instantly complied with; the patient indulges 298 SPECIAL THERAPEUTICS. in ludicrous gesticulations, picks at the bedclothes, or breaks out into paroxysms of weeping, moaning and howling, with contortions of the facial muscles; the patient puts out his tongue to its full length, repeats that he has no tongue-probably in consequence of the tongue feeling numb and dry as leather; the thirst is intense, but the least attempt to swallow water, causes horrible spasms in the throat accompanied with wild shrieks; noise and light are intolerable. At times the patient is uncontrolable, wants to uncover himself all the time and get away; swears, spits at those around him, uses obscene language, attempts to bite and strike; when thus excited, involuntary discharges from the bowels sometimes take place. DOSE.-Six globules, or a few drops, in a tumblerful of water, a tablespoonful every three or four hours. BRYONIA has the following symptoms: compressive headache, or headache when stooping, as if all the contents of the skull would issue from the forehead; or pain in both temples pressing from within outwards; heat in the head, with determination of blood to the head; vertigo as if the brain were turning in a circle; weight in the head, and pressure as if the brain were pressed from behind forward; stupefaction; delirium, with desire to escape, and an idea as if he were among strangers; irritable and irascible mood; sense of swelling in the epigastric region, costiveness, orange or rosecolored urine, petechiae, white miliaria, intense feverheat. In the epidemic typhus of 1813, Hahnemann gave Bryonia in alternation with Rhus toxicodendron, and, by means of this treatment, saved one hundred and eighty-three patients, being the whole number that came under his treatment; whereas under the alloeo SYMPTOMATIC INDICATIONS. 299 pathic treatment of that disease immense numbers perished. The indications for RHUS TOXICODENDRON are: reeling, with headache affecting the whole head, or as if the eyes would be pressed out of their sockets; or sensation on first opening the eyes to the light, as if the brain would be torn to pieces; or frontal headache when moving the arms, as if pressure were made with a dull point; or headache as if the brain were compressed from temple to temple, or as if it were loose in the head and striking against the skull; or burning-creeping sensation in the forehead or painful digging in the brain as with a needle; the head feels painful to contact like a boil; dizziness on rising from bed; reeling and tottering sensation in the body without the head feeling giddy; stupefaction and weakness of the head; absence of mind as if the eyes were swimming, with frequent vanishing of the objects; anguish about the heart, with trembling, oppression of breathing, and alternately slow and rapid pulse; tenesmus with nausea and tearing in the intestines; or stools mixed with blood, or watery stools, involuntary diarrhoea; hot or turbid urine, with eructations while urinating. DOSE.-When using either of these two remedies by itself, dissolve a few drops, or six globules, in a tumblerful of water, and give a tablespoonful every four hours. But when using them alternately give a tablespoonful of Bryonia first; three hours after give a tablespoonful of Rhus, and thereafter an alternate dose of medicine every three hours. HYOSCYAMus is indicated by the following group of symptoms: Stupefying ache- in the forehead, or undulating sensation in the brain, with pressure in the forehead, worse after stooping; headache alternating with pain in the nape of the neck; cloudiness of the head, and even complete stupefaction; the patient does not 800 SPECIAL THERAPEUTICS. know his own relatives; he neither sees nor hears anything; muttering delirium, the patient utters incoherent phrases; all sorts of strange fancies and illusions disturb his mind; he sings obscene songs, or uses obscene or vulgar language; he wants to travel and desires to escape, says that the pictures hanging on the wall, are falling down; the pupils are contracted, or the eyes roll about in their sockets convulsively; they are protruded, red and sparkling; at times there is an expression of fierce anger in the patient's countenance, and the delirium sometimes is accompanied with rage, and involuntary evacuations from the bowels. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every four hours. OPIUM is required when the following symptoms occur: frequent changes of color in the face, from red to pale, or paleness of the face and forehead, with glassy eyes; or clay-colored face, the patient slumbering with his eyes half open, he does not heed anything, gives vague answers, passes involuntary stool, settles towards the feet, and his respiration is short and anxious; or the face has a bluish color, all its muscles are relaxed, which gives the countenance a stupid expression, especially when the lower lip is depressed and the nostrils widely dilated; or the face is bloated, with hot and dry skin; or the face may have a cherry-brown color with distended veins, wild, red and protruded eyes, and convulsive trembling of the facial muscles, lips and tongue; incipient paralysis of the tongue, inability to talk, although the mouth is open; fearful disposition with tendency to start, ecstatic state of feeling, also alternating with sadness, delirium, also accompanied with frightful fancies; sour vomiting also with stupor; cos :-r ~ ~ SYMPTOMATIC INDICATIONS. 801 tiveness or watery diarrhoea, or discharges of a black substance from the rectum; retention of urine, drowsiness or continuous sopor;' also with rattling, stertorous breathing; trembling of the limbs, also with jerks of the body and quivering; convulsions and spasmodic motions, with foam at the mouth, or also with cries. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours until a decided improvement is obtained. For the above group of symptoms, either partially or totally, we prefer the Tincture of Opium to the attenuations, one or two drops in a tumblerful of water, giving a small tablespoonful every two hours. STRAMONIUM is another important remedy in typhus. It is indicated by the following symptoms: convulsive motions of the head and arms, also with hiccough; spasmodic drawing in the head and eyes, also with gritting of the teeth; feeling of intoxication, stupefaction of the head, with dimness of sight; or complete loss of sense, also accompanied with an internal uneasiness; he does not notice the things around him, is troubled with strange fancies; or he sees things as if in an oblique position, or he only sees parts of objects, or sees them double; bland or loquacious delirium, with ludicrous gesticulations, grasping at flocks, or frightful fancies, his features showing an expression of fright and terror; or he sees animals start out of the ground by his side, is alternately conscious and seized with rage; the face looks swollen and is turgid with blood, or it looks wild and frightful; or friendly at first, except the eyes, which stare and sparkle, but soon after it looks dismal and anxious, and is disfigured by deep furrows and wrinkles; suppression of stool and urine; deep, sound sleep with snoring breathing, or he wakes from his sleep with an important and solemn look; the pulse is either strong andfull, or tremulous, weak, and sometimes intermittent; the body 27 -- irWII 302 SPECIAL THERAPEUTICS. is covered with cold sweat, or red miliaria break out on the chest and back. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every three hours, until the symptoms change for the better, after which the medicine may be continued at longer intervals. ARNICA may be used as an intermediate remedy in typhus, when symptoms of a deep-seated gastric disorder set in, the patient complains of a foul, bitter mouth, a feeling of repletion in the epigastric region accompanied with loathing; the patient passes offensive flatulence, frequent small stools consisting of slime, or involuntary stool during sleep, brown urine with brickdust sediment, or a small quantity of yellow-red urine. A dose of Arnica may likewise be given now and then, if the disease originated in some mechanical injury. DOSE.-Hahnemann recommends a whole drop of the Tincture, either on a little sugar, or in a small spoonful of water. Watch the effects of this dose, and in five, six or twelve hours, or even after a longer period, either repeat the dose, or give some other medicine according as the symptoms may seem to require. ARSENICUM is more particularly useful in abdominal or hepatic typhus, or when symptoms of decomposition of the animal fluids have made their appearance; there is great tenderness in the ileo-coecal region, with tympanitis and starting when the ileo ccecal region is pressed upon; the patient is exceedingly weak; petechise or miliaria appear upon the skin; blood is discharged from the gums, nostrils, bowels, and even from the skin; the skin is dry and burning and afterwards cold and clammy; especially the skin on the forehead; the patient is tormented by an unquenchable thirst and involuntary, foul-smelling diarrhoea; there is sopor' on waking, the eyes have lost all their lustre and expression, they stare; the nose looks pointed, the features are I SYMPTOMATIC INDICATIONS. 803 sunken and elongated; the lips, teeth and tongue exhibit a black streak, technically termed fuligo; the patient is unable to protrude his dry and trembling tongue; the beverage rolls down in the gullet with a gurgling sound; the urine has a pungent smell and an acid reaction; the breathing is oppressed, anxious, hurried; the speech unintelligible, inarticulate; the pulse small, tremulous and wiry, from 120 to 140; the hands are moved involuntarily, and the patient is constantly muttering, especially at night; other symptoms indicating Arsenicum are spasms of the extremities at the commencement of the attack, accompanied with a sense of prostration and a cold and clammy sweat; the patient complains of an ominous feeling of danger which seems to be seated in the interior portions of the brain; or the attack sets in with a most excruciating pain in. the bowels or under the shoulder blades, the patient has to sit up on a chair or on the edge of the bed, bent double, with constant quivering and trembling of the lower limbs, a galloping pulse, an expression of intense suffering and agony in the features, a foul, thick, blackish-brown coating on the tongue, and sometimes an almost involuntary, foulsmelling diarrhoea. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every three or four hours. In one case of abdominal typhus, where petechie, fuligo labiorum, involuntary haemorrhage from the gums, eyes and rectum, petechiae, and other symptoms of disorganization of the fluids had developed themselves, and where the tenderness in the ileo-ccecal region was most intense, the patient was given up by his two attending physicians. We proposed Arsenic, the eighteenth attenuation, a medicine which the patient had not been given at all during his illness, and which was evidently indicated in his case, and probably had been during the whole course of his illness. One single dose of the eighteenth attenuation effected such a radical change in the symptoms, that in a fortnight after, the patient was again able to attend to his business. But if we should have to prescribe Arsenic from the first commencement of the attack, we should not. give __ 3041 SPECIAL THERAPEUTICS. the middle or higher attenuations, in case there should be an acute, agonizing local pain; but in all such cases we should at once select the third or even first trituration, centesimal scale, and give half a grain of this preparation every two hours until a decided improvement should have set in, after which the medicine might be continued every five or six hours in half grain doses. PHOSPHORUS is more particularly indicated in typhus pulmonalis, if the typhoid process seems to commence with the formation of an abscess in the substance of the lungs. Characteristic symptoms are, sharp, shooting, catching pain in one spot, with great soreness on the outer side, irritation throughout the lungs, with unceasing hacking or barking cough; the patient raises a greenish-yellowish, bloody sputa, he is weak, complains of pain in the temples, vertigo; the discharge from the lungs gradually changes to a greenish-bloody pus enveloped in a quantity of flocculent mucus and sinking to the bottom of the vessel, the discharge can be distinctly traced to the painful spot, showing that there is an abscess; the pain becomes more and more distressing, sharp and aching; the respiration is short and panting; the patient's complexion changes to a brown-yellow hue, hectic fever sets in, the urine looks black and has a foul smell, the patient becomes stupid, desponding, flighty, is troubled with unpleasant visions; his tongue is dry and stiff as leather and feels rough like a cat's tongue, with a dark brown coating; the taste is entirely lost and the hearing and sight are weaker; there is twitching and trembling all over. DOSE.-Half a grain of the third trituration, centesimal scale, dry on the tongue every four hours, until an improvement sets in, when the medicine may be continued, every six or eight hours. The mineral acids are more particularly indicated in the last stage of typhus. MURIATIC ACID is specifically indicated when symp __Y SYMPTOMATIC INDICATIONS. 305 toms of nervous torpor or paralysis appear, such as depression of the lower jaw, rolling of the eyeballs upwards, burying the back of the head into the pillow; the saliva hangs out in threads, the patient settles toward the foot-end of the bed, miliaria breaks out. DOSE.-One drop of the diluted acid in a tumblerful of water, a tablespoonful every two hours, until reaction takes place. ACIDUM NITRICUM is indicated by hfemorrhage from the rectum, with excessive sensitiveness of the abdomen, and particularly the ileo-coecal region, or discharges of a green, acrid mucus, tenesmus, aphthas, rattling cough, threatening paralysis of the lungs, fetid sweat. DOSE.-One drop of the diluted acid the same as the former. PHOSPHORIC ACID is adapted to most varieties of typhus, more particularly, however, to typhus abdominalis and cerebralis. In typhus abdominalis, it has been successfully used for the following symptoms: Constant somnolence, or also sleeplessness, bland delirium, both during the waking or sleeping state, apathy, stupid countenance, with circumscribed redness of the cheeks, incipient desiccation of the Schneiderian membrane, parched condition of the lips and tongue, or else thick coating on the tongue, with thirst, rumbling in the abdomen, particularly after drinking, sensitiveness of the abdomen, particularly in the ileo-ccecal region; two or three thin, fermented, painless evacuations a day, languor and pros. tration, dry and hot skin, or also profuse, exhausting sweats, clear urine, etc. Phosphoric acid is likewise indicated when the symptoms assume a malignant form, the stools are more copious, involuntary, and have a fetid smell, the sensitiveness of the abdomen is very great, there is excessive prostration of strength, and miliaria and phenomena of decomposition of the fluids develop 27* 806 SPECIAL THERAPEUTICS. themselves. Other symptoms, which indicate Phosphoric acid, are: dulness of the head, vivid redness of the face, great languor, prostration and apathy without vivid delirium, the fever is on the point of passing into the stupid stage. Phosphoric acid corresponds with a form of typhus, where the gastric derangement is very prominent, and characterized by watery stools, pappy taste in the mouth, coated tongue, and prostration of strength. DOSE.-Half a grain of the third trituration, centesimal scale, dry on the tongue, every four hours until relieved. In abdominal typhus, Phosphoric acid may be employed alternately with Arsenicum, same trituration, an alternate dose every three hours, commencing with Arsenic. If the triturated Phosphoric acid is not on hand, we may use a few drops of the diluted acid in a small tumblerful of water, a tablespoonful every four hours. SPIRITUS NITRI DULCIS, or SWEET SPIRITS OF NITRE. During the hospital-typhus of 1813, in Germany, Hahnemann recommended this agent for the following symptoms: Indolence of the internal sense, an apathy or sort of semi-paralysis of the mind; the patient lay quiet, without sleeping or talking; he scarcely answered any questions, even when urged; he appeared to hear without understanding; the few words he uttered, were uttered with a low tone of voice, but seemed rational; the patient did not seem to feel anything, and lay motionless, without being paralyzed. According to Hahnemann, the spirits of nitre should be old enough not to redden the cork. He mixed one drop of the spirits with one ounce of water, and gave the whole of this solution within twenty-four hours, in teaspoonful doses. CALCAREA and LYCOPODIUM have been recommended in abdominal typhus, if ulceration of the bowels had set in, as denoted by excessive tenderness of the abdomen, meteorism, sero-purulent discharges from the bowels, and when miliaria had broken out. REMARKS CONCERNING DIET, ETC. 307 DOSE.-A few drops, or six globules, of each, in half a tumblerful of water, separately, and a small tablespoonful alternately every three hours, commencing with the Calcarea, until an improvement takes place, or other remedies seem required. VERATRUM may have to be used in some forms of abdominal typhus, especially if the following symptoms occur: Vomiting and diarrhoea, or unperceived discharge of stool; coldness of the limbs or constant chilliness, rumbling in the abdomen, the bowels feel sore, unless flatulence is passed; faint feeling in the abdomen pre vious to an evacuation from the bowels, or burning in the bowels as from hot coal; cold sweat, hippocratic countenance, or cold and altered countenance, as of a dead person; illusions of the fancy, with dizziness, as if the contents of the skull were shaking; anguish, frantic delirium, rage or stupefaction of the brain. DOSE.-A few drops, or six globules, in a small tumblerful of water, a tablespoonful every two hours. Concluding Remarks Concerning Diet, the Use of Water, etc. There are several other medicines which have been proposed in typhus, such as Sulphur, Carbo vegetabilis, etc., yet we doubt whether they are of any practical value. But an important auxiliary in this disease is the use of water, cold or tepid, as the case may be. In abdominal typhus the frequent use of cold-water injections is undoubtedly to be recommended; and frequent sponging with cold water from the head downwards may likewise prove useful, provided clean and perfectly dry linen is put on the patient after every ablution. Otherwise the patient should be given as much cold water as he likes to drink, or, if he should prefer toast-water, or water mixed with a little syrup, or a slightly-acidulated drink, .~AII~---~-L~1~11113I~L31113--- 308 SPECIAL THERAPEUTICS. such as a weak lemonade, or water mixed with a little boiled milk, or water and sugar; he should be allowed any of these beverages, or indeed any other non-stimulating beverage, provided existing symptoms, such as diarrhoea, do not counter-indicate it. The diet should be perfectly simple, a little weak tea and toast, gruels, mush, hominy, farina, apple-sauce, or some other kind of fruit, stewed, baked or roasted, etc. During convalescence the patient's diet has to be attended to with the greatest care. The appetite is generally very great, sometimes amounting to canine hunger; but it would be exceedingly injudicious to gratify it. Three or four days after the termination of the fever the patient may be given some beef-tea, or very thin chicken or muttonbroth mixed with a little rice or farina, but without any fat; oyster-broth with the soft part of two or three oysters may likewise be allowed; he may also have a little very weak chocolate, or, if he is fond of coffee, some weak coffee with milk and sugar; in a few days we may give him a small piece of roast-beef, not rare, but fairly done, or roast mutton or venison; and, if he should desire it, he may have twice a-day a small glassful of good wine and water, and a little biscuit or sponge-cake to soak in it; in the second week he may gradually)return to his usual diet, but eat moderately, notwithstanding the ravenous appetite. Relapses from over-eating are quite frequent and exceedingly dangerous. All stimulating and hearty food, such as eggs, beef-steaks and fat meat, should certainly be strictly avoided for a few weeks after recovery. During the course of the fever it is of great importance to give the patient as much fresh air as possible, for which purpose the sick-room should be ventilated as often as possible, YELLOW FEVER. 309 without, however, exposing him. directly to any draught. All unnecessary noise and conversation should be strictly avoided, and nobody should be admitted into the sick-room except those who are necessary to the patient, or whom he may express a wish to see. One week after recovery the patient may be taken out, provided the weather is fair and not windy, damp or very cold. In the summer-season the patient may go out much sooner than in the cold winter or during the unsteady spring weather. Typhus is sometimes followed by so-called sequele or after-diseases, such as baldness, loss of memory, impaired condition of some special sense, cutaneous alterations; but it is scarcely ever necessary to combat these symptoms by medical treatment. Under homoeopathic treatment such after-symptoms occur much less frequently than under allceopathic treatment. Diet, regular exercise in the open air, provided the state of the weather permits it, and the daily use of cold water in the shape of ablutions, shower-baths, douche, etc., will prove sufficient to remove these after troubles. If the patient should desire to use medicine, he may take, every morning or evening, a few globules of the medicine which seems to have been principally instrumental in effecting a cure; but, as we said before, medicine is scarcely ever necessary. Yellow Fever. This dreadful disease seems to be endemic in some of the Southern portions of our country, and frequently rages as an epidemic disease. In this fever the bilious symptoms predominate. Mild cases of yellow fever are I _~ 310 SPECIAL THERAPEUTICS. easily mistaken for bilious remittent fever. The term yellow is derived from the yellow tinge which the skin exhibits in the second and last stages of the disease. This disease either has a continuous or remittent type, the latter most frequently when the disease is epidemic. Sporadic cases of this fever may occur at any time in consequence of exposure, irregular diet, sleeping in the damp night-air during the hot season, abuse of ardent spirits, violent emotions; the epidemic form depends upon atmospheric influences, malaria, and other miasmatic causes beyond the control of individual discretion. This fever is generally distinguished by stages, although the disease, in some cases, runs such a rapid course that the various stages are scarcely perceptible. If the disease runs a full course, we distinguish the inflammatory stage, the typhoid and the putrid stage, or black vomit. This division is, however, more or less arbitrary, and adopted merely for the sake of convenience. Inflammatory stage.-The attack sets in with sudden prostration, vertigo, faintness, a sensation of uneasiness throughout the body, chilliness, sometimes amounting to violent fits of shuddering, oppression and anxiety in the epigastric region, sickness at the stomach and even vomiting; shortly after these precursory symptoms have developed themselves, a violent fever sets in with pains all over, intense pain in the small of the back and loins, distressing headache, acute stitches through the 'brain and spinal marrow, and even down the lower limbs; burning pains in the pit of the stomach, oppressed, hurried breathing, with sighing and gasping for air; violent cerebral congestion, also with burning pains in the brain, flushes of the face, redness and burn __ YELLOW FEVER. 3.11 ing of the eyes, white fur on the tongue, although this organ is generally inflamed, parched and covered with a bile-tinged mucus, especially after the vomiting and hiccough have set in. This stage lasts from twenty-four hours to three days, and even longer, and sometimes ends in a remission of all the symptoms, moist skin, absence of pain, and comparative general comfort. In a few hours, however, the second or Typhoid stage develops itself; the fever returns with redoubled intensity, the skin becomes burning and dry, yellow; the eyes likewise have a yellow tinge and look glassy; the vomiting returns and causes great distress; the substance which is thrown up, is darker, and the burning in the epigastric region sometimes is most agonizing, and is accompanied with great tenderness to the touch, the thirst is constant and unquenchable; the patient begins to wander, and the pulse, which is generally strong and bounding in the inflammatory stage, becomes quicker and softer. This stage may continue from some hours to one or two days, when the third stage or the stage of the black vomit develops itself. This stage is characterized by spasmodic vomiting and retching, accompanied with belching up of rumbling flatulence; the substance which is thrown up, resembles coffee-grounds, and the agonizing burning in the pit of the stomach now reaches the highest degree. In his delirium the patient sometimes jumps out of the bed, but soon sinks down prostrate. Symptoms of bilious decomposition set in, the tongue becomes black, or shrivelled and parched; blood is discharged from various orifices of the body, even from the gums and the inner membranes; the discharges from the bowels are frequently mixed with the decomposed substance 312 SPECIAL THERAPEUTICS. which is thrown up during the vomiting; the urine is either suppressed or perfectly putrid; the features become altered, the eyes retreat into their sockets; the extremities become deathly cold, and are seized with cramps, subsultus tendinum sets in, the pulse flags, becomes irregular, intermittent, and death soon terminates the patient's sufferings. Treatment. From our own observation we can recommend the use of cold water in this disease as one of the best means of shortening the course of the fever by bringing on a speedy and permanent reaction. As soon as the attack has set in, wrap the patient in dry blankets from head to foot, and make him sweat as soon and as profusely as possible, which is facilitated by giving him plenty of cold water to drink. After having perspired profusely for an hour, raise him on his feet, throw off the blankets suddenly, and either plunge him into a bathing-tub full of cold water, head and feet, or else have a dripping sheet all ready, and rub him with it from the crown of the head to the soles of the feet, if possible all over at the same time. The patient may stand in a tub filled with cold water. As soon as the sheet begins to feel warm, he ought to be rubbed with a dry sheet, and, being perfectly dried, fresh and dry linen is to be put on him, after which he may be put to bed, and will feel a good deal refreshed and eased. This process may be repeated morning and afternoon. At the same time the following medicines should be given. During the inflammatory stage give ACONITE, a few drops of the tincture in a tumblerful __ ~__ _ ~~_~____I__ YELLOW FEVER-TREATMENT. 313 of water, a tablespoonful every hour. We ihave been assured by physicians who have had great experience in the homceopathic treatment of yellow fever, that they have obtained the greatest success with the concentrated tincture of the root of Aconite, giving a few drops in a tumblerful of water, a small tablespoonful every hour until a decided reaction had set in, after which the medicine is to be continued at longer intervals. Many cases have been cured with this medicine alone. If the patient should exhibit typhoid symptoms from the commencement of the attack, such as delirium, tremor of the extremities, spasmodic symptoms, the Aconite may be alternated with BRYONIA, a few drops or six globules in a tumblerful of water, a tablespoonful of medicine every hour, commencing with the Aconite. In the second stage a principal remedy is ARSENIC, especially if the prostration, the distressing vomiting, the thirst and burning in the epigastric region, are prominent symptoms. DOSE.-Half a grain of the first trituration every hour, dry on the tongue. If no relief should be obtained after a few doses, give ACONITE, concentrated tincture of the root, two drops in half a tumblerful of water, a tablespoonful every half hour, until relief is procured. MERCU'RIUS may prove useful, if the attack sets in with a feeling of coldness instead of a violent fit of shuddering, vomiting of green, bitter bile, distressing headache, not shooting stitches, but a feeling of soreness in the brain as if ulcerated, with aching and throbbing as if the skull-cap would fly off; distress and sensitiveness in the epigastric region as if ulcerated, with bloating, yellow tinge of the skin and eyes; constipation. 28 __ 814. SPECIAL THERAPEUTICS. DOSE.-Half a grain of the first trituration, centesimal scale, dry on the tongue every hour. In the third stage, when the black vomit has set in, give alternately ACONITE and VERATRUM, the former in the concentrated tincture as indicated above, and of the latter mix a few drops of the first attenuation in a tumblerful of water, and give the two medicines alternately every ten minutes, in half tablespoonful doses, commencing with the Aconite, and lengthening the intervals to two hours as soon as relief is obtained. DIET: In this disease it is perfectly proper to give the patient small draughts of ice-water, as often as he may desire, otherwise all that has been said about diet in the concluding remarks of typhus is strictly applicable to yellow fever. Yellow fever is not a disease that a person contracts only once; we have known individuals in New Orleans, who.had been laid up three times with this distressing and dangerous malady. It must not be supposed that the symptoms as we have described them, are exhibited in every case. The attack varies with the age, constitution and habits of the person; in some cases it is quite mild, and the fever seems like a violent bilious attack; in others the attack is fatal from the very commencement, and the patient dies in a few hours from paralysis of the brain. Lentescent, Hectic, or Consumptive Fever. Such fever is not generally an idiopathic disease, or in other words a disease by itself, having no dependence upon some more deep-seated disorder. Hectic fever generally is a sign of consumption of some vital organ, I __ I_ _ I ____ _ _~I __ b~ CONSUMPTIVE FEVER. 815 the lungs, bowels, urinary apparatus. But it may likewise be a symptom of a general nervous decline, in which case a restoration of the nervous power will undoubtedly result in the disappearance of the fevei The symptoms of this fever are not very violent, the pulse is quicker than usual arid may occasionally be somewhat bounding; but generally it is rather soft, a little full and swelling, but scarcely ever hard. The fever may be characterized by distinct exacerbations which generally occur in the evening, and are distinguished by a slight chill or only a sense of coldness, followed by flushes, dryness of the tongue, a little thirst, and lastly a general transpiration, although in some cases the patient is troubled with exhausting night-sweats. The fever may result from a general debility of the nervous system, developing itself spontaneously, as it were, or as a hereditary state; or it may have been induced by accidental causes, such as loss of blood, over-exertion, exposure, excessive lactation, violent emotions. The appetite is generally impaired, the tongue slightly coated with a whitish fur, or it is a dry tongue, with redness of the edges and tip; the patient is very nervous, and the night's rest is very much disturbed, or there is complete wakefulness. TREATMENT. This condition of the system requires not only medical, but general hygienic treatment. The treatment, however, must somewhat correspond with the existing cause of the disease. Above all things perfect rest, and as great an amount of fresh, balmy air as possible, are indispensable requisites to a cure. If the disease can be traced to any particular cause, this should be removed, of course. If it be owing to nursing, for instance, this must be.stopped. In the treatment of _ ~ 816 SPECIAL THERAPEUTICS. this weakness, the use of water is indispensable. Daily ablutions with cold water may be used first, and, if the reaction after cold water should not be sufficient, tepid water may be used, gradually substituting cold water for the tepid. As the patient's strength increases, showering may be tried, for which the reader is referred to the paragraphs on the use of water; for the costiveness use cold water injections. Short walks and riding on horseback may be resorted to as soon as proper, but all premature and fatiguing exercise should be strictly avoided. The following medicines will prove beneficial; but let it be remembered that patients who have got into this hectic state, are injured by excessive and frequent dosing. ACONITUM is an admirable remedy, if the nerves are irritated, the patient frets, feels low-spirited, thinks he is going into decline and will die; loses flesh, is troubled with feverish flushes, chilliness, or regular eveningexacerbations of the fever, restless nights, dreams, loss of appetite, furred tongue, load at the stomach, acidity, spitting up of food, costiveness or diarrhoea, palpitation of the heart, dizziness, headache, great weakness, nightsweats. DOSE.-A few drops, or six globules, in.a tumblerful of water, a small tablespoonful morning, noon, and evening, one hour before or two hours after each meal. Continue this treatment for a few days, then use only ene dose of medicine every day, and gradually discontinue altogether for a while; then resume if necessary. CHINA is indispensable, if this condition was caused by over-exertion, loss of animal fluids, blood, milk, etc. DOSE.--Same as Aconite, with which medicine the China may be usefully alternated, giving two doses of each medicine a day, and commencing with either. ARSENICUM, for excessive prostration, decided chills. ~ __ ~ __ _ _ II_ I _ L____ _~ _I_ -CONSUMPTIVE FEVER. 817 and fever, with thirst and subsequent sweat, emaciation, diarrhoea, distension of the bowels, scanty dark-colored urine, etc. DOSE -Same as Aconite, with which Arsenic may be alternated every two or three days, using Aconite for two or three days, then Arsenic for a similar period; then again the Aconite, and so forth. YERATRUM may prove serviceable, if the patient complains of coldness, is troubled with exhausting diarrhoea, vomiting of mucus, cramps in the bowels and extremities. DOSE.-Same as Aconite. AcONITUM and IGNATIA may be principally used when mental causes, such as continued depression of spirits, anxiety, grief, fright, chagrin, have induced the disease. For the particular indications the reader is referred to the chapter on " Diseases of the Mind." DOSE.-The same as indicated for Aconite. DIET: Patients who are afflicted with this kind of fever, may sometimes facilitate the treatment by following up an appropriate diet. If the fever is the result of excessive blood-letting, lactation or exhaustion in consequence of extreme physical exertions or privations, the moderate use of such stimulants as lager beer, porter or even a little wine, may be perfectly appropriate. Nourishing broths, jellies and small quantities of tender beef, mutton or venison may be allowed, if the patient should crave this kind of food. Even if the patient is in the last stage of consumption, a little nourishing meat-diet and a glass of porter in which the yolk of an egg is beaten up, may prove exceedingly refreshing and strengthening. As a general rule the patient may eat little at a time, but rather more frequently; let him use nourishing and easily digested food. 28* j 818 SPECIAL THERAPEUTICS. Diseases of the Nervous System. Before entering upon a description of these diseases, and upon the proper mode of treating them, it may be useful to give the reader a general idea of the structure and office of the nervous system. Most persons know that the nerves constitute the more immediate instruments of the vital force, and that, without a healthy condition of the nervous functions, the organs are unable to carry on their respective vital processes. The nervous system is composed of the brain, the spinal marrow and the nerves. The nervous tissue is different from any other tissue in the body; it is of a soft, pulpy consistence, and is composed of two portions, one of which is white and fibrous, and is termed the medullary subst'nce; the other gray, and globular in structure, and is called the cineritious substance. In the brain these two substances are more particularly exhibited to view. It is well known that the brain is enclosed within the skull, and that the spinal marrow is contained in the bony canal which extends down the middle of the back from the base of the skull to the sharp point at the lower extremity of the back. The brain and spinal inarrow together are known under the name of cerebrospinal axis. The brain is contained in the skull, and is composed of two principal divisions, one of which is termed cerebrum, the other cerebellum. The cerebrum fills the superior and anterior portion of the cavity of the skull, ~nd is separated from the cerebellum, which is situated in the posterior fossa or hollow of the cranium, by a I ______ 1 DISEASES OF THE NERVOUS SYSTEM. 819 hard, unelastic membrane called the tentorium. Both the cerebrum and the cerebellum are divided into parts; the cerebrum being first divided into two principal parts, called hemispheres, and each hemisphere, on its lower surface, again into three lobes. The cerebellum is simply divided by a longitudinal fissure into two lobes or hemispheres. On making a vertical section through one of the lobes of the cerebellum, we discover an arrangement like the branches of a tree, termed on this account arbor vitce or the tree of life, and caused by the intermingling of the gray and medullary matter. On looking at the brain, we discover a number of convolutions or. folds, the use of which will be pointed out below. Both the brain and the spinal marrow are envelopea in three membranes, the outer one being termed the dura mater, an unyielding, fibrous membrane, and closely adhering to the inner surface of the' cranium; the arachnoid membrane, a thin, transparent, serous membrane, and the pia mater, a cellular membrane which closely adheres to the substance, of the brain, and dips to the bottom of the fissures between the convolutions. The spinal marrow is likewise called cord, and the upper part thereof is termed medulla oblongata. This portion of the spinal marrow is situated opposite the foramen oyale, a large opening at the base of the skull, which can be distinctly felt by the finger on the outside. We will now proceed to say a few words about the nerves. The nerves are given off from the whole of the cerebro-spinal axis, viz: twelve pairs of nerves from the brain, and thirty pairs from the spinal marrow.T The nerves which come out of the substance of the brain are designated as the cerebral, and those which come out of 320 SPECIAL THERAPEUTICS. the spinal marrow as the spinal nerves. The office which these nerves fulfil will be explained presently. Beside these nerves, there is the great sympathetic nerve, which runs along the vertebral column, on either side, from the base of the cranium to the coccyx, or terminal bone of the spine. This nerve consists of two series or chains of ganglia or knots, which are united to each other by nervous cords, and send off filaments to all the internal organs. The sympathetic nerve is connected with the cerebral and spinal nerves by intermediate branches and plexuses. We are now prepared to say a few words in explanation of the functions of the nervous system. The cerebrum is instrumental in fulfilling the highest functions of the soul; without the brain, all the intellectual and spiritual life of man would be at an end. In what way the brain carries on the operations of the mind, it is impossible to say. We know, however, that the power of the brain depends upon the number of its convolutions, and the extent of surface of the cineritous matter. It is our opinion, however, that this statement is not altogether satisfactory, and that there is, moreover, a radical, although as yet unknown, difference between the human brain and the brain of the most intelligent animal. The cerebellum is looked upon by some as the seat of the animal propensities. According to others, it is principally instrumental in supplying the organs with animal life. All the spinal nerves arise by two roots from the anterior and posterior columns of the spinal cord; the posterior root is that portion of the nerve which conveys sensations to the brain, and the anterior root is that portion which conveys motor power to the organs. Hence, DISEASES OF THE NERVOUS SYSTEMS. 321 it will be seen, that we have nerves of sensation and nerves of motion. All sensation is perceived by the brain; the spinal column of itself, independently of the brain, does not perceive any sensations; hence a set of fibres is appointed to convey impressions to the brain through the spinal column, and the corresponding influence or mandate of the brain is then transmitted back to the spinal column, through another set of fibres, and it is from the spinal column that the appropriate motor nerves receive, indirectly as it were, the direction from the brain to fulfil their specific office in the particular case. This intermediate system of nervous fibres is called the reflex system of nerves. The office of the sympathetic nerve is not well defined; it is both a nerve of motion and of sensation, and seems to act as a general regulator of organic life. It seems unnecessary to go into a detailed explanation of the office of each particular nerve. Those who take an interest in such matters, may consult special works on physiology. Suffice it to mention a few special points by way of illustration. There is a nerve, for example, which, agreeably to the order of succession, is counted as the second nerve emanating from the brain, and is called the optic nerve. After penetrating the orbit of the eye, it expands into a net-work of exceedingly minute and delicate nervous fibres, called the retina, upon which every external object is distinctly pictured. This nerve is therefore the source or seat of sight, and is a nerve of sensation. If' this nerve should be wounded or destroyed, the sight would perish, but the eyeball would still preserve its power to roll about in the socket. For this power is not derived from the optic nerve, but from what, in numerical order, are termed the third, fourth _ __ I ~ 322; SPECIAL THERAPEUTICS. and sixth pairs of cerebral nerves, which are distributed over the muscles of the eye. It is understood that sentient nerves can only be excited by appropriate or corresponding stimuli. The sentient nerve of the tongue, for instance, cannot be excited by light; the sentient nerve, which is the source of the sense of hearing, cannot be excited by colors, it can only be acted upon by sounds. Some nerves are more essential to life than other nerves; thus, if-the pneumo-gastric nerve, which is distributed through the substance of the lungs and over the coats of the stomach, should be wounded, the animal must inevitably perish, for the lungs would cease to breathe, and the stomach could no longer digest its food. After these preliminary explanations of the structure and functions of the nervous system, we shall be prepared to speak intelligibly of the diseases to which the different portions of this system are subject. Rush of Blood to the Head. This affection is generally owing to an irritation or weakness of the cerebral nerves. The symptoms are sudden dizziness, sometimes amounting to loss of consciousness, sensation as if the brain were balancing, afterwards distressing headache, sense of fulness, tightness, soreness or sensitiveness of the scalp, throbbing, etc. TREATMENT.-For this weakness we have never found it necessary to give any other medicine than ACONITE, a few drops or six globules in a small tumblerful of water, a small tablespoonful every half hour or hour until the attack is entirely removed. VERTIGO, DIZZINESS. 328 Patients who are subject to such paroxysms, shouild employ daily ablutions with cold water, in the morning after rising; showering the soles of the feet, the abdomen and lower portions of the spine will likewise be found very useful. It is of the utmost importance for such patients to keep out of the sun; for exposure to the sun's rays is frequently a primary cause of a rush of blood. Vertigo, Dizziness. There are persons who are subject to sudden attacks of vertigo, without apparently any other. striking disturbance of the organism. All the functions seem to be_ carried on with a fair share of regularity and vigor, except perhaps a little costiveness at one time, or the opposite condition at another, occasional irregularity of the appetite, bilious state of the system, etc. This weakness is somewhat akin to rush of blood, and may be induced by various causes, such as fright, violent straining of the cerebral nerves, especially the optic nerves, exposure to the sun's rays; or the weakness may be hereditary, or it may result from repelled eruptions, or it may be a symptom of some deep-seated cerebral disorganization, or of a bilious habit. TREATMENT.-It-is of great importance, in this affection, to resort to daily ablutions with cold Water, in the morning after rising from bed, and to employ showering on the soles of the feet, the bowels and lower portion of the spine. Among the medicines the following may be given: ACONITUM, when the vertigo had been occasioned by fright, or is excited by a sudden surprise, such as sudden 824 SPECIAL THERAPEUTICS. noise, a sudden flash of light; and when it is accompanied by excessive paleness or redness, or alternate redness and paleness, stupefaction or loss of consciousness, burning sensation in the brain, throbbing in the head and region of the heart, confusion of sight, buzzing in the ears, full and tight feeling about the head, waving sensation in the brain or sensation as if a part of the brain had been taken away. Pulse either fluttering and unequal, or heavy, sluggish and full. DOSE.-A few drops, or six globules in a small tumblerful of water, a small tablespoonful every half hour, until an improvement sets in, after which the medicine may be continued for a day or two longer, a dose every two or three hours. DIGITALIS, if the vertigo is accompanied by a slow, heavy pulse, and seems to depend upon some deepseated cerebral derangement. DOSE.-Same as Aconite. MERCURIUS, when the vertigo is accompanied with a feeling of confusion in the head, blackness of sight, also with staggering and sensation as if a worm were crawling up in the chest and throat. DOSE.-Same as Aconite, There are a great many more remedies for vertigo, which it would be impossible to enumerate here; the reader will find them mentioned in our large Repertory, from pages sixty-one to eighty-one. A few globules, say three or four, of any of the remedies there mentioned may be dissolved in a tumblerful of water, and a small tablespoonful taken every two hours, or even less frequently, until a decided improvement is experienced, after which the medicine may be continued at longer intervals until the patient feels quite well. Hygienic rules: Persons who are subject to attacks of I _ i SEA-SICKNESS. 825 vertigo or to rush of blood, should abstain from alcoholic stimulants, and from the use of coffee and sometimes even tea; exposure to the sun's rays may likewise prove dangerous. They should eat moderately, especially of hearty food. Sea-sickness. The pathognomonic signs of this disease are as follows: dizziness followed by vomiting or empty retching; the substances which are thrown up, are either the ingesta of the stomach, or water, bile and mucus. The vomiting is sometimes attended with a good deal of distress, debility, and many persons are made really sick by the motion of the vessel. Sea-sickness seems to be owing to a cerebral irritation attended with rush of blood to the brain. For the common phenomena of sea-sickness, such as dizziness, vomiting, etc., there is no remedy. Some persons experience them more, others less, some not at all; but persons who are constitutionally disposed to sea-sickness, will be attacked with it, no matter what precautions they may take. An excellent plan of preventing sea-sickness as much as possible, is to lie against the motion of the ship, by which means the cerebral congestion is more or less prevented. Among the remedies which have been recommended for sea-sickness, and have been employed more or less successfully, are the following: ACONITE, for violent dizziness, headache, vomiting of bile, sudden changes of color. DOSE.-A few drops, or six globules, in a tumblerful, of water, a small tablespoonful every half hour, until the symptoms have abated, after which a few more doses may be taken at longer intervals, say every three hours. 29 _ _~ I_ ~ __ __ ~ ~~__~~~Cii_~_ I ~ ~ ~~~^_ ~~~~;:=;_ 826: SPECIAL THERAPEUTICS. COCCULUS has been recommended for excessive dizziness. DOSE.-Same as Aconite. PETROLEUM, for the same symptoms as Cocculus. DOSE.-The same. Nux VOMICA, if the vomiting is excessive, as if resulting from a spasm, accompanied with violent straining. DOSE.-Same as Aconite. TABACUM, for vomiting, with deathly paleness and sickness of the stomach. DOSE.-Same as Aconite. VERATRUM and ARSENICUM, for vomiting of phlegm and bile, attended with excessive weakness. DOSE.-Same as Aconite. Diet and General Hygienic Measures. Persons who cross the ocean, are very apt to be troubled with costiveness for some days at the beginning of the voyage. Those who think it necessary,: may take a Sedlitz-powder on an empty stomach in the morning, or an injection of water. It is not advisable to physick the bowels. In regard to diet, it is well to eat moderately, and at regular hours, even though the appetite should be quite keen all the time. We. have found shower-baths and frequent ablutions with cold water, quite refreshing and strengthening at sea. Apoplexy. This affection is, properly speaking, a cerebral affection, although an apoplectic condition need not neces sarily be confined to the brain and may first develop - I-----.-5-~.....~..-..-------- _~~.~--............ APOPLEXY. 327 itself at some point in the derivations of the nervous system. Cerebral apoplexy is generally preceded by premonitory symptoms, such as heaviness and fulness of the head, dizziness, dark redness of the face, injected appearance of the conjunctiva, dulness or blackness of sight, or confused sight, flashes; buzzing in the ears; indistinct hearing; drowsiness, indistinct speech, heaviness and numbness of the extremities. If the attack actually sets in, the patient suddenly falls to the ground, without sense or the power to move. Sometimes only one side or limb seems to be affected. The patient is unable to articulate, his face is puffed, purple or livid, he foams at the mouth. The breathing is slow and generally stertorous. Short, fleshy persons with thick necks are particularly liable to this disease, especially if they lead a sedentary life and indulge in spirituous drinks and a rich diet. Individuals with apoplectic constitutions, should avoid all stimulants and rich diet, confine themselves principally to vegetables and to fresh water as a drink and for daily ablutions, and take as 'much active exercise in the open air as possible, avoiding the sun's rays very strictly. Under the Old School practice it used to be the fashion to bleed a patient as soon as the premonitory symptoms of apoplexy made their appearance; this, however, is a most pernicious practice, and almost invariably hastens the attack. Under homoeopathic treatment the following remedies are chiefly resorted to: ACONITUM is the principal remedy when the following symptoms develop themselves: rush of blood to the brain, flashes before the eyes, violent throbbing in the blood-vessels, flushes about the face, redness of the conjunctiva, dizziness, dulness or stupefaction of the head, ___ 328 SPECIAL THERAPEUTICS. buzzing in the ears, quick and full, or excessively sluggish pulse. DOSE.-A few drops of the strong tincture in a tumblerful of water, a small tablespoonful every fifteen minutes, or every half or three quarters of an hour, until an improvement sets in, after which the medicine may be continued every two hours, until the danger has entirely disappeared. BELLADONNA may be substituted for Aconite, if, after a few doses of this medicine, no improvement should set in. Aconite and Belladonna may likewise be given in alternation. DOSE.-A few drops, or six globules, in ten tablespoonfuls of water, a tablespoonful every half hour; if given in alternation with Aconite, a dose of medicine should be given every fifteen minutes. OPIUM, for stupor or coma, with stertorous breathing, deeply flushed or livid face. DOSE.-Same as Belladonna. Nux voMICA, may be resorted to, if the patient had led a sedentary life; and had indulged in ardent spirits and a rich diet to excess; and if he is troubled with constipation. DOSE.-Same as Belladonna, Nux may be used alternately with Aconite, giving an alternate dose of medicine first every half hour, until an improvement sets in, then every two hours. LACHESIS is recommended by soine for apoplexy of habitual drunkards, or especially when the left side is affected. DOSE.-A few drops, or one or two globules every two hours, dry on the tongue. We have not much faith in the efficacy of this drug in this disease. ARNICA may be given, if the attack is accompanied with involuntary evacuations, and more particularly if some mechanical injury seems to have been the cause of it. For the paralysis which sometimes remains after an apoplectic attack, the best remedies are ACONITE, BEL --Y~ -r INFLAMMATION OF THE BRAIN, ETC. 829 LADONNA, COCCULUS and RHUs TOXTGODENDRON, Aconite being undoubtedly the best. In such a condition it is sometimes indispensable to use the saturated tincture of the root of Aconite, and the common tinicture of the other medicines. DOSE.-One or two drops in a tumblerful of water, every two, three or four hours, to be continued until the symptoms abate, after which the doses may be given at longer intervals. Frequent ablutions with cold water, and the use of the flesh-brush are very serviceable in such cases of paralysis. For more extensive details see page 390. Inflammation of the Brain, Meningitis, Encephalitis, Hydrocephalus, Dropsy of the Brain. It has been shown in the introduction to this chapter on nervous diseases, that the brain is surrounded by three membranes, the dura mater which lines the inner surface of the scull, the arachnoid membrane and the pia mater. An inflammation of the brain, may either affect the surrounding membranes of the brain, or the substance of the brain itself. The symptoms differ somewhat according as either one or the other portion of the brain is affected. In a case of meningitis or inflammation of the membranes of the brain, the pain is more acute, tearing, lancing; in a case of encephalitis or inflamma-. tion of the substance of the brain, the pains are generally dull and heavy, and apparently more deep-seated. The treatment being strictly conformable td the symptoms, we need not discriminate between the two forms of inflammation. This difference is a pathological curiosity rather than a subject of importance in practice. The inflammation generally sets in with a chill and 29* 330 SPECIAL THERAPEUTICS. all the symptoms of a violent rheumatic disease, pains all over; soreness, aching and sharp pains in the joints, etc. If children are attacked with this disease, they become fretful, lose all inclination to play, want to lie down, and show an inability to keep their heads erect. They- complain of headache, dizziness, are taken with vomiting, violent thirst, aversion to food, sensitiveness to light and noise, even conversation; the pupils are contracted, and an expression of deep suffering and anguish is perceptible in their countenances. The face looks flushed, and the head is burning hot, whilst the extremities are cold. Gradually the skin becomes hot all over except the feet, and the pulse becomes small and quick; in the beginning of the fever, the pulse is sometimes full and throbbing. As the disease progresses, the head cannot be moved, without causing intense suffering. The eyes stare, glisten and the child becomes emaciated and loses all its strength. Delirium sets in, sometimes of a muttering and bland, at others of a furibond character. Stupor develops itself. If the pulse suddenly becomes slow, and spasms and a cold and clammy sweat should break out, this is a sure sign that water has become effused into the ventricles of the brain. In such a case the head becomes enlarged, coma sets in, and in the course of this stage of the disease the children are sometimes seized with a ravenous desire for something to eat. From this excessive depression and comatose condition the children sometimes seem to rally; they show symptoms of consciousness; they seem to hear the mother's voice or to follow the movements of a hand before their eyes: but this improvement is frequently illusory; after having lasted half a day or a day even, the coma returns, the pulse becomes quicker and INFLAMMATION OF THE BRAIN, ETC. 831 quicker, the fever is more intense, than ever, and life gradually becomes extinct. TREATMENT.-In this disease it is eminently proper to apply ice, or ice-water to the head, but all the time, not by fits and starts; for, in this case, the application would be attended with mischief rather than benefit to the patient. As regards the medical treatment, the following remedies should be principally resorted to: ACONITUM in the commencement of the disease, when the patient first complains of the chill and the headache. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours, until the patient feels better. If no relief be obtained after a few doses, and the rheumatic pains predominate in the joints and extremities, give. BRYONIA, the same as Aconite. Or give these two medicines alternately, an alternate dose every.hour, until an improvement sets in, then every three hours. BELLADONNA, if the pains are excruciating, with delirium, burning heat of the head, sensitiveness to light and noise, staring or glistening eyes, contracted pupils, or alternate contraction and dilatation of the pupils, starting, coldness of the extremities, excessive thirst, inflamed edges and furred coating of the tongue, vomiting, furious delirium, pulse quick and soft. DOSE.-The same as Aconite. HYoscYAMUs, for drowsiness, stupor, loss of consciousness, delirium, froth at the mouth, staring or dilated pupils, muttering with symptoms of rage, picking at the bed-clothes. DOSE.-The same as Aconite. OPIUM, for stertorous breathing, comatose sleep, apathy, bloated and red appearance of the face and eyes. DOSE.-The same as Aconite. .__.__.___. _ II_ ~ _~ __ ~_~_ _I _~ 332 SPECIAL THERAPEUTICS. When effusion seems to have set in, it may be necessary to resort to the following medicines: DIGITALIS, a few drops or six globules in a small tumblerful of water, a small tablespoonful every two hours. If this should have no effect after a few doses, give ARNICA; in the same way as Digitalis, or alternate the two medicines, giving a dose every hour, until the patient is evidently better. HELLEBORUS, is appropriate, if the effusion is accompanied with aphthous ulcerations in the mouth. DOSE.-Same as Digitalis. MERCURIUS may be given if the fever was never very high, the eyes have a yellowish tinge, and the pain was originally accompanied with vomiting of green bile, or was centered in one part of the head. DOSE.-Same as Digitalis. If a homoeopathic physician should be called to a case of brain-fever that had been treated alloeopathically, he ought to review the whole case and prescribe such remedies as the case seemed to require originally. It makes very little difference what was the original cause of the disease, for the disease has to be treated according to the perceptible symptoms. Brain-fever may arise from cold, from exposure to the sun's rays, from repelled eruptions, concussion of the brain, etc. In any of these cases the treatment depends upon the existing symptoms. It may be stated, however, that, in brain-fever arising from exposure to the sun's rays, THE SPIRITS OF CAMPHOR, if taken at the very commencement of the attack, are calculated to arrest its progress. INFLAMMATION OF THE BRAIN, ETC. 833 DOSE.-Four or five drops of the spirits on a little sugar, to be repeated every half hour, until the symptoms change for'the better. In brain fever from repelled eruptions, the spirits of CAMPHOR are likewise recommended by some as an excellent means to restore the eruptions upon the skin, the dose being the same as indicated in the previous paragraph; or we may try CUPRUM ACETICUM, first trituration, half a grain every hour, dry on the tongue, until the eruption re-appears. Children who recover from inflammation of the brain, should be carefully guarded against cold, exposure to draughts of air, damp and chilly places, rough winds, etc. Relapses in this disease are not only generally fatal, but likewise very easy. In rheumatic and erysipelatous inflammation of the brain, which generally befalls full-grown persons, we have never derived any good from the use of the pellets; but have been obliged to use the strong tinctures, and principally the SATURATED TINCTURE OF THE ROOT OF ACONITE, or the common tincture of BELLADONNA or RHus TOX. In these inflammations the pain is intense, but the patient is seldom flighty, nor is the constitution as violently assailed as in meningitis. In the erysipelatous variety the erysipelatous inflammation is distinctly seen on the outside, the face is inflamed and swollen, the eyes are sometimes closed in consequence of the swelling, and the eyes themselves, and even the inner ear are often invaded. In such a case the pain is most agonizing, as if the brain were cut with knives, and it frequently happens that the hearing remains permanently impaired. The fever runs very high, with evening-exacerbations. The thirst is frequently intense. We commence the treatment with THE TINCTURE OF _ __C __ ___ _I~ _~~ ~ ~ _~ ~ ~_ r _~ 1_^_1~~~_I 8384 SPECIAL THERAPEUTICS. ACONITE, as stated before, one or two drops in a tumblerful of water, and give the patient a small tablespoonful every hour, until relief is obtained, after which we continue the medicine every two or three hours according to circumstances. After a few days, or if the brain should seem to suffer a good deal, we alternate the Aconite with BELLADONNA, one drop in a tumblerful of water, and give a dose of medicine every hour, or less frequently, if proper. If the erysipelatous symptoms should predominate, we sometimes give REus instead of Belladonna, and, by means of this treatment, we have never failed in curing the worst cases of rheumatic or erysipelatous inflammations of the brain in from one to two weeks. Rheumatic inflammation of the brain differs from erysipelatous inflammation, in this that the erysipelatous symptoms are absent, the pains in the head may otherwise be the same. In rheumatism of the brain the pains are generally of an aching and throbbing, stinging character; the parts feel excessively sore and hot, with sensation as if swollen; the inflammation may involve some special organ, the eyes, ears or even the nose. Only one side of the head may be affected. In scrofulous patients an abscess may often result from rheumatism of the brain. While the abscess is forming, the patient suffers excruciating pain, until the pus is discharged by the ears or even eyes. In rheumatic inflammation of the brain we depend principally upon the tincture of Aconite-root as we stated in the preceding paragraph, and upon Bryonia and Belladonna, the indications of which have likewise been given. After patients recover from such attacks, they sometimes experience a ravenous desire for food; this should INFLAMMATION OF THE BRAIN, ETC. 835 be gratified cautiously at first, lest an error in diet should cause unpleasant consequences. During the treatment, and even during convalescence, the patient should content himself with tea and toast, rice-gruels, farina, hominy, and gradually return to broths, light meat, soups, etc. A great many more remedies are proposed in medical works for inflammation of the brain; but it is doubtful whether they would be of much use, if the above-mentioned medicines should fail. Some of the principal remedies may, however, be mentioned. SULPHUR, may be given, when the indicated remedies, such as Belladonna, Digitalis, etc., seem to have no effect, and the symptoms continue to get worse. DOSE.-A few globules dry on the tongue, and if necessary, another dose in six hours, until an improvement is effected, after whch one of the previously mentioned remedies may have to be given. CALCAREA CARBONICA is recommended in the place of Sulphur, or in alternation with it, when the patient is evidently tainted with scrofula, as evinced by glandular swellings, discharges from the ears, etc. DOSE.-Same as Sulphur, except when alternated with Sulphur, in which Scase an alternate dose of medicine may be given every four hours. ZINCUM METALLICUM, may be tried when symptoms of effusion seem about to set in, or symptoms of paralysis of the brain develope themselves, such as: loss of consciousness, coldness of the extremities and skin, half closed eyes, labored breathing, small, weak, scarcely perceptible pulse. DOSE.-One grain of the third trituration every two or three hours, dry on the tongue, until relief is obtained. The Zincum may be alternated with Belladonna, if the symptomatic indications justify the use of Belladonna, a dose of medicine being given every hour, until the patient is better. ~h~c~------------ ~ 336 SPECIAL THERAPEUTICS. Inflammation of the Brain in little Children, Although we propose to devote a special chapter to the affections of children, yet this seems to be a suitable opportunity of offering a few remarks concerning a condition which is frequently looked upon as cerebral inflammation. Little children are sometimes seized with drowsiness or even stupor, from which they wake with a vacant stare, heat about the head, coldness of the extremities, vomiting, spasmodic twitchings of the muscles of the face, the corners of the mouth and even the limbs; violent starting of the body, redness of the face, and various other symptoms which evidently point to cerebral congestion, but do not constitute a case of inflammation. Such a group of symptoms may be occasioned by fright, by derangement of the stomach, worms, by a cold, teething, etc. The remedies to which these symptoms will yield quite readily in most cases, are: ACONITE, CHAMOMILLA, CALCAREA, BELLADONNA, OPIUM, MERCURIUS, and CINA. ACONITUM may be given, when these symptoms were caused by a fright, by teething or indeed by any other circumstance, especially when heat about the head, stupefaction of the senses, inability to nurse, vomiting, redness of the face, throbbing of the carotid arteries and coldness of the extremities, are prominent symptoms. DOSE.-A few drops, or six globules, in a small tumblerful of water, a dessertspoonful every hour, until a decided improvement becomes manifest If there should be no change after a few doses, give BELLADONNA, in the same manner as the Aconite, until the patient is better. After an improvement has set in, a dose of Aconite may be given, and the two medicines continued alternately at long intervals, say a dose every four hours. INFLAMMATION OF THE BRAIN, ETC. 337 CHAMOMILLA, may be given, if the cerebral symptoms are accompanied by fretfulness, vomiting of greenish bile, bilious discharges from the bowels, tumefaction of the abdomen, or when teething seems to be the cause of the trouble. DOSE.-Same as Aconite, with which the Chamomilla may sometimes be alternated, a dose of medicine every two hours, until the patient is better. OPIUM, when there is deep stupor with sour vomiting, and convulsive twitchings. DOSE.-Same as Aconite. It may, however, be necessary, in some cases to resort to a full drop of the tincture on a little sugar, or in a teaspoonful of water, for the purpose of exciting a reaction; this being accomplished, the Opium may be discontinued and Aconite, Belladonna or some other suitable remedy selected. MERCURIUS is indicated, if the cerebral disturbance seems to originate in a deranged condition of the mucous surfaces, accompanied with catarrhal or worm-symptoms, bilious vomiting, tenderness and bloat of the abdomen, sallow complexion, yellowish tint of the eyes. DOSE.-Same as Aconite. CINA is generally resorted to when worms are the cause of the trouble. It may be alternated with Aconite. DOSE.-If given alone, dissolve six globules, or mix a few drops in a small tumblerful of water, and give a dessertspoonful every two or three hours; if alternated with Aconite, give a dose of medicine every two hours, until an improvement sets in. SULPHUR and CALCAREA may be exhibited in this condition, if there should be a tendency to frequent, recurrence of such symptoms, or if a scrofulous taint may be suspected. In such a case, give first one of the aforesaid remedies, and after the acute symptoms are removed, exhibit Sulphur and Calcarea alternately as follows: Give two or three globules of Sulphur one day, and half a grain of the third trituration of Calcarea, dry on the tongue, the next day, and continue this treatment 30 338 SPECIAL THERAPEUTICS. for a week or fortnight. If another acute attack should set in, discontinue the Sulphur and Calcarea, treat the attack with the above-mentioned medicines, and afterwards resume the Sulphur and Calcarea. If there is an evident improvement in the constitutional condition of the patient, the Sulphur and Calcarea may be continued at longer intervals, say a dose every two or even every three days, until all medication seems unnecessary. We advise all mothers, whose children are subject to such attacks, to wash them several times a day with cold water, from head to foot. Few persons imagine that this simple proceeding does more for the health of children than medicine. A condition of the brain, characterized by such symptoms as we have described, often befals children during the period of teething. If they are habitually subject to such attacks from such a cause, a dose of CALCAREA may be given them morning and night, six globules dry on the tongue; and, while the attack lasts, one of the previously-mentioned remedies may be selected. We would caution parents not to overload their children's stomachs with cakes, pastry or sugar-plums; this is a most pernicious practice, which leads to habitual irritation of the bowels, and, by sympathy, to such cerebral irritations as we have.described in this paragraph. Simple bread and butter, cracker-soup, farina, oat-meal gruel, or even beef or mutton-broth, with the fat carefully skimmed off, and now and then a little stewed fruit: these, and similar articles of diet, are the very best food for children. Coffee and tea are utterly useless, and even injurious, to children; fresh water, or at most water and milk, is the only beverage that children require, either to quench the thirst or as a nourishment. CI __ ___ ~~_ I CONGESTION OF THE BRAIN. 839 Congestion of the Brain. By congestion we mean an engorgement of the bloodvessels distributed through the substance of an organ. Such an engorgement may be more or less constitutional, in which case the congestion is of a passive character, and, although characterized by pain, yet it does not result in the same terminations that characterize the acute form. The more important the congested organ-the higher it ranks in the scale of vital functions-the more serious and dangerous the congestion. An acute congestion always sets in with a chill, followed by a burning fever. In congestion of the brain, the chill is very severe, and the subsequent fever is extremely violent. The chill sometimes reappears for several successive days, and is frequently so violent that careless observers might mistake it for the shaking ague. The icy-coldness of the extremities, the blueness of the finger-nails, the mottled appearance of the skin, confirm them in this opinion. But the intense aching and burning pain in the head, the subsequent dryness and burning of the skin, which continues without interruption until the next chill makes its appearance; the drowsiness, stupor, the flushed appearance and bloating of the face, and the glistening of the eyes, betray to the more careful observer a deep-seated cerebral derangement, which can scarcely be taken for anything else than acute congestion. Children are, moreover, exceedingly fretful, peevish; they toss about, pull their hair, bury their little heads into the pillow, cannot bear being touched or looked at; they are unable to raise their heads, they want to drink all the time, and are seized with frequent attacks of vomiting, especially during the chill. This disease generally runs a course __~ 340 SPECIAL THERAPEUTICS. of from seven to ten or twelve days, seldom shorter, and either terminates in recovery or in effusion of blood on the substance of the brain, with paralysis of this organ. The recovery may likewise be partial, with paralysis of a special sense, particularly the sense of sight or hearing. The homoeopathic treatment of this affection is very simple, and most.generally successful. The principal specific remedy for it is undoubtedly ACONITUM NAPELLUS; in some cases it may be necessary to give a few doses of BELLADONNA. We may commence the treatment with the attenuated Aconite, dissolving six globules, or a few drops, in a small tumblerful of water, and giving a small tablespoonful of this solution every two hours. If an evident improvement follow the exhibition of this attenuated drug, we continue this preparation every four or even six hours, until the patient is in a fair way of recovery; but, if no improvement is observed in the condition of the patient in thirty-six hours, and the Aconite is still indicated, we at once resort to the tincture of the root, mixing one drop in a small tumblerful of water, and giving a dessert-spoonful every two hours.- After giving the tincture for one day and night, we mix one drop of the first attenuation of BELLADONNA in half a tumblerful of water, and give this alternately with the Aconite, in alternate dessertspoonfuls every two hours, and, if an improvement be obtained, every three hours. This treatment we have found generally sufficient. It may, however, be necessary to use other remedies in some cases; particularly MERCURIUS VIVUs: This agent is indicated by the following symptoms: a distressing sense of coldness, even in hot summer-weather, followed by heat and a _ ___~_ ___ __ I_ _I ___ __ HEADACHE, CEPHALALGIA. 341 sour-smelling sweat; intense aching, not burning, pain in the back part of the hea3, or also at the top of the head; thirst, sallow complexion, thick, dirty coating of the tongue; constipation, deep-yellow, strong smelling urine; the pain is most intense at night; in the day-time the remissions are more or less complete. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two or three hours. Palliative treatment.-If the bowels should be very torpid, it is proper to use injections of tepid water, mixed with a few spoonfuls of sweet oil, and a teaspoonful of salt. Ice may be applied to the head in bladders, if the patient desire it. He may be sponged every day with tepid water; the temperature of the room should be moderate, or to suit the feelings of the patient; the diet is to be perfectly simple, and, after recovery, all exposure to unfavorable weather is to be avoided for a time. Premature exposure, for instance, to a current of air, to keen winds, damp weather, etc., might bring on a relapse, which will often lead to inflammation of the brain, effusion into the ventricles, ahd finally terminate fatally. The diet should be the same which has been recommended under infflammation of the brain. Headache, Cephalalgia. By a headache patients commonly mean a pain in the head, either all over the head, or at a particular spot. This pain may either be a mere symptom of a general constitutional derangement, or it may seem to be a more or less local affection depending upon some primary irritation of the cerebral nerves, of the mem30* 342 SPECIAL THERAPEUTICS. branes or even substance of the brain. If the pain in the head is a mere symptom of some general constitutional derangement, this derangement has to be treated with appropriate remedies, under the influence of which the headache will likewise disappear. A headache may arise from a variety of causes, and may therefore have to be treated with a variety of remedies suited to the existing cause as well as to the existing symptoms. Agreeably to the cause which occasions the headache, or to the characteristic symptoms, we distinguish: Catarrhal and rheumatic headaches Arthritic headache. Bilious headaches. Nervous or sick headaches, hemicrania. Congestive or apoplectic headaches. Gastric headaches. Menstrual headaches, etc. In the subsequent pages, we furnish a list of the remedies which have proved most effective in the treatment of headaches. To the name of each drug we append a complete list of its symptomatic indications in the different varieties of headache; but in order to facilitate the selection of the appropriate remedy in any of these different forms, we will subjoin a classification of the medicines in accordance with the forms of headache, with which each series corresponds. It must not be supposed, however, that this classification is absolutely rigid; cases of catarrhal headache may sometimes occur where it may be necessary to employ a medicine which is ranged under bilious headache; or cases of bilious headache may require to be treated with a remedy that is recommended for some other form of headache. We repeat that this classification is only approximatively CATARRHAL AND RHEUMATIC HEADEACHES. 313 true, and that it is simply offered as a means of facilitating the selection of a remedial agent in particular cases. Catarrhal and Rheumatic Headaches. This species of headache is caused by exposure to a draught of air, by walking against a sharp and keen wind, by getting the feet wet, by the sudden suppression of perspiration about the head, or by some other exposure, such as under ordinary circumstances might result in a cold, influenza, or attack of rheumatism. As this headache passes off, symptoms of a common catarrh or cold in the head often make their appearance; these may be treated with the medicine indicated for cold in the head, or the medicine which seemed to be most suitable to the headache, may be continued a little longer, until the catarrhal symptoms have entirely disappeared. This form of headache, if the attack is a violent rheumatic attack, is generally attended with soreness of the scalp and brain; tearing and lancing pains in the scalp; violent throbbing or hard aching pain in the head; sensitiveness of the eyes, buzzing in the ears, chilliness, feverish feeling, weariness. If the rheumatic pains are very violent and seated, the treatment may have to be continued for several days before the patient is well again. The medicines which are most appropriate to this kind of headache, are, ACONITE, BELLADONNA, BRYONIA, CHAMOMILLA, and MEROURIUS VIVUS. - -----P-ms~c~~rw~-~ura~~-~lm~-u r~cY*c-wz~-~ar~rwruhcs~-r~-\_~~ -~IC~CYDDID~~CII~*B~CII~O~~~-LL-- 344 SPECIAL THERAPEUTICS. Arthritic Headache. This form of headache resembles the rheumatic headache, as far as the character of the pain is concerned. It attacks persons - who have the gouty diathesis, by which is understood a disposition to gouty or arthritic inflammation. If a headache of this kind results from metastasis or shifting of the inflammatory process from the extremities where the gouty disorder is generally localized, to the cerebral tissues, the pain is not only excruciating, but the attack may lead to serious consequences. The pain is generally tearing, lancinating, sticking, or a heavy oppressive, aching and throbbing, stupefying pain; the affected part feels hot, swollen, sensitive to the touch; after the pain passes off, a feeling of numbness often remains. For a headache of this kind, we generally prescribe ACONITE, BRYONIA, MERCURIUS VIVUS, LEDUM, sometimes BELLADONNA, and also COLCHICUM and RHus TOXICODENDRON. Bilious Headache. This form of headache is so called on account of the predominance of the bilious symptoms which characterize it. It may be occasioned by violent anger, altercations, or by excessive eating, abuse of spirits, exposure to the sun's rays. Individuals with bilious constitutions, as it is termed, are more or less subject to this kind of headache. It may last for one or more days. The pain is agonizing, stupefying, a violent throbbing pain, as if the skull-cap would fly off; lancinations darting through the brain in various directions; NERVOUS HEADACHES, ETC. 345 the brain often feels as if on fire, and so sore, that the least jar increases the distress; light is intolerable; the eyes have a yellowish look, and the complexion is often changed to a deep brown hue. Vomiting of bile is a constant symptom in this headache; every attack of vomiting causes an aggravation of the cerebral distress. For this kind of headache we prescribe ACONITE, ARSENICUM, CHAMOMILLA, MERCURIUS VIVUS. Nervous Headache, Sick Headache, Hemicrania. These headaches occur with a certain periodicity, every week, fortnight or month; they generally begin with sun-rise and terminate when the sun sets. The pain is most frequently felt on one side of the head; it is a sticking, tearing, throbbing or hard aching pain; the painful part feels sore; light and noise are intolerable; the eye of the affected side is sometimes very much irritated, swollen, inflamed and watery. Individuals of both sexes are subject to this kind of headache. It is often attended with severe retching, vomiting of bile and mucus. The medicines which are most suitable to this form of headache, are ACONITE, ALOES, COFFEA, ARSENICUM, IGNATIA, BELLADONNA, NUX VOMICA, OPIUM, PULSA'TILLA, TIJUJA, CHAMOMILLA, CHINA, QUININE. Gastric Headache. These headaches might also be termed sick headache, because they are generally attended with sickness at the stomach, or even vomiting. They are caused by overeating, or by partaking of food that does not agree with 346 SPECIAL THERAPEUTICS. the stomach, such as fat meat, gravies, flatulent food, cabbage, turnips, warm bread, pastry, ice-cream, raw fruit, etc. Our best remedies for this kind of headache are: ACONITE, IPECACUANHA, NUX VOMICA, PULSATILLA, and strong black coffee. Menstrual Headache. This kind of headache, arises from suppression of the menses. A suppression of this kind may occur in consequence of some violent emotion, fright, anger, grief; or it may be occasioned by exposure to wet, a draught of air, privations, over-fatigue, etc. Headaches of this kind are generally characterized by a violent determination of blood to the brain, redness and bloating of the face, excessive sensitiveness of the scalp to pressure, throbbing and tearing pains in the head, a leeling of fulness in the head, giddiness; among the sympathetic derangements we distinguish: sickness at the stomach, vomiting of bile, blood, or mucus; palpitation of the heart, oppression on the chest, spitting of blood or nose bleeds. A headache of this kind may last for several days before it is entirely subdued, and sometimes the head will feel embarrassed until the menses reappear. These headaches require principally: ACONITE, ALOES BELLADONNA, PULSATILLA, etc. Congestive, Apoplectic Headache. This form of headache is characterized by a violent determination of blood to the brain. This is the common way of designating such a condition; but this CONGESTIVE, APOPLECTIC HEADACHES. 347 apparent determination of blood results in reality from an inability of.the brain to keep up the harmonious movements of this vital fluid; the cerebral engorgement being simply a consequence of the impaired functional power of that portion of the nervous system upon whose stimulating influence the circulation of the blood in the brain depends. The attack sometimes sets in quite suddenly, and with such an intensity that the patient seems in imminent danger of apoplexy. The characteristic symptoms of this kind of headache are: stupor, flushed face, sensation as if the brain were rising and falling; sensation as if the top of the skull would fly off; excessive throbbing pain in the head and of the carotids; sensitiveness to noise and light; violent retching, the patient raising only a little froth or mucus; chilliness, coldness of the extremities. Coldness of the extremities, especially the lower, is a common attendant in all violent forms of headache. In the congestive or apoplectic form the extremities often feel numb, and the pulse is very much depressed, sometimes reduced to fifty and less beats in a minute; it is either a heavy pulse, or else very feeble, besides being slow and intermittent. The principal remedies in this kind of headache are: ACONITE and BELLADONNA. If the retching is excessive TARTAR EMETIC may prove useful. We here subjoin a list of the medicines which are used in the treatment of headache. Many of them are very seldom indicated by the existing symptoms. Those which are most frequently used, have been distinguished by italics. The therapeutic indications belonging to each class in the different forms of headache, have all been combined together, inasmuch as 348 SPECIAL THERAPEUTICS. many of the symptoms which characterize one form of headache, would have had to be mentioned again in describing the other kinds; this would occasion an unnecessary repetition without simplifying the indications of the true remedial agent in a given case. The diet and general hygienic measures which patients who are subject to headache, should pursue during an attack of headache, or for the purpose of eradicating a disposition to headache, are of sufficient importance to deserve special mention. Persons who are liable to attacks of congestive or apoplectic headache, had better avoid rich and fat food; let them partake of moderate quantities of meat and vegetables, drink water, avoid stimulants and all violent excitements, and sponge the skin with cold water.every morning after rising, unless the reaction should be imperfect, and the skin remain cold. Persons who are subject to bilious and nervous headaches, should abstain from coffee, ardent spirits, heavy farinacious dishes, fat, rich confectionery, etc. Persons who are easily threatened with catarrhal and rheumatic headaches, have to avoid exposure to dampness, wet, keen winds, draughts of air on the head. They may find it advantageous to wash their heads with cold water every morning about fifteen or twenty minutes after rising; it will likewise be advisable to keep the head sufficiently covered in the open air, to protect it from the immediate contact of atmospheric moisture. During an attack of headache, patients are generally averse to nourishment except perhaps a cup of tea. In general, persons who are troubled with headache, should content themselves with plain and moderate fare, avoid SYMPTOMATIC INDICATIONS, ETC. 349 late suppers, and use such nourishment as seems to agree with their digestive apparatus. Symptomatic Indications of every Medicine which may be of use in any of the different forms of Headaches mentioned in the above List. This list will be found very complete; it contains a number of medicines which may seldom, if ever, be required in the treatment of common headaches. There is hardly a form of headache which cannot be effectually controlled within a reasonable period by one of the medicines which will be found printed in italics. Upon looking over the list, the reader will find the following medicines distinguished by this kind of print; Aconitum, Belladonna, Camphor, Coffea, gnatia, Ipecacuanha, Mercurius vivus, Nux vomica, Opium, Pulsatilla, Tartar emetic, Veratrum. While the headache lasts, the patient sometimes feels very much relieved by the application of a cold water compress to the head, or by the use of a tepid sitz or foot-bath; none of these auxiliary means, if they otherwise afford relief to the patient, are incompatible with homceopathic treatment. Acbnitum, for the following symptoms: heat in the head, or burning as of fire; sensation as if the brain were shaking against the sides of the skull, or as if the top of the skull would fly off; violent throbbing in the head; stupefaction, excessive sensitiveness of the scalp to contact; shooting or tearing pains through the brain; fulness and weight in the forehead, with sensation as if the brain would press out at the forehead, or as if the eyes would start out of their sockets; inability to keep the eyes open; or burning headache as if the brain were 31 : _ _ ~ 350 SPECIAL THERAPEUTICS. agitated like boiling water; or headache as if a hot iron were bound round the head; or headache as if the head were compressed on all sides; headache arising from a small, circumscribed spot which is excessively sensitive to contact, also with stitches under the scalp, or sensitive spots about the scalp, and sensation as if the hair were standing on end, here and there. This medicine is eminently adapted to semilateral headaches, generally termed nervous headaches, megrim or hemicrania; the pain is of a drawing, pulling or tearing kind, or it is an agonizing burning, screwing, boring, wrenching pain, and the affected region is excessively sensitive to con-. tact, and sometimes looks swollen and inflamed. The parts are frequently quite numb, with tingling, or they feel sore, as if bruised; or it is a crampy sensation, as if in the bones, or above the root of the nose, with sensation as if one would lose one's reason; or a stitching pain, with pressure. These various forms of headache are generally accompaied with sickness at the stomach, vomiting of bile, a sense of coldness, and a small, agitated, or sometimes a full, bounding pulse. DOSE.-A few drops, or six globules, in a small tumblerful of water, a small spoonful every half hour, until the agony is relieved, after which the medicine may be continued at longer intervals, until the patient is well -again. In rheumatic, arthritic, bilious and apoplectic headaches, the strong tincture of the root is often required, one or two drops in a tumblerful of water, a small tablespoonful every half hour, hour or two hours, until the headache disappears. ARGENTUM NITRICUM is an admirable medicine for semilateral headaches or hemicrania, and is especially indicated by the following symptoms: pressure deep in the brain, accompanied with chilliness; undulating throbbing in the whole forehead; drawing along a narrow streak from the occiput to the middle of the SYMPTOMATIC INDICATIONS, ETC. 351 brain; sensation as if a cool current were blowing from the right frontal eminence to the right eye; tearing from the forehead to the left eye and left side of the face, with lachrymation of the eye which looks red and glistening; pressure, pain and heaviness in the right side of the head; digging up, raging pain in the right brain, with loss of sense and vertigo when attempting to walk; drawing and digging in the left frontal eminence, with a drawing tearing pain along the whole arm; digging, cutting motion through the left brain; the pain in the head is accompanied with a sensation as -if either the whole head, or only the affected part of the head, and the eye on this side were enlarged. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every hour, and, if relieved, every two or three hours. ARNICA may be given for headache caused by a fall, blow on the head, or some other mechanical cause. DOSE.-Same as Aconite, with which it may be alternated every hour. ARSENICUM is a good remedy for agonizing headache, humming in the ears, beating as if the skull would fly to pieces; or sensation as if the brain were moved, or as if it shook like water and dashed against the skull when walking or moving the head; snapping noise in the head; the scalp feels painful as from subcutaneous ulceration; aggravation of the pain at night. This headache is generally attended with violent vomiting of bile, pointing to serious derangements of the liver. DOSE.-Same as Aconite, or half a grain of the third trituration every two hours dry on the tongue. Belladonna is indicated by the following symptoms: The forepart of the head is principally affected; it feels sore and heavy, especially when stooping, and in --- -- -- - -- 852 SPECIAL THERAPEUTICS. the morning when first waking, looking at the light and moving about; painful sensation as if something were descending in the forehead, obliging him to keep his eyes closed; crawling sensation over the whole forepart of the head, pressure in the head, here and there extending over large surfaces; aching deep in the brain which is felt'over the whole head; pressing in the forehead as from a stone; sensation as if the whole brain were dilated and would press through the skull, or as if the brain would be dashed to pieces; sensation on waking as though the brain were rising and falling in the forehead, external pressure affording relief; violent throbbing in the brain terminating externally in acute stitches; lancinating and jerking pains in the head, boring and throbbing in the right side of the head and cheek; stitches darting through the brain in every direction; sensation as if the bones of the skull would be pressed asunder by some force applied internally; heat or burning in the head; sensation as if the brain were shaking to and fro; pain over the whole head as after pulling the hair; cramp-pain at the root of the nose or in the sides of the head; congestion of blood to the head, with redness of the face, glistening of the eyes, excessive sensitiveness to noise and light. DOSE.-A few drops, or six globules, in a small tumblerful of water, a spoonful every hour until relieved, afterwards every two hours. This medicine is sometimes eminently suitable after Aconite, or in alternation with Aconite, an alternate dose every hour until the symptoms abate, after which the medicines may be continued for a time every two or three hours.-If the attenuated Belladonna is not sufficient in a case where this medicine is indicated, give a drop of the tincture as indicated under Aconite. BRYONIA is indicated by the following symptoms: the headache sets in principally in the morning on waking, or it is aggravated by motion, particularly by CONGESTION, APOPLECTIC HFADACHES. 853 opening and moving the eyes; chirping noise in the head; movements in the vertex and forehead occasioning giddiness and stagnation of thoughts; rush of blood to the head, with heat in the head; beating in the head, with dimness of sight; pressing pain in the temples, from within outwards, or sensation as if the brain would issue through the forehead, on stooping; or headache after a meal, with pressure in the forehead from within outwards, during a walk, or headache in the back part of the head, when lying on the back, as far as the shoulders, like a weight which presses upon a sore spot. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two hours, and less frequently after relief is obtained. CALCAREA CARBONICA is a good remedy for semilateral headache, with empty risings; or stupefying pain in the forehead, during rest and motion; pressure in the head, at the top of the head, in the temples or forehead; headache arising from the nape of the neck; tearing pain in the temples, orbital and cheek-bones, with swelling of the parts; digging and pressing pain in the head, with slight attacks of fainting; stitches in the head, also through the eyes; momentary jerks in the head; throbbing in the middle of the brain; heat in the head, or icy coldness in and about the head; snapping sensation or shocks in the head. DOSE.-This remedy is principally adapted to chronic cases, and should not be used more than once every six or twelve hours, taking two or three globules dry on the tongue each time. It may even be proper to use a dose of medicine every day, or only every other day. Camphor is: frequently a useful remedy for headache, especially when it was caused by exposure to the sun, and is characterized by a sensation as if the brain were sore and bruised, or a constrictive pain at the base of the brain and at the root of the nose, with rush of blood 381* 354 SPECIAL THERAPEUTICS. to the head, inclination to vomit; or sensation as if the brain were compressed on all sides, or cutting thrusts darting to the centre of the brain from the forehead and temple; also for fine, tearing pains in the head. The headache disappears by thinking of it intently, and recurs again by thinking of something else. DOSE.-One or two drops of the spirits of Camphor on a little sugar, every half hour, or every hour, until relieved. CHAMOMILLA may be exhibited when the head feels heavy and bruised, or as if it would burst; for tearing pains in the forehead, with a sensation as if a lump were falling forward; drawing pain in one side of the head; tearing and lancing pains in the temples, from within outwards; pricking pain in the head, as if the eyes would fall out of the sockets; throbbing or cracking sensation in one side of the head; swelling and painfulness of the temple. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two hours, until relieved. This medicine is particularly suitable, if the headache seems to be accompanied with bilious derangement, or if it was caused by suppression of sweat or a fit of anger. COCCULUS is suitable for nervous headaches characterized by the following symptoms; constrictive, burning, tearing, digging and boring pain in the head; sensation as if something heavy were lying on the head, or as if the temples were screwed in; violent pressure in the whole head, or sensation in the right temple as if a blunt body were slowly pressed into the brain; frequent paroxysms of an acute, throbbing-lancinating pain at a small, spot in the left frontal eminence, followed by a tingling in the opposite eminence; or headache as if the eyes would be torn out or forcibly closed; also with trembling of. the head or shivering sensation on the left side of the occiput.,i * e of t CONGESTION, APOPLECTIC HEADACHES. 355 DOSE.-Same as for Chamomilla. Coffea for hemicrania, as if a nail had been driven into the parietal bone, or as -if the brain would be torn or dashed to pieces, also with heat in the face and red cheeks, after a meal. If the headache is caused by overloading the stomach, a cup or two of strong black coffee may be taken to promote vomiting, after which Nux vomica may be required. DOSE.-Same as for Chamomilla. COLOCYNTHIS: This remedy is recommended for some forms of hemicrania, especially when characterized by painful pressing in the fore part of the head, or a painful tearing digging through the whole brain, aggravated by moving the eyelids; or pressure along the upper and internal boundary of the left frontal fossa; severe pain in the left eye and vertex; heat of the head; sensitiveness of the head and eyes to the least movement. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two hours, until the pain abates. HYPERICUM PERFOLIATUM is an excellent remedy for headache, accompanied with menstrual suppression, especially when the following symptoms occur: dull headache at the vertex, gradually increasing, as if the whole brain would be pressed asunder, with loathing and inability to perform any kind of work; or beating on the top of the head, stupefying sense of compression in the brain, with palpitation of.the heart, hard stool, evening chilliness and flushes of heat, bloat all over, cachectic look, small, rather frequent pulse; or sensation as if the head became suddenly elongated, with considerable fulling off of the hair. DOSE.-A few drops of the tincture in a tumblerful of water, a small spoonful every hour, or two hours, until the patient is relioeed. I__ _ _ 356 SPECIAL THERAPEUTICS. Ignatza, for hemicrania characterized by the following symptoms: Pressure through the whole brain, as if the brain were too large; painful pressure above the root of the nose, obliging him to incline the head forwards, with inclination to vomit; sensation as if a nail were pressed into the brain; paroxysms of headache, as if something hard were pressed on the surface of the brain; headache in the temples, as if they would be pressed out; beating in the head, especially in one side of the occiput; headache on waking in the morning, as if the brain would be dashed to pieces; after rising, the pain goes off, and changes to a toothache, as if the nerve would be crushed and dashed to atoms; from the tooth the pain passes to the small of the back. DOSE.-One drop, or a few globules, dry on the tongue,, every three or four hours. Ipecacuanha is one of our most efficient remedies for hemicrania, especially for a sticking pain in the vertex, stinging and tearing pains, headache as if the brain and skull were bruised, penetrating through all the bones of the skull to the root of the tongue, with nausea; pressing pain from. within outwards, or almost boring at a small spot, now in the temples, then above the orbit of the eye; dull, drawing pain in the head, to and fro. A characteristic peculiarity of the Ipecacuanhaheadache is, that the pain is excited and aggravated by contact. DOSE.-A few drops, or globules, dry on the tongue, every four hours, until perfect relief is obtained. LOBELIA CARDINALIS may be given for dull and distressing headache, with fulness in the forehead and at Sthe base of the occiput, which latter is particularly painful; the pain is increased by motion or by shaking the SYMPTOMATIC INDICATIONS, ETC. 357 head, and as the headache increases, a throbbing and weakness in the lower extremities supervene; also with hot sweat on the forehead, throbbing in the forehead and base of the occiput; the head feels light, with disposition to indulge in reveries. These indications have been furnished by Dr. Samuel R. Dubs, of this city; they are scanty, it is true, but his proving of the Lobelia cardinalis, although only a beginning, seems so accurate, that we have deemed it proper to mention the above indications for headache in this work. DOSE.-A few drops, or globules, every three or four hours, dry on the tongue. LOBELIA INFLATA has been successfully exhibited for a dull, heavy pain, passing round the forehead from one temple to the other, on a line immediately above the eyebrows. DOSE.-A few globules every four or six hours dry on the tongue, until relieved. Miercurius vivus, is indicated by the following symptoms: vertigo, with pain in the whole head, relieved by sitting down and leaning the head against something; pressing pain in the parietal bones, from within outwards; violent headache as if the head would fall to pieces at the top, with pressure toward the nose; stitches through the whole head, also in the left region of the forehead, with chills over the whole body, cold hands and hot cheeks; shocks in the brain, especially when moving about or stooping; heat and burning in the head; headache as if the brain were sore and ulcerated, with vomiting of bile; the least attempt to perform some mental labor, makes the headache worse, which is frequently accompanied with deadly paleness 858 SPECIAL THERAPEUTICS. DOSE.-Mix a few drops, or ten globules, in a small tumblerful of water, and take a small tablespoonful every two hours, until relieved Nux JUGLANS may prove valuable in hemicrania; among its indications we find: headache, especially over the left eye; in the region of the left parietal bone, in a space of the size of a dollar, a very unusual pain like megrim, soon disappearing; burning heat in the head, whilst the extremities are icy-cold, in the evening, in bed. DOSE.-One or two drops of the tincture in half a tumblerful of water, a small tablespoonful every two hours. Nux vomica corresponds with the following symptoms: the headache is excited by over-eating, spirituous drinks, mental exertions, constipation; headache with nausea or vomiting of sour and bitter substances; stupefying headache, also with giddiness and heaviness in the head, early in the morning, as from intoxication; aching pain above the left eye, with pain in the bones as if he had knocked them against something, and inability to open his eye; painful pressure in the occiput, in the morning on waking, as if the brain were pushed forward; distensive sensation in the head, as if the skull would be pressed asunder; headache as if the brain would be split; tearing pain in the head, extending to the root of the nose and upper jaw; tearing headache after a meal, with feeling of heat in the cheeks, and a feeling of chilliness over the body and in the hands; jerks and bubbling and shaking sensation in the head, also jerks and dull stitches in the left brain, after a meal; headache, worse after dinner, followed by violent stitches in the left temple, with nausea and sour vomiting; stitching in the forehead, also with pressure. The headache for which Nux is suitable, is generally of a distressing kind, a SYMP:TOMATIC INDICATIONS, ETC. 359 raging, maddening sort of pain; it may be caused by long sedentary habits, over-eating, abuse of spirituous beverages, nightly revelling, exposure to damp air, suppression of the haemorrhoidal flow. DOSE.-Mix a few drops, or ten globules, in a tumblerful of water, and take a small tablespoonful every two hours, until relieved. If the headache is caused by abuse of alcoholic beverages, it may be necessary to use the strong tincture as prescribed under ACONITE. Opium may be useful in hemicrania, with pressure from within outward, increased by external pressure; or hemicrania characterized by tearing and beating in the forehead, with sour eructations and sour vomiting; or hemicrania as if the brain were torn, with sensation as if every part in the body were turning wrong side up. These various forms of hemicrania are generally accompanied with considerable cerebral congestion, stupefaction and even stupor. DOSE.-A few drops, or six globules, in a small tumblerful of water, a small tablespoonful every two hours; or, it may be advisable in some cases, to give a drop of the tincture instead of the globules, in the same quantity of water, and the same dose. Platina is recommended for a tensive, numb feeling in the sinciput, as if constricted, or sensation as if pressed together by force; also for a cramp-like pressing in the temples from without inwards, or pressure'in the forehead, as if everything would issue from it; accompanied with fitful mood,, depression of spirits, especially in hysteric females. DOSE.-One grain of the third trituration, dry on the tongue, every three hours, until relieved. Pulsatilla is a distinguished remedy in headache, when the following symptoms occur: Headache deep in the orbits, when moving the eyes, as if the forehead would fall out, and as if the frontal bone.were too thin, 360 SPECIAL THERAPEUTICS. with a gloomy feeling in the head in the evening; or hemicrania, as if the head would fly to pieces, and as if the eyes would fall out;. bruising or creeping sensation in the forehead; jerking, tearing pain in the head, particularly in the temples, as if they would be torn asunder; or tight feeling in the brain, with a boring pain in the vertex; single, sharp shocks or jerks in the right brain; or headache, as if a keenly-painful wind were rushing through the brain; pulsative sensation in the brain, when walking, like the snapping of electric sparks; headache, extending to the eyes, with pain and pressure in the eyes, lachrymation; or headache as if from intoxication and watching; stitching hemicrania, or hemicrania with nausea and vomiting; or headache from overloading the stomach, or eating fat meat, ices, fruits; also headache in the evening, in bed, succeeded by dry heat, drowsiness, delirious fancies; headache from suppression of the menses in consequence of a cold, exposure to wet. DOSE.-A few drops, or six globules, on the tongue, every four hours, until relief is obtained. RHEUM is an excellent remedy for various forms of hemicrania, especially such as are characterized by a dull, tight, dizzy sort of pain, extending over the whole head, and worse on the top of the head and in the temples; or stupefying headache, as if the contents of the skull were turned out of their places, worse during motion than when stooping; pulsative, crampy headache, now in the left, then in the right temporal bone, and on the head; or hammering sensation in the head, which seems to proceed from the abdomen; these various pains may be accompanied with sour vomiting. DOSE.-A few drops, or six globules, in a small tumblerful of water, a small tablespoonful every two or three hours. L ~~_~~__ ~~~______L_~ SYMPTOMATIC INDICATIONS, ETC. 361 RHUS TOXICODENDRON is used, when the patient complains of a painful pressure in the occipital protuberances, headache in the forehead on moving the arms, as if pressure were made with a dull point, or as if the eyes would be pressed out of their sockets, with yawning and chilliness; sensation, on stooping, as if the head could not be raised again; compressive sensation in the brain, from temple to temple; burning pressure at the right temporal bone; tearing in the head, to and fro, also in the upper part of the head, with soreness to the touch; or headache on first waking and opening the eyes, as if the brain behind the eyes would be torn to pieces, followed by a bruising sensation in the occiput; stitch in the head, followed by nausea, fulness, and a sensation of warmth ascending to the head; burning in various parts of the head, or burning-creeping in the forehead. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours until relief is obtained. SEPIA is recommended for chronic hemicrania, with nausea, vomiting, and a boring, sticking pain, extorting cries; painful beating in the occiput, or a violent jerking pain in the forehead, headache as if the eyes would fall out, or as if the head would burst; stitches in the forehead, with inclination to vomit, or stitches striking through the eyes; tearing in the head, over the forehead and in the eyes, also tearing and stitching, extend, ing from the forehead and occiput to the vertex; pain in the occiput, as if hollow, or pain as from subcutaneous ulceration, especially at night, and when lying on the part. DOSE.-One or two globules every twenty-four hours, for a few days, after which it is proper to wait a few days, and watch the effects of the medicine, and not to repeat the dose, or substitute some other drug, until we feel satisfied that the medicine has ceased to act. 32 362 SPECIAL THERAPEUTICS. SILICEA is likewise a good medicine for some forms of hemicrania, especially when the pain extends from the nape of the neck to the vertex; vibratory sensation in the brain as if shaking; jerking, with pressure in the middle of the forehead, when turning, rapidly stooping or talking; pressure in the occiput with sticking in the forehead, chilliness of the nape of the neck and back; pain in the brain as if compressed, or as if pushed forward; sensation as if the skull were pierced by violent stitches, or as if the brain were teeming with living things; boring pain in the forehead, or tearing as if the head would fly to pieces, with chilliness; the headache is accompanied with rush of blood to the head, and followed by obscuration of sight. DOSE.-In all respects the same as Sepia. SPIGELIA removes violent hemicrania, with inflammation and lachrymation of the right eye, sensation as if the eye would be pressed out of its socket, photophobia. DOSE--Same as Rhus tox. STAPHYSAGRIA is a remedy which is well deserving of attention in hemicrania; it is indicated by the following symptoms: sensation as if a heavy ball were lying in the region of the root of the nose; violent headache after waking, as if the brain were torn, going off amid spasmodic yawning; sensation when shaking the head, as if a leaden bullet were lying in the middle of the forehead; compressive sensation in the brain, with roaring in the ear; compressive sensation in the occiput, internally and externally; painful pressure in the left temple, as if pressed upon with the finger; pressure with stitching in the forehead, and then only in the left frontal eminence, going off during rest, and returning with much more violence during motion; sharp, burn I_ _ _ _ _ SYMPTOMATIC INDICATIONS, ETC. 863 - ing prickings in the left temple; dull sticking in the right temple, externally and internally, as if the bone would be pressed out, aggravated by contact; or headache as if the brain were loose, and standing off from the skull. DOSE.-Four globules, dry on the tongue, every three hours, until relieved. SULPHUR may be employed for chronic headache, in the same way as Sepia or Silicea, if the brain feels sensitive and sore, with pressure and tightness in the brain, or as if the head were between screws; or tearing pain in the head, shocks through the head, heat and burning in the head, buzzing, tingling, roaring in the head; or pain, when nodding, as if the brain were beating against the skull. TABACUM may be given for violent headache, as if the brain would be dashed to pieces, with violent dizziness and deathly sickness at the stomach. DOSE.-One drop of the tincture in a tumblerful of water, a small tablespoonful every two hours, until relievea Tartarus emeticus for tensive, stupefying headache, with pressure from without inwards, in the forehead and over the root of the nose, also proceeding from the temples, with drawing and digging to the root of the nose; tearing in one side of the head; trembling of the heart during motion. The headaches which yield to tartar emetic, are generally accompanied with symptoms of violent gastric disturbance, such as retching, vomiting, and with'symptoms of cerebral congestion, sometimes amounting to an apoplectic condition. DOSE.-One grain of the first trituration in a tumblerful of water, a small tablespoonful to-be given every hour until the retching and vomiting cea.e, and the head seems a good deal relieved, after which it may be necessary, either to select some other remedy, or to continue the same medicine at longer intervals. 364 SPECIAL THERAPEUTICS. THUJA is an admirable remedy for hemicrania characterized by the following symptoms: sensation as if the head were screwed asunder in the articulation of the malar bone and upper jaw, or as if a nail were driven into the vertex or right parietal bone, or as if the forehead would fall out, accompanied with internal chilliness; or, fnally, as if a button were pressed on the surface of the brain; numb feeling and humming in the left brain; pulsating, jerking pain early in the morning, with pressure and redness of the face; crampy sensation in the left side of the head; drawing in right parietal bone, with pressure and a warmth spreading all over the body; furious pressing in both temples, from without inwards, or violent lancination through the right brain from the occiput to the forehead. DOSE.-A few drops, or six globules, on the tongue, every six hours, until relief is obtained. VALERIANA is principally indicated by a sticking pain in the head, as if the eyes would be pierced from within outward; or a painful drawing around the orbits; or a painful, stupefying, contractive sensation affecting the whole head; or sensation of icy-coldness in the upper half of the head, when pressing the hand firmly on the head; or violent stitches in the interior of the forehead, coming and going. DOSE.-A few drops, or six globules in a small tumblerful of water, a small tablespoonful every two hours, until relieved. Veratrum for headache with vomiting of green mucus; or for paroxysms of pain in various parts of the brain, partly as if bruised, and partly like pressure; constrictive headache, with constrictive pain in the fauces; pressing pain in the vertex as if the head were pressed flat, changing to a beating pain by motion; _ _ _ ____ SYMPTOMATIC INDICATIONS, ETC. 3165 painful shocks in the head, with jerkings in the arm, and paleness of the fingers; a characteristic indication for Veratrum is cold sweat on the forehead, and-a sensation as if a cluster of hairs were electrified, with slight shuddering and creeping over the scalp. DOSE.-A drop, or two or three globules, on the tongue, every two hours, until relieved. VERBASCUM is a good remedy for hemicrania, when characterized by a stupefying pain in both sides of the forehead; stupefying, deeply-penetrating, sticking pain in the right temple, during dinner, aggravated by external pressure, and shifting to the upper teeth in the shape of a tearing pain; slow, long stitch through the left brain, from behind forward, with pressure; sensation as if both temples were pinched with pincers. SDOSE.-One drop of the tincture in a tumblerful of water, a small spoonful every two hours, until relief is procured. Those who are not satisfied with the foregoing list of remedies, will do well to consult Dr. Peters' Treatise on Headache, published by W. Radde, 300 Broadway, or our large Repertory, where every possible variety of headache will be found mentioned from pages 83 to 210. Chronic hemicrania is frequently not only difficult, but impossible to cure. Persons who are subject to this distressing malady, should be exceedingly careful in their diet; get up early, go to bed in season, avoid all sorts of stimulants, fat, rich gravies, ices, pastry, and the like; drink plenty of cold water, use regular exercise in fine, balmy weather, and even when the weather is cold, but keep out of the damp, and out of draughts of air. They should likewise make it a practice to use daily ablutions with cold water on rising from bed, and shower the lower part of the back and the bowels; if 39*. SPECIAL THERAPEUTICS. the bowels should be disposed to costiveness, it will be found advantageous to use a cold-water injection every morning after breakfast. Inflammation of the Spine Spinitis, Myelitis. Our readers will remember that at the commencement of this chapter, where we gave a description of the nervous system generally, we stated that the spinal cord, enveloped in its membranes, is contained in the bony canal along the middle of the back which, is known under the appellation of the vertebral column. The vertebral column is composed of bones termed vertebra, which are firmly held together by means of strong ligamentous bands. An inflammation of the spine may therefore attack: 1, the osseous portion; 2, the enveloping membranes; and 3, the marrow itself. a. Inflammation of the Vertebral Column. An inflammation of the vertebrae may befall persons of both sexes, and of any age. It is more frequent among young than among old people. It may be caused by a fall, a blow, or by some other mechanical injury; or it may result from a constitutional scrofulous taint. The disease is often very insidious; it may remain more or less hidden for years; and, when it is first fairly recognised, incurable disorganizations may have already been established. The symptoms by which the presence of this disease may be known: are, sensitiveness of the inflamed region to pressure; inability to move the spine without experiencing pain; swelling of the inflamed vertebra, either partial or total, and, at a later INFLAMMATION OF THE VERTEBRAL COLUMN. 867 period of the disease, curvature of the column. The inflammatory process is scarcely ever confined to the bones; the marrow which corresponds to the inflamed vertebrae, is generally more or less involved. This sympathetic irritation or inflammation of the marrow leads to a variety of constitutional derangements.. If the lower or lumbar portion of the spinal marrow is affected, the patient complains of formication, tingling numbness and paralysis of the lower extremities, paralysis of the bladder and rectum, and a sensation as if the body were enveloped by a band. If the middle or dorsal portion of the spinal column is affected, the patient experiences oppression of breathing, and a violent stitching, burning, and frequently maddening pain along the tract of the intercostal nerves. If the upper or cervical portion of the vertebrae is inflamed, the muscles of the neck show symptoms of paralysis, the head is frequently depressed, and the patient finds it difficult to swallow or to articulate. This disease is curable, if attended to in time; if the patients are very scrofulous, a radical cure is hardly ever possible, although the patient may be very much relieved by careful treatment. The remedies which will be found particularly useful in this affection, are ACONITE, BELLADONNA, the IODIDE of MERCURY, SULPHUR, and SILICEA. ACONITE, should be given, if the parts feel very sore, hot, and the patient is very restless, feverish, the urine looks highly colored, and the face is more or less flushed. The pulse is irritated and rather hard, but not very full or bounding. DOSE.-We prefer in this acute form of spinitis, the tincture of Aconite root, one or two drops in a small tumblerful of water, a tablespo6nful every hour. This treatment may be continued until the patient feels much re 368 SPECIAL THERAPEUTICS. lieved, after which the use of Aconite should be continued by all means, althoughwe may lengthen the intervals. The internal use of Aconite may be accompanied by the external use of the same tincture, mixing ten or fifteen drops in a tumblerful of water, and applying a linen compress, moistened with this mixture, to the inflamed part, taking care to tie a dry bandage over it. The compress should be moistened fresh every hour or two. Aconite may be alternated with BELLADONNA, if the brain seems very much irritated, the patient complains of severe headache, shows symptoms of delirium, with staring and glistening eyes, deeply flushed cheeks, stupefaction, obscuration of sight, buzzing in the ears, hardness of hearing, paralytic weakness of the tongue and organs of deglutition. DOSE.-A few drops of the first attenuation, or one drop of the strong tincture in a small tumblerful of water, of which a tablespoonful may be given in alternation with the previously mentioned mixture of Aconite every hour, or even every half hour, until an impression seems to have been made upon the disease. These two medicines are principally adapted to the acute form. If the patient has had the itch, or is subject to frequent eruptions, and has been treated with ointments and washes, we may give SULPHUR, in half-grain doses of the third trituration, a dose to be given three times a day. If the symptoms partake more or less of the acute form, we must not omit the use of Aconite, as previously described, in connection with Sulphur. If the bones have become disorganized by the disease, we may give CALCAREA CARBONICA, in the same manner as Sulphur, three doses a day of the third trituration. This medicine is adapted to spinal curvatures, and so is IODIDE OF MERCURY, same dose and preparation as Sulphur, particularly, if patients are very scrofulous, subject to glandular swellings, sores, etc. INFLAMMATION OF THE MEMBRANES. 369 SILICEA is given if the bones have become carious; it may be given in alternation with any of the above-mentioned drugs. DOSE.-Same as Sulphur. Chronic spinitis, particularly if disorganizations have resulted frori it, may require the use of mechanical means. For the necessary details in reference to this point, the patient is referred to the article on spinal curvatures in the last chapter of this work. b. Inflammation of the Enveloping Membranes, Meningitis spinosa. This is a very serious inflammation, which runs a rapid course, especially if it is the result of metastasis,* as it sometimes may be. This inflammation may arise from exposure to a draught of air, from retrocession of the perspiration, getting wet, etc. The existence of this disease is recognized by the following symptoms: impossibility of moving the spine without experiencing pain; absence of pain to pressure; the pain is an acute, stitching pain all along the course of the spinal marrow, sometimes continuous, and in other cases more or less paroxysmal. The constitutional derangements differ according. as one or the other portion of the spinal membrane is affected. If the lumbar portion is affected, the lower extremities are rigid, and the bladder and intestinal canal are more or less paralyzed. If the dorsal portion is affected, the patient complains of oppression, sensation as if the lungs were crowded or could not expand suffi* By metastasis, we mean a transfer of the disease from one organ to some other organ or tissue; by metaschematismus, we understand a similar transfer of the morbid process, with change of form. 870 SPECIAL THERAPEUTICS ciently, palpitation of the heart. And if the cervical portion is affected, the muscles of the neck are stiff; and the patient experiences difficulty in talking or swallowing. It seems hardly necessary to add that such a serious and acute inflammation must be attended with all the symptoms of an inflammatory fever, a full and bounding pulse, hot and dry skin, white-coated tongue, darkred urine, constipation, flushed face, etc. The homceopathic treatment of this extremely dangerous affection is exceedingly simple. First and foremost we have our ACONITE, not the globules or liquid attenuations, but the tincture of the root, two or three drops in a tumblerful of water, of which a tablespoonful may be given every hour, or even every half hour, until the patient feels easier. After decided relief has been obtained, this medicine may be alternated with BRYONIA, three or four drops of the first attenuation in a tumblerful of water, a tablespoonful every alternate hour. BELLADONNA may be alternated with Aconite if there seems to be danger of the disease invading the brain; the patient exhibits symptoms of delirium, stupor, complains of violent headache. To be given in the same manner as Bryonia. These medicines will likewise prove useful in chronic irritation of the spinal membranes. In this difficulty, cold water bandages may be applied to the back, as taught in the introductory chapters on the use of cold water as a therapeutic agent. The medicines may be taken for several days or weeks in succession, allowing every now and then an interval of several days or even weeks to elapse. INFLAMMATION OF THE SPINAL MARROW. 871 SULPHUR and the IODIDE OF MERCURY, particularly in the case of scrofulous persons, are likewise to be recommended. For the mode of administration, the reader is referred to the previous chapter. c. Inflammation of the Spinal Marrow itself, Myelitis vera. This inflammation is principally caused by exposure to wet, or to a draught of air, especially when the skin is covered with perspiration. The disease runs a very acute course, and is almost always fatal under alloeopathic treatment. It sets in with a violent chill, which is followed by heat and dryness of the skin, flushed face and violent thirst; the pulse is irritated, but rather soft, about one hundred beats in the minute, and the urine is red and turbid. These are the general febrile phenomena characterizing this disease. The local pains are an exceedingly distressing, drawing, and tensive sensation along the spine, which is felt whenever the patient attempts to move this part; a feeling of rigidity is likewise experienced in the muscles of the neck and back, which sometimes increases to complete rigidity in twenty-four hours, so that the patient is utterly unable to stir. These symptoms are more or less permanent; besides which, we notice occasional attacks of tremors and twitchings of the muscles of the back and, extremities, more particularly of the flexor-muscles. Very soon these twitchings increase to spasmodic convulsions, during which the trunk is bent backward and the toes are drawn in. These attacks end in the breaking out of a copious, fetid sweat. The symptoms of constitutional irritation, which have been described in the other varieties of this disease, are 372 SPECIAL THERAPEUTICS. likewise present in this form. The attacks, if very acute, are exceedingly dangerous, and may very speedily terminate in fatal softening of the marrow, watery effusions between the spinal membranes, congestion of the cerebral sinuses or large blood-vessels encircling the brain, and apoplectic engorgements of the lungs. Partial recovery may be effected, leaving a soreness and weakness of the back, and a variety of functional derangements of the lungs, of the abdominal organs, and muscular system. The alloeopathic treatment of this affection either terminates fatally, or leads to permanent, functional, or organic disorders. Alloeopathic practitioners know of no remedy for this disease. This is admitted by Professor Shoenlein of the University of Berlin, when he writes: "It would be desirable to know a remedy which is capable of preventing or abbreviating the spasmodic paroxysms incidental to this disease; for they endanger the life of the patient more or less. Unfortunately this remains for the present a simple wish." In our own practice we are better provided with remedial means in this disease. Jahr recommends Dulcamara almost as a specific remedy for this disease. We feel obliged to assert, that we have never seen any great effects from Dulcamara in this form of spinal inflammation. Our main remedy in this, as well as in the other varieties of spinitis, is ACONITE, two or three drops of the tincture of the root in a tumblerful of water, a tablespoonful to be given every hour, until a decided improvement may admit of the medicine being exhibited less frequently, every two hours. This medicine will be found eminently useful; it is more specifically indicated by the symptoms of INFLAMMATION OF THE SPINAL MARROW. 873 inflammatory fever, which are present in this as in any other acute inflammation. If Professor Shoenlein would accept a little instruction from his homoeopathic brethren, he might be informed that Aconite is the very remedy he seems to be in search of as a means to prevent the paroxysms of spasms, which are so distressing and dangerous in this disease. In the acute form of this affection, and likewise in chronic irritations of the spinal marrow, if any should remain as seqeulae, of the acute form, the use of cold water is of great advaritage. The wet sheet may be used, and cold water may likewise be applied locally to the back by means of wet bandages. Besides Aconite, we may likewise have recourse to the following remedies, if indicated by the symptoms: BELLADONNA, if the inflammatory process threatens to invade the brain, the patient inclines to be flighty, he complains of violent headache, and signs of sopor supervene. DOSE,-A few drops of the first attenuation in tablespoonful doses every hour; or if given in alternation with Aconite, every alternate hour. DULCAMAE~ A may be useful if the inflammation arise from exposure to wet and dampness. DOSE.-Same as Belladonna. 'HYOSCYAMUs may be required, if the brain seems to sympathize with the spinal affection, as evinced by delirium, spasms of the head, eyelids and eyeballs, mouth; dilatation or contraction of the pupils; redness, immobility of the eyes, involuntary passage of stool and urine; general spasms or convulsions. This medicine may be given in the same dose and preparation as Belladonna, if this had been used ineffectually for similar symptoms. 33 3741 SPECIAL THERAPEUTICS. If a few doses of Hyoscyamus should not produce a favorable change, STRAMONIUM may be substituted, especially if there seems to be a complete suppression of the urinary secretions and alvine evacuations; with sparkling eyes, diplopia or apparent blindness; tetanic spasms of the body and back, which is bent backward in the form of an arch; puffed and red face, vacant stare, distortion of the features, stupor, with delirium. DOSE.-Same as Belladonna. BRYONIA may be given after Aconite, if the patient continues to complain of acute rheumatic pains, aching and soreness all over, chills followed by flushes of heat, redness and burning of the face, hot and dark-colored urine, scanty stool or complete suppression of stool, oppression and pain in the chest. DOSE.-A few drops, or ten globules of the first attenuation in a tumblerful of water, a small tablespoonful every two or three hours, until relief is obtained. OPIum may be necessary, if stupor or coma supervenes, or the eyes look glassy or glistening, with furious delirium, coldness of the skin; suppression of stool and urine; full, slow and intermittent pulse. DOSE.-Same as Belladonna. Nux VOMICA will be found eminently useful in the progress of the disease, if the spasms or tetanic convulsions, and the paralytic symptoms, remain unchanged or increase. This medicine is particularly useful, if the medulla oblongata, or the uppermost portion of the spinal marrow, had been the seat of the disease, and paralytic and spasmodic conditions remain after the acute symptoms had subsided. Long experience has taught us, that INFLAMMATION OF THE SPINAL MARROW. 375 under these circumstances, it is eminently proper to use the strong tincture of Nux, five drops in a tumblerful of water, in tablespoonful doses, every two or three hours. Many physicians use even much larger doses with success, and without the least inconvenience to patients. If any desire to try the attenuations first, they may mix a few drops, or ten globules, in a tumblerful of water, a tablespoonful every hour until the symptoms abate, after which the medicine may either be continued less frequently, or some other more suitable remedy substituted in the place. If Nux vomica should not seem to produce a favorable change, substitute IGNATIA, to be given in the same manner as Nux; and, if Ignatia should likewise remain inoperative, give COCCULUS, same dose. SULPHUR corresponds more particularly with a chronic inflammation of the cord; it is more adapted to chronic inflammation of the lower portion of the cord, when the small of the back feels as if it would break, gets weary after the least exertion, with constipation, menstrual suppression, soreness, and sensitiveness to contact. DOSE.-A few drops, or globules dry on the tongue, morning and evening. This medicine may be suitably alternated with Nux vomica, especially in persons suffering with piles. A dose of Sulphur may be given one day, and a dose of Nux the next. In every form of acute inflammation of the cord, it is of the utmost importance, while giving any of the foregoing remedies, to interpolate every now and then a dose of Aconite, as previously indicated; as a general rule, we give three or four doses of Aconite in the twentyfour hours, until every vestige of inflammation seems to be effectually removed. We are confident that this treatment tends to prevent the distressing and incurable consequences of inflammation of the spinal cord, such as 876 SPECIAL THERAPEUTICS. softening or suppuration, with their concomitant conditions of paralysis, atrophy, and the like. But we are obliged to confess that the attenuations have not seemed efficient in this disease, and that the concentrated tincture, prepared from the root of Aconite, has been our chief reliance in combatting the inflammation. We mix two or three drops in a tumblerful of water, and give a tablespoonful every hour, until a decided reaction sets in, after which a dose may be given every two or three hours. If paralysis, either local or general, should remain, the remedies which we have found most efficient to control it, are the tincture of RHUS TOXICODENDRON, the tincture of Nux VOMTCA, and the CONCENTRATED TINCTURE of the root of ACONITE. We give Rhus and Nux alternately with Aconite, from three to five drops of each in a separate tumblerful of water, an alternate dose of medicine every two hours. Those who pursue this mode of treatment, will have no reason to regret it. In persons whose constitution is tainted with scrofula or psora, it is often impossible, in spite of the best treatment, to prevent the development of chronic weakness arising out of the original attack. The spine, either in part or wholly, remains weak, sore, sensitive to pressure, or painfully affected by motion; and the functions of the organs which have nervous power supplied to them by the affected portions of the spinal marrow, remain impaired. Many persons are suffering with these spinal weaknesses, without having had an acute attack of spinal inflammation. These subacute inflammatory conditions of the spine are generally embraced under the technical appellation of -~YLI~L~-~-~IIIIII SPINAL IRRITATION. 877 Spinal Irritation. In treating of acute inflammation of the spinal cord, we occasionally alluded to the chronic form of spinitis. Chronic spinitis seems to coincide, so far as the treatment is concerned, with that constitutional irritation of the spine which is known as spinal irritation. In a work of this kind it seems out of place to treat extensively of spinal malformations, such as the various kinds of spinal curvatures, and to describe the various mechanical appliances, braces, bandages, which have been contrived by ingenious individuals for the purpose of forcing delinquent nature into a more harmonious process of growth, or into some kind of change from an ugly to a beautiful, from a deformed to a well-proportioned form. Some of these braces are undoubtedly useful as means of support, just as much so as trusses; but the idea to cure malformations, weaknesses and irritation of the spine by, means of external appliances, seems to be perfectly preposterous. Most of these braces are contrived for the base purpose of lucre, and it is a pity that such things should be imposed upon a credulous and deceived public. Spinal irritation is a most troublesome and frequently a very distressing malady, not only on account of the pain; soreness, and weakness of the spinal region, but in consequence of the functional derangements in the organs whose nervous life is -supplied by the irritated portions of the cord. These functional derangements consist in a variety of morbid sensations, disturbances, and even organic alterations of the tissues. Ordinary phenomena of spinal irritation are, in the region of the O33 _I 378 SPECIAL THERAPEUTICS. spine: soreness, tenderness to pressure, either all over the spinal column, or in particular places between the vertebrae; sometimes the vertebre are sore as if ulcerated, and actual ulceration or caries may exist. To find out the precise locality of the irritation, we sometimes have to press with the point of the finger between the vertebrae, when the patient will suddenly shrink back as soon as the sore spot is touched. Other sensations in the spine are: burning as from sparks or hot coal, lameness, aching, drawing, boring, tearing, stinging, shooting or lancinating, wrenching pains; rigidity as if the back would break, especially in the lower part; sensation as if a red-hot iron were thrust through the spinal marrow; sensation as if the small of the back were surrounded by a hard band; pressing sensation in the spine; sensation as if the vertebrae were gliding over each other; crackling or crepitation in the spine. In the organs and tissues which derive their nerves from the diseased portions of the cord, a variety of changes and sensations are experienced, such as: constant rushes of blood to the head, with dizziness, intense headache, fulness about. the head, soreness, dulness, tightness of the head, blackness and dimness of sight, sensitiveness to the light, soreness of the eyes, buzzing in the ears, hardness of hearing, dryness of the nose, foul discharges from the nose, sore throat, glandular swellings about the neck and breast, sometimes coming and going; twitching in the throat and chest, oppression of breathing, sensation as if the chest were too narrow, palpitation of the heart, anxiety, load at the stomach, burning and tearing pains in the epigastric region and bowels, sensitiveness and swelling of the epigastric region, cramp in the bowels, troublesome costiveness, strangury, menstrual irregu SPINAL IRRITATION. 3,79 larities, suppression or flooding, dryness and troublesome itching of the vagina, suppression of the sexual desire or else excessive desire for sexual intercourse, emaciation or unnatural increase of flesh, aching and neuralgic pains here and there, in the muscles or internal organs, lameness, debility, soreness, dryness of the skin, furious itching shifting about, especially after scratching; nightmare, disturbed sleep, wakefulness, restlessness, and a variety of other sensations and functional derangements, according as the upper, middle or lower portion of the spine, is the seat of the irritation. A common pain in the back may proceed from various causes. It may be caused by a cold, a sprain or strain, or it may be merely a nervous pain, principally felt at one spot, more or less deep-seated, the spot feeling sore when pressed upon. A pain in the back is very often felt as a concomitant symptom of other diseases, such as piles, difficult menstruation etc. In such a case we do not prescribe a special remedy for the pain, but select a remedy in accordance with the general state of the patient. In the treatment of spinal irritation, we regard the external application of cold water as an indispensable, and most efficient means to combat this distressing weakness, or, at any rate, to moderate the symptoms. The cold water may be used both locally and generally. To apply it locally, cut bands of linen about half a foot wide, and of the length of the spinal column, from the base of the skull to the lower extremity of the spine; soak them with cold water, and apply them to the whole length of the spinal column. As soon as the water gets warm, dip them again into cold water, and continue this mode of applying the bands for about ALC----~14e~--LII-5*11111111~--~1_ 380 SPECIAL THERAPEUTICS. fifteen minutes, in a warm room. We renew this application three times a day,otwo hours before a meal, or, if inconvenient, morning and evening only. Sometimes we cover the linen band with a strip of flannel, and have both the linen and the flannel fastened to the back by means of strips of cotton, linen, or anything, else that does not feel disagreeable to the patient, over which he may then wear his flannel or silk jacket, or simply his shirt, or a jacket over the shirt. It is likewise important to shower the back with cold water several times a day, taking care to let the water fall on the nape of the neck. While showering, the patient should never stand with his bare feet on anything cold, oil-cloth, tin, etc. Let him wear slippers; nor should the operation of showering be undertaken in a very cold room. A tepid bath every night or every other night, is a great comfort to some of these patients. Besides the local showering, daily ablutions with cold water, frictions with the flesh brush, horse-hair mittens, or with a coarse towel, should not be omitted. As regards the general treatment of the back, it should be observed that every thing which has a tendency to fatigue or strain the back, must be avoided, such as lifting heavy weights, long stooping, walking, especially ascending long flights of stairs, steady sewing, and fatiguing work of any kind. The medical treatment may be conducted with the medicines which have been indicated for acute spinitis; for the convenience of the reader we here enumerate again the principal medicines suited to this condition. ACONITUM. This is one of the most efficient medicines in spinal irritation, and may be employed, both internally and externally. It is particularly indicated 1...... SPINAL IRRITATION. 881 by a burning, stinging, boring, lancinating, wrenching pain in the spinal region, which is always accompanied with soreness to the touch, or during motion. DOSE.-Mix a few drops, or six globules, in a tumblerful of water, and give a small spoonful every three or four hours. If the patient should complain of very sore spots any where in the region of the spine, that distress him a good deal, the external application of the tincture of Aconite may sometimes be resorted to with great advantage. Mix five drops of the saturated tincture of the root in a tablespoonful of brandy, and rub this mixture on the sore spot three or four times a day, consuming the whole of it each time. A single application is sometimes sufficient to remove the soreness, which may return, however, but will then again yield to a similar application, and sometimes be permanently removed. In the case of pregnant females, the torpor which may seize on that portion of the spinal marrow that supplies nervous power to the womb, in consequence of a cold or strain, may be of dangerous consequences to the patient; for the functional power of the womb may become weakened to such an extent, that miscarriage and death may ensue. In a case of this kind, the life of the patient can only be saved by the concentrated tincture of the root of Aconite, one or two drops in a tumblerful of water, a small tablespoonful every half hour, until a decided reaction has set in, after which the medicine may be continued every hour, and then every two or three hours, until the patient is out of danger, and restored to a normal condition. ARSENIC is indicated by the following symptoms; the pain returns every third or fourth day; with feelings of anxiety and sickening exhaustion in the back, gradually increasing to a violent burning pain, aggravated by contact and somewhat relieved by motion; periodical oppression of the stomach, want of sensibility, or elso excessive sensitiveness in the epigastric region, frequent desire for stool, with thin, yellowish and after 382 SPECIAL THERAPEUTICS. wards mucus discharges, accompanied with burning and soreness of the anus, debility. DOSE.-One' or two drops, or six globules, every evening, before retiring. This medicine may be alternated with Aconite, giving two doses of Aconite a day, three globules each time, the first dose on rising from bed, and the second two hours after dinner, and one dose of Arsenic every night. BRYONIA; the patient complains of rigidity of the small of the back, compelling him to walk crooked. If this stiffness is caused by a cold or strain, it is well to alternate Bryonia with Aconite. DOSE.-A few drops, or six globules, of each medicine in a separate tumblerful of water, a tablespoonful of each medicine every alternate hour. Bryonia is usefully alternated with, or followed by RHUS TOXICODENDRON, when the stiffness is relieved by motion, and the parts feel numb and lame. DOSE.-The same as Bryonia. Nux VOMICA, when the pain is caused by exposure of the feet to cold or wet, accompanied with constipation, strangury, stiffness of the lower part of the cord, drawing and dragging pains, sensitiveness to pressure, lameness of the back, htemorrhoidal disposition; it is a good remedy, when similar symptoms remain after acute myelitis. DOSE.--A few drops, or six globules, in a tumblerful of water, a small tablespoonful every three or four hours, until relieved. This medicine may be alternated with SULPHUR, especially in heemorrhoidal patients, or such as have taken a quantity of cathartic medicines, and more particularly when the bowels are habitually costive, and a cracking sensation is experienced in the vertebral joints, or a sensation as if the vertebrae were gliding over one another. DOSE.-Same as Nux, with which it may be alternated every four hours, for a few days; after which discontinue all medicine for a few days, and then resume the same or some other more appropriate remedy. It may likewise be alternated with Aconite, the dose of which has been indicated above. SPINAL IRRITATION. 383 BELLADONNA should not be forgotten, if the upper portion of the cord is affected, and the head-symptoms are strikingly developed in consequence, such as: rushes of blood, violent headache, impaired vision, weakness of memory, etc. DOSE.-One or two drops, or six globules, dry on the tongue, morning and night, for a week, then change to some other remedy, such as Aconite or Calcarea. CALCAREA CARBONICA is undoubtedly a most useful remedy, if the vertebral column itself is affected, and caries of the bones should threaten. DOSE-Give one grain of the third trituration, dry on the tongue, morning and evening, for a few weeks, then change to SILICEA, the same dose as Calcarea; continue for a week, and give SULPHUR, likewise the third trituration, the same as Calcarea. Afterward resume Calcarea, and interpolate every now and then some such remedy as Aconite, Belladonna, etc., according as the subjective symptoms of the patient may require. This kind of routine pretty nearly answers in all cases of disease of the spinal bones. STRYCHNINE, or the alkaloid of Nux and Ignatius' bean, is a great remedy in spasmodic affections arising out of incipient disorganization, such as softening of the medulla oblongata (that portion of the spinal marrow immediately back of the large opening in the neck below the occipital bone). Chorea and convulsive paroxysms arising from such a disorder, are either arrested or greatly modified by the use of Strychnine, or even of the strong tincture of Nux. DOSE.-Half a grain of the second or third trituration every six hours. Spinal irritation is a condition which it is exceedingly difficult to cure. Indeed a radical cure is impossible in 1 _ 384 SPECIAL THERAPEUTICS. most cases; all we can do is to afford the patient relief by judicious and persevering treatment. We have stated before, that the medicines which have been recommended for the different forms of acute inflammation of the spine, will likewise be found adapted to spinal irritation. They have to be selected in accordance with the symptoms which have been fully described in the chapters on acute spinitis, to which the reader is therefore referred. The first, second, or third attenuation of these medicines may be used, one drop or six globules morning and night. A dose of Aconite has to be interpolated every now and then, no matter what other medicine may be used besides. Cold water bandages and frictions with cold water must not be used, if the patient is so weak that the constitution is unable to react against the depressing action of this agent. Patients who have the opportunity, may have a gentle current of electro-galvanism sent through the spinal column once or twice a day. Persons who are afflicted with spinal irritation, may partake of such nourishment as agrees with them; but simple meats, gruel, farina, barley and rice, potatoes and other simple vegetables, will, upon the whole, prove the most suitable to their constitution. During an acute attack, the patient will not require any but the very lightest kind of nourishment, a little tea and toast, gruel, etc. -- -~ ---- --ra^u--.~_c--~i~,n,ni -z. - ~ -r^~;-r~~-rr--r--~r-~l~ 41-~1-~-- c--~.~ ~u~xL~~r~---L~~u-^-- -- --- -L - ~ - ~- ---- ~ -Z: NERVOUS AFFECTIONS. 385 GENERAL AND LOCAL NERVOUS AFFECTIONS. Tic douloureux, Neuralgia, Nerve-pain, of the Face, Extremities, Heart, Bowels, etc. This distressing affection consists in a very severe pain, confined to a particular spot in the tract of a nerve, or sometimes spreading from this spot, following the course of the nerve. This pain is therefore, strictly speaking, a nerve-pain, and is well known under the French name of Tic douloureux. It is a most excruciating, agonizing pain, characterized by a variety of sensations, such as burning, boring, wrenching, piercing, sticking, cutting, twisting, splitting, crushing. It is generally seated in the face, but may affect almost any part of the body, both external and internal. This affection is always obstinate; sometimes incurable, and relapses are of frequent occurrence. Changes of air are frequently indispensable to a cure; in other cases, such changes excite the pain. Neuralgia is sometimes caused by local injuries, venesection, etc., in consequence of which the nerve becomes exposed, and the atmospheric irritation produces the neuralgic suffering. For such a form of Neuralgia, there is no other remedy than to remove the exposed nerve by an operation. A similar operation has to be performed, if, in amputating a limb, a nerve should be left exposed and become irritated, Unless the nerve is cut offi the irritation may gradually develope a state of atrophy or marasmus, and finally cause death. Neuralgia of the face sometimes depends upon a carious tooth; this has to be pulled out; for the 34 -386 SPECIAL THERAPEUTICS. disease is incurable by treatment. The principal remedies for the various forms of neuralgia of the face and otheyr parts of the body, which have been employed with more or less success, are the following: ACONITE, for burning, boring, screwing, wrenching, lancinating, stinging, throbbing pain, with redness and swelling of the part, excessive sensitiveness to contact, weeping mood; the pain is agonizing and almost drives the patient to despair; if seated in the region of the heart, it is attended with agony and distressing palpitation. DOSE.-Mix a few drops, or six globules of Aconite, in a tumblerful of water, and take a tablespoonful every hour, until relief is obtained; afterwards the medicine may be taken less frequently. We have sometimes found it necessary, when the Aconite was evidently indicated, to apply it externally for which purpose, we use five drops of the concentrated tincture of the root in teaspoonful of brandy, and rub the whole of this solution on the affected parts, repeating the operation, if necessary, every half hour. After a few applications the pain leaves entirely, and only a little numbness remains, which however disappears in a few hours. The pain is sometimes so intense, that, if the patient can be relieved by the endermatic mode of applying' the Aconite, we should think it a wrong not to resort to it. If the Aconite, however, leaves us in the lurch, and the pain is seated in the face, or the region of the heart, SPIGELIA may be substituted, the dose being the same as for Aconite. BELLADONNA, for disagreeable tickling in the cheek, followed by violent cutting pain when rubbing the parts; violent tearing in the malar bones, with spasmodic.closing of the eyelids; these symptoms are sometimes accompanied with profuse secretion of tears, constipa-.tion, tensive and stitching pains in the articulation of the lower jaw, stiffness and painfulness of the neck. DOSE.--One drop, or three or four globules, on the tongue, to be repeated every two or four hours, if necessary. COLOCYNTHIS: violent tearing, burning and lancinat NEURALGIA, ETC. 387 ing pains through the left side of the face and head, sometimes affecting the upper jaw, nose, ear, and orbit; the pains are increased by contact and motion. This medicine has been recommended for this formr of facial neuralgia by almost all homoeopathic physicians; but we have never derived much benefit from the use of it, except in neuralgia of the femoral nerve, when the pains were of a shooting character, and came on unexpectedly when the patient made the least attempt to move the limb. A few weeks ago we treated a case of this kind of neuralgia with one drop of the strong tincture of Colocynth in a tumblerful of water, giving a tablespoonful every three hours. The patient got well after taking only a few tablespoonfuls. It was a case of four months' standing. The pain came in paroxysms on moving the limb (right limb); it was like a knife darting through the hip-joint down the thigh; the whole limb felt tired, and the general constitution had begun to feel the effects of this disorder. Before using the tincture, the third attenuation of Colocynth may be given first, the same as Belladonna. CONIUM MACULATUM, for tearing pains darting through the right half of the face. DOSE.-Three or four globules, dry on the tongue, every three hours. BRYONIA, for neuralgia of the teeth or face, consisting in a fine, flashing pain. DOSE.-Dissolve six globules, or mix a few drops in a tumblerful of water, and take a small spoonful every hour, until relieved. MEZEREUM: cramp-like stupefying pressure in the region of the left malar bone, and extending thence into the eye, temples, ears, teeth, and neck; sometimes accompanied with stitches in the side, suddenly coming and going, or with creeping in the integuments of the chest. __ 388. SPECIAL THERAPEUTICS. DOSE.-Same as Bryonia. MERCURIUS, for tearing in the right side of the head, face, jaw, accompanied with swelling of these parts, flow of saliva, lachrymation, pain in the small of the back. DOSE.-Mix a few drops, or six globules, in a tumblerful of water, and give a small spoonful every hour. This remedy may be alternated with Aconite, the same dose, giving a dose of the same medicine every alternate hour, until relief is obtained. PHOSPHORUS, when the pain was brought on by a cold; swelling and paleness of the face; tearing and stitches in the cheek, from the jaw to the ear; or the tearing may begin in the lower gums, and extend below the eyes; the pain is excited by talking or by the least contact, and may be accompanied by tearing in the vertex, whizzing in the ears and a feeling of tension in the cheek. DOSE.-Two globules, dry on the tongue, every two hours, until relieved. If not relieved, give Aconite as above. STAPHYSAGRIA should be given when the tearing commences in a carious tooth, thence spreading over the whole jaw; with spasms in the fauces, and spasmodic weeping when the pain is violent. DOSE.-Same as Phosphorus. IPECACUANHA is more particularly adapted to neuralgia of the bowels, when the pain is of a spasmodic nature, with sensation as if the fingers were pressed into the bowels. DOSE.--Two or three globules, dry on the tongue, every two hours, until perfect relief is obtained. For neuralgia of the optic nerve the best remedies are ACONITE, BELLADONNA, and SPIGELIA. ACONITE for a deep-seated, hard, aching pain, With extreme sensitiveness to the light. ___ CRAMP IN THE LEG. 889 DOSE.-As above, and if the attenuations should not prove effectual after three or four doses, use the tincture of the root, two drops in a tumblerful of water, a tablespoonful every half hour. BELLADONNA, for a similar pain, with swelling and redness of the eyeball, lachrymation. DOSE.-Same as mentioned above; if Belladonna should not relieve, substitute Spigelia, or give these two medicines alternately, a dose every hour. For neuralgia of the womb, especially when attended with an intolerable itching and tingling in the part, PLATINA is a good remedy, and a few drops or six globules in a small tumblerful of water, and giving a tablespoonful every two hours. This medicine may be alternated with Aconite. DOSE.-The same as Platina, a tablespoonful of the same medicine every alternate hour, until relief is procured. A variety of other remedies have been proposed for neuralgia, such as Arsenic, China, Veratrum, Hepar sulphuris, Cannabis, etc.; but we have never found it necessary to avail ourselves of these medicines in our practice, and therefore do not recommend them. DIET AND REGIMEN: Patients who are subject to attacks of neuralgia, should be extremely careful in regard to diet; they have to avoid all stimulating drinks, draughts of air, exposure to damp and wet places, all sudden changes of clothing and temperature; if they cannot observe such precautions, they have a fair chance of never being cured. Cramp in the Leg. This affection seems to be owing to a sort of weakness in the circulation of the. limb, and is sometimes effectually cured by ACONITE and MERCURIUS. During a violent paroxysm, six globules or a few drops of each 34* 390 SPECIAL THERAPEUTICS. medicine may be mixed in-a tumblerful of water, of which a small tablespoonful may be taken every fifteen or twenty minutes alternately, until relief is obtained. Between the paroxysms it is well to take these two medicines alternately two or three times a day each until the attacks cease. Apoplexy. This is originally a Greek work, which signifies in English, to strike one down with violence. An attack of apoplexy is sometimes so acute, that it seems as though the patient were struck down with a heavy blow, losing all consciousness; hence, the affection of the brain, of which this sudden falling down, with loss of consciousness, is a characteristic symptom, has been termed apoplexy. There are other diseases where a patient may fall down quite suddenly, with loss of consciousness; epilepsy is one of them. Nevertheless, upon a closer examination, we shall find that there is a vast difference between apoplexy and any other disease that might possibly be mistaken for it. This difference will at once become manifest, from a simple statement of the symptoms which constitute the pathognomonic features of this disease. An attack of apoplexy is generally preceded by precursory symptoms, or so-called prodromi. The patient is indisposed to perform any mental labor; the head feels dull, confused; the sight becomes blurred, obscured, and the sense of hearing is disturbed by a constant buzzing and humming in the ears. There is a constant inclination to sleep, which is sometimes so irresistible that the patient falls asleep even while talking. The eyes look APOPLEXY. 391 APOPLEXY. 891 red, the arteries of the neck. and temples beat violently, the face looks flushed, sometimes of a deep-red, cherrybrown color; the pulse is heavy, slower than usual, labored; the extremities are often numb, as if they would go to sleep, and colder than usual. If these symptoms have existed for some time, with periodically increasing and decreasing intensity, and treatment has not succeeded in relieving them, the attack sets in with the following symptoms: The patient suddenly loses all consciousness, falls down, and exhibits various symptoms of paralysis. During an attack of apoplexy, a little blood generally becomes effused into the substance of the brain. As soon as this extravasation of blood; takes place, the patients become pale, the pulse frequent and irregular, and the breathing is disturbed, intermittent, and often stertorous or snoring. This extravasation of blood may take place in various parts of the brain, in the lateral, anterior or posterior region. The head inclines toward the side where the extravasation exists. The extremities on this side are paralyzed. The patient may be entirely speechless, or he may still be able to utter inarticulate sounds. He may be entirely blind and deaf. The corner of the mouth is drawn down toward the paralyzed side; the point of the tongue likewise inclines to this side. If an attack of apoplexy has fully set in, the prospect of recovery is far less favorable than during the precursory stage. Under homoeopathic treatment, the precursory symptoms often disappear with the most perfect readiness. We give the patient AcONITUM, a few drops or ten globules, in about ten tablespoonfuls of water, of which a tablespoonful may be given every half hour, and as soon as a favorable re ~_ 392 SPECIALý THERAPEUTICS. action has begun to set in, every two, and finally every four hours, until all danger seems past. If no favorable reaction sets in after a few doses, we at once resort to the strong tincture of Aconite-root, one or two drops in a tumblerful of water, to be given in the same manner as the previous solution. This treatment will generally be found sufficient to avert all danger. But if the cerebral symptoms should not yield entirely under the use of Aconite, we then alternate this medicine with BELLADONNA, a few drops of the first attenuation in a tumblerful of water, of which a tablespoonful may be given every alternate hour, giving the Aconite the other alternate hour. Should the attack have actually set in, we employ the same medicines, Aconite and Belladonna, using the same preparations as have, been recommended for the precursory symptoms. If Aconite, and Belladonna had been employed during the precursory stage, and the attack sets in in spite of this treatment, the chan'ces of the patient are very.slim indeed. His life may be saved, but perfect recovery can hardly be expected. By dint of careful diet, and rigorous treatment, the effused blood may gradually be absorbed, but the bodily and mental functions will most probably remain permanently impaired, at least to a great extent. The patient may remain permanently blind, partially paralyzed, unable to retain his urine; he may lose his memory, or become affected with incurable idiocy. If, during the attack, the patient: should be perfectly comatose, so that no sign of consciousness can be obtained by:any effort in our power, we may alternate the tincture of Aconite with OPIUM, a few drops of. the first attenuation, or even APPEY 9 APOPLEXY. 893 of the strong tincture, in a small tumblerful of water, an alternate dose to be given every half hour, giving an alternate dose of Aconite between each two doses of Opium. If consciousness is restored, we substitute Belladonna for Opium, as stated above. A few more remedies are recommended in some books for apoplexy, such as Lachesis, Hyoscyamus, etc., but they are utterly useless in this affection, particularly the former drug, which has been altogether over-rated by the old-fogi of our school, and is hardly ever looked at by the scientific homoeopathists of this or any other country. Another remedy may commend itself to our attention, if the apoplectic condition can be traced to some mechanical injury, a fall or blow upon the head; it is ARNICA, of which a few drops of the first attenuation may be mixed in a tumblerful of water, to be given in tablespoonful doses every hour or less, or more frequently, if necessary. This medicine may be usefully alternated with the above-mentioned preparations of Aconite. If an attack of apoplexy can be traced to the excessive use of ardent spirits, we may give Nux VOMICA, a few drops of the strong tincture in ten tablespoonfuls of water, a tablespoonful every ten or fifteen minutes, until a decided reaction has taken place. This medicine may likewise be alternated with Aconite, if the symptoms should render this alternate use desirable. There are individuals who are constitutionally predisposed to apoplexy. These are persons with short and thick necks, and sanguineous temperament. If such persons indulge in rich and stimulating diet, have little exercise, and have to strain their minds by constant 394, SPECIAL THERAPEUTICS. study, they develop this constitutional predisposition to apoplexy, and may be attacked at any moment. In regard to sex, males are more frequently attacked than females. The period when apoplectic attacks ar.emost frequent, is from the age of forty-five upwards. Persons advanced in age, are more liable than middle-aged people. Apoplexy occurs likewise more frequently in very hot weather, or during sudden and violent changes of atmospheric temperature, than in the cold season or when the weather remains steady, bracing and of a moderate temperature. Persons with apoplectic constitutions should avoid every species of excess either physical or mental. They should content themselves with the simplest diet, use principally light and readily-digested food, rice, vegetables, moderate quantities of bread and butter, a little meat, particularly roast-beef and mutton, only at dinner; the supper should be exceedingly light, and should be taken at least three or four hours before bed-time. Stimulants have to be strictly forbidden. The only beverage that such individuals may partake of safely, is cold water and a cup of weak tea. An ablution with cold water may be resorted to every morning after rising; but the shower or douche-bath directly on the head is not advisable. It is far better to receive the stream on the lower portion of the spine and on the abdomen. If a limb remains paralyzed after an attack, the medical treatment may sometimes be assisted by receiving the douche on his paralyzed extremity. While the patient is under treatment for apoplexy, the diet should be of the simplest kind, tea and toast, gruels, etc. A return to a more substantial diet should only be __ GENERAL' AND- PARTIAL PARALYSIS. 895 permitted very gradully, and if all danger of a relapse is passed. There is hardly a disease where relapses take place as easily as in apoplexy. An error in diet, a little overindulgence, exposure to the sun's rays, a sudden and violent emotion, may threaten serious consequences to persons who have recovered from an apoplectic stroke. General and Partial Paralysis, Hemiplegia. If this condition should result from spinal irritation or inflammation, it has to be treated as indicated under inflammation of the cord. Paralysis may likewise be owing to organic disease of the brain, in which case it is incurable, or it may be a symptom of apoplexy; in this case it is curable, provided the action of the brain can be restored. A stroke of the palsy is generally accompanied with symptoms of cerebral irritation, although there is such a thing as local palsy, apparently at least, where the brain seems to be but little, if at all affected. Paralysis is generally ushered in by precursory symptoms, such as numbness, heaviness of the limb, tingling, a sense of heat in the limb, or also a feeling of'icy coldness, alternate paleness and flushes of the face, twitchings, etc. The pulse, previous to an attack is generally heavy and sluggish. TREATMENT.-Under the old-school practice, as soon as the precursory symptoms of paralysis have set in, the patient is bled, and the inevitable consequence of this murderous proceeding is to hasten the attack. Inste'd of bleeding the patient, the true mode of averting the attack is, to give the patient at once ACONITUM, one drop of the concentrated tincture of A L 396 SPECIAL THERAPEUTICS. the root, in a small tumblerful of water, a small tablespoonful every hour, or even every half hour, until the danger seems to be over. The Aconite has the effect of restoring the pulse, the sensibility and temperature of the part, and exciting a little perspiration; as soon as this is accomplished, the medicine may be continued every two hours, until the condition of the limb is entirely restored. In reference to the use of Aconite in paralysis, we cannot help expressing our amazement at the fact that this admirable specific in most cases of paralysis is scarcely ever thought of by homceopathic physicians. In some homoeopathic works it is not even mentioned. And yet it is a truth, that Aconite is the most important remedy for paralysis with which we are acquainted, and that the rational use of Aconite will surpersede the employment of such remedies as Sulphur, Lycopodium, Ferrum, Silicea, Pulsatilla, Alumina, Graphites, and a number of other medicines which are mentioned in homoeopathic books and are generally copied one from the other, but have no more to do with paralysis than the man in the moon. We have treated a number of cases of paralysis, general and local, and we do not remember a single case where we have failed to effect a perfect cure by means of the persevering use of the saturated tincture of Aconite, using in a few cases only, RHUS TOXICODENRON, ARNICA, PLUMBUM ACETICUM, Nux VOMICA, COCCULUS, or BELLADONNA. For the benefit of the reader we will relate a few cases which we have treated more recently. Paralysis with Apoplexy.-The patient was a lady of about forty-five years old, full habit of body, short and thick neck, and constantly under an apprehension that PARTIAL PARALYSIS. 897 she would die of apoplexy; when we were called, she was lying in bed, with loss of consciousness, one side of the face and body perfectly paralyzed, cold and almost pulseless; breathing heavy and stertorous. Mixed five drops of the tincture of Aconite in a tumblerful of water, and gave her a small tablespoonful every ten minutes. The liquid had to be dropped into her mouth, for she was utterly unable to swallow, and was not conscious of any thing being in her mouth. After a few spoonfuls of the solution, the pulse returned somewhat, and she showed symptoms of consciousness. She took the medicine every hour, was considerably better next morning, and went on improving from day to day, until the blindness, the paralysis of the tongue and face, and of the whole side had left her; in about three weeks after the attack, she was as well as usual, with the exception, occasionally, of a vacant stare, which she had been affected with previously. Hemiplegia, partial Paralysis.-A gentleman, forty years old. One whole side of the body paralyzed; his hearing was almost gone, and, in trying to read, he generally skipped four or five lines, or commenced in the middle of a line. Complete loss of memory; did not even remember his own name. Was not able to articulate more than one word at a time, and this only after great exertions and stuttering. The lower extremity was less affected than the upper. This patient had been under allceopathic treatment for six weeks, when we took charge of him; he had been getting worse all the time, and had lost every vestige of appetite for anything; his breath, had become extremely foul. We put him on the tincture of Aconite, commencing with two drops in a tumblerful 35 - i...... --- 898 SPECIAL THERAPEUTICS. of water, and gradually increasing to five drops, giving a tablespoonful, first every hour, and gradually every two or three hours. In three weeks after we commenced the treatment, the gentleman was able to go out and attend to his business. He is a merchant, and is now as well as ever, without a single untoward symptom having been perceptible when we discharged hiin. Every now and then we gave him a dose of the tincture of Rhus tox, but principally the saturated tincture prepared from the root of Aconite. Paralysis of the Tongue and (Esophagus. A lady of fifty, Complete loss of speech and power to swallow; the least drop of fluid poured down her throat choked her. Pulse low and almost collapsed. We gave her one whole drop of the tincture of Aconite on a little sugar, and in half an hour another drop. A reaction set in, the pulse returned, she was able to articulate, and to swallow a few drops of fluid without' choking; 'she was perfectly well in a week. This lady had had an attack of paralysis before this, for which she was treated alloeopathically for several months in succession, without ever having been perfectly restored. Paralysis of the Tongue.-A. lady of forty, very fleshy and, subject to violent rushes of blood to the brain. When we saw her, she was speechless, muttered inarticulate sounds, seemed to be quite stupid, the pulse was exceedingly heavy and full, down to thirty-five a minute. We put her on five drops of Aconite in a tumblerful of water, and gave her a small tablespoonful every five minutes. After the first dose the pulse rose to sixty, and in a quarter of an hour she was able to articulate, - PARALYSIS OF VARIOUS ORGANS. 899 and to state that there was an immense and distressing load on the top of her head. The Aconite was continued every fifteen minutes, then every half hour, every hour, and in two days the attack was entirely removed, and the lady was able to go shopping. Paralysis of the Tongue.-Patient a little girl of ten years. Tongue quite numb, with tingling, inarticulate speech, cold extremities, and weak pulse; pupils dilated and staring. We gave this child the third attenuation of Aconite, and next day she was quite smart. Paralysis of one side of the Face, Jaw, Sense of Hearing and Sight.--A lady of thirty; pupils dilated, insensible to the light; furious buzzing in the ear, jaw hanging down, mouth drawn to one side; able to articulate distinctly; pulse irritated, rather quick, irregular. She took a few drops of the tincture of Aconite in a tumblerful of water, a tablespoonful every two hours, and in three days she was perfectly well. Threatening Apoplexy.-A lady of fifty. Several of her brothers had died with apoplexy and paralysis. Found her stupid, almost insensible, not able to articulate, pulse down to thirty-five, heavy and very full; extremities cold, breathing heavy and slow. We mixed five drops of the tincture of Aconite in a tumblerful of water, and gave her a tablespoonful every five minutes. After the third dose the pulse rose to sixty, consciousness returned, and next day she was able to sit up; went out in a day or two. Paralysis of the sense of Smell and Taste.-A lady of twenty-five; complete loss of smell and taste, with difficulty of articulation, and the most perfect and distressing dryness of the Schneiderian membrane. _ __ 400' SPECIAL THERAPEUTICS. She took the Aconite, a few drops in a tumblerful of water, in tablespoonful doses every two hours, and had her senses restored in three or four days. Paralysis of the Optic Nerve and the Motor Nerves of the Lids.-Patient a lady; intense, deep-seated pain in the inner canthus of the eye, blackness of sight, dilatation of the pupil with insensibility to the light; stupefying, crampy pain in the region of the cribriform plate; depression of the upper lid; pulse full and heavy; extremity cold. Gave the patient a few drops of the tincture of Aconite in a tumblerful of water, in tablespoonful doses, first every hour, then every two or three hours; in a few days she was restored. Paralysis of the Sphincter of the Bladder.-Distressing numbness in the region of the bladder, constant discharges of watery urine, with inability to retain it; pulse small and quick; coldness of the extremities. Gave a few drops of Aconite in a tumblerful of water, a tablespoonful every two hours; the numbness soon disappeared, and the urine was again discharged naturally. Paralysis of an Upper Extremity after Pneumonia, treated Alloeopathically.-Patient, a girl of twelve years; numbness, coldness and paralytic weakness of the arm; the child was unable to use her arm, and, whenever she made an effort to hold or seize anything with the hand of this arm, the limb was seized with a painful spasmodic jerk, and she had to drop whatever she held in her hand. This condition had lasted three years when we first saw the child. The pulse of this arm was small, weak, irregular. Gave two drops of the tincture of Aconite in a tum. blerful of water, a small tablespoonful every two hours. This child was cured perfectly in a week. I... t... PARALYSIS OF VARIOUS ORGANS. 401. Paralysis of the Sphincter ani, after Dysentery treated Allceopathically.-Constant discharges from the anus, which the patient was unable to close. Pulse quick, small, and irritated. Gave Aconite as above, and cured the child in about ten days. We might mention more cases of paralysis, cured with the tincture of Aconite; but these few cases will suffice to show the extraordinary curative powers of this drug in paralysis, and will, we trust, cause homoeopathic physicians to direct their attention to this remarkable agent in a malady which is certainly curable, but is so frequently attended, even under homoeopathic treatment, with distressing consequences to the patient. Noack and Trinks mention several cases of painless paralysis of the feet, which were cured with the tincture of RHus TOX. In one case Hahnemann had treated the patient, who was a man, unsuccessfully for three years; he took the tincture of Rhus in increasing doses, and took four ounces of the drug, until his cure was completed, without experiencing any bad effects whatsoever from the medicine. The other case was that of a girl of fourteen years; the girl was perfectly cured by consuming two ounces of the tincture in increasing doses, and has been perfectly well ever since. In this form of paralysis, if Rhus should fail, give OLEANDER, one drop of the tincture in a tumblerful of water, a tablespoonful every two or t hree hours. Nux VOMICA has no effect in paralysis of the extremities, unless it can be distinctly traced to a diseased condition of the spinal cord, whether it be mere irritation 35* ~- ~~----- sI-- 402 SPECIAL THERAPEUTICS. or incipient softening. In such a case a few drops of the strong tincture may be mixed in a tumblerful of water, of which the patient may take a tablespoonful every two or three hours; larger doses may be required in some cases. In paralysis from abuse of spirits, Nux vomica is the best remedy, and should be exhibited in tinctureform, a few drops in a tumblerful of water, a tablespoonful every two or three hours. If the paralysis should depend upon spinal disorganization, such as softening, it may be advisable to give STRYCHNINE instead of Nux, second or third trituration, centesimal scale, one grain every four hours, dry on the tongue. PLUMBUM ACETICUM is indicated in paralysis with atrophy of the paralyzed part; the skin is pale, livid, yellowish, clay-colored, rough, dry, scales off, looks thinner and relaxed; the cellular and adipose tissues disappear, and the muscles are thin and soft. When this atrophy reaches the highest degree, the patient is reduced to a walking skeleton, and gangrenous spots appear here and there. For a complete. description of the various forms of paralysis which will yield to the action of lead, the reader is referred to the second volume of our Symptomen-Codex, pp. 557 and 558. STRAMONIUM is indicated by loss of voluntary motion and of the senses, deglutition remaining unimpaired. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours. HYDROCYANIC ACID may be given for paralysis of the lower, then the upper limbs. DOSE.-One drop, of the first attenuation, in a tumblerful of water, a small tablespoonful every three hours. ARSENICUM, for paralysis of the lower limbs, with loss of sensation. FAINTING, SWOONING, SYNCOPE. 403 DOSE-One grain of the third trituration, dry on the tongue, every four hours. BELLADONNA may be employed for hemiplegia, especially when one arm and lower limb are affected. DOSE.-Same as Stramonium. DIET AND REGIMEN.-Patients who are threatened with paralysis should confine themselves to a strict and moderate diet, abstain from the use of stimulants, eat very little meat, drink nothing but water, milk, and, at most, a little weak tea and chocolate; use daily ablutions with cold water, and take as much active exercise in the open air as they possibly can. Fainting, Swooning, Syncope. Fainting may result from a variety of causes. It may result from some organic affection of the heart; in this case the organic affection has to be treated, and the habitual fainting turns will disappear with it. Or it may result from constitutional nervousness, in which case the fainting will cease to trouble a person as soon as the harmony of the nerves is restored. Or it may be owing to some sudden emotion, a fright, a surprise, or a sudden rush of blood to the thoracic organs. In such a case, the pulse almost ceases for a short period, although the heart continues to beat. Hysteric females are frequently subject to fainting turns. In most cases, it is sufficient to sprinkle the face with a little cold water, or to cause the patient to inhale the spirits of hartshorn, a little Cologne-water, Hoffmann's anodyne, the spirits of camphor, or some other stimulant. If the swoon should be quite obstinate, it will suffice to dissolve six globules of Aconite in a tumblerful of water, and to give the -. -- - -- - 404: SPECIAL THERAPEUTICS. patient a tablespoonful every five or ten minutes; this will restore the pulse and consciousness. Or, if the patient should be unable to swallow, we may hold a vial, filled with the saturated tincture of the root of Aconite, under her nose, or touch the tongue with the cork of the Aconite-vial. This will remove the attack very speedily. Showering the small of the back, the bowels, or lower extremities, will likewise prove effective. In obstinate cases of fainting, when Aconite and the other appliances fail, give MoscHus, one grain of the second trituration, dry on the tongue, every fifteen minutes, until the patient is restored. Vertigo. There are persons who are subject to periodical attacks of vertigo. They come on with more or less intensity, and are frequently accompanied with partial loss of consciousness, so that the patient falls, unless he happens to be near some object that he can lay hold on. These chronic attacks of vertigo may have their origin in some habitual irritation of the cerebral nerves, which may culminate in a fit of vertigo, in consequence of exposure to excessive heat of the sun, or even of a furnace or stove; or the attack may be excited by violent and sudden disappointment, long stooping, hard and exhausting mental labor; it may also develop itself as a sympathetic affection, in consequence of gastric disorders or sudden torpor of the liver, in consequence of which, bile irritates the capillaries of the brain, and causes that depression in the capillary circulation of this organ, the leading characteristic of which is vertigo. As the ver VETGO 0 VERTIGO. 405 tigo passes off, and reaction sets in, a more or less violent, sometimes maddening and stupefying, headache prostrates the patient. We have known such cases of vertigo, where the attacks were excited by a sudden glare, such as the sudden flame of a locofoco match, even though the patient expected the explosion. If the attacks can thus be excited by a trifling cause, there is every reason to suspect the presence of some incipient cerebral disorganization which will prove incurable in the end. Temporary attacks of vertigo do not require any treatment; they pass off after a short period of rest without anything being done for them. Vertigo of the character we have described, may be treated medicinally to the great relief of the patient. The attack is generally attended with violent rush of blood to the head, buzzing in the ears, obscuration of sight, flushed face, and sometimes even with palpitation of the heart, irregular and intermittent pulse, sickness at the stomach. If these symptoms are present, we commence the treatment with ACONITUM, one drop of the strong tincture in a tumblerful of water, of which a tablespoonful may be given every fifteen minutes until a decided reaction has taken place. If the pulse is heavy, slow and intermittent, the patient looks pale, feels sick at the stomach, and the beating of the pulse does not harmonize with the beats of the heart, we may give DIGITALIS, in the same manner as Aconite. If both these medicines seem indicated, we may use them in alternation, giving a dose of the same medicine every alternate half hour. For simple giddiness, accompanied with biliousness, I _ _ _ _ ~ ~ ~ ~ ~_ ~ __~_ ~ 406 - SPECIAL THERAPEUTICS. sallow complexion, foul and slimy mouth, sickness at the stomach, we may use ACONITE, a few drops or six pellets to. be taken morning and evening, MERCURIUS VIVUS may be used for a similar group of symptoms, if the patient complains of feeling chilly, the bowels are costive, and the urine has a deep-yellow color, or looks watery and is discharged quite frequently. DOSE.-Sam'e as Aconite. PULSATILLA may prove of advantage, if the dizziness can be traced to menstrual suppressions; this medicine may be alternated with Aconite, giving one or two drops of Pulsatilla in the morning, and a similar dose of Aconite at night. Pulsatilla is likewise useful if the dizziness is attributable to gastric derangement caused by dating fat, pork or rich pastry. Nux VOMICA may be given, if the gastric derangement is caused by abuse of coffee, ardent spirits, want of exercise, excessive mental exertions. OPIUM is excellent, if the attack is accompanied by sopor, and was caused by a violent insult to one's feelings. Give a drop or six globules every two or three hours. DIET: Persons who are subject to attacks of vertigo, must abstain from everything that might excite them; they must not expose themselves to the sun's rays, and avoid such emotions or kinds of food or beverage, as might have a tendency to cause a bilious condition of the system. Coffee and ardent spirits are: decidedly injurious. Cold water is the best beverage for such individuals. .PILEPSY. 407 Epilepsy. This disease is so well known that it seems scarcely necessary to describe it. Epilepsy literally means ",falling sickness;" it is so termed by the Germans, because a characteristic symptom of this disease is the sudden falling down of the patient, generally with a loud cry, loss of consciousness, and spasmodic clenching of the fingers and thumb. The attack is frequently preceded by premonitory symptoms, such as: depression of spirits, gloomy mood, drowsiness, loss of appetite and sleep; these symptoms sometimes exist for a day or two before, the attack sets in; immediate precursory symptoms are: pain in the head, flashes before the eyes, singing or roaring in the ears, and the so-called epileptic aura, which is a peculiar tingling, vibratory sensation proceeding from some point of the periphery, and gradually moving upwards towards the head or heart. During the paroxysm the breathing becomes heavy and stertorous, the body is convulsed, sometimes bent double, so that the heels and head touch each other; the limbs tremble, sometimes the patient rises on his feet as straight as a candle, and then drops.down again suddenly; the tongue is sometimes pushed out of the mouth, and lacerated by the teeth in consequence of the clenching of the jaws: froth is at the mouth, and the face turns purple, and sometimes looks almost.black. After the attack the patient's memory is impaired for a time; he feels weak and drowsy, and low-spirited. The attacks are apt to set in with the full-moon. The disease, may be excited by various causes; generally it is hereditary, or it may be caused by bad habits, onanism, fright; rh~-~L31-----~ll----~-i~l~~--~lll~~~~l I - -L -L 408 SPECIAL THERAPEUTICS. and other causes. A cure is not always easy, and sometimes impossible, particularly if an organic disease of the brain accompanies the disease. If the disease is not hereditary, and the patients are attacked with it before the age of pubescence, they have a fair chance of being cured. A great many remedies have been proposed for this disease, some of which are certainly useless. The following remedies are supposed to have effected cures; for it is diffiult to know whether the disease is or is not cured; patients will sometimes remain free from an attack for years, and the disease may nevertheless break out again after that period. ACONITUM is indispensable when the patient complains of agonizing headache, burning in the head as from hot coal; when the attack seems to be characterized by anguish, palpitation of the heart, dark redness of the face, quick and full pulse. DOSE.-Mix a few drops, or ten globules in a tumblerful of water, and give the patiest a dose every three or four hours after the attack. In a day or two give only one dose of medicine a day, two or three globules every morning or evening, and gradually every two or three days, until the next attack sets in. If this attack is much less severe, give a dose of SULPHUR or MERCURIUS, three globules dry on the tongue, and in a few days resume the Aconite as above. ARSENICUM is indicated by the following symptoms: burning at the stomach, vertigo, aching pain in the occiput, burning pain in the spinal column, burning at the anus during stool, and burning in the urethra during micturition. DOSE.-One drop, or three globules, dry on the tongue, every six hours, for a few days, or alternate the Arsenic with Aconite, giving three globules of each every six hours alternately. BELLADONNA is a great remedy in epilepsy, and may be given when the following symptoms occur: great EPLESY 409~I~_~_~~ ~ EPILEPSY. 409 irritability of the nervous system, the patient starting at the least noise; tremor and twitchings of the muscles; sparkling of the eyes, double vision or squinting (in which case STRAMONIUM may be given alternately with Belladonna;) stammering, congestion of blood to the head, vertigo, roaring in the ears; twitching of the tendons, contortion of the features; or, when the fit commences in the upper extremities, with slight, painless convulsions, the face becomes bloated and dark-red, convulsive movements of the eyes and mouth, redness and protrusion of the eyes, and loss of consciousness even before the spasms and the foam at the mouth make their appearance: or, when, together with these last symptoms, the head and trunk are drawn backwards, the body is rigid, the thumbs are clenched, and the expirations very violent: or, when the attack commences with a warm sensation in the pit of the stomach, and a pressure rising to the head; the patient hears people talk, but does not understand them, with convulsions of the arms, clenching of-the thumbs, shocks of the heart, puffiness of the neck, sudden changes of color; or, when the attack commences with a creeping sensation along the extremities. DOSE.-One or two drops, or three globules, dry on the tongue, every twelve hours, giving from six to eight doses in all, after the attack. CICUTA, for epilepsy with strange contortions of the limbs, foam at the mouth, bluish face. DOSE.-Same as Belladonna. CHAIMOMILLA is a good remedy for epilepsy of children, when the attack is preceded by colicky pains; or, when the child bends itself backwards, followed by sudden stretching of the limbs and clenching of the thumbs; quick, suffocative breathing, convulsions of the 86 410 SPECIAL THERAPEUTICS. limbs, foam at the mouth, deep sopor after the attack, the tongue is sometimes convulsed and is rolled from one side of the mouth to the other, the attacks are frequently accompanied by sour vomiting, and paleness of one and redness of the other cheek. DOSE.-Three globules, dry on the tongue, every three or four hours, giving about twelve doses in all. CUPRUM METALLICUM, when the attack commences with the arm being involuntarily drawn to the body, or with foam at the mouth, opisthotonos, spreading of the limbs, open mouth; or when the patient falls down senseless, without a cry. DOSE.-Half a grain of third trituration, dry on the tongue, every six hours; half a dozen doses in all. HYoscYAMUS: The patient falls down with a sudden cry, convulsive tossings of the hands and feet, involuntary emission of stool and urine; or, if the patient lies still during the fit, with a meaningless smile in his countenance, and wakes with great weakness; or, if the fit is caused by the fear of punishment; or, if the fit commences with cramps in the calves, followed by cramps in the stomach, and terminates with heat, heaviness of the head, vertigo, the patient seeing fiery wheels during this time. Generally these attacks are characterized by bluish color and bloated appearance of the face, foam at the mouth, protrusion of the eyes; or the epileptic attacks are alternated with appearances denoting apoplexy. IGNATIA has been successfully given in recent cases of epilepsy, when caused by fright, anxiety or violent chagrin; in inveterate cases of this kind, SULPHUR is required. DOSE.-A few drops, or six globules, dry on the tongue, every six hours; take four doses, and then continue the medicine, one dose a day for a week. Nux VOMLCA, for epileptic fits brought on by abuse EPLPY 411. EPILEPSY. 411 of spirits, especially in persons with vehement and irritable dispositions. DOSE.-Same as Ignatia. OPIUM, when the paroxysms come on in the evening, night or morning, with suffocative breathing, violent tossing of the limbs, loss of breath or stertorous breathing, the patient has his eyes half open and seems insensible, in a deep stupor or lethargy. DOSE.-A few drops, or six globules, dry on the tongue, every three hours; give six doses, then a dose of Belladonna, and alternate Opium and Belladonna, one dose a day, for a week. ARGENTUM NITRICUM is a great remedy for epilepsy; for the indications the reader is referred to the Symptomen-Codex, Vol. T., p. 134, and to'Dr. Gray's interesting note in the same work, page 136. CALCAREA and SILICEA have been proposed as useful remedies for epilepsy, the former when the attacks occur during full, and the latter when they occur during newmoon. DOSE.-Two or three globules, dry on the tongue, every three or four days. Epilepsy is frequently an incurable] disease, especially when of an hereditary character, or a vicarious disease existing in the place of some other incurable malady, such as consumption. In some cases of curable epilepsy, medicine does not seem to do any good, but changes of air, travelling, surf-bathing, seem to be the most useful means to combat this frightful and most dangerous and distressing malady. Persons who are subject to epileptical attacks, have to avoid all violent emotions, excesses of every kind, more particularly sexual debauchery and inordinate use of food and drink. Regular exercise is indispensable. The use of plain food in moderate quantities, cold ablutions __ 41-2 SPECIAL THERAPEUTICS. every morning, and cheerful company facilitate the treatment. Chorea, St. Vitus' Dance. This affection consists in involuntary spasmodic, twitching or jerking motions of the extremities, sometimes of one or two only. Consciousness is not impaired by this disease. It generally occurs in children, but likewise affects full-grown persons. It yields to the following remedies, unless the disease depends upon softening or tubercles of the spinal marrow, when it is incurable. ACONITUM, when the disease is of recent origin, and the patient feels otherwise well. It may be caused by fright, or may be the sequela of some badly man aged acute inflammation. DOSE.-One drop of the tincture, in a tumblerful of water, a small tablespoon every two or three hours, until the disease seems quite removed. If, after using the Aconite for a week or two, there should be no very striking improvement, CUPRUM ACETICUM may be substituted for the Aconite, giving one grain of the third trituration every six hours. IGNATIA is useful, if the affection was caused by a sudden fright, in which case it is well to alternate this medicine with Aconite. DOSE.-If given alone, give a few drops, or six globules, of Ignatia, every night, dry on the tongue; if alternated, give a drop of the first attenuation of Ignatia, in the morning; in alternation with a drop of the same attenuation of Aconite, in the evening. SECALE CORNUTUM is a good remedy when the disease affects whole communities as an epidemic. DOSE.-A few drops, or six globules, dry on the tongue, every six hours. TETANUS, TRISMUS, LOCK-JAW. 413 Tetanus, Trismus, Lock-jaw. Tetanic spasms and convulsions are of various kinds: trismus or lock-jaw; opisthotonos or when the trunk is bent backwards; emprosthotonos or when the trunk is bent forwards; or, fourthly, when the trunk is bent to one side. This disease is more frequent in hot than in cold climates. In moderate and cold climates it is generally caused by some local injury, in consequence of which a nerve or tendon is wounded, and a nervous irritation is produced which finally terminates in the tetanic spasm. This species of spasms is called traumatic tetanus. The true seat of the spasm seems to be the spinal cord and particularly the medulla oblongata. The spasm generally commences in the medulla oblongata, a slight stiffness being felt in the back part of the neck, accompanied with sense of uneasiness at the root of the tongue, difficulty of swallowing, oppression on the chest, pain in the pit of the stomach, rigidity of the jaws which gradually increases to a complete locking or spasmodic compression of the jaws, and is frequently followed by spasms of the extremities, back and abdomen, so that the whole body becomes perfectly rigid. In the highest forms of tetanus the tongue is likewise convulsed, the eyes are set, the face is frightfully distorted and the most horrible anguish is pictured in the features. The pulse is small, the bowels confined, the urine high-colored. Such spasms frequently follow each other in rapid succession, and may last for days before death puts an end to the patient's sufferings. TREATMENT.-One of the most powerful and most efficient remedies for tetanic spasms is, 36* 4:14 SPECIAL THERAPEUTICS. Nux VOMICA, which strange to say, is not even mentioned in some of our standard works on homoeopathy. It is particularly indicated by the following symptoms: convulsions accompanied with paralysis of the extremities alternating with violent shocks or concussions; or by tetanic convulsions excited by the least contact or noise, with lock-jaw and extension of the trunk; or by tetanic spasms when the muscles of the chest are involved and the breathing is difficult and oppressed; or by frightful tetanic spasms of the whole body, the body being bent backwards every few minutes, with a drawing sensation in the muscles of the chest, loss of consciousness, rigidity of the limbs, hardness of the muscles as if made of wood, distortion of the.eyes and cherrybrown redness of the face; or by tetanus alternating with asphyxia and with paralysis and atony of the affected parts. DOSE.-Five drops of the tincture of Nux in a tumblerful of water, a small tablespoonful every ten or fifteen minutes, until the spasm seems to yield; after which, the medicine may be continued less frequently. If the patient should be unable to swallow, and it should be likewise impossible to apply the medicine to the tongue by some means or other, we may resort to an enema, in which case from five to ten drops of the tincture of Nux may be mixed in half a pint of cold water, and this mixture injected into the bowels. At the same time, the region of the medulla and upper portion of the spine may be rubbed with a mixture of fifteen to twenty drops of the tincture of Nux Vomica, in two tablespoonfuls of water, until the whole is consumed. If it is possible to reach the tongue, and the attending physician does not wish to commence the treatment with the tincture of Nux, he may first try the third, sixth or some higher preparation, giving a few drops every half hour until reaction commences. This may take place in some instances; in other cases the strong tincture will have to be resorted to; if this should have no effect, and Nux should nevertheless seem indicated, then it becomes necessary to employ the alkaloid. STRYCHNINE, half a grain of the second or third trituration, every half hour, until the spasm yields. These preparations of Nux are particularly indicated when TETANUS, TRISMUS, LOCK-JAW. 415 constant abuse of ardent spirits is one of the exciting causes of the disease. Strychnine is now employed by alloeopathic physicians for tetanus, and with great success; but they give it in doses of from one-thirtieth to one sixteenth of a grain of the original substance, repeating the dose as often as may be required; some even give two, three and more grains in some cases. OPIUM used to be the principal remedy for tetanus in former times; but it failed in most cases. It is only useful in cases of tenanus characterized by opisthotonic rigidity of the trunk and head, or when the spasm is caused by a fit of violent internal chagrin, caused by some mortifying, insulting treatment;' or opisthotonos with violent trembling of the limbs and sensation as if the nerves would be pulled to pieces. DOSE.-Six globules, or a few drops on the tongue, every half hour, until reaction sets in. In some cases it may be necessary to use the tincture, the same as Nux. ARNICA may be tried for traumatic tetanus, provided it is employed as soon as the spasm threatens to break out. DOSE.-Same as Opium, and if Arnica should fail, Opium may be substituted; if this should likewise fail us, then the spasm will have to be treated with Strychnine or some other suitable remedy. ACONITUM is an excellent remedy for tetanic spasms, if they are caused by injuries of a portion of the peripheral nerves inflicted by some pointed or cutting substance, or if some artery has been punctured or lacerated by some sharp body, a nail, a piece of glass, etc. For the surgical treatment of such cases, the reader is referred to the chapter on wounds in the last section of this work. Aconite may be given internally, a few drops or ten globules in a tumblerful. of water, a tablespoonful every two hours. In some cases it may be necessary to 416 SPECIAL THERAPEUTICS. give the strong tincture of Aconite, one or two drops in a tumblerful of water, in tablespoonful doses every hour or two hours. If Aconite should fail to afford relief, BRYONIA may be given, same dose as Aconite. It is likewise proper, under these circumstances, to give Aconite and Arnica in alternation, an alternate dose every fifteen or twenty minutes, until the attacks cease. ACONITUM, for tetanic spasms, with lock-jaw, convulsions of the eyes and facial muscles, expression of anguish, alternate redness and paleness of the face, dyspnoea, numbness of the limbs. DOSE.-Same as Cantharides; if the attenuation should fail, give the tincture, same as Nux, substituting three drops for five. If Aconite should fail to relieve after a few doses, BRYONIA may be given in the same yvay, and if this should remain inoperative, BELLADONNA. BELLADONNA is particularly indicated by tetanic spasms, with concussions of the body, screams and loss of consciousness, convulsions of the eyes, with redness and puffiness of the face, rigid extension of the limbs, distortion of the muscles, rattling breathing, spasmodic inclination of the body to the left side, creeping sensation in the muscles of the extremities, full and quick pulse. DOSE.-Two or three drops, or six globules, on the tongue, every half hour, until the limbs become relaxed, then every three hours, until the patient is well. MERCURIUS CORROSIVUS, for tetanic spasms terminating in paralysis of the extremities. DOSE.-One drop of the first attenuation in water, or on a little sugar every four hours, to be continued until a decided improvement takes place; then less frequently. MoscHus may likewise prove useful in tetanus, characterized by rush of blood to the head, pressure in the TETANUS, TRISMUS, LOCK-JAW. 417 nape of the neck, deathly paleness, coldness of the body, obscuration of sight, with staring, contracted pupils, nausea, distortion of the facial muscles, rigidity of the upper limbs and fingers. DOSE.-One grain of the second or third trituration every half hour, until relieved. SECALE CORNUTUM for tetanic spasms of every description, when accompanied with risus sardonicus and rage; the limbs remain distorted even after the spasms subside, the patients seem crazy, imbecile, stare at those who ask them any questions, or seem as if paralyzed. DOSE.-A few drops, or ten globules, on the tongue, every few hours, or a drop of the tincture in a small tumblerful of water, a tablespoonful every two or three hours. During the spasm, the medicine may be given every ten or fifteen minutes, until the attack seems to subside. ARSENICUM, for tetanic spasms, characterized by frightful contortions of the limbs, and rigidity of the lower extremities, especially when the spasms are excited by violent pain in the soles of the feet. DOSE.-A few drops, or six globules, on the tongue, every fifteen or twenty minutes, until relief is obtained; afterwards every hour. PLUMBUM ACETICUM is indicated by convulsions with frightful shrieks, alternating with pain in the bowels; or convulsions returning from time to time, with deep moaning towards the end, and pains in the limbs and epigastric region on waking; the spasms are sometimes accompanied by trismus, opisthotonos, rigidity of the limbs, delirium, loss of sense. DOSE.-One grain of the third trituration, dry on the tongue, every half hour, until the attack abates, then every two hours. SOLANUM NIGRUM is indicated by convulsions and spasms, with painful creeping in the limbs, imbecility, rage, tetanic rigidity of the whole body, trismus, epileptic paroxysms. rrt.~ -- 418 SPECIAL THERAPEUTICS. DOSE.-One drop of the first attenuation on the tongue, to be repeated every half hour, until an improvement becomes manifest. TARTRUS EMETICUS, for chronic spasms with loss of consciousness, lock-jaw, striking about with the limbs, loss of pulse and speech, and marble-coldness. DOSE.-One grain of the first trituration in a tumblerful of water, a small spoonful every half hour, or more frequently, until relieved, CANTHARIDES, for tetanic convulsions, accompanied with symptoms of hydrophobia. DOSE.-One or two drops, or six globules, on the tongue, every half hour, until reaction sets in, then every two hours. CAMPHOR, spirits of the tincture, for tetanic spasms, with loss of consciousness, which returns after vomiting has taken place. DOSE.-A few drops on sugar, every half hour, until relieved. CANNABIS, for tetanic spasms of the upper extremities and trunk, with vomiting of a yellowish fluid during the spasms, and delirium. DOSE.-Same as Cantharides. Many of these remedies are very seldom required for the cure of tetanus. With some of them the tetanic spasm is the effect of a sympathetic irritation arising from some primary disturbance of the gastric intestinal membrane, or of the cerebral tissues. In prescribing for tetanus, we have therefore to select a remedy that corresponds with the whole character of the existing disturbance, with the primary as well as with the sympathetic symptoms. Again, in order to prescribe the right remedy, we should study the history of the attack from its incipiency to the present moment, and select a medicine, the -effect of which upon the healthy body corresponds with the totality of these symptoms in all their fundamental characteristics. In most cases we _ ~ ____~_~~_ __ __ ~~__~__ r SPASMS, CON-ULSIONS. 419 shall find Aconite and Nux vomica, with its alkaloid Strychnine, sufficient to effect a cure. DIET.-If the spasm should be of long continuance, it may sometimes be necessary to inject nourishment into the intestinal canal; otherwise, if the patient is able to swallow, some nourishment may be introduced into the stomach by the mouth, such as a little broth, yolk of an egg, gruel, etc. Spasms and Convulsions. Spasms and convulsions are generally symptoms of a more general affection; they occur principally among children during the teething period, among hysteric females, or in consequence of effusion into the brain, or pleural cavities, or they may be caused by violent pain, by sudden and violent emotion, fright, anger, insulting treatment, or they may be a prominent symptom in the death-struggle at the termination of various maladies. For all such cases the treatment will be indicated when speaking of the particular malady. For spasms and convulsions generally, not depending upon any apparent more deep-seated disorder, or lesion of some important, organ, the following remedies may be employed beside those which have been indicated for tetanus and epilepsy, to which the reader is referred: ACONITUM, for epileptiform spasms, with the upper and lower limbs drawn in, hand and thumb clenched, the lower limbs constantly close to each other, sweat on the face, eyes turned up. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every half hour, until a reaction sets in, then every two hours. This medicine is an excellent remedy for spasms, when 420 SPECIAL THERAPEUTICS. they seem to depend upon a stoppage of the circulation, with collapse of pulse, coldness of the extremities, irregular or tumultuous action of the heart. DOSE.-As above during a paroxysm. For the spasms of hysteric females Aconite is likewise an admirable remedy. If the attenuations do not relieve, give the tincture, one or two drops in a tumblerful of water, a tablespoonful every fifteen minutes. BELLADONNA for spasms alternating with complete immobility; or for spasmodic stretching of the limbs, with violent contortion of the muscles; or for spasms with laughter, delirium, screams, and loss of consciousness, hiccough, anxiety; or for spasms which are excited again by the least contact, or after a violent fit of chagrin. DOSE.-Same as Aconite. AMBRA may be useful for muscular spasms and convulsions. DOSE.-One grain of the third trituration, every half hour. CICUTA, for spasmodic contortions or violent spasms of the limbs which cannot be straightened or bent. DOSE.-Same as Aconite, or more frequently, until relieved. HYoscYAMus, when the following symptoms occur: The limbs are spasmodically curved, and the curved body is tossed off the floor; or chorea-like spasms, with contortions and tossing of the limbs; or for spasms with diarrhoea, and coldness of the whole body; also, for spasms with watery diarrhoea and enuresis; or for convulsions with foam at the mouth, tossing of the body. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every fifteen or twenty minutes, until the attack subsides, then less frequently. MERCURIUS CORROSIVUS, for spasms and convulsions, terminating in paralysis. SPASMS AND CONVULSIONS. 421, DOSE.-One drop of the first or second attenuation three or four times a day IPECACUANHA, for the following symptoms: The body. is stretched as if rigid, after which the arms are spasmodically jerked toward one another. DOSE.-One drop, or six globules, on the tongue, every fifteeen minutes. COCcULUS has been found useful in spasms and convulsions of the limbs and body. DOSE.-Six globules, dry on the tongue, every twenty minutes, until relief is obtained. STRAMONIUM: Spasms of the arm and leg, followed by spasms of the head; also, when the limbs are tossed as by a spasm, or when the hands, not the thumbs, are clenched, but may be opened; or for convulsions at the sight of a candle, mirror or water, or when excited by contact, or commencing with a shock in the limbs. DOSE.-Same as Cocoulus. LAUROCERASUS, for spasms of the back. DOSE.-Same as Cocculus. CUPRUM METALLICUM, for spasms of the head, which is either twisted to one side or drawn backward, DOSE.-One grain of the third trituration, dry on the tongue, every half hour. SECALE CORNUTUM is indicated in spasms followed by contortions of the limbs, dilatation of the pupils, with imbecility and staring, as if paralyzed. DOSE.-One drop of the first attenuation four times a day, on sugar, or in a little water. ARSENICUM, for convulsions with frightful contortion of the limbs. DOSE.-One grain of the third trituration, dry on the tongue, every twenty minutes, until'relieved. These are some of the principal remedies for spasms and convulsions; if the list should not seem satisfactory, the reader will do well to consult our large Repertory, where all the known medicines for spasms and convul37 422 SPECIAL THERAPEUTICS. sions, together with their characteristic indications, will be found mentioned, from pages 1123 to 1127. Spasms and convulsions, to which children are subject, will be treated in one of the last chapters of this work, which is especially devoted to the diseases of children. Catalepsy. In this condition, patients seem motionless and deprived of life, as it were, but they may hear everything that is spoken around them, without being able to utter a word, or even give any sign of consciousness. We will mention two remedies that relieve this state; they are ACQNITUM and MOSCHUS. The former may be given first; six globules or a few drops on the tongue, or else in a small tumblerful of water, a small spoonful to be given every hour, until the cataleptic condition ceases; this medicine is especially indicated by a violent throbbing of the pulse, palpitation of the heart, or throbbing through the whole body. MoscHus is indicated when the catalepsy resembles a deep swoon, with coldness of the skin, cold sweat on the forehead, staring and protruded eyes. DOSE.-One grain of the third trituration every half hour, until the symptoms improve. Twitching, Nervousness, Nervous Debility. In some individuals, twitching is a prominent symptom of nervous debility. In others, the debility is characterized by constant restlessness, uneasiness. Nervous debility is a condition that manifests itself in a variety of ways-by loss of appetite and strength, pains NERVOUS DEBILITY. 423 in various parts of the body, loss of flesh, or the opposite state, excessive increase of flesh; by irregular sleep, wakefulness, distressing dreams, anxiety and apprehensions for one's health and future welfare; oppression on the chest, palpitation of the heart, vertigo, rush of blood, costiveness. TREATMENT.-The treatment of this condition is intimately connected with the treatment of lentescent, hectic or consumptive fevers, in subsequent chapters of this work, to which the reader is referred. In other respects the treatment is both medicinal and hygienic. A good deal depends upon the causes which brought on this condition. It may have been caused by over-exertion, by excessive nursing and watching, constant care and anxiety, grief, want of care and proper food, abuse of spirituous drinks, or it may be hereditary, or arise from a deranged condition of the spinal marrow. Medicine is indispensable in this affection, but only in rare doses, and never, or very seldom, the lower preparations. Exposure to sharp, keen air, especially sea-air, should be avoided; soft, mild, but bracing, inland air is preferable. Changes of air are sometimes very useful. Daily ablutions with tepid water, gradually substituting cold water in the place, are beneficial. The shower-bath hip-bath, and the various other forms of bathing adopted by hydropathic physicians, are likewise necessary in a number of cases. Strict diet should be enjoined; stimulants of every description should be avoided, except in rare cases. If nursing causes the debility, the nursing has to be discontinued; if over-exertion is the cause, perfect rest should be recommended. As regards the medical treatment, we may give AcoNITUM, when there is a tendency to hectic fever, 424 SPECIAL THERAPEUTICS. with chills and flushes of heat, inward fever, dizziness, palpitation of the heart, throbbing, weakness of the back, headache, distressing dreams at night, numbness of the limbs, tendency to go to sleep, twitching and restlessness, wakefulness, or constant drowsiness; weariness in the limbs, the patient feels like an old man or woman. DOSE.-A few drops, or six globules, in four tablespoonfuls of water, a small tablespoonful four times a day; to be continued, until the patient feels relieved, after which the medicine should be discontinued for a time, and resumed again if the symptoms reappear. ARSENICUM may be given, if the debility is very great, and the patient is troubled with constant thirst, and there is a considerable loss of flesh. DOSE.-Same as Aconite; it may be alternated with this medicine, two doses of each in the twenty-four hours. COFFEA may be given for obstinate wakefulness, a few globules dry on the tongue, an hour before retiring. CHINA is a good remedy, when the debility had been caused by excessive nursing, loss of blood, over-exertions and watching. Instead of China we may also give Quinine, half a grain of the first trituration, three times a day. DOSE.-Of CHINA, same as Aconite. MERCURIUS may be given if the patient feels weary, as if the joints had lost their flexibility, with tenderness of the flesh to the touch; a cold may have been the cause of the trouble. DOSE.-Same as Aconite. VERATRUM is indicated by coldness of the body, nausea, cramps in the legs, prostration, colic. DOSE.-One drop, or six globules, on the tongue, morning and night. This medicine may be alternated with Aconite, especially if the patient is troubled with spitting up of food after eating. Give one dose of each every twentyfour hours; _Y __ DEFICIENT INNERVATIONS. 425 Nux vOMICA should be given if the debility is traceable to the abuse of stimulating drinks, coffee, ardent spirits, wine. DOSE.--One drop, or three globules, on the tongue, every night before retiring, until relieved; then discontiue for a week, and afterwards take a dose at long intervals until quite restored. It should be remarked that, whenever the patient feels tolerably smart in this disease, the medicine should be discontinued as long as the improvement lasts, and that no medicine should be given until the ailments and pains of the patient reappear. Deficient Innervation, Marasmus, Atrophy, Nervous Consumption. This condition consists in a gradual exhaustion of the nervous energy, and, in the end, leads to consumption of the spinal marrow or tabes dorsualis. The same causes which occasion a state of nervous debility, may, by continuing to operate, lead to marasmus. It may be hereditary in some cases; or it may be induced by dissipated habits, especially by sexual excesses and onanism. Lesions of important nerves at the periphery of the body may gradually depress and finally extinguish the process of innervation; a very common cause of the disease is injury of the spinal marrow by a fall, a violent concussion, sprain. The disease sometimes develops itself very slowly, commencing with loss of flesh, weakness, disturbed sleep, loss of appetite, dyspeptic symptoms, and gradually undermining every animal or organic function, even the special senses, causing deafness and blindness, and terminating in derangement of the mental powers, loss of memory, idiocy, insanity which is sometimes characterized by intractability of 37* 426 SPECIAL THERAPEUTICS. temper, complete emaciation, paralysis of the extremities, and gradual exhaustion, until death closes the scene. All these symptoms of marasmus are sometimes the natural result of old age. TREATMENT: When this disease has reached its last stage, it seems useless to entertain the least hope of restoring health. If the disease can be traced to any particular cause, the cure is, of course, materially aided by the removal of this cause, provided this be possible. If want of fresh air, exposure to dampness in low dwellings, basements, etc., atmospheric miasms, deficient nutrition, over-work, want of cleanliness, squalid poverty, constant drain of the animal powers by privation of sleep, nursing, sexual abuses, onanism, should have caused the disease, these causes have to be removed before anything like a cure can be attempted. The opposite regimen has to be instituted, better diet, perfect regularity in all the bodily habits, daily ablutions with tepid or cold water, suitable ventilation and exercise, and the most rigorous abstemiousness in regard to sexual intercourse. And more particularly that destructive plague to young people, onanism, must be strictly avoided. The medical treatment may be confined to the following remedies: ACONITUM for flashes of heat, flushes in the face, restlessness, nervousness, disturbed sleep, loss of flesh, dryness of the skin, weakness and sensitiveness of the spinal region, heat and burning in the spine, impaired condition of most of the animal functions, dyspepsia, costiveness, inability to pass urine, spitting up of food, numbness and laming weakness of the limbs, soreness and aching pains in the limbs, stitches in the joints, dizziness, headache, rushes of blood, palpitation of the heart, oppression DEFICIENT INNERVATION. 427 on the chest, bad taste in the mouth, foul breath, furred tongue; melancholy mood. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every three or four hours, to be continued for some days, after which one of the following medicines may be given ARSENICUM.-If the patient complains of dryness of the tongue and thirst, and if emaciation, prostration of strength, anxiety of mind, despair of one's future welfare, are prominent symptoms. DOSE.-One or two drops, or six globules, on the tongue, morning and evening. Continue this for a few days, then discontinue all medicine for a day or two, and give Aconite as mentioned above. Aconite and Arsenic are excellent medicines to be given in alternation for a few weeks. ARNIcA may be given, if the affection has its origin in some mechanical injury, mutilation or concussion of the spinal marrow or branches of the spinal nerves. If Arnica should seem inefficient, give RHUS TOXICODENDRON, especially when the difficulty arose from a fall on the spine. DOSE.-Of either medicine, a few drops, or six globules, in a tumblerful of water, a tablespoonful every two or three hours; these two remedies may be given in alternation, a dose every three hours. CHINA is indicated, when loss of animal fluids, milk, blood, or the spermatic fluid, is the cause of the disease. DOSE.-A few drops, or six globules, on the tongue, three times a day, until a decided improvement sets in. CALCAREA CARBONICA is an excellent remedy, when this condition seems to be complicated with, or arise from a scrofulous taint characterized by glandular swellings, chronic discharges from the ears, bowels, nose, vagina, eruptions, soreness, etc. DOSE.-One or two drops, or six globules, dry on the tongue, twice a day, morning and evening. This remedy may be continued for a week, then give SULPHUR, six globules dry on the tongue, every evening, for another week, and either follow up with Calcarea, or with some other suitable remedy, to be 428 - SPECIAL THERAPEUTICS. selected from among those mentioned above, or from among the following. BELLADONNA.-When the brain and the upper portion of the spinal cord, seem to be involved, as evinced by constant headache, rush of blood, stitches through the head, sore throat, oppression of the chest, sensitiveness to the light, optical illusions, starting of the body, nervousness, laming weakness and creeping in the extremities. DOSE.-One or two drops, or six globules, morning and night, dry on the tongue. This medicine may be alternated with Aconite, giving two doses of each medicine a day, at equal intervals, always one hour before and two hours after a meal. PHOSPHORUS is an excellent remedy, if the bowels are weak, with constant disposition to diarrhoea, phthisicky condition of the lungs, cough, expectoration, sallow and dark complexion, bilious coating on the tongue, opalescent urine (or urine covered with a shining pellicle.) DOSE.-Same as Calcarea. Nux VOMICA may be exhibited, when the patient complains of distention of the bowels, costiveness, load at the stomach after eating, nervousness, debility, soreness, weakness and stiffness of the back, especially the lower part; furred tongue, loss of apetite, disturbed sleep. DOSE.-One drop, or six globules, on the tongue, every night. This medicine may be alternated with Sulphur, six globules every other night, especially if the patient is troubled with piles. VERATRUM may be given, when the patient suffers much from colicky, spasmodic pains in the bowels, nausea, vomiting of mucus, coldness, cramps in the extremities. DOSE.-One drop, or six globules, morning and night, on the tongue. BARYTA CARBONICA is recommended for the maras. mus of old people. DOSE.-One grain of the third trituration dry on the tongue, every night, until some other medicine is definitely indicated by the symptoms. PALPITATION, TREMOR, ETC. 429 IODINE may be recommended for a general wasting of the flesh, breasts, aching pains in the interior of the limbs, or when the atrophied condition is accompanied with scrofulous enlargement of the glands or joints. DOSE.-One drop of the third or first attenuation, three times a day, on a little sugar; if Iodine should have no effect, Bromine may be tried in the same way, for a week or two. PLUMBUM METALLICUM may prove useful in case the emaciation is characterized by softness and flabbiness of the muscles, pains in the bowels, brain and extremities, laming weakness. DOSE.-One grain of the second or third trituration, three or four times a day, dry on the tongue. DIET.-Stimulating diet should be avoided; the patient may eat little, at regular hours, and what little he does eat, should be strictly nourishing food. Sponging with cold or tepid water, as the case may be, may be of great use. If possible, the patient should reside in a mild climate. As strength returns, the influence of mountain, or sea-air may prove salutary. Palpitation, Tremor, Fluttering, Spasms of the Heart. This affection may be a mere symptom of some disease of the heart, in which case the symptom will disappear with the primary disease, provided this is curable. The affection is here alluded to simply as a nervous symptom, not accompanied by organic disease. A great remedy for palpitation of the heart is ACONITUM, especially when the following symptoms prevail: The palpitation sets in from the least excitement, or when one is lying on the left side in the evening; it is accompanied with anxiety, coldness and even numbness of the extremities; sometimes it is preceded by a __ 480 SPECIAL THERAPEUTICS. sensation as if the heart ceased to beat; or a heat may be felt in the region of the heart, a heavy, aching pain, stinging, shooting pains, the region of the heart feels sore to the touch. Pulse weak and quick, or irregular and heavy. DOSE.-A few drops, or ten globules, on the tongue, morning and night, or, during a violent and sudden paroxysm, to be mixed in a tumblerful of water, of which a small tablespoonful may be taken every half hour, or hour; until the distress is relieved. ARSENICUM is sometimes an excellent remedy for violent palpitation of the heart, the shocks being felt high up in the brain, especially when accompanied with religious melancholy. DOSE.-One drop, or six globules, on the tongue morning and night. AURUM FOLIATUM, for palpitation of the heart, accompanied with a desire to destroy one's life. DOSE.-One grain of the second trituration, three times a day. VALERIANA may prove useful when the palpitation is accompanied with stitches in the heart. DOSE.-A few drops, or six globules, on the tongue, three times a day. DIGITALIS is a good remedy for palpitation of the heart, when attended with a slow, irregular, or even intermittent pulse, vertigo, loss of sense. DOSE.-Dissolve six globules, or mix three drops in a tumblerful of water, and give a small tablespoonful every two or three hours. PULSATILLA, when the palpitation is accompanied with symptoms of gastric irritation. DOSE.-Six globules, or two drops, every morning, on rising, on thetopgue. If Pulsatilla should have no effect, CARBO VEGETABILIS may be tried in the same manner, especially when the patient complains of sour stomach and heartburn. This remedy may be suitably alternated with Aconite, giving a dose of Carbo in the morning, and Aconite at night, one drop or six globules of each, on the tongue. LU~U3AG0. 431 LUMBAGO. 431 IGNATIA is an admirable remedy for palpitation of the heart, when caused by long-lasting, silent grief. DOSE.-One drop, or six globules, on the tongue, every morning or night. It may be alternated with Aconite, one drop, or six globules every other day. COFFEA is sometimes useful, when the patient is troubled by wakefulness and nervous restlessness. DOSE.-A few drops, on the tongue, two hours before retiring. DIET AND REGIMEN.-Avoid stimulants and narcotics, including coffee, sleeping mixtures, and the like; employ daily ablutions with cold water, eat light suppers, and use light diet generally. Moderate quantities of cold roast meat are allowable; flatulent vegetables, and food which sours on the stomach, are injurious. An attack of palpitation of the heart, of temporary occurrence, is sometimes arrested by the use of a stimulant, such as a teaspoonful of brandy in half a tumblerful of water, of which a dessert-spoonful may be used every four or six hours. Lumbago. This is a severe and sometimes sudden attack of pain in the loins or small of the back. It may come on in consequence of a cold (rheumatic lumbago), or in consequence of a strain, and is sometimes felt unawares after. stooping, so that the patient is perfectly unable to stir without experiencing the most agonizing distress. Sometimes the attack comes so suddenly, and with such an acute pain, that the patient falls as if struck down. TREATMENT.-This distressing affection can be removed quite easily, provided homoeopathic physicians are willing to divest themselves of all prejudice in favor of certain routine modes of practice. What is lumbago, Psr~--------L 432 SPECIAL THERAPEUTICS. pathologically considered? It is a vascular engorgement of the lumbar muscles, occasioned by a torpid or embarrassed condition of the nervous capillaries in that region. In old school practice, general and local bleeding is the proper remedy for this acute suffering. Under homoeopathic treatment we have, instead of the lancet, that great blessing of the sick, the ACONITUM NAPELLUS. Of this medicine, a few drops or six globules may be dissolved in a small tumblerful of water, of which a tablespoonful may be given every half hour, until the patient is relieved; after which the same medicine may be continued less frequently, say every two hours, until the cure is completed. In many cases, this kind of treatment may suffice; but, in many other cases, it will not, and then we recommend most emphatically the use of the saturated tincture of the root of Aconite, one or three drops in a tumblerful of water, a small spoonful every half hour. And, if we choose to expedite the cure as much as possible, this same tincture should be rubbed on the painful region externally, ten drops in a tablespoonful of brandy, half of which is to be consumed every half hour; after one application, the pain sometimes disappears as by magic, and the patient feels as well as ever. If a little soreness should remain, the Aconite may be applied twice a day, morning and evening, for a few days, until the soreness is all gone. The external use of Aconite, in this distressing malady, is decidedly proper, and may sometimes be found necessary. We use the tincture of Arnica externally, we use Thuja externally, we apply the nitrate of silver externally, and various other drugs are used, and have to be used, externally; nobody, not even the most pedantic stickler, objects to such modes of practice; but who LUMBAGO. 433 LUMBAGO. 433 would dare to use the tincture of Aconite externally, even if the most undoubted experience should be in favor of this practice? Horrible. We have seldom found it necessary to use any other medicine for lumbago than Aconite; but there are cases where it may be necessary to give the Valerianate of Zinc, if Aconite does not seem to reach the case; this medicine may likewise be rubbed on the parts in the shape of an ointment, and it may at the same time be given internally, half a grain of the second or third trituration every hour. As soon as the pain is considerably relieved, it may then be proper to use Aconite internally, as stated above, particularly if the patient feels feverish, and the pulse is rather excited. This medicine will generally achieve a cure. In rare cases it may be necessary to use one of the following medicines: BRYONIA, if the pains are of a pressing character; the patient is unable to walk erect, feels chilly, with rheumatic pains in other parts of the body. DOSE.--A few drops, or six globules, in a tumblerful of water, a small spoonful every hour or two hours, until relieved. MERCURIUS, if the pulse is not much altered in consequence of the pain, which was caused by exposure to wet or a draught of air, with chilly feelings, sense of coldness which makes one desire to be near the fire, feeling of warmth in the palms of the hands, nausea, and catarrhal symptoms. DOSE.-Same as Bryonia. Nux VOMICA, if the pain is characterized by lameness, rigidity; it is aggravated by the least motion, or when it arises from suppression of piles. DOSE.-A few drops, or six globules, in a tumblerful of water, a small 38 484. SPECIAL THERAPEUTICS. tablespoonful every two hours; in the case of haemorrhoidal suppression, this medicine may be alternated with Sulphur, dose the same as Nux, every two hours. PULSATILLA is indicated when the pain seems to arise from menstrual suppression. DOSE.-A few drops, or ten globules, on the tongue, morning and night. ARNIcA may be given when the pain can be traced to a strain. DOSE.-Same as Bryonia. Apply the tincture externally, fifteen drops in a small wine-glass full of water, to be rubbed on the parts every half hour, in alternation with the external and internal use of Aconite, as explained above. If the pain should have been caused by a severe concussion of the back in consequence of a fall or blow, and symptoms of paralysis of the extremities develope themselves, we recommend the external and internal alternate use of RHUS TOXICODENDRON and ACONITE, internally use the globules, six of each or a few drops in a separate tumblerful of water, an alternate tablespoonful every hour or two hours, and externally ten drops of the tincture (the saturated tincture from the root, in the case of Aconite,) in a tablespoonful of brandy or water, to be rubbed on the part every hour alternately, using one-half at each rubbing, until decided relief is obtained, after which the applications may be continued at longer intervals. RHUS TOx. may likewise be given internally when the disease is caused by exposure to wet, or by suppressed perspiration; although, in such a case, the alternate internal use of Rhus and Aconite as mentioned above, may likewise be advisable. If the attenuations seem insufficient, use the strong tincture, as stated previously. CHAMOMILLA, may sometimes be required, if the disease originates in a fit of anger, suppression of the CUTANEOUS DISEASES. 435 perspiration, exposure to sharp wind, and the pains are of a lancing, pressing kind, accompanied with a sense of numbness. DOSE.-Same as Bryonia. APPLICATION OF COLD WATER: Sometimes patients derive great benefit from the local application of cold water. Individuals who are subject to attacks of lumbago, should employ daily ablutions with cold water, and accustom themselves to the use of shower-baths, especially over the spine. Exposure to wind and currents of air have to be avoided with great care. CUTANEOUS DISEASES. It is well known that the skin is the external covering of the body, and that its office is to afford protection to the parts which it covers, to serve as an organ of touch, and to be used for various purposes of secretion. The skin is continuous with the mucous membrane, and, at the various orifices of the body, the skin gradually passes into the mucous membrane. The skin is composed of the true skin or corion, and the cuticle or epidermis, which is the delicate pellicle that is distinctly seen on the external body, and is frequently detached, owing to a variety of causes. The internal layer of the epidermis is the so-called Malpighian net, a mucous tissue which, in the blacks, is the seat of the black color. The epidermis is covered with villi, or fine conical projections, by means of which the 436. SPECIAL THERAPEUTICS. sensation of tact is experienced. Beside these constituents of the skin, we have in a great many parts sebaceous glands which are most abundant on the scalp and in the face, and secrete an oily substance which, if allowed to collect on the skin, is apt to occasion an offensive smell. Upon a healthy condition of the skin depends in a great measure the health of the body. It is almost certain that the various cutaneous diseases which afflict mankind even now, originate almost exclusively in a want of care regarding the proper cultivation of the skin. The skin cannot be in a perfectly healthy state, unless it is well washed every day, from head to foot, and is exposed to the action of fresh air, if not directly, at least indirectly, by taking suitable exercise in the open air, and properly ventilating our houses. Frequent changes of linen are likewise indispensable to a proper preservation of the skin. It will be found that, if we accustom our children to the constant and daily use of general ablutions with cold water, shower and plungebaths, and the various other modes of using water for purposes of health and cleanliness, and establish rational systems of ventilation; provided, moreover, that every body has the means of putting on fresh underclothes every morning, or even twice a day, if necessary: chronic eruptions, such as the itch, tetters, etc., and even such eruptive diseases as variola, syphilis, etc., will gradually disappear; and it is very doubtful in our mind, whether scrofula in all its forms, and even such acute eruptive diseases as scarlet-fever, will not be completely eradicated. It is certain that medicine alone will not do this. All cutaneous diseases may be divided into acute and ___ __ __ ___ RASH. 487 chronic. Among the acute eruptions we distinguish. the following: Rash. A fine eruption, consisting of red pimples or spots, of the size of a pin's head, or larger, sometimes breaks out upon the skin in consequence of eating some indigestible food, or food that does not agree with one, or in consequence of exposure to heat, or from taking cold by getting the feet wet, or taking a cold drink while over-heated. The eruption causes a good deal of itching, burning, especially at night in bed; it sometimes wanders from one part of the body to another, and is frequently of a very evanescent character. A slight feverishness with chilliness, and some irritation of the pulse are likewise present. TREATMENT.-A little ACONITE is frequently sufficient to remove the difficulty. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two or three hours, After using this medicine for a day, a dose of DULCAMARA may be given, in case the rash should arise from exposure to wet or sharp wind; or a dose of PULSATILLA, in case the use of fat meat or pork should be the exciting cause. DOSE.-In either case, one drop, or three globules, on the tongue morning and night. ARSENIC, a dose morning and night, three globules each time, may be given, if the rash remains under the epidermis, of a whitish appearance, and attended with a sense of suffocation, anguish and violent burning. If this medicine should fail, give IPECACUANHA, same dose as Arsenic, three times a day. 38* I ~ _ 438 SPECIAL THERAPEUTIC. Hives. This eruption is frequently very troublesome to children. It consists of red spots which sometimes spread over a considerable surface, and are attended with swelling, itching and burning, especially at night. The redness sometimes comes and goes very rapidly, and is particularly troublesome in warm weather, and at night. Children who are subject to this affection, should be washed twice a day with cold water, and, if the eruption is very troublesome, a dose of ACONITE, one drop or six globules each time, may be given morning and evening. DULCAMARA, one dose a day, three globules may be given, if the hives show a constant disposition to break out again. As a general rule, medicine is of very little use in this disease, except to palliate, and the best mode of preventing its recurrence, is a frequent change of linen, frequent ablutions with cold water, avoidance of irritating clothing, such as woolens of any kind, on the bare skin, and the frequent enjoyment of cool refreshing air. Nettlerash, Urticaria, Prickly Heat. This is an eruption so called because it resembles the blotches which the contact with nettles excites upon the skin. The eruption has a reddish-whitish appearance, and a rosy hue is developed all around the blotch. These blotches come and go, shifting from place to place. The eruption is preceded by a feverish restless 1 NETTLERASH, URTICARIA. 439 ness, and causes a good deal of itching and burning. In the warmth the eruption disappears. Its most frequent cause is a cold, or the use of heavy, undigestible food, such as mussels, shell-fish. The principal remedies for this eruption are ACONITE, DULCAMARA, ARSENICUM, BELLADONNA, BRYONIA, COFFEA, COPAIVA, and TARAXACUM. ACONITE, when there is fever, chilliness, restlesness, thirst, white-coated tongue. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours, until perspiration sets in; then every four hours. BELLADONNA may be given after the Aconite, in case the brain seems affected, as evinced by delirium, headache, heat about the head, sensitiveness to noise and light. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every four hours. BRYONIA may be given, if Aconite seems indicated, but does not afford the necessary relief. DOSE.-Same as Aconite, or in alternation with Aconite, a dose every two hours. ARSENICU3r.-If the eruption does not seem to come out properly, and the patient is very restless, with anxiety and dyspncea. DOSE.-Four globules, or one drop, on the tongue, every four hours. COFFEA is sometimes useful as an intermediate agent, to relieve the restlessness. DOSE.-One-drop, or six globules, on the tongue, every six hours. COPAIVA, for isolated blotches all over the body, of a pale-red or bright-red color, sharply circumscribed, with violent itching, the tongue being slightly coated. DOSE.-One drop of the tincture every six hours on sugar. TARAXACUM, for a rash in patches upon an inflamed base;. the eruption consists of pimples of the size of a C 440 SPECIAL THERAPEUTICS. pin's head, of a purple or dark-red color; pulse accelerated, full and soft, frontal headache, thickly-coated tongue, costiveness. DOSE.-One or two drops of the tincture, in a tumblerful of water, a small tablespoonful every two or three hours. IPECACUANHA, may be useful if the sudden retrocession of the rash causes oppression of breathing, suffocative anxiety. DOSE. -One drop of the tincture in a tumblerful of water, a small tablespoonful every two hours, or every hour if necessary. MERCURIUS SOLUBILIS, when the urticaria changes to red spots. DOSE.-A few drops, or six, globules, in a tumblerful of water, a small tablespoonful every two or three hours, or every twelve hours, after an improvement has set in. ANTIMONIUM CRUDUM, for nettlerash consisting of white blotches, with red areolae, and violent burning and fine stinging in the face and on the extremities, with swelling of the fingers where no rash is perceptible; accompanied with violent thirst and nausea. DOSE.-One grain of the third trituration every six hours, until relieved. DIET.--While the rash lasts, the diet should be perfectly simple; cold water may be drank freely, and customary ablutions need not be interrupted. Measles. This eruption is so well known that it is scarcely necessary to describe it minutely. Before the eruption comes out, the children seem to have a very bad cold. The eyes water profusely, are irritated and very sensitive to the light; the nose is irritated and inflamed, with considerable sneezing and discharge of water; the throat is sore, and the patients are frequently troubled with a MEASLES. 441 hard, dry cough. Chilliness and fever are likewise present. After these symptoms have lasted for a day, or a day and a half, the eruption makes its appearance, first on the head and face, then on the neck, chest, abdomen, and lastly, upon the extremities. It consists of irregularly-shaped red spots, more or less crowded together, and leaving the intermediate skin of a natural color. These spots do not entirely disappear on pressure. In mild cases the eruption runs a course of from three to six days, after which the epidermis scales off, and a new one is formed, which is sometimes attended with considerable itching and restlessness. In severe cases the breaking out of the spots is sometimes preceded by a good deal of stupor, and even slight spasms and convulsions. Some children seem drooping for a week or a fortnight before the eruption breaks out. TREATMENT.-In ordinary cases of measles it is scarcely necessary to give any other medicine than ACONITE, a few drops or six globules in a tumblerful of water, a small tablespoonful every two or three hours. After continuing the globules for a day or so, we substitute a drop of the ordinary tincture in a tumblerful of water, and give a small spoonful every four or six hours. This treatment suffices, in almost every case, to hasten the development, and shorten the course of the eruption. If the eruption should seem to be obstinate, and the skin remains dry, a dose of PULSATILLA, three globules, or one drop on the tongue, may be given every twelve hours, giving the Aconite intermediately as above. BELLADONNA may be resorted to, if the eruption does not seem to come out properly about the head, and the brain remains disturbed in consequence, as evinced by _ ~ __ ~ 442 SPECIAL THERAPEUTICS. stupor, spasmodic twitchings about the face and extremities. DOSE.--A few drops, or six globules, in a small tumblerful of water, a dessertspoonful every three hours, until relieved. BRYONIA is indicated by alternate chills and flashes of heat, rheumatic pains in the back and extremities, and a deficient efflorescence on the chest, causing oppression, and a dry, racking cough. DOSE.-Same as Belladonna. ARSENICUM, if the eruption either disappears suddenly, with coldness, foul discharges from the bowels, or if the spots assume a brownish, dubious color, and great prostration sets in. DOSE.-One grain of the second or third trituration, dry on the tougue, every hour, until a favorable change takes place. CAMPHOR, spirits of Camphor may be resorted to for a retrocession of the eruption, giving a few drops on a little sugar, every half hour, until the skin becomes warm again, and the eruption reappears. DULCAMARA is a good medicine, when the eruption resembles nettlerash, or is a compound of nettlerash and measles, and the skin is dry and hot. DOSE.-One drop of the tincture in a small tumblerful of water, a small spoonful every two hours. DIET AND REGIMEN.-Give the children as much fresh cold water-no ice-water-to drink as they like to have, and keep them in a room that is sufficiently darkened not to irritate the sore eyes. The diet should be light and no stimulants should be used. The children may be washed several times a day with lukewarm water, and should have a change of perfectly dry linen every time they are washed. As soon as the new skin is formed, and is perfectly dry again, they may be taken out into the open air, provided the weather is fair. MEASLES. 443 MEASLES. 448 Under suitable homceopathic treatment, after-diseases do not occur, except in scrofulous or tuberculous children; in such, a chronic cough, hoarseness, soreness of the eyes and various other weaknesses frequently remain. These require to be treated with various remedies, the principal of which are ACONITUM, CALCAREA CARBONICA, SULPHUR, IODINE, PHOSPHORUS, MERCURIUS. ACONITUM, for hoarseness and sore throat, with swelling and soreness of the tonsils, hacking cough, symptoms of bronchitis, sore eyes. DOSE.-One drop of the saturated tincture of the root, in a tumblerful of water, a small spoonful every four hours. This medicine may be alternated with SULPHUR, third trituration, one grain, dry on the tongue, morning and night, giving Aconite intermediately as stated above. If the patient should be troubled with glandular swellings, continue the Sulphur for three or four days, then substitute CALCAREA CARBONICA, giving it in the same manner as Sulphur, and alternating it with Aconite as above mentioned. If neither Sulphur nor Calcarea should help, give IODINE, one drop of the tincture morning and night. MERCURIUS SOLUBILIS may be given for obstinate hoarseness and sore throat, with swelling of the tonsils; it may be suitably alternated with Aconite. DOSE.-Dissolve six globules, or mix a few drops of Mercurius in a tumblerful of water, and give a small tablespoonful every four hours. The Aconite to be given as mentioned above. After continuing the Mercurius for a few days without effect, BELLADONNA may be substituted in its place, a few drops or six globules in a small tumblerful of water, giving a dessertspoonful every three or four hours. 444 SPECIAL THERAPEUTICS. PHOSPHORUS should be given, if a chronic cough and oppression of breathing remain. DOSE.-A few drops or six globules, in a tumblerful of water, a dessertspoonful every three hours. It may be alternated with Aconite or Bryonia, dose the same as for Phosphorus, every two or three hours. NOTE.-There are many full-grown persons who pretend that they never had the measles. This may be true in some cases; but in other cases, the assertion may arise from the fact, that these individuals were attacked a few weeks or months after their birth. At this tender age the eruption is sometimes so fine, and the characteristic catarrhal and inflammatory symptoms may be so feebly developed, that the existence of the disorder may be overlooked by careless or ignorant nurses or parents. Rubeola. This eruption is sdmewhat irregular in regard to shape and the course it runs. It consists of spots, which may resemble measle-spots, or look like a common rash, and have a variety of shapes and shades of redness, from bright-red to dark-brown. The eruption is preceded by a sense of chilliness, frontal headache, nausea, restlessness, anxiety, lowness of spirits, costiveness and sometimes bilious symptoms, colic, yellowish color of the face and skin, etc. We have never found it necessary to give any other medicine for an eruption of this kind than ACONITE, a few drops or six globules in a tumblerful of water, a small tablespoonful every two hours; or, which is frequently better, a drop of the common tincture instead of the globules, the dose being otherwise the same. The Aconite speedily quiets the patient, renders the skin moist, and in a few days the eruption dries up and disappears. DIET.-Drink cold water and avoid stimulating nourishment. '~L-~.----.--.-L--.C~-C~--- SCARLET-FEVER, SCARLATINA. 445 Scarlet-Fever, Scarlatina. The old-fashioned, smooth, Sydenhamian scarlet-fever has become a rare disease; in its place we generally meet with the scarlet-rash, commonly termed scarlatina. The old-fashioned scarlet-fever consists in a smooth, bright redness of the skin, generally distributed in diffusive patches or spots which leave a whiteness on pressure, the redness returning, however, immediately from the centre to the circumference. The breaking out of the eruption is preceded by a variety of constitutional symptoms, chills and fever characterized by a very quick pulse, sore throat, headache, thirst, stupor, nausea or vomiting. The symptoms last for thirty-six hours, after which the eruption first appears on the face which is swollen, and on the neck, then on the breast and stomach, and lastly on the extremities. The specific remedy for this disease is BELLADONNA, which is not only indicated by the characteristic bright-red patches and efflorescence on the skin, but also by the constitutional symptoms: angina of the throat, headache, delirium, burning dryness of the skin, intense thirst, scanty and highly-colored urine, costiveness. DOSE.-A few drops, or six globules, in a small tumblerful of water, a smiall tablespoonful every four hours, until the skin becomes moist, then less frequently. If this fever should rage as an epidemic, Belladonna has been successfully used as a preventive (prophylactic,) giving a few globules, dry on the tongue, every third or fourth day. If a person, under the influence of Belladonna, should nevertheless be attacked with the disease, it generally runs a mild course. DIET AND REGIMEN.-Give the child plenty of cold water to drink, or any other drink that it seems to crave, and use frequent ablutions with tepid water, and frequent changes of perfectly dry linen. 39 __ 446 SPECIAL THERAPEUTICS. Scarlet-rash, Purple-rash, Purpura miliaria. The above mentioned smooth scarlet-fever has, in a great measure, been superseded by the scarlet-rash, which, in its general symptoms, resembles scarlet-fever, except that the general bright efflorescence of the skin is accompanied with a fine rash, which, upon examination, proves to be vesicular, and imparts to the skin a sense of granular roughness, when passing the hand over it. This eruption does not always appear on the body, and frequently develops itself upon the internal surfaces, or localizes itself on some internal organ, the tongue, lungs, bowels, brain. In such a case it may result fatally, in consequence of the intensity of the inflammation. In other cases, the rash may break out upon the skin, but is often so fine that it is scarcely visible, and its existence becomes manifest only from the subsequent desquamation. TREATMENT.-The specific remedies for this rash, are ACONITE, a few drops or six globules in a tumblerful of water, a small spoonful every three hours, until the skin becomes moist, after which the medicine may be continued at longer intervals. If there should be considerable restlessness, Hahnemann recommends a dose of COFFEA, two or three globules on the tongue; afterward the Aconite is to be resumed. Frequent ablutions with tepid water are very pleasant to such patients. Scarlet-rash and Scarlet-fever Combined. Scarlet-rash and the Sydenhamian smooth scarlatina may appear combined, and frequently prove exceedingly __ SCARLET RASH, PURPLE RASH. 447 fatal to children; they are accompanied or succeeded by a variety of constitutional derangements, such as swelling and ulceration of glands, disorganizations of the throat, dropsical effusions. The eruption is subject to many abnormal conditions. In some cases, it comes out imperfectly, or first appears on the extremities, leaving the internal organs under its influence. In other cases, vicarious symptoms develop themselves in the place of the eruption, such as general oedema, pneumonia, acute bronchitis, malignant sore throat, meningitis, or even obstinate glandular indurations. In some cases, the eruption has, from the first, a malignant type, and constitutes a typhoid form of disease. TREATMENT.-It is eminently proper to commence the treatment at once with the alternate use of ACONITE and BELLADONNA; dissolving a few drops or six globules of each in a separate tumblerful of water, and giving an alternate dessert-spoonful every hour. As soon as an improvement becomes manifest, we may continue the medicines every four hours. In simple cases, this treatment will generally prove sufficient. If the throat should be very sore, and the child is old enough to gargle the throat, a gargle of tepid milk and water, or a decoction of carrots, strained and mixed with part milk after straining, will afford great relief. Other medicines may be required by the presence of abnormal symptoms, among which the following are some of the most common: Putrid sore throat, internal inflammations, suppuration of glands, etc. NITRIC ACID is essential when putrid sore throat develops itself. DOSE.-One drop of the first attenuation on sugar, or in water, every four hours. __~_ 448 SPECIAL THERAPEUTICS. MERCURIUS SOLUBILIS, for obstinate glandular swellings during the course of the eruption, or likewise for ulceration of the tonsils, DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two or three hours. This medicine may be used in alternation with Belladonna or Aconite, same dose as Mercurius, an alternate dessertspoonful every two hours. OPIUM may be necessary by obstinate stupor, induced apparently by a deficient development of the eruption about the head. DOSE.-One drop of the first attenuation, on sugar, to be repeated in two hours, if necessary, and to be alternated with a similar dose of Belladonna in case of spasms an alternate drop to be given every half hour, until an improvement sets in. TARTARUS STIBIATUS is a good remedy, when spasmodic retching or vomiting sets in, accompanied with comatose stupor, or cold, clammy skin. DOSE.-One grain of the first attenuation in a tumblerful of water, a small spoonful every hour, until the symptoms cease, MURIATIC ACID is a good remedy in malignant scarlatina, if the putrid sore throat is not relieved by the Nitric acid, and typhoid symptoms, and symptoms of cerebral paralysis, develop themselves, such as dropping of the lower jaw, settling down toward the end of the bed. DOSE.-One or two drops, of the diluted acid in a small tumblerful of water, a small spoonful every hour or two hours, until relief is obtained. CONIUM MACULATUM seems useful in typhoid scarlatina, characterized by obstinate glandular swellings, delirium, stupor, or even loss of consciousness. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two or three hours, until a reaction takes place, after which the medicine may be alternated with, or- replaced by, Belladonna, Aconite or some other suitable remedy, to be administered as previously indicated. PHosPHORUS may be given, when symptoms of bronchitis or pneumonia exist, as evinced by bloody expecto I__ SCARLET RASH, PURPLE RASH. 449 ration, wheezing, dyspnoea, intense redness of the orifice of the windpipe, dry, distressing, racking cough, a flying pulse, absence of the eruption on external parts. DOSE.-One drop, or six globules, on the tongue, to be alternated with Bryonia, same dose, an alternate dose every second hour. ARSENICUM, one grain of the third trituration, dry on the-tongue, may be given every half hour, if a sudden exhausting and fetid diarrhoea, or gangrenous symptoms, make their appearance. A change of this kind is accompanied by a livid color of the skin, retrocession of the eruption, coldness, hippocratic countenance, and sometimes foul-smelling, clammy sweats. Continue the medicine until the danger has fairly subsided. The Sequelce, or After-diseases of Scarlet-fever and Scarletrash, may require some treatment. MERCURIUS SOLUBILIS or VIVUs may be given for glandular swellings and suppurations; for discharges from the ears, with hardness of hearing. DOSE.-One grain of the third trituration every four hours, dry on the tongue. This medicine may be alternated with Belladonna; or, if the patient had taken a good deal of this medicine, with IODINE, one drop of the first attenuation every four hours. If this treatment should not be satisfactory, give the IODIDE OF MERCURY, half a grain of the third trituration, dry on the tongue, every four hours. If extensive suppurations exist, this medicine may be alternated with HEPAR SULPHURIS, same dose as the Iodide, a powder every alternate third hour. HELLEBORUS NIGER is probably the best remedy for the dropsical swellings which sometimes set in after scarlet-fever. DOSE.-A few drops of the first attenuation, or even of the tincture in a tumblerful of water, a small spoonful to be given every two or three hours. 450 - SPECIAL THERAPEUTICS. The itching and the dropsical swelling of the body are sometimes considerably relieved by a tepid bath, in which a little pearl-ashes had been dissolved; two baths a day are sufficient. Actual destructions of the throat, velum, tonsils, remaining after the attack, are incurable. DIET.-As soon as the eruption begins to scale off, the patient may be sponged several times a day with tepid water; indeed, this sponging may be resorted to every day, once at least, during the whole course of the disease; frequent changes of perfectly dry linen should be provided. Give the patient cold water to drink, or, if he should prefer, a weak lemonade, toast-water, water mixed with sugar, syrup, etc. Diet to be perfectly simple-gruels, tea and toast, stewed fruit, etc. The patient should not be allowed exercise in the open air, until the new skin is perfectly formed and dry. Palliative means, such as poultices to the swollen glands, gargles, and, if the bowels should be very much confined, injections of tepid water, are allowable, and may even be necessary. - Il-LL~~-~~P~4rtl~a.r~I~PI~--~-----U---U- ~ILI-l~- -Y1__ VARIOLA, SMALL-POX. 451 YARIOLA, SMALL-POX. THIS loathsome disease sets in with fever, and pain in the small of the back. The fever is generally preceded by a chill, and attended with rheumatic symptoms, pains in the joints and extremities. But the pain in the back seems to be a characteristic symptom. The small-pox fever is always accompanied by the following symptoms, which belong exclusively to this, and no other fever: Nausea, vomiting, putrid odor from the mouth, badly smelling urine, bleeding from the nose, intense vertigo and headache, which is frequently attended with delirium and stupor. The immediate appearance of the eruption is sometimes preceded by convulsions. The eruption first appears on the face, next day on the hands, and the day after on the feet and the rest of the body. When first appearing, the eruption looks like small red points, called stigmata, which increase every hour in size and elevation. They can be distinguished from measles by little granules which exist on every stigma, even on the first day. Three or four days after the appearance of the first pustules, new pustules break out, which suppurate while the former are drying up. The pustule is small at first, depressed in the centre, and filled with a watery fluid, which changes to a yellowish pus in proportion as the pustule developes itself and becomes more elevated. A perfectly formed pock has the shape of a split pea. The suppurative stage lasts three, four, and in many cases, eight days altogether. After the lapse rkL~-~-------~--~ll~---~I~----~--~__~~ 452 SPECIAL THERAPEUTICS. of this period the scabs become detached, leaving red spots, and in many cases, cicatrices. Four stages may be distinguished in this disease, the febrile stage, the eruptive stage, the suppurative stage and the stage of desiccation. Febrile stage.-When the fever first sets in, with shivering, pain in the back and limbs, vertigo, headache, nausea, etc., give ACONITE, a few drops or ten globules in a tumblerful of water, a small spoonful every two hours; and if the rheumatic pains are very violent, alternate it with BRYONIA, same dose, every two hours; or, if the cerebral symptoms predominate, give BELLADONNA, instead of Bryonia, the dose being otherwise the same. Continue these medicines until the eruption is fairly out; then during the Eruptive stage, continue the ACONITE at longer intervals, and alternate it, as mentioned previously, with either BELLADONNA or BRYONIA, at intervals of four hours, provided the eruption develops itself fairly and regularly, and passes towards the Suppurative stage, without any untoward symptoms. During this stage the principal, remedies are MEROURIUS, SULPHUR, and VACOININE; TARTER EMETIC is likewise a most important remedy. DOSE.-One grain of the third trituration, of Mercurius, to be given al. ternately with one grain of the third trituration of Sulphur, every four hours; dry on the tongue. Particular indications for MERCURIUS, are an exceedingly foul breath, with ptyalism and sore throat, and for SULPHUR, excessive itching and dryness of the skin. TARTAR EMETIC, is indicated by symptoms similar to -- - --- -;r ra~rr- --1~1--- ---.--r -.-I-~~;--~ I-~~.r....~.. -.....VARIOLA, SMALL-POX, 453 those of Mercurius, especially by the ptyalism, and spasmodic retching, with distressing nausea. It may be alternated with Mercurius, one grain of the third trituration of each, every three hours, dry on the tongue. VACCININE has been used with good effect by some physicians; it seems to shorten the course of this stage, and diminish the violence of the attending symptoms. We give a powder of the third trituration every four hours. Some physicians prepare Vaccinine from the vaccine derived from a human being, others use for this purpose the cowpox-virus derived from the cow. We prefer the latter. VARIOLIN, has been used with success in epidemic small-pox in Germany, when every other remedy failed to save life. It is administered in the following manner: open a pustule as soon as it has reached maturity, and collect one or two drops of matter into a tumblerful of water; of this solution the patient is given a small spoonful every two or three hours. In the cases of epidemic small-pox, where this proceeding was resorted to, the disease ran a very mild course, unattended with any untoward symptoms. During the suppurative stage the fever sometimes runs very high; if this should be the case, it is advisable to interpolate every now and then a dose of ACONITE, giving one drop, or three or four globules dry on the tongue, and then waiting a couple of hours before any other medicine is given. Stage of desiccation.-No medicine is required during this stage, except, once in a while, a dose of ACONITE, if there should be a good deal of vascular excitement, or the patient should be troubled with a _~ I 454: SPECIAL THERAPEUTICS. dry, tearing cough, oppression, pains in the chest, hoarseness. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two or three hours. This medicine is suitably alternated with PHOSPHORUS, likewise a few drops or six globules in a tumblerful of water, a spoonful every two hours; or, if rheumatic pains make their appearance, and the flesh feels sore and tender, with BRYONIA, instead of Phosphorus, same dose; or, if the soreness should be quite considerable, as if the flesh had been bruised by blows, with ARNICA, the same dose as Aconite. Abnormal conditions.-The development of the eruption is frequently attended with untoward symptoms; in some cases the eruption settles upon some vital organ, the brain, lungs, stomach, bowels, causing convulsions, coma, suffocative dyspnoea, foul discharges from the bowels; in other cases it has a malignant form, of a livid color, and speedily develops symptoms of putrefaction and grangrene. The principal medicines for such abnormal conditions are ARSENICUM, CHINA, STRAMONIUM, and the saturated TINCTURE OF CAMPHOR. ARSENICUM is undoubtedly the best remedy, when the eruption seems to have invaded the intestinal mucous surfaces: the patient's skin becomes cold and clammy; foul and involuntary discharges from the bowels set in, and the patient seems to be without consciousness, in a state of stupor. DOSE.-One grain of the third, or, which we deem still preferable, of the first trituration of Arsenic, every half hour, dry on the tongue, until the skin becomes warm, the discharges cease, and the stigmata begin to show themselves upon the skin; after this, the medicine may be continued every two hours, until the eruption is fully out. STRAMONIUM may be given, in case the eruption __ VARIOLA, SMALL-POX. 455 should come out too slowly, and the brain should seem more or less disturbed, as evinced by stupor, staring looks, twitchings of the face and mouth, flagging pulse. DOSE.---A few drops, or six globules, in a small tumblerful of water, a small tablespoonful every two hours. This medicine may be alternated with BELLADONNA, same dose as Stramonium. CHINA is indicated by conditions similar to those of Arsenic; if, after giving three or four powders of Arsenic, there should be no symptom of improvement, China may be substituted. DOSE.-A few drops of the second attenuation, in half a tumblerful of water, a small spoonful every twenty minutes or half hour, until an improvement takes place. If China should likewise fail, we may then try LACHESIS, a few drops or ten globules of the third attenuation in half a tumblerful of water, a small spoonful every ten or fifteen minutes; and, if this should likewise fail, we may resort to the SPIRITS OF CAMPHOR, five drops on a little sugar or in a small spoonful of water, every five or ten minutds. If, during the course of the suppurative stage, the eruption should develop a malignant type, with symptoms of putrid or gangrenous decomposition, ARSENIC and CHINA should be given alternately, of the former the first or second trituration, in half grain doses, and of the latter one or two drops of the second attenuation in a small tumblerful of water, an alternate dose every hour, until the eruption assumes again a natural appearance; and, if these remedies fail, give dilute MURIATIC ACID, one or two drops in half a tumblerful of water, a small spoonful every two hours. In case the eruption should suddenly disappear from the skin, with symptoms of paralysis of the brain, coldness of the skin, dyspnoea, give SPIRITS OF CAMPHOR, three or four drops in a little ~LI~.~-----~---- __ 456 SPECIAL THERAPEUTICS. water, every ten or fifteen minutes, until the skin- becomes warm again, and the eruption reappears. If, while the eruption is coming out, the patient should seem comatose, in consequence of an imperfect development of the eruption, give OPIUM, one drop of the tincture in a small quantity of water, a small spoonful every half hour, until the coma is subdued. After-diseases. This loathsome and destructive disease may lead to permanent disorganizations, pitting of the skin, blindness, deafness, bronchial affections. A pock may break out in the eye or in the ear, and the consequence of this may be the loss of the special sense. The ophthalmia or otitis, which is caused by the small-pox pustule, we may treat with ACONITUM, one or two drops of the saturated tincture of the root in a tumblerful of water, giving a small tablespoonful of this solution alternately with TARTAR EMETIC, one grain of the third trituration, dry on the tongue, an alternate dose of medicine every two hours. As the symptoms improve, the intervals between the doses may be prolonged. For the bronchial symptoms, the cough and the hoarseness, we may use AcoNITUM, one drop of the saturated tincture of the root in a tumblerful of water, in spoonful doses, alternately with MERCURIUS VIVUS, one grain of the third trituration, dry on the tongue, an alternate dose every two hours, prolonging the intervals to four hours, as the symptoms improve. L ~ VARIOLA, SMALL-POX. 457 The furious itching is allayed by sponging the patient with tepid water in which a little pearlash has been dissolved. The pitting of the skin, according to recent experiments, is said to be prevented by covering the pustules with a substance which is impervious to the air. If the pocks should become confluent, it is sometimes necessary to open them in order to alleviate the burning; more particularly if the epidermis is very hard and tough, as in the soles and heels, or in the hands. Small-pox may co-exist in the patient with some other cutaneous disease which may happen to prevail at the time, such as scarlatina. In such a case, the small-pox will run its course first, and when this is nearly ended, the lesser disease, which had remained latent or suppressed until then, will break out, and will then have to be treated according to the rules laid down in this work. DIET AND REGIMEN.-It is of the utmost importance to keep up a permanent ventilation in the sick-chamber, and to have the temperature as low as the comfort of the patient will permit. The patient should not be exposed to a draught of air. Frequent sponging with tepid water, in which a little potash is dissolved, is very useful. If possible, the sheets and linen of the patient should be changed quite often, taking care that the fresh linen is perfectly dry. The patient may drink cold water freely; or, if he should prefer, some acidulated drink. Meat, and all stimulating diet, should be avoided during the course of the disease. Gruels, tea and toast, farina, sago, hominy, baked or roast apples and pears, stewed prunes, and afterwards light broths, etc., should constitute the patient's diet, until he is fairly convalescent. If the bowels are costive, an injection of tepid 40 45 SPECIAL THERAPEUTICS; water, with a little salt dissolved in it, if necessary, may be administered every now and then. Varioloid. According to some practitioners, this is a modified form of small-pox. Other authors consider varioloid as a disease essentially distinct from small-pox. Be this as it may, the treatment is altogether the same as that of genuine small-pox, to which the reader is therefore referred. The only perceptible difference between varioloid and variola seems to be, that the symptoms of varioloid are less intense than those of variola, and that varioloid is, upon the whole, a much less loathsome and less dangerous disease, although running the same course as variola. Varicella, Chicken-pox. This is an eruption to which children are liable; it is rarely met with in the case of full-grown persons. The eruption consists of little red spots which are gradually converted into vesicles filled with lymph; these dry up and form little crusts, which fall off without leaving a mark. They appear principally on the scalp, nape of the neck and body. The eruption is sometimes preceded by slight chills and fever, and, in severe cases, the fever is apt to hang on while the eruption lasts. The children are restless and peevish, although, in the milder cases, they continue their play. and even go out into the street. This eruption sometimes rages as an epidemic, and may be quite violent and even terminate fatally. ERYSIPELAS, ST. ANTHONY'S FIRE. 459 As a general rule no treatment is necessary, except perhaps a little ACONITE, one drop or six globules, on the tongue, morning and night. In severe cases, it may be necessary to give a dose of PULSATILLA, one drop or six globules, on the tongue, every morning, for a few days, which may be alternated with SULPHUR, four globules, dry on the tongue, in the morning, giving Pulsatilla one day, and Sulphur the next. Diet to be light gruels, light broths, fruit, etc; and sponging with tepid water. Erysipelas, St. Anthony's Fire. This is, strictly speaking, a spreading redness of the skin, of an inflammatory character, with swelling, tenderness, burning, and a painfu.1 sensation of tingling and tension. Previous to the attack, the patient feels chilly, languid, and the gastric functions are disturbed. The redness may appear on various parts of the body; it generally affects the face, and disfigures it considerably by the swelling, and inflammation. Erysipelas of the face is frequently attended with inflammation of the meningeal membranes, for which the reader is referred to erysipelatous inflammation of the brain, page. There is a species of wandering erysipelas, which comes and goes, and effects various parts of the body. Some persons are subject to erysipelatous attacks. In some seasons and districts this disease often prevails as an epidemic, and the least injury, even vaccination, may develope the inflammation. 460 SPECIAL THERAPEUTICS. The principal remedies for this disease are: ACONITE and RHUS TOXICODENDRON; for local or partial erysipelatous swelling, BELLADONNA, CHAMOMILLA, HEPAR SULPHURIS, PULSATILLA, BRYONIA and SULPHUR. ACONITE is undoubtedly one of the principal remedies for erysipelas, especially when there is fever, and the parts are very much inflamed, sore, tender to the touch. DOSE.-A few drops, or ten globules, in a tumblerful of water, a small tablespoonful every two hours, until the skin becomes moist, after which the medicine may be continued every four hours. BELLADONNA may be given, when the brain seems to be involved, and the patient complains of violent pressing headache from within outward, jerks and digging-up sensation in the head, delirium, lancinating headache, wild looks, violent thirst, dry or coated tongue, parched lips and tongue, constipation, brown-red and turbid urine. DOSE.--A few drops, or six globules, in water, same as Aconite, with which Belladonna may alternated, a dose every two hours. CHAMOMILLA may be given for swelling of the cheeks, with redness, gnawing pains in the bones, sometimes accompanied with bitter taste, thirst, burning heat and sweat, headache. DOSE-Same as Aconite, with which Chamomilla may be alternated, an alternate dose every two hours. HEPAR SULPHURIS for burning stinging in the face, covered all over with vesicles, or the face is swollen, hard, red and tense; frequent chills as if cold water were poured over one, hiccough and eructations; burning sensation in the bowels and over the skin; stitching and burning pain in the small of the back and back, restless sleep. DOSE.-One grain of the third trituration, every four hours, dry on the tongue. This medicine may likewise be given in alternation with Aconite, one drop of the strong tincture of Aconite in a tumblerful of water, giving a amall spoonful at a dose, and an alternate dose of medicine every two hours. I _ II__ L __ _~ I __ __ ERYSIPELAS, ST. ANTHONY'S FIRE. 461 PULSATILLA has been successfully given for' a swelling, redness and burning of the sole and dorsum of the foot, with a stinging pain during motion and contact. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours. BRYONIA for erysipelas of the joints, with aggravation of the pain during motion. DOSE.-Same as Pulsatilla. RHUS TOXICODENDRON is particularly adapted to vesicular erysipelas, whether in the face or on other parts of the body, accompanied with swelling, tension, shining redness of the part, and large blisters filled with a yellow fluid. DOSE.-One drop of the tincture, or a few drops of the first attenuation in a tumblerful of water, a small tablespoonful every two hours. ACONITE and BRYONIA in alternation, six globules or a few drops of each in a separate tumblerful of water, an alternate tablespoonful every two or three hours, are the best remedies for the so-called flying erysipelas, which comes and goes, and shows itself on various parts of the body. ARSENICUM may be given, if the erysipelatous inflammation assumes a gangrenous character. DOSE.-One grain of the first or second trituration dry on the tongue every two hours, until an improvement sets in. This medicine may be alternated with Rhus toxicodendron, same dose as mentioned above, an alternate dose every two hours. ACONITE is undoubtedly the best remedy for erysipelas produced by a mechanical injury, an operation, irritating applications, etc. DOSE.-As above. Special remarks concerning the use of the Concentrated Tincture of the Root of Aconite in this Disease. As we become better acquaintedI with the true curative action of our drugs, it will be found that Aconite is one 40* 462 SPECIAL THERAPEUTICS. of the best remedies for erysipelas, whether of the smooth or vesicular variety, or indeed for any form of common erysipelas, unless it should be marked by some exceptional malignant type. But it must not be supposed that the attenuations will answer in every case; no, indeed; in many cases, the saturated tincture of the root is absolutely required to check the disease, and prevent gangrene. We consider it our duty to call the special attention of practitioners to the importance of this fact; those who do not choose to profit by our advice, may leave it unheeded; all we can say to them is, that their patients will be the losers. We give one or two drops of the tincture in a tumblerful of water, a tablespoonful every two hours, until the symptoms mend, after which the intervals between the doses may be prolonged. Purpura HRemorrhagica. This disease seems to be a weakness of the capillary circulation, and consists of patechial spots caused by the extravasation of capillary blood in the subcutaneous muco-cellular tissue. Such a weakness is necessarily attended with general prostration of the vital forces; it is either the result of constitutional debility, or it may likewise result from debility occasioned by excesses. In treating this disease, we have to aim, in the first place, at restoring the integrity of the capillary circulation, and there is no known remedy in our practice, which does this as effectually as ACONITE, of which a few drops or six globules may be dissolved in a tumblerful of water, a small spoonful to be given every two hours, until the patient begins to CHRONIC ERUPTIONS. 463 feel warm and the skin becomes moist; after this reaction has set in, the intervals between the doses may be prolonged. If the reaction produced by the globules, should be but slight, we may substitute a drop of the tincture in a tumblerful of water, and give a spoonful every two or three hours. If Aconite should leave us in the lurch, there is very little hope left to save the patient's life; but we may try Hamamelis Virginiana, or the witchhazel, a few drops of the tincture in a tumblerful of water, a tablespoonful every two hours. It may be well to use this medicine alternately with Aconite. If this treatment should fail, we may try CARBO VEGETABILIS, a few drops or six globules in a small tumblerful of water, a spoonful every two or three hours. This medicine may likewise be alternated with Aconite, a dose every two hours. In this affection the wet sheet may prove useful. For the use of the wet sheet see page 149. CHRONIC ERUPTIONS AND EXTERNAL DISEASES. Boils, Carbuncles. (See the Chapter on Surgical Diseases.)* Chilblains. (See Surgical Diseases.) Corns, Callosities. These disorganizations of the dermoid tissue can scarcely be treated medicinally. Such defects can only be eradicated gradually by a suitable regimen, and more particularly by frequent washing of the feet with cold water. This should not only be done every day, but 464: SPECIAL THERAPEUTICS. after every heating and fatiguing walk. And clean stockings should be put on after every washing. Tight shoes or boots should be strictly avoided. If the corns or callosities become inflamed, apply externally, ARNICA, strong tincture, ten drops in a small wineglassful of water, renewing the application every hour until relief is obtained. This preparation may likewise be applied to indurations on the feet, when they burn and smart a good deal. In many cases paring off the corns is the only method of obtaining relief, and may be resorted to without hesitation, provided the parts are not wounded. Warts, Wens, Ganglia, Condylomata. Warts are sometimes very annoying, and disfigure a person a good deal, if seated in the face. Nevertheless it is sometimes a dangerous thing to cut them or tie them off, or to burn them out. It is better to apply externally the tincture of Thuja, rubbing a drop or two on each wart three times a day, and giving Thuja at the same time internally, a few drops or ten globules, on the tongue, morning and night. If Thuja should remain without effect, we may try RHus TOXICODENDRON, the same as Thuja, both internally and externally. ANTIMONIUM CRUDUM may be given for flat, hard, or brittle warts, DOSE.-Half a grain, on the tongue, morning and night, third trituration. Wens or Ganglia Are swellings which sometimes start up suddenly on the wrist or on some other joint in consequence of a slight, MUPS 465 MU MPS. 465 strain from hard work, washing, sewing, etc. These do not require any treatment except cold water-bandages and rest. We may give Silicea, third trituration, internally, a powder morning and night. Whitlows, Felons, Panaritia. (See Surgical Diseases.) Ulcers. (See Surgical Diseases.) Swellings, Tumors, Glandular Abcesses. (See Surgical Diseases.) Goitre. (See Surgical Diseases.) Mumps. This is a swelling of the parotid and submaxillary glands, to which children, and, in some cases, full-grown persons are liable. It is epidemic in some seasons. The swelling sometimes causes a bloat involving the surrounding parts, the face, eyes, up to the forehead. In some cases the swelling disappears again without any treatment, after running its course, which may be from a few days to a few weeks, generally a week. It may, however, be necessary to give a little medicine, in which case, nothing else is required than a little ACONITE or MERCURIUS. ACONITE, if the swelling feels hot, sensitive, with aching and throbbing pains. DOSE.-A few drops, or ten globules, or, which we prefer, one drop of the tincture in a tumblerful of water, a small spoonful every two hours. MEROURIUS is indicated, if the gland remains comparatively painless, and the surrounding parts are not much bloated, showing that the determination of blood to the parts is much less. DOSE.-A small powder of the third trituration, dry on the tongue, two or three times a day. This treatment may be continued for a few days, after which, all further medication will be found unnecessary. If complication should arise, see the treatment for Swellings, Tumors, and the chapter on Tuberculosis. _ ~ ~ 466 SPECIAL THERAPEUTICS. Scirrhus, Cancer. (See Surgical Diseases.) Irritation of the Skin. Unhealthy Skin. The skin of some persons is very irritable or unhealthy: the least scratch will make a sore, and heal with difficulty. This irritability of the skin is generally owing to a scrofulous taint in the system, and can only be removed by eradicating this taint. According to our experience medicine is of very little, if any avail, to accomplish this purpose. The best means of strengthening the skin, are a perfectly regular diet, abstinence from all stimulating food or drink, fat, gravies, old butter, made dishes, pies, pastry of any kind, spirituous drinks, etc.; frequent exercise in a healthy, bracing air, and, above all things, daily ablutions with cold water shower baths, sponging, etc. All irritating articles of clothing, directly on the skin, woolens for instance, should be avoided. Itching of the Skin, Pruritus. This condition of the skin should likewise be treated as the foregoing affection, irritability. In addition to these general rules we may use OPIUM for a stinging itching here and there, or an itching and creeping in the limbs. DOSE.-A few drops, or six globules, morning and night. Nux VOMICA for a burning itching all over, especially in the evening, in bed. DOSE.-One drop, or six globules, on the tongue, in the evening in bed. ACONITUM for a furious burning itching all over the skin, especially after getting warm in bed, with desire to scratch until the parts bleed; after Aconite try CHINA or ARSENIC. J~~ ~ ~ ~ ITCHING OF THE SKIN, PRURITUS. 467 DOSE.-Same as Opium. MEROURIUS VIVUS for a voluptuous itching, day and night, worse in the evening; or for a stinging itching as from flea-bites, or for an itching which is rendered pleasant by scratching, also with a bright-red, hot face. DOSE.-Same as Opium. RHUS TOXICODENDRON for excessive itching in the evening, with voluptuous sensation in the skin, followed by a burning after scratching until the blood comes; or for itching all over, especially on the hairy parts. DOSE.-Same as Opium. PULSATILLA for a burning itching all over, especially when getting warm in bed, or during a walk. DOSE.-One or two drops, or six globules, on the tongue, in the morning before breakfast. IGNATIA, when the itching is easily removed by scratching. DOSE.-One drop, or six globules, morning and night, on the tongue. COFFEA: itching all over, with nervous restlessness. DOSE.-Same as Ignatia. If this list of remedies should not meet the existing symptoms, the reader may consult our large Repertory, from pages 1108 to 1111. Some persons are troubled with itching of the anus or private parts; the best remedies for such a complaint, next to frequent bathing of the parts with cold or tepid water, are ARGENTUM NITRICUM for a creeping and burning at the anus. MERCURIUS vIVus for itching of the anus as from worms. SPIGELIA for an itching of the anus and os coccygis, which obstinately lasts for days. 468 SPECIAL THERAPEUTICS. ZINCUM for itching and corrosive dampness of the anus. Nux VOMICA for voluptuous itching of the anus. CHINA for a creeping and itching tingling of the anus, also affecting the urethra, with burning in the glans. SULPHUR may be giving for itching of the anus and rectum. DOSE.-Of any of the above mentioned remedies, one or two drops, or six globules, on the tongue, morning and night. The principal medicines for itching of the private parts, are: AcONITUM for a burning itching of the scrotum and vagina, with desire to scratch until the parts bleed. STAPHTSAGRTA for voluptuous itching of the external parts of the scrotum. ARSENICUM: gnawing itching of the penis. THUJA for a crawling itching of the scrotum, with burning pain when rubbed. SABADILLA for a slow tingling sensation in the testiticles, sometimes accompanied with a burning sensation ascending from the thighs PULSATILLA for an itching of the scrotum in and out of bed, early in the morning. MERCURIUS VIVUs for a voluptuous itching of the prepuce, glans, and pubic bones, or vagina. CHINA, stinging itching of the scrotum. DOSE.-Of any of the above named medicines, a few drops, or eight to ten globules on the tongue, morning and evening. Freckles, Hepatic Spots. These spots seem to arise from the coloring matter of the bile having become identified with the mucous tissue of the skin. As a general rule, medical treat _ __ EXCORIATIONS, SORENESS, INTERTRIGO. 469 ment does very little, if anything, for them. The best method of treating such eruptions, is a perfectly regular diet, strict avoidance of stimulating food or drinks, active exercise, within the bounds of moderation, in the open air, and daily ablutions with cold water. If the patient desires to take medicine, he may confine himself to AcONITUM, a few drops or six globules every day, if he shduld be troubled with dizziness, buzzing, rush of blood and other symptoms of an irregular circulation. MERCURIUS, same dose, if the bowels are torpid, and the discharges are dry like sheep's dung, of a dark-brown color. SULPHUR and Arsenicum may be given alternately; Sulphur one day, Arsenicum the next, if there be a good deal of itching and burning on the skin, and particularly where the spots are. Any other medicine seems useless. Excoriations, Soreness, Intertrigo. These appear very seldom in full-grown persons and generally affect infants or little children. (See the ' DISEASES OF CHILDREN,") Such a weakness occurs most frequently in warm weather,,and is best met by frequently bathing the parts with cold water, and using cold ablutions every day, even twice if possible. Frequent surf-bathing is exceedingly useful, if otherwise allowable. Medical treatment is unnecessary in the case of full-grown persons, except that a little ACONITE and CHAMOMILLA may be given in alternation, a dose of each medicine daily, Aconite in the morning, Chamomilla in the evening, when the soreness 41 -- i 470 SPECIAL THERAPEUTICS. is attended with burning and a smarting itching, or the sore parts are damp, and secrete a yellowish-looking, and sometimes bloody serum. Mercurius vivus will be found useful, if the sore parts itch, with occasionally a smarting, stinging pain, and oozing out of a yellowish serous moisture. DOSE.-One or two drops, or six globules, three times a day, dry on the tongue. Chapped Hands. Persons who are subject to this affection, should never allow their hands to remain wet or even damp, and should avoid all sudden transitions from cold to heat, or vice versa. In cold weather they should always wear gloves. We have no remedies for chapped hands; the books say something of internal treatment, but it is all moonshine. Dry your hands perfectly, after dipping them in water; in winter keep a pair of gloves on all the time, with the ends of the fingers cut out for the sake of convenience, and, if the hands chap, nevertheless, rub a little cerate or goose-grease on them, or, if you prefer, a little honey; this removes the pain and causes the cracks to heal. Sometimes these cracks are quite dis. tressing, penetrating to the muscular tissue. In such a case it may be desirable to apply court-plaster, and internally the patient may take MERCURIUS VIVus, for deep rhagades in the hands, or on the fingers, especially if on the inside. DOSE.-One drop, or six globules, morning and night. PETROLEUM, for rhagades of the hands, or chapping of the tips of the fingers, with stitching and cutting pains. DOSE.-Same as Mercurius. __ ITCH, SCABIES. 471 ZINCUM METALLIOUM, for painful chapping or burning rhagades of the hands. DOSE.-Six globules, or a few drops, morning and night. HEPAR SULPHURIS, for chapping of the skin and rhagades of the hands and feet. DOSE.-Same as Zincum. Itch, Scabies. This eruption is well known to most people. It is characterized by a distressingly-voluptuous itching, which excites a constant desire to scratch. The eruption consists of greasy-looking pustules scattered all over the body, on the nates, chest, but principally affecting the fingers and toe-joints, and sometimes forming extensive sores; or it may consist of a fine, inflamed-looking dry rash, with burning and itching; or sometimes the skin seems simply rough and inflamed. The disease is supposed to originate in the presence of a worm, termed the itch-acarus, which burrows under the skin, and causes the itching. This supposition, however, is very problematical. All that we know is, that, wherever the itching is experienced, the acarus is found; but it is not at all certain that the acarus stands to the itching in the relation of cause and effect; the acarus has the power to transfer the itching to healthy portions of the skin, but this does not prove that this animalcule is the first cause instead of being a product of the skin. TREATMENT.-In this disease, the cold-water treatment is most emphatically efficient. The sweating should be gone through twice a day, as described in the article on water. Some of the most inveterate cases of itch, which had defied medical treatment of any kind, have been - -- -- SPECIAL THERAPEUTICS. perfectly cured by the sweating process. The following medicines may, at the same time, be used internally: SULPHUR. A few drops, or six globules a day, dry on the tongue. This will suffice in some cases, especially if it is the genuine, uncomplicated, greasy-looking itch. As the eruption becomes less, and dries up, a dose of Sulphur may be given every other day, or even every three days. In many cases, however, this treatment is not sufficient, especially when the eruption is'accompanied with burning as from hot coal, and the skin looks inflamed, as if scorched, and the parts feel rigid and swollen, or are actually swollen. In such a case, it may be necessary to use an artificial sulphur-water, prepared as follows: Mix one ounce of the washed flowers of sulphur with a gallon of water and a tablespoonful of brandy, shake this mixture several times in the course of twenty-four hours, and then take a tablespoonful of this water morning, noon and night; and, if it should affect the bowels, only twice or even once a day. It may be sweetened with a little sugar; the sediment should be allowed to settle before the mixture is used. The continued use of this water will sometimes cure the most inveterate cases of dry, bleeding itch. MERCURIUS VIVUS is an admirable remedy for the itch, when it forms extensive running sores, with itching and burning, especially at night; or when the eruption looks red and humid. DOSE.-Six globules,. dry on the tongue, or a few drops, morning, noon and night. In many homoeopathic works, a variety of remedies are recommended for the itch, such as Lachesis, Arsenic, Carbo vegetabilis, etc., etc. These medicines are utterly useless in the treatment of this eruption, and would ITCH, SCABIES. 473 have been dropped long ago, if one author did not copy from the other. We repudiate all such. remedies, as speculative stuff, that has no more to do with the itch than the man in the moon. COLD WATER and the SWEATING PROCESS, SULPHUR and MERCURIUS, are the true curative agents in this loathsome and distressing malady. HEPAR SULPHURIS is recommended by Autenrieth as the best preparation of Sulphur for the cure of the itch. He prepares a solution of one part of Hepar sulphuris, and eight, twelve or twenty parts of water. With a sponge, previously dipped in hot water, and afterwards moistened with this solution, the skin is washed for several days in succession, once every four hours; the effect of this washing is, that all the pustules become blackish and dry up, so that the most extensive eruption disappears entirely in from fifteen to eighteen days. The solution should not be washed off until a few minutes after it had been applied. Frequent change of linen must not be omitted during this treatment. There are eruptions which resemble the itch; for such eruptions, SEPIA, CARBO VEGETABILIS, DULCAMARA, etc., may be used; but these medicines do not cure the genuine itch. The Sulphur-ointment may likewise be required in some cases; but we would not advise its employment except by and with the advice of a physician. DIET.-Patients who are under treatment for the itch, should avoid all stimulants, even coffee, all greasy and fat food, even butter; the diet should be perfectly plain and strictly nourishing. 41* 474. SPECIAL THERAPEUTICS. Eczema. This eruption consists of vesicles or blisters, of a larger or smaller size, and filled with a serous fluid, having a milky, watery or purulent appearance. The eruption sometimes is preceded by a sense of chilliness, and accompanied with a little fever, and slight gastric derangements, dizziness, headache, etc. It may be caused by exposure to excessive heat, by an excess of woolen clothing, by irritation or heavy food, etc. ACONITUM may be given for this eruption, when it is accompanied with dizziness, headache, vascular irritation. DOSE.-One drop of the ordinary tincture in a tumblerful of water, a small tablespoonful every two hours. This will induce a little perspiration, after which the vesicles gradually dry up. Other remedies may, however, have to be used, such as RIUS TOXICODENDRON, for confluent vesicles, containing a milky or watery fluid, without fever; or for small, burning vesicles, with redness of the skin all over. DODS.-One drop, or three globules, dry on the tongue, three times a day. MERCURIUS VIVUS, for small vesicles, crowded together on a reddened surface, and preceded by itching, which disappears after the vesicles are broken out. DOSE.-Same as Rhus. ARSENICUM, for black blisters, which cause a burning pain. DOSE.-One drop, or six globules, morning and night on the tongue. TARTARUS EMETICUS, for vesicles and blisters filled with pus, and resembling chicken-pox or variola. DOSE.-One grain of the third trituration, morning and night, dry on the tongue. For the various vesicular eruptions which can be cured by homceopathic remedies, the reader is referred to our large Repertory, from pages 1085 to 1088. SALT-RHEUM, TETTER. 475 The eczematous eruption which is more particularly caused by exposure to the heat of the sun, is termed Eczema solare.-This vesicular eruption is induced by the excessive action of the sun's rays, in consequence of which the skin gets scorched, and the epidermis is raised in blisters. The scorched surfaces may be bathed with fresh milk, and internally we may give AcoNITUM, one drop of the common tincture in a tumblerful of water, a small tablespoonful every two or three hours. This treatment will suffice. DIET.-During the treatment for such eruptions, the diet should always be simple and not stimulating. Salt-rheum, Tetter, Herpes, Ring-worm. Salt-rheum is a species of moist tetter, more or less inflamed, sore, discharging a moisture which is sometimes exceedingly acrid; the burning and itching are often distressing. The eruption frequently dries up, leaving a roughness behind, and breaks out again at certain periods, in consequence of atmospheric, dietetic or other influences. The skin is often deeply fissured. Herpes or Tetter, Is a peculiar and well known degeneration of the dermoid tissue, of which we have several varieties, such as: dry, furfuraceous or mealy, ring-shaped, bleeding, ulcerated tetter; salt-rheum is a species of herpes. TREATMENT.-Never apply lead-washes or mercurial ointments to such eruptions. Applications of cold watei are admissible and frequently required; internal treatment with medicine is too often unsuccessful. Frequent h 476 SPECIAL THERAPEUTICS. changes of air, exercise in the open air, may be useful and even necessary. Internally the following medicines may be used for tetter or salt-rheum, as nearly as possible in accordance with the peculiar distress or painful sensations experienced by the patient. STAPHYSAGRIA for dry, crusty herpes, or for herpes which itches in the evening and burns when scratched, or for herpes on the thighs and legs. DOSE.-Six globules, or two drops, every morning, on the tongue. ARSENIC for herpes having a red, unhealthy appearance, with vesicles and burning, particularly at night. DOSE.-Same as Staphysagria. CLEMATIS for scaly herpes, with a yellowish, corrosive ichor; or for herpes which is red and humid when the moon increases, and pale and dry when it, decreases. DOSE.-One drop of the first attenuation every night. SEPIA: Brown, herpetic spots, on the skin, or scurfy, humid herpes, with itching and burning, or ring-shaped herpes. DOSE.-Six Globules, or one drop, every other morning. SULPHUR for red-spotted herpes with vesicles, or almost any other variety of herpes, humid, miliary, crusty, scaly, ring-shaped, etc. DOSE.-Same as Sepia. LYCOPODIUM for shrivelled, yellowish-brown herpes, or for humid, suppurating herpes with deep rhagades and covered with thick crusts. DOSE.-Same as Sepia. MERCURIUS vivus for round herpes, especially on the forearm; the skin peels off, and the herpes causes a voluptuous itching; or for herpes which burns when touched, also for herpetic spots and suppurating pus SPECIAL THERAPEUTICS. 477 tules; or for herpes surrounded with a border of large scales (especially on the forearm and knee) discharging a good deal of moisture; or for dry, raised, burningitching herpes on the limbs, wrist-joints, hands and between the fingers; or for impetiginous herpes, herpes prmeputialis and other forms, such as dry miliary herpes, or herpes behind the thigh, the epidermis coming off when scratching it. DOSE.-Three globules, dry, every night, or one or two drops. AMBRA GRISEA is a good remedy to bring out suppressed herpes or even the itch. If Ambra does not do this, Sulphur may be used. DOSE.-One grain of the third trituration every night and morning. DULCAMARA for herpes on the labia, hands; herpetic crusts over the whole body, humid, suppurating herpes in the arm-pits and other joints. DOSE.-One or two drops of the tincture, three times a day. GRAPHITES for a red, rough, herpetic spot on the upper part of the thigh, opposite the scrotum, itching in the morning, or for herpes on the tibia, humid herpes. DOSE.-One grain of the third trituration morning and night. LEDUM PALUSTRE, for dry, itching herpes with anxiety. DOSE.-Same as Clematis. RHUS TOXICODENDRON for herpetic eruptions alternating with pain in the chest, and dysenteric stool. DOSE.-Same as Clematis. PHOSPHORus, for round herpetic spots all over the body. DOSE.-A few drops, or six globules, morning and night. A variety of forms of herpes will be found mentioned in our large Repertory, from pages 1090 to 1092, with the corresponding remedies. 478 ACNE, SCALD-HEAD. Acne. This is a very common eruption, to which a great many individuals are subject, especially such as have irritable nerves, are troubled with determination of blood to the brain, and have a full habit of body. The eruption consists of pimples or little blotches, crowded together more or less densely, or of a fine rash having a reddish appearance. Persons who indulge in stimulating drinks, rich and fat food, or heavy, farinaceous diet, are frequently attacked with acne. In drunkards it is very apt to invade and disfigure the nose. Individuals, who are troubled with this kind of irritation, should rigorously abstain from all kinds of stiinulants, such as coffee, brandy, etc., and eat very little meat; all rich, heavy diet should be avoided. The homoeopathic Materia Medica is full of remedies for eruptions of every kind. The reader will find in our large Repertory from pages 1074 to 1090, a very large number of medicines which are supposed to cure the various kinds of blotches, tubercles, papule, pimples, spots, vesicles, blisters, etc., which are often seen on the skin; the reader is therefore referred to the respective chapters in that work, which we should have to transcribe entirely, if we would mention all the remedies indicated for acne, and other chronic eruptions. Scald-Head, Tinea Capitis. This is a well-known herpetic eruption of the hairy scalp, not requiring any detailed description in a work of this kind. It is frequently occasioned by a want of cleanliness, engenders vermin, and destroys the follicles SCALD-HEAD. 479 of the hairs, preventing their growth, and causing bald spots which may remain during a person's life-time. For present purposes it is sufficient to distinguish dry and humid scald-head. TREATMENT.-One of the most essential means of cure is cold water. The child's head should be washed three or four times a day with a solution of cold water and castile soap, after which fresh water may be used for the purpose of washing off every particle of soap. The head must be carefully dried after each washing, but so as not to irritate the scalp by hard and rough rubbing. All lead-washes and mercurial ointments should be strictly avoided; the lead-washes especially, as the result of such applications may be the sudden drying up of the eruption on the scalp, and a metastatic transfer of the disease to the brain, leading to incurable effusions, mental diseases, or even sudden death by paralysis. The principal internal medicines for this disease are; ACONITE, ARSENIC, BARYTA CARBONICA, CALCAREA, MERCURIUS VIVUS, GRAPHITES, STAPHYSAGRIA, SULPTHUR, DULCAMARA, LYCOPODIUM and RHUS TOXICODENRON. ACONITE, is very useful, if the child's head is habitually hot, with evident determination of blood to the brain; the eruption has an angry look, discharges a yellowish, bloody humor, with swelling of the scalp, dark-brown crusts and ulceration, great soreness and sensitiveness, itching and burning. We once treated a young lady who had been afflicted with an eruption of this kind for years. It was particularly troublesome in the summer season. She suffered with distressing headache, rush of blood to the head; the scalp was covered with dark-brown crusts from beneath which a yellowish ~h2~-i-------i--------;- ~ ~;:~....~. 480 SPECIAL THERAPEUTTICS. fluid was discharged. The scalp looked inflamed, and the itching and burning were very troublesome. No kind of treatment had been found available. It was a species of scald-head which, if a name were required for it, we should term bilious scald-head and which we thought resulted from a torpid condition of the capillaries of the liver. We put the patient on the use of the tincture of Aconite, from two to three drops a day in water, dividing this quantity into half a dozen doses; and we had the satisfaction, in a comparatively short space of time, of freeing this young lady from an affection which her social position made exceedingly annoying. As a general rule we may regard as a suittable DOSE.-One drop of the saturated tincture of the root in a tumblerful of water, a small tablespoonful four times a day. BARYTA CARBONICA, when the eruption is attended with itching and gnawing, or fine stitches here and there in the scalp, and consists principally of, or is mingled with, pimples and small boils. DOSE.-One grain of the third trituration, dry on the tongue, for about a week, then some other remedy, (See " General remarks" below.) CALCAREA, is especially suitable for dry, scaly scaldhead, or for scald-head consisting principally of vesicles and blisters, with a burning itching of the hairy scalp; an additional indication for Calcarea are glandular swellings about the neck. DOSE.-Same as Baryta, for a week, and then give LYcoPobnum, six globules or one drop every other night, dry on the tongue, for a fortnight; after which resume Calcarea as above. In about a month from the commencement of the treatment, give SULPHUR, six globules or a few drops every morning _ ~ ~ ~ SCALD-HEAD, TINEA CAPITIS. 481 or night; this medicine may likewise be given from the commencement, when the following symptoms exist; dry scald-head, consisting principally of itching pimples and a fine mealy scurf, falling out of the hair. GRAPHITES, for humid scald-head, with itching, falling off of the hair, fetid smell, secretion of an acrid ichor forming a thick, dry scurf; the skin under the eruption looks red and sore; Graphites may likewise be a good. remedy for dry scald-head. DOSE.-One grain of the third trituration, morning and night. ARSENICUM, is particulary indicated when the eruption shows a tendency to spread, and discharges a malignant, thin, dark, fetid, bloody ichor which developes the disease wherever sound parts are touched by it. DOSE.-Six globules, or one drop, on the tongue, every night. MERCURIUS VIVUS, for a dry eruption over the whole head which causes an aching pain when touched, or for tinea consisting of small, elevated scabs between the hairs, and firmly adhering to the skin, also with itching and burning after scratching; humid scald-head, eating away the hair, with painful pressure, especially at the sore places. DOSE.-Six globules, or a few drops, morning and night. RHUS TOXICODENDRON, for tinea, eating away the hair, with nightly itching, discharge of a purulent humor, which is sometimes of a greenish color, or with crusts; scald-head mingled with small, soft tubercles on the hairy scalp; or dry crusts and scales on a humid base, and a dampness all around. In such a case Rhus may be alternated with Graphites. DOSE.-If Rhus alone, six globules, morning and night; if with Graphites, ono dose of Rhus in the morning, and a grain of the third trituration of Graphites at night. 41 482 SPECIAL THERAPEUTICS. STAPHYSAGRIA, for scabs on the hairy scalp, with violent itching; or badly-smelling humid scald head. DOSE.-Six globules or two drops, morning and night, DULCAMARA, is an excellent remedy for scald-head consisting of inflamed pustules discharging a yellowish, tenacious liquid, and then forming brown crusts; the eruption may spread over the forehead and face; a puriform lymph continues to be secreted under the crust. DOSE.-A few drops of the strong tincture morning,,noon, and night. GENERAL RE\MARKS.-The treatment of this disease is sometimes exceedingly obstinate. If a remedy should seem to be indicated, it may be continued for a week or fortnight, after which it may be well to do without medicine for a week, or to select some other remedy more in accordance with the symptoms. The above list is, we believe, nearly sufficient to cure almost any kind of curable scald-head. Cleanliness should be attended to, as was stated in the beginning of this chapter, and all irritating and heating covering on the head should be strictly avoided. The child should never lie on feather. beds or feather-pillows; soft, finely-cut straw, hay, moss, or horse-hair is the best. The old-fashioned mode of treatment, of putting on a pitch-cap, and tearing the eruption off, is so horribly barbarous that it seems scarcely necessary to condemn it. Falling off of the hair, Baldness, Alopecia. The hair sometimes falls out after a severe malady of the brain, such as inflammation, typhus; or in consequence of dryness of the scalp, deficient nutrition of the follicles, etc. In either of these cases it is a good plan to rub the head frequently with a little sweet oil, and ISIL~IIL~IIII GENERAL DISEASES, ACUTE RHEUMATISM. 483 afterwards to wash it with cold water, in which a little dilute ammonia is mixed; care should be taken to dry it after every washing. Females should cut their hair short, until the hair gets stronger and the falling ceases. Internal treatment is scarcely ever necessary, although the following medicines may be used: ACONITE if the head feels hot, and the scalp is dry, sensitive. DOSE.-A few drops or six globules every evening; continue for a week, then take BELLADONNA, same dose, for another week, and either resume the Aconite, or substitute LycOPODIUM, three globules every other day, if the hair should be very dry; in a fortnight after take SILICEA, same dose as Lycopodium. MERcURIUS VIVUS, two drops or six globules every night, may be given, if the patient is very sensitive to the air, and the head inclines to perspire. CALCAREA is useful in the case of scrofulous individuals, with glandular swellings, discharges from the nose and ears. DOSE.--Three globules, or one drop, every other day. None of these medicines should be continued for a longer period than a fortnight at a time. GENERAL DISEASES. Acute Rheumatism. Acute rheumatism is an inflammatory disease which is not only very painful, but sometimes very dangerous. Acute rheumatism may befall any part of the organism, even internal organs, such as the brain, lungs, pleulA, _ _ 481 SPECIAL THERAPEUTICS. bowels, stomach, etc. A rheumatic inflammation has a tendency to run a longer course than an ordinary inflammation; another tendency, inherent in rheumatic inflammations is, that the inflammation inclines to shift from one part of the organism to another. It is on this account that a rheumatic inflammation is sometimes dangerous; for it may shift from some external part to an important vital organ, such as the heart and its enveloping membranes, causing a most dangerous derangement, disorganizations and lastly death. Generally it is the muscular tissue that is the seat of the inflammation, which is always characterized by pain, swelling, redness, heat, sensitiveness to contact or pressure. A peculiar species of inflammatory rheumatism is rheumatism of the joints or articular rheumatism, which sometimes commences in one joint, and gradually spreads through a number of articulations. The disease is always accompanied with fever, dryness and heat of the skin, gastric derangement, thirst, restlessness, etc. It is ushered in by a chill or a sense of coldness, soreness, aching pains or stiffness in the back or extremities. The swelling does not, sometimes, come on until the disease has lasted for a few days. TREATMENT.-The great object to be accomplished in commencing the treatment, is to cause perspiration; this will relieve the pain, and is the beginning of a cure. No medicine will accomplish this result more speedily than ACoNITUM, of which a few drops or six globules may be dissolved in a tumblerful of water, and a small spoonful taken every two hours, until a decided reaction takes place, after which the intervals between the doses may be prolonged. Aconitum is a specific remedy for ACUTE RHEUMATISM. 48.5 articular rheumatism, rheumatic inflammation of the deltoid muscle or the muscle forming the top of the shoulder, and for every inflammation accompanied with high synochal fever and characterized by tearing, lancing, aching pains; in very many cases Aconitum is sufficient, without any other medicine; in a few cases only it can be dispensed with, and in other cases it has to be followed by some other medicine. In many cases again, Aconitum is suitably alternated with one of the following remedies: ARNICA, if the patient lies stiff in his bed, with pricking in the toes, fingers, knees, and joints of the arms, alternating with violent tearing and cutting in the muscles and tendons; stiffness in the hip and kneejoints; or, unceasing tearing pains in the hands and feet, the hands being swollen and shining-red; by alternating Aconitum and Arnica, such an attack will be cured quite readily. DOSE.-Of either, a few drops, or six globules, in a separate tumblerful of water, an alternate tablespoonful every two hours. BELLADONNA; tearing pain in the shoulder, striking along the bone as far as the hand, or tingling pain in the arm close to the bone, as if gone to sleep, with excessive lameness and pain on trying to raise it; or for acute, burning pain in the hip, most violent in the night; the parts are painful to the touch, with fine prickings in the skin. DOSE.-A few drops, or six globules, in a small tumblerful of water, a tablespoonful every three hours. If Belladonna should not relieve after three or four doses, give Aconite, dose as above. BRYONIA, for acute rheumatism of the lower limbs; tensive, stitching, tearing pains in the calves down to the ankles; the parts are swollen, rigid, of a shining, 42* ___ 486 - SPECIAL THERAPEUTICS. red color; dry heat all over, white-coated tongue, violent thirst, frequent and full pulse; urine red and burning; the pain is aggravated by motion. Sometimes the tearing pains are accompanied with a sensation as if the parts were seized with pincers and torn to pieces; or, as if a dull body were forced from the hip to the toes along the inferior surface of the tibiae, and there remained lodged in the parts. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every two or three hours. Bryonia acts more efficiently by alternating it with Aconite, every few hours. The dose of Aconite as above. CHAMOMILLA is suitable for drawing and tearing pains, especially when affecting the tendons, ligaments or bones, when there is no swelling, and the pains are accompanied with a burning or numb sensation. DOSE.-Six globules in a tumblerful of water, a small tablespoonful every two or three hours. DULCAMARA, if the tearing pains are accompanied with general oedema, white-coated tongue, and the pains are somewhat relieved by motion. DOSE.-Same as Chamomilla, IGNATIA, indescribable pain in the upper arm, as if it were broken, with pain in the shoulder-joint, when turning the arm backward, as if bruised or sprained, whereas stitching pain is felt when turning the arm inward; or, a boring lancination is experienced deep in the brain, with violent pain from the axilla to the tips of the fingers, as if the flesh would be detached from the bone; the arm feels paralyzed. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every four hours. LYCOPODIUM is suitable in chronic rheumatism characterized by a pain in the small of the back, cramp and ACUTE RHEUMATISM. 487 tearing in the whole spine, especially when sitting, also when making an exertion, worse in bad weather and diminishing in warmth; accompanied with rheumatic ten sion and tearing in the joints, stiffness in the limbs and coldness of the feet, headache when thinking, sickly complexion, heartburn, sour eructations. This is not a very efficient drug; in most cases Sulphur will act much better. DOSE.-Of each, six globules, or a few drops, twice a day, morning and evening, on the tongue or in a little water. MERCURIUS VIVUs, for a stitching and drawing pain in both lower limbs-the affected parts feel cold. This medicine is also indicated, if the muscles feel lame and aching internally: or if the joints of the extremities, more particularly those of the arms and hands, are somewhat swollen, with a slight rose-colored tinge, painful, lame, and this rheumatic affection is attended with a sense of coldness or chilliness, some thirst, impaired appetite, costiveness, deep-yellow and strong-smelling urine. DOSE.-A few drops, or ten globules, in a tumblerful of water, of which a tablespoonful may be given every two hours. Nux VOMICA is indicated by the following symptoms: chilliness all through, followed by aching pain in the head; drawing pain from the shoulder to the arms as if the parts would go to sleep, with inability to move them; a similar pain is felt in the lower limbs; stitches and stiffness in the hip-joint; painful contraction of the toes at night; the pain becomes worse during motion or by contact. Nux vomica may be exhibited alternately with ACONITE if the attack commences with violent chills and tearing pains in the limbs, followed by burning, gnawing heat and sweat, during which the pains 488 SPECIAL THERAPEUTICS. increase; or, if the pains are of a drawing and tensive nature, accompanied with a weak or numb feeling, or with cramp-pains and twitchings of single parts of muscles; or, if the patient is exceedingly sensitive to the cold or open air; or, if the rheumatism is accompanied with congestive symptoms, such as distension of the abdomen, flatulence, abdominal pulsations, intense pains in the region of the stomach, followed by a sort of boiling heat rising t6 the chest, and spreading through the brain and whole body, especially after eating or making an exertion. * DOSE.-Of Nux vomica alone, a few drops, or six globules, in a tumblerful of water, a small tablespoonful every four hours; and, if alternated with Aconite, proceed as with Mercurius and Aconite. GUAJACUM, when the rheumatism affects the lower extremities, and is characterized by quick lancinations from the toes upwards through the leg, with or without swelling of the parts. DOSE.-One grain of the second or third trituration, dry.on the tongue, four times a day. PHOSPHORUS may be exhibited when the tearing and drawing in the limbs are accompanied by loose stool, flatulent distension, frequent bleeding of the gums, turbid urine depositing a brick-dust sediment; heaviness and weariness in all the.limbs, headache alternating with the pains in the limbs. DOSE. - A few drops, or six globules, on the tongue, three times a day. Alternate with Aconite, an alternate dose.of each three times a day. PULSATILLA for a pain in the knee as if broken; drawing, tearing pain in the knees alternating from one to the other, or in the forearms, hands, shoulders, feet; the pain abates after the swelling develops itself. Pulsatilla is indicated if the approach of bad weather brings on stitches and a feeling of coldness in the limb, and if the ACUTE IHEUMATISM. 489 limb at one time swells, at another grows thin again, and finally wastes away; or, if the pain is less in the open air, and gets worse in the warmth or in bed; or if the tearing in the limbs is accompanied with tearing in the ears, and discharge from the ears; or, if the rheumatic pain shifts, and causes redness and swelling of the joints. Pulsatilla is a specific for rheumatic inflammation and swelling of the dorsum of the foot and instep. DOSE.-A few drops in ten tablespoonfuls of water, a tablespoonful every three hours. RHUS TOXICODENDRON: creeping in the fingers when the arm lies quiet, gradually extending to the whole arm, temples and occiput, with throbbing pain; painful stitches in the lower part of the spine when walking; the pain in the arm is sometimes relieved by a stingingburning in the ball of the foot; tearing pain between the scapulke; the parts upon which one rests, go to sleep. DOSE.-A few drops, or six globules, in a tumblerful of water, a small spoonful every four hours. Rhus may be alternated with Aconite, the dose to be the same as of Rhus, an alternate dose to be exhibited every three hours. According to Dr. Neidhard and others, Rhus is a specific remedy for rheumatism characterized by the following symptoms; rigidity, paralytic weakness in the joints, with stinging pain along the tendons and muscles; swelling and redness in or near the joints; the greatest rigidity and pain are experienced on first moving the joints after rest, and on waking up in the morning; after the joints are moved for a while the pain is lessened. THUJA may be administered for a tearing and beating pain in the shoulder, as if there were an abscess forming, extending thence to the fingers; twitching of the muscles from the shoulder to the middle of the upper arm; feeling of deadness in the forearm and fingers; the pains increase while the arm is pendulous, and in the _ ~ 490 SPECIAL THERAPEUTICS. warmth of the bed; they are diminished by motion, coldness and sweat; sensation of coolness in the arms, DOSE.-One or two drops of the tincture, morning and night. Chronic Rheumatism. All the above-mentioned remedies may be employed,for chronic rheumatism, even Aconite, which is one of our most powerful and serviceable agents for chronic rheumatism of the joints. In chronic rheumatism the use of daily ablutions with cold water, and the operation for sweating are highly to be recommended. In regard to the selection of particular remedies for particular groups of symptoms, the indications which have been furnished above for acute rheumatism will likewise guide the reader in the selection of the proper remedy in chronic rheumatism. General remarks regarding the Treatment of Acute and Chronic Rheumatism.-The reader will perceive that, in very many cases, we recommend the alternate.use of Aconite with some other remedy which is apparently specifically indicated. It may be safely asserted that, in three-fourths of all the cases of acute and chronic rheumatism, Aconite is not only an indispensable agent, but the truly curative remedy. The local application of cold water, by means of linen bandages surrounded by dry flannel, to swollen, hot, painful joints, is perfectly proper, and affords relief. The diet should be spare, and perfectly free from all stimulants. After getting better, such patients have to guard against draughts of air, sudden changes in the weather, exposure to rain, damp places, etc. Nervous or Neuralgic or Arthritic Rheumatism.-This is a species of rheumatism which does not seem to be CHRONIC RHEUMATISM. 491 attended with striking inflammatory symptoms, but is excessively painful. The parts bear contact and even pressure; there is no apparent swelling, no redness, but the burning, tearing, throbbing, jerking, boring pains, or the pain as if the parts would expand or grow smaller, are sometimes truly agonizing. The pulse is somewhat irritated, but not by any means indicative of serious inflammation. The skin is dry, and the internal mucous surfaces seem to be very dry likewise, although there is comparatively but little thirst. At night the pains are generally much worse, and the sleep is very much disturbed. The best remedy for this peculiar form of distressing and exceedingly tenacious rheumatism is ACONITE, a few drops or six globules, on the tongue, three or four times a day. This will induce perspiration, and the patient may be quite well in from two to three weeks. This species of rheumatism is a most insidious disease, which may undermine the constitution, develop debility, night-sweats, hectic fever, and gradually lead the patient to marasmus and death. We cannot close this chapter on chronic and arthritic rheumatism, without recommending to the attention of the reader a very useful agent which, though much abused by old-school practitioners, is nevertheless a very interesting remedy in the hands of homceopathic physicians, we mean Colchibum auctumnale, or the meadow-saffron. This medicine is used by many homoeopathic physicians with great success, both in the treatment of gout and arthritic rheumatism. The pains are of a tearing, sticking, gnawing and burning kind. It is particularly useful in rheumatic or arthritic inflammations which show a -~---_ 492 SPECIAL THERAPEUTICS. tendency to shift to internal organs, to the bowels, heart. If the inflammatory process should have actually shifted to internal parts, Colchicum should at once be given in alternation with the strong tincture of Aconite. If the mucous membrane of the bowels is invaded, with burning and tearing pains in the bowels and discharges of bloody mucus, we may depend upon Colchicum as an excellent remedy. In regard to the dose, we would remark that Colchicum has generally seemed to act better when given in massive doses of the tincture than when exhibited in small doses of the attenuated drug. We may give from five to ten drops of the tincture in a tumblerful of water, in alternation with a mixture of from two to three drops of the strong tincture of Aconite-root in a similar quantity of water, giving alternate tablespoonfuls every hour. In some cases of arthritic rheumatism, particularly if joints are invaded, none of the ordinary remedies for rheumatic inflammation seem to produce any decided curative results. The joints remain inflamed, swollen, hard, an effusion takes place, and finally this effused lymph becomes consolidated and the joint may remain permanently distorted. In these forms of arthritic rheu. matism, the best treatment that can be pursued, is to put the patient on the alternate use of iodine and Aconite. Of the Iodine three or four drops of the tincture may be mixed in a tumblerful of water, and the Aconite is to be exhibited as stated in. the previous paragraph. These two solutions may be given in alternate doses every hour. Iodine is particularly adapted to the scrofulous and tubercular diathesis, the presence of which is most frequently the cause of these obstinate forms of arthritic rheumatism of the joints. PERIOSTITIS. 493 PERIOSTITIS. 493 Periostitis. Inflammation of the Periosteum. This disease may attack individuals who have a comparatively sound constitution; but it is persons affected with the scrofulous or arthritic diathesis, that are particularly in danger of being attacked with inflammation of the bones or of the periosteum, which is a fibrous membrane that covers the substance of the bones, to which it adheres very firmly. Hence we distinguish, a. Ostitis, inflammation of the bones. b. Periostitis, inflammation of the periosteum. If the substance of the bone is inflamed, the patient experiences a violent boring, throbbing pain, with pressure; this pain is confined to a small portion of the bone; the bone is swollen, somewhat softer than usual, and no longer yielding the clear, ringing sound of a perfect bone. In inflammation of the periosteum, the pains are tearing, extending over a considerable surface, aggravated by motion and pressure. If the bone is near the surface, the periosteum is raised like a pad, together with the integuments, which are no longer moveable, and sometimes slightly reddened. At other times, the swelling is oedematous, or covered with sugillations. (Schoenlein.) A most distressing sensation in periostitis is a feeling as if the limb were swelling. Unless the disease is speedily checked, pus may form between the periosteum and the bone, and may injure or even destroy the bone, unless it is absorbed or removed by a free incision. If this disease takes place in scrofulous individuals, the bone is very apt to become carious, especially under allceopathic treatment. It may be induced by standing on cold or damp ground, or by wounding the periosteum. Abuse of mercury may likewise cause periostitis. The 43 -- ~' ~~ ~-i ~ -L~~-~~ILII 494 SPECIAL THERAPEUTICS. disease may run a course of from two to three, or even four weeks. The principal remedies, which exercise a decidedly curative influence in all the common, uncomplicated forms of rheumatic or arthritic periostitis, are ACONITUM and BRYONIA. A few drops of the second or third attenuation of each may be mixed in a small tumblerful of water, and a tablespoonful of these two mixtures may be given alternately every two or three hours. After the patient feels relieved, and a natural perspiration has set in, the medicines may be continued at longer intervals.* MERCURIUS VIVUS may be given, if the patient feels cold, and complains of tearing, drawing, ulcerative pains in the bones. Give a powder of the third trituration. three or four times a day, dry on the tongue. IODIDE OF MERCURY may be given in the same manner as Mercury, if the patients are of a marked scrofulous disposition. This medicine may be alternated with Aconite, if fever and the above-mentioned inflammatory pains are present. We may observe, that the fever in this (isease is of a torpid character, characterized by hectic flushes on the cheeks, and having more or less regular exacerbations, generally after or about midnight. Individuals who are threatened with inflammatory affections of this character, should always wear shoes or boots with good soles, so as to have their feet well. protected from cold or dampness. Stiff Neck, Wry Neck, Torticollis. This affection may be considered a species of rheumatism of the lateral muscles of the neck, principally of C1311Cer~113C~~I~lll~~311~~C~ GOUT, ARTHRITIS. 495 the sterno-cleido-mastoideus muscle, or the long muscle which arises from the thick point of bone immediately behind the ear, and slants down the neck, to be inserted in the clavicle, or collar-bone, and in the sternum, or breast-bone. The muscle is rigid, swollen, hard, sore, and the least attempt to move the neck is attended with acute pain. The best remedy for this affection is ACONITE, a few drops, or six globules, in a tumblerful of water, a tablespoonful every two hours, and, as soon as the patient feels easier, every four hours. After giving Aconite for a few days, if some hardness and soreness should remain, BELLADONNA may be given, for a day or a day and a half, in the same way as Aconite; then resume Aconite, and alternate with Belladonna in this manner, until the condition of the neck is again perfectly natural. Gout. Arthritis. This affection seems to be akin to rheumatism; it is characterized by similar pains, swellings, and other disorganizations; if the organism has once been invaded by gout, relapses are quite common. Repeated attacks of gout terminate in the deposition of a calcareous substance in the joints, causing indurations, which we term nodes or nodosities. These nodes are accompanied with disorganizations of the synovial membranes and articular cartilages. Gout and rheumatism frequently run into each other, may be induced by the same causes, although an attack of the gout is more apt to be brought on by excessive indulgence of rich and highly-seasoned food, and particularly of wines and other ardent spirits. Gout is likewise, upon the whole, a more painful disease than 496 SPECIAL THERAPEUTICS. rheumatism, and is, perhaps, more inclined to affect internal organs. An acute attack of the gout is generally accompanied with severe symptoms of gastric derangement, such as sour stomach, soreness of the bowels, flatulence, constipation. Meastasis of the gout to some internal organ, such as the stomach or heart, is a most dangerous occurrence, and frequently terminates fatally. TREATMENT.-The treatment of gout is, in all respects, similar to that of rheumatism; the remedies which have been mentioned for rheumatism, will likewise cure an attack of the gout. To guide the reader a little more precisely, the following medicines are suggested as the principal remedies in gout: ACONITE, BRYONIA, Nux VOMICA, PULSATILLA, PHOSPHORUS, SULPHUR, CALCAREA, ANTIMONIUM CRUDUM, COLCHICUM and IODINE. ACONITE should be given if the parts are swollen, of a shining redness, excessively sensitive to the touch, with stinging, burning, shooting or tearing pains, or when internal organs, such as the stomach and bowels seem to be involved in the attack. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours, until relieved. If there should be no relief, after taking three or four doses of the attenuated Aconite, give the strong tincture of the root, a few drops in a tumblerful of water, a tablespoonful every two hours. BRYONIA may be given in the same way as Aconite, if this drug should not produce any striking relief. Aconite and Bryonia may likewise be alternated, an alternate dose every two hours. If this treatment should fail, give PHOSPHORUS, same dose, especially if the swelling is of a dark purple color. If we are not quite sure whether Phosphorus or Sulphur had better be given, we may give GOUT, ARTHRITIS. 497 SULPHUR, after having given two or three doses of Phosphorus, and after a few doses of Sulphur, resume Phosphorus, the dose of Sulphur to be the same as that of Phosphorus. Either Phosphorus or Sulphur may be alternated with Aconite, if necessary, the Aconite to be given as indicated above. NUX VOMICA is adapted to high livers, or persons with florid, plethoric constitutions, and is particularly useful, if the attack had been caused by a debauch, and the symptoms of gastric derangement predominate. It should, however, be alternated with Aconite, a few drops or six globules of each in a tumblerful of water, a small spoonful every two hours. If, after giving a few doses of Nux, there should not be any improvement in the gastric symptoms, substitute ANTIMONIUM CRUDUM, the same dose as for Nux, and use it alternately with Aconite as mentioned for Nux, until its further use seems unnecessary. CALOAREA is more particularly suitable for nodes, and other chronic effects of the gout. DOSE.-Half a grain of the third trituration, dry on the tongue, three times a day. It may be alternated with Sulphur, same dose as Calcarea, an alternate dose of each, twice a day. PULSATILLA is an admirable remedy for gout of the toes, dorsum of the foot and instep. DOSE.-A few drops, or six globules in a tumblerful of water, a small spoonful every two hours, until relieved, then continue it less frequently. COLD WATER: This is a most useful adjuvans in the treatment of gout. Apply wet bandages to the inflamed parts, and renew them as often as the water gets warm. Cold water may likewise be drank very freely. COLCHICUM: This is a favorite remedy for gout and rheumatism in the hands of old-school physicians. We 43* -0 498 SPECIAL THERAPEUTICS. have never seen any good effects from Colchicum administered in very small doses; in all cases where it-seemed to afford positive relief, it had to be taken in tolerably large quantities of the strong tincture, so that the bowels were sometimes moved by the medicine. For full instructions regarding the use of Colchicum and Iodine in gout, we refer the reader to the preceding chapter on rheumatism. We recommend Aconite, Colchicum, and Iodine, as the leading remedies in acute and chronic gout. Diet and Regimen.-(See Rheumatism.) Inflammation of the Psoas-muscle, Abscess of the Psoasmuscle.-(See the chapter on Surgical diseases.) Sweaty feet. Persons who are troubled with this weakness, should wash their feet with cold water every morning and evening, and accustom themselves to cotton stockings all the year through; one ablution a day, with cold water, and a shower bath every morning should likewise be used. Internally the patient may take MERCURIUS, a drop or six globules one day, and GRAPHITES, same dose the next, alternating the two medicines for a fortnight, then discontinue the use of medicine for a week or a fortnight, and resume again after this period, if necessary. Tuberculosis and Scrofulosis. Most writers on diseases attribute a large portion of the chronic diseases which now infest the world, and which are not of a syphilitic origin, to the existence TUBERCULOSIS AND SCROFULOSIS. 499 of a peculiar dyscrasia as they term it, or a morbific taint, -miasm or virus, which is designated in the books, as the scrofulous or tubercular diathesis, or scrofulosis and tuberculosis. In his work on Chronic Diseases, Hahnemann traces all known chronic diseases three miasms, the psoric, syphilitic and sycosic miasms. The syphilitic miasm engenders all syphilitic diseases; the sycosic miasm, which Hahnemann recognizes as a distinct principle of disease, is similar in essence to the syphilitic miasm; the psoric miasm embodies itself in the itch-pustule as its most universal and most characteristic representative in modern times; Hahnemann traces this miasm to the remotest antiquity as the first and most fruitful cause of all non-syphilitic chronic disorders. His doctrine is that, after the original psoric miasm had embodied itself in some visible eruption upon the skin, the violent suppression of this eruption which might be looked upon as the comparatively harmless vicarious substitute for the internal disease, gave rise to the extraordinary variety and multiplicity of chronic diseases which now infect mankind. There is hardly a chronic disorder which Hahnemann does not trace to this source. The ancient psora, which is the Greek name for itch, is, according to Hahnemann, the mother of all non-syphilitic chronic diseases. It is remarkable that Hahnemann who was a sworn enemy to all purely speculative doctrines in medicine, should have started this extraordinary psora-theory. Many of his disciples adhered to it, and there are some who still believe in it; but the greater number of all thinking and independent homceopathic practitioners look upon the psora-dobtrine as.the offspring of an extraordinary effort of Hahnemann's genius to - I I I- C I ~ 500 SPECIAL THERAPEUTICS. range all diseases under one or more unitary principles. Viewedas a mere effort of the fancy, the psoratheory excites wonderment, and may even suggest many earnest and fruitful thoughts to philosophical minds; but, if presented as a scientific discovery, it must utterly and inevitably fail. It refutes itself, for the simple reason that Hahnemann takes the existence of the original psoric miasm for granted, whereas morbific forces must have been in existence anterior to the psoric miasm, which may not only have developed the psoric miasm, but that whole train of chronic diseases which Hahnemann attributes to the suppression of the cutaneous vicarious sign or symbol of the internal psoric disease. In the present condition of medical science we have just as good a right to look upon the cancerous or the gouty miasm as independent principles of disease, as Hahnemann had to consider them all as the mere offspring of psora. One great fact we may find corroborated by Hahnemann's statements and reasonings, it is this: that all suppressions of an eruption by violent artificial means, such as lead-washes, ointments, cauterizations, etc., will inevitably prove injurious to the constitution, if the eruption is the natural external sign or offspring of a constitutional disorder. An external injury may be treated with external means, fomentations, ointments, etc., without the least injury to the constitution, because the constitution had nothing whatsoever to do with the development of the trouble. Eruptions which spring up as the ultimate development of an internal malady, cannot be repelled without causing the morbid process to invade some vital organ. If Hahnemann's main object in developing the psora-doctrine, had been to show the dangerous impropriety of repelling such TUBERCULOSIS AND SCROFULOSIS. 501 eruptions by artificial means, there would have been very little, if any, opposition to his teachings; he failed in undertaking to force all chronic diseases, even the most heterogeneous, under the same general principle. Modern pathologists account for the existence of chronic diseases by their theory of dyscrasias, by which term we understand a bad habit of body; and they designate a peculiar or constitutional disposition of developing one dyscrasia in preference to some other, by the term diathesis. The principal diatheses recognized by authors are the cancerous, scrofulous, or tubercular, scorbutic, rheumatic, gouty or arthritic, and calculous. We may likewise speak of a hcemorrhoidal diathesis, nervous or neuralgic diathesis; but there is no necessity of multiplying the list, since it is quite easy to range any other diathesis under one of those leading six. In treating the diseases resulting from these different dyscrasias, we have not yet fully succeeded in assigning absolutely specific remedies to each of them respectively, though it must be admitted that a good deal of positive certainty has been arrived at in this respect, thanks to the indefatigable exertions of the practitioners of both the New and the Old Schools. One of the most powerful and most reliable remedies for the cancerous dyscrasia, for instance, is ARSENIC; for the scrofulous and tuberculous dyscrasia, IODINE; for the arthritic dyscrasia, ACONITE and COLCHICUM, etc. We should, however, bear in mind that these remedies, although limited in number, cannot be grouped with reference to those dyscrasias within positive lines of demarcation. As regards the doctrine of dyscrasias itself, it explains the origin of chronic diseases no better than Hahnemann's doctrine of psora. A dyscrasia, as understood by modern pathologists, is no I I - I 502 SPECIAL THERAPEUTICS. more nor less than the chronic disease itself; the eruption or local disorganization is the material manifestation or sign of the constitutional disease. We have already dwelt upon the treatment of rheumatism and gout, and will here simply add that these morbid conditions are hereditary in many families. These morbid conditions are not necessarily fatal, nor do they even necessarily shorten life. However, in proportion as they perpetuate themselves in succeeding generations, they are very apt to develop disorganizations which will sooner or later exhaust the natural vitality of the organism. The disorders arising from the calculous diathesis, such as gravel, stone, etc., will be treated in the chapter on Surgical Diseases at the end of this work, where the treatment of cancerous affections will likewise be found indicated. Let us now devote some attention to the scrofulous and tuberculous dyscrasia, or to tuberculosis and serofulosis. According to many pathologists these two dyscrasias are identical. Hufeland thinks that the difference between scrofulosis and tuberculosis consists in this, that scrofulosis affects principally the external parts, glands, lymphatics, skin; and tuberculosis the internal parts, the mesentery, lungs, brain, and bones. According to Schoenlein, scrofulosis and tuberculosis are not identical, but analogous forms of disease. Scrofulosis or scrofula is a name derived from the Greek word scrofa, a sow; this name has been given to the disease of which we shall give a description in the following pages, because swine were presumed to be subject to a similar complaint. The disease was popularly known by the name of king's evil. It was so '-"'~~'~ ' ' -L ~ ' TUBERCULOSIS AND SCROFULOSIS. 503, named because it was supposed to yield to the royal touch. The scrofulous diatbesis is so universal that there is hardly a human being that is perfectly exempt from it. The scrofulous disposition may remain undeveloped for. years, until some peculiar change in the habits of' a person, or some accidental cause, which is sometimes very trifling, a common cold even, causes it to break out, insidiously at first, but gradually and steadily undermining the constitution. The first appearance of the scrofulous disease generally takes place during the first period of dentition, ten months after birth; it increases in intensity until the seventh or eighth year; after this period it decreases again, and is least troublesome during the period of fully-developed manhood or womanhood; past this period the signs of scrofula reappear. The uncomplicated scrofulous diathesis may be measurably overcome by suitable diet and treatment; but a complication of the scrofulous and syphilitic miasms begets an almost unconquerable poisonous monster which often saps the very foundations of life in spite of all the care that wealth and professional skill can bestow. Females are more frequently affected with scrofula than males. Schoenlein distinguishes two kinds of scrofula, irritable and torpid. This distinction seems very appropriate and shows an admirable faculty of nice and accurate observation. Children with irritable scrofula have an exceedingly fine, delicate, velvety skin, black or auburn hair, long and silky eye-lashes, and exhibit a remarkable precocity of intellect. Children affected with t6rpid scrofula have large heads, shaggy and blond hair, thick lips, with the upper lip often excoriated by the mucus flowing from the nose, large noses ~h/--------LI---- -- 604' SPECIAL THERAPEUTICS. and bellies, and rather thin extremities. Such childrenare of a dull intellect, sleep a good deal, want to eat all the time, and are particularly fond of bread, milk, farinaceous food, etc. At a later period, when the scrofulous disease is fortunately overcome, these children often take a most favorable turn in their development, whereas the precocious little ones seem physically and mentally stunted even at the tender age of ten or eleven years. Such old-looking little boys and girls, with precocious intellects and all the passions of the full-grown man prematurely roused, are a pitiable sight. Hufeland distinguishes. 1. The scrofulous disposition. Scrofulous parents always give birth to scrofulous children. A scrofulous constitution is indicated by the following appearances: large head, particularly the occiput; short, thick neck; sunken temples; broad jaws; puffed face; frequent swelling of the upper lip and nose (principal symptom;) blond hair; fair skin with red cheeks; generally blue eyes and large pupils; plethoric, full habit; flabby, spongy flesh; distended abdomen; frequent bleeding0 of the nose, and continual accumulation of mucus in the lungs, trachea, nose and intestinal canal; worms; irregular stool, the bowels being at times constipated, at others loose; animated disposition, with premature development of the mental faculties; retarded development of the body, such as slow dentition, etc. 2. The fully developed scrofulosis, or scrofulous disease. The most characteristic symptoms are: glandular swellings and indurations, first on the neck below the jaws, on the nape of the neck, afterwards 'in the axillme, groins, and finally all over the body; the swellings are at first soft, painless, moveable; afterwards they TUBERCULOSIS AND SCROFULOSIS. 505 become harder, larger, painful, inflamed, and, finally, suppurate and form scrofulous ulcers. Glandular swellings likewise take place in the interior of the body, particularly in the mesentery, lungs, also in the liver, spleen, and even in the brain; glandular organs, particularly the eyes, are frequently in a state of inflammation; (scrofulous ophthalmia;) other symptoms of scrofulosis are: frequent, chronic blennorrhoea, (otorrhoea or discharge from the ears, fluor albus or whites;) cutaneous diseases (achor, favus, tinea or scald-head;) tetters; constant distension of the abdomen; lymphatic swellings; extravasations; indurations; scirrhus; swelling of bones (spina ventosa or rickets, paedarthrorace;) caries. According to: Hufeland, cretinism is the most perfectly developed form of scrofulosis. If the disease should last a length of time, it terminates in atrophia meseraica, or atrophy of the mesenteric glands, or scrofulous consumption, hydrops or dropsy, (particularly ascites, or dropsy of the bowels, and hydrocephalus or dropsy of the head;) and scrofulous cancer, particularly on the lips and face. The course of the disease varies. Sometimes it is confined to childhood, and disappears at the age of pubescence. In the generality of cases, it first breaks out in the second and third year, and is frequently excited by accidental causes or pathological irritations, such as wounds, teething, acute fevers, particularly exanthematic and contagious acute diseases, small-pox, measles, scarlatina, and even by vaccination. In some cases, the disease breaks out between the ages of twenty and fifty. Spring seems to have considerable influence on the development of the disease, likewise the increasing moon. 44 1 506 SPECIAL THERAPEUTICS. Remote causes are: scrofulous or syphilitic parents, or parents who have indulged in excesses of all kinds; nursing from debilitated, sickly, scrofulous or syphilitic mothers or nurses; a close, damp, chilly atmosphere; humid, dark, ill-ventilated dwellings; uncleanliness; food made of bad, heavy, not sufficiently risen flour; potatoes; abuse of brandy; sedentary life, or want of exercise; premature mental exertions; acidity; worms in the prime viae, or small intestines, etc. Terminations.-1. Recovery generally slow, with gradual disappearance of the oxalic and benzoic acids from the urine. 2. Partial recovery, with cicatrices, leucoma,* staphyloma,tf curvature and disorganization of bones. 3. Phthisis, dropsy. 4. Death from one or the other afore-mentioned diseases. TREATMENT.-Medical treatment is frequently very useful and efficient in this disease; but it must not be supposed that medicine,, without attending to general dietetic and hygienic means, is of much avail. Scrofulous individuals should use daily ablutions with cold water, frequent exercise in the open air; a bracing mountain or sea-air is very useful; a plain and moderate diet, free from all stimulants, and from all heavy, indigestible farinaceous food, is strictly to be enforced; they may eat carrots, turnips, and roots generally, but no cabbage; good meat and meat-soup, and an abun* Leucoma, arising from scrofulous ophthalmia, is a thick coagulable lymph, extravasated between the delicate layers of the cornea, imparting to this membrane a milky appearance, and rendering it, of course, impervious to light. f Staphyloma is an unequal, embossed, bluish or whitish tumor on the eye, having a round or conical shape, and of variable size; it is formed by the projection of the transparent cornea, which is sometimes distended and extenuated, and at other times thickened. Both these disorganizations may result from scrofulous ophthalmia. _ ~ _Cq ~ __ i_ I __ ~ TUBERCULOSIS AND SCROFULOSIS. 507 dance of fresh water, free from lime, should be recom. mended; feather beds should be strictly prohibited, and the apartment should always be properly ventilated. Frequent changes of dry linen are likewise indispensable. As regards the medical treatment of scrofulosis, it is not necessary, for practical purposes, to distinguish different stages; it will be sufficient to enumerate the remedies which are most efficient in scrofulosis, and to furnish with each remedy the symptomatic indications belonging to it.. ACONITE is sometimes required in scrofulosis, when the glands are inflamed and hard, or when other symptoms of scrofulous inflammation develop themselves. DOSE.-One or two drops of the saturated tincture of the root, in a tumblerful of water, a small tablespoonful every two or three hours, until the inflammation is subdued. If Aconite should not suffice, BELLADONNA may be resorted to; a few drops, or six globules, in a small tumblerful of water, a small tablespoonful every four hours. RHUS TOXICODENDRON is principally indicated by a stone-hard swelling and inflammation of one of the cervical or submaxillary glands, the neighboring glands being likewise swollen and hard, but less so. DOSE.-Hartman says, that a single dose of Rhus is sometimes sufficient, provided it is allowed to act for several weeks in succession. Next to Rhus, we have DULCAMARA, particularly if the induration of the cervical glands first commenced in consequence of a cold, or of exposure to a damp, chilly air. The glands are swollen to the size of pigeon-eggs, the lymphatic vessels feel like knotty strings, and parts of the head and body are covered with eruptions. DOSE.-One drop of the-brst attenuation three times a day, 508 SPECIAL THERAPEUTICS. CONIUM MACULATUM is an excellent remedy for glandular swellings, if the glands are semi-inflamed, and quantities of Mercury and Sulphur had been administered under alloeopathic treatment, and the glands had acquired a schirrous hardness. DOSE.-Same as Dulcamara. TODIUM, or Iodine, is a great remedy for scrofulous swellings, but it has to be used in the lower preparations, one drop of the first attenuation three times a day, or even one or more drops of the tincture, three times a day. If lodium does not help, we may try in its place, SPONGIA TOSTA, especially if other scrofulous symptoms, such as hardness of hearing, buzzing, etc., are present. DOSE.-Of Spongia, one grain of the third trituration, morning and evening. BARYTA CARBONICA is useful in the treatment of painful glandular swellings and scrofulous indurations of the submaxillary glands. DOSE.-Same as Spongia, AURUM FOLIATUM may be resorted to when the glandular swelling had beeri mismanaged with large doses of Mercury, and had become very hard and painful. DOSE.-One grain of the third trituration, three times a day; instead of Aurum foliatum, Aurum muriaticum may be used, same dose. SULPHUR is frequently a useful remedy for scrofulous glandular swellings if the induration had remained after an acute attack of inflammation. DOSE.-One powder of the third trituration, morning, noon and night, dry on the tongue. After giving Sulphur for a week, give CALCAREA, the same dose as Sulphur, for another week; then discontinue all medicine, or resume Sulphur if necessary. If no impression should be made on the swelling, try TUBERCULOSIS AND SCROFULOSIS. 509 LYCOPODIUM, same dose, every morning and night, for a week; then give MERCURIUS vivus: For another week, same dose; after Mercurius give Sulphur, or else continue Lycopodium and Mercurius alternately, provided an improvement has set in. CALCAREA and SULPHUR are likewise excellent remedies in the higher forms of scrofulosis, when the bones are affected, scrofulous ulcers have broken out, and the slow suppurative process develops hectic fever with evening exacerbations, moderate chills and flashes of heat, disposition to sweat, particularly on the head and trunk, mucus diarrhoea and great prostration; one grain of the third trituration may be given twice a day, of each medicine alternately. When these symptoms are developed, we may, after giving Calcarea and Sulphur for a week, give BELLADONNA, a few drops or six globules in a turiblerful of water, a small tablespoonful every four hours. After giving this for a few days PHOSPHORUS should be substituted, the dose being the same as for Belladonna. In a few days, and particularly if the patient should feel very weak, and the diarrhoea should amount to a perfect lienteria, with discharge of undigested food, we may try CHINA, one drop of the first attenuation in a tumblerful of water, a tablespoonful every four hours. After China an excellent remedy is FERRUM METALLICUM, one grain of the second trituration three times a day, dry on the tongue. MERCURIUS VIVus, may be given if the patient should be troubled with sour-smelling night-sweats, loss of appetite, pappy, uinpleasant taste in the mouth, salivation, etc. 44* _~ ~_ 510 SPECIAL THERA PEUTICS. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every two or three hours. SILICEA may be a most useful remedy, when scrofulous ulcers, with secretion of a thin, lymphatic and rather acrid humor, swollen, pale, hard edges, and a spongy, unclean appearance at the base, have broken out, accompanied with symptoms of constitutional derangement, such as chills and flashes, night-sweats, ner-, vousness, etc. DOSE.-One grain of the third trituration, three times a day. ARSENICUM may be eminently useful in the higher forms of scrofulosis, when the debility is very great, the patient is troubled with a constant thirst, burning dryness of the tongue and throat, distension of the bowels, sallow complexion, emaciation. DOSE.-One drop, or six globules, three times a day. In case Arsenic should have no effect VERATRUM may be used in the same way as Arsenic. OLEUM JECORIS or COD LIVER OIL, is an excellent remedy for scrofulosis, and is frequently used by the best homoeopathic physicians, especially in Germany. Hartmann recommends it very strongly in his work " on the treatment of acute and chronic diseases." He gives it in every form of scrofula, especially in the precursory stage, when no particular organ is affected, when the patient looks pale, emaciated, the muscles become flabby, the patient shows an aversion to meat and vegetables, and wants to eat bread and butter all the time; it is likewise useful in scrofulous affections of the bone DOSE.-A teaspoonful, morning and evening. During the treatment of scrofulous diseases a condition of the system every now and then develops itself resembling fever; the patient complains of feeling chilly, the cheeks look flushed, the pulse is somewhat irritated, TUBERCULOSIS AND SCROFULQSIS. 11, with other symptoms of feverishness which 'may require the exhibition of a dose of Aconite once or twice a day or every other day. A few drops of the first attenuation may be given in a spoonful of water. This method of using Aconite is particularly advisable in the treatment of Infantile Remittent Fever, Which some of the most distinguished European pathologists designate as " acute scrofula." Under alloeopathic treatment this is a very obstinate and very often fatally terminating disorder. Under skilful and persevering homoeopathic treatment the disease is much more manageable, and the chronic disorganizations to which the alloeopathic treatment of this affection frequently leads, are avoided. Children are generally attacked between the seventh and eleventh year, especially during spring; the fever may be induced by a cold, getting the feet wet, a draught of air, etc. The disease runs a course of three oriour weeks; perfect recovery. seldom takes place before that period,. even under homoeopathic treatment. The fever sets in with a.chill, followed by heat. The pulse is up to one hundred and twenty to one hundred and thirty beats, not very hard, rather soft; this frequency continues all night. Toward morning the fever abates, and partial sweat breaks out. After three or fgr remissions of this kind, there sometimes occurs a complete intermission of the fever-symptoms, during which the little patients look.pale and sickly. Suddenly the fever reappears; the children lose their appetite, complain of nausea,.vomit even; they experience pinching pains in the bowels, are troubled with diar 512 SPECIAL THERAPEUTICS. rhcea, resembling stirred eggs; a little hacking cough sets in, attended with stitching pains in the chest here and there, and soreness to the touch, more particularly under the sternum, in the region of the bronchial glands; auscultation reveals murmurs and sanguineous engorgement in the lungs. The fever now assumes a continuous type, the pulse remains constantly frequent, the skin becomes drier, and the urine is secreted in smaller quantities and has a deep color. These are the ordinary and most characteristic symptoms of infantile remittent fever as graphically described by that admirable painter of diseases and correct diagnostician, Professor Schoenlein of Berlin. Recovery is indicated by the breaking out of copious perspiration all over the body; the urine is secreted in profuse quantity, deposits a sediment, and some of the external glands of the neck or groin swell very rapidly and suppurate. The recovery may likewise be partial, and result in the formation of chronic glandular swellings. If dropsical symptom either in the abdomen or chest, supervene, we may safely prognosticate a fatal termination. Infantile remittent fever or acute scrofula requires but few remedies under homoeopathic treatment; they are ACONITE, the IODIDE of MERCURY, and ARSENICUM. We are satisfied that no other medicine is required for the successful treatment of this disease. ACONITE should be administered off and on during the whole course of this disease. We may mix from three to five drops of the first decimal attenuation of the root in about twelve tablespoonfuls of water, and give the child a small dessert-spoonful of this solution every three or four hours. This treatment may be continued TUBERCULOSIS AND SCROFULOSIS. 513 for a few days, and may often give such a favorable turn to the disease, that no other medicine may.be required. All we may have to do is to continue one or. two doses of the same Aconite-solution every day, until health seems restored. If diarrhoea should become troublesome, we may give ARSENICUM, a few drops or ten globules in eight spoonfuls of water, giving a dessert-spoonful every four hours. If fever-symptoms should appear, give Aconite and Arsenic in alternation. IODIDE OF MERCURY will prove useful, if the bowels become large, or glandular swellings show themselves. Give half a grain of the third trituration every six hours. The medicines which have been indicated for scrofulosis generally, may, in some few cases, be of use, partially at least, in infantile fever. The diet which has been recommended for scrofulous conditions generally, should be enforced with the utmost rigor in this case. All pastry, cakes, and made-dishes, should be absolutely forbidden. During the fever the children may eat stewed fruit, sweetened with a very little sugar, rice, hominy, sago, a slice of stale bread every now and then; they may drink fresh, soft water, and occasionally a cup of weak, black tea diluted with milk and sweetened with sugar. Gradually, as the symptoms of convalescence become more and more firmly established, broth without any fat may be given; a little fresh roast beef or mutton, carrots, cauliflower, green peas, and mealy potatoes in very small quantities, and the soft part of oysters and oyster-broth, but no green corn, cabbage, or any. heavy farinaceous or flatulent food. Cleanliness, frequent changes of linen, pure air, frequent ablutions 514 SPECIAL THERAPEUTICS. with tepid or cold water, according to the season, are of the utmost importance. One of the most distressing developments of scrofulosis is Rhachitis, Spina ventosa, bifida. Rickets. This is a morbid alteration of the bones, characterized by swelling, softening, deformity. The following are the general pathognomonic symptoms of the disease, according to Hartmann: 'The frontal and parietal bones recede from each other, the fontanelles do not close, on which account the forehead becomes more prominent, and the head acquires an.unusual size and heaviness; in many cases, hydrocephalus sets in. The head descends towards the shoulders, and the child is constantly trying to rest it on one or the other shoulder. Afterwards the long bones become involved; they become soft, the ends of the bones swell, and the shafts become, in the same proportion, thinner and longer. These swellings are most striking on the radius, elbow-joints, knees, and the lower ends of the tibia and fibula. The clavicles become curved, the shoulders are drawn forward, the spinal column is curved, either from before backwards (kyphosis), or sideways, and sometimes even in different directions (scoliosis), or from behind forwards (lordosis), whence a hollow back with protruded abdomen. This state of the bones leads to dislocation of the ribs and pelvic bones, curvatures and deformities of various kinds, and especially curvatures of the lower extremities, at times from without inwards, and at others from within outwards. The children are constantly seated, squat on the floor, and compress the soft bones more and more, RICKETS. 615 RICKETS. 515 The distortion of the thorax induces asthma, and the abdominal viscera, especially the liver, are constantly compressed, in consequence of the children being constantly seated. If the children should afterwards be able to walk, their gait is unsteady, and they are constantly tottering from side to side. Sometimes the enlarged bones become inflamed, giving rise to local swellings (tophi, osteomalacia), bad suppuration, caries. The digestive organs become deranged, blennorhoea, cutaneous eruptions, exhausting sweats, etc., inake their appearance. Rickets is a very slow disease; it frequently lasts for years, and, if badly managed, leads to malformations of bones, which may be the cause of phthisis, asthma, hydrothorax, miscarriages, unnatural labor, etc. TREATMENT.-The treatment is pretty much the same as that which has been indicated for scrofulosis generally. The daily use of ablutions with cold water, and the use of a tepid bath every other day, are indispensable. Among the medicines which seem to be most effectual in this disease, we have BELLADONNA, CALCAREA, SILICEA, SULPHUR, PHOSPHORUS, the PHOSPHATE OF LIME, PHOSPHORIC ACID, and HEPAR- SULPHURIS. BELLADONNA, two drops morning and night, is one of the principal remedies when the abdomen is hard and distended, when the child's gait is unsteady and staggering, with flabby muscles, pale complexion, occasional flushes, sensitiveness of the pupils to the light, etc. After Belladonna seems to have acted sufficiently, we may give SULPHUR, six globules in the evening, and allow this dose to act for a week, after which, CALCAREA, six globules, may be given, and in a week L ~ 516 SPECIAL THERAPEUTICS. another dose of Sulphur, alternating in this way until the improvement, if there be any, seems to remain stationary. SILICEA may then be resorted to, especially when there is osteomalacia, tophi, and caries of the bones. We may give a powder of Silicea, third trituration, morning and evening, for a week, and if there should be a change for the better, we may let the medicine act until the improvement ceases. After Silicea, we may either have to repeat Sulphur, or give HEPAR SULPHURIS, same dose as Silicea, especially if the affection of the bones is accompanied with suppuration of glandular organs; or else, if the glands are not involved, we may give THE PHOSPHATE OF LIME, third trituration, one powder three times a day, continuing it for about a fortnight, and giving afterwards Sulphur, Belladonna, or some other of the above-mentioned drugs, in the doses indicated. PHOSPHORUS may be required, if hectic fever and a general wasting away have developed themselves, giving a few drops, or six globules, on the tongue, twice every day, morning and night; and, if a few doses should not have any effect, PHOSPHORI ACIDUM may be given, one powder of the third trituration, dry on the tongue, every morning. Afterwards we may give BELLADONNA, a few drops, or six globules, in a tumblerful of water, a small tablespoonful every three or four hours. And, if Belladonna should not seem to act with sufficient energy, we may even give ACONITE, after the Belladonna, one drop of the satu RICKETS. ~j-7 RICKETS. 517 rated tincture of the root, in dessert-spoonful doses, at intervals of from four to six hours. For caries of bones and pedarthrocace, the best remedies are, CHINA, STAPHISAGRIA, SILICEA, MERCURIUS, DULCAMARA, ASAF(ETIDA and MEZEREUM. CALCAREA and SULPHUR are likewise to be numbered among the most efficient remedies for such disorganizations. The medicines may be given in the following order: CALCAREA, one grain of the third trituration, next day SULPHUR, same dose, then again CALOAREA, and so on alternately for a fortnight. Then give SILICEA, one grain of the third trituration twice a day, morning and evening, for one week. After Silicea give CHINA, one drop of the first attenuation, twice a day, and in a week give again Calcarea, and resume the same course of treatment. SILICEA is more particularly indicated if splinters become detached by suppuration. CHINA, when the hectic flushes and night-sweats are fully developed. MERCURIUS VIVUS is particularly indicated by nocturnal exacerbation of the pain, sour-smelling nightsweats, sallow livid complexion, constipation, ptyalism; the joints are carious and suppurate; or the bones are soft and can be crushed with the fingers. DOSE.-One grain of the- third trituration, dry on the tongue, every evening. After Mercurius RHUS TOXICODENDRON may be tried, especially if the glands are swollen, cold and hard, and an aching-lancing pain, with a sense of numbness and coldness is experienced in the limbs. DOSE.-One drop of the first attenuation, three times a day. AURUM FOLIATUM should not be forgotten in caries 45 ~ _ _~ 618 SPECIAL THERAPEUTICS. of the bones, especially the facial and nasal bones, more particularly if the disease arose from abuse of Mercury or originated in a syphilitic taint. DOSE.-One grain of the second or third trituration, dry on the tongue three times a day. Instead of Aurum foliatum, Aurum muriaticum may be preferable, same dose. TARTARUS EMETICUS may prove useful in caries of the skull-bones. DOSE.-One grain of the third trituration three times a day. STAPHISAGRIA has likewise been tried with more or less success in inflammation and caries of bones, especially in affections of the hip-joints, when suppuration threatened to set in. DOSE.-One drop of the first attenuation, three times a day. MEZEREUM was given by Dr. Hartmann in a case of scrofulous excoriation of the nostrils and fauces, with success. The disease disappeared in a week after one drop of the third attenuation. ASAFUETIDA is recommended by some for scrofulosis of the bones, characterized by inflammation, swelling, softening, curvature and caries; others, on the contrary, doubt its efficacy in this disease, except where the symptoms can be traced to mercurial action. DOSE.-A few drops of the first or second attenuation, three times a day. ACONITUM, STRAMONIUM and LAUROCERASUS may be resorted to as intermediate remedies in carious affections of the joints. ACONITUM, if the parts feel sore and lame. DOSE.-One or two drops, or six globules, to be repeated in four or six hours, if necessary. STRAMONIUM, when the patient experiences a sensation of distressing weakness in the joints of the extremi ties, as if the parts were separated from the body. DOSE.-Same as Aconite. HIP-DISEASE-HYDROCELE. 519 LAUROCERASUS for a sensation as if the joints were put loosely together. DOSE.-Same as Aconite, Oleum jecoris or Cod-liver oil is highly recommended by many homoeopathic physicians in this disease, a dessert-spoonful to be taken morning, noon and night. For the surgical treatment of this affection, the use of braces and bandages, we refer the reader to the chapter on Surgical Diseases. Hip-Disease or Morbus Coxarius, and White-Swelling or Tumor Albus, Which constitute one of the most insidious and formidable forms of scrofulosis of the joints, will be more fully described, together with the treatment, in the chapter on Surgical Diseases at the end of the work. The treatment of rickets and caries of bones generally, as indicated in the previous paragraphs, may likewise be consulted in connection with the details furnished in our last chapter. Another disorganization resulting from scrofula is, Hydrocele or Dropsy of the Scrotum. This disease generally attacks persons in the decline of age. The testicles are surrounded by several coverings or membranes; the water collects under these integuments and can be removed by resorting to the process of tapping, which has to be conducted by a surgeon. It is doubtful whether this disease, if fully developed, can ever be cured by internal treatment; we may try, however GRAPHITES and SILICEA alternately, giving one drop, _____ 520 SPECIAL THERAPEUTICS. or six globules of Graphites first, and in three days a similar dose of Silicea, alternating the two remedies for a few weeks. If the disease is curable, symptoms of improvement will then begin to show themselves. PULSATILLA and MERCURIUS may sometimes be required as intermediate remedies, especially when the hydrocele resulted from previous inflammation or was more immediately caused by a cold, by some external injury, or by a syphilitic taint; in the latter case Mercurius solubilis may be used; for hydrocele caused by suppression of gonorrhoea, see gonorrhoea. DOSE.-One drop of the third attenuation of Pulsatilla, or one grain of the third trituration of Mercurius. If Mercurius solubilis has no effect, we may use MERCURIUS CORROSIVUS in the same way as Mercurius solubilis. ACONITE may be necessary, if the effusion is the result of previous inflammation which had been mismanaged by allceopathic or other treatment. If Aconite has no effect under these circumstances we may use IODINE, one or two drops in a small tumblerful of water, a tablespoonful every two or three hours. ARNICA may be employed when the disease originated in mechanical injury. We do not believe, however, that Arnica does much good in such disorganizations, as its true curative sphere seems to be contusions, bruises, lacerations of the muscular fibre. However, the Arnica may be used, alternately with Pulsatilla; of Arnica mix a few drops or ten globules in a tumblerful of water, and of Pulsatilla the same dose in another tumblerful, giving an alternate dose, of a small tablespoonful each, every two hours. If these medicines do not remove the disease, we shall then be obliged to have recourse to an ----Y SCROFULOUS OPHTHALMIA. 521 anti-psoric treatment, and employ principally the previously-mentioned remedies, CALCAREA, SILICEA and GRAPHITES. For the treatment of dropsical affections generally, the reader is referred to the end of this chapter, a few pages further on. We have deemed it advisable not to complicate a description of their treatment with the few details contained in this and the following chapter, on Scrofulous Ophthalmia. This distressing affection generally attacks children, scarcely ever full-grown persons. The inflammation generally attacks the conjunctiva of the eyeball and lids, although the cornea is likewise affected in many cases. There is considerable photophobia, so that the least ray of light sometimes proves exceedingly irritating, causing a spasm of the lids, and a profuse discharge of acrid tears. The sclerotica is of a rose-color, and bundles of vessels run towards the cornea which frequently becomes dim from the extravasation of lymph between the lamellae or layers of the cornea, or from the phlyctzenm or vesicles which develop themselves on the cornea and frequently change to ulcers. This inflammation, if not properly attended to from the first, may lead to permanent disorganizations of the cornea, lids, etc. TREATMENT.-A variety of remedies are mentioned in the books for this disease, but we venture to affirm that even the worst cases of scrofulous ophthalmia will yield to the judicious use of the following medicines: AcoNITE, BELLADONNA, CALCAREA, SULPHUR, ARSENIC, EUPHRASIA, MERCURIUS CORROSIVUS. ACONITE should be exhibited if the inflammation is 45* 522 SPECIAL THERAPEUTICS. characterized by intense redness, photophobia, spasmodic closing of the lids, profuse discharge of acrid tears, and aggravation in the night. DOSE.-One drop of the saturated tincture of the root, a small tablespoonful or dessert-spoonful every two hours. The common tincture made from the stems and leaves of the plant, is much less efficacious in this disease than the root, the globules are of little use; but the tincture of the root may be looked upon as one of the very best remedies for Scrofulous ophthalmia. Continue the medicine until a decided improvement sets in. If Aconite alone should fail of producing decided relief, alternate it with ARSENIC, one grain of the third trituration three times a day, continuing the Aconite every two hours. In many cases this treatment will be sufficient. SULPHUR is more particularly indicated when the inflammation is unaccompanied with lachrymation, and the eye is generally dry and itching. DOSE.-One drop or six globules three times a day. This medicine may be alternated with CALCAREA, same dose, two doses of each every day; Calcarea is likewise indicated if there is a good deal of ulceration of the lids, and a quantity of pus is discharged from the canthi or from the Meibomian glands in the lids. If these glands appear swollen, hard, sore, give MERCURIUS CORROSIVUS, one drop of the third attenuation three times a day; many excellent homoeopathic physicians apply the mercurial preparation externally in the shape of an ointment. Mercurius may be alternated with SULPHUR, of which one grain of the third trituration may be given morning and night. BELLADONNA may be exhibited in scrofulous ophthalmia, when the eye remains dry, but the sensitiveness to the light is excessive. DOSE.-One drop, or six globules,, morning, noon and night. EUPHRASIA is indicated by symptoms similar to those .ACUTE OPHTHALMIA. 523 of Aconite, except that the sensitiveness to the light is less. DOSE.-A few drops of the first attenuation, or even of the tincture, three times a day. This medicine may be given occasionally as an intermediate remedy. WATER: The sore eyes may be bathed quite frequently with either cold or tepid water, which ever is most agreeable to the patient. Tepid milk and water is sometimes very soothing. Exposure to dampness, cold and sharp winds, draughts of air, should be strictly avoided. Diet to be plain, but nourishing. Avoid stimulants and read over the treatment indicated in the chapter on Scrofulosis generally. The eyes are subject to a variety of derangements to which we will briefly refer in this place, in order to preserve the unity of the subject. Acute Ophthalmia, Acute Inflammation of the Eyes. Having described the characteristic symptoms and the treatment of scrofulous ophthalmia, we will now describe the treatment of a common inflammation of the eyes, such as may be induced by a cold, a mechanical injury, and by other causes. The eye being composed of different membranes or tissues, we may have to contend with more than one group of inflammatory symptoms. W e may have a. Conjunctivitis, or Inflammation of the Conjunctiva.-- The conjunctiva is a delicate mucous pellicle which constitutes the outermost membrane or covering of the visible portion of the eyeball, and likewise lines the inner surface of the eyelids, thus uniting the lids to the globe of the eye. The moisture secreted by the conjunctiva serves to lubricate the globe of the eye, to faci I~C--TL--~-~~-~"I~-~1~---~1-~11-- - 524 SPECIAL THERAPEUTICS. litate its motions in the orbit, and to prevent friction, which would soon cause pain and develop inflammatory symptoms. If foreign substances, dust, sand, etc., get into the eye, the conjunctiva becomes irritated and more or less inflamed, and it endeavors, by an increased secretion of mucus, to protect the eye from the mischievous consequences of the intrusion, and to expel the foreign body. The conjunctiva may likewise become inflamed in consequence of exposure to dazzling light, wind, a cold, etc. This inflammation is characterized by the following symptoms: The conjunctiva looks red, feels dry, as if the eye were full of sand; after a certain period a copious secretion of tears and of purulent mucus may take place; there is great sensitiveness to the light, stinging pains, a distressing feeling of heat, and, if the inflammation is very severe, the patient often complains of heavy, aching, and tearing pains over the eyebrows. This inflammation, unless radically cured, may leave the eye weak, and the sight may remain permanently obstructed by thickening or hypertrophy of the conjunctiva and the consequent loss of its transparency. Conjunctivitis may assume a most malignant and destructive form. We allude to a form of conjunctivitis which is described by writers as purulent ophthalmia. The secretions which are at first of a mucous character, as in ordinary catarrhal conjunctivitis, soon change to a purulent/ substance. The conjunctiva presents a puckered appearance, and is sometimes raised all round the cornea like a little pad, a condition which physicians term chemosis. The pain finally becomes agonizing, and the eye is often destroyed by the disease The British hospitals of Chelsea and Kilmainham contained at one ACUTE OPHTHALMIA. 525 time two thousand three hundred and seventeen soldiers totally blind in consequence of this disease. Purulent conjunctivitis may be induced by various causes; it may result from a peculiar strumous or scrofulous condition of the system, in which case it may be considered as a form of scrofulous ophthalmia; we may term it a. Strumous, or Scrofulous Conjunctivitis.-Or the affection may be caused in new-born children by the contact of acrid matter from the vagina with the eyes of the child, during its passage into the world; this form is known as b. Purulent Ophthalmia of new-born Infants.-And lastly, the disease may be caused by the contact of gonorrhoeal or syphilitic matter with the eye, producing c. Gonorrhoeal Conjunctivitis.-Some writers assert that this form of conjunctivitis may be occasioned by the metastatic action of the gonorrhoeal virus upon the eye. Others reject this doctrine, and assert that this inflammation can only result from the actual contact of gonorrhceal matter with the eye. Our own belief is that it may be produced by either cause. It is a most dangerous form of opththalmia. Emigrants to California, who reside along the seashore, are sometimes attacked with a malignant and exceedingly obstinate form of conjunctivitis, which very speedily threatens to result in the disorganization of the cornea and conjunctiva. If the conjunctiva is very much inflamed, the membrane which is immediately covered by it in front of the pupil, and which we term cornea,.becomes likewise inflamed. In this case we have both conjunctivitis and c. Corneitis, or Inflammation of the Cornea-The cornea is a transparent horny membrane composed of several 526 SPECIAL THERAPEUTICS. layers superimposed one upon the other. It is convex anteriorly and concave posteriorly, forming nearly onefifth of the anterior part of the eye in front of the pupil. It is an insidious disease, coming on gradually; at first the cornea may simply present a hazy appearance or look like glass that has been'breathed upon; at a later period of the disease, the vessels of the conjunctiva and sclerotica (another enveloping membrane of which we shall speak presently,) become injected; those of the sclerotica sometimes encircle the cornea like rays from a centre; and the delicate capillary network of the conjunctival membrane extended over the cornea, sometimes becomes so distinct that it covers the cornea like a piece of red cloth, a condition which pathologists term pannus. The pains are those which usually characterize ophthalmia, shooting, burning pains, sensitiveness to the light, lachrymation, etc. The disease may terminate in destruction of the cornea, effusion of coagulable matter between the layers of the cornea which becomes organized tissue and causes thickening and opacity of the cornea; the cornea may become ulcerated, break, giving rise to protrusion or prolapsus of the iris, etc. Back of the cornea we have the chambers of the eye, filled with a fluid termed the aqueous humor. Suspended in this fluid, from above downwards, is a delicate, highly vascular, and nervous circular membrane, the iris, which gives expression to the eye, and is perforated in the centre by the pupil for the transmission of the rays of light. The iris is an exceedingly sensitive little membraneous veil which may become inflamed from various causes. This form of ophthalmia is designated as c. Iritis, Inflammation of the Iris.-One of the principal ACUTE OPHTHALMIA. 527 causes of iritis is an operation for cataract. Acute iritis is a very dangerous inflammation which may speedily terminate in the destruction of sight. If it has a catarrhal origin, the disease is much more tractable than when resulting from a constitutional syphilitic taint. It may also originate in gout, and develop itself as a scrofulous or strumous disorder. The treatment has to be modified in accordance with these differences of origin. If inflamed, the iris loses its brilliancy, and we likewise notice a change of color. An iris, for instance, which is naturally blue, becomes purple, gradually changing to a black or greenish-black, and finally assumes a dingy-green or grass-green color. The iris also loses its contractility; the pupil remains insensible to the light, sometimes widely dilated, but generally irregularly contracted. Adhesions may also take place between the pupillary margin of the iris and the crystalline lens behind, or the cornea in front. Sometimes a coagulable lymph is effused into the anterior and posterior chamber, causing obscuration of vision and often total blindness. The inflammation is attended with a violent pain in the frontal region, over the eyebrows, intense photophobia, lachrymation, and very frequently delirium. The treatment will be indicated at the close of our description of these various forms of ophthalmia. Dividing the interior of the eye into four-fourths, we have at the union of the first fourth with the three last fourths, and adjoining the posterior half of the chamber which contains the aqueous humor, the crystalline lens. This is a lenticular, transparent body, the object of which is to collect the impinging rays in one focus as it were, for which purpose it is so placed, that the axis of the lens corresponds exactly to the centre of the pupil. ~-----~----~---------~~----------------- 528 SPECIAL THERAPEUTICS. It is shaped like a double convex lens, the posterior surface of which is more convex than the anterior. There is a little space between the anterior surface and the iris, which is filled with the aqueous humor, and is termed the posterior chamber. The lens is enveloped in a capsule, which is perfectly transparent in a healthy state, but may become opaque, when it constitutes a capsular cataract. The body of the lens itself may likewise lose its transparency, forming what physicians term a lenticular cataract. On removing the lens we arrive at the vitreous humor, a transparent jelly-like mass, which nearly fills the posterior three-fourths of the globe of the eye, and is so named from its resemblance to glass. It is enveloped in a very delicate membrane termed the hyaloid membrane, which dipping into the substance of the humor, separates it into an irregular number of compartments or cells. Having removed the vitreous mass, we next observe the Retina, the immediate seat of vision. It is essentially a nervous membrane, and by most physiologists believed to be a terminal expansion of the optic nerve. This nervous network may become inflamed, constituting a form of ophthalmia which physicians term d. Retinitis, Inflammation of the Retina.--This inflammation is not very common, and generally exists only as an accompaniment of other forms of ophthalmia. Like all other forms of acute inflammation, retinitis is attended with high fever; there is an intense, deep-seated, aching pain in the socket, which is often complicated with signs of cerebral inflammation. Light is unbearable; the patient is troubled with all sorts of spectral illusions; the iris is motionless, the pupil contracted, and the eyeball exceedingly sensitive to the least motion. Retinitis ACUTE OPHTHALMIA. 529 is a most dangerous form of inflammation which may terminate in extensive disorganization of the internal structures of the eyeball, in purulent effusion and consequent rupture of the cornea, with collapse of the whole organ of vision. Chronic retinitis is much more common than the acute form. The chronic form is characterized by a deep-seated, dull, aching pain in the back part of the orbit, sensitiveness to the light, visual illusions, diminution of visual power, and finally loss of contractility of the iris, and consequent destruction of sight. Next to the retina, we have another membrane, the choroid, which is an exceedingly vascular membrane, and is covered with a black pigment. This membrane seems to be more particularly instrumental in supplying nourishment to the eyeball; it is covered on the outside by the last and most external membrane of the globe of the eye, termed the sclerotica. This is a thick and strong fibrous membrane, unyielding, and enveloping the whole eyeball, except in front, where it presents a circular opening, into which the cornea is fitted. It is of a pearly white color, and is known in common parlance as the whites of the eye. This membrane is likewise liable to becoming inflamed. This form of ophthalmia consti. tutes e. Sclerotitis, or Inflammation of the Sclerotica.-Inflam,mation of the sclerotica is generally of rheumatic origin. The eye looks red, the congested blood-vessels of the selerotica are seen running towards the cornea, round which they form a vascular wreath, which encircles the whole of this membrane. The pain is of a stinging and often tearing character, worse at night. There is profuse lachrymation and great photophobia. The sclero46 830 SPECIAL THERAPEUTICS. tica enveloping the whole eyeball, the pain must of necessity be felt all round the orbit, frequently darting down the cheeks, and extending to the forehead. An inflammation of this kind involves more or less other parts of the eye, particularly the conjunctiva; the iris likewise becomes less active. Fever is always present. Aseegards the treatment of these different forms of ophthalmia, it will be found that the same medicines are required more or less for the whole of them. We here subjoin a list of the principal remedies for ophthalmia; the indications for their use, in the different forms of this disease, have been simplified as much as was found consistent with correctness and lucidity. One of the principal remedies in ophthalmia is ACONITUM: it is indispensable in every form of ophthalmia, which is not of a syphilitic origin. The indications for its use are both local and general. Among the general or constitutional indications, we distinguish high fever, which is often preceded by a violent chill; intense. pain over the eyebrows, and very frequently delirium. The local symptoms are exceedingly numerous: pains of various kinds, stinging, shooting, deep-seated aching, throbbing, burning and tearing pains; photophobia (sensitiveness to the light), excessive dryness of the eyeball, or else profuse secretion of tears (lachrymation), secretion of purulent mucus, redness of the eye, sensation as if the eyes were full of sand or sharp points; lesser degrees of inflammation are sometimes attended with furious itching. DOSE.-In acute ophthalmia, we never hesitate to give the tincture of the root, one or two drops in about twelve tablespoonfuls of water, of which solution we give a tablespoonful every hour, or less frequently, according as the existing symptoms may be more or less intense. This medicine is often sufficient, if judiciously used, to cure the most violent forms of uncomplica. _ ~ ACUTE OPHTHALMIA. 531 ted acute ophthalmia. We once made an Alloeopathic surgeon of note, confess that Aconite cured a case of Iritis. He had operated upon a patient for cataract. The medical treatment, if any should be required, was to be conducted by us. Iritis set in, and we put the patient on the use of Aconite, as stated above, and had the satisfaction of seeing the inflammation completely cured in about five days from the time when the treatment commenced. BELLADONNA is another great agent for the treatment of ophthalmia. The indications for Belladonna are somewhat similar to those of Aconite. The sensitiveness to the light is frequently so intense, that exposure to the rays of light causes maddening pain, with delirium. The eyeball is dry, red, protruded; the pupil is either very much contracted or else dilated; the inflamed eye has a glistening, sparkling expression; at times the face looks red and bloated, on account of the excessive determination of blood to the brain; the skin is dry and warm, the pulse quick, rather full; urine red, bowels bound. Two or three drops of this medicine may be mixed in twelve tablespoonfuls of water, to be given in spoonful doses every two hours, or, if we prefer, in alternate doses with Aconite, a dose every half hour or hour, until an improvement has been accomplished. Belladonna will be found particularly useful in iritis and retinitis, though likewise adapted to the other forms of ophthalmia. APIS MELLIFICA or the honey-bee poison is another drug which has been introduced more recently as a remedy for ophthalmia, particularly for conjunctivitis It is indicated by the symptoms which usually characterize conjunctivitis, sensitiveness to the light, injected condition of the conjunctiva, secretion of mucus, agglutination and swelling of the lid, sense of roughness and sticking feeling in the eyes, etc. We may mix a few drops in a small tumblerful of water, and give a table ~_ 532 SPECIAL THERAPEUTICS. spoonful of this solution every three or four hours. If the symptoms are very severe, and fever is present, it will be well to give a few doses of Aconite before we give Apis, or to alternate these two agents. MERCURIUS vivus will be found admirably adapted to conjunctivitis, if the following symptoms are present: the conjunctiva looksinjected, with sensation of roughness in the eye as from sand, or as if a sticking body had got into the eye; this feeling excites a constant desire to wipe the eye, for the purpose of removing the supposed intruder. In the first stage of the disease, a watery fluid is secreted in abundance: afterwards this changes to thick mucus and pus; the lids are agglutinated in the morning, and the eye is tolerably sensitive to the light; at times the patient experiences a good deal of itching, there is very little fever, at most a sense of coldness followed by an increase of warmth, and dryness of the skin; the pulse is soft, and a little quicker than usual. In severe cases, we prescribe a powder of the third trituration dry on the tongue every four hours; in milder forms, a few globules, or one or two drops of the attenuated Mercury in a tumblerful of water, a tablespoonful every three or four hours. EUPHRASIA is recommended for conjunctivitis, when the discharge of water and mucus is very profuse, with redness of the eye and great photophobia. Give a few drops of the tincture in half a tumblerful of water, a tablespoonful every two or three hours. PULSATILLA is another excellent remedy for conjunctivitis and sclerotitis, more particularly in the case of females, if the disease is caused by a cold and accompanied with menstrual suppression; the eye looks red, injected; there is profuse secretion of tears and mucus, _ ___ _____________1_1_________ ACUTE OPHTHALMIA. 583 photophobia, with stinging, shooting, lancinating, boring and burning pains; the lids are likewise inflamed, swollen, with tendency to the formation of styes. Mix a few drops of the first or second attenuation in ten tablespoonfuls of water, and give a tablespoonful every two or three hours. This medicine is also particularly suitable, if the disease has a rheumatic or arthritic character. SULPHUR is another good medicine in chronic conjunctivitis, sclerotitis and corneitis, if the disease can be traced to the suppression of some cutaneous disorder by means of ointments or washes. It is also adapted to chronic conjunctivitis in scrofulous patients; in their case it may be alternated with CALCAREA CARBONICA or with the IODIDE OF MERCURY. Give a powder of the third trituration, dry on the tongue, three times a day. (See "Scrofulous Ophthalmia.") PHOSPHORUS is excellent in chronic conjunctivitis; the conjunctiva has a rose-colored tinge; mucus is secreted in the canthi the eyes are sensitive to the light. Give a few globules or one drop three times a day. ARSENICUM, which we have recommended for scrofulous ophthalmia (see this article), is likewise adapted to conjunctivitis, if arising from a cold, more particularly if the secreted fluid or mucus is of an acrid, corroding nature; the pain is intensely burning, and the photophobia very great. We give a powder of the third trituration dry on the tongue every six hours. NITRI ACIDUM is useful in purulent ophthalmia, especially when originating in a syphilitic taint. In nonsyphilitic purulent ophthalmia this medicine should be used in alternation with Aconite; of the acid mix a few drops of the first or second attenuation in ten tabie46* I _ ___ 534 SPECIAL THERAPEUTICS. spoonfuls of water, giving a tablespoonful every tw3 hours. For syphilitic ophthalmia we use NITRI ACIDUM, and the mercurial preparations, more particularly MURCURIUS SOLUBILIS, MURCURIUS CORROsIvUS and the IODIDE OF MERCURY; of any of these drugs a powder of the third trituration may be given every three hours dry on the tongue. In the severer forms of ophthalmia, the medicines may sometimes have to be continued for some time, one or more weeks, extending the intervals between the doses according as an improvement takes place. In regard to the use of eye-washes, we would observe, that a simple eyewash may sometimes prove very soothing, especially in tedious chronic cases. Bathing the eyes with a little rose-water, two or three times a day, may be very pleasant and strengthening. Some patients derive benefit from the external application of a teaspoonful of brandy in a cupful of tepid water. In acute ophthalmia it some. times affords great relief to bathe the inflamed eye frequently with cold water. Patients under treatment for acute ophthalmia have to be very careful not to check an existing perspiration by exposure to a draught of air or by placing the bare feet upon the floor. In one case which we treated recently, a sudden arrest of the perspiration caused a frightful relapse with most agonizing pain, intense fever, etc. We had the patient enveloped in hot blankets; the perspiration soon reappeared, the pain abated, and the treatment which we had instituted soon effected a cure. An inflammation of the lids, blepharophtitis, is best treated with ACONITE, BELLADONNA, PULSATILLA, STRAMONIUM, SULPHUR, the IODIDE OF MERCURY, CALCAREA and HEPAR SULPHURIS. STYE, SORE EYES, WEAK EYES. In scrofulous individuals, this inflammation is quite common, and is generally characterized by the supervention of inflammatory little tumors, resembling styes. In chronic cases, a whitish scurf is seen in the eyelashes, which are apt to fall out. For the general indications, we refer the reader to the symptoms mentioned in the preceding pages. If the inflammation is acute or subacute, we use ACONITE, BELLADONNA, STRAMONIUM-the.last named particularly, if the margin of the lids is ulcerated; and in scrofulous subjects, HEPAR SULPIIURIS, SULPHUR, and the IODIDE OF MERCURY; giving these medicines in the same doses as mentioned above. In chronic cases we use these same medicines at longer intervals, and likewise CALCAREA. For a common Stye, Hordeolum, We give PULSATILLA, one or two drops, three times a day, and, if the inflammation is very severe, we alternate this drug with ACONITE, same dose, a dose every three or four hours. What people term Sore Eyes, Is simply the chronic form of the various forms of ophthalmia which have been described in this chapter; the treatment is to be conducted with the same medicines that we have recommended for the acute form, except that they may be given at longer intervals. Weak Eyes Are a common complaint of persons who have to strain ~_ 536 SPECIAL THERAPEUTICS. their eyes by fine work, or work at candle-light, reading, etc. The most natural remedy for weak eyes is not to use them much. Strong gas-light is injurious. Bathing the eyes with a little weak brandy and water may be very soothing and strengthening. Weak eyes are generally a sign of scrofula. If the eyes are inflamed, if they itch and burn, and weep much, we may give a drop or six pellets of ACONITE, morning and night. If they are very dry, we may alternate BELLADONNA with Aconite, same dose. SULPHUR, three globules every night, dry on the tongue, may be of use in the case of scrofulous persons subject to eruptions; so may ARSENICUM, if the cornea looks hazy, as if the eyes saw through a fog; give three globules, morning and night. Watery Eyes Require the same treatment as weak eyes. The eyes water in the room, and feel dry in the open air. We use the same medicines: ACONITE, ARSENICUM and SULPHUR, as for weak eyes. If the disease is obstinate, a cute is often impossible, principally because the patients get tired of treatment. Falling of the Lids May be congenital, or the result of paralytic weakness. If congenital, it is incurable; if from weakness, we may treat it with ACONITE, BELLADONNA, and STRAMONIUM, giving one or two drops of Aconite one evening, and the SQUINTING, WEAKNESS OF SIGHT. &S7 same dose of Belladonna the next. Repeat this treatment for a week, every now and then. Squinting, Strabismus. This condition of the eye, which is owing to excessive contraction of one of the muscles of the eye, has generally to be remedied by an operation. In recent cases, we may succeed by means of treatment. The best remedies are ACONITE, BELLADONNA, Nux VOMICA, or STRYCHNINE. We give two or three drops of the first attenuation of any of these drugs, three times a day, except Strychnine, of which we may give a powder of the first centesimal trituration, three times a day. Weakness of Sight, Amblyopia, May arise from various causes. Persons afflicted with weakness of sight are generally more or less scrofulous. Weakness of sight may terminate in complete blindness. It may be caused by excessive watching, by nightly studying, by the pernicious vice of onanism, and by other causes. Persons afflicted with this weakness have to guard their eyes against all exposure to dazzling light; they may bathe the eyes frequently in cold water; they should never fatigue the eyes by sewing, reading, or fine work. Sometimes we succeed, by dint of care and treatment, in restoring such eyes to a somewhat normal condition. The medical treatment consists in the use of ACONITUM and BELLADONNA, in alternate doses, a few drops of each every alternate evening in a little water. These two medicines are most commonly indi 538' SPECIAL THERAPEUTICS. cated in affections of the eyes resulting from an irritated or weakened condition of the retina. ACONITE is indicated, if the patient is subject to attacks of vertigo, sudden blackness of sight, the eyes look blood-shot, feel dry, hot, and sometimes itch a good deal. Other symptoms are: twitching of the lids, a sense of quivering in the globe of the eye; objects look blurred, hazy; a dull aching pain is often experienced in the back part of the orbit. The symptoms.generally point to chronic retinitis. If this weakness should go on increasingly, it might terminate in complete loss of innervation and consequent blindness. BELLADONNA has somewhat similar symptoms to those of ACONITE; in addition the pupil shows a greater tendency to remain dilated; the patient sees very indistinctly; the eyes look red, are affected with spasms; tremulous quivering of the letters while reading; red rings around the candle-light; and other optical illusions, such as: stars and silvery clouds at the ceiling, flames before the eyes; bright spots before the eyes; one sees things double or upside down. PULSATILLA may be of service, if the weakness is attended with, or more or less depending upon, menstrual difficulties, with boring, aching, and lancinating pains in the eyeball. Of any of these three drugs, we may give six globules or one or two drops of the first or second attenuation every morning and night. HYOScYAMus has considerable power over the visual nervous apparatus; it causes obscuration and even complete loss of vision, vibratory appearances before the eyes; appearance as if one had been weeping; optical illusions, things look scarlet-red, smaller or larger than they really are; one sees objects double; the lids close AMAUROSIS, OR BLINDNESS. 539 spasmodically. We may give a drop or two morning and night. S STRAMONIUM, when the person is only able to distinguish words at a distance; he sees things double as if one object were placed a little above the other; he only sees one half of an object as if it were cut through; objects look blurred, hazy, the darkness of vision is followed by a deep-felt pressure in the middle of the eyeball; the margin of the lids is ulcerated. Same dose as for Hyoscyamus, or three doses a day. ARSENICUM may be useful, if the weakness is owing to dimness of the cornea, grayish spots in the conjunctiva, the eyeball looks dull, shrunk; particularly adapted to scrofulous individuals. Give six globules or one drop morning and night. SULPHUR and the IODIDE of M1ERCURY are useful to scrofulous or other individuals, if the weakness arises.from chronic irritation of the conjunctiva or cornea; the eye feels dry, rough, looks blood-shot, or mucus is secreted in the corners (termed canthi); the pupil is not affected. DOSE.-One powder of the third trituration morning and night. A weakness of sight may gradually terminate in Amaurosis or Blindness. An acute attack of amaurosis is curable under homoeopathic treatment. It may be owing to rheumatic paralysis of the optic nerve, in which case we treat it with ACONITE and BELLADONNA, used alternately, a few drops of each in a separate tumblerful of water, giving a tablespoonful every two or three hours. Beer mentions 540 SPECIAL THERAPEUTICS. a case of amaurosis which resulted from violently repelled itch; he restored the itch by giving SULPHUR internally, in doses of one-sixteenth of a grain, and the patient recovered the full use of his sight. If amaurosis results from a general marasmus of the globe of the eye, it is incurable. HYOSCYAMUS and STRAMONIUM may be of service; the indications are the same as under " Weakness of Sight." The treatment of amaurosis has to be conducted by a skilful physician. Scrofulous Otitis, Inflammation of the Ear. Scrofulous individuals, particularly children, may be attacked with inflammation of the ear, which is an exceedingly distressing disease. A common inflammation such as may be caused by a cold, though painful, is easily manageable under homoeopathic treatment. If such an inflammation attacks scrofulous persons, and the scrofulous virus becomes roused, it may become a very intractable disorder, entailing chronic weakness of hearing, discharges from the ear, earache, and even partial or total destruction of the organ of hearing, upon the sufferer. The ear which is the organ for the transmission of sound to the brain, is distinguished into the external ear, the middle ear or drum, (tympanum,) and the internal ear or labyrinth, whose wonderful mechanism is enclosed within the hard, bony prominence situated immediately behind the external ear. From the interior of the drum a canal leads to the upper part of the pharynx; this canal is termed the tube or trumpet of Eusra SCROFULOUS OTITIS. 541 chius, and serves to establish a communicationi between the vibratory movements of the atmospheric air passing through the ear. If this canal should become obliterated or closed, as it sometimes may be by abnormal secretions, (ear-wax, for instance,) deafness ensues. The drum of the ear is traversed by a chain of little bones which, from their respective shapes, are termed the hammer, anvil, handle and stirrup. These bones or ossicula are set in motion by means of very delicate muscles attached to them; they are indispensable instruments in effecting the perception of sound. In malignant forms of otitis, these little bones may become destroyed by ulceration, a result which inevitably entails deafness. Otitis is a very painful disease on account of the extreme delicacy and sensibility of the tissues which compose the internal ear. The organ of hearing being composed of three parts, we may have. a. Inflammation of the external ear, characterized by redness, tumefaction, pain and heat, accompanied by a discharge of mucus and pus from the external passage, or technically termed external meatus. b. Inflammation of the middle and internal ear. This is a most distressing disease. The pain in the inner ear is a hard throbbing, darting pain which sometimes extends to the brain; the inflammation readily terminates in the. formation of an abscess which may discharge through the outer passage and likewise through the Eustachian tube. The drum of the ear or the little bones are often destroyed by this inflammation. This inflammation may be attended with violent delirium; a high degree of fever is always present. Full-grown persons are very seldom attacked with 447 __ 542 SPECIAL THERAPEUTICS. inflammation of the ear; scrofulous children are most liable to this disease. We treat this inflammation with ACONITE, BELLADONNA, PULSATILLA and MERCURIUS VIVUS. ACONITE is indicated by the following symptoms: acute inflammation of the external ear; it looks red, swollen and is very hot; or if the inner ear is inflamed, the patient complains of beating, shooting, lancinating pains, with excessive sensitiveness to noise; buzzing and whizzing sounds in the ear; discharge of pus and blood from the ear, distress in the head, delirium, fever. DOSE.-A few drops, or ten globules, in a small tumblerful of water, of which a tablespoonful may be given every hour, until the patient feels relieved. This medicine is often sufficient to remove the whole difficulty. It may however be necessary, in the case of scrofulous children, to give a drop of the tincture of the root instead of the attenuated drug, in the same quantity of water; also the same dose. BELLADONNA is particularly suitable in scrofulous otitis, if dark-red blood is discharged from the ear. The pain is deep-seated, a hard throbbing pain, with pressure and tearing, as if the ear would be pushed out of the head; the ear looks dark-red and the internal passage is likewise inflamed as far as can be ascertained. DOSE.-Same as Aconite, with which Belladonna may be given in alternation, especially if the brain seems to be involved in the inflammation, the patient complains of great distress and noises in the head, with delirium. PULSATILLA is an excellent remedy for otitis, with or without scrofulous complication; the ear feels hot internally and externally, with discharge of pus, excessive sensitiveness to sound, distress in the head, noises in the ear and head, lancinating and throbbing pains. It is particularly suitable if the affection is accompanied by menstrual suppression. DOSE.-Two drops, or ten globules, in a tumblerful of water, a tablespoon ~"~1~1111111111---~1--------- ~- ~ CHRONIC DISCHARGES FROM THE EAR. 543 ful every hour, or two hours, until the patient is relieved. If the fever is high, Pulsatilla had better be given in alternation with Aconite. MERCURIUS VIvus is a capital remedy for otitis, if the pains are much worse at night, the pains are beating and tearing; the internal ear, and the bones behind and below the ear feel sore as if they would ulcerate; pus is discharged from the ear; the distress in the ear is great; the patient complains of a distressing buzzing and whizzing. noise in the head. The external ear does not look very red and inflamed, nor is there much fever. DOSE.-One drop, in six tablespoonfuls of water, of which a tablespoonful may be taken every four or six hours. If the symptoms of constitutional scrofula are well developed, we may resort to the IODIDE OF MERCURY, third trituration, giving a powder every six hours. HYGIENIC REGIMEN: Persons who are subject to otitis, should never walk in the wind; they should protect the internal ear from all irritations by cold air, wind, water, or violent noise. It is also advisable not to sleep on feather-pillows. During the treatment the pain may be soothed by warm fomentations of milk, slippery elm, or bread and milk poultices. Chronic discharges from the Ear Are very common among scrofulous individuals who had been affected with previous inflammation of the ear. Among children they are apt to remain as a sequel of measles or scarlatina. The ear must be kept perfectly clean by washing it frequently with tepid milk and water. Every now and then the inner ear may be carefully and gently injected with this liquid by means of an appropriate syringe. It is proper to wear a little 544 SPECIAL THERAPEUTICS. cotton in the ear. The remedies are the same as those recommended for otitis. ACONITE is particularly suitable if the discharge has a dark greenish-yellow or brown appearance, of a thin and purulent consistence, and having a very offensive smell. Under careful homoeopathic treatment discharges of this kind are not apt to remain after acute eruptive diseases, or after acute otitis; but under alloeopathic treatment this result is quite common. We have often cured a discharge from the ear of the above-mentioned character, which had been entailed upon the patient by alloeopathic treatment, by means of Aconite, giving a drop of the tincture of the root every two days in eight tablespoonfuls of water, a tablespoonful at a dose. PULSATILLA is indicated by a bright yellow, fetid discharge, particularly in the case of girls, if the menses are suppressed, or for a discharge remaining after measles. DOSE.-One drop every two days, in eight tablespoonfuls of water, a tablespoonful at a dose; four doses a day. BELLADONNA suits as a remedy, if dark blood and pus are discharged from the ear, with deep-seated pain in the ear and head, noises, the internal ear looks dark-red. DOSE.-One or more drops, in a small tumblerful of water, a tablespoonful every four or six hours. We have often found it necessary to use a drop of the common tincture, prepared from the recent plant, instead of the attenuation. MERCURIUS for a bilious-looking discharge with soreness of the ear, and even the of jaw-bones and mastoid processes behind the ear; pain at night, noise as of a windmill. DOSE.-One drop, morning and night in a spoonful of water. If the patients are very scrofulous, we have found the IODIDE OF M1ERCURY, one powder of the third tritura --YLI---~~---~II~~~---~II~---- EARACHE, NOISES IN THE EAR, ETC. 545 tion dry on the tongue, three times a-day, a very excellent remedy. Earache, Otalgia Is often a symptom of chronic inflammation, and attended with more or less discharge, noises in the ear. The medicines recommended for otitis are likewise useful in this affection. An acute earache caused by a cold, exposure to wind or sudden stoppage of a chronic discharge from the ear, will almost always and speedily yield to ACONITE, one drop of the tincture of the root in ten tablespoonfuls of water, a small tablespoonful every fifteen or twenty minutes, until the pain is relieved. Noises in the Ear Have to be treated with the same remedies as have been recommended for earache. These noises are generally attended with pains and discharges, which will determine the particular remedy to be used. Deafness Is often the result of a sudden cold or exposure to dampness and wind, which may have induced a paralytic weakness of the nerve of hearing. This condition is removed by ACONITE, same dose as for earache. Chronic deafness is not only difficult, but often impossible to cure; in most cases it can only be relieved. Deafness may be owing to obstructions in the Eustachian tube, in which case this canal has to be syringed by a 47* 546; SPECIAL THERAPEUTICS. surgeon. If it arises from disorganizations in the inner ear, it is incurable. Partial deafness may be owing to chronic weakness of the auditory nerve, thickening of the lining membrane of the inner ear, deficient secretion of earwax or cerumen, retrocession of an eruption, exposure to excessive noise and to other causes. If it can be traced to retrocession of an eruption, we may treat it with alternate doses of SULPHUR and CALCAREA, a few globules every alternate third or fourth day, dry on the tongue. MERCURIUS may be given in alternation with Sulphur, in the same manner, and same dose, if the deafness is worse in damp weather, or by exposure to a current of air, or by taking the least cold; also when the salivary glands are easily irritated, the jaw-bones feel sore and the glands below the ear are apt to swell. Instead of Mercurius vivus, the IODIDE OF MERCURY may be given, a powder of the third trituration every other night, if the patient is of a marked scrofulous diathesis. SPONGIA is also indicated in the case of scrofulous patients, if they complain of loud reports in the ear, with sensation as if something would force its way out of the ear. Same dose as Iodide. PULSATILLA and ACONITE in alternation, one drop every alternate morning, are useful in the case of females whose menses are totally or partially suppressed. ARSENICUM is not unimportant in the case of cachectic individuals, when the ear seems to be dry, and they com plain of a great deal of blowing in the ear. DOSE.-One drop, or six globules, every night, in a little water. -~II-~---~. ~~-- ---- ---Eu~-------~--- - __ NASITIS, OZCENA Scrofulous Inflammation of the Nose, Nasitis. The swelling is sometimes very considerable. The nose looks bulbous, red, it burns, and ulcers often develop themselves from the least scratch. An acute inflammation of the nose, in the case of scrofulous persons, is particularly apt to attack drunkards. It yields to the alternate use of ACONITE, one or two drops of the tincture of the root in a tumblerful of water, and BELLADONNA, a few drops of the first attenuation in a similar quantity of water, an alternate tablespoonful every hour, and, as soon as the swelling begins to subside, every two or three hours. The ulcer, if any should have formed, will heal of itself in proportion as the swelling subsides. Sometimes Ozoena Sets in; this is a discharge of fetid and often ichorous pus from the nose of scrofulous persons, which may lead to the destruction of the Schneiderian membrane, which is the mucous membrane that lines the nasal cavity, and to loss of smell. This may be an acute as well as a chronic affection. The acute form of ozoena, which is in reality an acute scrofulous inflammation of the Schneiderian membrane, is best treated with ACONITE, two drops of the tincture of the root in a tumblerful of water, a tablespoonful every two hours. MERCURIUS, and particularly the Iodide of Mercury is suitable, if the discharge is more purulent, thick, offensive, and attended with yellowish ulceration of the nostrils. ~~_ _ 548 SPECIAL THERAPEUTICS. DOSE.-One powder of the third trituration, dry on the tongue, every four hours. This preparation may be alternated with SULPHUR, same dose and preparation. ARSENICUM may be used, if the discharge is ichorous, fetid, exceedingly malignant and corrosive. DOSE.-Same as Mercurius. AURUM is recommended for foul discharge; dose same as Mercurius. OZ(ENA may be caused by syphilis, in which case the remedies recommended for constitutional syphilis have to be used, particularly NITRI ACIDUM, a few drops of the first or second attenuation every four or six hours; or IODIDE OF MERCURY, same as above; or KALI HYDRIODICUM, two or three grains dissolved in an ounce of water, from twenty to twenty-five drops three times a day; or MERCURIUS SOLUBILIS, same as Iodide of Mercury; or MURIATE OF GOLD, same as Iodide. A physician had better be consulted. Loss of Smell, Anosmia, May be owing to a cold, which induces a paralytic weakness of the olfactory nerve; this affection may be removed by means of ACONITE, same dose as for deafness. (See above.) Bad Smell in the Nose Will yield to the same medicines that have been recommended for ozoena, especially ACONITE, MERCURIUS and IODIDE OF MERCURY, same doses as for ozoena. _ ~ ~ ~ ~ SCROFULOUS INFLAMMATION OF FACE. (49 Scrofulous Inflammation of the Face May be treated with ACONITE and BELLADONNA, used alternately, as indicated for scrofulous inflammation of the nose; the face is hard, swollen, red, hot, with fever. In a few cases MERCURIUS VIVUS may be used, if the face is hard, of a livid purple color, and the salivary glands are irritated. DOSE.-One powder of the third trituration, dry on the tongue, every three hours. Fomentations of tepid milk and water may ease the pain, and help to soften the swelling. SA common swelling of the face may be caused by a cold, more particularly on the side where a bad tooth may happen to be. The cheek may become hard, swollen, red, hot, sore, with throbbing pains in the swollen part. This is a simple rheumatic swelling. An, abscess may form on the inside, and even, but much less frequently, on the outside of the cheek. The suppurative process may be promoted by the application of a bread and milk poultice on the outside, and by gargling the inside with tepid milk and water. After the inflammation is subdued, the unsound tooth had better be extracted. In most cases, it may be possible to scatter the swelling before suppuration sets in. We accomplish this result by the same remedies which have been recommended for scrofulous swelling of the face, giving the same doses. __~ 550 SPECIAL THERAPEUTICS. Scrofulosis of the Mesenteric Glands, Phthisis Meseraica, Atrophy of the Bowels, Consumption of the Bowels. Before entering upon our subject, we will endeavor to convey to our readers a knowledge of what is meant by the mesentery and the mesenteric glands. The term mesentery really means "the bowels in the middle." It stands to reason, that unless the intestines were supported in their places, they would be continually inclined to descend to the bottom of the abdominal cavity. Hence they had to be suspended, as it were, in this cavity. This suspension is accomplished by folds or duplicatures of the peritoneum, a shut sac or serous membrane, enveloping most of the abdominal viscera. The peritoneum being attached to various fixed points, it is enabled to support the intestine which is enclosed within the two layers or laminae of the peritoneum, in such a manner that the necessary freedom of motion is not interfered with. Not only the intestine, but also the vessels that pass to it, and a number of lymphatic glands or ganglions, are contained between these two layers. By " mesentery," physicians understand these duplicatures, folds or layers of the peritoneum, enclosing and supporting a corresponding portion of intestine, vessels, glands, nervous plexuses and lacteals. It is through these glands of the mesentery that the chyliferous vessels pass to the thoracic duct, carrying the chyle to this canal, in order to be emptied into the vena cava and carried to the right ventricle of the heart, for the purpose of being converted into venous blood, and being sent onward on its mission as a life-preserving agent. The mesenteric glands occupy such an important place on the high-road of reproduction, our lay readers _s SCROFULOSIS OF MESENTERIC GLANDS. 551 will easily comprehend why a diseased condition of these glands should entail deep-seated and dangerous suffering upon children. For it is in children that these glands are particularly active in sustaining the reproductive functions of the organism. The disease to which we desire to devote some attention in these paragraphs, may result, unless arrested in its career, in destruction of these glands and the consequent death of the patient from absolute inability to repair the waste of the tissues. The disease is described under the.name of scrofula or scrofulosis of the mesenteric glands. This affection is characterized by distension and hardness of the bowels, irregular stools, offensive or sour smell of the evacuations, discharges of undigested food, soreness of the bowels; at a later period the stools become more watery, they lose their bilious tinge, assume a gray, whitish appearance, and a tenacious, slimy consistence, frequently resembling clay mixed with a quantity of water. The further development of this form of scrofulosis is thus described by Hartmann: "Sometimes diarrhoea alternates with constipation, the reproductive functions being of course suffering. Striking symptoms are: excessive voracity of the children, sour smell of the stools, of the cutaneous secretions, and frequently even of the turbid jumentous urine; the breath likewise smells sour and the patients vomit a sour substance. In spite of the excessive appetite, the child does not crave nourishing food, meat, etc., but heavy, indisgestible food, sour bread, heavy farinacious diet, potatoes, etc. " As the disease advances, the abdomen becomes more and more distended, and is frequently so hard that 552 SPECIAL THERAPEUTICS. it is impossible to make the least impression upon the abdominal integuments. The symptoms of the lymphatic system become more and more prominent; the rhachitic state likewise develops itself:; emaciation and prostration increase; the child becomes peevish, ill-humored, taciturn, indolent. The patients complain of shooting, colicky pains deep in the abdomen. Upon examining it, swellings of different sizes and forms are discovered in it, which are moveable and painful to pressure. These are the enlarged mesenteric glands filled with a scrofulous and tuberculous substance. " At a more advanced stage of the disease, after it has lasted a year or so, hectic fever sets in, with nocturnal exacerbations, violent thirst, restlessness, sleeplessness. The child becomes more and more feeble. The pulse is from ninety to one hundred; there are no marked febrile symptoms in the day-time. The tongue, which is generally without any coating, has a color like raw flesh; it is dry, the lips crack, the skin becomes hot, and the pulse rises to one hundred and ten or one hundred and twenty beats. After the disease has reached this degree of intensity, the little patients rapidly sink, and generally die after a succession of short spasms. TREATMENT.-The remedies for this disease are the same as those for scrofulosis generally; among these, however, we may distinguish principally ACONITE, CALCAREA, CIHAMOMILLA, CHINA, ARSENICUM, CINA, BELLADONNA, the IODIDE OF MERCURY, PHOSPHORUS and SULPHUR. A good many other medicines for scrofulous inflammation of the mesenteric glands are mentioned in the books, but they are of very little, if any, avail. ACONITE may be given every now and then, when SCROFULOSIS OF MESENTERIC GLANDS, ETC. 553 the child is very restless, the fever runs high, and the patient has no sleep. DOSE.-A few drops of the first decimal attenuation of the tincture of the root in about eight tablespoonfuls of water, of which a dessert-spoonful may be given every two hours, until a marked improvement is perceived; if this should not set in after giving from four to six doses of this preparation, we may mix a drop of the common tincture of Aconite in a small tumblerful of water, a small spoonful to be given every two or three hours, until the patient seems better. If Aconite has done all the good it can for the time, give BELLADONNA, if the glands are painful, with shooting stitches, and the bowels are very hard and costive. DOSE.-A few arops, or six globules, in half a tumblerful of water, adessertspoonful every three hours. After Belladonna, we may give SULPHUR, same dose as Belladonna, if the bowels are alternately loose and costive, the discharges have a sour or offensive smell, the abdomen is hard and distended. CALCAREA may be given, if the passages are more or less involuntary, watery or purulent, and the glandular swellings very large. DOSE.-A powder of the third trituration every four hours, dry on the tongue. Calcarea may be alternated with Belladonna or Sulphur, dose as above. CINA is a good remedy, if the worm-symptoms are much developed, or if worms are actually passed. DOSE.-One drop of the first attenuation, three times a day. ARSENICUM is a distinguished remedy in scrofulosis of the mesenteric glands, if the diarrhoea is constant, exhausting, of a watery consistence and offensive odor; the hectic flushes are quite troublesome, emaciation, night-sweats, etc., have set in. DOSE.-One grain of the third trituration, three times a day. If Arsenic does not produce a favorable change after taking a few doses, give 'CHINA, one drop of the first attenuation in a small tumblerful of water, a dessert-spoonful every two or three hours, especially if the food be discharged undigested. 18 I 554: SPECIAL THERAPEUTICS. PHOSPHORUS may be given, if the diarrhoea is involuntary, of a watery or serous consistence. DOSE.-Same as Calcarea. If Phosphorus should fail to give relief, we may have recourse to the IODIDE OF MERCURY, one grain of the third trituration four times a day. It is especially indicated by foulsmelling, serous, or dark-brown liquid discharges, and by such constitutional symptoms as sour sweats, ptyalism, thirst. If all these remedies should fail, we may have recourse to OLEUM JECORIS, a teaspoonful morning and night. The use of this agent should, however, not be postponed too long, as it might then be too late to effect any good by means of it. In regard to diet and general hygienic treatment, we refer the reader to our remarks contained in the chapter on Scrofulosis. Children who are disposed to inflammation and enlargement of the mesenteric glands, should be allowed as much active exercise in a pure bracing air as possible; mountain and sea-air is particularly beneficial. All sour, heavy food has to be peremptorily forbidden; pastry and sugar-plums are hurtful; they may eat stewed fruit, stale bread and a little fresh, sweet butter, moderate quantities of fresh beef and mutton, broth without fat, a reasonable quantity of sweet and mealy Irish potatoes; give them their meals regularly, do not send them to bed with their stomachs burdened with a copious supper; keep them clean, let them drink cold water, neither tea nor coffee; do not confine them too closely to their studies; they will soon regain, after their natural vigor is fully restored, what they may have lost during a few months or even during a year's strict TUBERCULOSIS. 555 and careful attendance to their bodily health; and, as far as medical treatment can be of any avail, depend principally upon Aconite, tincture of the root, Belladonna, Arsenicum and the Iodide of Mercury. Aconite has to be given every now and then during the whole course of the disease. It acts specifically upon the congested glands by keeping up an endeavor in the diseased organs to get rid of the engorgement. Another medicine, which we have not mentioned in the foregoing list, but which is of importance as an excellent remedy for children, is Chamomilla. It may be useful as an intercurrent remedy in quieting children, if they become very fretful and irritable, which they often do in this disease. Tuberculosis. According to Schoenlein this dyscrasia is not identical with, but analogous to, scrofula. Tubercles may be developed in almost every organ of the body, but principally in the lungs, mesentery, brain, bones and liver. What is a tubercle? A tubercle is a deposit of calcareous matter in the body of an organ, without, apparently, any organized existence. As long as the tubercle remains in its crude state, without being irritated, it is comparatively harmless; but when tubercles become inflamed in consequence of some irritating cause, a cold, a mechanical injury, etc.; they may become dangerous, owing to the tendency which is inherent in all tuberculous deposits to become soft and converted into pus, and to develop extensive suppurations, with their concomitant symptoms of chills and fever, emaciation, debility, etc., which may gradually terminate in death. __ 556 SPECIAL THERAPEUTICS. The disposition to the formation of tubercles is generally hereditary, although they only begin to form when the organ is fully developed. Tuberculous habit: Schoenlein remarks, that " in children with this habit, we notice a remarkable tendency to the formation of carburetted hydrogen gas and pigmentous secretions, either in the shape of mucous patches, or a peculiar coloration of the skin, which is different, however, in the different forms of tuberculosis; in tubercles of the lungs, for instance, the skin is rather brownish; in tubercles of the liver it is greenish, as in chlorotic subjects." TERMINATIONS: "1. In recovery, by shrinking or ossification. cf the tubercles, deposition of earthy substances. 2. In some other disease: phthisis, by liquefaction of the tuberculous substance; dropsy, death. Tubercles of the liver lead more to dropsy, whereas, tubercles of the lungs lead more to phthisis." We will now proceed to speak more particularly of the different kinds of tubercles, and, for this purpose, follow Schoenlein's classification and description. Pulmonary Tubercles. "The simple pulmonary tubercle is present in individuals with a tuberculous disposition. The patient complains of a dull pressure below the clavicle in the upper portion of the lungs. This pressure varies from time to time, drawing or even tearing pains shoot from the pectoral muscles towards the upper arm, with sensation of heaviness and numbness in the latter part. These pains are generally considered of a rheumatic nature. The patient coughs in the evening on going to bed, and MENSTRUAL AND PUERPERAL TUBERCLES. 557 on rising in the morning; the cough being generally dry, spasmodic, with expectoration of a simple, gray, tracheal mucus, which is sometimes streaked with blood. Percussion yields a dull, faint sound below the clavicle, or between the clavicle and scapula. This sound being at first limited to a small space, the attempt to percuss the chest has to be repeated several times, The respiratory murmur at this place is very indistinct, sometimes a mucous rattle is heard in the bronchia. The patients lose flesh in spite of a great appetite. The disease generally appears between the ages of eighteen and thirty; it is less frequent after this period. It is more frequently occasioned by bad nourishment and the abuse of spirits, than by a suppression of the cutaneous secretion. The disease generally terminates in phthisis, preceded by frequent hbemorrhages from the lungs. This condition is accompanied with hectic fever, which generally sets in in the afternoon or morning, with slight chills, followed by heat and partial night-sweats " Menstrual and Puerperal Tubercles. "These tubercles make their appearance between the age of twenty and thirty; it is peculiar to these tubercles to be seated in the lower lobes of the lungs. The menses are at first scanty, and finally cease altogether, and give place to fluor albus, with menstrual colic, followed in a few days by pain in the stomach, eructations, vomiting, even vomiting of blood. In a few days the affection extends to the chest, occasioning difficulty of breathing, palpitation of the heart, cough, with bloody expectoration which sometimes smells like menstrual blood; this cough generally continues with the other 48* 558 SPECIAL THERAPEUTICS. symptoms as long as the menstrual flow lasts. This group of symptoms is, moreover, accompanied with accelerated pulse; increased temperature of the skin, thirst. The more frequently these attacks come on, the more the lung becomes affected: the shorter are intervals between the paroxysms, they finally disappear altogether, until the pulmonary symptoms become permanent, except an exacerbation at the time of the menses. The disease is excited by suppression of the menses in consequence of a cold, exposure to wet, or a sensitive condition of the lungs at the time of the menses. The disease, sooner or later, terminates in galloping consumption, sometimes in from six to eight weeks. "Puerperal tubercles are occasioned in consequence of a suppression of the lochia, of the cutaneous secretions during confinement, or of the secretion of milk. They are accompanied with stinging pain in the chest within a circumscribed place, generally in the lower lobe of the lungs. A deep inspiration induces coughing, with expectoration of a large quantity of clear mucus, which afterwards assumes a dark, greenish color. These tubercles likewise suppurate very rapidly, sometimes in from six to eight weeks, occasioning death." Tubercles arising from Cold Drink. "These tubercles are very frequent; they are not easily distinguished at first, and were first described by Autenrieth. Individuals at the age of pubescence are attacked with this disease in consequence of taking a cold drink after having become heated by violent exertions. These tubercles set in in company with various symptoms of derangement of the stomach, such as loss EXANTHEMATIC TUBERCLES, ETC. 559 of appetite, pressure in the region of the stomach after taking the least nourishment, disposition to vomit, vomiting. The region of the stomach is somewhat distended, painful to pressure; the bowels are alternately confined and loose; the evacuations are frequently watery, mixed with lumps of a dark-brown, viscid faecal matter. Patients generally suppose that they are laboring under a simple derangement of the stomach." Exanthematic Tubercles. SThese tubercles occur almost exclusively in young people previous to the age of pubescence; they are occasioned in consequence of the course of some exanthematic disease, such as measles and scarlatina, being disturbed in its last stage. The patients complain of great oppression and heaviness on the chest, shooting pains in the chest; short and panting breathing. Percussion and auscultation yield the usual symptoms. The cough is violent, attended with expectoration of large quantities of a clear, albuminous mucus. The pulse is very quick, hard, rarely tense; the patient sweats profusely; the urine deposits a copious sediment; the cheeks are red, circumscribed, glowing, with burning heat in the palms of the hands and soles of the feet." Impetiginous Tubercles. " They generally occur in adults, between the ages of twenty and thirty, in consequence of the suppression of some chronic cutaneous disease, particularly scabies and herpes. At first the patient complains from time to time, particularly towards evening, of asthmatic attacks, as if __~_ ~_____11____1 _ I~__ _ _~ 560 SPECIAL THERAPEUTICS. the chest were constricted, as if he had to inhale the vapor of sulphur. After a little while, the attack terminates in the expectoration of some phlegm, which is sometimes attended with a little retching. Sometimes the attacks resemble those of globus hystericus. Some time after, generally when the bad season sets in, the patient complains of stinging pains shooting through the chest, from the nipple to the scapula. Cough supervenes; this is permanent, most violent towards evening, with a serous, frothy expectoration, mixed with small, crumbling, tuberculous particles, but rarely streaked with blood. The other usual symptoms of tuberculosis are likewise present." Arthritic Tubercles. "They occur between the ages of fifty and sixty, in individuals who, in former years, were affected with a fully-developed arthritis, or with mere indications of the disease, which had disappeared or had become altered in consequence of a cold, etc. " PHENOMENA: The patient becomes hoarse, complains of a peculiar burning sensation in the larynx and down the trachea, accompanied with a constant irritation and urging to cough, and expectoration of a considerable quantity of tenacious, greenish mucus. An oppressive sensation under the clavicle soon supervenes, with decrease of the laryngeal and tracheal symptoms. The symptoms of the stomach disappear likewise as the pulmonary symptoms develop themselves. Cough sets in. The expectoration contains mucus, mixed with a substance resembling soaked barley; this substance sometimes appears in strings, the globules being of a small __ HEREDITARY TUBERCLES. 561 size, crumbling when pressed upon with the finger-nail, and yielding a grating, harsh sound. The urine at first deposits a purple-colored arthritic sediment, mixed with a rose-colored acid; afterwards, when the tubercles have commenced forming, the urine clears up again, at most a slight sediment being discovered in the urine that is emitted after dinner." Hereditary Tubercles. "The parents of such patients either died of pulmonary phthisis, or of some disease of the heart. The patients have a phthisicky habit, characterized by the following symptoms: Slender, delicate body (the last joints of the fingers having sometimes a bulbous shape, and the nails being arched); long, slender neck, without any prominence of the thyroid body; flat chest, contracted superiorly; the scapulhe are turned forward, somewhat wing-shaped, (hence it is that the patients generally stoop); their skin is of a dazzling white; the cheeks easily become flushed, either by a physical or moral excitement. In childhood, such individuals are subject to frequent bleedings of the nose; afterwards to attacks of angina, which almost always terminate in suppuration. At the age of pubescence the chest, which had appeared perfectly sound so far, becomes congested; palpitation of the heart sets in, the chest feels too tight; a sensation as of something warm rising in the chest is experienced; the patients commence spitting blood; afterwards a purulent, crumbling substance is expectorated." II~ -U--~-~---~-~----~--~-~II~-~--~---- 562 SPECIAL THERAPEUTICS. Tubercles in the Brain. " We distinguish three stages in this disease, the stage of irritation, that of convulsion, and the stage of paralysis. The first stage is characterized by the following symptoms: At one spot of the head, the patient feels a dull pressure, and afterward, around that spot, a more or less violent pain which appears periodically. Vertigo is experienced from time to time. This stage sometimes lasts for months, even years, sometimes only from eight to twelve days; in this case, however, the inflammatory symptoms round the spot where the pressure is experienced, are much more violent, and the patients spend sleepless nights. " In the second stage the patients are seized with epileptic attacks, which likewise occur periodically, but at irregular intervals. The attacks are not preceded by the aura epileptica, but by an increase of the pressure to the highest degree of violence. The convulsions generally affect one side of the body only, but even if both sides should be affected, the side which is opposite to the seat of the tubercles, is most violently convulsed. After the termination of the paroxysm the patients feel stupefied, fall into a short kind of sopor, and constantly complain of a violent pain at the above described spot in the head. This stage likewise lasts for days, months, and years. " Third stage: If the tubercles exist only in one hemisphere, only one side of the brain is paralyzed; but if the pons variolii should be the seat of the disease, both sides of the brain are paralyzed, one, however, more than the other. Even after paralysis has set in, the above-mentioned pressure in the brain, and the burning TUBERCLES IN THE SPINAL MAREOW, ETC. 563 and. stinging pain all around, continue. The mental powers flag, and a state of idiocy sets in. The disease does not always run a full course, many patients die in the second stage." A common termination of tubercles at the base of the brain, in children, is dropsy of the brain. This is an incurable disease Tubercles in the Spinal Marrow. "The first stage is characterized by the following symptoms: the patients complain of pressure, with a surrounding inflammation. At a circumscribed spot of the spinal marrow, without any alteration being visible, a burning, stinging pain is experienced which generally follows the course of one or more nerves. The pains are generally very acute. After a shorter or longer period the parts which receive their nerves from the diseased portion of the spine, become convulsed. "In the second and third stages, the convulsed parts become paralyzed. The above-mentioned pains in the spine continue." Tubercles in the Liver. "These tubercles occur principally among children. They are very rare, never exist as a primary disease, and occur only as a symptom of an extensively-developed tuberculosis, particularly of the abdominal organs. Tubercles in the liver are, at first, accompanied with dyspeptic symptoms, sensation of pressure in the stomach after eating, distension of the region of the stomach, eructations, occasional vomiting of bilious substances 564 SPECIAL THERAPEUTICS. and of the ingesta, slow stool with hard and burnt fieces. Occasional pressure in the right hypochondrium, and pains, shooting from below upwards. The skin has a dingy-gray appearance; the face is bloated. As the pains increase, the liver becomes enlarged, uneven, distended, knotty, painful. " Men are more frequently affected than females, generally between the ages of thirty and fifty. The disease appears to be hereditary, particularly among drunkards." General Treatment of Tuberculosis. Tubercles require the same treatment, no matter in what part of the body they are located. In homceopathic books we see a number of remedies mentioned for tubercles, and yet we have not a single drug in our Materia Medica, of which it could be positively asserted that it is a specific remedy for tubercles. If we have any remedies for tubercles, we have to discover them by comparing the subjective symptoms of the patient with the pains occasioned by the drug, and by studying the alterations which our drugs are disposed to effect in the reproductive system; whether any drug would, by its progressive and continuous action, ultimately produce tubercles, cannot be determined by experience, and has to be inferred by the pure reason from the partiallyknown action of the drug upon the organism. This, then, is the question: of what drugs can we reasonably infer that they occasion in the organism a morbid condition similar to that which, as a natural disease, results in the formation of tubercles? We do not believe that there are many, and we likewise believe that a great many remedies, and more particularly anti-psoric reme SYMPTOMATIC INDICATIONS. 505 dies, are mentioned in our books, which have no relation whatsoever to tuberculosis. Sulphur, for instance, is set down in all our works, as a great remedy for tuberculosis; but we are strongly disposed to doubt its efficacy in this dyscrasia, even in that form of tuberculosis which we have termed " impetiginous" tubercles. If we desire to try Sulphur, it ought to be given pretty high, but we would not, by any means, rely upon it. Carbo vegetabilis, Alumina, Causticum, Conium, Sarsaparilla, and various other anti-psorics have been recommended for tuberculosis, but there is nothing in the known pathogenesis of these drugs, to warrant the belief that they can do much, if any good, in this disease. The only drugs from which any good effect may be obtained in tuberculosis, are: Aconite, tincture of the root, Bryonia, Calcarea, Iodine, Spongia, Hepar sulphuris, Squills, the Iodide of iron, and in a few cases, now and then Sulphur, China, Millefolium, Phosphorus, Belladonna, Hypericum perfoliatum. Symptomatic Indications. ACONITE, although very little used by homoeopathic physicians in this disease, is undoubtedly a very powerful remedy for tubercles, and is principally indicated by the following symptoms: flying stitches in the side and chest, painful sensation as if something would break loose, crackling or snapping noises, soreness, acute pains at circumscribed spots, chilliness and sudden dark flushes, dizziness and headache, burning pains, dry, spasmodic or hacking cough with frothy, or sometimes purulent expectoration, oppression of breathing, palpitation of the heart, nervousness, restlessness, aching rheumatic pains in the chest, sensation as if the lungs 49 __ __ 566 SPECIAL THERAPEUTICS. were crowded, and had not room enough to expand constipation, dark urine, scanty menstruation with pains and spasms, loss of appetite, sore mouth and tongue, foul breath as of bad pus, sensation as if the throat had become widened or as if a ball were rising in the throat; haemorrhage from the lungs or air-passages, etc. DOSE.-Mix one drop of the saturated tincture of the root, in a tumblerful of water, and take a small tablespoonful every twoor three hours. This should be continued for a week, and then two drops should be used instead of one, and a tablespoonful of this solution should be taken every four hours for another week. The medicine may then be discontinued, and some other suitable remedy, such as SPONGIA, substituted; of this dissolve a few drops or ten globules in a tumblerful of water, and take a tablespoonful every three or four hours, continuing this medicine for a few days or weeks. After Spongia, the Aconite may be resumed as above indicated, provided the above-mentioned symptoms continue to exist more or less. We will state here once and forever, that, in treating a case of tuberculosis, we constantly return to the saturated tincture of the root of Aconite for a few days, after having given one of the other medicines for a while. No medicine is endowed with more specific powers than Aconite to counteract the formation of tubercles. IODIUM may be tried, if the following symptoms occur: deep and dry cough, with stitches in the chest; sensation of heaviness from the throat to the chest, followed by cough with expectoration of mucus, or mucus streaked with blood; pulsations in the chest, stitches during an inspiration, burning and stinging in the integuments of the chest. DOSE.-From four to five drops of the first attenuation, in a small tumblerful of water, a small tablespoonful every two hours. If Iodium should not relieve, ~;cl~--~-~~ll~L---~~~--c~--~~l-- ~ SYMPTOMATIC INDICATIONS. 567 SrONGIA may be substituted, especially if the patient complains of a burning in the larynx and ears, hoarseness, sensation as if the throat were stopped up with a plug, hollow cough day and night, with expectoration; or constant cough from a deep spot in the chest, with pain at that spot, as if sore; dry cough day and night with burning in the chest, abating after eating or drinking. DOSE.-A few drops, or six globules in a tumblerful of water, a tablespoonful every three hours. Instead of Spongia, BROMINE may be tried, if necessary, same dose as lodium. CALCAREA is more suitable for cough with expectoration than for a dry cough, although it likewise corresponds to a nightly dry cough with violent beating of the heart and arteries; the expectoration consists of mucus, or a yellowish purulent substance, also having a sweetish taste; the cough is accompanied with painful shootings in the head; the chest is painful when touched; stitches and soreness in the chest, with dyspnoea and oppressive anguish. This medicine may be followed by, or alternated with, HEPAR SULPHURIS, giving of each the third trituration, a stiff powder each time, dry on the tongue, an alternate dose every four hours. -Hepar is particularly indicated by a sense of tightness and contraction in the air-passages as if it were difficult to breathe through them. BRYONIA answers pretty much the same indications as Aconite, and may be given after the Aconite had been tried for a week or so, without effecting much relief. DOSE.--A few drops, of the third attenuation in a tumblcrful of water, a 568 SPECIAL THERAPEUTICS. tablespoonful every two or three hours. It may likewise be given alternately with one drop, of the tincture of the root of Aconite, in a tumblerful of water, an alternate tablespoonful to be given every two hours. SQUILLA for cough with expectoration of flocks of pus, frequert haemorrhage preceded by a pricking pain in the chest. DOSE.-One drop of the tincture in a tumblerful of water, a small tablespoonful every two hours. HYPERICUM PERFOLIATUM, when the chest symptoms are accompanied with menstrual suppression, characterized by a distressing sensation as if a tight bandage were applied round the lower part of the abdomen. DOSE.-One drop of the tincture, same as Squilla. This medicine may be alternated with Aconite, in the same way as Bryonia. MILLEFOLIUM may be used as an intercurrent remedy, to arrest violent hemorrhage. DOSE.-A few drops of the tincture every five or ten minutes, until the haemorrhage stops. ARSENICUM is employed in tuberculosis when the pains are of a burning nature, with dyspnoea and anguish, palpitation of the heart, nightly suffocative'cough, dry, or also with difficult expectoration of a whitish or greenish froth. DOSE.-One grain of the third trituration every four hours. KALI CARBONICUM may be given for spasmodic cough with raising of a purulent, fetid, sanguineous substance. DOSE.-Same as Arsenic. PHOSPHORUS, may be substituted for Kali carbonicum, in case this agent should prove ineffectual after a few doses. DOSE.-Same as Arsenic. FERRUM IODATUM may prove useful in tuberculosis, especially when there is considerable tightness and SCURVY, OR SCORBUTIC DIATHESIS. 569 oppression on one side of the chest, and the patient raises considerable pus and bleeds now and then, with soreness of the spot from whence the blood seems to come. DOSE.-One grain of the first trituration every three or four hours. BELLADONNA may be tried in tuberculosis of the brain, though we doubt its efficacy. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every four hours. DIET AND REGIMEN.-It is of the utmost importance that the patient should constantly remain in the same temperature, and should not be exposed in the least to any sudden changes of air, clothing, diet, etc. The diet should be simple, not stimulating, light broths, stewed fruit, vegetables of easy digestion, such as carrots, cauliflower, spinage, mealy potatoes, in some cases sweet potatoes, salad without vinegar, or only very little vinegar, tea, toast, light chocolate, and small quantities of easily digested boiled or roast meat, such as muttonchops, venison, tender roast-beef. Water should be the only drink. Cold winds and damp weather are injurious to such patients. A bracing inland-air is more suitable. Scurvy, or the Scorbutic Diathesis. In former periods scurvy was a very common disease. It was a regular accompaniment of a sea-faring life. In modern times it is comparatively of rare occurrence; a naval surgeon may end cruise after cruise without seeing a single case of scurvy. Scurvy or the scorbutic diathesis is essentially characterized by a disintegration of the fluids and solids of the living body. We distinguish sea and land-scurvy, but 4A* 570 SPECIAL THERAPEUTICS. the symptoms of these two divisions of scurvy are the same, and the causes which develop the disease, are likewise similar. They are want of cleanliness, insufficiency and deficient variety of food, absence of green vegetables, excess of salt meat, want of fresh air and water; peculiar atmospheric conditions and regional influences may likewise have something to do with the development of scurvy. Dr. Good gives the following definition of true scurvy:," Spots of different hues, intermixed with livid, principally at the roots of the hair; teeth loose; gums spongy and bleeding; breath fetid; debility universal and extreme." He adds that this form of scurvy "occurs chiefly at sea, after, exposure to a moist, cold and foul atmosphere, with long use of salted food and stagnant water." It is however a well-established fact that scurvy is not confined to mariners; it may likewise prevail on land. The army of St. Louis before Damietta, was decimated by this scourge. Dr. J. 0. Curran of Dublin states in a late communication that he had collected from competent observers a list of upwards of six hundred cases of scurvy which happened in various parts of Ireland, and in some of the principal towns of Great Britain. The disease is scarcely ever met with among classes that live in ease and comfort, and enjoy all the invigorating influences of a suitably varied diet, cleanliness, changes of linen, ventilation, exercise, plenty of fresh and wholesome water. It is generally seen among people who live in close, damp and dark basements, dirty hovels, and whose only nourishment consists in salt pork and old, sour flour, combined with an utter want of cleanliness and fresh linen. Hence the frequency of this disease on ship-board in former years) SCURVY, OR SCORBUTIC DIATHESIS. 571 when the crews were fed on salt meat and sour shipbiscuit, and had to content themselves with foul water to quench their thirst. In modern times when our ships, and more particularly our men-of-war, are so admirably ventilated and abundantly provided with fresh water and provisions, scurvy is a comparatively unknown disease. Professor Dunglison condenses Dr. Curran's description of the disease in the following paragraph, in his Practice of Medicine: "The disease generally comes on gradually, with feelings of general debility, disinclination to motion, and difficulty of breathing on the least exertion. The face becomes of a pale or yellowish hue; the gums are tumid, soft, spongy, and sometimes livid, 6r they present a blue line scarcely distinguishable from that caused by lead poisoning, and bleed on the slightest friction; or they are sometimes pale and exanguious, but never natural, the breath is offensive, and the skin dry and rough, but sometimes smooth and shining. If attention be paid to the cutaneous surface, it will generally be found covered with livid spots; which run together, so as to form large blotches, especially about the legs and thighs. The legs swell, and ultimately the whole body becomes cedematous. The muscular parts of the legs and thighs, and still more frequently the insteps and ankles, are more or less indurated, and deep-seated nodular indurations, as large as nutmegs, according to Dr. Curran, can be felt in the calves of the legs, and backs of the thighs. The phenomena differ somewhat in different cases, but essentially resemble those that have been described as characteristic of ancemia.* * By ancmia physicians understand a condition, the opposite to plethora. __ __ 572 - SPECIAL THERAPEUTICS. Throughout, excessive pain is usually experienced in the limbs, with total mental prostration, so that the individual is incapable of any intellectual effort. If sores exist, they discharge a fetid or bloody sanies, and put on characters which have received the epithet 'scorbutic,' the base of the sores being covered with sloughs, and the edges livid and lined with a soft, bloody fungus which increases rapidly. In the advanced period, the emaciation is great, and there is a tendency to syncope on the slightest exertion. Haemorrhage takes place, at times, profusely, from the different mucous membranes; and the patient dies, in unfavorable cases, either hydropic, or exhausted by some sudden exertion. "In the course of the disease, inflammatory affections may supervene in internal organs, so as to occasion some degree of reaction, as increased heat, greater frequency and force of pulse, etc. This circumstance is of unfavorable import, for there is usually so little vitality in the patient, that they exhaust him the sooner. "On dissection, effusions are found in the different cavities, in the substance of the skin, in the subcutaneous and inter-muscular cellular tissue, and in the muscles themselves. At times the blood is coagulated, but almost always it is extremely fluid; the different solid viscera are softened, and contain collections of blood; the spleen and lungs are engorged in this manner; the heart is fluid; and the mucous membranes, like the skin, are covered with numerous hmemorrhagic patches; but the brain and its dependencies are said, by Dr. Rachoux, to exhibit no marks of mischief." In very bad cases of scurvy, the bones and articulaThe term anemia literally means without blood, bloodless. The blood has a watery consistence; it is deficient in red corpuscles. ~ SCURVY, OR SCORBUTIC DIATHESIS. 573 tions are invaded. The joints, especially those of the lower extremities, and more particularly the knee-joints, swell and become painful; but the swelling is soft, without redness. The pains in the bones are excessive boring pains, which are particularly felt in the night, not so much in the long bones, as in the joints-a peculiarity which distinguishes scorbutic pains from those occasioned by syphilis. At the same time, the bony substance dwindles away, and finally the bones become so soft, that they are in danger of breaking, even by the excessive action of a muscle. Scurvy does not necessarily disorganize the constitution in every case. In many cases, the disease remains confined to the mucous membrane of the mouth. The gums swell, become bluish and livid, spongy, and bleed from the least touch. Nevertheless, even if the disease remains localized in the mouth, the blood throughout the body is tainted with the scorbutic virus; it has a sourish, bad taste, and the breath is very fetid. Scurvy seems to be emphatically a disease of the blood. Although this expression may not seem strictly scientific, yet it conveys to the reader's mind a good idea of the essential character of this disease. In scurvy, the blood is undoubtedly diseased. The blood, which seems to be the great reservoir of the reproductive elements of the organism, supplies morbid food to the tissues; hence the universal disintegration of the solids. According to some of the older observers, the blood, during the process of the disease, becomes black as ink, a result that is owing to the diminution of fibrin, upon whose presence in the blood the plastic or organizing vitality of the blood depends; in other cases, however, the blood seemed to remain more or less natural. Cases 574 SPECIAL THERAPEUTICS. have even been recorded, where the blood presented all the appearances which are usually exhibited by blood during an inflammatory state of the system. It has been generally supposed, that the disease originates in the abuse or exclusive use of salt meat. This is an error. Dr. Dunglison informs us, that in the Milbank Penitentiary, where the scurvy prevailed extensively in 1819, "the diet consisted of peas, barley-soup, and brown bread; and that, in four-fifths of the cases reported to Dr. Curran, the patients had been living on bread and tea, or coffee, when attacked; the others had been using grains of various kinds, or grains and flesh or fish, but in no single instance could he discover that green vegetables or potatoes had formed part of their regular dietary." As regards age and sex, scurvy is seldom met with among the young people before the age of pubescence. In the recent scurvy that prevailed in England and Ire land, at least two-thirds of the patients were past the middle period of life; no case was known to Dr. Curran to have occurred under eighteen years of age. Females are less liable to an attack of scurvy than males. As regards treatment, the first thing to be done is to remove all those noxious influences which tend to engender scurvy. Patients should be transferred to habitations where they can have pure air, plenty of fresh water, and the comforts of cleanliness and a change of linen. A mixed diet is absolutely necessary; moderate quantities of fresh meat and an abundant supply of green vegetables. Lemonade may be given as a drink. Lemon juice has been found to be one of the most certain neutralizers of the scorbutic virus. Brandy and alcoholic wines, Madeira, Port, etc., are hurtful; some of the -- r SCURVY, OR SCORBUTIC DIATHESTS. 575 Rhenish wines, which contain a certain acid principle, may be admissible in some cases. Scurvy-grass, cresses, horse-raddish and similar acrid vegetables may be used as salad or condiment. Heavy diet, pastry, farinaceous food, are to be discarded. The mouth should be kept very clean; after every meal it should be rinsed with tepid water. The teeth may be rubbed with a soft brush sprinkled with a powder composed of fine vegetable charcoal and Peruvian bark; if they bleed easily, they may every now and then be washed with a solution of burnt alum. The medical treatment of true scurvy reduces itself to the use of the tincture of Aconite-root and to the Carbonate of Ammonia. Why Aconite should be a remedy for scurvy will appear quite obvious to those who are acquainted with the effects of the long continued use of Aconite upon the blood. No drug is possessed of more specific powers to induce a state of anaemia than Aconite. It produces alterations in the character of the blood which are in all respects similar to those induced by the scorbutic virus; and, as a consequence, all the bad effects of deficient or disorganized reproduction will be developed by Aconite as they are by the scorbutic poison: flabbiness of the muscles, cedematous and finally dropsical swellings, loss of strength, melancholy state of mind, etc. Of this medicine we may give the tincture, one or more drops in from six to eight tablespoonfuls of water, the whole of which should be taken every twenty-four hours in three or four doses. The Carbonate of Ammonia corresponds with the putrid stage of scurvy. Huxham, in his Essay on Fevers, mentions the following remarkable case illus Lh 576 SPECIAL THERAPEUTICS. trative of the ill-effects resulting from the long-continued use of this salt: "I had lately under my care," he observes, " a gentleman of fortune and family, who so habituated himself to the use of vast quantities of volatile salts, that at length he could eat them in a very astonishing manner, as other people eat sugar and caraway-seeds. The consequence was, that he brought on a hectic fever, vast hemorrhages from the intestines, nose, and gums; every one of his teeth dropped out, and he could eat nothing solid; he wasted vastly in his flesh, and his muscles became as soft and flabby as those of a new-born infant, and he broke out all over his body in pustules. His urine was always excessively highcolored, turbid, and very fetid. He was at last persuaded to leave off this pernicious custom; but he had so effectually ruined his constitution, that, though he rubbed on in a miserable manner for several months, he died, and in the highest degree, of marasmus. And I am persuaded he would have died much sooner, had he not constantly drank very freely of the most fine and generous wines, and daily used large quantities of asses' milk, and anti-scorbutic juices, acidulated with juice of lemon." If there be any truth in homoeopathy, the CARBONATE OF AMMONIA must be the most powerful specific for scurvy. We would recommend to give one grain of the first trituration three times a-day, dry on the tongue. The tincture of Peruvian bark may have to be resorted to in some cases to counteract debility, loss of appetite, and a remaining tendency to marasmus and cedematous swellings; we recommend a watery infusion which may be acidulated with lemon-juice, to be given in dessertspoonful doses, three times a-day. I DROPSICAL EFFUSIONS, ETC. 577 DROPSICAL EFFUSIONS. Anasarca, General Dropsy of the Cellular Tissue, This is an accumulation of the watery constituents of the blood in the cellular membrane under the skin, and occurs either as a primary disease or as a symptom of some other organic malady. It may likewise set in as a sequela or consecutive disease of some acute eruptive fever, especially scarlatina. Dropsy may develop itself as an acute primary disease, setting in with a chill and fever in consequence of a cold, a sudden suppression of some habitual eruption, or of a sudden fright. The swelling is at first soft and doughy, and afterwards becomes shining and elastic. The skin over the swelling is tense, cool, not red; on pressing with the tip of the finger upon the swelling, a pit forms in the skin and remains even after the pressure ceases. Red spots gradually show themselves and spread over the swollen parts; the skin assumes a livid, blackishbrownish hue; phlyctaenm and even gangrenous sloughs form. The abdominal functions are of course more or less interfered with in dropsy. The urinary secretion is very scanty, the exhalations from the skin are wanting, the bowels are either constipated or loose, the breathing is very much impeded, the appetite is impaired, the sleep is uneasy and disturbed, and from the emaciation of the parts where no dropsical deposit exists, we may infer that a general waste of the solids is taking place. TREATMENT.-The principal remedies for this disease are: APIS MELLIFICA, ACONITE, ARSENICUM, APOCY50 578 SPECIAL THERAPEUTICS. NUM, CHINA, DULCAMARA, FERRUM, HELLEBORUS, MERCURIUS. The particular indications will be given below. Ascites, Dropsy of the Abdomen. The swelling uniformly develops itself from below upwards. When standing, the swelling is perceived below and in front; in a recumbent posture the swelling is seen directly above the crest of the ilium. Fluctuation is observable by the patient, and also by those near him, during a quick motion; or, while lying on the back, fluctuation is perceived on the opposite side to that which is struck with the finger. In order to examine the patient, he must occupy a position where the water will press against the abdominal walls; a kneeling position, for instance, while leaning on his hands. The skin is dry as in general dropsy; the urine scanty, of a deep-yellow or red, and frequently depositing a sediment; the pulse is weak and irregular; emaciation, hectic fever and symptoms of jaundice are frequently, and, indeed, generally present. Other symptoms are: loss of appetite, thirst, fullness and pressure in the epigastric region after eating, oppression of breathing, disturbed sleep. This disease is frequently complicated with, or a consequence of organic disease of the liver or spleen, in which case it is incurable. The principal remedies for this disease are the same as those which have been proposed -for anasarca, in addition to which we have BRYONIA, COLCHICUM, SCILLA MARITIMA, PRUNUS SPINOSA, LEDUM, SOLANUM NIGRUM. The particular indications will be found below. Hydrothorax, Dropsy of the Chest. This is an accumulation of serous fluid in one or both DROPSY OF THE CHEST. 579 pleural cavities. It must not be supposed, however, that, because the disease is called hydrothorax, there is, on this account, water in the chest during the whole course of the disease. The water in the chest is simply the last development of a certain morbid condition of the respiratory organs, and the disease may therefore be hydrothorax even without any water being as yet actually present. Dropsical effusions are secondary developments of certain morbid conditions, but do not constitute the primary disease. One of the first symptoms of hydrothorax is oppression and a disposition to faint, on making an exertion, walking fast, or ascending an eminence. The patients frequently wake at night with a start and dyspnoea, they ask for air, and want to have the window opened. As the disease increases, a recumbent posture becomes unbearable, the patient are constantly seized with paroxysms of suffocation, especially during an unfavorable change of the weather, or when the wind shifts from the south or west to the east or north-east. They have to sit up, with their legs hanging over the edge of the bed. The lips become bluish and bloated, the extremities are cold, the forehead is covered with a clammy sweat, the heart throbs violently at times, the pulse is small, feeble, intermittent. The patient is troubled with a cough, which is at times a mere bark, at others amounts to a spasmodic cough, dry at first, and gradually changing to a moist cough with discharge of large pieces of tenacious phlegm, or quantities of a purulent substance. When effusion has actually taken place, that part of the chest where the effusion exists is pushed outward; one or both pleural cavities may be thus enlarged. In the last stage of the disease, symptoms of general ................ - 580 SPECIAL THERAPEUTICS. dropsy set in; the lower extremities swell; from the feet upward. A sudden disappearance of this swelling of the extremities is a dangerous and generally fatal symptom. The constitutional symptoms are the same as those in ascites and anasarca. Hydrothorax may be caused by a cold, sudden suppression of the perspiration, over-exertion, anxiety and fright, organic disease of the heart or lungs, abuse of spirits, debility, metastasis of gout, suppression of some eruption or the drying up of an ulcer on the legs by ointments or lead-washes. Hydrothorax caused by organic disease is incurable. The principal remedies for this disease are the same as those for dropsy generally; especially, however, ACONITE, ARSENIC, DIGITALIS, SPIGELIA, HELLEBORUS, AMMONIUM CARBONICUM, SQUILLA. Particular indications, see below. Dropsy of the Pericardium. The pericardium is a serous membrane which envelops the heart like a sac. This membrane may become inflamed, and the consequence of such an inflammatory irritation may be an exudation of serum. The accumulation of this fluid between the pericardium and the substance of the heart is what pathologists designate as dropsy of the pericardium. Schoenlein furnishes the following diagnosis of this disease: " The patient complains of a feeling of pressure and weight in the lower part of the region of the heart; violent restlessness and anguish, which is frequently so violent that it induces vomiting, dullness of the head, stupor and even delirium. The pit of the stomach swells. If there is much water, the skin at the pit of _C DROPSY OF THE UTERUS. 581 the stomach forms a sac in the erect posture, which, when percussed, yields a watery sound. The patient cannot bear a low posture, least of all any recumbent posture; he is most easy when sitting erect or when lying on the left side. He complains of palpitation of the heart, though, upon examination, the beats of the heart are not felt, or else are very dull and faint, resembling the sound which is heard on striking against a bladder filled with water; at the same time a dull, faint sound is heard over a large surface, sometimes even in the right chest; there is no respiratory murmur perceived in that region of the chest, as the lungs are crowded to one side by the accumtlated fluid. The pulse is gene. rally small, feeble, very frequent; it becomes intermittent when some'of the valves are ossified; vibratory, when hlypertrophy is present. These symptoms are accompanied with cedema of the ankles and lower limbs, which spreads rapidly upwards, extending even to the back of the left hand, and being accompanied with a sensation of numbness, diminution of all the secretions, etc." In a case of dropsy of the pericardium, which set in as a sequela of scarlatina, and terminated fatally, the disease was ushered in by incessant and small discharges of a muco-feecal matter from the bowels. The principal remedies are ACONITE, DIGITALIS, ARSENIC, HELLEBORUS, LAUROCERASUS, SPIGELIA, COLCHICUM. Particular indications see below. Hydrometra, Dropsy of the Uterus. Hartmann offers the following diagnosis of this disease: " The patients have a leucophlegmatic, bloated appearance, the menses cease, and from this period dates 50* __ __ 582 SPECIAL THERAPEUTICS. the swelling of the abdomen. The swelling does not take place as uniformly as during pregnancy; it frequently develops itself very rapidly, attains a very high degree in a short time, and then stops. The swelling extends in breadth, the abdomen does not become pointed in front. The swelling has an elastic, uniform feel; it is equally hard all over, is not painful to pressure, does not change its locality with the position of the body. Fluctuation is perceptible more or less distinctly; the percussion-sound reveals the presence of fluid very faintly. An internal examination shows that the vagina is cold, the vaginal portion of the uterus is felt higher up in the vagina than usual, and is in most cases obliterated; the uterus is distended; fluctuation is distinctly perceptible, but no presentation of a fetus. This condition is accompanied with general dropsical symptoms, but in a moderate degree; cedema of the lower limbs, labia, cellular tissue, peloic region; dry, cracking skin, cold extremities, a small, weak, wiry, empty pulse, diminished secretion of urine." The principal remedies for this disease are CANTHARIDES, SQUILLA, DIGITALIS, PLATINA, SABINA and the medicines which have been recommended for dropsy generally. The particular indications will be found below. Dropsy of the Ovaries. "On one side of the abdomen, generally on the right, less frequently on the left side, where the horizontal ramus of the pubic bone joins the crest of the ilium, a swelling forms, which at first occasions only a sensation of pressure and heaviness and is indistinctly felt through DROPSY OF THE OVARIES. 583 the abdominal integuments, but afterwards becomes more distinct, and occasions an unequal distension of the abdomen. The swelling can be pushed to and fro; upon turning quickly from one side to another, the patients experience a sensation as if a globular, cold body were falling from one side to the other. An examination by the vagina shows that the uterus is pushed to the opposite side; it is always raised, and sometimes so high that it can scarcely be reached with the finger. Fluctuation is perceived on examining the tumor. Consensual symptoms: sensation of numbness in the thigh of the affected side, frequently alternating with a drawing, tearing pain; rising of the globus hystericus or the hysteric ball towards the stomach, nausea, vomiting, frequent urging to urinate, with difficulty of emitting the urine; constipation, flatulence, and the symptoms which are generally present in dropsy, but very slightly in this variety; great paleness of the face after the disease has lasted for some time; small, quick pulse; dry skin, oedema of the ankles; sometimes the oedema is first perceived about the genital organs. The disease occurs most frequently after the critical age, in females who had borne many children or who had indulged in sexual intercourse to excess without conceiving. The prognosis is unfavorable; the disease sometimes lasts from six to eight years, and most generally terminates in death." The best remedies for this disease are, together with the remedies for dropsy in general, PULSATILLA, PLATINA, CANTHARIDES, IODINE, MERCURIUS, ARSENIC, PRUNUS SPINOSA. The symptomatic indications will be furnished below. APIs is also reccommended. ----I-----~-s~- I ---I 584 SPECIAL THERAPEUTICS. Inflammation and Dropsy of the Knee-Joint, Hydrarthrus. An effusion of water into the knee-joint is the last development or result of some other disease such as inflammation, debility; or it may be caused by metastasis, external injuries, etc. It is either acute or chronic. Acute inflammation of the knee-joint developes itself very rapidly; the joint swells, becomes extremely painful, the least motion or contact causes great suffering; the skin is tense and red, the part feels hot, and, after a while fluctuation becomes perceptible on the outside. In chronic hydrarthrus the disease develops itself much more slowly at first, but is none the less fierce after it has. once become fully established. For a long time, sometimes for months, the patient complains of a deep-seated, aching pain in the interior of the joint; if this is not removed by treatment, the joint gradually becomes enlarged, stiff; a cold, or standing on cold stones or on damp ground, is often sufficient to rouse the disease, and give it a most acute form, with agonizing pain, prickings in the joint, burning heat in the joint, lancinations as if the joint were cut with knives; the effusion is distinctly felt. This form of the disease is frequently a symptom of general inflammatory rheumatism. TREATMENT.-We will anticipate the description of the general treatment of dropsy by indicating the treatment of this particular form of dropsy in this place. The principal remedies for this affection are ACONITE PULSATILLA, IODINE, and SILICEA. The best mode of proceeding with the treatment is as follows: Mix one or two drops of the first attenuation or even the tincture o Acoite in a tumblerful of water, and a drop of the first attenuation or tincture of Pulsatilla in another IROPSY OF KNEE-JOINT. 585 tumblerful, and give an alternate dose of these medicines every half hour, until a reaction has commenced, after which the medicines may be continued, an alternate dose every hour, and lastly every two hours. This treatment is sufficient in most cases, unless complications should exist. After the inflammatory symptoms have been removed, and a weakness, hardness or tendency to enlargement remains, we may give SILICEA, third trituration, in one-grain doses, alternately with Pulsatilla, prepared as above, giving an alternate dose of medicine every two or three hours. After having given Silicea for three or four days CALCAREA may be.substituted for Silicea, and given alternately with Pulsatilla as above. If necessary, Silicea may be resumed in a few days, until the disease is perfectly cured. IODIUM or IODINE may become indispensable if the joint looks swollen, is red and painful, hot, sore, and Aconite which may have seemed indicated by the symptoms, has no effect upon the disease. We may mix one or two drops of the tincture in a small tumblerful of water, and give a tablespoonful of this mixture every two or three hours. This medicine is more particularly indicated, if the patient exhibits unmistakeable signs of a scrofulous habit. COLD WATER.-Cold-water bandages may be applied to the joint with great benefit. The patient should avoid exposure after the cure, lest a relapse should take place. We have recommended the tincture of Pulsatilla together with the attenuations; we are satisfied that, in some cases of this disease, the tincture acts better than 586, SPECIAL THERAPEUTICS. the attenuations, though these two have effected brilliant cures. Spina Bifida, Dropsy of the Spine. This is a fissure in the spinal column, with deficient formation of the vertebrae. Where the fissure is located, a tumor becomes visible on the outside, from the size of a walnut to that of a goose-egg. This tumor is filled with a clear, and sometimes turbid or reddish fluid. The disease is frequently attended with hydrocephalus or some other organic disease. It is doubtful whether it can be, or ever has been, cured. At any rate, a physician will have to be consulted for this purpose. Hydrocephalus, Dropsy of the Brain. For a description of the nature and treatment of this disease the reader is referred to Meningitis, page 329, and Tuberculosis of the Brain, page 562. General Treatment of the Different Varieties of Dropsy. We have no specific remedies for the different varieties of dropsy, and it has therefore been deemed advisable, in speaking of the treatment of dropsical effusions, not to distinguish the different medicines for dropsy into particular classes, adjudging some to one variety of dropsy, and others to some other variety; but to indicate in their unbroken totality the symptoms, by the presence of which, in any particular case of dropsy, the selection of the appropriate remedy has to be decided. APIS MELLIFICA has proved a useful agent in anasarca, ---------- GENERAL TREATMENT OF DROPSY. 587 - ascites and hydrothorax, especially when complicated with strangury. DOSE.-One or more drops, of the first attenuation or tincture, in a tumblerful of water, a tablespoonful every three or four hours. ACONITE.-This medicine is a powerful agent in dropsy, especially when the disease is accompanied with determination of blood to the brain, palpitation of the heart, dizziness, wakefulness, nervous restlessness, etc. If the disease originates in a sudden fright, Aconite is strictly indicated. In a case of general dropsy which came on after a sudden fright, and had continued for nearly eighteen months, getting worse all the time, we gave the patient, who was a lady of forty years, the tincture of Aconite, a few drops in a tumblerful of water, a tablespoonful every two hours. A few days after commencing the Aconite, she began to discharge a bloody looking serum from the womb and bladder, which increased to a pailful a day, until the dropsical deposit had entirely disappeared and ceased to form anew. Previous to the commencement of the treatment the patient was enormously swollen all over the abdomen, extremities, even the neck' and parts of the face being involved in the swelling; the skin was stretched to the utmost, and a blood-tinged serum would spirt out wherever the skin was pricked with a needle. After the dropsical symptoms were entirely removed the lady moved away from the city; since then we have lost sight of her. Aconite is an admirable medicine in hydrothorax, when the following symptoms occur: sudden fainting spells after the least exertion, walk, ascension of an eminence; palpitation of the heart, frequent waking in the night, with a start, dyspncea, shocks of the heart, 588 SPECIAL THERAPEUTICS. the patient gasps for air, has to sit up; frequent and sudden changes of color, from pale to red, and vice versa; chills and flashes of heat; coldness of the extremities, distressing giddiness, anxiety; the pulse is small, quick, irregular. DOSE.-In all such cases, employ the tincture of Aconite, and frequently the tincture of the root, a drop or two, in a tumblerful of water, a small tablesponful every two or three hours. ACONITE is an excellent remedy in hydrothorax if the disease can be traced to organic disease of the heart. In such a case it is well to alternate the Aconite with DIGITALIS, giving of the Aconite the same dose as before mentioned, and of Digitalis a few drops of the tincture in half a tumblerful of water, a tablespoonful at a time, an alternate dose every two hours. Instead of the tincture of Digitalis many homoeopathic physicians of the highest standing employ a weak infusion, of which they give a teaspoonful three or four times a day. CANNABIS APOCYNUM may be given in dropsy caused by suppression of fever and ague, or after scarlatina, two or three drops of the tincture in a tumblerful of water, a tablespoonful every four or six hours. ARSENICUM is a great remedy in every variety of dropsy, especially when the following symptoms are exhibited: general dropsical swelling of the face' and body; swelling of the right side of the body down to the hips; swelling of the face and feet; general coldness, with parchment-like dryness of the skin of the affected parts; or else burning, and burning itching of the skin; peeling off of the skin in large scales; petechial disorganizations of the skin, green, yellow, or brownish color of single parts; fetid liquid diarrhoea or else constipation, scanty discharges of foul, blackish, saturated urine; GENERAL TREATMENT OF DROPSY. 589 burning, unquenchable thirst, oppression, especially at night; anguish, despair of one's recovery; excessive palpitation of the heart; yellow, livid complexion, with expression of sadness and anxiety in the countenance; excessive debility and rapid emaciation. ARSENIC is useful in every variety of dropsy; likewise in those forms of dropsy which are developed as sequele of acute eruptive fevers, such as scarlatina, and particularly in ascites, depending upon chronic diseases of the liver. DOSE.-One grain of the third trituration every three hours. DULCAMARA is useful in dropsical swellings remaining after acute eruptions such as measles, scarlatina, urticaria; or in dropsies which come on after sudden suppression of the perspiration by exposure to wet and dampness, or to a draught of air; it may be alternated with, or followed by, COLCHICUM. DOSE.-Of each, a few drops of the first attenuation, or even of the tincture in a separate tumblerful of water, a small tablespoonful in alternate doses, every two hours, until the cutaneous and urinary secretions are restored, after which the medicine may be continued less frequently. HELLEBORUS NIGER is adapted to acute and chronic dropsies, coming on in consequence of suppressed eruptions, or after measles, scarlatina, etc.; it is particularly indicated when the dropsical symptoms develop themselves very rapidly all over the body, even the genital organs and face, with oppression of breathing, aphthous exulcerations in the mouth; in dropsy of the pericardium it is a valuable remedy, and may be alternated with Arsenic, the latter in one grain-doses, as mentioned above, an alternate dose every two hours. CHINA is generally recommended for dropsy arising from loss of animal fluids, excessive depletions, sexual excesses, onanism, exhausting diseases, or excessive 51 590 SPECIAL THERAPEUTICS. physical exertions, watching, impoverished condition of the reproductive system by privations, vitiated air, starvation, etc. China is likewise useful in dropsies arising from affections of the liver and portal system, or organic disease of the heart and spleen; it is more particularly indicated by suppression of urine, oppression of the chest, and a troublesome, short cough with expectoration. DOSE.-One or more drops of the first or second attenuation in a tumblerful of water, a small tablespoonful every two hours. China may be alternated with, or followed by Arsenicum, as indicated above, or by FERRUM, especially when there is great tendency to rapid emaciation or marasmus, a chlorotic habit,-with sickly and cadaverous color of the face and skin, debility, nocturnal distress, nausea and vomiting after eating, constipation, etc. DOSE.-One grain of the third trituration every four hours; and,, if alternated with China, an alternate dose every two hours. MERCURIUS VIVUS is particularly indicated, if dropsy, and especially ascites, depends upon organic disease of the liver, and is complicated with symptoms of jaundice, pain in the pit of the stomach as if ulcerated, deep yellow color of the urine which is secreted in small quantities, constipation. DOSE.-One grain of the third trituration every three hours. BRYONIA is a good intermediate medicine in ascites, especially when the disease was caused suddenly by a cold drink while heated, accompanied with inflammatory symptoms of the organs of respiration and bowels, constipation, flushed, jaundiced color of the face. DOSE.-One or twio drops of the first or second attenuation to be repeated in from four to six hours, if necessary, after which the more specifically indicated medicines may be continued. I GENERAL TREATMENT OF DROPSY. 591 ZINCUM METALLICUM, according to Dr. Wahle, is an excellent remedy for dropsical affections, if the patients complain of distress or uneasiness in the renal region. He likewise cured a case of dropsy of one year's standing with AURUM MURIATICUM, sixth attenuation; a fine clear urine was secreted after the use of this agent, whereas the PRUNUS SPINOSA was followed by the secretion of a turbid urine with strong ammoniacal odor. PRUNUS SPINOSA is recommended by Dr. Wahle as an excellent remedy for ascites; we use the tincture, a few drops in half a tumblerful of water, a tablespoonful every two or three hours. KALI CARBONICUM seems indispensable in anasarca and ascites caused by menstrual suppression. DOSE.-One grain of the third trituration every four hours, until an improvement is perceived. This medicine may likewise be tried in ovarian dropsy, same dose. In this species of dropsy, and in anasarca and ascites depending upon menstrual suppression we have likewise CHINA and FERRUM, same dose as indicated above; and PULSATILLA, one or more drops of the first or second attenuation in a tumblerful of water, a small teaspoonful every two or three hours, or even less frequently, every six hours. CANTHARIDES is a most important medicine in ovarian dropsy, ascites, and dropsy of the womb, especially when the patient is troubled with a constant urging to urinate, and inability to pass any water, DOSE.-One or two drops of the tincture in a small tumblerful of water, a small tablespoonful every hour or two hours, until the urine is discharged freely. If Cantharides has no effect, we may try __ 592 SPECIAL THERAPEUTICS. APIS, as recommended above, or likewise SQUILLA MARITIMA, which, according to Hartmann, has to be given in large doses, as it has only a palliative effect in dropsy. He recommends that it be given as a powder, or as oxymel squilliticum; also in pills. We may first try the tincture, from eight to twelve drops in a tumblerful of water, a tablespoonful every hour, until a copious flow of urine sets in; and, if this does not take place, the physician, if he think fit, may try the squills in substance. Hartmann makes the same remark concerning DIGITALIS, which is considered an excellent remedy in hydrothorax, dropsy of the pericardium, or ascites. According to Hartmann, and other eminent homoeopathists, it should be given as an infusion, in dessert-spoonful doses, three or four doses a day. We may also give it in the same dose as Pulsatilla. EUPHORBTUM CYPARISSIAS and SOLANUM NIGRUM were given, by Hartmann, in two instances of anasarca; one drop of the tincture, in each case, effecting a cure, according to his belief. IODIUM and PLATINA may be tried in ovarian dropsy, the former more particularly if the disease is complicated with a scrofulous taint. DOSE.-Of Iodium one or more drops, of the first attenuation every four or six hours, or, if deemed proper, the tincture may be employed in the same quantity. Of Platina give one grain of the third trituration every three or four hours. LEDUM PALUSTRE may prove serviceable in anasarca or ascites having a rheumatic origin. DOSE.-Same as Cantharides. APIS MELLIFICA may prove valuable in dropsy of the womb and ovaries. DOSE.--A few drops of the first or second attenuation in a tumblerful of water, a tablespoonful every four or six hours. I__ GENERAL TREATMENT OF DROPSY. 593 SECALE CORNUTUM may be exhibited in dropsy of the womb, if the patient is troubled with pressing-down, expulsive pains, or if the dropsy is complicated with pregnancy. DOSE.-One or more drops of the tincture, in a tumblerful of water, a tablespoonful every hour or two hours, until a copious discharge of water takes place. After Secale, PULSATILLA may be given in this disease, in the same dose as for ovarian dropsy. We have never treated more than one case of this disease in a pregnant female. The fetus was expelled dead, and the patient recovered very rapidly after that expulsion had taken place. Whether the expulsion was brought on by treatment, or took place spontaneously, we are unwilling to decide. PALLIATIVE TREATMENT OF DROPSY.-Tepid baths are sometimes exceedingly soothing to a dropsical patient, and should be administered whenever the patient desires it, of course with due regard to all other circumstances. Dropsical patients require a dry, soft, warm air; damp, raw weather is extremely unfavorable. If the disease can be traced to the influence of the climate to which the patient is habitually exposed, or is the consequence of a badly-managed intermittent fever, which is endemic in the region of country where the patient resides, it is doubtful whether medical treatment alone will do much for the patient; in such a case, he will have to move to a more healthy locality, or put up:with his disease until it carries him off. The diet should be exceedingly light; in acute dropsy, the diet is to be the same as in every other acute disease; in chronic dropsy, patients sometimes have a fair appetite, but they have to be exceedingly careful lest they should eat too much, or indulge in food that does not agree with them. All rich, heavy 51* 594: SPECIAL THERAPEUTICS. articles of diet should be rigidly prohibited. The best drink, to quench the burning thirst with which dropsical patients are frequently tormented, is cold water; but any other beverage for which they express a desire, and which does not interfere with the medicine, may be given them; milk, curd, butter-milk, are allowable. A very light ale, a pure malt-brew, is likewise allowable under certain circumstances. Drinks which promote the secretion of urine, decoctions of wild-brier, parsley, asparagus, radishes, cucumbers, etc., are useful palliatives. The sweating method, as employed ander the hydropathic treatment, may prove eminently beneficial in dropsy, if patients are willing to resort to it; it may be, and ought to be, combined with homoeopathic treatment. Tapping is frequently necessary as a palliative means; in organic dropsy it is unavoidably required to afford the patient relief. DISEASES OF THE DIGESTIVE ORGANS. Toothache, or Odoutalgia. This affection is so well and so universally known, that it does not require any particular description. It is sometimes exceedingly difficult to cure, and, if the tooth is carious, the only thing that will stop the pain effectually, is the extraction of the tooth. Jahr proposes as an effectual means to.arrest toothache from a decayed tooth, the insertion into.the cavity of the tooth of-a little piece of cotton moistened with a drop of the tincture of TOOTHACHE, OR ODONTALGIA. 595 Aconite. A decayed tooth sometimes causes neuralgic pains shooting over the face and down the neck; if this be the case, it is absolutely necessary to extract the tooth, as no treatment can relieve such pains, and their permanence or constant recurrence might affect the constitution. The following medicines have been given for toothache with more or less success, the dose being the same for all these medicines as is indicated for Aconite. ACONITE, for throbbing pain, after a cold, affecting the whole side of the face and jaw, with redness of one cheek; the pain is frequently accompanied with violent congestion of blood to the head, burning heat in the face, restlessness, nervousness; or it is a shooting, lancinating, boring, wrenching pain, with excessive sensitiveness of the teeth, as if ulcerated, redness and bleeding of the gums; sensation as if the tooth were loose and would fall out of the socket. DOSE.-A few drops, or six globules in a tumblerful of water, a small tablespoonful every hour until the pain is eased. BELLADONNA, for rheumatic toothache, especially in females, the pain being a tearing, digging, throbbing, lancinating pain; also during pregnancy, and sometimes felt alternately in the teeth, ear, face. Or, for excessive pain in an uncertain tooth. This remedy may be used alternately with Aconite, an alternate dose every half hour until relief is procured. Of the following medicines give six globules dry on the tongue, every two or three hours, except the northpole of the magnet. CALCAREA CARBONICA, tearing in hollow as well as sound teeth, in paroxysms, aggravated by cold, and especially by cold air. __ __ __ 596. SSPECIAL THERAPEUTICS. BRYONIA, for a fine flashing-stinging pain. in the teeth. CHAMOMILLA, if the toothache affects only one side, or if there is a tearing pain in one side of the head, jaws, and in the ear of that side. Or, for rheumatic toothache, the pain being intolerable, in paroxysms, not affecting any one tooth in particular, darting, tearing, lancinating, or also digging-up and gnawing, grumbling and drawing; the pain is most violent in the night and after a meal, aggravated by cold drinks and the warmth of the bed, the gums being sometimes swollen and burning; the pain is often attended with swelling and redness of the cheeks, and, in some cases, comes on regularly with the menses. CHINA, beating toothache, relieved by pressing the teeth firmly together, but increased by slight pressure. COFFEA, throbbing toothache, with nervousness and violent weeping. CYCLAMEN, if the pain is of an arthritic nature, a stitching-boring pain. HYoscYAMus, for a tearing and pulsative pain continuing in the socket of a tooth which had been pulled out, and extending through the cheek into the forehead; violent chilliness, followed by heat; redness of the face and eyes, which glisten; frenzy, spasmodic rolling of the eyes, the patient screams, beats about, wants to escape. Or, tearing and beating toothache, the pain extending to the root of the nose and eyes; the pain is aggravated by pressure; the teeth feel elongated. Or, beating and whizzing in the tooth, with tearing in the gums; the teeth feel loose when chewing, accompanied with violent congestion of blood to the head, and violent heat. ____~____~~______________ TOOTHACHE, OR ODONTALGIA. 597 The NORTH-POLE OF THE MAGNET removes toothache affecting a hollow tooth and brought on by a cold, with swelling and inflammation of the gums, and swelling redness and heat of the cheek; the pain is worse in the warmth and after a meal, and is sometimes accompanied with dartings through the periosteum of the jaw-bone, increasing from a jerking pain, with pressure, to a digging pain, with tearing, and sometimes consisting in burning stitches. Apply the magnet to the affected part. MERCURIUS, tearing pain in the teeth, or stitches in the hollow teeth, and tearing in the roots of other sound teeth; the pains are worse after eating, aggravated by cold air, eased by warmth; ptyalism is sometimes pre sent, accompanied with itching of the gums, which are inflamed, swollen, red or livid, or bright-red around the borders, looking as if corroded, suppurating, painful, or spongy; putrid smell from the mouth. MEZEREUM, for a drawing pain in the jaws, alternating with a boring pain in some teeth, and a stitching pain extending into the cheek-bone; the teeth are set on edge, feel numb and elongated; sometimes a sensation of numbness is experienced in the whole side of the head; the pains are increased by contact. Or, the pain may be darting, lancinating, with sensation as if the tooth were raised out of its socket. Aconite may likewise be used for this group of symptoms. Nux VOMICA, stitching or tearing pain, or a digging. up pain, or a drawing pain with fine stitches, in carious teeth, increased by reading, meditation, warm or cold substances, cool air, coffee, spirituous drinks; sometimes the pain can be relieved by applying warm cloths or poultices, it is aggravated by cold things; there is no _ _ 598 SPECIAL THERAPEUTICS. swelling of the cheek, although the submaxillary glands may be swollen. Nux vomica is a good remedy for the rheumatic toothache of pregnant females, a drawing and tearing pain without swelling. PULSATILLA, a drawing, gnawing or tearing pain in both the carious and sound teeth, or a drawing and jerking pain in the nerve of the tooth as if put upon the stretch and then let loose again, with a fine stinging gnawing in the gums; or a stitching, digging up pain, setting in in paroxysms with evening or nightexacerbations; the pain is always aggravated by the contact with warm substances, or by the warmth of the bed, and relieved by the application of cold; it is not increased by chewing but may be excited by a toothpick. RHUS TOXICODENDRON, a tearing pain of a rheumatic or arthritic nature; it is always made worse by cold, and relieved by warmth. SABINA, throbbing toothache in females, with sensation as if the tooth would be shattered to pieces from within. SEPIA, for a chronic beating toothache, or for the toothache of pregnant females; it is generally accompanied with a stitching sensation, the pain extending as far as the ears and through the arm, with a tingling sensation in the fingers; sometimes accompanied with swelling of the cheeks and submaxillary glands. SPIGELIA, for a drawing and tearing pain in the teeth, or for a beating toothache, especially when a violent pain darts like lightning through the roots and crowns of some teeth, or when accompanied with stitches and tearing in the eyes and ears, heat in the mouth, tearing and burning in the cheek-bone, pale, puffed face, violent TOOTHACHE, OR ODONTALGIA. 599; palpitation of the heart, purring sensation in the chest, chilliness, restlessness. Aconite will also be found useful. STAPHYSAGRIA, for a violent gnawing pain in a molar tooth, with drawing in the whole row, or the drawing extending towards the eye; or- when the teeth are extremely sensitive all the time, when the pain is excited by eating, drinking, by cold air; when chewing is impossible, the pain is somewhat relieved by warmth. SULPHUR, for a drawing toothache which is increased by warmth, or for a pain as if the teeth and head were pierced through; or, for a beating toothache consequent upon a repelled eruption, the gums being swollen and throbbing. VERATRUM, for a beating toothache accompanied with -swelling of the face, cold sweat on the f6rehead, nausea and vomiting, bruised feeling in the limbs, failing of strength, coldness of the whole body, internal heat and unquenchable thirst. If these different remedies should not be found sufficient to meet every case of toothache, the reader is requested to consult our Repertory, from pages 416 to 44:1, where every possible kind of pain which may affect the teeth or gums, will be found mentioned, together with its, appropriate remedy. Consult also in the same work the Index under Teeth, pages 1211 and 1212, and under Toothache, page 1215. HYGIENIC TREATMENT.-The preservation of the teeth is an important duty devolving upon every sex, condition and age. Bad teeth cause a good deal of trouble, disagreeable breath, gastric derangements, neuralgic pains, etc. It is not by any means difficult to preserve one's teeth, provided we are willing to discard all praeý ~------------~-------- 600 SPECIAL THERAPEUTICS. tices that must necessarily in the long run destroy the enamel which constitutes the beauty of a tooth. A man who chews tobacco, or who. has a cigar in his mouth from morning to night, cannot expect to keep his teeth sound. The habitual use of strong drinks likewise tends to corrupt the teeth. Children are very apt to have their teeth spoiled by eating too many sugar-plums, pastry and the like. The abominable habit of chewing ice or the opposite habit of eating food scalding hot, is likewise ruinous to teeth were they naturally ever so sound. Persons who wish to preserve their teeth, should avoid either extreme. It is an excellent practice, after every meal to rinse the mouth with a little tepid water, and to rub the teeth with a soft brush in order to remove the remains of meat or the little husks which may have lodged between the teeth. Every now and then a. tooth-powder may be used, such as may be found in homceopathic pharmacies; these powders are composed of non-medicinal substances, and simply help to remove the sordes which may still adhere to the teeth even after rubbing them with pure water. If a tooth-pick is to be used let it be made of wood, horn, or of a goosequill; but never use a tooth-pick at the table, or in company; this is another vile habit to which even men who call themselves gentlemen and men of education are addicted. Caries or Decay of the Teeth. If possible the carious portion may be filed off. Internally the disposition to become carious, and even actual caries may be combated with the following remedies: __ __ ULCERS ON THE GUMS. 601 SEPIA, for a disposition to decay speedily. DOSE.-One drop, or three globules, every other morning, in a spoonful of water. STAPHYSAGRIA, for exfoliation of the incisors. DOSE.-Same as Sepia. PLUMBUM ACETICUM, if the tooth becomes more hollow, friable; it breaks and gives out a foul smell. DOSE.-One grain of the third trituration every morning or night. MERCURIUS DULCIS, breaking off, exfoliation, blackness, looseness and falling out of the teeth. DOSE.-Same as Plumbum, MERCURIUS VIVUs, when the teeth are set on edge, loose, fall out, and become yellow and carious. DOSE.-Same as Plumbum. ARGENTUM NITRICUM, exfoliation of the molar teeth, with ulcerative pain, and as if loose DOSE.-Same as Plumbum, or two powders every day, morning and night. Gumboils, Ulcers on the Gums. Of the following medicines, three globules may be taken twice a day, dry on the tongue, morning and night. Or one drop in water. MEROURIUS viVus for ulceration and whitish indentations of the gums. SEPIA, for sore, ulcerated gums. SILICEA, for a gumboil, with swelling of the gums. PHOSPHORUS, for small ulcers on the gums, with painful sensitiveness of the gums; or for a bleeding ulcer on the gums over a hollow tooth. Nux VOTICA, for a gumboil, with drawing and burning pain. 52 602 SPECIAL THERAPEUTICS. HEPAR SULPIIURIS and CALCAREA CARBONICA, may be given for a common gumboil, in alternation, an alternate dose of each every day, giving a powder at a dose. LYCOPODIUM, for dental fistula in an old socket. ACONITE, for gumboil, also after extraction of a tooth, with stinging sorenes. Foul Breath. A foul breath may result from a variety of causes. If a decayed tooth is the cause, and the decayed portion of the tooth cannot be filed off or the decay removed by treatment, or washing, the tooth must come out. If want of cleanliness causes the foul smell, the teeth should be cleaned carefully after every meal. If gastric derangement causes the trouble, the gastric functions have to be restored to their normal condition. If the bad odor should be the result of mercurial poisoning, the mercury has to be antidoted; or, if the weakness be traceable to any particular cause, this should be acted upon and removed by appropriate treatment. If no particular cause can be found, we may employ the following medicines, giving a few drops in a spoonful of water, or six globules morning and night, dry on the tongue. ACONITE, for a foul smell, as if proceeding from bad pus. This medicine is particularly suitable to tuberculous individuals. In this case a drop of the strong tincture may have to be used in a small tumblerful of water, giving a dessert-spoonful every four hours. Nu xvoMICA, for fetid breath from the mouth, also attended with vertigo, stooping; or for foul breath __ BAD TASTE IN THE MOUTH. 603 after rising in the morning, or after dinner; the tongue may otherwise look clean, and the taste in the, mouth may be natural. MERCURIUS vivus, for a a fetid cadaverous odor from the mouth, especially when offensive to others. ARNICA, for foul breath, or foul vapor coming out of the mouth during an expiration. AURUM FOLIATUM is considered one of our principal remedies for foul breath; also in girls at the age of pubescence. STANNUM, foul breath from the mouth and throat. PULSATILLA, bad smell from the mouth, on waking, also with dry mouth and throat. SULPHUR, for fetid smell from the mouth after a meal, or in the morning and evening. CHINA, for foul breath which is removed by eating. CHAMOMILLA, for fetid smell, especially after dinner. Bad Taste in the Mouth. This is generally a symptom of gastric derangement, which has: to be treated in order to correct the taste. For bad taste, without any marked derangement of the gastric functions, we have a variety of remedies which the reader will find enumerated in our Repertory, page 549, under the head of Putrid Taste, and Bad, Foul Taste, or any other kind of taste that is not a natural, healthy taste. If it should be accompanied with bilious symptoms, constipation, etc., these conditions have to be treated. See these particular affections under the head of Gastric Derangement, Constipation, Liver-Complaint. __ ~ 604: SPECIAL THERAPEUTICS. Canker-sores, Aphthous Ulcerations of the Mouth, Cancrum Oris. These ulcers occur frequently in nervous individuals, or persons who are troubled with dyspepsia and torpid liver. Sometimes these ulcers are intensely inflamed, and sting like nettles. Persons who are subject to such weaknesses, should carefully avoid stimulants, drink much cold water, employ daily ablutions with cold water, and take a suitable amount of bodily exercise. If these aphthe depend upon liver-complaint, dyspepsia or pregnancy, they have to be treated with reference to these conditions; common aphthoe, without any other complications, may be treated with the following medicines: MERCURIUS VIVUs, for ulcers and sores, with burning and smarting pain; or for painful spreading ulcers in the mouth, bleeding or else discharging a fetid ichor; also with ptyalism. DOSE.-One drop, in water, or six globules dry on the tongue, morning and evening. IoDIUM fitly succeeds Mercurius, especially when ptyalism is present. DOSE.-One drop of the first attenuation, morning and night. Iodium is particularly indicated when the gums are red, loose, spongy, with slightly bleeding, small, ash-colored, painful ulcers, and a profuse fetid ptyalism. NITRI ACIDUM, for ulcers in the mouth and fauces, also with stinging pain as from a splinter. DOSE.-Same as lodium. KALI BICHROMICUM, for sloughing ulcers at the roof of the mouth. DOSE.-One grain of the third trituration, dry on the tongue, morning and night. I ~ DECAY OF THE INNER MOUTH. 605 CHINA may be given for small, deep-seated, stinging ulcers, covered with a whitish pus. DOSE.-A few drops, or six globules, morning and night. ACONITE may be given instead of China, or alternately with it, if the ulcers are surrounded with an inflamed border, burn, and are extremely sore, and smarting or stinging. DOSE,-One or two drops of the tincture of the root, in a tumblerful of water, a tablespoonful every two or three hours; the attenuations are much less reliable in this affection. FERRUM ACETICUM is an excellent remedy for aphthae of nursing females. DOSE.-This preparation should be used as a wash, five drops of the tincture in a tablespoonful of water, with which the mouth should be rinsed three or four times a day. We have succeeded in relieving nursing females by this means, when every thing else failed. REGIMEN.-Persons who are subject to this affection, should live on simple food, good beef and mutton, a good supply of vegetables, drink nothing but fresh and soft water, or at most a little black tea, avoid all heavy and fat compounds, resort to frequent ablutions with cold water, and take as much exercise in a bracing air as opportunities offer for so doing. Stomacace, Decay of the Inner Mouth. This affection may result from a want of cleanliness, from abuse of mercury, from mismanaged inflammation of the mouth, or from a general debility of the reproductive system. If. it be owing to a want of cleanliness, the mouth should be carefully washed with cold or tepid water several times a day. If owing to mismanaged inflam52* _ _ 606 SPECIAL THERAPEUTICS. mation, the specific remedies are ACONITE, CANTHARIDES and MERCURIUS. If owing to abuse of Mercury, the action of this poison has to be antidoted by appropriate remedies, such as IODIUM, NITRI ACIDUM, HYDRIODATE OF POTASH, AURUM, or the higher attenuations of MERCURIUS; and if owing to a general debility of the reproductive functions, the following medicines may have to be used: ACONITE, MERCURIUS, ARSENICUM, IODIUM, Nux VOMICA, BELLADONNA, HYOSCYAMUS: CANTHARIDES. Particular Indications. ACONITE, when resulting from mismanaged inflammation; the mouth feels dry as wood, stiff, is ulcerated, with burning and stinging pain, and discharge of a viscid, foul, badly-smelling fluid ichor. The lips are constantly glued together, and the tongue adheres to the roof of the mouth. The patient wants to wet the mouth constantly. DOSE.-One or two drops of the saturated tincture of the root, a tablespoonful every hour. This medicine may be alternated with CANTHARIDES, same quantity as Aconite, an alternate dose every hour. MERCURIUS VIVUS: the gums are detached and retracted, and bleed readily; ptyalism, discharge of a yellowish-bloody saliva from the mouth, fetid odor from the mouth, tearing toothache, ulcerative pain when eating, constant chilliness, even in bed; burning and itching at the anus. DOSE.-One grain of the third trituration every three hours, or six globules in a tumblerful of water, a tablespoonful every two hours. Nux VOMICA, when the gums are swollen and look like foul flesh; blood oozes from the surface of the MERCURIAL STOMACACE. 607 mouth; fetid odor from the mouth; sunken features and sickly complexion; loss of appetite, irritable disposition. DOSE.-One drop of the first attenuation three or four times a day, in a spoonful of water. BORAX may be used externally and internally; internally, one grain of the third trituration three times a day; and externally as a wash, dissolving a few grains of Borax in a cupful of tepid water, and rinsing the mouth with it four times a day. ARSENIC may be given in stomacace, when the ulcers threaten to become gangrenous, and the patient feels excessively prostrated. DOSE.--A few drops in a spoonful of water, or six globules, dry on the tongue, three times a day. If Arsenic should not help, substitute LACHESIS, two globules of the 200th potency, and another dose in twelve or eighteen hours, if necessary. And if Lachesis likewise proves inefficient, give BELLADONNA, a few drops or six globules in a tumblerful of water, a small tablespoonful every two hours, until relieved. PALLIATIVE TREATMENT.-It may prove very useful to rinse the mouth three or four times a day with a solution of from ten to fifteen drops of dilute sulphuric acid in half a cupful of water. Mercurial Stomacace. This affection is best treated with AURUM, NITRI ACDUM, STAPHYSAGRIA, HYDRIODATE OF POTASH, and the higher preparations of Mercurius. Commence with AURUM, and more particularly AURUM MURIATICUM, one grain of the second trituration three or four times a day. Continue for a week, then give 608 SPECIAL THERAPEUTICS. NITRI ACIDUM, one drop of the first or second attenuation four times a day. In a week resume Aurum or else give the HYDRIODATE OF POTASH, second trituration in one grain powders four times a day. And, after using this medicine for a week, give STAPHYSAGRIA, one drop of the second attenuation four times a day. But, if any of the aforesaid remedies should have produced a sensible improvement, continue the medicine to which the improvement may be attributed, as long as it lasts. Another great remedy for Mercurial stomacace is IODIUM, especially when there is profuse, fetid ptyalism and ichorous exulcerations. DOSE.-Same as Staphysagria. MERCURIUS VIVUS is a good remedy for Mercurial Stomacace of long standing, with discharge of a yellowish, bloody saliva from the mouth, foul smell, looseness and caries of the teeth. DOSE.-A few drops of the.twelfth attenuation, in a tumblerful of water, a small tablespoonful every two hours. In cases of chronic poisoning, when the effects of the poison have assumed the character of a dynamic disease, the higher attenuations of the poison are often used by homoeopathic physicians as an antidote, not always however with success. Speaking of Mercury, we may likewise recommend this remedy for the following group of symptoms. MERCURIUS VIVUS is a good medicine if the local disease had developed a constitutional derangement, with spongy, ulcerated, readily-bleeding gums, loose teeth, aphthous exulcerations all through the mouth attended with burning and stinging pains; profuse discharge of badly smelling, sanguineous saliva; loose stools, which corrode the anus; dark-red, fetid urine; debility, depression of spirits. PTYALISM. 609 DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours, until relieved, after which the medicine may be continued every four hours; a powder of the third trituration every four hours may likewise prove serviceable. Compare the remedies which have been indicated for canker-sores. Ptyalism. This disease may be induced by a cold, causing an irritation of the salivary glands, or it may be caused by mercurial action. In the former case the best remedies for this disease are ACONITE, if the secreted fluid is of a scalding nature, causing a sensation of rawness in the mouth, and a feverish feeling throughout the system. DOSE.-One or two drops of the saturated tincture of the root, a small tablespoonful every hour, or two hours. MERCURIUS VIVUS is indicated if the flow of saliva is incessant; the saliva is of a clear, watery consistence, sometimes having a saltish taste; the throat may feel sore on performing the act of empty deglutition, and the glands and tonsils are sometimes swollen. DOSE.-Half a grain of the first centesimal trituration every four hours. IODIUM may be given instead of Mercury, if the discharged saliva has a fetid smell and taste. DOSE.-One or more drops of the tincture in a tumblerful of water, a small spoonful every two hours. If the disease should have been caused by Mercury, give the antidotes to Mercury, and consult the article on Mercurial Stomacace, page 607. Consult also page 443 of our Repertory, where a large number of remedies for ptyalism will be found indicated. __ 6 10. SPECIAL. THERAPEUTICS. Ulceration and Swelling of the Jaw-bone. This affection is principally treated with MEROURIUS VIvus and SILICEA, using the third trituration of each, in half grain doses, an alternate dose every two or three hours. Instead of Silicea, it may be well to use now and then HEPAR SULPHURIS, same trituration and dose. MERCURIUS DULCIS may be substituted for Mercurius vivus, especially when the soft and hard parts, face, lips, cheeks, gums, teeth, upper jaw-bones are involved in the destructive process, principally in children. The dose is the same as that of Mercurius vivus. If the disease was caused by abuse of Mercury the antidotes to Mercury will have to be administered. Glossitis, Inflammation and Swelling of the Tongue. This is a very dangerous disease under alloeopathic treatment, although under sound homeopathic treatment the danger is, comparatively speaking, small. The following medicines may be required to cure this affection. The symptoms of the disease will be found contained in the symptomatology appended to each drug. ACONITE, when the tongue is swollen, excessively painful, burning, of a dark-red color, dry, and the patient craves cooling drinks all the time. DOSE.-One drop of the tincture in a tumblerful of water,a small tablespoonful every two hours, or even more frequently, until relief is obtained. MERCURIUS VIVUS, for swelling and inflammation of the tongue, palate, fauces, gums, lips and inner mouth, with profuse secretion of a tenacious fluid, livid and swollen face, aphthme; or for a hard swelling of the STAMMERING. ~31i STAMMERING. 611 tongue, with ulcerated indentations along the edges, and a white coating. DOSE.-One grain of the third trituration, every two or three hours. CANTHARIDES, when the tongue is inflamed and covered with a number of vesicles. DOSE.-Same as Aconite, with which this medicine may be alternated. BELLADONNA may be given, when the papille are of a bright-red color, inflamed and swollen. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every two or three hours. A number of remedies for partial swelling and inflammation of the tongue will be found on pages 453, 454, and 455 of our Repertory; but the above-mentioned list is sufficient to meet almost every case. Stammering, Difficulty of Speech. This weakness may result from former paralysis of the organs of speech, or it may be a constitutional difficulty. In very many cases it can be overcome by patient efforts. We know that Demosthenes lisped and stuttered, and, nevertheless, he became the most eloquent orator of antiquity. He endeavored to articulate slowly and distinctly even with a pebble.in his mouth, or while running up hill; or he would speak loud enough to hear himself even while walking along the sea shore. Accustom yourselves to speak slowly, articulate every syllable distinctly, and with the same regularity as the beats in music. If children stutter, kind and patient treatment, and absolute avoidance of all ridicule will go a great ways to enable them to overcome the weakness. Inter, nally it may be treated with ~ ~--~--~---~--~-~--~-c~---------------- 612 SPECIAL THERAPEUTICS. SULPHUR, one drop, or a few globules every two or three days. BELLADONNA for stuttering as from intoxication. DOSE.-One drop, or three globules, every third day. STRAMONIUM, for stuttering and uttering inarticulate sounds, also with a loud voice. DOSE.--One drop, or three globules, every few days, same as Belladonna. ACONITE, when the stuttering seems to proceed from former paralysis of the tongue, or from actually-existing paralytic weakness of this organ. DOSE.-A few drops, or six globules, every morning or evening. Ranula, or Swelling under the Tongue. This is a painless swelling under the tongue, soft impeding speech, and generally having to be removed by an operation. In homoeopathic practice attempts, more or less successful, have been made to cure it with THUJA, MERCURIUS, CALCAREA, SULPHUR. Mercurius is particularly indicated when there seems to be a syphilitic taint. These different remedies may be given alternately at intervals of from three to eight days; but in most cases the swelling will have to be removed by an operation. Sore Throat, Angina Faucium, Tonsillaris, Uvularis. Although we have a variety of names and forms of this disease, according as one or the other part of the throat is more affected, yet this classification is purely theoretical, and has no practical value whatever. We have therefore considered it expedient to comprise the various forms of. inflammation of the throat under the well-known name of " SORE THROAT." In the books, a D ~_ _ I~ ~ SORE-THROAT. 613 number of different remedies are mentioned for this disease; but there is no need of a large number of remedies; common sore throat can be cured perfectly and easily with ACONITE, BELLADONNA, MERCURIUS, CHAMOMILLA and IGNATIA. ACONITE is indicated by the following symptoms: dryness and burning heat in the throat, which looks red, as if scorched; sense of fulness and choking in the throat; stinging and pricking in the throat; sense of rawness; the throat is lined with a transparent, viscid mucus; dark-red inflammation and swelling of the uvula; the velum is likewise inflamed, dark-red, and frequently covered with 'small ulcers, secreting a whitish, cheesy substance; the tonsils look like two lumps of raw flesh. The patient feels feverish, chilly, thirsty, complains of headache and dizziness; the tongue is generally furred, and ptyalism is sometimes present. Swallowing water eases the distress. DOSE.-One drop, of the common tincture, in a tumblerful of water, a tablespoonful every two hours, until the patient feels easier. This medicine is sometimes fitly followed by BELLADONNA, especially when the throat feels very dry, with.burning and rawness, stitches in the fauces; the internal throat, and even the muscles of the neck, are swollen; swelling, inflammation and suppuration of the uvula and tonsils; constrictive sensation in the throat, impeding deglutition, even liquids return by the nose, and cause a spasm in the throat; aversion to liquids; strings of tenacious mucus hanging out at the mouth; redness of the face and glistening of the eyes. DOSE.-A few drops, or six globules, in a tumblerful of water, a small tablespoonful every two hours. MERCURIUS is indicated when the uvula and tonsils 53 614 SPECIAL THERAPEUTICS. are swollen, but the parts have not the deep redness which characterizes the Aconite sore throat; the parts exhibit a livid-red hue, and are lined with a quantity of viscid, saltish or tasteless phlegm; empty deglutition is particularly painful. The patient wants to swallow saliva all the time, although it hurts him. In many cases there is profuse ptyalism. DOSE.-Same as Belladonna, or one grain of the first trituration every three hours, until decidedly relieved. CHAMOMILLA is particularly suitable when the sore throat was induced by a sudden change of a light for a thick cravat, at an improper season, particularly at a time when the weather was damp and raw. DOSE.-Same as Belladonna. IGNATIA is recommended by Hahnemann, when the stitches in the throat are experienced while not swallowing; and when the patient experiences a sensation as though the throat were obstructed by a plug. DOSE.-Same as Belladonna. PALLIATIVE TREATMENT.-Wrap a wet bandage round the throat, and gargle the throat with warm milk and water, or with a strained decoction of carrots or flax-seed. Ulcerated Sore-throat, Quincy. This affection of the throat, which consists in an inflammation of the throat, with formation of abscesses on the tonsils, uvula, and other parts of the throat, is treated with the same medicines as a common sore throat, except that, in this affection, ACONITE and BELLADONNA are the principal remedies. But let it be well understood that we do not recommend the globules of the MALIGNANT SORE-THROAT. 615 Aconite, nor the common tincture made from the stems and leaves of the plant, but the saturated tincture prepared from the root, by maceration or percolation. Of this tincture we give from one to two drops in a tumblerful of water, a small tablespoonful every hour, until the swelling of the tonsils subsides, after which the dose may be reduced or continued at longer intervals. Those who will pursue this mode of treatment will find, that the disease cannot only be cut short by this means, but that future attacks can be prevented, or reduced to a simple sore throat. The Aconite may be alternated with BELLADONNA, one drop of the tincture or first attenuation in a tumblerful of water, in tablespoonful doses, an alternate tablespoonful every hour. This treatment suffices in every case of ordinary quincy. The abovementioned palliative means for simple sore-throat may likewise be employed in quincy. If an abscess should form, it will soon come to a head under this treatment, assisted by the above-mentioned gargles. Malignant Sore-throat. This species of sore-throat is characterized by a dark redness of the parts, excessive dryness, burning and sense of excoriation. The throat is dotted with stinging and burning little ulcers penetrating considerably below the surface and secreting a whitish, cheesy matter; the parts are lined with a glairy mucus. The patient wants to moisten the throat, tongue, and lips, which look as if parched and raw, and bleed more or less all the time. Every now and then there is a sort of haemorrhage from the surface of the throat. If the disease is not checked, sloughing of the ulcerated parts takes place. -- T-~ 616 SPECIAL THERAPEUTICS. The medicines which we have used with success for this disease, are, ACONITE, CANTHARIDES, BELLADONNA, ARSENICUM, NITRI ACIDUM, but more particularly, ACONITE and CANTHARIDES. ACONITE is, however, useful only when the saturated tincture of the root is employed, a few drops in a tum. blerful of water, a tablespoonful every hour. It is indicated by dark redness and distressing dryness, burning and soreness of the parts, as if they were raw, swelling and inflammation of the tonsils and uvula; the throat is dotted with inflamed little ulcers covered with a grayish muco-purulent matter; the patient constantly hawks up a tough saliva, complains of foul taste and smell, or of excessive dryness of the nose with loss of smell; the lips are parched as if burnt; they bleed frequently; blood is likewise blown from the nose and hawked up from the throat. The affection sometimes spreads downwards to the bronchia, causing a constant hacking; the neck feels stiff, as if affected with rheumatism; an aching pain, and a feeling of soreness are experienced even to the nape of the neck. Dizziness, distressing headache, loss of appetite, constipation, and various other symptoms of gastric derangement are present; the tongue looks as if raw, it peels off in patches and is covered with a thick, nasty looking fur. If these symptoms should be accompanied with a sense of suffocative constriction in the throat, especially when attempting to swallow liquids, or if, instead of ulcers the throat should be covered with vesicles, the above preparation of Aconite may be alternated with CANTHARIDES, one or two drops of the tincture in a tumblerful of water, in tablespoonful doses, an alternate I__ _ I MALIGNANT SORE-THROAT. 617 dose every hour. If Cantharides should seem insufficient to remove the spasm, substitute BELLADONNA, same dose as Cantharides. ARSENICUM may be exhibited when the pulse begins to flag, the skin feels cold and clammy, or dry as parchment, and symptoms of sphacelus develop themselves in the inflamed parts. DOSE.-One grain of the first trituration every hour or two hours, until a reaction becomes apparent. MERCURIUS viVUs, may be given when the parts have a livid hue, and a quantity of foul, tenacious saliva is secreted; the gums bleed, look whitish, spongy, ulcerated, the uvula and tonsils are covered with bleeding, whitish-gray ulcers; the patient complains of feeling chilly, and experiences a good deal of thirst,.with a constant desire to drink. DOSE.-One grain of the first trituration, every two hours, until relieved. NITRI ACIDUM has been used with good effect when the ulcerated parts show symptoms of mortification, and begin to slough off. DOSE.-One to three drops of the first attenuation in a small tumblerful of water, a tablespoonful every hour or two hours. LACHESIS may be tried, if every other remedy should fail, for gangrenous inflammation of the throat, preceded by burning pain and rawness; the skin and flesh become detached. DOSE.-Two globules of the two hundredth attenuation, to be repeated in four hours, if necessary; or to be dissolved in a small tumblerful of water, a tablespoonful to be given every three or four hours. REGIMEN: It must be obvious that in severe and dangerous affections of this kind, patients should be exceedingly careful to guard against relapses. Exposure of the neck to draughts of air, and particularly to the 53* 618 SPECIAL THERAPEUTICS. immediate contact of damp and cold air, should be avoided. It is important to keep the throat uniformly covered according to the season. All undue coverings, calculated to keep the parts over-heated and to excite abnormal perspiration, are decidedly improper. Loss of Appetite, Anorexia. This is generally a symptom of some constitutional derangement of the system; the biliary or digestive functions -are out of order, and the totality of these symptoms has to be considered, if we wish to restore the appetite. The reader will therefore have to consult the chapters on Derangement of the Stomach, Bilious Derangement, etc. For simple loss of appetite, without any other apparent disturbance CHINA may be given, three globules, dry on the tongue, every morning or evening, or, if accompanied with constipation, Nux VOMICA, three globules every night, until the appetite is restored. Stimulants should be strictly avoided, and no other drink used than cold water; daily ablutions with cold water may likewise be employed, and exercise in the open air is of great use. Voracious Appetite, Bulimy. This is likewise, in most cases, a symptom of some general derangement of the digestive functions; it is frequently present in worm-affections, during pregnancy, or it may be accompanied with general emaciation, as a symptom of marasmus, or set in during recovery from INDIGESTION. 619 INDIGESTION. 619 some acute disease, such as typhus, scarlet-fever. In all such cases the general affections have to be treated, whatever they may be. For simple bulimy, CHINA and Nux VOMICA may be used alternately, three globules of each, every alternate evening, one evening China, the next Nux, or, if the hunger should be felt after a meal, give ACONITE and CHININUM SULPHURICUM; of the former two doses a day, one drop or three globules each, morning and evening; and, if this should not help after eight doses, give of the Chinin. sulph. one grain of the third trituration morning and night. Our Materia Medica has a large number of medicines which will cure both an unnatural craving for, and an aversion to, food, or particular kinds of food. All these medicines will be found indicated in our large Repertory, on pages 541, 542, 543, and 544. Indigestion. An attack of acute indigestion may sometimes prove a dangerous malady. It is always a distressing malady, and frequently amounts to an inflammatory state of the stomach and bowels, in which case the disease is accompanied with violent fever, headache, dizziness, even delirium, spasmodic vomiting, excessive pain in the stomach and bowels, thirst, constipation, distension and soreness of the bowels, etc.; when these symptoms occur, we have to commence the treatment with ACONITE, a few drops or six globules in a tumblerful of water, giving a small tablespoonful every hour or two hours until the skin becomes moist, after which the Aconite may either be continued at longer intervals, say ICI-~----~-CII-~--~-~~--~--~ 620 SPECIAL THERAPEUTICS. every four hours, or some other more appropriate medicine may be given. An acute attack of indigestion may be caused by overloading the stomach as well as by eating something that does not agree with one, or by eating at improper hours. Indigestion caused by overloading the stomach, is sometimes readily relieved by drinking a few drops of strong, black coffee without sugar; this induces vomiting and, at the same time, a gentle perspiration, after which, a few days' fasting is sufficient to restore the tone of the stomach. PULSATILLA is an excellent medicine, if the attack was caused by eating fat pork, butter, or a quantity of fruit or ices; it is particularly indicated by looseness of the bowels, sour, greasy vomiting, especially in the night, load at the stomach. DOSE.-One drop, or six globules, in a small tumblerful of water, a small tablespoonful every two hours, until relieved. Nux voMICA, when the indigestion is characterized by spasmodic vomiting which continues even after the contents of the stomach had all been discharged. DOSE.-Same as Pulsatilla, except that the dose may first be repeated every half hour, until the vomiting is arrested. ARSENIC may be given after Pulsatilla, in case the attack should be accompanied with excessive prostration, vomiting of bile and blood, burning at the stomach, or constant and painful bloody bilious discharges from the bowels. In a case of this kind, where the patient had first taken a little cold, and then ate a late supper, consisting of a quantity of beef-steak, porter and the like; and where the disease broke out about an hour after the meal, a discharge of bile and blood taking place every two or three minutes, with great pr'otration, the whole -.-...... _, -- ~ WEAK STOMACH, DYSPEPSIA. 621 trouble was checked with three powders of Arsenic, eighteenth attenuation, taken at intervals of fifteen minutes. TARTARUS EMETICUS may prove serviceable, if there should be copious and exhausting evacuations from the bowels accompanied with spasmodic vomiting and symptoms of cerebral congestion. DOSE.-One grain of the third trituration every two hours. If vomiting is a principal symptom, see this article; or if diarrhoea should be, see Diarrhoea. Weak Stomach, Dyspepsia. This affection is either hereditary, or brought on by excesses, want of exercise, care and anxiety, irregular habits, want of proper nourishment, over-work, mechanical injuries, onanism, abuse of tobacco, etc. It is a weakness which it is very difficult, and sometimes impossible to cure. Dyspeptic persons have to be very careful in regard to what they eat; and it is particularly of importance that the cause of the dyspepsia should be removed if possible. If the habit of chewing tobacco be the cause, this has to be stopped; or, if irregular or over-hasty eating be the cause, this should be regulated. The only cure for dyspepsia sometimes is the strictest moderation and regularity in the use of food; many dyspeptic persons have cured themselves by confining themselves to the use of a few soda-crackers and a few pints of cold water a day, for a period of time. If the dyspepsia is not of too long standing, it can be materially benefitted or even cured by strict diet, exercise on horseback, (in many cases,) and by the use of one or more of the following remedies: L 622 SPECIAL THERAPEUTICS. ACONITE, if the patient is of a full habit of body or else very thin, sallow, bilious-looking, and complains of nervousness, restless sleep, palpitation of the heart, acidity of the stomach, spitting up of food after eating, load at the stomach, sour or bilious vomiting, with shooting pains about the head or agonizing distress in the head as though it would fly to pieces, oppression, chills and flushes of heat, followed by sweat. DOSE.-One drop, or three globules, morning and night. Continue the Aconite for a week, then wait a few days, or a week, and select one from among the following remedies, to be given for a week, after which, Aconite may be resumed, if deemed necessary. We have cured several cases of dyspepsia characterized by perfect atony of the stomach, as evinced by complete absence of all desire of food, and by entire loss of thirst by the continued use, for several weeks, of the tincture of Aconite root, giving one drop daily in divided doses. In one case, the patient was unable to swallow the least quantity of cold water, without experiencing a paroxysm of this kind: shortly after swallowing the water, there was a sensation as though the body would swell up like a balloon; this sensation started from the pit of the stomach, and gradually spread to the skin, which felt as if it would burst; the sensation was accompanied with violent dizziness, partial loss of consciousness, fainting feeling, anxiety, dyspnoea, palpitation of the heart, and terminated in the breaking out of a copious perspiration, after which the patient felt relieved. The disease had lasted six years, and was originally caused by drinking icewater while over-heated. The patient was completely cured by the use of the tincture of Aconite, was able to eat and drink without inconvenience, and to our knowledge, has remained well since we discharged him, two years ago. Nux VOMICA is indicated by the following symptoms: sour or bitter taste in the mouth; food, and particularly bread, have a sour taste; the patient complains of a loaa at the stomach after eating, nausea, vomiting, dizziness, headache, drowsy and tired feeling; sour, acrid risings and empty eructations; the clothes around the stomach and bowels feel tight; constipation, an hypochondriac, irascible mood, heat and redness of the face, are generally present. This medicine is particularly useful, ~_ WEAK STOMACH, DYSPEPSIA. 623 when the weakness is caused by abuse of ardent spirits, mental labor or sedentary habits. DOSE.-Six globules, or one drop, in half a tumblerful of water, a small tablespoonful every three or four hours until relieved, after which the medicine may be continued every night, or every other night, three globules, dry the tongue each time, until the patient seems cured. PULSATILLA is indicated by the same symptoms as were mentioned under "Indigestion;" two doses may be given every day, morning and evening, three globules each. CHINA, when the dyspepsia is owing to loss of animal fluids by bleeding, sexual excesses, and when it is characterized by sour or bitter taste, drowsiness and fulness after a meal, spasmodic or cramp-pains in the stomach and pit of the stomach; or when the attacks come on at regular periods. DOSE.-A few drops, or six globules, morning and night, or if not relieved after the sixth dose, one grain of the third trituration of Chininum sulphuricum, dry on the tongue, morning and night. ARSENICUM may be given, if the epigastric region feels tender, bloated, burning, with constant desire to vomit after eating; anxiety. DOSE.-One grain of the third trituration, three times a day. This medicine may be alternated with BARYTA CARBONICA, same dose, especially if the food seems to pass over an ulcerated surface. Give the two medicines every alternate day, one day Arsenicum as above, next day Baryta, same dose, and so on alternately, until an improvement takes place. CARBO VEGETABILIS, one drop or six globules morning and night, for sour and bitter taste, acidity of the stomach, which seems to be in relation with palpitation of the heart, sour eructations, flatulence on the stomach, offensive diarrhoea, bloated stomach and bowels. ~r~-----------~---~-~---- 624 SPECIAL THERAPEUTICS. CARBO VEGETABILIS is a capital remedy for dyspepsia, if the patient complains.of a heavy load in the pit of the stomach after eating,with a sense of suffocative oppression, and belching up of wind which affords relief; the wind is brought up by rubbing the region of the stomach or pit of the stomach; every now and then the mouth fills with insipid, thin, watery mucus. The wind is sometimes brought up with a sharp wheezing sound. DOSE.-A powder of the third trituration, dry on the tongue, every four or six hours. MERCURIUS, sensation as if the egigastric region were ulcerated; sallow, jaundiced complexion, constipation, or else hard, lumpy, dark stools, bilious tinge and strong odor of the urine. DOSE.-One drop, or three globules, morning and night; or one powder of the third trituration dry on the tongue. CALCAREA CARBONICA may be given, same dose as Mercurius, every night, if the patient is troubled with acid stomach, distension of the bowels, sour eructations, tendency to. looseness. This medicine may be alternated with SULPHUR, same dose, an alternate dose every other night..Sulphur and Nux vomica are particularly useful, if the patient is troubled with piles. CHAMOMILLA is suitable if the patient complains of sour eructations, the pain in the stomach is aggravated by eructations, sour vomiting, vomiting of food with distension of the bowels, heat and sweat of the face after eating or drinking, pressure in the pit of the stomach after eating; hard aching pain in the pit of the: stomach, exceedingly distressing, bloated condition of the epigastric region. DOSE.-One drop, or six'globules, every night. DERANGEMENT OF STOMACH, FLATULENCE, ETC. 625 IPECACUANHA may be given, if the stomach feels oppressed after eating; the stomach feels as if deprived of the power of acting, without vitality, watery, with occasional spitting up of water, and retching. DOS.-A drop, or about six globules, three times a day. Derangement of the Stomach, Bilious Derangement of the Stomach. The symptoms of such a derangement, and the medicines corresponding with such symptoms, are the same as those mentioned under " Indigestion and Dyspepsia," to which the reader is referred. Eructations, Flatulence, Wind on the Stomach. This weakness is generally a symptom of dyspepsia, but it may likewise be contracted by habit. The habit of belching up wind is very annoying, and is often a sure sign of ill-breeding. Parents should see to it that their children do not indulge in such a disagreeable practice. In our country it is unfortunately a prevailing habit among a certain class of people. Persons who are subject to such a weakness, be it constitutional or acquired, should avoid stimulants, fat, even butter, eat slowly and moderately, chew their food carefully, and drink but little during their meals. We should recommend wearing the wet bandage, daily ablutions with cold water, rubbing the bowels and pit of the stomach well with cold water every morning before breakfast, and, if the patient should deem it desirable to take medicine, he may select from among the medicines which have been indicated for " Weak Stomach and Indigestion." 51 __ 626 SPECIAL THERAPEUTICS. Years ago when we were strictly guided by the authority of books in prescribing for symptoms without much regard for the essential character of the derangement which had to be removed, we met with a case of wind on the stomach which was of a most extraordinary character. The patient was an unmarried lady of fifty, of a paralytic habit and had suffered a great deal from dyspepsia for years past. She was seized with an attack of wind on the stomach; she rolled the wind off her stomach in such quantity that the noise resembled the rolling of drums more than anything else. We treated her to the best of our ability in accordance with the demands of the technical symptom-homoeopathy which was then still the order of the day with most practitioners; we selected one antipsoric after another, and fairly despaired of curing our patient, when we concluded to try a common sense practice. We concluded to look upon this case as a case of venous congestion of the stomach arising from infarctions, (according to the language of former pathologists,) or from a congested condition of the portal system of circulation; and in accordance with this theory, we prescribed the common tincture of Aconite a few drops in a tumblerful of water, and had the satisfaction of seeing the whole trouble ended afterthe patient had taken a single tumblerful of this solution. Since then we never have had any trouble in curing such a condition; our pathology has never proved. untrue, and we advise our readers to learn by this experience. How often do we look for remedies far off, when the very specific is within our grasp! --~L-~-L---~Y-II~ -~r-~-C- - -~- -Y- Y- IC -~---- WATERBRASH, HEARTBURN. 627 Waterbrash, Heartburn. This is a rising of water from the stomach, which is either tasteless, or acid, acrid, and sometimes accompanied with a spasmodic, burning sensation. Observe the same rules as were laid down for wind on the stomach, and use the following medicines: ACONITE, for acid and burning rising from the stomach, nausea, spitting up of food, dizziness, palpitation of the heart, oppression, anxiety. DOSE.-One drop, or three globules, dry on the tongue, three times a day. Nux VOMICA, for sour-bitter eructations, especially after eating, with sensation of a load in the epigastric region; or for rancid heartburn as after eating rancid grease. DOSE.-Three globules, dry on the tongue, or one drop every night, until relieved. If this medicine should not avail any, try CARBO YEGETABILIS, same dose as Nux. ACIDUM NITRICUM, for acidity in the mouth, which causes a violent burning in the throat. DOSE.-One drop of the-third attenuation, morning and night, CALCAREA CARBONICA, for sour eructations, with a burning sensation ascending from the pit of the stomach; a brownish, sour liquid rises into the mouth. DOSE.-Same as Nux vomica. CAPSICUM, for a watery, flat taste in the mouth, followed by heartburn. DOSE.-Same as Acidum nitricum. CHINA, for a burning, scraping sensation, followed by a sensation of warmth from the chest to the stomach. DOSE.-One drop of the first or second attenuation three times a day. KALI BICHROMICUM, for sour risings and burnings at the stomach. DOSE.-One grain of the third trituration morning and night. 628 SPECIAL THERAPEUTICS. Acid Stomach, Pyrosis. Consult the medicines which have been mentioned for heartburn and dyspepsia, and add the following: AcIDUM SULPHURICUM, if a quantity of sour fluid is raised off the stomach every now and then. DOSE.-One or more drops of the first attenuation three times a day. BELLADONNA may be given alternately with Nux VOMICA, when the acidity of the stomach is the result of abuse of ardent spirits. DOSE.--Three pellets of Belladonna in the morning, and three pellets of Nux in the evening, to be continued until the acidity is removed. Instead of ]3elladonna, Aconite may be substituted every two or three days. Nux to be continued in the same manner. PULSATILLA may be given when the weakness seems to have been caused by eating quantities of fat, ices, pastry; this medicine is more particularly indicated when the symptoms are more troublesome in the night, and when the bowels are disordered, loose, with slimy discharges. DOSE.-One drop, or six globules, every morning. Spitting up of Food. This weakness is a symptom of dyspepsia, which has been treated above. It generally yields to ACONITE, IPECACUANHA or ARSENICUM. ACONITE is particularly indicated when the spitting up of food is accompanied with sour stomach. IPECACUANHA, when bile and mucus are brought up with the food. ARsENICiU is particularly suitable when liquids are spit up. __ ___ NAUSEA, VOMITING. 629 Nux VOMIOA, after coffee and spirituous beverages. DOSE.-Of any of the above mentioned remedies, give one drop, or six globules morning and night, and consult the articles on Dyspepsia, Indigestion. Nausea, Vomiting, Vomiting of Bile. This is somewhat similar to the foregoing condition, and frequently yields to the same means. It may be owing to weakness of the stomach, a cold, some violent emotion,'a fit of indignation, etc. If it is a mere symptom of a more general derangement, such as fever, dyspepsia, spasm, consult this derangement. If it seems to be an isolated symptom, it will generally yield to ACONITE, NUX VOMICA, IPECACUANHA, YERATRUM. Under alloeopathic practice, emetics are frequently used for this affection, for the purpose of removing the bile, which is supposed to be the cause of the disorder in the stomach; but this practice is injurious and erroneous. There may be bile in the stomach, and the bile may irritate the coats of the stomach like a foreign agent. But why is the bile there? Simply because the liver has not performed its function, which is to secrete the bile out of the circulating fluid, after which it is collected in the gall-bladder for ulterior purposes. Rational treatment would therefore consist in removing the torpid condition of the liver, and enabling it to perform its appropriate function. This is best done by the following medicines, some of which are likewise indicated in case the vomiting should arise from a simple spasmodic irritation of the stomach. ACONITE, for spasmodic vomiting of dark-green bile, with hiccough, or rising of sour water. This is the spe54* _ _ 630 SPECIAL THERAPEUTICS. cific remedy for a nervous nausea, With which many nervous or hysteric females are troubled. DOSE.-One or more drops of the first or second attenuation of Aconite in a small tumblerful of water, of which the patient may take a tablespoonful every half hour, until he feels relieved, IPECACUANHA, for vomiting of mucus, or mucus and bile, especially at night. DOSE.-Three globules, dry on the tongue, or one drop, and again in twelve hours if necessary. NUx VOMICA, for spasmodic vomiting, induced by overeating or abuse of liquor. DOSE.-One drop, or six globules, in a tumblerful of water, a small tablespoonful every half hour, until relieved. VERATRUM may be given after Ipecacuanh'a, in case this should fail to give relief. Veratrum is particularly indicated, if the vomiting is accompanied by anxiety and violent straining. DOSE.-Same as Ipecacuanha. MERCURIUS, for vomiting of bitter, yellow or greenish bile, sallow complexion, dizziness. DOSE.-Same as Nux vomica. LOBELIA INFLATA, for copious vomiting, with extreme nausea, profuse perspiration, prostration of strength. DOSE.--One drop, or three globules, to be repeated in a few hours, if neces~ ary. ARSENICUM, for chronic vomiting of everything that one eats or drinks; or for vomiting of brownish or blackish substances. DOSE.-One drop, or six globules, in a tumblerful of water, a small tablespoonful every hour, until relieved; or three globules, dry on tongue, iorning and night. PULSATILLA, vomiting of acrid, bitter, sourish mucus at night. DOSE.-One drop, or six globules, morning and night. ___ VOMITING OF BLOOD. 631 A large number of remedies for vomiting and nausea will be found indicated in our large Repertory, pages 514 to 523. Vomiting of Blood, Hsematemesis. Vomiting of blood, if it be not a symptom of tuberculous consumption, but a weakness, brought on by some exceptional cause, such as straining, a blow on the stomach, over-heating, etc.; can be arrested by one of the following remedies: ACONITE, if the following symptoms are present: coldness of the extremities, with thin and feeble pulse; or else strong and and full pulse, with heat and dryness of the skin; dizziness, anxiety, violent throbbing of the heart, burning in the chest or epigastric region; the vomiting is preceded by nausea and a sweetish taste, or taste as of blood in the mouth. DOSE.-Two drops of the tincture in a tumblerful of water, a dessertspoonful every fifteen minutes, until the vomiting ceases, after which the medicine may be continued every two hours for a day or two longer. ARSENICUM is more adapted to chronic vomiting of blood, or also to vomiting, characterized by nausea and violent ejection of a brownish substance which is frequently mixed with blood, attended with violent bodily straining. DOSE.-When acute, give one grain of the third trituration every half hour or hour, until an improvement becomes manifest; in chronic cases, three globules morning and night. MILLEFOLIUM, three drops of the tincture in half a tumblerful of water, in tablespoonful doses every ten or fifteen minutes, may sometimes stop a sudden vomiting of blood. CANTITARIDES removes constant retching with vomiting of blood. 6832 SPECIAL THERAPEUTICS. DOSE.-Same as Aconite. If this should prove ineffectual, give -MERCURIUS CORROSIVUS, one grain of the third trituration every hour, until relieved. IPECACUANHA may arrest a vomiting of blood, or of blood, mucus and bile, when accompanied with nausea and a distressing spasmodic retching. DOSE.-One drop, or six globules, in a tumblerfuj of water, a small tablespoonfulevery half hour, until relieved. If Ipecacuanha should not suffice, after the sixth dose, give Nux VOMICA, same dose. ARNICA may be given, if the hmemorrhage is owing to mechanical injury. DOSE.-A few drops of the first attenuation every half hour. PALLIATIVE MEANS.-It is perfectly proper to try ice, or ice water in such cases, or to apply ice to the pit of the stomach. Cardialgia, Gastrodynia, Spasm of the Stomach. This is an affection to which many persons, particularly females, are subject. The attacks are various. In some they are characterized by a hard aching pain, with sensation as if a heavy stone were oppressing the epigastric region, and extreme tenderness to contact; in others the paroxysms are characterized by an incessant and most distressing belching of wind; in others again by a swelling up of the epigastric region, excessive soreness of the parts when. touched, constant retching, vomiting of water and blood, oppression and anxiety; in others again there is constant vomiting of mucus, with violent straining and dizziness. Cardialgia might be considered as an acute attack of dyspepsia, for the pathological character "of these conditions seems to be the same. The principal remedies for this disease are AcoNITE, SPASM OF THE STOMACH. 633 CHAMOMILLA, CARBO VEGETABILIS, MERCURIUS VIVUS, ARGENTUM NITRICUM and VERATRUM. ACONITE we use invariably when the extremities are cold and the pulse is thin and small; in which case Aconite is generally indicated by the existing symptoms of the epigastric affection; but when there is swelling of the epigastric region, tenderness to the touch, excessive retching and straining with expulsion of a bloody phlegm, burning sensation in the epigastric region, or sensation as if a cold stone were lying there, dizziness and headache, depression of spirits, oppression, anxiety, palpitation of the heart, Aconite is indicated as the specific remedy. But it must not be supposed that the globules will always reach the case; they may sometimes; but generally they will do nothing whatsoever in a case of this kind; under such circumstances we resolutely give a few drops of the tincture, either five or six drops of the common tincture from the leaves and stems, or one or two drops of the saturated tincture prepared from the root in a small tumblerful of water, a small tablespoonful every half hour, until the patient feels decidedly better, after which we continue the same medicine for a day or two longer, a dose every two or three hours. CHAMOMILLA, if the attack is characterized by a hardaching pain in the pit of the stomach, violent eructations, after which the pain is worse, sour vomiting; and particularly when these symptoms were caused by a fit of anger. DOSE.-One drop, or half dozen globules, in a tumblerful of water, a small tablespoonful every half hour or hour, until better. CARBO VEGETABILIS for cardialgia with continual sour eructations; more adapted to chronic cases. DOSE.-Three globules, morning and night, or if necessary, every five or aix hours. MEROURIUS viVUs, when the attack is characterized C- ~ 634 - SPECIAL THERAPEUTICS. by excessive tenderness and bloating of the epigastric region, as if ulcerated, acrid-sweetish risings from the stomach, dizziness, retching. DOSE.-Same as Chamomilla. ARGENTUM NITRICUM is a great remedy for cardialgia, especially when the following symptoms occur: twisting sensation at pit of stomach; cardialgia with internal chilliness, nausea, sense of hunger, especially early in the morning before breakfast. DOSE.-One grain of the third trituration, every two hours, until relieved. FERRUM CARBONICUM may yet be mentioned for cardialgia, especially in the case of hysteric females with scanty menstruation. DOSE.-Same as Argentum nitricum. Nux VOMICA should not be forgotten in cardialgia, if the affection can be traced to sedentary habits, and to abuse of coffee or spirits. Tailors are frequently subject to cardialgia which requires to be treated with Nux. DOSE.-A few drops of the second or third attenuation in a tumblerful of water, of which a tablespoonful may be given every half hour during an attack, and afterwards, one drop every night, in order to prevent the paroxysms if possible. In the case of drunkards, the strong tincture may have to be substituted for the attenuations. YERATRUM is indicated by pinching pain in the umbilical region, spasmodic flatulence which cannot pass off, straining to vomit, constriction of the chest, dyspnoea, dull, seated pain in the left side, distension and sensitiveness of the bowels, prostration after an attack; the same -dose as Nux. PALLIATIVE MEANS.-Apply cold water bandages to the pit of the stomach, and observe all the dietetic rules laid down for dyspeptic patients. Stomach-ache, Colic. We have a large number of remedies in our practice STOMACH-ACHE, COLIC.6 635 which may be given for a simple colic. Colic may be induced by various causes, by a cold, by food which does not agree with one, incarceration of flatulence, worms, disturbed feelings, etc. For all such common colics the following medicines will generally be found sufficient, and, if they should not, the reader is referred to our large Repertory, from pages 602 to 608, where every symptom relating to colic will be found described, and the appropriate remedies indicated. ACONITE, is a remedy for colic when induced by a cold, a fright; the bowels are distended, sore, hot, with flatulence shifting to and fro, urging to stool, -pressure on the bladder, nausea, constipation, or else watery discharges, or small discharges of mucus and blood; dizziness, headache, coldness of the extremities, chills, followed by flashes of heat. DOSE.--Two or three drops of the common tincture, or one drop of the tincture of the root in a small tumblerful of water, a small tablespoonful every half hour until relieved. CIIAMOMOILLA, for colic with sour vomiting, painful eructations, hard-aching pain in the pit of the stomach. DOSE.-One. drop, or six globules in a small tumblerful of water, a tablespoonful every half hour or hour, until relieved. BELtADONNA is useful if the colic is accompanied with constipation, and the big gut is distended like a pad, and swollen. DOSE.-Same as Aconite. Nux VOMICA is useful if the colic was caused by exposure. to dampness, with abuse of spirituous beverages or coffee, and these drinks did not agree; the bowels are distended, sore, with sensation as if pricked with a number of pins. DOSE.-Same, as Chamomilla, or, if no better after three or four doses, 6386 SPECIAL THERAPEUTICS. substitute a drop of the tincture for the globules, in the same quantity of water, and the same dose. PULSATILLA is useful, if the colic was caused by fat, ices, pastry and the like, with acrid, sour eructations slimy discharges from the bowels, etc. DOSE.-Same as Chamomilla. PALLIATIVE TREATMENT.-In a case of common colic, relief is sometimes afforded by applying flannel soaked with warm brandy, or hot water, to the bowels; a common mustard-plaster will sometimes ease the pain. If pain can be relieved by such simple contrivances, they are always admissible. Lead-Colic.-(See " Poisoning by Lead.") Worm-Colic.-(See " Worms.") Menstrual Colic.-(See " Menstruation.") Bilious Colic. This distressing affection is caused by the irritating effects of bile which acts upon the bowels as a foreign poison either previous to the bile being secreted by the liver, out of the circulating fluid, or, after the bile passes into the duodenum out of the gall-bladder. The poisonous action of the bile upon the bowels causes a train of the most distressing pains, spasms, etc., generally consisting in the following sensations and phenomena: burning as from hot coal, distension and excessive tenderness of the bowels, agonizing spasmodic pains in the bowels, intense thirst, coldness of the extremities, parched lips and tongue which is covered with a thick yellowish-brown fur and looks inflamed around the edges, red urine which has a strong fetid smell and deposits a red, bloody-looking sediment on the sides and bottom of the vessel, nausea and vomiting of a greenish, ..-r;.~ ~ ~. BILIOUS COLIC. 637 yellow, bitter bile, constipation, anguish, palpitation of the heart, dizziness, headache, etc. There are persons who are periodically subject to attacks of bilious colic. Under allceopathic treatment this affection may terminate fatally; under proper homoeopathic treatment it is comparatively harmless, although always exceedingly distressing while it lasts. We have never been obliged to use any other remedies for this disease than ACONITE, CHAMOMILLA, MERCURIUS, COLOCYNTHIS, IPECACUANHA, VERATRUM, and ARSENICUM. ACONITE is indicated by the following symptoms: excessive burning in spots or streaks, in the bowels or epigastric region; vomiting of a greenish-yellowish bile; distension and tenderness of the bowels; thirst; dryness of the mouth; thick, bilious coating of the tongue; anguish; dizziness, headache; red urine, constipation; coldness of the extremities; thin, compressible pulse, or else a hard, bounding pulse. DOSE.-Three or four drops of the saturated tincture of the root, in a small tumblerful of water, of which a dessert-spoonful may be given every half hour, until the bile is discharged from the bowels, the skin becomes moist, and a general reaction sets in, after which the medicine may be continued every four hours for two or three days longer. CHAMOMILLA, for spasmodic, crampy pains in the bowels which are extended, and feel extremely tender; nausea, with or without vomiting of bile; dry tongue which exhibits a yellowish coating; thirst. DOSE.-One drop, or six globules, in a small tumblerful of water, a tablespoonful every half hour, until relieved. MERCURIUS, when a sudden, violent, pinching pain is experienced in the bowels, with coldness all over, sensation as if the patient would lose his senses, a cold sweat breaks out all over, with sickness at the stomach, disten55 ~ 638 SPECIAL THERAPEUTICS. sion and tenderness of the bowels; the attack frequently terminates in emission of flatulence and bilious evacuations from the bowels. DOSE.-Same as Chamomilla. COLOCYNTHIS; violent pains in the abdomen, with sensation as if the bowels were squeezed between stones or cut with knives, sensitiveness of the abdomen to contact, meteorism, retching, anguish and uneasiness, constipation or diarrhoea. DOSE.-Same as Chamomilla, or else substitute one drop of the tincture for the globules, in the same quantity of water, and give the same dose. In some works on Homoeopathy, it is recommended to give black coffee after Colocynth, in order to subdue the aggravation of the pains caused by this medicine, What a nonsense! When will Homoeopathy be cleared of the childish nonsense which a few self-styled, and self-complacent leaders have introduced into her sacred temple? IPECACUANHA, sickness at the stomach, distension and excessive tenderness of the bowels, sensation as if the fingers of the hand were pressed into the bowels, constipation. DOSE.-Same as Chamomilla. VERATRUM; pain in the abdomen as if cut with knives, or stitching pain in the bowels, accompanied with stitching pains here and there in the body; violent pressure from the pit of the stomach to the sternum and sides of the abdomen; urging to stool with faint feeling in the bowels. DOSE.-Same as Colocynthis. ARSENICUM for excessive pains in the abdomen, especially at night or after eating or drinking, with vomiting or diarrhoea, anguish, lamentations, internal uneasiness; sensation as if the intestines became twisted, with pinching, cutting, and tearing pains in the bowels; cold and chilly or else burning sensation in the abdomen; I.-~~~------ CONGESTION OF THE BOWELS. 639 excessive swelling and painfulness of the abdomen, rumbling in the bowels; constipation or violent and freqdent discharges; excessive prostration, coldness, thirst. DOSE.-Same as Chamomilla, or also half a grain of the third trituration, every hour, until relieved. DIET AND REGIMEN.-Even after the patient feels perfectly well, a strict diet should be pursued; stimulants are injurious, and all indigestible food, fat, rich gravies, coffee, etc., should be carefully avoided. Cold water is the best drink. Exposure to dampness, draughts of air, or to sudden changes of the temperature or weather, may bring on the attack. Bloating, Passive Congestion of the Bowels. This weakness does not alone yield to medical treatment. In some it is habitual; in others it comes on after eating. If it be a symptom of scrofula, the medicines which have been proposed for scrofulosis have to be used. Persons who are subject to this weakness, should take moderate exercise of an active nature, or ride on horseback, use daily ablutions with cold water, shower the back and abdomen, eat little and regularly, avoiding stimulants and unwholesome, heavy, rich food, and wear a wet bandage on the bowels. This bloating is not a constant symptom; it comes and goes, according to certain states of the weather, or after certain kinds of food. It is generally depending upon a torpid condition of the liver and infarctions of the portal system of circulation. This system constitutes a system of veins, which is more or less independent of the general circulation. The branches of origin of this system commence in all the abdominal organs concerned _*_ 640 SPECIAL THERAPEUTICS. in the function of digestion, and by their union form the vena portme, or portal vein, which, after having reached the transverse fissure of the liver, divides into a right and left branch; these branches again sub-divide, and spread into all parts of the liver, some forward and others backward, but all following a transverse direction. The harmonious action of the portal system of veins is of the utmost importance to the maintenance of sound digestion. If infarctions, or, to use the more modern pathological designation, obstructions, engorgements, embarrassments or congestions (for these different names all mean the same thing), take place in this system, the process of digestion, especially the second stage of this process, involving chylification and the normal elimination of bile, and its passage into the bowels, are greatly interfered with. Hence arises a great deal of trouble, particularly this bloating or flatulent distension of the bowels, which is the subject of the present article. This bloating is frequently attended, as a matter of course, with bilious derangements, foul taste in the mouth, yellow or dirty whitish coating on the tongue, loss of appetite, sallow complexion, turbid urine, irregular action of the bowels. Exercise in the open air, particularly along the sea-shore, or in bracing mountain air, may do much towards relieving this condition; but in many cases medical treatment is likewise required. One of the leading remedies to remove, or, at any rate, to palliate this difficulty, is ACONITUM NAPELLUS. No drug in our Materia Medica is possessed of more specific powers of stimulating the action of the liver, whenever torpor of this organ is attended with obstructions of the portal circulation, than Aconite. If the bowels are very much LY- - CONGESTION OF THE BOWELS. 641 bloated after eating, and pressure on the bowels causes a belching up of wind; the bowels feel tender and sore, a sense of warmth is often diffused through the bowels; the urine looks turbid, has a foul smell; the bowels are irregular, the evacuations having a very dark appearance, hard, as if burnt; at times the patient complains of a sinking feeling in the pit of the stomach, with throbbing, anxiety; dark and sallow complexion, foul taste in the morning, loss of appetite; debility, languor, an apathetic state of mind: these, and similar symptoms, require Aconite. DOSE.-We sometimes give from two to three drops of the first decimal attenuation of the tincture of the root, in a tumblerful of water, or one drop of the strong tincture, or two or three drops of the common tincture in a similar quantity of water, a small tablespoonful every three or four hours. In all ordinary cases this treatment is sufficient. And even in very obstinate chronic cases we pursue this course of treatment whenever an uncommon paroxysm of the complaint arises from one cause or another. There are other medicines which may be of great use in this weakness, but they will be required much less frequently than Aconite..Some of these medicines are: Nux VOMICA, if the complaint can be traced to abuse of spirits, or to excessive sedentary habits; the bowels are costive, or there is a tendency to small discharges of white mucus, with bearing down. DOSE.-One or two drops of the first attenuation morning and night. PULSATILLA, in the case of females who are troubled with menstrual suppressions, of a lymphatic habit. DOSE.-Same as Nux vomica. BRYONIA, may be useful, if the bowels are torpid oppressed; the appetite is gone, the patients are incommoded by exercise; jarring the epigastric region by making a false step, causes a painful stitch in that part. DOSE.-Same as Nux vomica. 55* 642 SPECIAL THERAPEUTICS. CHINA is not inappropriate if the bowels are costive, the patient has an earthy complexion, complains of slimy mouth, loss of taste, and the tongue is covered with a dirty-looking grayish mucus. DOSE.-Same as Nux. FERRUM CARBONICUM may be given in the case of females of a chlorotic habit, costive, the face looks sallow, or exhibits a greenish-brown hue, with purple flushes on the cheeks, oppression, palpitation of the heart. DOSE.-One powder of the first or second trituration, dry on the tongue, three times a day. MERCURIUS is an admirable remedy for this weakness, when the bowels are habitually costive, and the passages are dry, lumpy, dark-brown or green, alternating at times with bilious discharges from the bowels; the patient is sensitive to draughts of air, is apt to feel chilly, the palms of the hands are warm, and the sweat smells habitually sour; the urine looks reddish or yellow, but at times has a natural color, and either a strong, offensive smell, or a smell as of burnt sugar; the salivary glands are easily irritated by a cold, and exposure to cool air causes a sense of feverish chilliness, rheumatic feelings, soreness of the throat and various other catarrhal feelings. DOSE.--One drop, or six globules, dry on the tongue, every night; in some cases, a powder of the third trituration may be better. ARSENIOUM is likewise an useful medicine in this weakness, if the patient is of a scrofulous habit, and the bowels are hard and distended like a drum, and alternately loose or costive; the evacuations have a very offensive smell, and look foul, decomposed, blackish or ACUTE CONGESTION OF THE BOWELS. 643 brown, greenish, of a slimy consistency, intermixed with lumps of faecal matter. DOSE.-One grain of the third trituration morning and night. We should not forget SULPHUR, in cases of chronic bloating of the bowels, especially in the case of children, with irregular action of the bowels, the stools have a fetid smell, worm-symptoms are present, the urine requires to be voided quite frequently. DOSE.-Six globules, or one powder of the third trituration dry on the tongue, morning and evening. Acute Congestion of the Bowels Sets in with a chill, followed by fever, and is characterized by distension, tenderness to the touch, inability to move about the room, soreness, heat in the bowels, urging to stool frequently without ability to pass anything; colicky pains in the bowels, highly-colored urine, thirst, foul taste, loss of appetite, coated tongue, dizziness, headache, weakness. This condition yields principally to ACONITE, BRYONIA, and MERCURIUS. Of the Aconite give a few drops or six globules in a tumblerful of water, a tablespoonful every hour or two hours; and if, after the second day, Aconite should still be indicated by the above-mentioned symptoms, give one or two drops of the tincture of the root in the same quantity of water, a tablespoonful every two hours. In three days, substitute the tincture of Bryonia, same dose as Aconite, and, after giving Bryonia for a day or so, alternate Bryonia with Aconite, an alternate dose every two hours. MERCURIUS should be given if the chilliness and L~R~C----~-C~--~--- 644 SPECIAL THERAPEUTICS. fever are not so very violent, there is a moderate degree of heat and soreness about the bowels; they are hard, distended, bound, and what is passed, is passed with great difficulty, straining, and looks dry, dark, lumpy, with little smell; or else the passages are of a deepyellow color, soft or liquid, excoriating, hot. DOSE.-One drop, or ten globules, in a tumblerful of water, a tablespoonful every two hours; or a powder of the third trituration dry on the tongue every four or six hours. DIET AND REGIMEN.-Sponge with cold water twice a day, morning and evening, when the stomach is empty, and dry gently with a towel. Drink plenty of cold water, and let your diet be low until health is perfectly restored. Diaphragmitis, Inflammation of the Diaphragm. The diaphragm is a muscle stretched across the interior of the body and forming the base or floor of the thorax; it separates the thoracic from the abdominal viscera, and is perforated by. various openings for the transmission of vessels. This muscle is liable to inflammation, either wholly or in part, which is generally complicated with pneumonia, pleurisy, inflammation of the kidneys or liver. According to Hartmann, diaphragmitis is known by the following symptoms: violent pain in the lower portion of the thoracic cavity, which is more or less superficial or deep-seated, limited or extended, being felt lower down during a deep inspiration, with sensation of contraction in the whole region of the diaphragm, from the sternum to the back and loins. If the whole diaphragm is inflamed, the pain is exceedingly distressing, extending from the lowest ribs to the INFLAMMATION OF THE DIAPHRAGM. 645 dorsal vertebrae. The epigastric region, and particularly the pit of the stomach are very hot, sensitive, drawn in, sometimes swollen, tense, beating, and burning internally. The inflammation is accompanied with a violent fever, with small, quick, sometimes intermittent pulse; violent and constant delirium soon sets in, with restlessness and excessive anguish, which the patient expresses by his looks and features; in many cases risus sardonicus, trembling, singultus, dry and distressing cough, vomiting, convulsions, attacks of paleness as if the patient would faint. The pain increases to a frightful extent from the least pressure or motion of the diaphragm. In higher degrees of inflammation deglutition is impossible. The respiration is hurried, short, suffocative, anxious, sighing or moaning. The pain remains the same in any position of the body, and is somewhat relieved by an erect posture, with a slight inclination forward. This disease is generally caused by exposure to atmospheric changes, sudden checking of the perspiration, draughts of air, or by mechanical injuries, or inflammation of adjoining organs. TREATMENT.--Diaphragmitis may prove a very dangerous disease, not only under alloeopathic, but likewise under homceopathic treatment. This disease is much more effectually treated with the lower than with the higher attenuations. The higher attenuations are very apt to leave the patient with a chronic cough, purulent, foul expectoration, weakness, loss of appetite, pains in the chest and region of the diaphragm. The lower attenuations cure the disease effectually. The principal remedies are ACONITE, BRYONIA and CHAMOMILLA, unless complications should exist, such as pneumonia, in _ __ 646 SPECIAL THERAPEUTICS. which case the remedies which are required by these accompanying inflammations, have to be prescribed. ACONITE is to be given invariably when the fever is high, with a burning heat and dryness all over, and a full, hard and bounding pulse, or else coldness of the extremities, and a small, quick, easily compressible or irregular, and even intermittent pulse. DOSE.-Three or four drops of the common tincture of Aconite, or one or two drops of the tincture of the root in a tumblerful of water, a tablespoonful every hour, until the pain is decidedly better, and the skin becomes moist; after this reaction has set in, Aconite may be alternated with BRYONIA, one or two drops of the tincture in a tumblerful of water, an alternate tablespoonful every hour or two hours. CHAMOMILLA is indicated by the following symptoms: swelling of the pit of the stomach and subcostal region; beating, burning pain from the pit of the stomach to the spine, aggravated by pressure; anxious, short or intermittent breathing; dry cough; vomiting, spasms, restloss tossing about, etc. DOSE.-A few drops of the first attenuation in a tumblerful of water, a tablespoonful every hour until relief is obtained. This medicine acts better by being given alternately with the above preparation of Aconite, an alternate dose every hour; or else, if Chamomilla be given alone, Aconite should be given after Chamomilla, if no relief is obtained after one or two doses of the latter. Nux VOMICA is a good remedy, according to Hartmann, " when the lower part of the chest feels constricted as with a band, with short, dry, distressing cough, anguish, retention of stool, thirst." DOSE.-Same as Chamomilla. We have never had occasion to use this drug in this disease. BELLADONNA may prove useful, if the disease is attended with symptoms of cerebral irritation such as delirium, risus sardonicus, spasms, catching at flocks, etc, INFLAMMATION OF THE STOMACH., 647 DOSE.-A few drops of the first attenuation in a small tumblerful of water, a tablespoonful every two hours. PALLIATIVE MEANs.-Cold water bandages round the chest and bowels will prove excellent auxiliaries to mitigate the pain and combat the inflammation. The patient may use copious draughts of cold water, Gastritis, Inflammation of the Stomach. The stomach is situated under the left side of the thorax, stretching from the pit of the stomach through the left hypochondriac region. It is a pouch-shaped sac, having two openings, a superior opening towards the left side, coinmunicating with the oesophagus through which the food passes into the stomach, and termed the cardiac orifice from its proximity to the region of the heart; and an inferior orifice, towards the right side, and termed the pylorus, through which the digested food passes out of the stomach into the duodenum, and thence, after having become commingled with the bile, into the smaller and larger intestines. The tissue of the stomach is composed of four coats, a peritoneal, muscular, cellular, and mucous coat. The peritoneal coat constitutes the outermost coat of the stomach, as well as the outermost envelop of the abdominal viscera generally; the muscular coat is composed of longitudinal and circular fibres, which, by their alternate contractions and extensions, enable the stomach to cause the food which is introduced into it, to perform its gyratory motions for the purpose of being thoroughly impregnated with, and acted upon by, the gastric juice; the mucous coat is the innermost coat of the stomach, from which the gastric juice is secreted. It is also called the villous coat, from rh/~------------------~-----;~- i 618 SPECIAL THERAPEUTICS. the villi or hairy prominences with which this coat is studded, and which consist of nerves, blood-vessels and lymphatics. Each of these coats is subject to inflammation, the least dangerous of which is the inflammation of the muscular tissue, the most dangerous that of the peritoneal and villous coats. In inflammation of the muscular tissue, the patient complains of burning in the region of the stomach, tenderness to the touch, sense of swelling and actual distension, oppression and anxiety, thirst, inability to retain food or drink on the stomach, palpitation of the heart, constipation, foul taste in the mouth, with coated tongue, dizziness, headache, restlessness, burning, dryness of the skin, full and bounding pulse. The best remedy for this form of gastritis is ACONITE, one drop of the tincture of the root in a tumblerful of water, a small tablespoonful every two hours, or even every hour, until a favorable change takes place, after which the medicine may be continued every four hours. Hardly ever any other medicine is required in this form of gastritis. In some cases we may give BRYONIA, same dose as Aconite, after Aconite had been given and the improvement remains stationary; after giving Bryonia for a day, it is proper to resume Aconite and give it alternately with Bryonia, Aconite one day and Bryonia the next, until the disease is cured. The muscular coat of the stomach is scarcely ever inflamed without the peritoneal coat being more or less invaded by the inflammation. The symptoms of mucous gastritis are as follows: excessive burning in the region. of the stomach, as from hot coal: heat and tenderness of this region to the touch; tearing, stitching, and constrictive pains in the region of the stomach; anguish and _ _I ~ INFLAMMATION OF THE STOMACH. 649 shortness of breath; vomiting, agonizing retching which is sometimes excited by the least pressure, inability to retain any liquid on the stomach, although the patient craves cooling drinks and is tormented by thirst; the tongue is inflamed around the edges and covered with a thick, brown, blackish fur, or it is of a dark-red color and parched; the pulse is wiry, exceedingly rapid, irregular; the face is pale, distorted, with an expression of anguish in the features; the extremities are cold, stool and urine cease to be discharged, and a variety of nervous phenomena, such as twitching, restlessness, singultus, excessive prostration and even stupor develop themselves. Many individuals are troubled with chronic gastritis, and many pathologists, especially those who belong to the school of Broussais, look upon chronic gastritis as the great source of most of our sufferings. Persons affected with chronic gastritis complain of a variety of pains and sensations, closely resembling those which have been described under dyspepsia, such as: burning, soreness and sensitiveness to the touch; feeling of rawness in the epigastric region; load, fullness, tightness, frequent belching up of wind and spitting up of the ingesta; distress after eating, costiveness, distension of the bowels, weakness, bad taste, loss of flesh, oppression of breathing, palpitation of the heart, dizziness, aphthous exulcerations in the mouth, peeling off of the tongue, etc. Gastritis may be induced by various causes, such as indigestion, exposure to a draught of air, to damp and wet weather, cold drinks while the system is overheated, mechanical injuries, repelled eruptions, poisons. The principal remedies for the most dangerous forms 56 __ _ __ 650 SPECIAL THERAPEUTICS. of gastritis are: ACONITE, ARSENIC, and PHosPHORus. Other equally important remedies, but corresponding more with bilious congestion of the stomach, are CHAMOMILLA, and MERCURIUS. In some cases CATHARIDES and CAMPHOR may be required. Particular Indications. ARSENIC is required, if the patient complains of intense burning in the pit of the stomach, with agonizing distress, painfulness to contact, heat when touched, distressing vomiting, intense, unquenchable thirst, with inability to keep a drop of liquid on the stomach; coldness of the extremities, wiry, thin, excessively rapid pulse; expression of agonizing suffering in the features. DOSE.-One grain of the third trituration every half hour, until a change for the better takes place after which the medicine may be given every two or four hours. PHOSPHORUS is indicated by burning in the stomach, thirst, tenderness and bloating of the epigastric region and bowels, pain, with sense of pressure in the stomach and bowels, incessant vomiting and diarrhoea, feeble and even imperceptible pulse, spasms and delirium, coldness all over. DOSE.-Same as Arsenic. CHAMOMILLA is suitable, if the patient complains of a hard, aching pain in the pit of the stomach, with soreness, heat, vomiting of sour bile. Chamomilla corresponds with a condition of the stomach which might be termed "bilious congestion of the stomach." DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoon. ful every two hours, until the patient feels better. MERCURIUS VIVUS. This drug likewise coresponds _ _ PARTICULAR INDICATIONS. 651 more particularly with bilious congestion of the stomach, as characterized by soreness, heat, tenderness to the touch, bloat, vomiting of a bitter, yellow-greenish bile, constipation, dryness of the mouth, foul tongue, unquenchable thirst, sallow complexion, quick and rather soft pulse, chilliness followed by fever. DOSE.-Same as Chamomilla; or else one grain of the third trituration every two hours. CANTHARIDES and CAMPHOR are recommended for gastritis, but it is our belief that neither one nor the other will prove of much use in this affection. Hartmann recommends these two remedies for the following symptoms: "CANTHARIDES for a stinging, burning and cutting pain, particularly in the region of the orifice of the stomach, feeling of fullness, sensation as if the parts were screwed together from the stomach to the dorsal vertebrae, vomiting of the ingesta and of blood, with constant retching, agonizing uneasiness, small and intermittent pulse, with burning thirst. This kind of gastritis is always accompanied with pains in the abdomen, kidneys and bladder, the pains in the latter organ descending from the ureters, and being attended with ischuria. " CAMPHORA corresponds to burning with pressure in the stomach, with coolness in the pit of the stomach, painfulness of the pit of the stomach to contact, violent vomiting of bile and blood, gulping up of the ingesta, cold sweat in the face, general coldness of the body, hurried breathing, feeling in the back as if bruised, feeble, scarcely perceptible pulse. DOSE.-Of Cantharides, give one drop of the second attenuation on a little sugar, every hour, until a decided change for the better sets in; then every three hours; and of Camphor, give three drops of the pure spirits on sugar, likewise every hour until relief is obtained. 652 SPECIAL THERAPEUTICS, Chronic Gastritis Ought to be treated with the same remedies as the acute form, but principally with ACONITE, ARSENIO, MERCURIUS, BRYONIA, PULSATILLA and the medicines which have been mentioned for dyspepsia and indigestion. Chronic gastritis is not, generally, accompanied with fever, but the symptoms of congestion of the intestinal mucous membrane, especially in the stomach and bowels, are very marked. Chronic gastritis is very apt to run into consumption of the bowels, and patients afflicted with this disease, have to take every precaution to prevent such a result. They have to observe the strictest diet, and avoid every exposure to sudden changes of temperature, or to all such causes as, under ordinary circumstances, are apt to induce a derangement of the bowels, or the digestive functions generally. The principal symptoms of chronic gastritis are pretty much the same as those of a deep-seated dyspepsia; we distinguish in most cases: heat in the epigastric region, load in the region of the stomach after eating; sensation as if the region of the stomach were bloated, with tenderness and soreness to pressure; throbbing in that region, spitting up of the food, water-brash, bad taste in the mouth, coated tongue, constipation, or else irregular stools, at times constipated, at others loose with more or less tenesmus; red urine with brick-dust sediment; dizziness, headache, loss of appetite, weariness and debility, loss of flesh. ACONITE may be given, if the disease remains after allceopathic treatment with its local and general bleeding and its revulsive and cathartic methods. The patient complains of heat in the stqmach, fullness and tension, 654. SPECIAL THERAPEUTICS. horseback is very useful. Stimulants awd spices are injurious. Enteritis, Inflammation of the Bowels. It is well known to the reader that the bowels are a portion of the abdominal viscera; but it may not be equally known that the bowels, together with the rest of the abdominal viscera, are contained in the peritoneum, which is a shut sac and serves as a means of support to its contents. The peritoneal membrane closely adheres to the bowels of which it forms the outermost coat. The tissue of the bowels moreover consists of a mucous and muscular coat. The muscular coat is next to the peritoneal, and is composed of external and internal fibres, the former being longitudinal, the latter circular. These fibres, by their successive contractions and extensions, induce a peristaltic motion of the bowels, by means of which the contents of these organs are successively and thoroughly exposed to the action of the lacteals or absorbent vessels in the intestines, whose pffice is to extract or absorb from the comminuted food in the intestines all that portion which is necessary to the preservation of the organism. By means of the peristaltic motion of the bowels the food is gradually pressed downwards, and that portion of it which cannot be assimilated, is expelled from the rectum, to accomplish which purpose this portion of the intestinal canal is surrounded by more powerful muscular fibres than all the rest. An inflammation of the bowels may involve the peritoneal, muscular or sub-mucous coat. Peritoneal inflamInation will be treated more particularly in the next CHRONIC GASTRITIS. 655 chapter. If the muscular and mucous coats are the seat of the inflammation, the distinction of the symptoms between muscular and mucous inflammation is not only difficult, but without any practical value. This inflammation generally commences in one spot,.most frequently in the region of the navel, from which the pain gradually spreads over the abdomen. It is an acute, stitching pain, lasting all the time. The abdomen is hot, painful to the touch, bloated, sometimes hard and distended like a drum. Other symptoms are: obstinate constipation, violent thirst, a small and contracted, wiry pulse. The urine looks red, the secretion of this fluid is more scanty; nausea and vomiting are generally present, vomiting of mucus and bile, and sometimes even of faecal matter. The patient is uneasy, nervous, anxious, he moans and sobs. The disease may run a course of from one to three weeks, before the patient is quite recovered, or it may terminate in adhesions, suppuration and gangrene. Nothing can be more injurious than the allceopathic mode of treating this disease by cathartics, drastics and bleeding. When the reactive vitality of the bowels is so completely prostrated as it is in this disease, the violent action of drastic medicines may easily, and frequently does lead to, gangrene and perforation of the intestines. All that the homceopathic physician has to do, is, to restore the tone of the bowels by removing the depressed condition of the. nervous reaction, and he accomplishes this object without resorting to any revulsive means, simply by giving the following medicines: ACONITE, when the above mentioned symptoms occur. DOSE.--A few drops, or ten globules, in a tumblerful of water, a table, 656 - SPECIAL THERAPEUTICS. spoonful every hour, and if better, every two or three hours. After using the attenuation for a day, the cure is sometimes expedited by substituting a drop of the tincture in the same quantity of water as above, and giving it in the same dose fur three or four days longer. If the bowels should remain bound, bloated, sensitive, but without much fever, we may give BRYONIA, same dose as Aconite. Of this medicine we prefer the tincture in this case. MERCURIUS may be given, if the bowels feel tender, hard, rather hot, the tongue is coated yellow, and the patient has a sallow or jaundiced complexion, and the whole skin partakes of this tinge. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every two hours; or one powder of the third trituration every three or four hours. ARSENICUM may be used, if the pain abates suddenly involuntary discharges of fetid, liquid stools set in, the patient's features assume a transfigured expression, the pulse collapses, the extremities become cold. DOSE.-One grain of the third trituration dry on the tongue, every nour, or even half hour, until a reaction takes place; if this should not set in after two or three powders, give VERATRUM, a few drops of the first attenuation in half a tumblerful of water, a tablespoonful every fifteen or twenty minutes. If a reaction takes place, the patient warms up again, and the pulse again becomes bounding and full, we may then resume Aconite as above. COLOCYNTHIS is not out of place in some forms of enteritis; it is indicated by cutting and burning pains in the bowels, with spasmodic distress as if the bowels were all twisted up in a knot, intense soreness, discharges of bloody mucus, or tympanitic distension with constipation and constant ineffectual urging. DOSE.-One or two drops of the tinicture, or from three to five drops of the first attenuation in a small tumblerful of water, a tablespoonful every hour or two hours, until relief is obtained. CHRONIC ENTERITIS. 657 BELLADONNA should not be forgotten, if the bowels are hard and distended, sore, hot, with crampy and stinging pains; the nervous system seems to be very much shaken, the patient is delirious, is affected with twitchings of the tendons, single muscles, &c. DOSE.-A few drops of the first or second attenuation in a small tumblerful of water, of which the patient may have a tablespoonful every two or three hours. DIET AND REGIMEN.-In acute inflammation of the bowels, the patient does not require any food, except water, a little weak tea, and, as he is getting better, a little gruel, and gradually some beef or mutton tea. He should be very cautious in returning to his former diet. Fruit, loosening or indigestible food should be avoided for a long time, and most of it altogether. COLD WATER.-The application of a wet bandage to the bowels in accordanice with the rules laid down in the chapter on the use of cold water, is desired by many patients, and is admissible under homoeopathic treatment, but not, by any means, necessary; nor does it expedite the cure. Chronic Enteritis. An inflammatory condition of the bowels is very apt to remain after the allceopathic treatment of acute enteritis; but it may likewise arise from constitutional debility of the organs, and more particularly from an habitual irritation of the middle and lower portion of the spinal column. The principal symptoms of chronic enteritis are soreness and sensitiveness of the bowels, distension of the bowels, aching pain and pressure, increased by food or even drink; the tongue is red and ~g 658 SPECIAL THERAPEUTICS. smooth, or else coated and red at the tip and edges; the alvine discharges are irregular, either loose and slimy, or hard as if burnt, and scanty, taking place at long intervals. Urine red, saturated, having a strong smell; pulse accelerated, soft, thin; debility, emaciation. TREATMENT.-This is nearly the same as for acute enteritis. The principal remedies are ACONITE, BRYONIA, MERC.URIUS and NUx vOMICA. LACHESIS, PULSATILLA, and the medicines mentioned for acute enteritis may sometimes be required. Give ACONITE when the inflammation remained after the alloeopathic treatment of acute enteritis, or when it arises from spinal weakness or hysteria, and the bowels feel hot, sore, hard; the stools are irregular, sudden gushes of liquid stools and then again constipation; or when the diarrhoea is permanent, slimy or watery stools, or loose yellow stools. DOSE.-Ten globules in a tumblerful of water, a tablespoonful every two or three hours; in three days, substitute one drop of the tincture of the root in a tumblerful of water, a tablespoonful every four hours. Aconite is suitably followed by BRYONIA, one drop of the tincture in a tumblerful of water, a tablespoonful every three hours, especially when the bowels are bound, and distended. If there should be a tendency to acrid, bilious, mucous stools, with urging, colored faeces, yellow-colored urine, soreness of the bowels, whitish-yellow coating of the tongue, sallow complexion, thirst, sour sweat at night, give MERCURIUS, a few drops or ten globulesin a tumblerful of water, a tablespoonful every two hours, or a powder of the third trituration every four hours, dry. Nux voMIcA may be given when the inflammation was occasioned by indigestible food, or by spirituous beverages, especially while the patient was laboring INFLAMMATION OF THE PERITONEUM. 659 under a cold; the bowels feel sore, with pricking pains, and distension; diarrhoea or constipation, generally the latter. DOSE.-Same as Mercurius, and if this should not avail after the sixth dose, one drop of the strong tincture in a tumblerful of water, of which a tablespoonful may be taken every two hours. PULSATILLA may be substituted for Nux vomica, if there are frequent discharges of slime from the bowels, with vomiting of sour, acrid mucus, principally at night. DOSE.-A few drops of the first attenuation, a tablespoonful every four hours. Should the affection have arisen from a blow, or from some other mechanical injury, ACONITE and ARNICA should be given in alternation; of the former one drop of the tincture of the root, and of the latter a few drops of the first attenuation, each in a separate tumblerful of water, an alternate tablespoonful every two hours. COLD WATER.-In this affection the application of a wet bandage to the bowels will prove highly useful. DIET AND REGIMEN.-No stimulants; broths, gruels, meat without fat, easily digestible, boiled or roasted, a little stewed fruit, rice, barley, farina, and no vegetables except such as are not flatulent; no cakes, pastry, cheese; the simpler the diet, the better. Peritonitis, Inflammation of the Peritoneum. The symptoms of this inflammation are very much like those of common enteritis, except perhaps more intense. The inflammation generally commences in one spot below the navel, where a stitching, burning pain is experienced, whence it spreads over the surface of the abdomen. The bowels feel very hot, sensitive, and are bloated, sometimes like a drum. The burning is fre L 660 SPECIAL THERAPEUTICS. quently as from hot coal; other symptoms more or less present, are: nausea or vomiting of bile, thickly-coated tongue, intense thirst, constant urging to stool with discharge of mucus or blood, or constipation, sometimes a watery diarrhoea; red, scanty urine with a brick-dust sediment; dizziness, delirium, cold extremities, prostration; pulse quick, contracted, wiry. This disease is very apt to befall women in confinement. If not cured, it may terminate in adhesions, suppuration or gangrene. TREATMENT.-The treatment is almost the same as that for enteritis, and the same medicines, given in the same doses and for similar symptoms, will be required. The principal remedy in this disease is undoubtedly ACONITE, but we advise the reader not to rely upon the globules in this affection, but to give at once, one or two drops of the tincture of the root, a dessert-spoonful every hour, until a warm sweat and other symptoms of a favorable reaction set in, after which the medicine may be continued every three hours. Aconite is particularly indicated by the intense, shooting and burning pains, diarrhoea or constipation, coldness of the extremities, small, quick, wiry pulse, hiccough, vomiting of bile, anguish and restlessness. When these symptoms are more or less subdued, we may then alternate Aconite with BRYONIA, if there should be much constipation, or shooting and stinging pains, or with BELLADONNA, if the patient should be very uneasy, or inclined to stupor and delirium. The dose of either of these two remedies to be two or three drops of the first attenuation in a tumblerful of water, an alternate tablespoonful every hour. MERCURIUS, ARSENIC and VERATRUM have the same symptomatic indications as under enteritis. Otheir ' ' INFLAMMATION OF THE LIVER. 6.61 remedies have been proposed in this disease, but will be useless, if the above-mentioned medicines should fail. DIET AND REGIMEN.-The patients may be given as much cold water to drink as they desire; otherwise the same rules of diet apply that have been mentioned for enteritis. The utmost quiet should be observed in the sick-room; nobody should be admitted at any time except the regular attendants, or persons whom the patient may desire to see. The linen should be changed daily, and should always be perfectly dry. Hepatitis, or Inflammation of the Liver. The liver, is situated in the right upper side of the abdominal cavity, and fills it almost entirely. The lower edge of the liver reaches as far down as the last rib. The disease may either affect the outer or convex side of the liver, or the inner, concave surface and the substance of the organ. The former inflammation is distinguished by a burning and stitching pain in the right side; it is increased by drawing breath, and strikes to the sternum and the right shoulder-blade, and sometimes extends as far as the right lower limb, also with numbness and tingling in the right arm; the patient cannot lie on the right side. Ant inflammation of the concave surface is distinguished by a deep-seated, painful pressure, yellow color of the eyes, face, sometimes amounting to complete jaundice; bitter taste, saffron-colored urine, vomiting, hiccough. The pain is increased by lying on the left side, but alleviated by lying on the right. Hepatitis is always.accompanied with high inflammatory fever, dryness of the skin, intense.thirst, 57 662 SPECIAL THERAPEUTICS. constipation, and sometimes a short and dry cough. The right side is painful to the touch, and swollen. TREATMENT.-The homoeopathic treatment of this disease is principally confined to the use of ACONITE, BRYONIA, MERCURIUS, ARSENICUM, DIGITALIS, and Nux VOMICA. Give ACONITE, if the fever is high, with dry skin, thirst, anguish and restlessness, inflamed and yellow-colored tongue, and the pains above-described. DOSE.--A few drops, or ten globules, in a tumblerful of water, a tablespoonful every two hours. This preparation suffices in many cases; but if the reaction should not be sufficiently marked, substitute one or two drops of the tincture for the globules, mixing them in a tumblerful of water, and giving a tablespoonful every two hours. After giving Aconite, it may sometimes be advisable to give BRYONIA, especially if the bowels remain bound, and there is much stinging or shooting pain. DOSE.-One drop of the tincture in a tumblerful of water, a tablespoonful every two hours. MERCURIUS, if the fever is not so very high, but the skin is dry and hot, with tendency to sour night-sweats. Eyes look jaundiced and the skin looks sallow all over the body. Evacuations hard and knotty, dark-colored, or else reddish-yellow, soft; or liquid and excoriating stools; tongue coated yellowish, with foul taste in the mouth. DOSE.-Ten globules, or a few drops, in a tumblerful of water, a table, spoonful every two hours. ARSENICUM suits the severer forms of hepatitis, when bordering on typhus, or if the pain is intense, with coldness of the extremities, small, contracted, uneasy and irregular pulse, distressing vomiting of bile, fetid, blackish diarrhoea. DOSE.-One grain of the first or second trituration, dry on the tongue. __1_1~ LIVER COMPLAINT. 663 every two hours, or even every hour if required by the severity of the symptoms, and every four hours after an improvement has commenced. DIGITALIS may prove useful when the concave side is inflamed, with irregular or slow pulse, whitish stools, dull painful pressure in the side. DOSE.-One or more drops of the tincture in a tumblerful of water9 in table spoonful doses, it may be alternated with a solution of two drops of the tincture of the root of Aconite in a separate tumblerful of water, same dose; an alternate dose every two hours. Nux VOMICA will be found useful when the disease is complicated with irritation of the middle portion of the spine, or when abuse of spirituous beverages had something to do with it. DOSE.-A few drops, or ten globules, in a tumblerful of water, a tablespoonful every two hours, and if no better in one or two days, substitute one drop of the tincture in the same quantity of water; same dose. DIET AND REGIMEN.-See Enteritis and Peritonitis. Chronic Inflammation of the Liver, Liver-Complaint. The symptoms of liver-complaint are quite numerous, and are generally distinguished by a sense of fullness, tension, various kinds of sounds as from flatulence, such as rumbling, buzzing, purring; soreness and sensitiveness to contact or pressure, heat, sense of weakness or hollowness in the epigastrium, crampy pains, foul taste, especially in the morning, coated tongue, also with inflamed edges or tip, or an appearance as if it would peel off-a dyspeptic tongue; bloating in the region of the liver, deep-seated aching or stitching pains in this region; sallow tinge of the face and skin, although the face is sometimes flushed; highly-colored urine, constipation, or also several soft stools a day; sickness at- the stomach, occasional vomiting of bile, dizziness, headache, - -- 064: SPECIAL THERAPEUTICS. palpitation of the heart. Many of these symptoms occur at more or less regular intervals, in paroxysms. Liver. complaint may be one of the consequences of the alloeopathic treatment of hepatitis, but it may likewise be a constitutional malady, hereditary, and depending upon an,irritated condition of those spinal nerves which go to the liver. The treatment is conducted with the same medicines that have been recommended for the acute disease; principally, however, with ACONITE, MERCURIUS, and Nux VOMICA. ACONITE is indicated by a sense of fullness in the region of the liver, distension, soreness, throbbing, crampy and stitching pains, also by heat and burning, wind on the stomach, foul taste, dizziness and headache, costiveness, the faeces looking as if burnt, load at the stomach after eating, dingy, sallow complexion, dirty coating on the tongue, with inflamed tip and edges, loss of flesh, debility. DOSE.-A few drops, or six globules, morning and night, or if no better in a week, one drop of the tincture in four tablespoonfuls of water, a tablespoonful every morning, before breakfast, and every evening on retiring. MERCURIUS is indicated by soreness and oppression in the region of the liver, anxiety, as if the liver were crowded, aching pains, sensation of warmth in the liver, occasional nausea and Water-brash; coated tongue, loss of appetite and strength. DOSE.-A few drops, or six globules, morning and night, or if no better in four days, one grain of the third trituration morning and night. A higher attenuation of Mercurius may also be given, if the liver had. been deranged by the abuse of Calomel. Dose as above. Nux VOMICA is suitable, if the disease depends upon spinal irritation or had been gradually developed by a sedentary mode of life, or by abuse of spirituous drinks. DOSE.-One drop, or six globules, every night; in case of spinal irritation, __~ ABSCESS OF THE LIVER. 665 Aconite may be given alternately with Nux, one drop or six globules of Aconite, early in the morning, and Nux at night. ARSENIC is an excellent remedy, in case the derangement had been occasioned by abuse of Quinine. DOSE.-One grain of the third trituration morning and night. In this case, CINCHONA, six globules of the twelfth or eighteenth attenuation, morning and night, is likewise an useful remedy; but Arsenic is preferable. COLD WATER is admirably adapted to this weakness. Use the shower-bath every morning, immediately after rising, and also a general ablution with cold water, and strong friction with a coarse towel afterwards. Drink cold water; avoid stimulants and live regularly, without using spices, acids, fat, rich food, made-dishes, pastry, etc. Use cold water injections after breakfast, if the bowels should be habitually torpid. Or better still, drink much cold water, rub the bowels well with cold water, take sufficient exercise, and the bowels will gradually become regular. Abscess of the Liver. Individuals who are subject to liver-complaint, are in danger of being attacked with abscess of the liver. This may result from exposure to a draught of air, or from some similar rheumatic influence. A portion of the liver becomes inflamed and very speedily the inflammation may tend to suppuration. This process must necessarily be accompanied with inflammatory fever; the skin is hot and dry, the patient's countenance looks sallow, flushed; the region of the liver is very sensitive, hot, bloated; if the abscess forms on the external surface, the part looks red, the patient experiences a throbbing pain 57* 666n SPECIAL THERAPEUTICS. in the swelling which is distinctly seen; at a later period fluctuation may be discovered by pressure. For a trouble of this kind we have never been obliged to use any other medicines but the following: ACONITE, MERCURIUS, and HEPAR SULPRURIS. ACONITE is invariably indicated during the inflammatory stage, if the patient is laboring under high inflammatory fever. We invariably use the tincture of "the root in this. affection, from one to two drops in a tumblerful of water, of which the patient takes a tablespoonful every two hours. The attenuations are unable, as far as our experience goes, to effect a reduction of the swelling, or an absorption of the pus, if any should have begun to form. MERCURIUS is another excellent remedy for this condition; the swollen part looks less inflamed than it does when Aconite is indicated; it has a rosecolor instead of the deep-red color of Aconite; the fever is less high, the skin is dry and looks sallow, rather jaundiced, the tongue has a dirty yellow, grayish coating on it; the urine is of a deep-yellow, and has a strong, fetid odor; bowels costive. DOSE.-One powder of the third trituration, dry on the tongue, every three hours. HEPAR SULPHURIS is resorted to if we find it impossible to prevent the discharge of. pus; we may give the dose as indicated for Mercurius. But even if the abscess must discharge, we do not hesitate to use either Aconite or Mercurius, (whichever was primarily indicated,) in alternation with Hepar. By this means we limit the secretion of pus as much as is possible, and arrest the inflammatory diathesis, if any should still be present. If the discharge of pus cannot be prevented, it is per CONGESTION OF THE LIVER, JAUNDICE. 667 fectly proper to favor the breaking of the abscess by means of bread and milk poultices. Sometimes the abscess forms on the inner surface; this is a most dangerous termination, since the pus may produce dangerous inflammation of some adjoining organ, gangrene, perforation of a vital viscus, and thus destroy life Congestion of the Liver. This derangement of the liver sets in with a chill, followed by fever, dry skin, thirst, jaundiced tinge of the skin, face and eyes; flushes on the cheeks, soreness and heat in the region of the liver, bitter, foul taste in the mouthy coated tongue, loss of appetite, thirst, constipation, high-colored urine. The treatment is the same as for acute and chronic hepatitis, to which the reader is referred. The remedies principally indicated in this affection, are ACONITE and MERCURIUS, to which the reader is referred, Jaundice. This disease has its name from the yellow color of the skin, which is first seen in the whites of the eyes, and then all over the skin, varying in degree from pale to a blackish-yellow. It is principally caused by a deficient action of the liver in consequence of which the bile remains in the capillary circulation as a foreign agent; and this torpor of the liver may again depend upon violent emotions, an indigestion, a cold, the presence of gallstones or other substances obstructing the biliary duct; or also by irritating: poisons and drastics. Sedentary habits, abuse of spirits and aperient medi cines predispose one for this disease. C~-- ~ 668 SPECIAL THERAPEUTICS. TREATMENT. The principal remedies for this disease are undoubtedly ACONITE and MERCURIUS. CHINA, DIGITALIS, NUX VOMICA, CHAMOMILLA, ARSENIC, OPIUM, and BRYONIA may likewise prove useful, and are frequently necessary. ACONITE is indispensable when there is inflammatory fever, constipation, violent thirst,.dizziness, headache, saffron-colored or blackish urine. DOSE.-A few drops, or ten globules, in a tumblerful of water, a tablespoonful every two hours. But Aconite is likewise eminently useful in jaundice, without any apparent inflammatory action, when the faeces are dry, and gray, like dog's excrements. In this case it is indispensable to give one or two drops of the tincture of the root in a tumblerful of water, a tablespoonful every two or three hours. This preparation may be alternated with two drops of the tincture of Digitalis in a tumblerful of water, same dose; an alternate dose every two hours. MERCURIUS is indicated by a yellowness of the whites of the eyes, and a yellow tinge of the skin, constipation, saffron-colored urine, and characteristically by a pain in the pit of the stomach as if ulcerated. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every two or three hours. CHINA is a good remedy if the jaundiced condition had been caused by frequent suppression of fever and ague by means of large doses of Quinine. DOSE.-Six globules, norning and night. Arsenic may be alternated with China, giving six globules of this medicine in the evening, and six globules of China in the morning. ARSENIC is likewise useful both in acute and chronic jaundice, especially when the patient is suffering with liquid, bilious, bloody, mucous discharges from the bowels, excoriating the anus and debilitating him a good deal. DOSE.-One grain of the third trituration every six hours, in chronic cases, and every two hours in acute cases, especially when the attack is characterized by vomiting of bile, violent headache, diarrhoea or constipation, anxiety. I~ BILIOUS. 669 Nux VOMICA is indicated when the disease originates in abuse of spirits. DOSE.-A few drops, or six globules, in a tumblerful of water, a tablespoonful every two hours, or, if no better after the sixth dose, one drop of the tincture in a tumblerful of water, a tablespoonful every two or three hours, until the patient sweats profusely, after which the medicine may be continued for two or three days, every five or six hours. CHAMOMILLA, if a fit of anger was the cause of the disease. DOSE.-A few drops, or six globules, in water, the same as Nux. If the attack is accompanied by stupor or coma, give OPIUM, same as Chamomilla. BRYONIA is useful when the urine deposits a rosecolored sediment. DOSE.-Six globules, three times a day. DIET AND REGIMEN.-Drink water, gruels, and avoid stimulants of any kind; light food, light broth, and vegetables, roast apples and baked pears, rice, farina, and afterwards a little roast meat, beef, mutton, or venison; tea and toast may be used if desired. Bilious. In the spring of the year and frequently at other periods, persons complain of feeling bilious. In order to counteract this condition of the system, a blue pill or some other purgative medicine is taken. Persois who employ homoeopathic treatment, need not torture their bodies with blue-pills and rhubarb in order to get rid of the bile. This result may be obtained much more speedily and safely by using the following medicines: Aconite, Mercurius or Nux vomica; but principally the two former. __ 670 SPECIAL THERAPEUTICS. ACONITE, first, second or third attenuation, is a capital remedy for biliousness, if the patients complain of dull headache, dizziness, bad taste in the mouth, especially in the morning on waking; the tongue looks coated; they have a dark, sallow complexion, little or no appetite; the bowels are costive, the urine looks dark and has a strong smell; the patients complain of nausea and are even obliged to vomit up bile and phlegm. DOSE.-Give a drop, or six globules, three times a day, or mix this quantity in six tablespoonfuls of water, and take this mixture every day in four doses, repeating it for one or two days. MERCURIUS VIVus will suit better than Aconite, if the symptoms are similar but less marked; the patients look heavy, complain of tightness of the head, pappy taste, have to spit much without feeling very sick at the stomach; the tongue is somewhat furred, the appetite diminished, the skin feels dry, as if dead, the bowels are torpid, the evacuations look dark, they are dry and lumpy; the urine has a fetid smell, sometimes it has the odor of burnt sugar. DOSE.-One drop, or six globules, in six tablespoonfuls of water, one of which may be taken three times a day. Nux VOMICA will relieve costiveness, loss of appetite, sensation of a load after eating with inclination to vomit, acidity, stitching and crampy headache. DOSE.-Same as Mercurius. If the bilious condition should result in some violent paroxysm of bilious symptoms, the reader may have to consult the remedies that have been indicated for Bilious fever, Congestion of the liver and Liver-complaint; one or more of the remedies mentioned in those chapters will omit the existing symptoms. HYGIENIC TREATMENT.-In the spring of the year, INFLAMMATION.OF THE SPLEEN. 671 when every living organism in the vegetable as well as in the animal kingdom passes through a change resulting in a more active rush of vitality, it is not well to encumber the organism with an excessive amount of rich nutrient matter for the elaboration of the new tissues. Stimulants and all heavy, fat nourishment should be avoided. A small quantity of tender meat, such as lamb, young beef and spring-chickens, is admissible. Fresh vegetables are very useful. Dandelion and scurvy-grass, if they can be had, may be prepared as vegetables; they are useful aliments during the first spring-months. Fresh soft water is the best drink. Light ale is likewise admissible. Fresh eggs suit many persons, but in others they excite bilious symptoms, diarrhoea, colic, etc. Splenitis, or Inflammation of the Spleen. The spleen is situated in the left hypochondriac region towards the back, between the diaphragm above and the large end of the stomach on its right side. The spleen is a very vascular organ, but its uses are not well known. An inflammation of this organ is recognized by pressing and stitching pains in the region of the spleen, which appears bloated and is painful to pressure. When the inflammation is violent, it is accompanied with vomiting of blood. TREATMENT.-ACONITE should be given if the fever is high, and the pressing and shooting pains, and the soreness very severe. DOSE.-A few drops, or six globules in a tumblerful of water, a tablespoonful every two hours. This medicine is generally sufficient, especially if, after using the globules for a day, or a day and a half, we then substitute one or two drops of the tincture in a tumblerful of water, a tablespoonful every Y ~_~ ~~~ ~ 672 SSPECIAL THERAPEUTICS. two hours; if, however, a sense of fullness, throbbing, and aching pain should obstinately remain, we may then give BELLADONNA, in the same way as Aconite, commencing with the globules and ending with a drop of the tincture. If the spleen had become deranged by the abuse of Quinine in fever and ague, we may restore its functional harmony by means of ARSENICUM, one grain of the third trituration every six hours; every alternate day six globules of CHINA may be taken morning and night, omitting the Arsenic on such days. Nux VOMICA may be used alternately with Belladonna, if there be obstinate constipation. DOSE.-Six globules of each, in a separate tumblerful of water, in tablospoonful doses, an alternate dose every two hours. Weakness of the Bowels, Constant Urging to Stool. This may be induced by various causes, a cold, the use of ice-water while the body is overheated, a strain, hereditary; disposition, consumptive habit. If this weakness should be accompanied with soreness of the bowels, aching and shooting pains, give ACONITE, one or two drops of the tincture of the root in a tumblerful of water, a tablespoonful every two or three hours. If better, use the medicine less frequently. MERCURIUS may be given, if the urging results in small discharges of mucus, and Aconite does not seem to afford any relief. DOSE.-One grain of the third trituration every four hours. NUX VOMICA and SULPHUR may be used alternately, if the patient be subject to piles. Of the Nux mix one drop of the first attenuation in a tumblerful of water, CONSTIPATION, COSTIVENESS. 673 and give a tablespoonful of this solution alternately with one grain of the third trituration of Sulphur every two or three hours, until relieved, then every six hours. COLD WATER.-The application of a wet bandage to the bowels will be found extremely useful in most cases. DIET AND REGIMEN.-Use daily ablutions of cold water, and rub the bowels well with a coarse towel; shower-baths may likewise be resorted to; avoid stimulants, indigestible food, fat, pastry, made dishes, and loosening, flatulent food. Constipation, Costiveness. This affection is generally a mere symptom characterizing a more general disease. In every case it denotes a weakness of the bowels. Obstinate constipation is sometimes a symptom of incipient atrophy or consumption of the bowels. It frequently depends upon weakness or irritation of the spinal column. The alloeopathic treatment of acute diseases is apt to leave constipation as an habitual state of the bowels. TREATMENT.-Aconite is indispensable, if constipation is caused by a deep-seated emotion, disappointed love, etc., or if it is the result of alloeopathic treatment, or is accompanied with weakness of the back; the stools are hard and look as if burnt. DOSE.-Six globules, morning and night. It is particularly adapted to plethoric nervous individuals, subject to rushes of blood, dizziness, headache, or to cases induced by a sudden check of diarrhoea by means of opiates. MERCURIUS, if the faeces are lumpy, or are pressed out in one solid ball, dark-colored, dry or covered with slime. DOSE.-Same as Aconite. 58 S!l SPECIAL THERAPEUTICS. Nux VOMICA is useful if the constipation is caused by sedentary habits, abuse of stimulating beverages, irregu larities of diet, abuse of rich and fat food, travelling, or when it is accompanied with a disposition to haemorrhoids. DOSE.-Six globules, every night dry on the tongue. In chronic constipation, especially when a hoemorrhoidal disposition is present, it is well to give every third or fourth night, a dose of SULPHUR, six globules-dry on the tongue, and six globules of'Nux on each intervening evening. OPIUM may be given in cases of sudden constipation, with determination of blood to the face, glistening eyes, dark redness of the cheeks; the bowels seem dead, totally inactive. DOSE.-One or two drops of the tincture, in half a tumblerful of water, a tablespoonful every two hours. This medicine is particularly suitable when the constipation was occasioned by the influence of lead, among painters, in lead factories, etc. PLUMBUM ACETICUM is useful if the constipation is attended with spasmodic retraction of the abdominal walls, flabbiness of the muscles, emaciation, livid color of the face and body, and the fieces are composed of hard, bullet-shaped masses. DOSE.-One grain of the third trituration every four hours. Various other medicines have been proposed for constipation, such as Lycopodium, Natrum muriaticum, Sepia,: Alumina, etc.,. but they are seldom required as remedies for constipation; if they remove constipation, it is because they cure the whole group of symptoms to which the constipation belongs. DIET AND REGIMEN.-USe daily ablutions and frictions with cold water, and cold water injections half an hour after breakfast. Avoid stimulants, spirits, spices, pastry, made dishes; use plain food, simple vegetables, meat without fat, fruit, stewed or raw, rice, barley, and DIIhA 6,7 DIARRH(EA. 675 any kind of simple nourishment which seems to agree with the bowels. Diarrhoea, Watery, Serous, Bilious. This weakness is either temporary or chronic. Diarrhoea may be occasioned by various causes, a cold, an indigestion, a sudden emotion, over-exertion, etc. A simple diarrhoea is sometimes effectually stopped by a glass of brandy and water, or even a cup of black coffee sweetened with sugar. The medical treatment of diarrhoea is as follows: ACONITE, if the disease is caused by a cold, an emotion, or even an indigestion, with chilliness, followed by fever, nausea, headache; the discharges look watery, serous, or greenish, having a fetid smell and causing soreness at the anus and debility. DOSE.-One or more drops of the tincture of the root, a tablespoonful every hour or two hours. We regard Aconite as one of our most efficient remedies of common catarrhal, rheumatic and bilious diarrhoea. This medicine will, however, prove unavailing in these affections unless the tincture is used. A medicine which affects so powerfully the biliary secretions and the capillary network of the intestinal mucous membrane, must of necessity be one of our most powerful agents in the treatment of diarrhoea. It puzzles the superficial observer how the same medicine can be indicated for two opposite conditions; how Aconite, for instance, can be recommended as a remedy for diarrhoea and constipation. We will endeavor to explain this mystery. Every drug exercises a certain specific action in the I _ 676 SPECIAL THERAPEUTICS. organism, which the organism endeavors to overcome. Physiologists designate this compound action by the terms "action and reaction." The action or primary disturbance is attributable to the drug; the reaction or contrary action is attributable to the organism This secondary action or organic reaction must necessarily be opposed to the primary action. This doctrine not only applies to drugs, but also to dynamic principles or forces which produce disease. Let us illustrate the doctrine by means of Aconite. The primary action of Aconite upon the capillary nervous network of the intestinal mucous membrane is to induce torpor such as might be considered analagous to the torpor induced by cold. The first consequence of this torpid condition of the nerves, is to cause a relaxation of the mucous membrane and an excess of the mucous secretion. This excess of the secretions would affect the character and regularity of the alvine evacuations; the stools would be thin, slimy, and the desire to evacuate the bowels would be felt more urgently and more frequently. But under ordinary circumstances the relaxed condition of the mucous membrane would hardly continue long enough to affect the evacuations in a permanent manner. Organic reaction will soon take place, and an opposite condition is set up; instead of excessive, we shall have a deficient secretion of intestinal mucus which may induce a corresponding costiveness. Supposing the intestinal mucous membrane were primarily disturbed, not by Aconite, but by a similarly-acting dynamic morbific force, the same phenomena would develop themselves in a similar order; first there would be looseness on account of an excessive secretion of mucus, DIARRH EA. 677 DIARRH(EA. 677 and, shortly after, costiveness, in con:equence of the deficient action of the intestinal lining membrane. From this statement it must be obvious to the reader that every drug is necessarily homoeopathic to two opposite conditions, because itself is capable of developing two opposite conditions, one of which is, properly speaking, the effect of the drug, and the other the condition of organic reaction. Thus then a medicine may be homoeopathic to both a state of hyperemia or excess of blood, and a state of anemia or deficiency of blood; to both atony and excessive irritability of the stomach; to a condition characterized by paralysis as well as to a condition characterized by spasm. Aconite and Nux may be used as true homoeopathic remedies in paralysis as well as in tetanus; Ipecacuanha may remove perfect atony as well as spasmodic irritability of the stomach; Opium cures diarrhoea as well as constipation, excessive wakefulness as well as drowsiness and stupor; Mercurius will check as well as promote the secretory action of the pancreas; Secale answers in uterine hemorrhage from atony of this organ as well as in spasmodic uterine contractions, it will arrest the former and quiet the latter simply by virtue of the beautiful and life-saving law that every drug is exactly homceopathic to, and therefore adaptable as a specific curative agent to, two morbid conditions which are in direct or polaric opposition to each other. There is a difference in regard to the dose which may be required according as a medicine is homoeopathic to some primary morbid condition, or to a group of symptoms, developed by the secondary or reaction of the organism. If the medicine is prescribed as homceopathic to some primary condition, we may have to give a larger dose than if the same medicine is exhibited 58* __ 678 SPECIAL THERAPEUTICS as homceopathic to a condition in polaric opposition to the former. Thus if Aconite is given for diarrhoea, the dose should be larger than if the same medicine is given for constipation, the former being a relation of primary, the latter one of secondary homceopathy. ARSENIC is excellent if the discharges are darkcolored, greenish, brown, mixed with blood, causing a sudden and complete exhaustion. DOSE.-Half n grain of the third trituration every two hours. This medicine is likewise indicated when the discharges are very copious, mixed up with a quantity of faecal matter, as though the bowels were paralyzed and could not retain any of their contents. In this case it is well to alternate Arsenic with Aconite, giving the same doses as stated above, an alternate dose every hour. VERATRUM is excellent if the stools pass off without being perceived by the patient. DOSE.-One drop of the first attenuation in half a tumblerful of water, a tablespoonful every hour, until an improvement takes place MERCURIUS: this is a great remedy for diarrhoea, when the discharges cause soreness at the anus, and have a bilious appearance of a reddish-yellow color, mixed up with mucus and little pieces of dark-brown fiecal matter. DOSE.-One grain of the third or second trituration every two hours. If Mercurius does not arrest the diarrhoea, and the discharges should be attended with nausea, dizziness, prostration, complete loss of appetite, we may resort to the alternate use of Aconite and Arsenic, as described above. CHAMOMILLA may be given if the diarrhoeic stools have a sour or else an offensive smell, and look darkyellow, as if mixed with bile; the passages are accompanied with cramp-pain in the bowels and sensitiveness to contact or pressure. DOSE.-A few drops or six globules, in a tumblerful of water, a tablespoonful every hour, until relieved. COFFEE may be useful in mild, bilious diarrhea, if CHRONIC DIARRHEA. 679 the passages produce a sensation of warmth and a slight feeling of roughness at the anus. A tablespoonful of common coffee without milk, sweetened with a little sugar, may be taken three times a day. If persons are in the habit of using coffee every day, the homoeopathic tincture of Coffea may be used, a few drops of the first attenuation every four or six hours in a little water. There are persons who are subject to frequent attacks of diarrhoea a little fatigue, mental excitement, the least excess in the use of food, will bring on an attack. Such individuals should avoid every circumstance that might tend to irritate the bowels; they may find it advisable to use an injection of cold water every morning after breakfast, or to wear a wet bandage on the bowels, and to frequently rub the abdomen with cold water. A diarrhoea will frequently set in during an attack of acute fever, or in the course of treatment for constipation. The appearance of such a change may be highly favorable; it always is, if the diarrhoea is accompanied with a feeling of relief and an increased buoyancy of spirits. Under such circumstances it should not be interfered with. Chronic Diarrhoea. This weakness may be entailed upon a person by the allceopathic treatment of inflammation of the mucous lining of the bowels. It may also be left as a sequela of an attack of Asiatic cholera or common choleramorbus; it may be induced by long exposure, excessive bodily fatigue, great and lasting mental anxiety, sleeping on damp ground., excesses in eating or drinking; and CHRONIC DIARRH(EA. 681 patient has a sallow, earthy look, the eyes have lost their brilliancy, the tongue has a brown or dirty-gray coating upon it, the edges and tip of the tongue are red as if inflamed, and often ulcerated; the patient complains of constant thirst, feels feverish, weak, has little appetite; consensual symptoms, such as palpitation of the heart, dizziness, are often present. At a later period of the disease the skin becomes clammy, the muscles are soft and flabby, the fat or adipose tissue disappears, the strength is gone, and the patient looks like one who is in the last stage of consumption. In this condition of things we invariably resort to the tincture of the root of Aconite, of which we mix one or two drops in about twelve tablespoonfuls of water, and administer a tablespoonful every four hours until an improvement sets in, when the medicine may be continued less frequently: In many cases the exclusive use of this drug will effect a cure. MERCURIUS VIVUS is another excellent remedy for chronic diarrhoea; the passages are dark-brown, a mixture of bile, mucus and faecal matter, sometimes watery or serous, excoriating the anus, more or less attended with severe urging; the urine smells foul, is scanty, the patients look sallow, the skin has likewise a dingy, sallow look, feels dry, feverish. DOSE.-One powder of the third trituration dry on the tongue, morning and evening. CHINA is suitable for chronic diarrhoea, if the patient's strength is failing, the food passes off undigested, he looks haggard, sallow, the tongue exhibits a dirty yellowish or grayish coating, the evacuations, though papescent and slimy, can only be expelled by dint of hard straining. If the patient should exhibit symptoms L ----------- SUMMER COMPLAINT. 683 fat, calfs-foot jelly, rice, hominy, starch, stale bread, cold roast mutton or beef in very moderate quantity, sea-biscuit, and perhaps a little weak black-tea, sweetened with sugar and one-fourth milk, cold water, or a spoonful of port-wine in a glass of water at dinner, will prove the most suitable diet for the patient. Exercise should be taken in moderation and gradually; whether riding on horseback, sawing wood, and similar kinds of exercise, will prove useful, experience has to decide. Summer Complaint, Cholera Infantum. The medicines which have been indicated for diarrhoea, are likewise suitable in this diarrhoea of children. For the sake of completeness, we will transcribe a few remarks on the treatment of cholera infantum, which the reader will find appended to a paragraph in Hartmann's Diseases of Children, translated by one of the authors of this work, and published by W. Radde, New York, 300 Broadway. "'In our climate cholera infantum, or the so-called summer-complaint of children, is a very frequent and even dangerous disorder, which destroys thousands of lives. It generally befalls children of one or two years old, when they are cutting their teeth. ' Beside the above-mentioned remedies for diarrhoea, the following medicines have been employed with advantage for this affection. " ACONITE is one of those medicines which a physician will have to fall back upon in this disorder every now and then. When the child seems to become very restless, especially at night, and feverish flashes set in at certain periods of the day, the child is thirsty, loses its I 684: SPECIAL THERAPEUTICS. appetite, the urine looks red, deposits a sediment, the discharges from the bowels have an offensive smell, and look greenish, watery, mixed with slime and a little blood, the bowels feel hot, and are hard and distended; or when the attack sets in with vomiting of a greenish bile and singultus: no medicine will be found better adapted to this group of symptoms than Aconite; and our advice to the reader is to use one or two drops of the tincture of the root in a tumblerful of water, a teaspoonful every half hour or hour, until the first violence of the attack has been checked, after which the medicine may be given at longer intervals. This remedy is sufficient, in many cases, to arrest the disease from the commencement, although it may be expedient and even necessary to recur to it every now and then in the course of the summer or fall. Even if other remedies should have to be resorted to, Aconite will prove an invaluable auxiliary in conducting the treatment of this disease. For there will be a rise of fever every now and then, sometimes regularly every day or night, the children will be restless, nervous, impatient, peevish; and we have no remedial agent in our practice that is as well calculated as Aconite, to regulate the disorders of the circulation and the disturbed condition of the glanglionic system in which they originate. "If Aconite should still be indicated without having afforded relief, or if it should have afforded partial relief, we may have recourse to "BRYONIA, one or two drops of the first attenuation in half a tumblerful of water, a dessert-spoonful every two or three hours. Or Aconite may be alternated with Bryonia, an alternate dose every two hours. SCALCA.REA CARBONICA is indicated when a process SUNMMER COMPLAINT. 685 of ulceration seems to be going on in the intestinal mucous membrane of the child. The discharges are purulent or serous, the children are very weak, they are unable to stand without being supported, their flesh is soft and flabby, and they have no appetite. If this condition should be accompanied with regular fever-flashes, or feverish exacerbations, it may be well either to alternate Calcarea with Aconite, or, at any rate, to interpolate a dose of Aconite every now and then. DOSE.-Of Calcarea: one grain of the third trituration every three or four hours. Acidum nitricum, one or two drops in a tumblerful of water, a small spoonful at a time may likewise be alternated with Calcarea, an alternate dose every two hours. "e MERCURIUS VIVUs is one of the most efficient remedies in cholera infantum. It is indicated by the following symptoms: there is very little, if any, nausea or vomiting; the discharges from the bowels are of a greenish or sometimes of a dark-brown color, accompanied with tenesmus, soreness of the anus; frequently the passages are mixed with blood and slime, or it is.a mixture of pus, blood, and now and then a little fecal matter. The child smells sour, has no rest, and the diaper has to be changed quite frequently, even every ten or fifteen minutes, or every half hour or hour. DOSE.-A powder of the second or third trituration every two or three hours, or six globules, in a tumblerful of water, a dessert-spoonful every two hours. PHOSPHORUS may be tried when the discharges from the bowels seem to be quite involuntary, unnoticed by the child. A typhoid state seems to develop itself. The child lies in a stupid slumber, the discharges are inodorus, watery, unmixed with blood or faecal matter; the child's lips are dry, blackish, the tongue looks dry, parched, rough, glazed, and lined with a thick, brownish coating. 59 686 SPECIAL THERAPEUTICS. DOSE.-One grain of the third trituration every two hours. Veratrum may be alternated with Phosphorus. Dose of Veratrum, one or two drops of the first attenuation in half a tumblerful of water, in dessert-spoonful doses, an alternate dose every hour. " ARGENTUM NITRICUM may be given for involuntary, frequent, watery or serous passages; there is no teeesmus or sickness at the stomach. DOSE.-One grain of the third trituration every three hours. " CHAMOMILLA may be given if the child is attacked with sour vomiting, the diarrhoea is watery, the tongue is lined with yellow mucus, and the respiration is anxious and labored. DOSE.-A few drops, or six globules, in half a tumblerful of water, a dessert-spoonful every two hours. " JALAPPA answers for the same symptoms as Chamomilla, especially if the children are very restless, cry a good deal, and seem to have a good-deal of colic. DOSE.-Same as Chamomilla. " RHEUM may be given if Jalappa should seem ineffectual. DOSE.-The same. ARSENICUM is finally to be recommended, if the children are very much prostrated, emaciated, the evacuations look and smell foul, are watery, decomposed, apparently a mixture of foul bile, blood and diseased mucus. DOSE.-One powder of the third trituration three times a day. DIET AND REGIMEN.-Rice, farina, barley-flour, arrowroot, also light broths without any fat, and cracker-soups. Good milk, diluted with water, is allowable. Frequent changes of air are very useful; a mild country air, or warm see-breezes are sometimes indispensable to the restoration of the little patient's health. CHOLERA MORBUS. 687 Cholera-Morbus. An attack of cholera-morbus is generally characterized by the following symptoms: diarrhoea and vomiting, burning in the epigastric region, coldness of the extremities, cramp in the calves, dizziness, prostration. This disease is sometimes an epidemic, but generally a sporadic disease occasioned by accidental causes, such as a cold, the improper use of ice-water, or fruit with iced-milk, etc. A common attack of cholera-morbus is easily controlled by ACONITE, VERATRUM or.ARSENIC. ACONITE may be given first, two or three drops of the first decimal attenuation, or even one or two drops of the tincture of the root in a tumblerful of water, half a tablespoonful every ten or fifteen minutes, until the vomiting and diarrhoea cease, which is generally the case after two or three doses. The patient gets warm, perspires, and, in a few days, feels perfectly well again, with the exception, perhaps, of a little weakness and soreness. There may be cases, however, where Aconite is either not sufficient or not indicated; in such cases VERATRUM may be used, a few drops of the first or second attenuation in half a tumblerful of water, a small tablespoonful every quarter of an hour, or every half hour, until a reaction sets in, afterwards less frequently; Veratrum is likewise useful after the temperature of the system had been restored by Aconite, and the vomiting and diarrhoea had been arrested, but the patient is still troubled with cramps. ARSENIOUM is indicated when the attack is accompanied with an extraordiary feeling of debility, as -9 - 688: SPECIAL THERAPEUTICS. though the patient should die with weakness, and the evacuations are exceedingly copious. DOSE.-One powder of the first trituration every half hour, until the patient feels better. It is well known to physicians and intelligent laymen that an attack of cholera-morbus may be traced to a sudden derangement of the functions of the liver, and that this derangement is characterized by a sort of paralytic torpor. Hence the violent symptoms occurring during an attack of cholera-morbus arise from the presence of the bile which acts upon the tissues like a foreign poison. No agent in our Materia Medica is possessed of greater powers to relieve the liver of this paralytic torpor and to restore the harmonious action of the secretory functions of this organ than Aconite. Hence Aconite is the first and best remedy for cholera-morbus. We are utterly amazed at the ignorance which is displayed by homoeopathic physicians in this respect; they will travel all round Robinhood's barn in search of a remedy for cholera-morbus, when such a powerful and reliable remedial agent stares them in the face almost every hour of the day. For years past we have hardly ever used any other medicines in the treatment of cholera-morbus than ACONITE, and occasionally ARSENIC, and have never failed in affording speedy relief. We remember some cases where brandy and water had to be used in connection with these remedies. Latterly we have had many encouraging proofs from other physicians, of the specific efficacy of the tincture of the root of Aconite in cholera-affections. In the little pamphlet on Apis Mellifica, recently published by William Radde, 635 Arch street, Philadelphia, we see with pleasure that Dr. C. W. Wolf, of Berlin, Prussia, likewise IW) ASIATIC CHOLERA. 689 recommends ACONITE as a chief remedy in cholera-morbus. He likewise suggests the propriety of using it in Asiatic cholera. DIET AND REGIMEN.-The habit of drinking ice-water in summer, is productive of very many attacks of cholera-morbus. The use of ice-water should be indulged in with care and moderation. The simultaneous use of icewater and cucumbers will almost generally cause an attack of cholera. There are cases of cholera-mnorbus, where a glass of brandy and water will prove an excellent remedy. For a time after the attack the patient should abstain from fruit, ices, and indigestible food, such as lobster, radishes, turnips, etc. Asiatic Cholera, Cholera Asphyxia. This frightful epidemic has lost many of its horrors under homoeopathic treatment. When it first broke forth over Europe, it was dreaded as an irresistible destroyer. The alloeopathic treatment seemed utterly powerless to arrest the devastating scourge. Most of the patients who fell into the hands of alloeopathic physicians perished. Even at the present day, after all the experience which alloeopathic physicians have had in treating Asiatic cholera, the average mortality under their treatment is from fifty to sixty out of every hundred patients. Guided by the law "similia similibus," homceopathic physicians are far more successful in combating the monster cholera than their allceopathic brethren. The average mortality under homoeopathic treatment is scarcely ever more than fifteen' per cent., and very seldom reaches this number. Since the invasion of the last cholera epidemic, an isolated case of cholera occurs every now and then 59P 690 SPECIAL THERAPEUTICS. among persons who are exposed to atmospheric changes, or who neglect proper hygienic precautions. Homceopathic physicians are not afraid of meeting-such an enemy. An attack of Asiatic cholera is in most instances characterized by vomiting and diarrhoea, cramps in the calves and soles of the feet, coldness and rapid sinking of the pulse. The attack sometimes sets in quite suddenly, destroying life in the space of an hour, or the disease develops itself gradually, and seems to have a precursory stage of from twelve to eighteen hours duration. The patient feels sick, weak, looks sad and anxious, as though he dreaded some accident or misfortune; his features are altered. He is out of humor, and has an aversion to food or drink. The symptoms of nervous and vascular derangement become more and more apparent. The skin feels dry and cool, and portions of it are covered with a clammy sweat. A disagreeable pressure, tension, creeping and rumbling are experienced in the stomach and bowels. In some cases the patient complains of a load in the pit of the stomach, a burning sensation, anxiety and oppression, labored breathing; the head feels dizzy, aches, with a feeling of heat and fullness. The urine is more scanty, pale or red and turbid. After a while the disease breaks out in all its fury. The patient begins to vomit; first he throws up the food, a sort of projectile vomiting, as in tuberculous disease of the brain; the vomiting is accompanied with diarrhoea which is at first papescent, mixed with fiecal matter, but gradually changes to a watery, serous consistence, like rice-water. The patient has from twenty to thirty discharges in the space of twenty-four hours, both from the bowels and by the mouth. The prostration increases, and the pulse becomes weaker and weaker. _ ~ ~ ~. ASIATIC CHOLERA. 691 The evacuations are perfectly free from every trace of bile. After the evacuations have lasted for a time, spasmodic twitchings begin to set in, or real spasms which sometimes amount to a tetanic rigidity of the limbs. In some violent cases the spasms appear at the commencement of the attack. The spasms affect most frequently the calves, forearms and hands. As the evacuations increase, the burning in the epigastric region and behind the sternum becomes more and more distressing, and the patient is tormented by an unquenchable thirst, although nothing can be kept on the stomach. The pulse collapses, the skin becomes cold, sometimes like that of a dead person, the tongue and breath even are cold; the tongue is not much coated, and looks dry, sometimes pale and bluish with inflamed borders, or red and parched; towards the end it becomes shrivelled. The skin looks livid and bluish, like the skin of a woman who has been washing in soap-suds. At this stage of the disease the features of the patient show that peculiar alteration which has been termed the " cholera face," facies cholerica, sunken, cadaverous expressive of anxiety and sadness, with a vacant stare, cold and bluish tip of the nose, the eyes sunken and turned upward, and having sometimes a reddish or bluish tinge, surrounded by margins of a grayish-brown color. The voice is likewise altered, thin, without resonance, hoarse, or, in some cases, completely suppressed. The secretion of urine generally ceases in the last stage of the disease. The alvine discharges are likewise arrested. The nose is perfectly dry. TREATMENT.-The homoeopathic treatment of cholera is infinitely more effectual than the allceopathic, although the homoeopathic treatment may likewise be more or less 692 SPECIAL THERAPEUTICS. successful, according as it is conducted with more or less skill and knowledge of the curative resources of our art. The principal remedies, under homoeopathic treatment, are: the SPIRITS OF CAMPHOR, ACONITE, BELLADONNA, ARSENICUM, VERATRUM, CUPRUM, TARTARUS EMEIICUS, SECALE CORNUTUM, and HYDROCYANIC ACID. A great many other medicines are mentioned in the books, but hardly one of them has any true physiologico-pathological relation to cholera. The SPIRITS OF CAMPHOR may be resorted to in the commencement, as well as during the progress of the disease, when the evacuations have set in, the patient feels cold, is troubled with the distressing burning or load in the epigastric region, cramps, etc. DOSE.-Five or six drops of the spirits, on a little lump of sugar every five minutes, until a reaction sets in, after which the Camphor may be continued at longer intervals, say every two hours. ACONITE has been one of our most favorite remedies for cholera, in every stage of the disease, especially when the following symptoms were present: Coldness, collapse of pulse, cramps, spasmodic and projectile vomiting, rice-water evacuations from the bowels, distressing burning and load in the epigastric region, brain- etc., unquenchable thirst, the tongue is either cold and bluish, or as if dead, burnt and excoriated, great anguish and oppression. DOSE.-From two to three drops of the saturated tincture of the root, half a tablespoonful every five or ten minutes, until the evacuations cease, the skin becomes warm, and the pulse fuller and swelling; as soon as such a change for the better commences, reduce the dose of Aconite to one drop in the same quantity of water, and continue it every half hour, and gradually every hour or two hours, until the reaction is complete; then watch the condition of the patient, and continue the medicine at longer intervals. In many cases Aconite is sufficient to complete the cure, but in a large number of cases it has to be followed by ASIATIC CHOLERA. 693 VERATRUM, especially when, after the evacuations have ceased under the use of Aconite, the spasmodic rigidity of the extremities, the coldness and the shrivelled appearance and condition of the skin, still continue. DOSE.-One or two drops, of the first attenuation on a small piece of sugar every hour, until an improvement sets in, then less frequently as with Aconite. ARSENICUM is a great remedy in cholera, when the attack sets in suddenly, with excessive evacuations and prostration of the vital forces. DOSE.-One half of a grain of the first trituration every fifteen minutes, until a reaction becomes visible, after which, a powder may be given every hour. It is perfectly proper to alternate the Arsenic with either Aconite or Veratrum, according as the symptoms may seem to require, the dose to be the same as indicated above. BELLADONNA may be used as an intermediate remedy, when symptoms of cerebral congestion are very prominent. DOSE.-One drop of the third attenuation, every hour, until relieved. In many cases the congestion which we observe in cholera, has not much, if any affinity to such a congestion as Belladonna is capable of inducing; Aconite will then be found preferable. TARTARUS EMETICUS is indicated by the same symptoms as Arsenic, with, perhaps, this difference, that the Tartar emetic vomiting is of a more spasmodic nature, and accompanied with symptoms of a well-marked cerebral congestion, without the consciousness being at all affected. DOSE.-One grain of the third trituration every twenty minutes, until relieved. SECALE CORNUTUM is recommended by Rummel, when the pains and cramps in the extremities are particularly distressing. DOSE.-One drop of the first attenuation, every half hour or hour. I __ _ _ _ r 694 SPECIAL THERAPEUTICS. CUPRUM is proposed, if the vomiting is particuarly distressing and of a spasmodic nature. DOSE.-One grain of the third trituration, every half hour or hour. If Cuprum should fail, we may try IPECACUANHA, especially if the patient brings up quantities of phlegm. DOSE.-Same as Secale. We cannot recommend all these remedies from personal experience, for the reason that we have never been obliged to employ them. We have found that Asiatic cholera, even the most desperate cases can be successfuly treated with the saturated tincture of Aconite root, Arsenicum, Veratrum, Camphor, and Cuprum; other physicians have testified to similar facts, and have confirmed our statement that, if a case of cholera does not yield to the curative action of these drugs, Secale or any of the other drugs which have been experimented with in Cholera, will hardly over save the patient's life. In conclusion we may mention two remedies which are said to have saved life in a few instances, when all other means seemed to fail: they are HYDROCYANIC ACID and CARBO VEGETABILIS; these remedies have been given when the paralytic symptoms in the cerebral sphere seemed on the increase beyond the hope of recovery. A few drops of the first attenuation of the acid, and of the fourth or sixth of Carbo may be given every fifteen or twenty minutes, until a reaction takes place. We confess that we have very little, if any, faith in such medicines as Carbo, Sulphur, etc., in Asiatic cholera. DIET AND REGIMEN.-The same as for cholera-morbus. During a cholera-epidemic all sudden changes of diet and clothing should be avoided. Violent emotions, irregularities and excesses of any kind, are injurious. Relapses are generally fatal, and may be caused by the least exposure, indigestible food, etc. The cholera patient may have frequently small quantities of ice-- water, if desired. DYSENTERY 89 DYSENTERY. 695 After-diseases. Under the use of Aconite, Arsenic and Veratrum, after-diseases, as a general thing, do not occur. If a typhoid state should linger behind, the continued use of ACONITE and ARSENIC will remove it; no other remedies are required. Use these two medicines in alternation, one drop of the concentrated tincture of Aconite in a tumblerful of water, in tablespoonful doses, and the first trituration of Arsenic in half grain doses, an alternate dose of medicine every hour for a few days, until the skin becomes warm and moist, and the tongue assumes a more natural redness; then continue less frequently. For cholerine, which scarcely ever troubles the patient after the use of Aconite, Arsenic, and Veratrum, give alternately the saturated tincture of'Aconite, as before, and PHOSPHORUS, third trituration, in one grain doses, an alternate dose of the medicines every two hours; in some cases Phosphoric acid, a few drops or ten pellets in a small tumblerful of water, a small tablespoonful every three or four hours, will be found available. Dysentery. Dysentery is, properly speaking, an inflammation of the rectum, and is characterized by the following symptoms: chill followed by fever which is more or less severe, aching, stitching and crampy pains in the bowels, soreness of the bowels, painfulness to contact, uneasiness in the bowels, tenesmus with discharges of blood or mucus, highly-colored urine, thirst, coated tongue, nausea or vomiting, dizziness and headache, 696 SPECIAL THERAPEUTICS. The literal meaning of the term "dysentery" is: through the bowels: people in former times had an idea, and it is to this day a vulgar prejudice that the essential character of dysentery consists in the contents of the bowels running through. This is a great mistake. ii dysentery the bowels are bound, and if natural diarrhoeic passages should set in, the disease might most probably be considered arrested. An attack of dysentery is very often ushered in by precursory symptoms, such as violent aching and cramppains in the bowels, soreness, sickness at the stomach, vomiting of bile. Gradually the pain localizes itself in the lower bowels, and the dysenteric symptoms make their appearance. In some seasons of the year dysentery is an epidemic disease, and may assume a more or less malignant character. Under careful homoeopathic treatment the disease has scarcely ever a fatal termination. TREATMENT.-In this affection it is of the utmost importance that the patient should remain as quiet as possible; if the attack is very severe, the patient should not even be allowed to rise from his bed, a bed-pan should be used. The patient may drink as much cold water as he pleases, and the diet should otherwise be light, consisting of tea and toast, gruels, and, when recovery is setting in, light beef or mutton-broth, or even chicken-broth may be used. Relapses by over-eating are quite common in this disease, and may prove exceedingly troublesome and even dangerous. The best remedies for this affection are ACONITE, COLOCYNTHIS, MEECURIUS VIVUS and SUBLIMATUS, and STAPHYSAGRIA. ACONITE is our principal remedy for dysentery, when there is fever, with heat and dryness of the skin, full and hard, or even soft and accelerated pulse, coated DYSENTERY. 697 tongue, pain in the bowels, highly-colored urine, tenesmus. DOSE.-One or two drops of the tincture of the root in a tumblerful.of water, a tablespoonful every hour. The globules are very seldom of any use in this affection. Aconite is frequently sufficient to cure the disease, but it may have to be continued for four or five days, and sometimes in increasing quantities, mixing three or four drops in a tumblerful of water, a tablespoonful every hour. Some homoeopathic physicians spend weeks in treating cases of dysentery which the persevering use of the tincture of Aconite would cure in a week. COLOCYNTHIS is indicated when the discharges consist of a whitish or bilious-looking mucus rather than of blood, although an admixture of blood is no counterindication of Colocynth. D.OSE.-One or two drops of the tincture in a tumblerful of water, a tablespoonful every two hours. MERCURIUS VIVUS is excellent when the tenesmus is accompanied with a constant urging to urinate. DOSE.-One grain of the second or third trituration, every two hours. If the tenesums is felt at the lowest extremity of the rectum, and results in discharges of blood and mucus, MERCURIUS CORROSIVUS may be given, same dose as Mercurius vivus. STAPHYSAGRIA may be given, when there are constant discharges of white mucus preceded by tenesmus of the rectum, as if something would press out. DOSE.-One or two drops of the first attenuation in a tumblerful of water a tablespoonful every two hours. ALOES, two or three drops of the tincture in ten tablespoonfuls of water, a tablespoonful every two hours, may be given for dysenteric diarrhoea, with feverishness and tenesmus, the passages consisting of fical matter, mucus, bile and blood. These few remedies will cure every ordinary form of dysentery. As an epidemic disease it might possibly 60 698 SPECIAL THERAPEUTICS. assume a peculiar character, requiring some peculiar specific remedy which cannot possibly be determined beforehand. The books talk of many other medicines, such as Arnica, Carbo vegetabilis, Arsenicum, the inevitable Lachesis, and others. These medicines are no more homoeopathic to dysentery than hobnails are adapted to the human stomach. It is only the symptom-homoeopathist who, after having obscured the genuine character of the disease by his superficial bungling, may consider himself obliged, in accordance with his uncertain indications, to go through a whole round of drugs which every intelligent and careful practitioner can do without. If dysentery should attack persons affected with weakness of the bowels, chronic diarrhoea, dyspepsia, or deep-seated scrofula, it may become a very troublesome complaint, and may even develop malignant typhoid symptoms. If this should be the case, the reader will have to consult the remedies that have been recommended for malignant or typhoid fever, page 287. Piles, Haemorrhoids. This is an affection of the hmmorrhoidal veins coursing along the rectum. The affection is characterized by swellings or tumors at the anus, with or without discharge of blood. It is sometimes marked by very severe pain, a painful dragging and tearing in the rec turn and anus, burning and stinging pains, rigidity of the small of the back as if it would break, constipation dizziness, and general debility. When there is a dis charge of blood, we call it flowing piles, and when no blood is discharged, we designate this condition as blind _ - -- - PiS 699 PILES. 699 piles. Piles sometimes are'a symptom of general constitutional debility and even consumption. Individuals affected with piles should bathe in saltwater as often as convenient, and, if too feeble to bathe in the surf, they should use salt-water baths of a suitable temperature. If possible, the patients should take three or four hip-baths daily in their own rooms. Stimulating drinks should be strictly avoided. The best medicines for piles are ACONITE, when there are profuse discharges of blood, with stinging and burning pains, fainting sensation, dizziness; the blood spirts out as from a syringe, generally while straining at stool. DOSE.-One drop, or six globules, three times a day, or morning and night, until relief is obtained. MERCURIUS, when no blood is discharged, but in its stead a yellowish mucus, with itching and stinging smarting of the anus. DOSE.-Same as for Aconite. Nux voMIcA and SULPHUR are generally used for chronic piles, blind or flowing, six globules of Nux one night, and six globules of Sulphur on the night following. The alternate use of these two drugs has to be continued until an improvement sets in, after which the medicines may be given at longer intervals, say an alternate dose every two or three days. Every now and then it may be necessary to give a dose of Aconite. Nux is particularly useful, if the attack is caused by the use of coffee or spirits. Very few medicines beside these four, have ever done much good in piles under homceopathic treatment. A remedy which has lately been tried with some stuecess in piles is Collinsonia canadensis or horse-wreed, I C 700 SPECIAL THERAPEUTICS. horse-balm. It has to be given in tolerably large doses, either from five to ten drops of the alcoholic tincture three times a day, or a dessert-spoonful of a watery extract morning and night, or even more frequently. HYGIENIC TREATMENT.-Persons who are subject to piles, have to avoid coffee and any kind of food or drink that causes bilious derangements. Stimulants, such as beer, wine and brandy, may likewise prove injurious. If an acute attack of piles is brought on by abuse of drastics, such as Aloes, the specific antidote to the disease is the tincture of Aconite-root, one or two drops in a tumblerful of water, a tablespoonful every hour or two hours. Sometimes the hsemorrhoidal tumors are so troublesome, cause so much distress and interfere to such an extent with the expulsion of the fbeces, that it becomes necessary to tie them off. This operation should be avoided as long as possible; but if it should have become unavoidable, it is not necessary to dread it as a thing that must necessarily be fraught with all sorts of mischievous consequences. It would be absurd to encourage operations of this kind; but on the other hand, the unbecoming croaking of certain fossil-authors of the homoeopathic school is equally luidcrous. These tumors sometimes become excessively inflamed in consequence of the irritating action of bile; in such a case the pain may be absolutely maddening. We once were called to a patient where the tumors were highly inflamed; there was a constant oozing of greenish bile and blood; the tumors were so sore that the patient had to lie on his stomach. He had been in this condition for a week, when we were called. The patient was a man of education, full of determination, and had been inured to _ I __ __ ____ _I WORMS, WORM-FEVER. 701 suffering. But the paroxysms of pain had become so horrible that they almost deprived him of reason. The main characteristic of the pain was a sensation as if the tumors were on fire. The pulse was at times feeble and intermittent, but quick; at others rapid, hard, jerking, sometimes full and bounding. The patient was a strong believer in the high potencies and had been using them for a week when we were consulted. We prescribed a preparation of. Aconite-root, consisting of one drop of the strong tincture to five drops of alcohol. Of this. preparation we mixed three drops in about ten tablespoonfuls of water, and directed a tablespoonful to be taken every ten or fifteen minutes. Immediately after taking the first tablespoonful the pain ceased as by magic, the pulse became quiet and regular, and the patient was able, in about half an hour after, to leave his bed and dress himself for a walk. Persons who are afflicted with chronic hemorrhoidal tumors, may derive great relief from daily injections of cold water after breakfast. These injections keep the bowels regular; they facilitate the expulsion of fsecal matter, and prevent all undue sensitiveness of the tumors, so that they can be easily put back after stool. Worms, Worm-Fever, Helminthiasis. Worms may exist in the organism of adults as well as in those of children. They arise from a diseased condition of the mucous membrane of the intestinal canal. The presence of worms is generally inferred from certain symptoms, but the existence of these symptoms does not always justify the conclusion that the intestinal canal must be infested with worms. These symptoms simply 60* 702 SPECIAL THERAPEUTICS. point to a morbid condition of the lining membrane, although it is perfectly true that, in the last stage of the disease, when the worms are actually formed, the irritation of the mucous membrane which is caused by these parasites, may be characterized by distinct and unmistakable symptoms. The worms in the human system are principally of three kinds, the maw-worm, also known by the name of the pin-worm or thread-worm (ascaris); the round worm (lumbricus), and the tapeworm of which we have two kinds, the solitary tapeworm, composed of long and slender articulations, and the broad tape-worm, the joints of which are broader and thicker than those of the former variety. This worm scarcely ever comes away entire, but generally in pieces. The first symptoms of an incipient worm disease are developed in the features of the child. The countenance looks pale and sickly, the eyes become sunken and are surrounded with livid circles. Other symptoms are: foul breath, flushes on the cheeks, and, as the disease develops itself, we have picking at the nostrils which frequently look sore, a ravenous appetite for bread and butter, meat and heavy food; flow of water from the mouth, especially during sleep, nausea and vomiting, swelling of the bowels, colicky pains in the bowels, with sensitiveness of the abdomen to contact or pressure, constipation or diarrhoea, or alternate looseness and retention of stool, itching and burning of the anus and rectum, or even of the vagina; constant urging to urinate, involuntary flow of urine. The symptoms sometimes increase to a high degree of violence, even spasms and convulsions. Children infested with tapeworm, are frequently subject to epileptic attacks.!~~~-m ________^________^______~,.~~,..~~~~,~,~~*~~ 11,1..___ WORMS, WORM-FEVER. 703 Scrofulous children, with a leuco.phlegmatic habit are more or less predisposed to worms. Children of all classes of society are liable to be infested by these parasites, but the children of the poor, who are fed on unwholesome food, who have to breathe a vitiated air and do not enjoy proper care, cleanliness and a sufficient change of linen, are principally subject to worm-diseases. TREATMENT.-Homoeopathic books mention a frightful array of medicines for worms, and yet, if the treatment be otherwise judiciously conducted, very few remedies will suffice to effect the desired relief. One of our chief remedies for worms is ACONITE, which is especially indicated by the following symptoms: feverishness, tumefaction and sensitiveness of the belly, crawling sensation along the oesophagus, flow of water from the mouth, nausea and vomiting, starting, spasms, itching and smarting at the extremity of the intestinal canal, diarrhoea and tenesmus, especially when accompanied with small discharges of mucus; sometimes the worms crawl out at the mouth and nostrils. DOSE.--Six globules, dry on the tongue, or one drop in a little water, morning and night for a week, or until the symptoms change for the better. MERCURIUS is an excellent remedy when the child complains of a good deal of itching at the anus, has a ravenous desire for bread and butter, and is troubled with mucus and bilious diarrhoea. DOSE.-Same as Aconite. SPIGELIA is a favorite remedy for pin worms, especially when they are see:i crawling out of the anus, and their irritating action seems to result in drowsiness, starting, excessive fretfulness, or even spasms. 704 SPECIAL THERAPEUTICS. DOSE.-Same as Aconite; sometimes, however, it may be necessary to give three drops of the tincture, morning and night, until the worms are discharged and the symptoms mend. CINA may be administered, if the children grit their teeth, pick at the nose, have a ravenous hunger, look pale and thin, start during sleep, and especially if the presence of lumbrici may be suspected. DOSE.-One drop, or six globules, every night, for a week. CHINA is a good remedy for worms when the child has a ravenous desire for food, and the food passes off again indigested. DOSE.-Two or three drops of the first attenuation of the tincture morning and night. SULPHUR may be administered when the worm-symptoms are very obstinate, and the ravenous appetite, the swelling of the bowels, the diarrhoea or constipation, and the irritation of the nostrils and anus refuse to yield to any of the above mentioned remedies. DOSE.-One drop, or six globules, every other night. If an improvement is perceived, discontinue the medicine for a time, and resume again when necessary, or else follow up with some other medicine to be selected from among those mentioned above. Sulphur alternates beautifully with Calcarea, same dose, an alternate dose every other evening, especially in case of leucophlegmatic children. DIET AND REGIMEN.-Milk, pastry, sweetmeats, fruits and vegetables are injurious; good meat without fat, either roasted or boiled, is the best nourishment for worm-patients.. Fresh water is the best drink, and plenty of exercise in the open air is indispensable. Daily ablutions with cold water, and shower-baths are of great use and importance. Tape-worm, Tsenia. The presence of tenia can scarcely ever be diagnosed TAPE-WORM. 705 TAPE-WORM. 705 with certainty until pieces of the worm have actually been discharged. Common symptoms are: a crawling or twisting sensation from the left side of the abdomen towards the stomach and even the oesophagus; sensation as if a cool ball were ascending and descending like a wave in one or the other side, sinking sensation in the abdomen, vertigo, tingling and numb sensation in the fingers and toes which are disposed to go to sleep; the pain is periodical, not continuous; it occurs principally in, the morning and before breakfast, and is generally eased by eating.-(Hartmann.) The treatment of tvenia is conducted with the same medicines which have been mentioned for the other varieties of worms. The choice of the medicine depends upon the existing symptoms. The following medicines have been used by a number of homoeopathic physicians both for the expulsion and radical cure of tcenia. FILIX MAS. Dr. Bicking directs his patient to drink a quantity of cold water, to use cold water injections, and to apply cold water douches to the abdomen. After this he gives the patient a saturated decoction of Filix mas (half an ounce every day); although the tenia was frequently reproduced, yet it was speedily expelled again by similar means, and finally ceased to reappear. Lobethal affirms, that the daily use of a few drops of the concentrated tincture of Filix mas was quite sufficient in his hands. A case of frightful worm-colic was cured by a single drop of the tincture of Filix mas; eight days after the colic, fifty yards of tmnia were discharged, without the dose having been repeated. PUNICA GRANATUM. Lobethal recommends this remedy in obstinate cases. Dr. J. 0. Mieller mentions the following symptoms as having been removed by this drug: 706 SPECIAL THERAPEUTICS. Convulsive movements, catalepsy and epilepsy, fainting turns, emaciation, sudden waking, hallucinations, hypochondria, vertigo, stupor, tremulous motion before the eyes, dilatation of the pupils, yellow complexion, grating of the teeth, flow of water in the mouth, variable appetite, gulping up of a watery fluid, vomiting, sensation in the stomach as if a body were rising in it, distension of the abdomen, colic, chronic palpitation of the heart, etc. DOSE.-A good dessert-spoonful of the saturated decoction half an hour after each meal., DIET AND REGIMEN.-The same as for common worms. Itching and Soreness of the Anus. This is generally a symptom of worms, scrofula, or some other constitutional weakness, which has to be eradicated in order to cure the above-mentioned affection. It is advisable that the patient should use daily ablutions with cold water, shower-baths on the small of the back and bowels, and frequent hip-baths. His diet should be perfectly simple, and stimulating drink or food should be strictly avoided. The following medicines may be used: ACONITE, for itching and burning, soreness, dampness, eruption of boils round the anus, nervousness, dizziness, palpitation of the heart. DOSE.-A few drops, or six globules, morning and night. Continue for a week, then use CHAMOMILLA, in the same way, for another week; but if Aconite should have induced a decided improvement, resume it after a while, until the cure is completed. MERCURIUS is useful when there is much itching, with swelling and dampness of the mucous membrane. DOSE.-Six globules, morning and night. PROLAPSUS OF THE RECTUM AND ANUS. 707 Prolapsus of the Rectum and Anus. This weakness is quite frequent among children. When passing water, or while straining at stool, the bowel falls out, but can easily be replaced by the finger, which should be well lubricated with sweet oil for this purpose. It is sometimes necessary to support the bowel by means of a silk pad, or some other similar contrivance, while a cure is being attempted. Cold water should be used in the same manner as was indicated for itching and soreness of the anus, and the following remedies may be employed: ACONITUM, when the patients are very nervous, subject to rushes of blood, palpitation of the heart, or when the weakness remained after the alloeopathic treatment of dysentery. DOSE.-Six globules, morning and night. IGNATIA is suitable to mild and sensitive temperaments, and may be used after Aconite, or in alternation with it, six globules or one drop every night. MERCURIUS is indicated, when the falling is accompanied with much itching and oozing of a yellowish mucus. DOSE.-Six globules, morning and night. NUx voMICA may be given when the children are troubled with constipation, and have to strain a good deal at stool. DOSE.-Six globules, every night. ~___~~~~~ ~_~ ~~__~~~~_~__ _~ _ 708 SPECIAL THERAPEUTICS. DISEASES OF THE URINARY AND GENITAL ORGANS. Nephritis or Inflammation of the Kidneys. The kidneys are glandular organs whose office is to secrete the urine. There are two of them, one on each side of the spine, in the lumbar region. By means of two narrow tubes, called the ureters the urine is transmitted from the interior or pelvis of the kidneys to the bladder. An inflammation of the kidneys is charaterized by the following symptoms: stitching, pressing pain in the region of the kidneys, with dartings from that region to the bladder; difficulty to urinate; the urine is red and hot, and frequently mixed with blood and pus: the whole lower limb of the affected side is sometimes spasmodically affected, numb; there is vomiting, colic, tenesmus; the pain is increased by standing, walking, or lying on the back. The simultaneous inflammation of both kidneys is a rare event. TREATMENT.-This inflammation can be cured perfectly by means of ACONITE and CANTHARIDES. Other medicines such as Pulsatilla are scarcely ever required. ACONITE should be given at once, especially if the fever is very high, with ischuria, bloody discharges from the urethra, dizziness, headache, delirium, vomiting of blood, constipation. DOSE.-Six globules, or a few drops, in a tumblerful of water, a tablespoonful every hour, until relief is obtained. If no relief is procured after one or two doses, substitute a drop of the tincture of the root for the globules, the dose being otherwise the same. If the fever be much less, and strangury and soreness remain, give ~~ 710 SPECIAL THERAPEUTICS. This kind of rheumatic inflammation is characterized by soreness, warmth in the region of the bladder, aching and stitching pains, difficulty of voiding the urine, with much urging; the urine is red and burning, deposits a red sediment which changes to whitish flocks as the inflammation abates. The bladder has another set of muscular fibres which are designed to open or close the bladder as may be necessary. These are termed the sphincter of the bladder, and may likewise become affected with rheumatism, in which case, beside the usual inflammatory symptoms, the patient is troubled with an unceasing urging to' urinate. The best remedy for rheumatism of the bladder is ACONITE, a few drops or ten globules in a tumblerful of water, of which a tablespoonful may be given every hour, and gradually every tvo or three hours. This medicine will remove the disease without using any thing else in the greater number of cases. If, after the inflammatory symptoms have subsided, some soreness, urging or strangury should remain, we may give PULSATILLA or Nux VOMICA, same dose as Aconite, or use Aconite and either of these two medicines in alternation, the former particularly in the case of females who are troubled with suppression of the menses, the latter in the case of persons with sanguineous' habit of body, and subject to attacks'of piles, or who are troubled with constipation, or addicted to the use of coffee and ardent spirits. The more violent forms of cystitis, as described above, require to be treated with CANTHARIDES, same dose as for nephritis; in order to be sure of the treatment, we had better give STRANGURY. 711 CANTHARIDES and ACONITE in alternation. If, after the violent symptoms have subsided, the cure should seem to remain stationary, we may give PULSATILLA, same dose as for nephritis, and afterwards give a few more doses of Aconite, or of Cantharides or both together in alternation. The treatment of this disease may be assisted by using mucilaginous drinks; persons who are liable to inflammatory trouble about the bladder, should abstain from coffee, ardent spirits or any kind of drink that excites the bladder. The best drink is cold water, milk and water, or a little very weak black tea. Strangury, Ischuria, Inability to pass Urine. A variety of medicines are recommended for this affection; but it can be effectually controlled by means of ACONITE, NUX VOMICA, MERCURIUS, PULSATILLA, CANTHARIDES, OPIUM, and COLD WATER. Use ACONITE when the affection is caused by a cold, with intense pain, urging, burning and fever. DOSE.-A few drops, or ten globules, in a tumblerful of water, a tablespoonful every hour, until the pain is relieved. Nux VOMICA, if the weakness is caused by abuse of spirits, coffee, suppression of piles. DOSE.-Same as Aconite. PULSATILLA, if the strangury be accompanied with discharge of mucus from the urethra, or with sudden menstrul suppression. DOSE.-Same as Aconite, or in alternation with it. MERCURIUS, if the strangury is caused by a cold, and a constant urging is present, with discharge of a small quantity of watery urine. J __ 712 SPECIAL THERAPEUTICS. DOSE.-Same as Aconite. CANTHARIDES may be given after Aconite, if this drug should not afford sufficient relief. DOSE.-The same. OPIUM should be given, if the strangury is.accompanied with spasmodic pains in the region of the bladder. DOSE.-A few drops, in a tumblerful of water, a tablespoonful every hour. This medicine may be alternated with Aconite, same dose as Opium, an alternate dose every hour. APIS may prove useful, especially if the difficulty is more or less chronic, and co-existing with symptoms of dropsy. DOSE.-A few drops, or six globules, three times a day. CAMPHOR is to be used, if the weakness is caused by the poisonous action of Cantharides. DOSE.-Five drops of the Spirits of Camphor, on a little sugar every fifteen or twenty minutes, and the Spirits of Camphor to be likewise rubbed on in the region of the bladder, externally. COLD WATER will sometimes remove the strangury instantaneously, by restoring the contractile action of the bladder. Apply a wet bandage to the region of the bladder. Enuresis, Incontinence of Urine. This weakness may result from paralysis of the sphincter of the neck of the bladder, caused by apoplexy, surgical operations, syphilitic diseases, old age, and resulting in a constant dribbling of urine; or from some accidental irritation of the bladder by worms, gravel, or mechanical pressure on the bladder by tumors, the prolapsed uterus, etc.; or the urine may escape involuntarily at night, during sleep. I__ _ _ ____~_ INCONTINENCE OF URINE. 713 TREATMENT.-ACONITE will be found indispensable, if the weakness result from mismanaged inflammation, paralysis, or spasm, or if it be caused by worms..DOSE.-Six globules, or a few drops, in a tumblerful of water, a tablespoonful every hour.. SULPHUR is an admirable remedy, if the discharge takes place at night during sleep, and if the patient has to void urine every half hour, no matter what the cause may be. DOSE.-One grain of the third trituration every four hours. MERCURIUS, if there be a constant urging, with discharge of small quantities of watery urine, both at night and in the day time; the weakness may be induced by a cold, by worms, or by syphilis. DOSE.-Same as Aconite. A number of medicines are mentioned in the books, but most of them are unnecessary. An excellent remedy, however, may be found in NITRI ACIDUM, a few globules or one drop three times a-day. This medicine is particularly indicated, if the disease is troublesome at night, or if the patient had taken much mercury. CANTHARIDES may also be found useful, if the weakness is accompanied with constant and irresistible urging. DOSE.-Same as Nitri acidum. If worms should be the real cause of the difficulty, we- may give the medicines, recommended for worms, particularly CINA, same dose as Nitri acidum. DIET AND REGIMEN.-Stimulating drinks and food have to be strictly avoided. Milk and cold water.should 61* 714 SPECIAL THERAPEUTICS. be the patient's drink. He may eat meat, but little or no fruit, and no flatulent food. Children, who wet their beds, must sleep on hard mattresses, and not drink any thing in the evening. Frequent hip-baths in cold water, and daily ablutions with cold water, or shower-baths are very useful. Diabetes mellitus. Common diabetes is an uncommon flow of urine which has a weakening effect and is attended with loss of strength. It is treated with the same medicines as enuresis, the principal remedies being ACONITE, MERCURIUS and SULPHUR. They may be given alternately; of Aconite mix two or three drops or one drop of the tincture of the root in a small tumblerful of water, and give it in tablespoonful doses; and of the SULPHUR give half grain doses of the third trituration, an alternate dose every two or three hours. If the urine contain much saccharine matter, say about an ounce of sugar to a pound of urine, the disease is called diabetes mellitus, and is attended with a gradual waste of the tissues. It is doubtful whether this disease can be effectually cured, although, if attended to in the beginning, a good deal can be done to arrest its further development. The principal medicines, in the commencement, are the same that have been recommended for common diabetes. If these do not relieve, we may try PHOSPHORI ACIDUM, third attenuation, a few drops every four hours. After giving this medicine for a week, we may then give HIEMORRHAGE OF THE BLADDER. 715 MERCURIUS VIVUS, in the same way as Phosphori acidum. If necessary, a physician should be consulted. DIET AND REGIMEN.-The same as indicated for enuresis. Hemorrhoids of the Bladder. These may either be blind or flowing. Generally there is frequent urging to urinate, distress in passing water as if the urine could not pass; blood is discharged in many cases, but in other cases there is not much, if any, distress, and no blood is passed, but in its stead a whitish mucus is discharged. TREATMENT.-When there is strangury, discharge of blood, burning, etc., treat the disease with the same medicines as strangury and ischuria. If there be simply a mucous discharge, a dose of PULSATILLA may be taken one morning, and the.next morning a dose of SULPHUR; but the best mode of treatment is to avoid every thing that has a tendency to irritate the bladder, and to confine one's-self to the use of mucilaginous drinks, milk and water, barley and ricewater, and strictly to avoid coffee, tea, spirits, etc. Cold water ablutions, and cold hip-baths will be found very useful. Bloody Urine, Hemorrhage of the Bladder. For the treatment of this affection the reader is referred to the chapters on Inflammation of the.Kidneys, Bladder, and Urethra, and to the preceding article on i__ 1~_1___~ ~__;~~ __~__I~__~___~_____ __~___~_~ _________I__~ ~___~ 716 SPECIAL THERAPEUTICS, HIemorrhoids of the Bladder. Among the remedies there mentioned, we may select more particularly ACONITE, when the discharge is accompanied with burning and tearing pain, anxiety, and excessive urging to urinate. DOSE.-One drop of the tincture of the root in a tumblerful of water, half a tablespoonful every hour, until relieved. ARNICA, if the haemorrhage is caused by mechanical injury, concussion. DOSE.-Same as Aconite, with which Arnica may be alternated, an alternate dose every hour. If Aconite should not afford any relief, and the urging to urinate should be excessive and distressing, we. may give CANTHARIDES, one drop of the tincture in a small tumblerful of water, a teaspoonful every hour, until the patient is relieved. If all these medicines should fail, and there should be a discharge of blood and pus, as if the urethra were clogged with it, with a forked and scattering stream, give CANNABIS, same dose as Cantharides. MERCURIUS SOLUBILIS is required when the disease has a syphilitic origin, or when it originates in a cold, and there is a constant urging to urinate, especially at night, attended with sensitiveness of the urethra, painful erections as if the penis would snap off. DOSE.--A powder of the third trituration every four hours, until the symptoms change for the better. DIET AND REGIMEN.-The same as for haemorrhoids of the bladder; rest is indispensable. Urethritis, Purulent Urine, Discharge from the: rethra. A discharge of pus from the urethra may be occasioned,by a catarrhal inflammation of the mucous membrane;(see Urethritis); or it may proceed from an ulcer in the URETHBITIS. 717 URETHRITIS. 717 urethra, or from an abscess or suppuration of the kidneys and bladder. Worms may cause such discharges, or they may be occasioned by a scrofulous taint, or by the gonorrhoeal virus. TREATMENT.-If such discharges proceed from a catarrhal inflammation of the mucous membrane of the urethra with strangury, constant urging to urinate, burning during urination, discharges of blood and pus, chilliness and fever, swelling and soreness of the orifice of the urethra, give ACONITE, one drop of the tincture of the root in a small tumblerful of water, a tablespoonful every hour, until a favorable reaction sets in, after which the medicine may be continued every three hours for some days. If the pain is moderate, and there is simply a soreness and swelling, without much acute inflammation, but a good deal of itching, give MERCURIUS vIvus, a powder of the third trituration every two hours. If the discharge arises from an ulcer in the urethra, give AcIDUM NITRICUM, one or two drops of the first attenuation in a tumblerful of water, a tablespoonful every two or three hours. If there should be much burning, and chills and fever, with periodical exacerbations, thirst, loss of flesh, night-sweats, alternate Acidum nitricum with ACONITE, one drop of the tincture of the root in a tumblerful of water, in tablespoonful doses, an alternate dose every two hours. PULSATILLA may prove useful, if the purulent discharge is accompanied with straining during micturition, especially in individuals of a leuco-phlegmatio disposition, and more particularly females. DOSE.-One or two drops of the first or third attenuation in a tumblerful of water, a tablespoonful every two or three hours. C~ _ __ __ 718 SPECIAL THERAPEUTICS. CANNABIS and CANTITARIDES may have to be used; for the indications, the reader is referred to the chapter on Bloody Urine. If the discharge should be caused by worms, we may give MERCURIUS and SULPHUR in alternation, giving six globules of Mercurius in the morning, and six globules:of Sulphur in the evening, and continuing this treatment until an improvement sets in, after which the two medicines may be continued every other day, instead of every day. ACONITE, six globules, or a few drops, morning and night, may be given, if there should be much burning in the urethra, with discharge of mucus, and unusual urging to urinate. If Aconite should not relieve these symptoms, APIS may be resorted to, same dose as Aconite. This drug is an admirable remedy in urinary difficulties' generally, more particularly if they are attended with inflammatory or dropsical symptoms. Urethritis caused by the gonorrhoeal virus is generally designated as Gonorrhea, Gleet. The gonorrhoeal virus is infectious. Some persons are more, others less sensitive to the contagious character of this poison. Acute gonorrhoea is sometimes a very distressing malady, which, if badly managed, may entail the most distressing weaknesses upon the patient, such as strictures of the urethra, incontinence of urine, enlargement of the testicles, impotence. Gonorrhoea, if attended to from the commencement by a skillful physician, is not very difficult to manage,................ .GONORRHCEA, GLEET. 719, provided the affection is not complicated by the scrofulous or some other dyscrasia. If complicated by scrofula, or arthritic rheumatism, it may become very troublesome, and more.or less constitutional. The homoeopathic treatment of this affection is principally conducted by means of ACONITE, CANNABIS, CANTHARIDES, the NITRATE OF POTASH, balsam of COPAIVA, and CUBEBS. ACONITE is a most admirable medicine in gonorrhoea, if the inflammatory symptoms are well developed; the patient complains of burning pains in the urethra; sometimes these pains are attended with a spasmodic sensation as if single fibres of the urethra were put upon the stretch; the burning is often intense, as if a red-hot pin or wire were stuck through the urethra; it may be accompanied or followed by discharge of blood; the urine is hot, dark-red, bloody; the paroxysms of pain are worse at night; they may be attended with a chill and subsequent fever, headache, sickness at the stomach, constant urging to urinate. This acute inflammatory condition may set in in consequence of the sudden suppression of the gonorrhceal discharge. DOSE.-One or two drops of the tincture of the root, of which a tablespoonful may be given every half hour, until the symptoms are decidedly improved, If the discharge returns, a remedy must be selected in accordance with its character.:CANNABIS SATIVA or hemp is one of our most efficient remedies in acute gonorrhcea. The symptoms which indicate Cannabis are the following: profuse discharge of yellow or greenish pus; spasmodic erections (chordee) especially at night; stricture of the urethra; the stream is forked or scatters like a fan; the urethra feels knotty, sore as if ulcerated. DOSE.--In reference to the dose in this disease, we may perhaps di~fer 720 SPECIAL THERAPEUTICS. with many homoeopathic physicians. We must be permitted to advise our readers in accordance with our own experience and that of many other intelligent and careful observers. We have found that the most efficient mode of using Cannabis in this disease, is the strong tincture, giving at least two drops at a dose three or four times a day; we have even given from three to five drops at a dose, three times a day. Wherever Cannabis was indicated, the result of this treatment has uniformly proved satisfactory, a cure being always effected in all simple, uncomplicated cases. If the disease was complicated with rheumatism, or scrofula, we had to alternate Cannabis with Aconite, tincture of the root, or Iodide of Mercury, or sometimes a dose of Sulphur, both these remedies of the third trituration, a powder every four or six hours. Thuya or Nitri acidum may be required in some cases of this sort, especially if the patient bad had the disease before, and had been treated with revulsive doses of Calomel. CANTHARIDES is often useful if the burning, chordee, the ischuria are intense, with discharge of blood. DOSE.-Same as Aconite; if Cantharides does not help, give Aconite. NITRATE OF POTASH may be given if the mucus discharge is attended with burning and frequent urging to urinate. This drug is more adapted to acute gonorrhoea of the milder sort. DOSE.-Dissolve five grains of the salt in an ounce of water, and take from fifteen to twenty drops of this solution in a dessert-spoonful of water, three times a day. COPAIVA is adapted to mild forms of acute, and also to chronic gonorrhoea. In the acute form, it is indicated by burning inflammation, swelling and itching at the orifice of the urethra, heat in the urethra, throbbing and discharge of pus and blood, frequent urging. DOSE.-Five drops on sugar, three times a day, In the chronic form the dose may be less. CUBEBS may be given for mild gonorrhoea; the discharge is a thin mucus, with a little burning, and increased desire to urinate. Give half a teaspoonful of the pepper three times a day, mixed with the same quantity of white loaf sugar. Chronic gonorrhoea is sometimes very difficult to treat. _ GONORRH(EA, GLEET, 721 It should be treated with the medicines which were indicated by the original attack, to which such medicines as Sulphur, the mercurial preparations, Touya, and Nitric acid, may be added. Among the mercurial preparations, we use principally MERCURIUS CORROBIVUS, MERCURIUS SOLUBILIS HAHNEMANNI, CINNABARIS, the IODIDE OF MERCURY, and the RED OXYDE, or MERCURIUS PRRCIPITATUS RUBER. Of any of these preparations, we may give a powder of the third trituration three times a day. The mercurial preparations are particularly indicated if the patient had been previously afflicted with syphilis; if pressing at stool or tenesmus are present, with a good deal of voluptuous itching at the orifice of the urethra, which is increased by rubbing; the discharge is thin, but may assume the consistence of mucus, accompanied with smarting and shooting pains through the urethra; a cutting and burning pain is often felt during the passage of urine. One of the most efficient mercurial preparations, in inveterate gonorrhoea, is MERCURIUS CORROSIVUS. During the treatment, it is best to confine one's-self to simple diet, meat, vegetables, black tea and milk, and to avoid liquids which excite urination, such as lagerbeer, or spirituous drinks. In some cases of chronic gleet, without any trace of inflammation, but simply denoting a weakness of the mucous membrane, an astringent injection may be use" ful; tannin, or the sulphate of zinc, may be used for this purpose; but we would advise the patient to take the advice of a physician, before resorting to.such a pro. ceeding. 62 722 SPECIAL THERAPEUTICS. Inflammation and Swelling of the Testicles, Orchitis. If thi. inflammation is caused by a cold, and is accompanied:with fever, headache, delirium, agonizing pain, give ACONITE, a few. drops, or six globules, in a tumblerful of water, a tablespoonful every hour, until the pain is relieved. If the inflammation had been caused by mechanical injury, alternate Aconite with ARnIcA, same dose as Aconite, an alternate tablespooniful every hour, or every two hours, if the pain is moderate. PULSATILLA should be given, if the disease was caused by suppression of a gonorrhoeal discharge. DOSE.-Same as Aconite, with which Pulsatilla may be alternated in the same way as Arnica, if there be much fever. If Arnica does not relieve, give HAMAMELIS, a few drops in a tumblerful of water, a tablespoonful every two hours; and externally, from twenty-five to thirty drops in a cupful of water, with.which a line.n colpress may, be kept moistened, which is to be applied to the swelling. MERCURIU.S -SOLUBILIS may be given, if the infla.mmation has a syphilitic origin, or. results from the.suppression: of a discharge for which Mercurius was the remedy.,DOSE.-One grain of the third trituration every four hours. CLEMATIS ERECTA is recommended by Hahnemann for swelling and hardness of a testicle, if the, affection results from: suppressed gonorrhcea. Cold water bandages.may be applied to the parts with great:benefit. -`--- -~I------ ~a --r~L~I -~r~ -~-~u--u~-r-~--i HARDNESS OF THE TESTICLES, ERUPTIONS. 723 Hardness of the Testicles. For hardness of the testicles, if resulting from a cold, give ACONITE, as above. If resulting from suppressed gonorrhoea, give PULSATILLA as above, which may have to be alternated with BELLADONNA if there is soreness and throbbing, or with ACONITE, if there is heat, redness and other signs of inflammation; if the gonorrhoea indicated MERCURIUS SOLUBILIS, give this remedy as above;. or IODIDE OF MERCURY, one powder three times a day, if the patient is tainted with a scrofulous diathesis, or MERCURIUS CORROSIVUS, if a mercurial preparation seems indicated, and Mere. solub. does not seem to reach the case. Eruptions, Breaking out on the Genital Organs. An eruption upon the sexual organs may be owing to various causes, principally, however, to the syphilitic virus and to a scrofulous diathesis. It may also be induced by a cold, or by chafing. If the eruption is owing to the action of the syphilitic virus, we treat it with the remedies employed for syphilis. Generally the eruption has the form of herpes or tetter; or a sore may break out upon the parts, which is particularly the case among children. The penis may become chafed during an embrace, if the vagina is very narrow. In regard to treatm6nt, the application of cold water is often sufficient to remove the difficulty. Cleanliness will generally prevent a breaking out. If the patient is scrofulous, we may give him a little 724 SPECIAL THERAPEUTICS. SULPHUR, a few globules or a drop morning and night; and if the eruption looks like a common sore, as if caused by a cold, with a yellow-greenish crust, or the glans and prepuce are somewhat inflamed we may give MERCURIUS VIVUS, same as sulphur. BELLADONNA is useful for bleeding ulcers on the penis, a few globules or a drop three times a day. CHAMOMILLA is adapted to children, if the parts look inflamed, smart, burn and itch, and a moisture is secreted from the inflamed skin. DOSE.-Same as Belladonna. ARNICA is useful if the parts had become chafed by friction or from some other cause. Apply a lotion of twenty or twenty-five drops of the tincture in a cupful of water, until the parts are healed. Inflammation of the Penis. If the penis should become inflamed, and the affection is not of a syphilitic nature, we may use ACONITE, if the inflammation is acute, with redness, swelling, heat, and intense soreness of the parts; the inflammation is generally confined to the forepart of the penis, glans, and prepuce. DOSE.-A few drops, or ten globules, in about twelve tablespoonfuls of water, a tablespoonful every two hours. BELLADONNA is useful, if the parts look dark red and bleed. DOSE.-Same as Aconite. CHAMOMILLA, particularly for children, if the prepeuce and glans look swollen, with oozing of a yellowish and bloody serum, same dose as Aconite. MERCURIUS VIVUS for inflammation with formation of _ I ___~ ~I SEMINAL EMISSIONS, ETC, 725 sores, or puffing up of the prepuce, with inability to move it. DOSE.-Same as Aconite. SULPHUR may be given morning and evening, a few globules, for chronic soreness of the penis. CALCAREA, or the Iodide of Mercury, may be necessary to counteract a scrofulous diathesis from which such inflammatory conditions of the penis may frequently spring. Patients who may be more or less subject to such irritations, should use the utmost cleanliness and bathe the parts at least twice a day, morning and night, but not while heated. Seminal Emissions, Spermatorrhoea, Impotence. Involuntary nocturnal emissions, if they do not take place too frequently, say only once a month or every six weeks, and are not followed by a feeling of debility,. drowsiness, disinclination to attend to one's ordinary business, are not injurious, and can hardly be prevented in the case of healthy persons who work and eat a good deal. No treatment is required under these circumstances. If they become too frequent and debilitating, medical treatment may have to be resorted to, in order to arrest the loss of a fluid which is so essential to the. maintenance of the physiological harmony of the organism. Medical treatment is particularly required in case the weakness was caused by sexual excesses. In the case of strong, plethoric individuals; the abuse of the sexual organs, more particularly the pernicious practice of onanism, may give rise to a constitutional determination of blood to these parts..The prostatiq gland may become engorged, and a soreness, fullness, an 62* I _r _ I _ _ 726. SPECIAL THERAPEUTICS. aching and throbbing pain may be experienced in that region. A vascular engorgement of the prostatic gland may be attended with an inability to procure strong and permanent erections; the erections are quick and feeble, and are excited by the least attempt to dally with a female, or even by a mere fancy. Discharge of prostatic juice takes place after the least sexual excitement. Under these circumstances we quiet the nervous sensitiveness of the parts and remove the vascular engorgement by means of ACONITE, a drop of the first or second attenuation of the root morning and night. CHINA, same dose, may be of service, if the penis is weak, cold, with scarcely any power to become erect; the scrotum is constantly relaxed. MERCURIUS VIVUS, if the penis is shrunk, cold, especially the glans; the parts perspire all the time, they are covered with a viscid kind of sweat. DOSE.-One drop, or ten pellets, morning and night. PHOSPHORI ACIDUM, same dose as Aconite, if the patient is otherwise well, but has too many emissions, with exciting dreams. MoscHUs, one grain of the first trituration, dry on the tongue, morning and night; the parts feel nervous, excitable, the emissions are rather painful. A stout man, forty-six years old, had been afflicted with impotence for four years in consequence of a cold; all treatment had been unavailing; he was completely restored by triturating Moschus for a time, and remained well ever since. OPIUM is an excellent remedy for nocturnal emissions, if the patient's fancy is very much roused, and the sexual excitement is very great. i - I COLD IN THE HEAD. 72.7 DOSE.-One or two drops, of the tincture, morning and night. In inveterate cases the patient had better consult an experienced physician. One more remedy may be recommended for impotence, it is SPIRITS OF CAMPHOR, if the parts are cold, shrunk, and all power of erection seems to have become extinct. DOSE.-One-sixteenth of a grain, twice a day, with a little powdered sugar. It is important to bathe the parts several times a day in cold water, always an hour before eating. In some cases it may be of use to send an electro-galvanic current through the penis. AFFECTIONS OF THE RESPIRATORY ORGANS. Common Catarrh, Cold in the Head, Coryza. A cold in the head is a very common trouble, and yet it may require some treatment to get rid of it. Many persons succeed in arresting a cold in the head by drinking one or two pints of cold water before retiring; this induces a copious perspiration, and nips. the whole trouble in the bud. If a cold in the head is accompanied with feverishness, creeping chills, frontal headache, fullness about the head, dizziness, spasmodic sneezing, discharge of thin water form the nose, and the patient feels better in a. cool room, it may be well to give a few doses of ACONITE, a few drops in a tumblerful of water, a tablespoonful every four hours. 728 SPECIAL THERAPEUTICS. CHAMOMILLA is an excellent remedy, especially for children, if the nose feel sore, obstructed, sometimes with violent sneezing; the cold arises from suppressed perspiration; the patients feel restless, peevish, feverish. DOSE.-Same as Aconite. MERCURIUS vivus is required, if the patient complains of itching at the nose, sneezing, discharge of thin mucus from the nose, soreness and ulceration of the nostrils, yellow crusts at the nostrils, with discharge of brightyellow pus. The patient likes to be near the fire. DOSE.-Same as Aconite. This medicine may be alternated with SULPHUR, same dose, if Mercurius should be insufficient. ARSENICUM may be useful for a cold in the head, if the patient feels cold, with thin and yet irritable pulse, discharge of thin, acrid, excoriating liquid from the nose, foul smell in the nose. DOSE.-A drop, or six globules, dry on the tongue, three times a day. ARGENTUM is not inappropriate for spasmodic sneezing and discharge of water from the nose. DOSE.-Same as Arsenicum. Nux VOMICA is given by many homoeopathic physicians at the onset of a cold, if the nose is still dry and obstructed. We have never been so fortunate as to effect anything great with Nux in catarrhal affections of any kind. It may be given in the sane dose as Arsenicum. DIET.-The common saying: "Feed a cold and starve a fever," is one of the many stupid prejudices that, ignorance has called into being. The safest and speediest. mode.: of getting rid of a cold, is to drink plenty of cold water, and to confine one's-self to the simplest diet, such L..,;..~-rr~~; - -C ~.-:,. -1~, 1_ ~J-...~'...:....-..~-~..."~.... ~;....~.~.. SUPPRESSED CATARRH*2 729 as gruels, farina, a little tea and toast, rice, apple-sauce, and the like. Meat and stimulants, such as coffee, beer, brandy, etc., are very objectionable. Suppressed Catarrh. A catarrhal discharge from the nose may become suddenly suppressed. A suppression of this kind may be attended with the most dangerous consequences to the patient, and generally develops acute congestion or inflammation of some internal organ, such as the brain, lungs; or the suppression may give rise to ophthalmia, general rheumatism, or some violent nervous disorder, such as spasmodic weeping, moaning, tremors, spasmodic twitchings, even cholera and convulsions. If any of these conditions should arise, we have to treat them with the remedies that are indicated for them respectively in other parts of this work. As a general rule, we may fall back upon ACONITE and BELLADONNA, if the brain and the nernous system generally are principally involved; the patient complains of oppressive headache, violent distress and beating in the head, heavy, dull or glistening eyes, redness of the cheeks, or alternate redness and paleness, vertigo, fullness and tightness in the head, excessive soreness of the scalp as if ulcerated, inflamed eyes, sensitiveness to noise and light, twitching and starting of the limbs, spasmodic moaning and weeping, drowsiness, chilliness and afterwards feverish heat, palpitation of the heart, weariness, depression of spirits, anxiety and foreboding fear. These symptoms need not all set in together, nor may it be necessary to give Aconite and Belladonna in alter ~_ I I 730. SPECIAL THERAPEUTICS, nation; we recommend their alternate use on' this occasion simply because no possible harm can be done to the patient, even if one of them should be unnecessary, and it is undoubtedly safer that the layman or beginning practitioner should lose no time by fruitless experiments. ACONITE, BRYONIA, and PHOSPHORUS may be given, if the chest is principally affected. For the 'indications, the reader may be referred to Cough, Bronchitis, and the other chest-affections. A summary of the leading indications will be found presented in the following list of symptoms: ACONITE: oppression of breathing, soreness; pain in the chest, more or less seated; dry, racking cough, with expectoration of frothy mucus; raising of blood; constriction across the chest; stitches in the chest; tremulous sensation in the chest; palpitation of the heart. BRYONIA: tightness of the chest, all over or in part; aching pain in. the chest, with sore spots; dry, tearing cough; stinging and lancinating pain in the chest. PHOSPHORUs: oppression on the chest; barking cough, constantly, depriving the patient of breath, the irritation being felt throughout the chest, with soreness, stinging pain, heat. DOSE.-If any of these medicines is required, a few drops, or ten globules, may be mixed in ten tablespoonfuls of water, of which a tablespoonful may be given, every two or three hours. In very. many eases of suppressed catarrh, Aconite is alone sufficient to restore the discharge. Chronic Discharge from the Nose, Ozaena. If this is caused by neglected catarrh, we may treat the affection with ACONITE, BELLADONNA, CHAMOMILLA, MERCURIUS, SULPHUR, HYDRIODATE OF POTASH, IODIDE OF MERCURY. CHRONIC DISCHARGE FROM THE NOSE..731 SACONITE, if the discharge is very thick, yellow, bloody; having an: offensive smell, the nose feels sore internally especially at the spot where the discharge occurs. DOSE,-A few drops of the first or second attenuation, or even a drop of the tincture of the root in a small tumblerful of water, of which a tablespoonful may be given every three or four hours. BELLADONNA, if the nose is swollen, tuberous, discharging blood when blown, with pain in the forehead. DOSE.-Same as Aconite. CHAMOMILLA, sore nostrils with itching, sneezing; the nose, feels sore internally. DOSE.;-One.drop, or six globules, three times a day. MERCURIUS.VIVUS, ulceration of the nostrils and of the Schneiderian membrane (the mucous membrane lining the nose), with discharge of thick, greenish, fetid pus. DOSE.-Same as Chamomilla, or a few drops, or ten globules, in twelve spoonfuls, of water, giving a. tablespoonful every two or three hours. This medicine may be alternated with,SULPHUR, if Mercury is not sufficient. If the patients are very scrofulous, we may give IODIDE OF MERCURY instead of Sulphur, a powder dry on the tongue, three times a day. The seat of ozemna may sometimes: be in the interior of the upper jaw-bone, or the so called antrum Highmorianum, which is likewise lined by mucouis membiaine. If no opening exists, through which the matter,can be discharged, a.tooth may have to be pulled.out, in order to establish a passage for the escape of pus. The cavity may be syringed with tepid water, and the medicines which have been indicated for ozena of the nose, may be given internally. In two cases of ozaena, one of the nose and the other of the- antrum Highmoriahumr, characterized, in one case 732 SPECIAL THERAPEUTICS. by discharge of fetid purulent mucus and blood from the antrum, and incipient caries of the bone; and, in the other case, by expulsion from the nose of hardened clots of greenish-yellow fetid mucus of an inch long, with foul smell in the nose, inability to distinguish odors, and a monomaniacal suspicion that the patient's breath must be very offensive to everybody, which caused hypochondria, and led to thoughts of suicide; the greatest relief was accomplished by ACONITE, a few drops of the first attenuation in water, three times a day, and in the other case, three drops of the tincture every other day, alternated with HYDRIODATE OF POTASH, fifteen grains in a pint of water, a good dessert-spoonful three times a day. This drug will be found a capital remedy in chronic cases of coryza with the character of ozoena, especially if the patient had taken much mercury, or had been affected with syphilis. The dose should not be less than from four to six grains in a pint of water, in tablespoonful doses once every four or six hours. Epistaxis, Nose-Bleed. This affection may result from a fall or blow upon the nose, in which case it may be arrested by bathing the nose in cold water, or snuffing it up until the bleeding stops. At the same time we may give ARNICA, a few drops in a small tumblerful of water, a tablespoonful every few minutes. A solution of twentyfive to thirty drops of Arnica in a cupful of water may likewise be snuffed up. ACONITE is indispensable, if the bleeding is profuse, L~~_l ~ NOSE-BLEED. 733 attended with violent rush of blood, fullness of the head, blackness of-vision, dizziness. DOSE.-A few drops, in a small tumblerful of water, of which a dessertspoonful may be given every few minutes until the bleeding stops. Many other remedies are mentioned in some homoeopathic works for nose-bleed, such as: LYCOPODIUM, GRAPHITES, CHINA,.REUS, BRYONIA, SILICEA, etc These medicines are useless. ACONITE and ARNICA Will arrest haemorrhage from the nose unless it should be purely symptomatic, in which case the general affection has to be prescribed for. Haemorrhage, for instance, may be a vicarious discharge of blood, in the place of the regular menstrual discharge; or it may occur in the course of a typhoid fever; the attacks may set in as a symptom of constitutional weakness with a certain periodicity; frequent nose-bleed often denotes a phthisicky habit, and is a very bad sign, if it occurs among young people whom it leaves weak and pale after an attack. A simple nose-bleed often acts as a natural relief to the brain; if. robust and lively children are frequently attacked with nose-bleed without the general constitution being impaired by it, it may save them a good deal of trouble about the head, such as headache, congestion, and perhaps dropsical affections of the brain. Persons who are subject to nose-bleed, should lead a temperate life, avoid stimulants, use frequent ablutions of cold water, and take moderate and regular exercise in the open air. Violent exercise, gymnastics, much stooping are injurious. In the case of drunkards or high livers, especially if they are naturally of a plethoric habit of body, a timely nose-bleed may avert the danger of apoplexy. If it should take place too frequently, the attacks may be arrested by taking 63 734 SPECIAL THERAPEUTICS. Nux VOMICA, a drop or six pellets every night; of course the mode of living has to be altered. Hoarseness. A simple hoarseness induced by a cold may pass off without any medical treatment. Drinking plenty of cold water at night, and tying a wet bandage around the throat over night, may be sufficient in all ordinary cases to restore the normal reaction of the lining membrane of the throat. In most cases, however, a little medicine may be required to overcome the difficulty, and to prevent ulceration and chronic disorganizations of the throat. The two medicines with which all acute forms of hoarseness may be overcome, are ACONITE and MERCURIUS VIVUS. ACONITE is indicated by hoarseness with complete loss of voice, aching pain in the throat, dryness and soreness of the throat as if raw, or stinging as from needles in the throat; the throat feels hot, a sweetish fluid is hawked up at times; the patient has to make a great effort to articulate sounds even in the lowest tone of voice, and all such efforts are very painful. This kind of hoarseness, if neglected, may become seated, and finally terminate in ulceration and laryngeal phthisis. DOSE.-We can affirm from abundant experience, that the tincture of the root in this disease is far better than the attenuations. Mix one or two drops in a tumblerful of water, and give a tablespoonful of such a solution every two hours, and gradually every four hours, to be continued until the trouble is entirely removed. MERCURIUS VIVUS is to be used, if the symptoms resemble those which indicate Aconite, but are milder; HORSNES 7:35_ HOARSENESS, 7835 the thioat feels dry, but without the aching and excoriating pain mentioned in the previous paragraph; the throat feels warm, and the patient craves cooling drink, particularly fresh water; he feels cold, chilly and likes to be near the fire or well covered in bed. A sweetish and sometimes a saltish watery fluid may be hawked up. DOSE.-A powder of the third trituration, dry on the tongue, every six hours. If these acute forms of hoarseness have been treated allceopathically, no impression is sometimes made upon the disease, which consequently runs into the chronic form, characterized more or less by all the symptoms of the original acute attack, in addition to which ulceration and suppuration set in, with more or less hectic fever and night-sweats. For these forms of chronic hoarseness the same remedies may be, and ought to be, used as for the acute form. For partial hoarseness, other medicines may be used, besides the two former: CARBO VEGETABILIS is useful in evening hoarseness, or hoarseness which comes on after reading or singing. DOSE.-A powder of third trituration dry on the tongue, every morning and night. AMMONIUM CARBONICUM is not inappropriate for hoarseness in the region of the larynx, with sense of oppression. DOSE-Same as Carbo. SULPHUR and MERCURIUS may be given for hoarse ness remaining after small-pox. DOSE.-An alternate dose of one drop, or six globules, every day. Sulphur in the morning, Mercurius at night. If the hoarseness is accompanied with cough, the remedies for cough have to be chosen, such as BRYONIA, 736 SPECIAL THERAPEUTICS. PHOSPHORUS, etc., to which the reader is referred. As we stated before, chronic hoarseness is a sure sign that chronic bronchitis or laryngeal phthisis is threatening. Influenza. This disease seems to affect in the first place the nervous system, and secondarily the mucous membrane. It often assumes an epidemic form, though it may likewise break out in isolated cases and districts. The patient first feels a shivering, complains of creeping chills, which soon give place to fever. The muscles and joints feel sore, the skin is sensitive; other symptoms are: headache, with vertigo, sore throat, inflammatory irritation of the air-passages; coated tongue, nausea, loss of appetite, diarrhoea, prostration. In 1832, the year after the first cholera-epidemic in Paris, epidemic influenza suddenly broke out in that capital, attacking about one hundred thousand individuals. A characteristic symptom of that epidemic was a sub-acute swelling of the lesser joints. For this disease we use ACONITE, MERCURIUS, ARSENICUM, EHUS TOXICODENDRON, PHOSPHORUS, BRYONIA. ACONITE invariably commences the treatment, a few drops in about twelve tablespoonfuls of water, of which solution a tablespoonful may be given every two or three hours. In mild cases of influenza, if the patient will consent to keep his room and drink plenty of cold water, the disease may often be entirely cured in a few days by taking a spoonful of a solution of Aconite every six or eight hours. If, after perspiration has set in, the improvement should not continue, some other medicine has to be chosen in accordance with the symptoms. INFUEZA 737_ INFLUENZA. 787 BRYONIA is excellent, if the chest feels sore, oppressed, with dry, tight, tearing cough, and a stitching pain here and there. DOSE.-Same as Aconite. PHosPHORUS is an excellent remedy for inflammatory symptoms of the chest; the lungs feel oppressed, sore; the cough is dry, a constant hacking, with irritation through the whole chest. DOSE.-Same as Aconite, or a powder of the third trituration dry on the tongue, every six hours. ARSENICUM is useful, if the patient feels prostrated, sore, looks sallow, the bowels are out of order, he is inclined to sleep, the. tongue is coated with a thick darkyellow or brown fur; he feels thirsty, wants to drink all the time, complains of nausea and a burning pain in the pit of the stomach; the eyes water a good deal, feel sore and sensitive to the light, DOSE.-Same as Phosphorus. MERCURIUS was found to be an excellent remedy in the great epidemic of 1832, when the joints were swollen, sore, lame, having a slight rose-colored tinge, with soreness and rheumatic pains generally; the patients felt chilly, liked to be quiet, drank a good deal, had no appetite; the catarrhal symptoms, sneezing, discharge of water from the nose, sore and weeping eyes, may likewise be very prominent. DOSE.-Same as Phosphorus. BELLADONNA may possibly be required in some cases, but very seldom; it may be given, if the brain seems affected by the disease, with violent distress in the head, stupor, delirium. Some homceopathic physicians recommend Tartar emetic as a specific for influenza. It may be of use in 63* 1 788 SPECIAL THERAPEUTICS. a few cases where Tartar emetic would be generally indicated; for instance, where the patients are troubled with a good deal of retching, with watery and exhausting diarrhoea, and where the retching is attended with violent determination of blood to the head, drowsiness, coldness, prostration and complete loathing of food; in all such cases Tartar emetic may be given in water, one grain of the first trituration in twelve tablespoonfuls, of which the patient may take a tablespoonful every two or three hours. But we must reject the indiscriminate use of Tartar emetic as a specific remedy for influenza; the results of this species of empiricism are not at all commensurate with the zeal with which it is advocated by so'me. If an attack of influenza should set in quite suddenly, with coldness, great prostration, and no reaction should take place very speedily, we may give the patient CAMPHOR, five drops of the spirits, on a little sugar, every five minutes, until he warms up or begins to'perspire, after which some other more suitable remedy may be given. Through mismanagement, or in consequence of peculiar conditions of the system, influenza may develop a typhoid state, which may require the same treatment that has been recommended for typhoid fever, to which the reader is referred. DIET AND REGIMEN.-Persons who have an attack of influenza, should not be in too great a hurry to leave their rooms. Relapses are quite common, and may be troublesome and even dangerous. The simplest diet is the best; cold water, tea and toast, rice, gruel; the body may be sponged with tepid water once or twice a day. Draughts of air have to be carefully avoided. COUGH, SYMPTOMATIC INDICATIONS. 739 Cough. Cough is very often symptomatic, an accompaniment of congestion, inflammation, or organic disease of the respiratory organs. It may likewise be the effect of a simple cold on the chest, or catarrhal irritation of the bronchial or pulmonary mucous membrane. It is with this catarrhal cough that we have to deal here. The symptoms of this Catarrhal Cough, are: tickling in the throat-pit, irritation in the chest, inducing a constant desire to cough; pains in the chest here and there, shifting or more or less seated; soreness and stricture across the chest, etc. We treat this cough with ACONITE, BRYONIA, CHAMOMILLA, MERCURIUS VIVUs, SULPHUR. Cough may likewise be the resultof nervous irritation of the chest; it is a spasmodic sort of cough, coming on in sudden, violent, spasmodic paroxysms, which are sometimes attended with a feeling of suffocation and exhaust the patient. For this species of Spasmodic or Nervous Cough, we use ACONITE, BELLADONNA, lHYOSCYAMUS, IPECACUANHA. If cough is a symptom of bronchial or pulmonary disease, we have to give the remedies indicated by the general affection. Symptomatic Indications. ACONITE has a very wide range of symptoms in catarrhal affections of the chest. The principal of these symptoms are: tightness and oppression of the chest; tickling and soreness in the air-passages; seated aching pains in the chest; sore feeling in the chest or region of _LIICI___~III___U_~__ 740 SPECIAL THERAPEUTICS. the sternum, which is increased by coughing; the cough is dry and tearing; after the paroxysm, the patient hawks up phlegm and a watery froth; the paroxysm is often excited by a violent titillation in the throat-pit, and is attended with rush of blood to the head, as if the skullcap would fly off; sometimes it results in vomiting of mucus, bile, and even food, particularly after eating, and causes complete loss of breath and exhaustion. DOSE.-A few drops of the first or second attenuation, of which a tablespoonful may be given every two hours. BELLADONNA, same dose as Aconite, has a very limited range of symptoms in cough. It may be used in spasmodic cough, if the cough is dry and excited by a tickling in the back part of the larynx; it is worse at night, a hollow, barking cough, or a spasmodic, hacking cough, with a scratching sensation in the throat, or a sensation as if the cough were excited by some foreign substance that had got into the throat; it may be attended with a taste of blood in the mouth, and with expectoration of catarrhal mucus, which looks like old pus. BRYONIA, same dose as Aconite, does very well, if the chest feels constricted, either all over or in some parts; the cough is mostly dry, tearing, with sore, aching pain at the spot whence the cough seems to proceed. This medicine may be given in alternation with Aconite. CHAMOMILLA, same dose as Aconite, is indicated by spasmodic tightness across the chest, with tickling behind the upper part of the sternum, or in the throat-pit, dry cough at night; spasmodic cough, especially among children, who lose their breath when coughing. iHYOSsYAMUS may be tried, if Belladonna remains ineffectual; it is principally useful for dry night-cough of a spasmodic character, leaving the patient weak and the brain exhausted after a paroxysm. -~-- --- -....--.. COUGH, SYMPTOMATIC INDICATIONS. 741 DOSE. -One drop, or six globules dry on the tongue, three times a day. MERCURIUS VIVUS: tickling in-the throat-pit, inducing spasmodic cough which can only be soothed by drinking cold water, or water and sugar; the paroxysms are worse at night; the irritation may likewise be seated in the chest, with a dry, hard, tearing cough, resulting in the hawking up of a little saltish and sometimes sweetish mucus. It is also adapted to a loose catarrhal cough which was at first dry and hard; the expectoration may consist of thick whitish or yellowish mucus. DOSE.-In many cases a few drops in a tumblerful of water, of which a tablespoonful may be given every two hours, will be sufficient; in other eases a powder of the third trituration, dry on the tongue, may be taken every three or four hours. If Mercurius is not sufficient, and the cough begins to assume a chronic form, and the patient complains of a feeling as if the throat were full of smoke. SULPHUR may be used in the same dose as Mercurius. These two medicines may also be given in alternation, an alternate dose every three hours, if one alone should not suffice to produce a decided impression. IPECACUANHA may be given if the cough is excited by a spasmodic titillation in the throat-pit, and the paroxysms terminate in loss of breath and sometimes in nausea and even vomiting. DOSE.-One drop, or six globules dry on the tongue, three times a day. If the cough should have assumed a chronic form, the same medicines may be administered, except that they should be given at longer intervals. In chronic cases, we may add to the above mentioned list: CALCAREA CARBONICA, CARBO VEGETABILIS, PHOSPHORI ACIDUM, PHOSPHURUS, ARSENICUM, HEPAR SULPHURIS. CALCAREA CARBONICA for a dry, hacking cough, which comes on occasionally in paroxysms, or for a loose cough, with titillation, and expectoration of a frothy mucus. -~cl--~------~cl-~l~-~--------~----- -,, ~,, 742' SPECIAL THERAPEUTICS. PHOSPHORUS, for paroxysms of cough with irritation throughout the chest, oppression, desire. to take a long breath; during the use of Phosphorus a dose of Aconite may be interpolated occasionally. PHOSPHORI ACIDUM, for a dry cough, with burning in the chest which excites the cough, deep-seated titillation in the throat-pit. HEPAR SULPHURIS, cough with tendency to hoarseness, dryness in the larynx, soreness,-and burning deep-seated in the chest, expectoration consisting of tenacious mucus. ARSENICUM if the cough is very troublesome at night, dry, with stricture across the chest, oppression and anxiety; the cough and the expectoration cause a disproportionate feeling of debility. DOSE.-Of any of these remedies, one drop, or six globules, dry on the tongue, three times a day. While using these drugs, one or two of the former list may every now and then have to be given. Persons affected with cough, should drink cold water, avoid stimulants and violent exercise, and shun all kinds of exposure. Moderate exercise in the open air, if the weather is dry and pleasant, is admissible. Other medicines are recommended by homceopathic authors for spasmodic and chronic cough; but we cannot say much in their favor. Even such drugs as Nux VOMICA, which we find stereotyped in all homceopathic books as a remedy for cough, and even for certain forms of catarrhal sore throat, has never proved of much use in our hands for such affections. It is recommended for a spasmodic, weakening cough, depending upon a dyspeptic condition of the stomach that indicates Nux. It is particularly suitable to persons who lead a sedentary life, tailors, shoemakers, literary men; or to individuals who are addicted to abuse of spirits or strong coffee, or who are suffering from. the consequences of suppressed piles. A drop or half a dozen globules may be taken three times a day. BLOODY COUGH. 743 Bloody Cough, Hemoptysis, Haemoptoe Many persons cough up a little blood without being seriously inconvenienced by it. This is not, properly speaking, hmmorrhage from the lungs. By haemorrhage from the lungs we mean a copious and sudden expulsion of blood from the lungs, which is sometimes attended with a violent suffocative paroxysm of cough, a violent tumult in the circulation, redness or alternate redness and paleness of the face, coldness of the extremities, and other symptoms which will be found more fully described among the therapeutic indications. For a simple spitting up or hawking up of blood and mucus during a coughing fit, we may use ACONITE, BRYONIA, MERCURIUS, PHOSPHORUS, SQUILLS. ACONITE is good for consumptive individuals affected with tuberculosis of the lungs; it is also adapted to chlorotic females and persons whose chests are very full, showing that the lungs are large and overcharged with blood, a condition which physicians term hyperemia. For hmmoptysis attended with suppression of piles, it is an excellent remedy. The patient may have taken cold; he experiences slight shiverings or creeping chills, feverflashes; the face is flushed, especially in the evening; the chest may feel slightly oppressed; he finds it difficult to take a long breath, an attempt of this kind is arrested by obstructions in some parts of the chest, and excites a coughing fit; every now and then the patient coughs up a mass of flocculent mucus; on examination this mucus is found to surround a nucleus consisting of softened tuberculous matter: the expulsion of such a softened tubercle is often attended with discharge of red blood varying in quantity from a teaspoon to a table 744: SPECIAL THERAPEUTICS. spoonful. This process of tuberculous suppuration, and the cough which accompanies it, may often be arrested, for a time at least, by the timely and persevering use of the tincture of Aconite-root. We give one or two drops in half a pint of water, of which the patient may be given a tablespoonful every hour, until the raising of blood is entirely stopped, after which the medicine may be continued every two and finally every four hours, until the cough ceases entirely. We have cured many a cough of this kind with nothing but Aconite; sometimes, however, we found it advisable, to alternate Aconite with BRYONIA, a few drops or ten globules in a tumblerful of water, giving an alternate dose every hour. Bryonia is more particularly useful, if the affection of the chest is accompanied with rheumatic pains in the muscles and extremities. SQUILLS is excellent for bloody cough when resulting from neglected catarrh on the chest, particularly in the case of florid individuals; the hemorrhage is preceded by sickness at the stomach, a pricking pain is experienced at the spot whence the blood is discharged, with a sense of warmth and a bubbling or gurgling sound; the cough is loose, with expectoration of purulent mucus. DOSE.-One or two drops of the tincture in a small tumblerful of water, of which a tablespoonful may be given every half hour,. and gradually every two and four hours, until the patient is well. Sometimes Squills may be advantageously followed by a few doses of Aconite, or the two may be given in alternation. P SPSHORUS may be useful in haemoptysis, if the cough is hard, tearing, accompanied with a sense of oppression, and hard clots of bloody mucus are raised during or after the paroxysms. DOSE.-A powder of the third trituration dry on the tongue, every four hours; or a few drops, or ten globules, in half a pint of water, of which the r BLOODY COUGH. 745 patient may take a tablespoonful every three or four hours. This medicine is adapted to acute as well as chronic cases. ARSENICUM may be given in chronic cases, if the cough causes much weakness, and the blood looks dark and is expelled with a burning sensation previous to, or during the haemorrhage. DOSE.-Same as Phosphorus. MERCURIUS VItUs may be given if the cough is hard and dry, the patient feels oppressed on the chest, and coughs up pure blood. DOSE.-Same as Phosphorus. If these medicines do not arrest the disease, the probability is that it is an incurable organic disorder. The patient may then resort to a change of climate, if his means permit; but he should, above all things, take the advice of an intelligent and honest-hearted homoeopathic physician. If hbemoptysis should occur as a consequence of menstrual suppression, we may conduct the treatment principally with ACONITE and PULSATILLA. In such a case we invariably prefer the tincture of Aconite to the attenuations, although these may suffice in some cases. Of PULSATILLA we may use the first attenuation. SABINA may likwise be tried-a few drops of the tincture, in half a pint of water, in tablespoonful doses every two or three hours. The ACETATE OF IRON (Ferrum aceticum), and CHINA are important remedies in hanmoptysis arising from this cause, especially if the patients look and feel feeble and exhausted. Of either of these agents a few drops may be given three times a day; of FERRUM ACETICUM we may likewise give a powder dry on the tongue, three times a day. FERRUM ACETICUM is particularly useful for a dry cough, which is especially troublesome at night, with discharge of blood, and fol64 _ _ 746 SPECIAL THERAPEUTICS. lowed by increased dyspnoea; or the patient raises froth and blood, and sometimes a sweetish greenish pus; the face is more or less flushed. CHINA may be given, if the patient complains of loss of appetite, pappy taste, looks sallow, with creeping sensation in the chest, palpitation of the heart, occasional rush of blood to the head, flushed face, dizziness. Hamoptysis may be caused by the presence of a foreign body in the lungs; a spiculum of bone, or even the larva of some insect may have become embodied in the substance of this organ. We once were called to a lady who had been affected with cough and raising of blood for about thirty years. She seemed in comparatively good health. When we were called she had had a violent coughing fit with hemorrhage, during which she spit up a spiculum of bone, or rather a lamina which was about half an inch long, a quarter of an inch wide, and very thin. As far as we know she had no hemorfage after this attack. In the Philadelphia Ledger of May 21st, 1858, we read the following interesting fact: " Insect in the Lungs.-The Evansville (Ga.) Journal relates that a young man of that city had been for some months afflicted with a serious cough and hmmorrhage from the lungs, so that it was feared he was entering into a fatal consumption. But he was relieved in a singular manner. One night he was attacked, while in bed, with a violent fit of coughing, which was followed with a copious hemorrhage, and as the blood flowed from his lips, he felt a solid substance of some size pass them. On examining the blood thrown up, a bug with six horny legs and incipient delicate wings was found in it. The head of the insect was out of proportion to HEMORRHAGE OF THE LUNGS. 747 its body. The former was of the size of a small pea, with eyes distinctly perceptible, while its body was only the size of a large grain of barley. The thing was alive and active. Since this occurrence the unpleasant sensations have passed off and the cough has ceased, and the only trouble has been one slight hemorrhage a day or two after expectorating the bug. The sufferer is of the opinion that he inhaled the larva, or egg of the insect, and that it entered the substance of his lungs and then hatched, as the sensation of expelling the creature was like tearing away a portion of the organ." REGIMEN.-It seems hardly necessary to remark that persons who are suffering with hemoptysis, should avoid all excitement, violent exercise, and rich, stimulating diet. Light diet, stewed fruit, vegetables, such as green peas, spinage, cauliflower, and ripe, mealy Irish potatoes, rice and mucilaginous articles of nourishment, and in some cases small quantities of cold roast beef, lamb or mutton, may constitute the principal nourishment of the patient. Of course, the constitution and previous habits of the patient, and the character of the symptoms, may greatly modify the general hygienic treatment. The best drink is cold water, not ice-water; black tea and milk and light cocoa may be used. Stimulants should be avoided. If the patient has made. abuse of alcoholic stimulants, he may take a dose of Nux VOsIcA every other night, in connection with the medicine which he takes for his disease. A more immediately dangerous accident is Pneumorrhagia, Hoemorrhage of the Lungs. In this disease the blood may either be discharged from the mouth or else it may be effused into the sub _~ 748 SPECIAL THERAPEUTICS. stance of the 1ings and even into the heart and muscular tissue. Let us first consider the former variety, together with the treatment. The actual outbreak of the disease may be preceded by a feeling of oppression on the chest; generally this oppression is only felt at a circumscribed spot; if the patient makes an effort, if he talks too much or walks too fast, this oppression is increased to dyspnoea; the patient is unable to take a long breath, and, if he attempts to do so, a slight hacking cough sets in. These symptoms may continue for a longer or shorter period, and, unless arrested by treatment, terminate in actual haemorrhage. An attack of hemorrhage is accompanied or preceded by a sensation of warmth in the chest; a bubbling is felt, a tickling in the larynx, the patient has to cough and raises blood with a gurgling sound. The quantity raised varies from a cupful to half a pint or a pint. The blood is generally frothy, mixed with a quantity of air-vesicles; it may also be coughed up in solid masses. During the attack the pulse is excited, full, bounding; the face is flushed, the skin hot and dry, the extremities cold. An attack of this kind generally befals individuals between the ages of twenty and forty years. Men are more frequently attacked than women. The attack may be provoked by a sudden cold on the chest, neglected catarrh, stoppage of habitual discharges of blood (menses, piles,) mechanical irritation of the lungs by some foreign substance, a blow or fall on the chest, abuse of alcoholic beverages. It may likewise be hereditary, depending upon.abnormal conditions of the structure of the lungs. If the blood is not discharged from the mouth, but is _ _I I_ _ _ __ I I_ APOPLEXY OF THE LUNGS. 749 effused into the pulmonary cells, we term this form of pulmorary hmemorrhage Apoplexy of the Lungs. An attack of this kind may likewise have a precursory stage, charcterized by oppression on the chest, dyspnoea, short, hacking cough; palor of the countenance and coldness of the extremities. During the attack the patients lose their senses, the face assumes a bluish hue, as is the case with those who are choked to death; the eyes are protruded and froth mixed with blood is seen at the mouth. The pulse is small and thin and the breathing is short and irregular. The extremities are cold, and a rattling noise is heard in the air-passages, as when air is blown into soap-suds. This second form of haemorrhage is more dangerous than the first, and is very apt to terminate in some lingering organic disorder of the lungs, such as oedema or phthisis. TREATMENT.-The patient has to be placed in a half sitting and half recumbent posture; the chest must be freed from all pressure, the clothes should be removed, and cold water applied to the chest in order to induce contraction of the pulmonary vessels. At the same time we prepare a mixture of one or two drops of the tincture of Aconite-root in a spoonful of water, and drop from five to ten drops of this mixture on the patient's tongue every few minutes, until the hnemorrhage is arrested, and symptoms of a favorable reaction set in. As soon as this takes place, we may mix a drop of the tincture of Aconite in half a pint of water, and give the patient a tablespoonful of this mixture every hour or two hours, until all danger is fairly removed. If Aconite should 64* I _ _ 750 SPECIAL THERAPEUTICS. seem inadequate to arrest the haemorrhage, we may, after giving a few doses of this medicine, give MILLEFOLIUM, five drops of the tincture every five or ten minutes; or these two drugs may be given in alternation, in the doses mentioned. PHOSPHORUS is excellent in pulmonary apoplexy, in alternation with the Aconite; of Phosphorus give a drop or two at a dose, an alternate dose every five minutes, until reaction sets in. ARNICA is adapted to all cases of haemorrhage that are caused by external violence, a blow, fall, etc. We may mix a few drops of the attenuated drug, or also a few drops of the tincture in half a pint of water, and give the patient a tablespoonful of this mixture every ten or fifteen minutes, or less frequently, until the haemorrhage ceases. At the same time the chest may be bathed with a solution of forty or fifty drops of Arnica tincture in half a pint of cold water. In all acute attacks of hemorrhage from the lungs, these three remedies will be sufficient to effect a favorable change; if the hemorrhage occurs in small quantities, more or less periodically, assuming a chronic form, we have to treat it with the medicines that have been recommended for haemoptysis, and tubercular consumption. REGIMEN.-The suggestions offered under haemoptysis, are likewise applicable to haemorrhage. Even after the patient is perfectly restored, the diet should remain of the simplest kind, absolutely free from all stimulating influences; all exciting conversation, emotions, etc., should be avoided by the patient. Violent exercise, riding on horseback, gymnastics, rapid walking may cause a return *of the disease. INFLAMMATION OF THE LARYNX, ETC. 751 Laryngitis, Tracheitis, Inflammation of the Larynx and Wind-Pipe. The larynx is the upper part of the wind-pipe. It may be discovered in the upper part of the throat, where the cartilaginous sides of the larynx are distinctly felt by making pressure with the forefinger and thumb, and moving the integuments backwards and forwards. The cartilages unite in front, constituting a pointed prominence superiorly which is designated as the pomum Adami, Adam's apple. The larynx consists of several moveable pieces which form a complex apparatus intended for the organ of the voice. The vocal cords which constitute an essential part of this apparatus, are contained within the larynx. The interval between the cords, of which there are two on each side of the larynx, is termed the glottis or rima glottidis. The upper orifice of the larynx being contiguous to that of the pharynx, food or other substances might easily glide into the larynx if this accident were not provided against. For this purpose nature has covered the larynx with a moveable and highly elastic valve which opens and shuts according to the requirements of the moment. In using the larynx for the purpose of emitting sounds, the valve opens, and if anything is to be swallowed, even mere saliva, it closes, thereby affbrding perfect protection to the larynx. The larynx is lined with a very sensitive mucous membrane having a pale pink color. It has also a number of mucous glands which keep the larynx properly lubricated during the performance of its various uses. __ _Y ~_ _ ~CI~ ~~ 752 SPECIAL THERAPEUTICS. The trachea is a continuation of the larynx; it is a movable, cylindrical tube surrounded by cartilaginous rings, from ten to twelve lines in diameter in the male, and from nine to ten in the female; its length is from four to five inches. At the lower extremity, the trachea divides into two tubes, one of which goes to the right, the other to the left lung. This division of the trachea is designated as the bifurcation of the trachea. One of these tubes or canals is called a bronchus; in the plural they are named bronchi. The right bronchus is much wider than the left, and its diameter is not much less than that of the trachea. Cruveilhier informs us that in a female, whose trachea was ten lines in diameter, the right bronchus was eight and the left five. On the other hand, the right bronchus is much shorter than the left; the right bronchus being one inch in length, and the left two. The bronchi and trachea are likewise lined by mucous membrane which is a continuation of the mucous membrane of the larynx. The posterior surface of the trachea is studded with.mucous glands which perform the same office in the trachea as the laryngeal mucous glands do in the larynx. The bronchi, after dipping into the substance of the lungs, ramify into a number of branches, which are called bronchia or bronchial tubes or ramifications. A bronchial tube goes to each pulmonary lobule. It is through these tubes that the air flashes to every part of the lungs. The lungs nearly occupy the whole of the thoracic cavity. They are two in number, but so intimately connected. by the bronchia and blood-vessels, that they must be looked upon as separate parts of a single organ. The base of the lungs rests upon the diaphram which separates them from the stomach, the liver and all the INFLAMMATION OF THE LARYNX. 753 other abdominal organs. The heart is embedded in the substance of the lungs which are excavated for the purpose of receiving the heart, the left lung more than the right, because the heart projects more to the left than to the right side. Hence, Avicenna has called the lung the bed of the heart. Each lung is lined by a serous membrane which is termed the pleura and which is likewise extended over the parietes or walls of the thorax. The pleura forms a shut-sac; at its internal surface it constantly exhales a serosity by means of which the movements of each lung upon the walls of the thoracic cavity are facilitated. The tissue of the lungs is a spongy texture, the cells of which are filled with air. These cells are united into groups by very delicate cellular tissue; a group of cells is termed a pulmonary lobule. The pulmonary tissue is exceedingly elastic; this property is absolutely necessary to the periodical expansion and contraction of the thorax during the act of respiration. We are now prepared to enter upon a description of some of the diseases to which the larynx, trachea and lungs are liable. The treatment of these diseases which frequently entails, in the hands of Old-school physicians, permanent disorganizations upon the patients, is not only exceedingly simple as conducted by homoeopathic practitioners, but is at the same time crowned with extraordinary success. Laryngitis, Inflammation of the Larynx. The symptoms of this disease differ according as.one or the other parts of the larynx are affected. This inflammation presents itself for treatment both in an 754 SPECIAL THERAPEUTICS. acute and chronic form. The disease is generally seated in the mucous membrane which lines the laryngeal carti lages and the epiglottis. In the acute form, the patients complain of a stinging and burning pain in the whole larynx, which is very much aggravated by pressure. If the epiglottis is involved in the inflammation, the food which the patient attempts to swallow returns again by the nostrils and mouth. The voice has a peculiarly shrill, crowing sound; in the lesser degrees of inflammation it is hoarse. Laryngitis is always attended with a wheezing, ringing cough, which is generally dry, or accompanied with expectoration of a gelatinous, bloodstreaked mucus. The inspirations often have a wheezing sound. Like all other inflammations, acute inflammation of the larynx is attended with high fever. In chronic laryngitis, the pain is rather circumscribed; it is a burning pain, without much tickling, and rendered worse by pressure. The pain sometimes intermits for days and weeks, until an unfavorable change in the weather excites it again. The voice is likewise altered, cracked, at times giving out all at once, or disturbed by hoarseness, which is often only momentary. This form of laryngitis is characterized by a spasmodic cough, with profuse expectoration of a tenacious, purulent, inodorous mucus; at other times the expectoration is wanting. Laryngitis may likewise be caused by mechanical injuries, a fall, or the part may be wounded by some sharp instrument. Another and most dangerous cause of the disease, is the syphilitic or gonorrhoeal virus. This form of laryngitis may result from mismanaged or suppressed gonorrhcea or syphilis. The expirations take place with a peculiarly wheezing sound; the voice loses all resonance, has a dull, often barking sound. The __ INFLAMMATION OF THE BRONCHIA. 755 disease is characterized by sudden paroxysms of suffocation, and may terminate in cedema of the epiglottis, and sudden death by suffocation. In scrofulous individuals, laryngitis may lead to ulceration of the larynx and laryngeal phthisis. The treatment will be given below. Tracheitis, Inflammation of the Trachea. An inflammation of the trachea is, in a measure, characterized by the same symptoms as laryngitis. The stinging and burning pain is felt further down the throat; the voice has a ringing, metallic sound; the ingesta return by the mouth and nostrils, and, if the inflammation is very violent, the neck swells somewhat. The cough may be dry and spasmodic, or attended with blood-streaked expectoration. The treatment will be indicated below. Bronchitis, Inflammation of the Bronchi and Bronchia. The pain, in this disease, is likewise burning and stitching; it is seated behind the upper extremity of the breast-bone, and may extend downwards as far as the middle of the chest. The burning and stinging pain is principally felt in the bronchi, or primary ramifications of the windpipe, though it may likewise affect the bronchia, or smaller bronchial tubes. If the inflammation is principally seated in the latter, a distressing incisive pain is often experienced by the patient. The complaint is accompanied with oppression of breathinig, although the patient is able to expand the chest. The cough is at first dry, spasmodic, but soon results in the raising of - - ----U~UW~IO~._~~TYIUPI~~~L~L~L~LIQY9re-T I 756 SPECIAL THERAPEUTICS. blood-streaked mucus, and, at a later period, a purulent, bloody substance. A coughing fit is often preceded by spasmodic tickling. The disease is accompanied with all the symptoms of inflammatory fever. If the inflammation is neglected or mismanaged, it may assume a chronic form, and, in the case of scrofulous or tuberculous individuals, the disease may lead to very serious results. Chronic bronchitis very often terminates fatally, by gradual suppuration and ulcera tion of the air-passages. Bronchitis, instead of first affecting the larger bronchial tubes, may commence in the more minute bronchial ramifications in the interior of the lungs. The symptoms are the same: oppression, burning, stinging pain in the chest, tickling, dry, spasmodic cough, expectoration of frothy mucus and blood. This variety of bronchitis requires very careful management, as some seated chronic irritation is apt to remain behind. The chief cause of laryngitis, trachitis and bronchitis is exposure to a draught of air, to keen and cutting winds, sudden changes of temperature. The treatment of laryhgitis, bronchitis and tracheitis is conducted with the same medicines and may therefore be described under one general head. One of the leading remedies for these inflammations is ACONITUM, for dry and spasmodic cough, or with expectoration of frothy, or purulent blood-streaked mucus; spasmodic tickling in the throat-pit, burning and stinging, or incisive pains in the air-passages, oppression, dyspnoea, hoarseness or loss of voice; the cough is often excited by spasmodic tickling in the throat; othei symptoms are; fever, headache in the frontal region, dizziness, palpitation of the heart, constipation. INFLAMMATION OF THE BRONCHIA. 757 DOSE.-In this disease we generally prefer the tincture to the attenua tions. We mix one or two drops of the tincture of the root, in a tumbler of water, and give the patient a tablespoonful of this mixture every hour or two hours. We have cured many a case of bronchitis with the tincture of Aconite without using any other medicine. Even in cases which had become chronic by previous mismanagement, we have effected cures by means of the exclusive use of Aconite. In the case of a gentleman, for instance, who had been under Old-school treatment for acute bronchitis for two months, and who then complained of spasmodic, tearing cough which seemed to start from the throat-pit, with stinging and burning pains in the throat, cutting pains in the bronchia, dyspnoea, palpitation of the heart, great soreness -under the sternum, expectoration of bloody pus, loss of appetite, night-sweats: we gave the tincture of Aconite, about two drops every twenty-four hours in water, and cured the patient perfectly, without a vestige of the cough remaining, in one fortnight. Sometimes it may be advisable to give SPONGIA TOSTA, a few drops or ten pellets in half a pint of water, a tablespoonful every two hours, if the cough is very dry, spasmodic, without any expectoration but a little frothy mucus; the coughing is attended with oppression of breathing, tearing sore pain in the region of the Adam's apple. Instead of the attenuatiohs, the tincture may be used, a few drops in the same quantity of water. HEPAR SULPHURIS is recommended by some physicians if the voice has a wheezing sound, the cough is dry, crowing, and the patient is oppressed for breath. It is also useful, if the terminal bronchia are the seat of the irritation, with dry, tearing, spasmodic cough. 65 758 SPECIAL THERAPEUTICS. DOSE.-A powder of the third trituration, dry on the tongue, every three or four hours. IODIUM may be used instead of Spongia, if this medicine should disappoint us; lodium is particularly adapted to scrofulous individuals, if the thyroid gland in front of the neck is disposed to become enlarged. (Goitre.) DOSE.-One or two drops of the tincture, in a tumblerful of water, of which a tablespoonful may he given every two hours, BELLADONNA may possibly be useful in some cases if the cough is very troublesome at night, tearing, and attended with purulent expectoration of an offensive kind; during a coughing fit the blood goes to the head, the skull feels as if it would fly to pieces. DOSE.-A few drops, or ten pellets, in twelve tablespoonfuls of water a tablespoonful every two or three hours. These are the principal remedies for bronchitis, laryngitis, and tracheitis; they may likewise be employed in the chronic form of these inflammations. If any other remedies in this form should be required, we may resort to those that have been recommended for Cough. In the chronic form benefit may be derived from KALI BICHROMICUM, a powder of the third trituration, Iry on the tongue, every three or four hours, if we have reason to suspect the formation of an ulcer in the trachea or larynx; the spot feels sore on pressure, and a cough is excited by pressure, with tearing, sore pain, and discharge of fetid pus from this spot. BROMINE may be used in the place of Iodium, same dose, if the air-passages feel very sore, with oppression of breathing, heat in the air passages. During the treatment of acute or chronic bronchitis, whatever other medicines may be used, a dose of Aconite should every now and then be interpolated. INFLAMMATION OF THE LUNGS. 759 REGIMEN.-During the treatment, the patient may use mucilaginous drinks, gum-water, barley-gruel, ricewater, and rice-gruel, jelly, and the like. Cold water is an appropriate drink. Pneumonia, Inflammation of the Lungs. Inflammation of the lungs is particularly frequent in ramp and raw seasons, when violent north-easters prevail; hence, the disease is most frequently met with during the months of December, January, until April or May. The immediate cause of the disease may be exposure to draughts of air when over-heated, walking or riding against a keen, cutting wind, sudden suppression of the perspiration, or of some habitual discharge of blood, such as the piles or menses. A violent attack of pneumonia generally sets in with a severe chill followed by dry heat, white-coated tongue, full and tense pulse (about ninety or one hundred beats), and dark urine. In many cases of pneumonia the pulse is not hard and jerking, but soft, beating from one hundred and ten to one hundred and twenty times in the minute. In these forms of the disease the patient is often drenched with sweat, and the urine deposits a sediment, generally towards morning. The fever in pneumonia generally remits towards morning, and the local symptoms abate at the same time; towards evening the fever returns again, with aggravation or exacerbation of all the local symptoms. These local symptoms are a sensation of oppression and heaviness on one side of the chest, if only one lung is affected, and over the whole chest, if both lungs are inflamed. The oppression --? 760 SPECIAL THERAPEUTICS. in many cases amounts to real dyspnoea. The cough which takes place spontaneously as well as when the patients attempt to draw a long breath, is either dry, or attended with expectoration of tenacious mucus, or mucus streaked with blood, or pure blood, or the socalled rusty sputa. The breathing is hurried and is carried on with the abdominal muscles rather than with the thorax. The percussion-sound of the inflamed lung is dull, and on applying the ear to the chest, a crepitating murmur is heard, similar, according to Schoenlein, to the noise which is caused by scattering table-salt on heated sheet-iron. Pneumonia may likewise have an intermittent fevertype. In the morning the fever symptoms and even the local symptoms intermit almost entirely; but towards evening the fever returns without any previous chill, and with the fever the disease again breaks forth with redoubled fury. The dyspnoea is extreme, the cough so violent that it seems as though the patient must die of suffocation; the pulse is hard and tense, and the patient seems in imminent danger"of death. During the violence of the paroxysms, the patient is often delirious. If both lungs are inflamed, we term the inflammation compound pneumonia. In this form of the disease,-thc pulse is small and tremulous, the patients are delirious When the inflammation has reached its acme, we term this condition of the lungs " red hepatization." In this state the lungs look dark-red, with a violet tinge, and have almost the consistence of liver. If an incision is made into the lungs, blood flows out. Hepatized lung is heavier than in the sound state; it sinks to the bottom of the vessel. At a later period of the disease, when an effusion of lymph takes place from the inflamed lungs, _I__ ~_ _ INFLAMMATION OF THE LUNGS. 761 they assume a grayish appearance, with here and there blackish streaks pervading the grayish mass as remnants of the pulmonary tissue. This stage of the disease is designated as that of "white hepatization." A healthy lung has a spongy feel, and is easily broken down or torn. A hepatized lung, on the contrary, ceases to crepitate, is dense like liver, of larger volume than in the normal state, and showing the impressions of the ribs. We may observe that if the inflammation affects the pleural covering of the lungs rather than their parenchyma or the substance of the pulmonary tissue, the thorax may feel exceedingly sore externally, and the patient experiences a sharp, shooting, lancinating pain when attempting to take a long breath. The Ordinary Old-school treatment of this disease is exceedingly murderous. In justice to many intelligent and humane practitioners of the Old-school, it should be stated, however, that the bleeding operations which, from time immemorial, have been deemed indispensable in this disease, have either been entirely abandoned or considerably modified by many of them. The homoeopathic treatment of pneumonia is principally conducted with ACONITE, BRYONIA, PHOSPHORUS, TARTARUS EMETICUS. Intermediate remedies such as: BELLADONNA, ARSENIC, SULPHUR, etc., may have to be used for intermediate symptoms. ACONITE is invariably used at the onset, when the inflammatory symptoms are fully developed, hard and bounding pulse, hot and dry skin, etc. DOSE.-A few drops, or ten globules, in a tumblerful of water, or a drop of tincture in the same quantity of water, of which a tablespoonful may be given every half hour, if necessary, or every hour or two hours, until the patient feels easier. Case after case of simple pneumonia has been cured by 65* _ _ ~__ _ ~ 762, SPECIAL THERAPEUTICS. homoeopathic practitioners with nothing but Aconite, in from three to five days, If Aconite is not sufficient, we may give BRYONIA, for tearing or loose cough, with stinging, shooting pains in the chest, soreness, oppression. DOSE.-Same as Aconite. PHOSPHORUS is a capital remedy for pneumonia, with violent dyspnoea, bloody expectoration, constant hacking or spasmodic cough, with an unceasing irritation to cough; the pulse begins to flag, the extremities are cold, and the patient is often delirious. Phosphorus is also homoeopathic to abscess in the lungs, with discharge of greenish, flocculent pus when coughing, and typhoid symptoms. DOSE.-The same as Aconite; or a powder of the third trituration, dry on the tongue, every two or three hours. TARTARUS EMETICUS is a good remedy toward the termination of the disease, when resolution is beginning to set in, and we are anxious to facilitate this process; the tenacious phlegm, which the patient hawks up, is loosened by this substance. DOSE.-Same as Phosphorus. BELLADONNA, one or two doses of one drop or six pellets each, may be given, if the brain seems very much disturbed, as manifested by stupor, muttering delirium, alternate pallor and redness of the face. ARSENIC may save the patient's life, if symptoms of gangrenous inflammation, or utter prostration of the vital forces, show themselves; the patient feels cold, the skin is clammy, the pulse thready and sinking, and the oppression of a suffocative character; the patient's countenance has an expression of anxiety and death-like alteration of the features. DOS$.-One or two drops, or a powder of the third trituration every twenty minutes, until symptoms of a decided reaction set in. __ __ INFLAMMATION OF THE LUNGS. 763 SULPHUR, a few globules twice a day, may be given during the progress of the treatment, if the patients are scrofulous, and the common medicines, even if correctly chosen, do not seem to have the desired effect, CHINA, a few globules, or one or two drops, may be given every two or three hours, if patients come to us after having undergone repeated venesections for pneumonia. It is best to alternate China with Aconite, an alternate dose every two hours. For chronic cough, remaining after pneumonia, consult the remedies indicated for " Cough," page 737. Syphilitic or gonorrhceal laryngitis is treated with the same medicines that we use for constitutional syphilis. If the disease can be traced to suppressed gonorrhoea, we may conduct the treatment principally with MERCURIUS SOLUBILIS, a powder of the first or second trituration, dry on the tongue, every three or four liours, or MERCURIUS CORROSIVUS, a powder of the,second or third trituration in the same manner, and COPAIVJE BALSAMUM, five drops of the balsam. three times a day, on a lump of sugar. ACONITE, tincture of the root as-above, should not be forgotten, if the symptoms of acute inflammation predominate. This drug may be alternated with any of the above-mentioned medicines. In syphilitic laryngitis, the same medicines may be used, and in addition, HYDRIODATE OF POTASH, six grains in two ounces of water, of which from twenty to twenty-five drops may be taken four times a day. REGIMEN.-The diet, during the treatment of this disease, should be of the lightest kind, simple gruels, tea 764 SPECIAL THERAPEUTICS. and toast, stewed apples, and, during convalescence, light broths without fat, and gradually simple vegetables, a thin slice of cold roast beef or mutton, etc. Cold water is the best drink; mucilaginous beverages are permitted. A variety of pneumonia, which patiologists term Bilious Pneumonia, May be mentioned in this place. The patients complain of a stitching pain, generally in the rig1t side of the chest, low down; this pain is accompanied with oppression, soreness, and cough, which is dry, spasmodic and often attended with vomiting. The cough results in the hawking up of a saffron-colored, greenish, frothy mucus, which is often streaked with blood. This form of pneumonia is treated with the same medicines as common pneumonia, principally, however, with ACONITE and BRYONIA, in alternation. ARSENIOUM may likewise be required, if indicated by the above-mentioned symptoms. Another medicine in this disease is MERCURIUS VIVUS, if the cough is tearing and spasmodic, with soreness of the affected part, and expectoration of a yellowish, sweetish or saltish purulent matter. DOSE.-Same as Arsenic, or Phosphorus. Another variety of pneumonia, which principally affects old people, is Pneumonia Notha. This is, properly speaking, a catarrhal affection of the chest, where the symptoms of nervous irritation predominate over the inflammatory. The patients expe RHEUMATISM OF THE LUNGS.,765 rience a stinging and burning pain in the chest, with loose cough and oppression; they expectorate mucus, which is sometimes streaked with blood. The disease inclines to terminate in paralysis of the lungs. We treat this disease with ACONITE, BRYONIA, ARSENICUM and PHOSPHORUS, commencing with ACONITE, same dose as mentioned previously. If insufficient; if the mucus is raised in increased quantities, and the pains do not yield, give BRYONIA, same dose as Aconite, with which it may be alternated; or, if there is much oppression, with danger of paralysis, coldness of the extremities, violent dyspncea, constant irritation and cough, give PHOSPHORUS, same dose as above; and if the patient suddenly threatens to pick, with hippocratio countenance, deathly coldness, collapse of pulse, ARSENIOUM, same dose as Phosphorus. REGIMEN.-See the remarks offered in the previous paragraph. In the case of old people, the moderate use of gentle stimulants, a little good wine, Bourbon-whiskey, or beer may not be inappropriate. Previous habits, circumstances and temperament have to be our guide in such cases. Rheumatic Pneumonia, Rheumatism of the Lungs, Is sometimes met with, especially during a rheumatic fall or spring season; the lungs feel sore, the patient complains of stinging, sore pains, sometimes only on the side; the pains are increased by a deep inspiration and by pressure on the outside of the chest or on the intercostal muscles. The inflammation sets in with chills followed by fever, after which the chills may return. ----------- 11 ý V 766 SPECIAL THERAPEUTICS. The skin feels dry, at most only a partial moisture breaks out on the forehead and chest; the pulse is quite frequent, one hundred and ten to one hundred and thirty beats in the minute, rather hard, jerking; the cough is accompanied with expectoration of a tenacious, frothy and sometimes rusty-looking mucus. The thirst is considerable, tongue coated, urine of a dark color. This form of pneumonia is principally treated with ACONITE and BRYONIA in alternate doses, a few drops or ten globules of each in half a pint of water, a tablespoonful every two hours. Aconite may be sufficient in some cases, or it may be continued for a few days, as long as the patient improves under its use. If the improvement seems to remain stationary, we may then resort to Bryonia, or give the two medicines in alternation. During the course of the treatment it will be necessary every now and then to interpolate a few doses of Aconite. It is exceedingly doubtful in our mind whether Phosphorus is ever required in purely rheumatic inflammations; nevertheless the reader will do well to read over the treatment of ordinary pneumonia for the purpose of ascertaining whether any of. the medicines there mentioned may not be required by some existing group of symptoms. Pleurisy, Pleuritis, Inflammation of the Pleura. The patient has been informed that the pleura is a serous membrane which envelopes the lungs and likewise lines the walls of the thorax. This membrane may become inflamed in consequence of exposure to a draught of air, sudden arrest of the perspiration, sudden change of temperature, or through some mechanical cause, INFLAMMATION OF THE PLEURA. 767 a broken rib, etc. The inflammation sets in with a chill followed by fever, heat and dryness of the skin, full and bounding pulse from ninety to one hundred, a stitch in the side, so that the patient is unable to take a long breath, short, hacking, or hard and tearing cough which the patient seeks to suppress all the time, with expectoration of blood and mucus; the affected side feels sore so that the patient cannot lie upon it; the pain and fever often induces delirium; the face looks flushed, and the patient often complains of dizziness, distressing headache, sickness at the stomach, vomiting, constipation, dark and offensive urine. TREATMENT.-The remedies for this disease are principally ACONITE and BRYONIA. ACONITE may be given alone at the commencement of an attack, if the above-mentioned symptoms are present. DOSE.-A few drops, or ten pellets in half a pint of water, giving a tablespoonful every half hour, until the patient feels more comfortable, after which the medicine may be continued every two hours. If the improvement remains stationary, BRYONIA may be given, same dose as Aconite, with which the former may be alternated, an alternate dose every two hours. SQUILLS, one or two drops of the tincture in ten tablespoonfuls of water, a tablespoonful every two hours, is not inappropriate in pleurisy of a sub-acute character, with loose cough and expectoration of a purulent, bloody substance. If effusion of serum has taken place in the side, Aconite may be alternated with SULPHUR, a powder of the third trituration at a dose, an alternate dose every hour. If chronic cough remains, which is hardly ever the ~h 7682 SPECIAL THERAPEUTICS. case under homceopathic treatment, consult the remedies for " Cough." If the attenuated Aconite should fail of producing the desired effect, and the symptoms still indicate Aconite, do not hesitate to use a 'drop of the tincture instead of the attenuated dose, in the same quantity of water. REGIMEN.-The same as that recommended for pneumonia. Pleurodynia, or False Pleurisy, Is a stitch in the side without much, if any, fever. It is an inflammatory irritation of some intercostal muscle produced by exposure to a draught, or by a strain. The pain is particularly severe during an inspiration, when the intercostal muscles are put upon the stretch. This pain may be removed by.the internal use of ACONITE AND ARNICA, a drop of the tincture in separate tumblerfuls of water, in tablespoonful doses, an alternate dose every hour. At the same time a wet bandage may be applied to the affected side. If a strain had anything to do with the pain, the bandage may be moistened with a mixture of forty or fifty drops of Arnica-tincture in a pint of water. Congestion of the Lungs. By congestion of the lungs we understand an engorged condition of the pulmonary capillaries. An acute congestion of the lungs sets in with a chill, which is soon followed by a hot fever. The chest feels sore, the patient complains of oppression of breathing, hard aching pains in the chest, and has to cough more or less all the time, CONGESTION 0'F THE LUNGS. 769 or the cough breaks forth in paroxysms, is hard and tearing, spasmodic; a paroxysm is often excited by an insupportable tickling in the windpipe, and causes a loss of breath and perfect exhaustion after the paroxysm is over. During the coughing fit the head feels as if it would snap, or fly to pieces. The fever in this disease has a remittent type, and is characterized by exacerba. tions which generally take place in the evening and during the night. The bowels are generally confined and the urine is dark-colored and has a strong smell. At the commencement there is very little,;if any expectoration after coughing, at most some frothy mucus which is sometimes streaked with blood, if the paroxysm is very violent; gradually the expectoration becomes more copious, consisting of tough and even purulent mucus. The main remedy for this disease is ACONITE of which we may mix a drop of the tincture of the root, or a few drops of the attenuated Aconite, or ten pellets in half a pint of water, and give the patient a tablespoonful every two hours. This drug will often suffice to remove the whole difficulty, though we should have to use it more or less, at intervals of from two, to four or six hours, for several consecutive days, even for a week. We may alternate this medicine with BRYONIA, same dose as Aconite, or with BELLADONNA, same dose as Aconite, if the head feels excessively sensitive, as if it would split during a coughing fit, though this symptom may likewise point to Aconite and be perfectly covered by this drug. Give an alternate dose every two hours. MERCURIUS VIVUs is indispensable in congestion of the lungs, if the mucous lining is the primary seat of 66 770 SPECIAL THERAPEUTICS. the irritation. The chest feels tight, oppressed, the cough is hard, tearing; after a spasmodic paroxysm of cough, preceded or -excited by titillation, a little sweetish or saltish mucus may be hawked up. Generally a pain is felt when coughing at some particular spot, where the congestion seems to have become fixed, and unless scattered, might terminate in suppuration or ulceration. This symptom is a pathognomic characteristic of acute pulmonary congestion, and likewise indicates Aconite, An additional indication for Mercurius in this disease is a sallow complexion, a dingy color of the skin generally, strong-smelling and deep-yellow urine which smells very foul after standing, and obstinate constipation, with excessively dry, lumpy excrements having a pale greenishbrown color. DOSE.-A few drops, or ten pellets, in a tumblerful of water, of which a tablespoonful may be given every two hours, or else a powder of the third trituration, dry on the tongue, every three or four hours. REGIMEN.-The same regimen may be observed as has been recommended for pneumonia. Passive or Chronic Congestion, Rush of Blood to the Chest, Fullness, Oppression of the Chest, May be characterized by chronic cough, in which case this condition of the chest has to be treated with the same medicines that have been recommended for "Cough," see page 737. But passive congestion of the chest may be characterized by other symptoms, such as occasional fullness about the chest, a sensation of fluttering or an undulating sensation in the chest, feeling of warmth in the chest; a desire to relieve the chest by taking a long breath; occasionally a dull, seated pain may be experienced in some part of the chest; or a little __ ASTHMA, DYSPNEA, ETC. 771 soreness may be complained of, oppression, inability to walk fast or to ascend an eminence without losing one's breath. The chest sometimes feels hollowed out; the patients describe this condition as a goneness, a feeling of goneness. They likewise suffer with palpitation of the heart, dizziness, general debility, restless sleep which is disturbed by dreams or by night-mare; or they may be troubled with wakefulness. If these symptoms occur, give ACONITE, a drop or a few globules twice a day, morning and evening. It may be necessary to take a few doses of this medicine every now and then, before the difficulty is effectually removed. This condition of the chest is apt to trouble hysteric females, who are afflicted with excessive and too frequent menstruation. If it should set in as a consequence of menstrual suppression, Aconite may be given in alternation with PULSATILLA, same dose as Aconite, Pulsatilla in the morning, and Aconite at night, a few doses of each until the menses return. Asthma, Dyspnoea, Apnoea, Spasm of the Chest. By dyspnoea we understand a difficulty of breathing. This may either be symptomatic or idiopathic. If it is a symptom of pulmonary disease, such as pneumonia, phthisis, etc., it will yield with the disease itself; if it is idiopathic or a morbid condition by itself, not symptomatic of some other disease, it requires to be treated by the medicines which will be found mentioned below. APN(EA is a higher degree of dyspnoea, a constriction of the chest amounting to suffocation or a complete ~ L 772 SPECIAL THERAPEUTICS. inability to breathe. This may likewise be either symptomatic or idiopathic. As an idiopathic condition it requires to be treated with ACONITE, ARSENIC, IPECACUANHA, or some one of the other remedies mentioned in the subjoined list. ASTHMA is a spasmodic difficulty of breathing; it occurs in paroxysms which take place with a certain periodicity, every week, fortnight, month, or even every six months or once a year. The paroxysms generally come on at night or towards evening, sometimes without any premonitory symptoms; at other times the patient feels somewhat oppressed or "stuffed" as it is termed, for a few days previous to the outbreak of the paroxysm. Sometimes the patients are suddenly waked from sleep by the attack. The attack sets in with a feeling of constriction across the chest; the thorax refuses to expand; during the respiratory movements the thorax is rather heaved up and down; every inspiration is accomplished with a sudden jerk, which is sometimes so violent that it seems as though the lateral muscles of the neck (the sterno-cleido mastoidens-muscles) would snap.:The breathing has a wheezing sound, and is carried on with the greatest distress. The patient desires to be fanned, to have the windows opened and to have the chest freed from all pressure. He has to sit up in bed or on a chair, with the head inclined forward and the shoulders drawn up. After repeated attacks the chest begins to cave in, and looks hollow. During the paroxysm the face of the patient looks distressed, bloated, flushed.; the lips have a purple or pale look, the eyes protrude, look bloodshot. An attack may last from a couple of hours to one or more days and even weeks. If the patients begin to expectorate, they feel relieved. In dry asthma the attacks ASTHMA, DYSPNCEA, ETC. 773 pass off without expectoration; in moist or humid asthma, the attacks terminate in loose cough. The expectorated substance is mucus, which sometimes looks like pus, and may be discharged in enormous quantities. The causes of asthma are various; it may be an hereditary weakness, or the disease may be induced by suppression of an eruption, nettlerash, tetter, salt-rheum. It may also develop itself gradually as the result of neglected catarrh, or of inflammatory chest-affections mismanaged by frequent and copious depletions, particularly in the case of young, plethoric and sensitivelyorganized individuals. Spasmodic asthma is variously affected by the state of the weather, by climate, dryness or moisture of the air, mountain-air or low and damp districts. A low and damp region of country generally disagrees with asthmatic patients, and excites the attack. A dry, soft, sufficiently bracing inland-air is more suitable.' Some patients are so sensitive to atmospheric influences that they will breathe with perfect ease on one side of a house, and be attacked with asthma on the opposite. The inhabitants of mountainous districts, where the air is pure, though cold, are scarcely ever attacked with asthma. Asthma, unless cured, may give rise to organic diseases of the heart, hypertrophy of the right ventricle, hydrothorax, with general marasmus. This very obstinate disease is often cured under homceopathic treatment. Sometimes, however, medical treatment proves unavailing, and nothing seems to have any effect, except a change of residence. Among the medicines which we use for dyspnoea, apnoea and spassmodic asthma, we distinguish ACONITE, ARSENICuM, 66* I ~ ~ _ 774 SPECIAL THERAPEUTICS. IPECACUANHA,.LOBELIA INFLATA, MOSCHUS, NUX YOVMICA, PULSATILLA, CHAMOMILLA, CUPRUM, VERATRUM.. ACONITE is useful in dyspnoea, apnoea and asthma, if the paroxysm is attended with a feeling of oppressive anguish, irregular action of the heart, violent determination of blood to the head, purple color of the face, coldness of the extremities, sickness at the stomach, and gradual supervention, towards the conclusion of the paroxysm, of a feverish condition of the system. DOSE.-A few drops, or ten pellets, in a tumbler of water, a tablespoonful every half hour during the attack. ARSENICUM is useful in chronic asthma, when the paroxysms are attended with a feeling of excessive anguish and suffocative constriction across the chest, with excessive thirst and parchment-like dryness, or cold and clammy feeling of the skin. DOSE.-Same as Aconite. IPECACUANHA may be given after, or in alternation with, Arsenic, if the attack comes on quite suddenly, with spasmodic tightness across the chest, an utter inability to expand the chest, a feeling of death-like anguish and oppression, cold extremities, sickness at the. stomach, with gagging and vomiting of tenacious mucus. The attacks come on at night, with the regularity of fever. paroxysms; or during a first attack, caused by the sudden disappearance of a rash. DOSE.-Same as Aconite, but more frequently, say every ten minutes until the patient feels easier. VERATRUM is excellent in spasmodic constriction of, the chest, with gagging and retching, dull and stupid feeling in the head, and perhaps spasmodic pains in the bowels, as from incarcerated flatulence. DOSE.-Same as Aconite. ASTHMA, DYSPNCEA, ETO. 7W5 Nux VOMICA is excellent in cases of asthma affectingpersons addicted to high living, excessive use of tobacco, and irregular habits generally; they complain of an oppressive, aching, pain in the chest; the respiration is exceedingly wheezing, and seems to be carried on with the abdominal, rather than with the intercostal muscles; every now and then the patient has a paroxysm of coughing, and, after great effort, raises a quantity of tough phlegm; the attack may last an indefinite number of hours or days, and is distinguished, as an attack of asthma generally is, by evening or night exacerbations. DOSE.-One drop of the attenuated medicine every six hours; we remember a most distressing case where a cure was effected by means of a drop of the strong tincture. LOBELIA INFLATA has cured spasmodic asthma. It may be given before or after Nux. The patient complains of oppression, aching pains in the chest, a constrictive tightness in the lungs, as if the air-cells were deprived of all power of expanding; burning pain in the epigastrium and air-passages, or throat; great agony of breathing. DOSE.--The Thompsonians who.depend upon this drug as a: standard article in their prescriptions, give it in teaspoonful doses during an attack of asthma, and many cures are reported by them as having been effected by this heroic treatment. Homoeopathic physicians obtain the same results by giving drop-doses of the tincture or even, of the attenuated drug every half, hour or hour, during an attack. MOScHUS, half a grain of the first. decimal trituration, may be administered as a palliative during a fit of suffo. cative asthma, when the patient looks pale as if he would die, and cold; Moschus may stimulate the vital reaction and prepare the way for some other drug. PULSATILLA may do good in the case of sensitive females, with impressible temperaments, and suffering 776 -SPECIAL THERAPEUTICS. with menstrual suppression; they complain of habitual dyspnoea or asthmatic oppression, especially at the time when the menses should appear; the attack may pass off with profuse expectoration and cough. DOSE.-Same as Aconite, with which Pulsatilla may be usefully alternated. CHAMOMILLA is useful, if an attack should be provoked by a fit of anger, with a general accompaniment of bilious symptoms, vomiting of bile, headache, sallow complexion; or by sudden suppression of perspiration, with spasmodic stricture across the chest, aching pain and soreness in the chest; or in the case of children who lose their breath by crying, or during a coughing fit. DOSE.-Same as Aconite, until the patient feels easier; afterwards every two or three hours. CUPRUM METALLICUM may be of service in a few cases, characterized by short, spasmodic cough, suffocative paroxysms, wheezing inspirations, and a feeling of agonizing distress. DOSE.-A powder of the third trituration dry on the tongue, every hour, or two hours, until relief is obtained. HYGIENIC TREATMENT.--Persons who are subject to asthma must manage to live in- a climate that agrees with them. Low and damp places are generally unfavorable. A wet bandage on the chest may be useful in some cases. During a paroxysm, the distress may sometimes be relieved by drinking a cup of strong black coffee, sweetened with sugar, or smoking Stramoniumleaves, or even tobacco, provided the patients are no habitual smokers. If asthma is caused by repelled itch, there is great danger of tubercular phthisis setting in, in the course ASTHMA, DYSPN(EA, ET(O 777 of the disease. The patients are no longer troubled with asthma, but the symptoms of phthisis make their appearance in its stead; they feel a stitching pain in the chest, they commence to hack, feel oppressed, and an examination reveals the formation of tubercles. If we do not succeed in bringing the eruption out again, by the internal use of SULPHUR and HEPAR SULPHURIS, in half grain doses of the second or third trituration, or even lower, and in other cases higher, according to the disposition or idiosyncratic sensitiveness of the patient, he has no chance of recovery. These medicines may be repeated every. three, four or six hours. Hepar sulphuris may be administered, according to Autenrieth's method, externally and internally; see a description of this method, page 473. Old people are, in some instances, subject to dyspnoea which is more or less permanent and often increases towards evening to a violent paroxysm of asthma. According to Schoenlein, the breathing is habitually short and hurried, especially when the patients attempt to walk rapidly, or to ascend an eminence, stairs, etc. During the asthmatic paroxysms they sit in bed, breathing with the abdominal muscles, with the trunk bent. forward, and their necks stretched. The face is pale, expressive of anguish. The extremities are cold, the pulse small, intermittent.; the beats of the heart are at times so feeble that they are almost imperceptible, at other times a sort of palpitation is observed. The attack may terminate in the discharge of a small quantity of tracheal mucus, (dry asthma with wheezing, sawing respiration,) or in increased secretion of a tenacious, ball-shaped mucus, (asthma humidum,) with rattling breathing. I ~L ~ 778 SPECIAL THERAPEUTICS. This form of asthma, which is technically designated Asthma senile Sooner or later terminates fatally. Death is caused by ossification of the arterial vessels, (aorta, pulmonary or coronary arteries,) paralysis of the heart or lungs, or pulmonary disorganizations of various kinds. The only medicines with which any relief can be afforded are: ACONITE, DIGITALIS, ARSENICUM and IPECACUANHA. ACONITE, if the paroxysm sets in suddenly; the patient looks cadaverous, the extremities are icy-cold, the heart either ceases to beat or labors irregularly and with great difficulty, the breathing is exceedingly superficial and the patient's features are expressive of deathlike agony. DOSE.-Two drops of the tincture of the root, in eight tablespoonfuls of water, of which a teaspoonful may be given every five minutes, until reaction sets in. DIGITALIS and ARSENIOUM, if the dyspncea is more or less permanent and symptoms of hydrothorax seem to develop themselves. DIGITALIS is particularly indicated, if the pulse intermits, not only during the erect but also in the recumbent posture. It may be alternated with Aconite. DOSE.-Same as Aconite. ARSENIC is suitable, if the patients complain of an agonizing oppression in the region of the heart, and look sallow, jaundiced, or have a cherry-brown complexion. DOSE.-A drop, or ten globules every four or six hours; or a powder of the third trituration dry on the tongue, as often. IPECACUANHA is adapted in sudden paroxysms, such as have been described under Asthma, page 774. L.... __ _ _ __ SUFFOCATIVE CATARRH OF CHILDREN. 779 Speaking of asthma, we may as well describe in this place a form of asthma to which children are sometimes subject and which, after Millar, an English physician who first described the disease in the last century, has received the technical name of Asthma Millari, Suffocative Catarrh of Children. Little children, more particularly infants at the breast, are liable to being attacked. After the first milk-teeth are cut, all danger of further paroxysms seem to pass away. It is especially frequent in damp, wet seasons, and may be occasioned by just such an exposure as might lead to croup, inflammation of the brain, etc. The disease may terminate fatally in a few hours, or it may last two or three days or even weeks. Sometimes precursory symptoms are present, but they may likewise be wanting. The children cough in the day-time; towards evening the cough has a ringing sound, and a little fever is present. At other times the attack comes on suddenly; about midnight the children start up suddenly from sleep, toss about in their bed, draw up the larynx and shoulder-blades, and the respiratory muscles are spasmodically agitated; the respiration is panting, short, unequal, with a hollow metallic ring, but seldom any wheezing. The face looks blue and the eyes protrude from their orbits; the extremities are cold, the pulse is small, contracted, tremulous, intermittent; pressure upon the larynx does not excite the least symptom of pain. The paroxysm may last from two to ten minutes, with intermissions. At the close of the paroxysm the children cough up a quantity of tenacious mucus, sometimes with inclination to vomit. After L~~ ~~ ~ _ ~ 780 SPECIAL THERAPEUTICS. the attack the little patients feel exhausted, fall asleep, and wake in the morning without any signs of illness. If the paroxysms become more frequent, they last longer, and finally take place even in the day-time, so that the intermissions cease to be entirely free from symptoms of irritation. There seems to exist an intimate relation between the spasmodic character of this disease and an inflammatory action set up in the laryngeal mucous membrane, or even in the external integuments of the larynx. Oldschool physicians are well aware of this fact, and hence many of the most experienced practitioners of that School propose to act upon the disease by setting up an artificial inflammatory process in the region of the larynx. In our practice we do not resort to the same means of treatment. But our treatment of this disease is based upon the same pathological view which takes the implied correlation between the spasmodic and inflammatory character of Asthma Millari for granted. Hence we treat the disease with remedies which are alike adapted to spasm and inflammation. Such remedies are: Aconite, Belladonna, Chamomilla and Sambucus, In Old-school practice Moschus, Asafoetida, Valerian and other anti-spasmodic agents are employed in this disease strictly in accordance with their principle of CONTRIARIA; these drugs can at most be recommended as palliatives in large doses. In homoeopathic practice, no case of asthma Millari can resist the action of the above mentioned medicines, if a cure is at all possible. We can affirm that we have effected cures of this disease with Aconite alone, without using any other medicine. We mix a drop or two of the first decimal attenuation of the root in two tablespoonfuls of water, and give ten or ASTHMA THYMICUM. 781 fifteen drops of this) mixture every two or three minutes, until the patient is decidedly easier. If no positive relief is obtained after giving a few doses, we substitute a drop of the tincture in the same manner as before. BELLADONNA may be administered during the continuance of the attack, if children have large heads, the head feels hot, the color of the face is apt to change from one extreme to the other. DOSE.--A drop, or ten pellets, in six tablespoonfuls of water, a dessertspoonful every two or three hours. CHAMOMILLA, if the children are very fretful, flushed in the face or only on one side; they grasp at the throat, seem oppressed, troubled with a dry, spasmodic cough. DOSE.-Same as Belladonna. SAMBUCUS is very useful, if after the paroxysm is over, the children perspire profusely; both Chamomilla and Sambucus are excellent, if the disease seems to have originated in suppressed perspiration. DOSE.-Same as Belladonna. Any of these medicines may be alternated with Aconite at the very commencement of the attack. IPECACUANHA may be given, if a titillating spasmodic cough remains after the attack, same dose as Belladonna. This, however, need not be feared under the use of the above mentioned remedies. Some physicians regard Asthma Thymicum As a variety of the former; others look upon it as a distinct disease. It has been first described by Kopp whose name it sometimes bears, Kopp's asthma or asthma Koppii. The child suddenly wakes at night with a shrill cry, seems to suffocate, the face becomes blue and 67 ~~ ti2 SPECIAL THERAPEUTICS. livid, the extremities cold, the pulse small, feeble intermittent, unequal. After a while the spasm ceases, the children commence to cry very:vehemently, and feel very much prostrated. This form of asthma is connected with hypertrophy of the thymus gland, (a-glandular body situated under the sternum, which is very large in the fetus, but disappears almost entirely in after-age, and the uses of which are unknown;) the gland swells up in consequence of vascular engorgement, and, unless this is removed, the little patient will eventually perish. Hence we treat this affection, during the acute attack, with Aconite and Belladonna, like asthma Millari, and, if a disposition to the disease should remain, we may endeavour to eradicate it with IODINE, mixing a drop of the tincture in four tablespoonfuls of water, of which a teaspoonful may be given to the little patient three times a day. REGIMEN.-Children who are threatened with asthma, should be kept out of draughts, and away form all exposure to dampness and sharp winds. Phthisis. Phthisis is a morbid condition which developes itself as a secondary disease out of some other primary disturbance. It may be caused by previous inflammation, by a tubercular dyscrasia, or by a suppurative process set up in the substance of an organ in consequence of the irritating presence of foreign bodies, such as drugs, etc. Any organ where suppuration is possible, and which affects the general condition of the organism, may be attacked with phthisis; but the organs where the secretory process is conducted with the greatest activity, LARYNGEAL PHTHISIS. 7!838 are most frequently the seat of this disease. According to most observers, the mucous membrane of the respiratory organs and bowels is most frequently attacked; next the urinary and osseous. systems, and lastly the brain and spinal marrow. Phthisis is a suppurative process characterized by loss of flesh, a gradual and finally a complete disappearance of the adipose or fatty matter of the body, and hectic fever, which is at first intermittent, but gradually assumes a remittent, and finally a continuous type. In a popular work, like the present, it is impossible to do much more than present a general view of the most important forms of phthisis, and to point out the treatment which may possibly arrest and perhaps eradicate the disorganizing process. It may be doubted whether a radical cure of phthisis is possible under any circumstances. One thing, however, is certain, that ihe homoeopathic treatment of this disease, if judiciously conducted and begun in time, holds out fair chances of recovery, provided the external circumstances in which the patient is placed, favor the treatment. -4--t-e-- PHTHISIS OF THE RESPIRATORY ORGANS. a. Laryngeal Phthisis. Schoenlein gives the following description of this disease: "At one spot of the larynx the patients experience a prickling, stitching, burning or constrictive pain. This pain is likewise felt by the patient, if the larynx is pressed upon, especially if the ulcerative process is _7 784 SPECIAL THERAPEUTICS. going on in a part which is not covered by cartilage. If the ulcer is situated on the posterior wall of the larynx which adjoins the oesophagus, deglutition is sometimes impeded to such a degree that perfect dysphagia is the consequence, and both solid and liquid nourishment is discharged again by the mouth and nostrils. It sometimes happens that the ulcer perforates the wall of the larynx so that a communication is established between the windpipe and the oesophagus, and liquids, which the patient attempts to swallow, penetrate into the trachea and are coughed up again. The voice loses its metallic ring, becomes sonorous, hoarse; at a later stage of the disease, the voice becomes completely extinct (aphony). The cough is characteristic; it does not proceed from the chest, but from the larynx, a sort of hawking for the purpose of expelling the secreted matter from the larynx. At times the cough sets in in paroxysms, during which the rima glottidis becomes contracted, and the patients seem suffering with croupy symptoms, accompanied by a violent sense of constriction in the throat, which threatens suffocation. The expectoration is quite considerable in proportion to the size of the ulcer, a purulent mucus mixed with a good deal of saliva. If the color is located high up in the larynx, the tonsils and fauces are of a fiery-red. The root of the tongue is always thickly coated; only one side of the tongue is coated, a large streak extends from the root to the tip of the tongue, showing on which side the ulcer is seated in the larynx. An exploration with the finger shows that the glottis and epiglottis are puffed up, cedematous; they have lost their smoothness. Auscultation reveals a rattling sound induced by the accumulation of mucus in the larynx. Hectic fever is present: _Y LARYNGEAL P~ITHISIS. 785 a frequent, hurried pulse, colliquative sweats, very frequently colliquative diarrhoea and dark urine, which is sometimes.covered with the oily pellicle peculiar to phthisis." This disease may be caused by exposure, by repelled itch, or by the suppression of gonorrhoea or chancre. If the disease is not caused by syphilis, but has a rheumatic origin, or springs from a scrofulous or tuberculous dyscrasia, we first endeavor to control the inflamnatory process by giving ACONITE, one drop of the tincture of the root in half a pint of water, of which the patient may take a tablespoonful every two or three hours. This medicine has to be resorted to every now and then during the treatment. Another excellent remedy in this disease is SPONGIA TOSTA, same dose as Aconite, or a few drops of the first decimal attenuation instead of the tincture, if the paroxysms of suffocative cough become very troublesome; this drug may be given in alternation with Aconite. HEPAR SULPHURIS may be given if the cough is attended with purulent expectoration, wheezing respiration, hoarseness, excessive feeling of dryness in the larynx. DOSE.-A powder of the third trituration every four hours. If Hepar should prove unavailing, we may give KALI BICHROMICUM, same dose as Hepar. DROSERA has been recommended if the cough is spasmodic, with suffocative anxiety and constriction, dryness, wheezing; this medicine will prove utterly unavailing after the ulcerative process has become fairly established. 67* 786 SPECIAL THERAPEUTICS. DOSE;-A few drops, or ten pellets, in a tumblerful of water, giving a tablespoonful every three hours. This medicine may be alternated with Spongia. IODINE is useful in the case of scrofulous individuals, if the larynx feels dry, with continual paroxysms of spasmodic irritation, wheezing respiration, suffocative cough, expectoration of tenacious, and even purulent mucus. If Iodine is insufficient, and the purulent expectoration increases, we may give IODIDE OF MERCURY. Of Iodine mix one or two drops of the tincture in six tablespoonfuls of water, and give a dessert-spoonful of this mixture every two or three hours; of the Iodide give a powder of the third trituration every four hours, dry on the tongue. CONIUM MACULATUM AND SULPHUR may likewise be of advantage to scrofulous individuals, the former if they complain of a dry, burning spot in the larynx which gives rise to constant hacking, and the latter, if the larynx feels as if full of smoke. DOSE.-Of Conium, give one drop, or six pellets, three times a day, and of Sulphur the same dose, or a powder of the third trituration three times a day. If laryngeal phthisis has a syphilitic or gonorrhceal origin, we may treat the disease with ACONITE, IODIDE OF MERCURY, the HYDRIODATE OF POTASH, and the Mercurial preparations, especially MERCURIUS SOLUBILIS, MERCURIUS CORROSIVUS, the NITRATE OF MERCURY, and NITRI ACIDUM. COPAIVJE BALSAMUM may likewise be employed. Of the Copaiva five drops may be given three times a day. Of the mercurial preparations we may use the third trituration, giving a powder dry on the tongue every four hours. The Hydriodate of Potash is best used in substance, six grains to be dissolved in two ounces of water, of which from fifteen to twenty drops may be given three or four times a day. CONSUMPTION. 787 CONSUMPTION. 787 REGIMEN.-Patients who are afflicted with this disease, should absolutely refrain from talking; a warm and humid atmosphere suits them better than a dry and keen air which would excite the ulcerative process. Stimulants have to be avoided. Nourishing diet is the best; whatever the patient eats, should be of easy digestion, lamb or chicken-broth, the.soft part of oysters, stewed, raw or boiled, oyster-broth, cold roast beef or mutton in moderate quantities, fresh milk, provided it otherwise agrees with the patient, etc. Phthisis Pulmonalis, Pulmonary Phthisis, Consumption. Consumption of the lungs is a very common disease in all parts of the world where the climate is subject to frequent and sudden changes. Regions of country situate in the temperate zone, are principally visited by this disorder. The disease may be hereditary, or it may be excited by frequent and severe exposure. Consumption of the lungs sometimes steals along very insidiously; it may be years before the disease breaks out in its devastating fury. The character of this disease consists in dissolution of the pulmonary tissue. An excavation is established where the parenchyma becomes thus disorganized; this excavation may extend in size, breaking down one portion of lung after another. At first these excavations may be small, filled with fragments of purulent matter, and the surrounding pulmonary parenchyma may preserve its solidity and compactness, although infiltrated with blood and water. Percussion at this part will yield a dull sound, duller even than in the normal condition of the lungs. But if the excavation is of larger size; if a whole lobe of. the C_ ~ ~~_ ~ 788, SPECIAL THERAPEUTICS. pulmonary tissue has become destroyed, and the cavity is perfectly hollow and not filled with pus; and if the lungs are moreover adhering to the costal pleura (or that portion of the pleura which lines the walls of the thorax), percussion will yield a clear, vibrating sound. Auscultation yields the following results: a. absence of the normal respiratory murmur, no matter whether the sound obtained by percussion is otherwise clear or dull; b. vesicular crepitation; this is caused by air-vesicles becoming mixed up with the fluid contained in the cavity, which afterwards break and cause a peculiar crepitating murmur; but if the cavity is empty and communicates with the bronchia, a blowing sound is heard at the moment when the air rushes into the cavity; o. pectoriloquy; this phenomenon takes place if an empty cavity communicates with a bronchial tube; on applying the ear or the stethoscope to this cavity, the sound of the patient's&voice seems to strike the ear directly ascending out of the chest through the stethoscope; this peculiar sound can only be perceived if the lungs adhere to the costal pleura, and the opening of the bronchial tube into the cavity is not obstructed by mucus or pus. Before making this experiment, it is advisable to cause the patient to clear the air-passages by coughing up as much mucus as possible. Cough is not always a very troublesome symptom in pulmonary consumption. In some cases of phthisis it is entirely wanting towards the latter part of the disease. In many cases the patient is not troubled at all by cough in the night; nor is the cough very violent in the day-time. The same differences exist in regard to the copiousness of the expectoration. Schoenlein observes that enormous cavities have been known to CONSUMPTION. 789 CONSUMPTION. 789 exist without scarcely any expectoration, whereas in other cases small cavities were attended with very copious expectoration. The expectoration is most copious in tubercular phthisis. During the last stage of the disease, the expectoration gradually diminishes in quantity, and finally ceases altogether. The character of the expectoration differs in different individuals. In tubercular phthisis the expectoration may consist of a cheesy or gelatinous nucleus surrounded by flocculent mucus detached from the lining membrane of the trachea. Or the expectoration may consist of a purulent mass mixed with blood; it may look yellowish, or else whitish like cream: at other times it has a greenish tinge, or is of a dingy-brown appearance, and has a very fetid, cadaverous smell. It may be more or less consistent,, at times very tenacious, and at other times fluid; it has generally a sweetish and sickening taste. The constitutional symptoms which are the regular accompaniments of pulmonary consumption are a general wasting of the adipose tissue contained in the muscles. Hence, the muscles become flabby and soft. Hectic fever is always present. It may either have an inflammatory type from the very onset of the disease, or else it may assume: the character of torpor, a typhoid type, which runs a rapid course and constitutes what we have been in the habit of terming galloping consumption. If this type prevails, the patient's life may be destroyed after an illness of a few weeks only. Other constitutional symptoms are colliquative sweats, and colliquative diarrhoea; they may either co-exist, or else they may break forth as substitutes of one for the other. As regards the character of the urine, it is often tolerably clear and light colored; in other instances, it looks dark, deposits _~ 790 SPECIAL THERAPEUTICS. a copious sediment of urea, and has a strong ammoniacal odor. Pulmonary phthisis may be caused by the presence of foreign bodies in the pulmonary tissue; a wound inflicted by a ball or sharp instrument, may likewise lead to phthisis. An ulcerative process may be set up within the pulmonary parenchyma, which may gradually destroy this organ. This form of pulmonary phthisis is designated as ulcerative phthisis. Tubercular Phthisis is a form of phthisis where tuberculous portions of the pulmonary parenchyma soften and suppurate. This leads to the gradual destruction of the organ. For a description of pulmonary tuberculosis the reader is referred to the chapter on Tuberculosis, pages 498-569. Tubercular phthisis is the most distressing form of pulmonary consumption. The gradual breaking down of the lungs is often attended with agonizing distress. The disease is marked by violent paroxysms of chills, followed by burning fever and exhausting sweats. The burning distress in the lungs and the dyspnoea are exceedingly troublesome and prostrating. Towards the last, the patient is often unable to lie down, and has to be supported in a sitting posture. The cough is racking and agonizing in the extreme. The patients -die of gradual exhaustion and suffocation. Mucous or pituitous phthisis is a mild form of phthisis, which consists in the gradual wasting away, by suppuration, of the pulmonary and bronchial mucous membrane. The patients sometimes preserve their appetite to the last, rest comfortably at night, barring slight nightsweats; the fever is of a mild type, the cough loose, and the decline of vitality takes place very gradually. Patients have no difficulty in breathing with comparative CONSUMPTION, SYMPTOMATIC INDICATIONS. 791 ease, and expanding the chest. The bowels are rather loose, but they are seldom moved more than twice a day; the stools are soft, but not diarrhoeic, except occasionally. The treatment of pulmonary phthisis is conducted with the following remedies: ACONITE, BRYONIA, BELLADONNA, ARSENICUM, SPONGIA, IODINE, IODIDE 'OF IRON, IODIDE OF MERCURY, MERCURIUS VIVUS, SULPHUR, CALCAREA CARBON., STANNUM, KALI CARBONICUM. Symptomatic Indications.,,ACONITE is one of the leading remedies in phthisis, and should be exhibited, every now and then, during the whole course of the disease. We. may use the first attenuation, the common tincture prepared from the leaves and blossoms, or the tincture of the root, one drop in half a pint of water, giving a tablespoonful every two, three or six hours, as the case may be. BELLADONNA is excellent, if the patient coughs up bright-red blood every now and then; the color of the countenance changes frequently from pale to red, and vice versa; the expectoration has a foul taste,'the tongue looks dry, brown, parched, with torpid fever and symptoms of a typhoid type stealing on. DOSE.-A few drops, or ten globules, in a tumblerftil of water, of which a tablespoonful may be taken every three or four hours. Or a drop of the tineture instead of the attenuation. BRYoNIA, for tearing cough, with profuse expectoration of mucus. DOSE.-Same as Belladonna. PHOSPHORUS, for dry and exhausting cough, with abscess in the lungs, discharging a- greenish, fetid pus. General typhoid symptoms,.muttering delirium, torpid fever; galloping consumption. - - MAP W -- ---- -- IF 792 SPECIAL THERAPEUTICS. DOSE.-A powder of the third trituration, dry on the tongue, every three or four hours, ARSENICUM, for violent chills, followed by burning fever and sweat, thirst, dry and racking cough, diarrhoea, deep-colored and foul urine. DOSE.-Same as Phosphorus. HEPAR SULPHURIS, for cough, with bubbling and burning pains in the lungs, discharge of profuse quantities of yellow pus, hoarseness, wheezing breathing. DOSE.-Same as Phosphorus. SULPHUR may be useful in the case of scrofulous patients, if the air-passages feel as if they were filled with smoke; the cough is dry and hard, or attended with expectoration of gray and sweetish mucus. This medicine is particularly appropriate, if we can connect the origin of the disease with the suppression of the itch, or an itch-like eruption. DOSE.-Same as Phosphorus, or a few drops or ten globules, in a tumblerful of water, of which the patient may take a tablespoonful every four hours. SPONGIA and IODINE are useful in the case of scrofulous patients, who are, or had been, affected with goitre; more particularly if the development of phthisis dates from the disappearance of the goitre. The cough is dry, rather spasmodic, the expectoration scanty, tenacious, of a muco-purulent character. DOSE.--Of Spongia, the same as Belladonna, and of Iodine two drops of the tincture in ten tablespoonfuls of water, of which the patient may take a tablespoonful every three or four hours. IODIDE OF IRON is recommenaed as a great remedy for phthisis, even if the disease is far advanced, with hectic fever, profuse purulent expectoration, colliquative sweats, and diarrhoea; especially adapted to chlorotic patients. CONSUMPTION, SYMPTOMATIC INDICATIONS. 793 DOSE.-A powder of the first or second trituration every four hours. IODIDE OF MERCURY may be given under the same circumstances, if a syphilitic taint, or a combination of the syphilitic and scrofulous virus, may be suspected. DOSE.-Same as Iodide of Iron. MERCURIUS VIVUS is useful in mucous phthisis, if the patient is troubled with constant titillation, cough, purulent expectoration, sour night-sweats. ,W..-Same as Sulphur, with which this medicine may be usefully alternatd!. The reader may likewise consult the treatment of Tuberculosis, pages 565 to 569. CALCAREA CARBONICA may be of advantage in the suppurative stage of mucous phthisis, if the cough is hard, but attended with profuse mucous or purulent expectoration; the chest feels rather sore and warm. DOSE.-One or two drops, or six globules, dry on the tongue, three times a day; or a powder of the third trituration dry on the tongue, three times a day. STANNUM is suitable, when the cough is attended with profuse expectoration of yellowish or greenish pus. DOSE.-A powder, of the third trituration, dry on the tongue, three or four times a day. KALI CARBONICUM, or the carbonate of potash, same dose as Stannum, is useful, if the cough is loose, with expectoration of mucus, but attended with pain in the chest here and there, sore spots, feeling of obstruction when drawing a long breath. Phthisis may be the result of a chronic inflammation of the bronchial mucous membrane, in which case we designate it as Chronic Bronchitis. The suppurative process gradually terminates in ulceration of the bronchia, with the characteristic symptoms of phthisis. The treatment is conducted with the same medicines that have been recommended for consumption generally. Experi. 68 794 SPECIAL THERAPEUTICS. ence has taught us that it is indispensable every now and then to give the patient a few doses of Aconite; this medicine has a wonderful soothing effect upon the patient, and, if administered in time, will often stay the progress of the disease for months and even years. Some patients require the tincture of the root; in others this causes a feeling of tightness, oppression, arrests the free and easy expectoration of matter, and changes the cough to a spasmodic, dry, hard cough. Under these circumstlance the attenuations will produce an opposite effect. An excellent remedy, or rather palliative, in pulmonary consumption is Cod-liver oil. In the last stage of the disease it is useless. But at the commencement, when the patient is still able to attend to business, and take out-door exercise, it may be of use in easing the cough and keeping up the strength of the patient. A dessertspoonful may be taken three times a day. Some patients can even bear, and are indeed benefited, by taking a tablespoonful three times a day. Is consumption curable? This question may safely be answered in the affirmative within certain limitations. On the other hand it is certain that, as a general rule, phthisicky patients will sooner or later fall victims to this disease. Patients whose lungs are tuberculous, may be attacked with pneumonia, and nevertheless recover. We were once called to a patient who was under Thompsonian treatment for pneumonia. His two physicians pronounced his case hopeless. We were sent for, and found him covered with a cold, clammy sweat, breathing very hurriedly and superficially, pulse very small and hurried, (about one hundred and twenty); he was coughing incessantly; the countenance had become hippocratic, the extremities were cold as ice, and the patient was CONSUMPTION, SYMPTOMATIC INDICATIONS. 795 utterly speechless. We saw him first at ten o'clock in the evening. The patient took a drop of Aconite, third attenuation, in about ten tablespoonfuls of water, of which solution a tablespoonful was to be given every two hours. Next morning we found the patient sitting up in bed, with a bright countenance, warm, coughing easily, and able to take a long breath. He then explained to us' that the medicine had helped him immediately, and had very speedily removed the horrid, stitching pai. he had been suffering with in his side. He continued Aconite and Bryonia off and on for a fortnight, and was able to go out and attend to his business. This patient's lungs were altogether tuberculous, and he had been coughing up hard tuberculous masses off and on for several years previous. He lived six or seven years after his present illness in comparative health, able to attend to business without cough or any other troublesome symptoms. He finally died of tubercular phthisis. Schcenlein is of opinion that consumption is curable. A cure may be effected in various ways, but generally by means of granulations which fill up the cavity, and whose structure, density and color differ essentially from those of the surrounding pulmonary tissue. Another mode of effecting a cure is by means of the communication of the bronchial tubes with the cavity in the lungs becoming closed, so that an empty cavity or vomica remains behind. A cure may likewise be effected by the exudation of plastic lymph, which fills up the cavity in the shape of globular, polypous excrescences that adhere to its walls. The pathognomonic signs of the disease gradually disappear, the expectoration is no longer purulent; tracheal mucus continues to be secreted until the cough finally ceases. ------------ 796 SPECIAL THERAPEUTICS. Phthisis is most frequently rhet with among persons between the ages of twenty and forty. It is rarely, if ever, met with among butchers and tanners; but it is quite frequent in manufacturing towns, among tailors, woolcarders, cabinet-makers, shoemakers, masons, stonecutters, workers in steel, etc. Pregnancy seems to arrest the course of phthisis for the time being, but after confinement the disease breaks out again with increased vehemence, and destroys its victim in a couple of weeks. A great deal has been said concerning the diet of phthisicky patients. We would advise a slimy diet as eminently adapted to their condition. Barley-gruel, jelly without spices, farina, sago, tapioca, etc., are excellent articles. Mealy potatoes, fresh vegetables, such as cauliflower, spinach, fresh carrots and turnips, green peas, and stewed fruit, if the condition of the bowels is not in the way, may be enjoyed. If the inflammatory fever is not too troublesome, light broths without fat, cold roast or boiled beef, lamb, chickens, and oysters, may be used. Milk, especially goats' and asses' milk, is universally recommended for phthisicky patients, provided they are able to take out-door exercise. The climate is of great importance. A mild climate, free from all sudden changes, and where the thermometer ranges from 700 to 800 F., is, generally speaking, the most suitable to such invalids. On our own continent, we recommend as a residence, middle Florida, the island of Cuba, Trinidad, etc. It may be stated, however, that the propriety of sending phthisicky patients away from their homes to foreign countries, is greatly abused by some physicians. If a patient has sunk into the last stage of tubercular phthisis, it is worse than foolish to send him to a strange place, away from his friends and family, for no other COMSUMPTION, SYMPTOMATIC INDICATIONS. 797 purpose than to die among strangers. Let him remain at home, make himself as comfortable as his circumstances will permit, and patiently and resignedly await the inevitable end. We have mentioned a number of remedies as applicable to phthisis. This should be no inducement, howees, for frequent changes in the exhibition of remedial.ts. In all forms of phthisis, we shall have to depend p 'nIally upon the tincture of ACONITE-ROOT, BELLADON.A, MERCURIUS VIVUS, the IODIDE OF IRON, PHOSPHORUS, SULPHUR, and incidentally, ARSENICUM, HEPAR SULPHURIS, etc. The course of phthisis is very frequently marked by sudden and violent changes, some of which may require the prompt interference of the physician. Some of these accidents are: a. Hcemorrhage. If this is accompanied with considerable vascular irritation, we may often succeed in arresting it by means of ACONITE, of which one or two drops of the tincture of the root may be mixed in eight tablespoonfuls of water; the patient may take a dessertspoonful of such a mixture every few minutes, until the flow of blood is arrested. If Aconite does not speedily arrest it, the tincture of MILLEFOLIUM may be given, in five-drop doses, every five or ten minutes. Sometimes the haemorrhage may have to be arrested by palliative means, such as twenty-five or thirty drops of Laudanum, or a solution of kitchen-salt, a tablespoonful in half a cupful of water. b. Diarrhea. If this should be the result of simple abdominal congestion, ACONITE will arrest it, same dose as above. If owing to the presence of ulcers in the intestinal mucous membrane, we may try to arrest it' 68* 798 SPECIAL THERAPEUTICS. with CALCAREA CARBONICA, a powder of the second or third trituration every two or three hours, or we may have to resort to the mineral acids, NITRI or PHOSPHORI ACIDUM, a drop of the second attenuation every few hours. If curative medication proves fruitless, and the patient must have some relief, we need not hesitate, if intestinal ulcers are present, to resort to the cautious use of the ACETATE OF LEAD, as a palliative; we may gi it in doses of one-eighth or one-quarter of a grain, rvu i: up with a little loaf-sugar. The tincture of CHIn,.:f three to five drop doses, every six hours, may likewise prove a means of relief. c. Sweat may be a very troublesome symptom, which can only be met by palliative means. We may try SAMBUCUS, a few drops of the tincture before retiring. Sulphuric acid, from five to ten drops of the diluted acid in half a pint of water, which the patient may empty during the day, may likewise be tried. But, if these means fail, we may have to resort to a dose of OPIuM before bed-time, from ten to fifteen drops of the tincture on sugar, or in a spoonful of water. Schoenlein recommends frictions with warm almond-oil over the whole body, shortly before bed-time. Instead of almond-oil, warm brandy and water may be tried. The patient should not eat anything warm at supper, and the temperature of the bed-room should be very uniform-not too cold, so that the patients need not put on much covering, which might provoke sweat; nor too warm, which would likewise excite sweat. d. Decubitus, or bedsores. Phthisicky patients sometimes dwindle down to skin and bones. Hence, the constant pressure on the same emaciated parts may induce soreness, chafing of the skin, and finally painful sores. CONSUMPTION, SYMPTOMATIC INDICATIONS. 799 An accident of this kind, which inflicts great distress upon the patient, should be prevented by all means. The bed-linen must always be even, so as not to show any folds or roughness; and it may be well to have the patient rest on a soft deer-skin, which is to be spread over the mattrass. If parts become chafed, they may be bathed with a mixture of ARNICA, in the proportion of fifty drops in a cupful of water, or the Arnica-salve may A.: ailied to the sore. If necessary, the sore may be drcs, with an ointment of simple cerate mixed with a little Opium. e. Patients sometimes complain of a burning thirst, which nothing seems able to quench; a dessert-spoonful of brandy, in half a pint of water, proves very often exceedingly refreshing to such patients. f. The expectoration sometimes becomes suddenly suppressed, in consequence of a cold, and consequent inflammation in the diseased organ. This is a most distressing circumstance to the patient, which requires speedy aid. No medicine is better calculated to remove this inflammation, and restore the expectoration, than a little AcONITE, either a drop of the tincture or a few drops of the attenuated drug, in half a tumblerful of water, of which the patient may be given a dessert-spoonful every fifteen or twenty minutes, until the difficulty is removed. During the course of the disease, ACONITE will prove an admirable aid in subduing many a distressing symptom, that may turn up unexpectedly every now and then, such as sudden oppression, palpitation, a sense of suffocation, with coldness of the extremities, tremulous, rapid and intermittent pulse, acute pain in some part of the chest, etc. It is a great comfort to such patients to be sponged CONSUMPTION OF THE BOWELS. 801 period the bowels remain bound. The evacuations are frequently accompanied with tenesmus. They consist of flocculent pus, which is occasionally streaked with blood, or to which an admixture with blood imparts a dark reddish-brown color. If collected in a glass vessel, separately from the frecal matter which may be mixed:rith it, it is found to have a very fetid smell. The constitutional signs of this disease are perhaps.more.arked than in any other form of phthisis. The pati:ent are very speedily reduced to mere skeletons, the pulse is thin, wiry, extremely hurried, from one hundred and twenty to one hundred and thirty beats in the minute; colliquative sweats are always present, the urine looks turbid and is secreted in small quantity; the fever has a continuous type. Patients who are afflicted with this disease, must confine themselves to mucilaginous diet, light roast-meat, lamb, mutton, tender beef; oysters and oyster-broth are not inadmissible. A little Port-wine and water, or a dessert-spoonful of Bourbon-whiskey in a tumblerful of water may likewise be of service in many cases. As regards medical treatment, we may consult the article on "Diarrhoea" and ",Chronic Diarrhoea," and depend particularly upon the following medicines: ACONITE, MERCURIUS VIVUS, PHOSPHORUS, and PHOSPHORI ACIDUM, NITRI ACIDUM, ARSENICUM, VERATRUM, PULSATILLA, NUX VOMICA, SULPHUR, CALCAREA CARBONICA. ACONITUM is useful in this disease throughout its whole course, especially if the pain and soreness in the bowels are very distressing, the patient complains of a good deal of tenesmus during stool, the evacuations contain a good deal of blood. We may mix a drop of the 802 SPECIAL THERAPEUTICS. tincture in half a pint of water, and give the patient a tablespoonful every four hours. Nux VOMICA is useful, if the patient is troubled with frequent urging to stool and discharges of white mucus. DOSE.-A drop, or ten globules dry on the tongue, morning and night. PULSATILLA may be resorted to, if the discharges are principally troublesome at night, consisting of slime that has a fetid smell. DOSE.-Same as Nux. MERCURIUS VIVUS may be given if the discharges.are accompanied with tenesmus, and consist of mucus, bile and blood all mixed up together. DOSE.-One drop, or six globules, three times a day, or else a powder of the third trituration, dry one tongue every six hours. PHOSPHORUS is useful, if the diarrhoea is very troublesome, and the discharges consist principally of serum and some flocks of mucus. DOSE.-Same as Mercurius. If Phosphorus has no effect, we may try PHOSPHORI ACIDUM, a few drops three or four times a day; and, if the discharges are mixed with foul-smelling blood, and are very debilitating, we may try NITRI ACIDUM, same dose as Phosphori acitum. ARSENICUM is useful, if the diarrhoea assumes, all at once, an alarming form, and is attended with momentarily increasing weakness. DOSE.-A powder of the third trituration, dry on the tongue, every three hours. If Arsenicum does not help, we may try VERATRUM, same dose as Phosphori acidum. SULPHUR is advisable, if the discharges consist of tenacious and fetid mucus, and the patient complains of much pressure in the rectum. DOSE.-Same as Arsenicum. r CONSUMPTION OF THE BOWELS. 803 If the consumption is of the galloping order, the patient runs down very rapidly, and the fever has a typhoid character, with brown or blackish coating of the tongue, expression of stupidity and prostration in the countenance, continual discharge from the bowels of a fetid, bloody, serous or mucous liquid, with excessive St'hirst, acute pain in the region of the umbilicus or on t. right side in the ileo-coecal region: we may resort to I:.iUS TOXICODENDRON and ARSENICUM in alternate doies: giving a few drops or ten pellets of Rhus in half a pint of water, a tablespoonful at a dose, and of Arsenicum a powder of the third trituration, dry on the tongue, an alternate dose every hour, until the symptoms mend, which they should do after giving a few doses. If these two medicines do not seem to produce any perceptible change for the better, we may try PHOSPHORUS, or PHOSPHORI and NITRI ACIDUM, Phosphorus particularly, if the sensibility of the bowels seems to have become nearly extinct. The indications for NITRI ACIDUM are the same as those that have been furnished previously. If the bowels should seem perfectly paralyzed and the passages take place unconsciously to the patient, have a cadaverous smell, and the typhoid symptoms are fully developed, with muttering delirium, catching at flocks, or picking at the bed-clothes, we may give HYOSCYAMUS, same dose as Rhus, or even a drop of the tincture in the same quantity of water. This medicine may be alternated either with BELLADONNA, if the cerebral indications, such as drowsiness or stupor, frequent changes of color in the face, ocular spectra, such as dogs, frightful or horrid animals, or masks, etc., justify its use, or else with 804 SPECIAL THERAPEUTICS. RHUS TOXICODENDRON, if the skin is beginning to become cold and clammy. In this typhoid condition, the chapter on Typhus, page 293, may be consulted, if more medicines should seem required. Consumption of the bowels, especially tubercular consumption, is just as difficult a disease to treat as pulmonary phthisis, and the chances of recovery are not much better. A characteristic symptom in some cases of inteo.tinal phthisis is constipation. The bowels, are ab:lutely torpid, and injections even seem fruitless. Th condition often depends upon atrophy of the liver. If such patients are treated with purgatives and drastics, as is always the case in old-school practice, their doom is speedily sealed. Under homoeopathic treatment, we use the same medicines that have been recommended for " Constipation." The use of cold-water injections may be of service in either of these two forms of phthisis abdominalis. Coldwater bandages on the abdomen may likewise be of great use. INFLAMMATION OF THE HEART AND ITS ENVELOPING MEMBRANE, CARDITIS, ENDOCADITIS, PERICARDITIS, Some of the purely nervous affections of the heart, such as Palpitation, Tremor, Fluttering, etc., have already been treated of on page 429 of the present work. We have now to consider the more important and dangerous affections to which the heart is liable. These are: Rheumatism of the heart or rheumatic endocarditis and Pericarditis or inflammation of the pericardium (the serous sac in which the heart is enveloped). RHEUMATIC ENDOCARDITIS. 805 Rheumatic Endocarditis. Rheumatic inflammation of the heart scarcely ever attacks any but young persons, more particularly of the male sex. It may set in as a separate and distinct malady in consequence of exposure to a draught of air, of sudden suppression of the perspiration; or the heart may become involved in an attack of general constitutional rheumatism, or the disease may have a metastatic origin, arising through the shifting of an inflammatory rheumatic action set up in the muscular coverings of the chest, or even in the extremities, to the heart. Metastatic rheumatism of the heart is of the most dangerous kind, particularly if the rheumatism was originally of the arthritic order. In rheumatic inflammation of the heart the muscular tissue of the heart may be alone affected; in most cases, however, the valves of the heart are likewise involved. One of the leading symptoms of rheumatic endocarditis is violent palpitation of the heart, which is heard over a large surface. On applying the ear to the chest, or listening through the stethoscope, we hear a peculiar crepitating murmur which accompanies the violent contractions of the heart. If the valvular apparatus is involved in the inflammation, we hear a bellows' murmur in the region where the valves of the aorta and left auricle are situated. The fever which accompanies this disease, is not always very violent; but as a general rule, synochal or erethic fever is present; the pulse at the wrist is small, feeble, jerking, and the rhythm between the beats of the heart and the pulsations in the extremities is interrupted. Other phenomena which are always present in inflammation of the heart, are: oppres 69 806 SPECIAL THERAPEUTICS. sion of breathing which sometimes increases to perfect apnoea; irregularity in the movements of the heart, at times it beats with great 'force, at other times the beats of the heart are scarcely perceptible; the patient is oppressed with a feeling of anguish which makes him exceedingly restless, and may even induce fainting. The serous-covering of the heart may be involved in the inflammation, or may be the principal seat of the disease. In such a case, the patients complain of a burning-oppressive pain under the inferior half of the sternum, towards the left side of the chest, a sensation of constriction in the region of the heart and suffocative distress for breath (apncea). The face expresses anguish and restlessness. The pulse is at first hard, full and bounding, as it always is in the first stage of acute inflammations of serous membranes, but afterwards it becomes small and feeble, the extremities are cold and 'the features are altered. This form of carditis is almost always accompanied with violent paroxysms of cough which is either dry or attended with slimy, gelatinous expectoration. The costal pleura on the left side, or the lungs, are more or less involved in the inflammatory process. In arthritic carditis, which takes place when arthritic inflammation suddenly shifts to the heart from some external part, or when an attack of gout, instead of affecting as usual, a joint, suddenly invades the heart, the beats of the heart and the pulsations at the extremi ties are very irregular. Towards evening or before midnight, the patient experiences an attack of pain in the region of the heart, with oppression of breathing and suffocative paroxysms; the patients are obliged to sit up in bed; in a few minutes they feel easier, but RHEUMATIC ENDOCARDITIS. 807 after repeated paroxysms they faint away. On applying the stethoscope, a peculiar murmur is heard as though the blood had difficulty in passing through the orifices of the heart. Fever is present; the skin is either dry or covered with a sour-smelling sweat; the urine deposits a sediment which contains a good deal of uric acid; it has an acid reaction. TREATMENT.-Our chief remedy in acute inflammation of the heart is ACONITE, of which we mix from three to four drops of the tincture of the root in half a pint of water, and give the patient a tablespoonful every hour or even every half hour, until a decided improvement becomes manifest. If the disease springs from an arthritic source; if it is the result of metastatic gout, or constitutes an attack of acute gout of the heart, we alternate Aconite with the tincture of COLCHICUM, of which we mix five drops in half a pint of water, and give a tablespoonful every alternate half hour. BELLADONNA may be alternated with Aconite, if the agony of breathing and the burning distress in the region of the heart, are excessive. DOSE.-Of Belladonna, mix a few drops or ten pellets in half a pint of water, and give an alternate tablespoonful every hour. Instead of the attenuated drug, a drop of the tincture may sometimes be preferable. PULSATILLA may be of service in the case of females, when the inflammation is evidently connected with menstrual suppression. DOSE.-Same as Belladonna; it is best to alternate this drug with Aconite. Acute inflammation of the heart is very apt to result in chronic heart-disease, such as: enlargement or hypertrophy of the substance of the heart; dilatation or contraction of the ventricles, thickening and insuffi 808 SPECIAL THERAPEUTICS. ciency of the valves, etc. These disorganizations are generally incurable; all that can be done, is to palliate the patient's distress by giving him such medicines as the symptoms may indicate. We generally depend upon ACONITE, DIGITALIS, NUX VOMICA BELLADONNA, ARSENICUM, PULSATILLA and SPIGELIA. We use ACONITE, to relieve violent palpitation, stitching pain in the heart, heat about the heart, oppression and weight; it is also indicated by vertigo, an expression of distress and anxiety in the countenance, irregular pulse, coldness of the extremities. DOSE.-From three to five drops of the tincture in twelve tablespoonfuls of water, a tablespoonful every few hours. SPIGELIA may be used in alternation with Aconite, same dose. BELLADONNA, for violent distress in the region of the heart, with excessive rush of blood to the head, staring and glistening expression of the eyes,_~p ed and red face. DOSE.-Same as Aconite, except the attenuated drug instead of the tincture. ARSENICUM, for violent suffocative agony at the heart, with burning distress, coldness of the skin and extremities. DOSE.-A powder of the third trituration every few hours. PULSATILLA may be given instead of Arsenic in the case of females whose menses have stopped through some accidental cause. This medicine should be alternated with Aconite. DOSE.-Same as Belladonna. Nux VOMICA, if the heart is seized with a sudden spasm and either ceases to beat, or beats with the greatest difficulty. DOSE.-A few drops of the tincture in a tumbler of water, of which a tablespoonful may be given every few minutes. I INFLAMMATION OF THE PERICARDIUM. 809 Persons affected with heart-disease, have to avoid excitement of any kind; exciting emotions, excessive physical exertions, irregularities of any kind. They may derive great benefit from the use of daily ablutions and frictions with cold water, and of the wet bandage on the chest. Pericarditis, Inflammation of the Pericardium. This disease often sets in very insidiously; the patients experience perhaps only a feeling of pressure, but soon after the disease breaks out in all its fury, with violent fever, very frequent and hard, but contracted pulse. In some cases the fever partakes of the character of erethism, a simple vascular excitement. The patients complain of a burning pressure under the sternum, low down and rather on the left side; this is attended with apnoea; the beats of the heart are dull, indistinct, sometimes imperceptible. The anguish frequently terminates in fainting fits. Pericarditis sometimes sets in as a complication of pulmonary phthisis. This disease is perfectly curable under homoeopathic treatment. If mismanaged or timidly treated, incurable adhesions between the pericardium and the substance of the heart, or between the pericardium and the adjoining organs may take place. A chief remedy at the onset of this disease is ACONITE, a few drops of the tincture in a tumbler of water, of which a tablespoonful may be given every half hour or every hour until relief is obtained. After the violent symptoms have subsided, we may continue Aconite in alternation with 69* 810 SPECIAL THERAPEUTICS. BRYONIA, a few drops in a tumblerful of water, an alternate dose every hour. If the patient is troubled with a short, barking, hollow cough, which causes anxiety and a suffocative sensation, with dullness of the beats of the heart which are heard at a distance from the ear, we may give DIGITALIS, same as Aconite, in alternation with ARSENICUM, a powder of the third trituration, dry on the tongue, an alternate dose every hour. In acute pericarditis it is not probable that slight adhesions can be entirely prevented; if they are not complicated with other extensive disorganizations, and only exist partially, at isolated points, they may not materially interfere with the normal functions of the heart. If the septum which separates the right from the left ventricle, is not properly closed, and admits of the blood in the right and left ventricles being mixed up together in the heart, whereas the venous blood should first pass through the lungs before it enters the left ventricle, a pathological condition arises which pathologists term Cyanosis, or Blue Disease. This is an incurable malformation, characterized by a blue tinge of the lips, nose, face, buccal cavity, fingers and nails, and which becomes more marked after every violent exertion. We need not go into a detailed description of the general symptoms of this disease; we simply mention it here for the purpose of suggesting ACONITE and DIGITALIS as the only remedies by means of which the suffocative distress with which such poor patients are often tortured, can be relieved. We may POSNS 1 POISONS. 811 give a drop or a few globules of each remedy every few hours or more frequently, if'necessary. Dropsy of the Pericardium, Which is generally a fatal disease, has been alluded to under the general heading of " Dropsy," to which the reader is therefore referred, page 580. Of the medicines named there, we would particularly recommend DIGITALIS and ARSENICUM, more particularly if the dropsical effusion is a sequela of scarlet fever, as it sometimes may be. We would recommend the first attenuation or even the tincture of DIGITALIS, from three to five drops in half a pint of water, to be given in tablespoonful doses, and of ARSENICUM, the third or first trituration, in small powders dry upon the tongue, giving an alternate dose every hour in acute cases, and every two or three hours in all chronic cases. The prospects of a cure in this disease are very slim indeed. If the application of a mustard-plaster in the region of the heart should be deemed advisable as a palliative, let this and similar means be resorted to without delay. POISONS, And the Treatment to be Pursued in Cases of Poisoning. Poisons may affect the animal organism locally as well as generally or remotely. On chewing a piece of the root of Aconite, for instance, the numbness and stinging which are experienced in the lips and on the ~1~C9-~----~--~IC~--~-~~-~~~~II---- 812 SPECIAL THERAPEUTICS. tongue are strictly local impressions of the poison; or, on holding the end of the finger over a glass-tube containing strong Prussic acid, a sense of numbness is felt in the part such as is experienced from exposure to intense cold. This is likewise a local effect. Such local effects may be produced by corrosion, as from the Nitrate of silver, by irritation and-by nervous impressions. The remote effects of poisons may either be induced by sympathy or by absorption. The rapidity with which poisons develop their remote or constitutional effects, varies; some developing them in a few seconds, others in a much longer period. Conia, the active principle of hemlock, for instance, when injected into the femoral vein of a dog, will destroy the animal three or four seconds after the injection had taken place. Alcohol, Prussic acid, Strychnia, and various other poisons act with equal promptitude and intensity. In a work of this kind the reader will not expect to find a complete treatise on poison; we can only furnish a few general remarks on poisoning, which will, however, prove sufficient to meet all common cases. Having stated that some poisons affect the system remotely or constitutionally, we may as well add that, according to the observations of toxicologists, some of these poisons act principally upon the heart. Of this class are the salts of Magnesia, Zinc, Copper, Lime, Strontia, Baryta, Lead, Silver, Ammonia and Potash, Oxalic acid, Digitalis, and other poisons. Others, belonging to this class of poisons, operate on the brain, such as Opium and its active principle, Morphia; some act specifically on the spinal cord, such as Nux vomica and its active principle, Strychnia; Conia, which is the active principle of hemlock, and the Wourari-poison. Some poisons seem to act more ANIMAL POISONS. 813 specifically upon the general capillary circulation; some poisons act more particularly upon one, others more upon several vital organs at once. Arsenic, for instance, acts on the brain, heart, and lungs; the stomach and intestines; the lining membrane of the nostrils and eyelids, the kidneys, bladder and vagina. Mercury, likewise, acts upon a variety of organs and tissues, the mucous and osseous tissues, the glandular system, etc. Those who take an interest in such details, are referred to Christison's admirable Treatise on Poisons which is adapted to every person of ordinary intelligence and education, and is, nevertheless, exceedingly complete. TREATMENT.-As soon as we have ascertained what poison had been swallowed, we ought at once to employ suitable means for the neutralization or mechanical removal of the poison by means of suitable antidotes, the stomach-pump, emetics, etc. Corrosive poisons should at once be neutralized by their antidotes, and mucilaginous drinks should afterwards be administered. Instead of expatiating on general measures, we deem it more expedient to describe the treatment which should be pursued in a particular case of poisoning. Every kingdom of nature contains poisonous substances, and, for the sake of order, we will classify poisons into animal, vegetable and mineral poisons. With regard to their properties they might be divided into irritant, narcotic and narcotico-acrid poisons. 1. Animal Poisons. CANTHARIDES. This poison causes an intense burning in the throat and stomach, violent pain in the lower abdomen, strangury, and very often priapism. 814 SPECIAL THERAPEUTICS. ANTIDOTAL TREATMENT.-Produce vomiting by swallowing large quantities of tepid water, or by tickling the throat with a feather, or by placing a pinch of snuff or mustard, mixed with salt, upon the tongue, or by drinking a tumblerful of warm water, with which a teaspoonful of the flour of mustard has been stirred, and afterward drinking warm water as above; or by injecting tobaccosmoke into the anus through a pipe-stem. Any of these means is preferable to the use of emetics. If the vomiting should have set in spontaneously, encourage it by drinking tepid water, or tickling the throat with a feather. Injections of sweet oil into the rectum and bladder will relieve the strangury and constitutional irritation. Applications of the spirits of Camphor may be made to the region of the bladder, and a pretty strong solution of Camphor may be taken internally, in tablespoonful doses. If inflammatory symptoms should afterwards remain, give ACONITE, one drop of the mother-tincture in a tumblerful of water, a small tablespoonful every two hours. If this medicine should not seem sufficient, follow it up with ARSENIC, six globules in a tumblerful of water,, a tablespoonful every three hours. Give the patient mucilaginous drinks in abundance. 2. Poisonous Mussels and Oysters. Oysters are not generally poisonous; but, in certain seasons, some oysters have been known to develop poisonous effects. These poisonous effects of oysters, and more particularly of mussels, consist in tension of the stomach, cardialgia, nausea and vomiting; prickly feel POISONOUS FISH, GLANDERS. 815 ing in the hands, or all over the body; heat and -constriction of the mouth and throat; difficulty of deglutition and speech; numbness about the mouth, which gradually extends to the arms, debility of the limbs. The secretion of urine is sometimes arrested, and the features express anguish. ANTIDOTAL TREATMENT.-Give charcoal mixed with sugar and water; afterward, strong coffee without sugar or milk, and a solution of Camphor internally. Poisonous Fish, Eels, etc. Some of the symptoms may be similar to those of poisonous mussels, and there may likewise be violent colic, diarrhoea, etc. ANTIDOTAL TREATMENT.-Give charcoal and sugar in brandy; afterward, strong black coffee without sugar or milk; and, if all these,means should fail, give vinegar and water. If a rash should afterward appear, give ACONITE and IPECACUANHA alternately, six globules of each in a separate tumblerful of water, an alternate tablespoonful of medicine every two hours, commencing with Aconite. 3. Glanders. This disease is well known in Germany as the, Milzbrand," analogous to the pustule maligne of the French. It is an epidemic which sometimes prevails among cattle, and is characterized by the breaking out of large gangrenous carbuncles in various parts of the body. This disease may be communicated to man, and is frequently fatal. Lh - 816 SPECIAL THERAPEUTICS. TREATMENT.-We do not know whether this disease, in man, has ever been successfully treated by homoeopathic physicians; but the most appropriate remedy seems to be ARSENIC, of which six globules may be dissolved in a tumblerful of water, and a tablespoonful taken every two hours. A still better mode of treatment would seem to be suggested by the condition of the workmen and their families inhabiting the " voirie et chantier d'e'carrissage of Montfaucon." In this enclosure, which has existed close to the walls of Paris for centuries, some forty or fifty thousand horses, dogs and cats are flayed every year. Among this number, it is calculated that several thousand are affected with carbuncle, glanders or farcy. The stench is abominable, for there is no drain; all the solids and fluids are preserved for special purposes; and yet all the workmen and their families are stout, healthy, and long-lived. This must be owing to the fact that the foul emanations, which these people constantly inhale, act as a preventive principle against the poison of glanders; and hence this poison might be used as a remedial agent against its own destructive effects. Sausage-poison, the Poison of Old Cheese, Bacon, Veal, Pickled Salmon. The more immediate symptoms, indicating this kind of poisoning, are: violent pain in the epigastrium, difficult breathing, irregularity of the pulse, prostration and alarm, coldness of the extremities, and vomiting. If a longer period elapses, pain in the region of the duodenum, or of the sigmoid flexure, tension and tenderness L _ THE HYDROPHOBIC VIRUS. 817 of the belly, frequency of the pulse, and ineffectual urging to stool, and sometimes nettle-rash, supervene. See Christison's treatise on Poisoning, from which these symptoms are extracted. Christison proposes emetics and cathartics as the proper:antidotal treatment. Others propose dilute vinegar, or strong black coffee with lemon juice, or strong black tea without milk or sugar, as the best antidotes. The Hydrophobic Virus Is one of the most subtle and deadly poisons. It is peculiar to mad dogs, wolves, etc. A bite inflicted by a mad dog need not prove fatal at the time when the wound is inflicted. The wound may heal, and still the poison may slumber in the tissues, until some accidental cause excites the disease, which is one of the most frightful maladies that call for the interference of art. The bitten part assumes a livid appearance; it swells and a burning and acute lancinating pain is experienced in the wound, penetrating towards the interior parts. Soon after these symptoms of local irritation have developed themselves, the patient becomes restless, anxious, and is unable to swallow liquids. Every attempt to swallow liquids, causes a spasmodic constriction of the fauces, which seems to threaten suffocation and is attended with a feeling of horrid anguish. Finally, as the disease progresses, a spasm of this kind may be excited even by the mere sight of water, or of some shining substance. Though tormented by thirst, the patient is unable to swallow a drop of liquid on account of the spasm. Glairy mucus hangs out at the mouth; he is seized with paroxysms of rage, attempts to bite 70 818 SPECIAL THERAPEUTICS. and strike, and then, after the paroxysm ceases, he is,utterly prostrated. The wound opens and discharges a fetid, sanious ichor. Gradually the pulse sinks and death puts an end to the sufferings of the patient. As soon as a suspicious-looking dog has inflicted a bite, let the wound be washed and sucked out with all the force the patient can muster; and, if he cannot do it himself, let some friend do it for him. Then wash the wound with a few drops of the tincture of BELLADONNA, and take the same medicine internally, a drop of the first or second attenuation every four hours. Continue this treatment for a few days, and then await the result. If the disease should nevertheless break out, it will most probably appear greatly modified, and may then be treated with BELLADONNA, STRAMONIUM, HYOSCYAMUS, and CANTHARIDES; Belladonna and Cantharides are principally indicated by the spasmodic constriction of the throat and the paroxysms of rage, and Stramonium, if the paroxysms are excited by the sight of shining objects. DOSE.--A drop or two of the appropriate medicine on a little sugar every half hour or hour, until the patient feels relieved. This disease offers a fair opportunity of testing the' virtues of isopathic remedies, in the present instance, of SHYDROPHOBIN, which may be administered during the course of the disease, a few globules of the third or sixth attenuation, every hour or two hours, until a decided impression seems to have been made upon the disease. Our data concerning the- curative virtues of this agent in hydrophobia are as yet exceedingly scanty. _ _ .VEGETABLE POISONS. 1819 VEGETABLE POISONS. Poisonous Fungi. The symptoms of poisoning by poisonous fungi are extremely variable; in some, the symptoms amount to pure nervous irritation; in others, the symptoms point to the most striking narcotism; in others again, a condition resembling cholera is excited; even external suppu. ration and gangrene have been developed as terminations of the constitutional poisoning. ANTIDOTAL TREATMENT.-As soon as the poisoning is discovered, vomiting must be induced, and kept up until every vestige of the poisonous matter is thrown up. Large quantities of strong black coffee may be sufficient to excite the vomiting, and the coffee would likewise neutralize the narcotic effects of the poison. Charcoal with sweet oil may likewise be given, and hartshorn held to the patient's nostrils. If symptoms of gastritis or enteritis remain, they have to be treated with the medicines indicated for these diseases in their respective places. Spurred Rye, Ergot, Secale cornutum. The spur is a disease of the rye, which is chiefly met with in damp seasons and in moist clay soil. The spur is from a few lines to a few inches long, and from two to four lines in thickness. Its effects on man are: giddiness, headache, flushed face, pain and spasms in the stomach, nausea and vomiting, colic, purging, and a sense of weariness and weight in the limbs. These are 0820 SPECIAL THERAPEUTICS. some of the minor effects; its more characteristic effects are ergotism, of which we have two varieties, the spasmodic and gangrenous. The spasmodic variety has occurred several times in the form of an epidemic, more particularly in Germany, and according to Drs. Taube and Wagner, was characterized by the following symptoms: dimness of sight, giddiness and loss of sensibility, followed soon by dreadful cramps and convulsions of the whole body, risus sardonicus, yellowness of the countenance, excessive thirst, excruciating pain in the limbs and chest, and a small, often imperceptible pulse. In the milder cases the convulsions came on in paroxysms, were preceded for some days by weakness and weight in the limbs, and a strange feeling as of insects crawling over the legs, arms, and face; in the intervals between the fits the appetite was voracious, the pulse natural, the excretions regular; and the disease either terminated in recovery, with scattered suppurations, cutaneous eruptions, anasarca or diarrhoea, or it proved in the end fatal amidst prolonged sopor and convulsions. In another epidemic the symptoms were: periodic weariness, afterwards an uneasy sense of contraction in the hands 'and feet, and at length violent and permanent contraction of the flexor muscles of the arms, legs, feet, hands, fingers, toes, with frequent attacks of a sense of burning or creeping on the skin. The gangrenous variety appeared in its most severe form in Switzerland, in 1709 and 1716; it commenced, according to Lang, a physician of Lucerne, with general weakness, weariness, and formication of the skin; when these symptoms had lasted some days or weeks, the extremities became cold, white, stiff; benumbed, and at length so insensible that deep incisions were not felt; POISON-VINE. 821 then excruciating pains in the limbs supervened, along with fever, headache, and sometimes bleeding from the nose; finally the affected parts, and in the first instance the fingers and arms, afterwards the toes and legs, shrivelled, dried up, and dropped off by the joints. A healthy granulation succeeded; but the powers of life were frequently exhausted before the stage of sphacelus was reached.. The appetite continued voracious throughout. These are most of the principal symptoms of poisoning by spurred rye; there are modifications, which it is, however, needless to mention. ANTIDOTAL TREATMENT.-In the spasmodic variety, above described, every case was cured by emetics, laxative medicines, and frequent small doses of Opium, provided the treatment was commenced in reasonable time. The best treatment is undoubtedly to promote vomiting until the spurs are all discharged, and then to give large quantities of strong black coffee until the patient perspires copiously, and has a sound natural sleep afterwards. For further details on this subject the reader is referred to Christison's "Treatise on Poisons," from which the above accounts are taken. Rhus toxicodendron and Radicans, Poison-vine. This plant being quite common in the United States, cases of poisoning by its juice are of frequent occurrence. The principal symptoms are: intolerable itching, burning of the skin, vesicular eruption, swelling and redness of the eyes, face, 'joints, genital organs, etc. These symptoms sometimes reappear, but less violently, at certain periods. 70* __ 822 SPECIAL THERAPEUTICS. ANTIDOTAL TREATMENT.--An ointment of the Meicurius praecipitatus ruber has been employed with effect externally, on the inflamed and itching parts. A decoction of Sassafras is used internally. Bathing the parts with an alkaline solution will give great relief. Flour may likewise be applied. Some derive great benefit from the internal use of ACONITE and BELLADONNA, in alternation, dissolving six globules or a few drops of each medicine in a tumblerful of water, and taking a tablespoonful every two hours, commencing with Aconite. Opium or Laudanum. According to Christison, "the symptoms of poisoning with Opium, administered at once in a dangerous dose, begin with giddiness and stupor, generally without any previous stimulation. The stupor rapidly increasing, the person soon becomes motionless and insensible to external impressions; he breathes slowly; generally lies still, with the eyes shut and the pupils contracted; and the whole expression of the countenance is that of deep and perfect repose. As the poisoning advances, the features become ghastly, the pulse feeble and imperceptible, the muscles excessively relaxed, and, unless assistance speedily arrives, death ensues. If recovery take place, the sopor is succeeded by prolonged sleep, which commonly ends in twenty-four or thirty-six hours, and is followed by nausea, vomiting, giddiness and loathing of food." In the case of children, moderate doses have been known to produce convulsions. Lockjaw, spasms and convulsions have been likewise observed in the case of full-grown individuals. r STRAMQNIUM, OR THE THORN-APPLE. 823 Morphine acts similarly to Opium, but its action is more energetic. ANTIDOTAL TREATMENT.-Give large quantities of very strong black coffee to excite vomiting. If this should fail, try any of the means above mentioned, and if these should likewise prove insufficient, give the SULPHATE OF ZINC in the dose of from half a drachm to two scruples, repeating the dose after a short interval, if the first dose should fail. Keep the patient roused as much as possible. The best method of evacuating the stomach is to use the stomach-pump, and the emetics should only be used in case no physician with a stomachpump could be had. After the stomach is emptied, the patient must not be allowed to sleep, and, if he cannot be kept roused by any other means, he must be shaken and dragged and tossed about, until the vital reaction is thoroughly roused. In the meanwhile he. must be made to drink large quantities of strong black coffee until copious perspiration sets in. If any cerebral symptoms should remain, he may be given BELLADONNA, six globules in a tumblerful of water, a tablespoonful every two hours, until he is better. Stramonium or the Thorn-apple. The principal symptoms of poisoning by Stramonium are delirium, stupor with dilatation of the pupils, spectral illusions, lockjaw, swelling of the abdomen, tremor of the extremities, spasms, etc. ADTIDOTAL TREATMENT.-Excite vomiting, give a laxative medicine, and large quantities of coffee as for Opium; 824: SPECIAL THERAPEUTICS. Belladonna, Atropa B. A characteristic effect of Belladonna upon the eyes is to dilate the pupils. The principal symptoms of constitutional poisoning by Belladonna, are: dryness of the throat, merry or frantic delirium, immoderate laughter, aphonia, loss of consciousness, retention of urine, stupor, lockjaw, subsultus tendinum, partial convulsions. ANTIDOTAL TREATMENT.-The same as for Opium and Stramonium. If drowsiness should remain, give internally OPIUM, ten globules or three drops in a tumblerful of water, a tablespoonful every two hours. Aconitum Napellus, Monk's-hood. The principal symptoms of poisoning by this narcotic are: burning internally, nausea, numbness and tingling in the lips and cheeks, extending gradually all over the body; sinking, intermission, irregularity and collapse of the pulse; muscular debility, deafness, blindness or confusion of sight, depression of spirits, involuntary weeping, vertigo, frothing at the mouth, constriction of the throat, tremor, loss of voice, laborious breathing, cold, clammy sweat, paleness of countenance, etc. ANTIDOTAL TREATMENT.-The same as for Opium, Belladonna and Stramonium. After the vomiting give black coffee, cup after cup every few minutes, until copious perspiration sets in. Veratrum album, White Hellebore. This poison is both an irritant and a narcotic. Its irritant and narcotic properties are evinced by such STRYHNI. 825 STRYCHNIA. 825 symptoms as these: sensation as if the intestines were wound up into a clue, swelling of the tongue, sore mouth, burning in the throat, oesophagus and stomach, followed by nausea, dysuria and vomiting; weakness and rigidity of the limbs; giddiness, blindness with dilatation of the pupils, convulsive breathing, faintness, small pulse. ANTIDOTAL TREATMENT.--Excite vomiting, give gentle laxatives, and quantities of strong lemonade. Digitalis, Foxglove. Characteristic symptoms of poisoning: nausea and vomiting, frontal headache, dryness in the gums and pharynx, giddiness, sparks before the eyes, with gradual dimness of vision, languor, restlessness, incoherent talk' ing, fainting fits, watery diarrhoea, slowness and even intermission and collapse of the pulse, convulsions. ANTIDOTAL TREATMENT.-Vomiting and strong coffee, as above. Strychnia. The effects of a poisonous dose of Strychnine on the animal system are frighful in the extreme. The general effects are: excessive anguish, stupor, loss of speech and tetanic convulsions. ANTIDOTAL TREATMENT.-According to Dr. Donne, of Paris, Iodine, Bromine and Chlorine, antidote the action of Strychnia and Veratria, by combining with these alkaloids and forming iodides, bromides and chlorides-of strychnia, which have no deleterious effects. But these antidotes must be administered immediately, for a delay of ten minutes may be fatal. - ~1... 826 SPECIA.L THERAPEUTICS. Tobacco. General effects of poisoning: giddiness, fainting, nausea, vomiting, stupor, stertorous breathing, general spasms with insensibility of the pupils. ANTIDOTAL TREATMENT.-Vomiting and black coffee, as above. Camphor. Poisonous doses of Camphor seem to induce languor, listlessness, giddiness, a state of forgetfulness, a sense of lightness of the body as if one were skimming along the floor without touching it, paleness and chilliness, or even loss of consciousness, convulsions and maniacal frenzy. ANTIDOTAL TREATMENT.-Vomiting, which is to be kept up by large quantities of black coffee, after which a teaspoonful of Madeira wine may be given every now and then for the after-symptoms. Hyoscyamus. The general poisonous effects of this narcotic, are: dryness of the throat, loss of speech, dilatation of the pupils, coma, furious delirium, and various other exceptional symptoms, such as ludicrous gesticulations, altered vision, dark spots and vesicles upon the cornea, and even convulsions. ANTIDOTAL TREATMENT.-Vomiting and black coffee as above. Conium macnlatum, Hemlock. This plant is supposed to have furnished the poison with which the Greeks destroyed their criminals, and which Socrates was obliged to drink. ~. I 828. SPECIAL THERAPEUTICS. familiar to require description here. These symptoms are soon followed by dozing and gradually increasing somnolency, which may at length become so deep as not to be always so easily broken. After the state of somnolency has continued several bhurs, it ceases gradually, but is followed by giddiness, weakness, stupidity, headache, sickness and vomiting. 3. The third degree of poisoning is not so often witnessed, because, in order to produce it, a greater quantity of spirits must be swallowed pure and at once than is usually taken by those among whom poisoning in the second degree chiefly occurs. When swallowed in large quantity, there is seldom much preliminary excitement; coma approaches in a few minutes and soon becomes profound, as in apoplexy. The face is then sometimes livid, more generally ghastly-pale; the breathing stertorous, and of a spirituous odor; the pupils sometimes much contracted, more commonly dilated and insensible; and, if relief is not speedily procured, death takes place, generally in a few hours and sometimes immediately. Convulsions are not common in such cases. Christison mentions one case in which the coma was accompanied with constant alternating opisthotonos and emprostotonos. For further details we refer the reader to the classical "Treatise on Poisons,"by Christison, from which the above statements are taken. ANTIDOTAL TREATMENT.-The stomach-pump.should be applied at once. If vomiting can be excited, so much the bettet. The vomiting may be encouraged by means of large quantities of black coffee, which will likewise have a tendency to induce copious perspiration. If the coffee should not produce sufficient relief, we may then give _--CI'~ - ~ -- ~- ~ --- -~- -~ ~ - -- DELIRIUM TREMENS, 829 Nux VOMICA, one drop of the concentrated tincture, (not the globules, for they have no effect in this kind of poisoning), in half a tumblerful of water, a small tablespoonful every five minutes. As soon as the patient begins to perspire, the medicine may be given less frequently, and discontinued altogether when the patient is rid of the trembling, numbness, anguish, and so forth. We once treated a man who had drunk thirty-nine tumblerfuls of brandy and water in one night. He was a stout man, his limbs trembled, they felt dead, and he was in great fright, and behaved like a child, saying that his limbs were dying. He was attacked with: a peculiar species of frenzy, although perfectly conscious. The skin felt dry as parchment. We prescribed one drop of the tincture of Nux vomica as above indicated, and after the second spoonful a most copious perspiration broke out, and the patient felt relieved and was quite well on the day following. The habitual abuse of alcohol frequently superinduces a maniacal affection characterized by tremor, especially of the hands, delirium, and even coma. This derangement of the cerebral functions is well known under the name of Delirium Tremens. The principal remedies for this disease are Nux VOMICA, OPIUM, BELLADONNA, ARSENIC and VERATRUM. Nux VOMICA should be given when the consciousness is not impaired, but when there is trembling of the extremities, pain in the pit of the stomach, spasmodic vomiting of bile. DOSE.-Dissolve six globules, in a tumblerful of water, and give a table71 L_ 830 SPECIAL THERAPEUTICS. spoonful every two hours. If, after a few doses, this should not stop the vomiting, give a drop of the strong tincture in a tumblerful of water, a tablespoonful every hour until the vomiting ceases. BELLADONNA, when the face is red and bloated, the eyes look congested and swollen, the patient is delirious, partially comatose, the stupor being mingled with startings of the limbs, twitching; also when the secretions are suppressed. DOSE.-Six globules, in a tumblerful of water, a tablespoonful every two hours, until relief is obtained. If necessary, resort to the tincture, giving it in the same manner as indicated for Nux vomica. OPIUM, for coma, with or without furious delirium; or when there is only stupor with muttering or furious delirium. DOSE.-Same as for Belladonna. Use the tincture as mentioned for Belladonna,:if the globules have no effect. Belladonna and Opium may be given alternately, a drop of the tincture of each in a separate tumblerful of water, a dose of medicine every hour, commencing with Belladonna. ARSENIC, if the patient talks pretty rationally, but complains of vermin crawling about the bed, or sees dogs, monstrous phantoms. DOSE.-Six globules, in a tumblerful of water, a tablespoonful every two hours. VERATRUM, for excessive prostration, with diarrhoea and vomiting, sensation as if the bowels were drawn into a clue, coldness of the skin, internal burning. DOSE.-Same as Arsenic, with which it may be alternated every hour, until a decided improvement takes place. _ I____ ___~ ~ POISONS, ARSENIC. 881 MINERAL AND METALLIC POISONS, AND POISONOUS ACIDS AND ALKALIES. Arsenic. As soon as the poisoning is discovered, excite vomiting, if necessary, by the Sulphate of Zinc, and then give the hydrated Sesquioxide of Iron, in tablespoonful doses, by which means the arsenical compound, in case it should be dissolved by the fluids of the stomach, will be thrown down again. However, before and after vomiting has begun, the patient should drink milk, enough to have something to throw up, and to prevent the empty retching, but no more. If spontaneous vomiting should have set in, no artificial vomiting need be resorted to. We may here allude to the diuretic method, which Professor Orfila proposes as a remedy for poisoning with Arsenic, and which has indeed proved efficient. The diuretic he recommends is a mixture of ten pounds of water, five pounds of white French wine, a bottle of Seltzer water, and three ounces of nitre; the dose is two wine-glassfuls, frequently. This diuretic may be given after the poison has been discharged by vomiting. For the after-effects, the following medicines should be given: ACONITE, IPECACUANHA, VERATRUM, CHINA, and the moderate use of stimulants may be resorted to. ACONITE, for the inflammatory condition of the intestinal canal, with burning, soreness, tenderness, tenesmus of the rectum. DOSE.-One drop of the tincture of the root of Aconite, in a tumblerful of water, a tablespoonful every two hours. - --.. - ---I-. --- - - 832 SPECIAL- THERAPEUTICS. IPECACUANHA, for the spasmodic vomiting; and, if Ipecacuanha should not arrest it, VERATRUM. DOSE.-Of either, six globules in a tumblerful of water, a tablespoonful every hotir or half hour. CHINA, for the excessive prostration. DOSE.-Same as for Ipecacuanha. Small quantities of wine may likewise be given from time to time. Corrosive Sublimate. Administer the white of a dozen or more eggs, or an emulsion of gluten or wheat-flour. The constitutional effects of mercury are best removed by the Iodide of Potassiuim, and the sweating process, under the watercure treatment. Tin. The poisonous effects of tin are antidoted by the white of eggs, sugar, and copious draughts of milk. Acetate of Copper, or Verdigris. Give the white of eggs in sufficient quantity, or whiteo sugar, also the Ferrocyanite of Potass, or a few ounces of iron filings. Orfila recommends particularly the white of eggs. The after-treatment, if any should be necessary, is the same as for Arsenic. Tartar-emetic. Give large draughts of warm water, and tickle tho throat, to bring on vomiting. At the same time a decoction of Cinchona-bark, particularly the yellow bark, L.y ACETATE OF. LEAD. 833. should be administered, which will decompose the poison. The tincture of Cinchona may likewise be given for this purpose. And, until the decoction is ready; the dry powdered bark may be administered. According to some, an infusion of galls is superior to the bark. Should there be signs of inflammation in the intestinal canal, give ACONITE, one drop of the tincture of the root in a tumblerful of water, a tablespoonful every two hours. If this should not suffice, follow it up with ARSENIC, six globules in a tumblerful of water, a tablespoonful every two hours. Nitrate of Silver. Give the muriate of soda to decompose it, and afterwards give mucilaginous drinks very copiously. Mucilaginous injections may likewise be administered for the irritation in the intestines and diarrhoea. Acetate of Lead. This irritant poison i. neutralized by the sulphate of magnesia or the phosphate or bicarbonate of soda. Vomiting should likewise be induced by any of the above-mentioned means, unless spontaneous vomiting has set in. If inflammatory symptoms should remain behind in the intestinal canal, give ACONITUM, six globules in a tumblerful of water, a tablespoonful every two hours. One of the most dreadful effects of constitutional poisoning with lead is the well-known disease termed 71* II- - - - 834. SPE.CIAL THERAPEUTICS. Colica Pictonum, or Painters' Colic, for a complete description of which the reader is referred to our Symptomen Codex, Vol. I., p. 548. In white-lead manufactories, where this disease occurs almost constantly, it is generally treated with salts and Opium. A powerful dose of some laxative salt is given, and an hour afterwards a good dose of Opium. In this practice it is doubtful whether the salts do any good, for the bowels are not generally moved until the Opium has had a full chance to act. Iomoeopathic physicians discard the use of the salts, and at once proceed to the employment of Opium, which, in this disease, should be given in doses of two or three drops, in a teaspoonful of water, every few minutes, until the bowels resume their natural condition. If the spasm is relieved and the bowels still remain torpid, ALUMINA, a powcer of the second or third trituration may be given every half hour or hour, dry on the tongue, until the bowels are moved. Baryta. The salts of Baryta are speedily antidoted by Sulphate of Soda, or Sulphate of Magnesia. -~1 -~sr --~~-pllC*IPPCII-~p~~II ------ -r -- - -- roisoXous A00s. 835 P 0ISON0 US A CIDS. a. Sulphuric, Qxalic, Nitric, and Hydrochloric or Muriatic Acids. These acids are antidoted by chalk or magnesia, provided these antidotes are administered without delay. A solution of soap is also a good antidote. The bicarbonates of soda or potass are also excellent antidotes. While the antidotes are being prepared or sent:for,, copious draughts of milk or some oleaginous fluid should be administered. In.the: case of Oxalic acid no alkalis, but only chalk or magnesia should be, used. If inflammatory symptoms should remain behind, we:may combat them with ACONITE, one drop of the tincture in a tuniblerful of water, a tablespoonful every two hours; and.this nmedicine may be followed up by ARSENICUM, six globules in a tumblerful of water, a tablespoonful every two or three hours. These two medicines may be,given alternately, in the bove quan. tities, every two hours. b. Hydrocyanic Acid, Prussic Acid. If the dose which had been swallowed, be not too large, and necessarily fatal, the effects of the poison may be gradually -controlled by the use -of powerful stimulants, such as dilute liquid Ammonia,; Chlorine,, and even the cold affusion of water; one drop.of liquid ammonia may be taken internally, every few minutes until the _ I 83.6f SPECIAL THERAPEUTICS. danger is over, and the spirits of ammonia may, at the same time, be held to the nostrils. The Chlorine should be inhaled; according to Orfila, this is the most powerful known antidote against Prussic acid. The cold affusion should be administered in the form of a douche to the head, and along the spinal column. Messrs. T. and H. Smith of Edinburgh, propose the following chemical mode of neutralizing the poison: "A solution of one hundred and forty-four grains of Carbonate of Potash in two ounces of water, and another solution composed of a drachm and a half of Sulphate of Protoxide of iron, together with two drachms of the same salt converted into sulphate of sesquioxide by by means of sulphuric and nitric acids in the usual way. Of the solution of potash about four drachms should be administered, and, immediately after, four drachms of the second solution; this will be sufficient to neutralize the poison." Bitter Almonds. It.is well known that bitter almonds contain prussio acid; and, if any body should get poisoned with this fruit, the same treatment as has been proposed for the acid itself, should be pursued. Alkalis. Potass, Ammonia, are antidoted by vinegar, lemonjuice and other acid substances of this nature; after which mucilaginous drinks should be used. -I ACUTE INFLAMMATORY AFFECTIONS. 837 AFFECTIONS PECULIAR TO FEMALES AND LITTLE CHILDREN. The affections to which females are liable, may be conveniently ranged under the following general heads: 1. Acute inflammatory affections; 2. Sub-acute and chronic inflammatory affections; 3. Menstrual irregularities; 4. General disorders; 5. Affections incident to pregnancy; 6. Affections incident to confinement.. ACUTE AND CHRONIC INFLAMMATORY AFFECTIONS. a, Ovaritis, Oophoritis, Inflammation of the Ovaries. The ovaries constitute a most essential portion of the female organs of generation. The ovaries, so-called on account of the small vesicular ova which they contain, represent the testicles in the male; both the ovaries and testicles secrete a product which is absolutely indispensable for reproduction. From this analogy between the ovaries and testes, the ancients called them "female testicles" (testes muliebres). The ovaries are two in number, and are situated one on each side of the uterus. They contain the germs or ova which float in the limpid serosity contained in the ovarian vesicles. These ova constitute the rudimentary beginnings of the future man. In order to give our readers an idea from what an almost imperceptible point the human organism develops itself, we will indicate the 838 SPECIAL THERAPEUTICS. size of the ovum and of the germinal bodies contained within its delicate membranes. The ovum itself is a spherical body of uniform size (about 1-120th of an inch in diameter); within the yolk contained in the ovum, is situated the germinal vesicle of Purkinje (about 1-720th of an inch' in diameter), and within that the germinal spot of Wagner (about 1-2500th or 1-3500th of an inch). The changes incidental to impregnation, according to Dr. Barry, commence in the germinal spot and vesicle. The ovaries are subject to several more or less important derangements, such as inflammation, dropsy, enlargement and induration. Let us consider the symptoms and treatment of Ovaritis, Oophoritis, Inflammation of the Ovaries. According to Professor P. Clarus, whose views are adopted by Schoenlein, we may distinguish two forms of this disease, first: simple ovaritis, and secondly: ovaritis with heemorrhage from the womb. The symptomatology of this disease is thus described by Schoenlein. The patients have a dull, sometimes rather burning, but not always permanent pain deep in the pelvis. While the abdominal integuments are relaxed, an examination in the region above the symphysis pubis, where the horizontal ramus of the pubic bone unites with the ileum, reveals a moveable tumor, deep-seated and painful to pressure. Generally only one ovary is thus affected. These changes are often accompanied by a feeling of pressure in the direction of the stomach, spitting up of water, and symptoms of hysteria, such as hysteric headache as if a nail were sticking in the head. These nervous symptoms sometimes increase to convul _ ~ ___ INFLAMMATION OF THE OVARIES. 839 sions, and often induce delirium of the character of nymphomania. If the nervous symptoms are moderate or entirely wanting, the fever is acute; on the contrary, if the nervous character of the disease is strongly marked, the fever has a milder, erethic type, and shows itself more decidedly in the evening. The menses are either suppressed, or only appear momentarily and suddenly. If there is much haemorrhage from the uterus, the vascular excitement is very considerable, and keeps the nervous symptoms in the back-ground. The pain and burning in the ovary are more intense; the patients experience a drawing pain from the ovary towards the uterus; at times even the vulva on the affected side swells and looks inflamed. The haemorrhage from the uterus may take place every eight, ten or fourteen days, setting in very profusely and giving rise to symptoms of anemia, with coldness of the extremities, pale face and small, feeble and tremulous pulse. This disease is very apt to be caused by excessive sexual excitement; hence it is most frequently met with among females who lead a disorderly life, or who are addicted to the dreadful vice of self-abuse. The principal remedies for this disease are ACONITE and BELLADONNA; Pulsatilla, Apis and Cantharides may likewise be serviceable in some cases. ACONITE may be given first, a few drops in half a pint of water, a small tablespoonful every two hours, as soon as the disease shows symptoms of its presence. If the nervous symptoms which have been described in the preceding paragraph, predominate, BELLADONNA may be given, same dose as Aconite; or these two medicines may be given in alternation. _~ ~ ~ _~ ~~ ~ ~ I~~ ~~r_~_ 840 SPECIAL THERAPEUTICS. APIS is useful, if the inflammation 'is accompanied with strangury or ischuria. DOSE.-Same as Aconite, with which Apis may be alternated. CANTHARIDES may be given, if urinary derangement and symptoms of nymphomania set in together or separately; same dose as Aconite. PULSATILLA is useful, if the menses are suppressed. Same dose as Aconite, with which Pulsatilla may be alternated. In case of haemorrhage, give Aconite and Belladonna in alternation as above. The application of cold-water compresses to the inflamed ovary may prove highly beneficial and soothing. In regard to doses, we will observe that we have known cases where the attenuation of the medicines that we have recommended for this disease, proved insufficient, and where larger doses speedily affected the tumor and brought about resolution without any further untoward consequences. Ovarian tumor and dropsy require to be treated with the same medicines that we have recommended for inflammation, in addition to which we may depend upon IODINE. In ovarian tumor, Iodine may be used externally and internally, the tincture externally and internally, the first or second attenuation, a few drops three times a day. SEPIA may likewise be thought of, a few globules three times a day. b. Metritis, 'Uteritis, Inflammation of the Womb. This inflammation is ushered in with a chill followed by heat, full, jerking, tense pulse, whitish coating of the tongue, violent thirst, red urine. The lower or vaginal portion of the uterus may be the principal seat of the INFLAMMATION OF THE WOMB. 841 inflammation, or the posterior or anterior wall of the uterus may be inflamed. If the vaginal portion is inflamed, the patient complains of a burning pain high up in the vagina, and the orifice of the uterus is clogged up with thick mucus. The patient experiences, moreover, a feeling of heat in the upper part of the vagina. If the posterior wall of the uterus is inflamed, an examination by the rectum shows that the organ is swollen and sensitive; stool is likewise painful. An inflammation of the anterior wall is characterized by pain over the symphysis pubis, swelling and painfulness of the abdomen in the region of the uterus. Strangury is generally present in metritis. If every part of the uterus is inflamed, all the above-described phenomena are present. Inflammation of the uterus shortly after confinement, or during pregnancy, is particularly dangerous, and attended with violent symptoms of local and sympathetic constitutional derangement. The inflammation may be accompanied with vomiting, determination of blood to the head, delirium, etc. Typhoid symptoms, such as torpid fever, melancholia, excessive prostration, brown or dirty yellow coating and dryness of the tongue, may be present. Metritis may be caused by exposure to dampness, standing or sitting on the damp grass or pavement, sudden suppression of the menses, mechanical irritation, metastasis, violent moral emotions, etc. The only remedies which seem to be of any use in metritis, are ACONITE and BELLADONNA. They may be given in alternation, in tablespoonful doses every hour, mixing a few drops of each in twelve tablespoonfuls of water. In some cases we have found a drop of the tincture of Belladonna preferable to the attenuated drug. Bel72 842 SPECIAL THERAPEUTICS, ladonna is particularly useful, when a typhoid character is apparent, the skin is dry and the pulse frequent, but not very full; every now and then small quantities of dark, foul-smelling blood are discharged from the womb; the region of the womb feels hot, sensitive, and is somewhat swollen; the abdomen is otherwise soft, the bowels rather torpid, or brown, fetid, thin evacuations may be present, and the urine has a foul smell, looks dark and deposits a bloody sediment. Cold water compresses to the womb may prove very agreeable. Vaginitis, Inflammation of the Vagina. The mucous lining of the vagina may become inflamed-in consequence of exposure to dampness or wet, by sitting on the damp or wet ground, by mechanical irritation, corrosive injections, the gonorrhoeal virus, etc. The vaginal membrane looks red, is exceedingly sensitive; the patient complains of acute soreness and heat in the vagina which may even extend to the bladder and lower abdomen; stinging and lancinating pains are experienced; the external parts are involved in the inflammatory process; blood and a purulent matter are discharged from the vagina in profuse quantities; the emiission of urine causes a great deal of pain. The constitutional symptoms are: fever, with full and bounding pulse, thirst, coated tongue, headache, loss of appetite. Even little children may be affected by this disease. * We treat this disease first with ACONITE, of which we prefer a drop or two of the tincture in half a pint of water, a tablespoonful or dessert-spoonful every two hours, until the symptoms mend. __ INFLAMMATION OF THE VAGINA. 84S After an impovement has been effected it may be advisable to give a few doses of PULSATILLA, if the menses had become suppressed with the setting in of the inflammation; or of BELLADONNA, if the womb had been invaded, mixing a few drops or ten globules of either medicine in half a pint of water, and giving a tablespoonful every three or four hours. MERcURIUS VIVUS, same dose, or a powder of the third trituration dry on the tongue, every four houirs, is useful after the inflammatory symptoms had been subdued, and a purulent discharge remains, with soreness and aching, pressing pains in the vagina. If the patient is of a very scrofulous habit, SULPHUR and the IODIDE OF MERCURY may be used, third trituration, the same as Mercurius, three powders of Sulphur one day, and three of.the Iodide the next. It will be found advisable to interpolate a few doses of Aconite every other day, if the disease has a rheumatic or scrofulous origin. Fomentations of tepid milk and water will prove of great advantage to the patient. Vaginitis may occur in a chronic form, with heat, burning and soreness in the vagina, and discharge of pus and blood. The chronic form of the disease will yield to the same treatment that has been recommended. for the acute form. The medicines may be used in the following order: the first week or fortnight use ACONITE and BELLADONNA alternately, same dose as above', but at longer intervals. If the soreness and heat are much less, and the purulent discharge still troublesome, alternate SULPHUR and MERCURIUS for another week; then return to Aconite and Belladonna; or use a few doses __ 844 SPECIAL THERAPEUTICS. of Pulsatilla, if the menses are stopped; and if there is much urinary trouble, urging to urinate, and difficulty of passing urine, a few drops of APIS may be serviceable. Frequent injections of tepid water may prove a soothing palliative. Let the patient use as little irritating exercise as possible; all stimulating food or drink should be carefully avoided. Vulvitis, Inflammation of the Vulva, Requires no other treatment than the alternate use of ACONITE and BELLADONNA, same doses as have been indicated for vaginitis. If an abscess should form, MERCURIUS may be given in alternation with HEPAR SULPHURIS, a powder of the third trituration dry on the tongue every four or six hours. It is proper to apply a bread and milk poultice until the abscess discharges. Until the cure is completed a few alternate doses of Aconite and Belladonna may be interpolated every now and then, in order to prevent the return, or scatter the remains o~ inflammatory action. Mastitis, Inflammation of the Mamma, Gathered Breasts. This inflammation scarcely ever happens except after confinement, when the breasts are full of milk. In con. sequence of various causes, principally exposure to a draught of air, or dampness, an inflammatory action is set up in the breasts, in consequence of which the lactiferous tubes remain engorged with milk, and the breasts swell up, become hard, inflamed, and finally suppurate. This distressing condition which often proves a source of infinite annoyance under alloeopathic treatment, some GATHERED BREASTS. 845 times yields quite readily to specifically-adapted homoe-. opathic agents. At the onset, when the breasts are hard, knotty, inflamed, and exceedingly sore, with stinging or lancinating pains, we may exhibit with great success ACONITE, a few drops or ten globules in half a pint of water, of which the patient may take a tablespoonful every two hours. In many cases a drop or two of the tincture in the same quantity of water will be found preferable tp the attenuations. If Aconite does not produce a decided improvement after taking a few doses, we may alternate it with BELLADONNA, same dose, especially if the breasts look rose-colored, the inflammation seems to radiate from some central point, the skin is excessively sensitive; the patient complains of headache, congestion about the brain; othe face looks red and bloated, the eyes begin to sparkle, the distress in the head may sometimes be very great; the fever assumes a torpid character, and the patient is exceedingly restless. BRYONIA is useful, if the patient complains of aching pains and great soreness in the breast, the external symptoms of inflammation are comparatively unimportant. DOSE.-Same as Aconite. CHAMOMILLA is indispensable if the condition of the breast was caused by a fit of anger; if Chamomilla does not speedily afford relief, Aconite should be resorted to as above. If the gathering of the breast cannot be prevented and an abscess forms, we may give MERCURIUS viVus, same as Aconite, or a powder of the third trituration, dry on the tongue, every four hours. If the abscess comes to a head, HEPAR SULPHURIS and SILICEA may prove efficient 72* 846 SPECIAL THERAPEUTICS. means to promote the suppurative process and heal the wound. DOSE.-Same as Mercurius. PHOSPHORUS is recommended, if fistulous openings form in the breast. DOSE.-Same as Mercurius. If the formation of an abscess cannot be prevented, it is perfectly proper to apply a bread and milk poultice to the tumor while we administer the specific remedies internally. In treating a sore breast of this kind, we make it a rule to give every now and then a dose of Aconite and Belladonna, with a view of counter-acting any remaining tendency to inflammation. An embrocation made of fresh Plantain leaves to the breast will sometimes succeed in scattering the inflammation. A Plantain-salve, which may be had at the Homoeopathic Pharmacy, No. 635 Arch street, Philadelphia, will facilitate the discharge of the abscess and the ultimate healing of the sore. Menstrual Irregularities. The menses, catamenia or courses as they are termed, constitute one of the most important functions of the female organism. In our climate, this change in the uterine life generally sets in at the age of fourteen or fifteen; in warmer climates, it takes place at a much earlier period, even at the age of eleven or twelve years. The. menstrual functions are subject to a variety of irregularities which may require the interference of art. The menses, for instance, may not make their first appearance in consequence of the debilitated condition or abnormally-imperfect development of the organism; i,,, RETENTION OF MENSES. 847 or they may have been suppressed by some accidental cause, such as exposure, over-fatigue and exhaustion, deficient nourishment, sickness, mental anxiety or other violent emotions; or their regular appearance may be attended with great distress, cramps, fainting; at other times the menstrual appearance may take place too frequently and copiously, amounting to an actual flooding; finally the menses may delay beyond the proper period, they may be too scanty, and these various abnormal conditions of such an important function may entail a variety of constitutional disorders upon the female organism. The treatment of menstrual disorders affords the most convincing proofs of the superiority of homoeopathic treatment over the treatment pursued by any other class of practitioners. Let us now first consider the case, when the catamenia do not make their first appearance in the young girl; we designate this condition by the term Menostasia, Retention of the Menses. Retention of the menses beyond the natural period is not always attended with such symptoms as may call for medical interference. Some mothers become unnecessarily excited, if their daughters do not begin to menstruate about the period when these functions generally appear, and they desire medical aid for the purpose of hastening the course of nature. The interference of art, however, is ill-advised, unless the general constitution is actually suffering. In hundreds and perhaps thousands of cases, the menstrual discharge is retarded by the indiscretions of the young girl. The thin-soled boots which are worn by our fashionable young ladies on a 848 SPECIAL THERAPEUTICS. damp pavement, and on the damp and wet ground, constitute a kind of exposure which must inevitably result in embarrassing the nervous energies of the growing organism, and retarding the development of the uterine system. These weakening influences are indeed counterbalanced to some extent by the wild excitement produced by novel reading, premature activity of the sensual fancy, and the constant and unnatural compression to which young people are subjected at school; but the whole mode of living and the system of education, which are now in vogue among the higher and a vast majority of the middle classes; and the inexorable necessities to which thousands of our poorer girls are subject, having to sit out a miserable existence from the dawn of day until the midnight-lamp sends forth its last flicker, must inevitably derange the delicate mechanism of the growing female, and exhaust the powers which were required in order to prepare the uterine system for a higher and more perfect activity. Under these circumstances, if menstrual retention takes place, and is to be remedied, it becomes first of all necessary to assist nature by regulating the whole mode of living adopted by the female, in harmony with nature's laws. As far as medicines can be of any use we may help the efforts of the system along by means of ACONITE, PULSATILLA and FERRUM, and by other medicines which will be mentioned when the subject of chlorosis is treated of.. ACONITE will prove of great use, if the girl is of a plethoric habit of body, or if the opposite condition takes place; that is, if the blood is thin and watery, and the girl looks pale, bloated, her eyes are sunken, she is depressed in spirits, feels weak, has no appetite..These indications constitute, as we have shown in a previoup _ _ RETENTION OF MENSES. 849 chapter, a species of secondary homoeopathy; the primary indications for Aconite would be: rush of blood to the head, flushed and bloated countenance, bloodshot eyes, buzzing in the ears, ringing noises in the head, dizziness, palpitation of the heart, sickness of the stomach, a weary feeling, disturbing dreams, night-mare, etc. DOSE.-If these symptoms are very troublesome, a few drops of the medicine may be mixed in half a tumbler of water, of which the patient may take a tablespoonful every six hours, until a decided improvement takes place, then stop. PULSATILLA is useful, if the patient complains of palpitation of the heart, sickness of the stomach, watery and greasy taste in the mouth, and acrid risings from the stomach, fullness about the chest, weary feeling, lowness of spirits, etc. DOSE.-Same as Aconite. FERRUM may be given in the place of Aconite, if the female looks pale, bloated, and complains of weakness, palpitation, sour and acrid risings from the stomach. DOSE.-A powder of the third trituration, dry on the tongue, every six hours. Menstrual retention may be owing to some mechanical cause, to the presence of an imperforate hymen, for instance; if this should be the case, the membrane has to be separated before the menstrual blood can escape. An imperforate hymen may be the means of giving rise to improper suspicions. The menstrual blood may accumulate in the womb, and cause a distension of this organ which may similate pregnancy. If such a condition should arise, an examination has to be made, in order that the facts in the case may be properly investigated, and the difficulty may be removed by an opera. tion. IPII~---~-~-C----~II-----~l--~~--~-~--L- I 850. SPECIAL THERAPEUTICS. Menstrual retention may sometimes be symptomatic of a general enfeebled condition of the system such as is designated by the term Chlorosis. The literal meaning of this term is " green sickness;" the Germans designate this condition by a much more characteristic expression, "pale sickness." According to Professor Bedford of New York, "one of the most constant symptoms of chlorosis is pallor of the cutaneous surface, assuming not unfrequently a yellowish hue; but it is well to remember that this pallor is more marked in certain portions of the integumentary surface than in others; the conjunctiva of the eyelids, the mucous covering of the lips and nose, present in full this peculiar characteristic of the disease. The digestion is much impaired, no appetite, sometimes a longing for unnatural food; constipation; the tongue is white and coated; sometimes there is great thirst; as a general rule, the urinary secretion is diminished; the circulation is more or less disturbed; palpitation of the heart and intermittent pulse, often accompany this disorder; there is occasionally cough; the nervous system is.always more or less deeply involved, as is exhibited in the sleep by nights, depression of spirits, headache, vertigo, throbbing of the temples and ears, and not unfrequently -many of the hysteric phenomena." The complexion of chlorotic patients sometimes have a greenish tinge, especially under the eyes and around the mouth, whereas a dark flush is occasionally perceived on the cheeks. The breathing is often oppressed, a pain in the side is complained of, the skin feels cold, CHLOROSI. 851 the blood has a watery consistence, and the menses are generally absent. This, however, is not a permanent symptom; the menses may occur with the usual regularity, except that the menstrual blood is thin and watery; at other times a leucorrhceal discharge may take place instead of the menses, of a serous and watery consistence. Chlorosis sometimes yields quite readily to the action of specific remedies; at other times, especially in the case of tuberculous patients, the disease proves intractable and finally terminates in consumption. Some of the causes of chlorosis have already been alluded to in the previous paragraph. Exposure, want of suitable nourishment, long confinement in workshops, mental anxiety, and similar causes, may develop a condition ot the reproductive functions that must lead sooner or later to a watery alteration of the blood, and to the whole train of symptoms which are incident to such an impoverished condition of this vital fluid. After having regulated the external conditions of the patient to the best of our ability, we may resort to the following treatment: ACONITE, for disorders of the circulation and violent nervous symptoms, such as: dizziness, headache, fullness about the head, sickness at the stomach, palpitation of the heart, coldness, oppression of breathing, cough, etc. DOSE.-A few drops in ten tablespoonfuls of water, of which a tablespoonful may be given every four hours until the symptoms mend. PULSATILLA is excellent, if a leucorrhceal discharge sets in in the place of the menses at the regular periods. DOSE.-Same as Aconite, for a few days. CHINA may be given in alternation with Aconite, 852 SPECIAL THERAPEUTICS. same dose, if the chlorotic condition is owing to severe alloeopathic depletions. FERRUM, first trituration, a powder dry on the tongue every six hours, is a capital remedy, if the patient complains of fits of oppression, palpitation, anxiety, loss of appetite, coldness, oedema or bloating of the feet and bowels; constipation. CALCAREA CARBONICA may not be amiss, a powder of the third trituration every six hours, if the patient wastes away, the skin feels clammy, and an insipid watery fluid is spit up more or less all the time or in paroxysms. This medicine may be alternated with Ferrum. HYGIENIC TREATMENT.-If possible, let the patient enjoy all the fresh air and pleasant scenery she can; frequent ablutions with cold or tepid water will prove very strengthening; occasional trips to pleasant parts of the country, or visits to dear and agreeable friends, are exceedingly useful. Good diet, fresh vegetables and tender meat, venison, poultry, beef, mutton, are essential to a cure. Stimulants are unnecessary, but may be useful, if the impoverished condition of the system was in a measure due to poor diet. Mothers should not hesitate to find out, whether the sickness may not be induced by secret habits; great delicacy and caution are required in endeavoring to obtain certainty concerning this all-important subject. Thousands of young girls ruin themselves for life by such dreadful practices, and it is doing them a service of infinite magnitude to enlighten them regarding the precipice into which they are rushing. -e "~'~~` '-I.--' ' ----~--.-.. MENSTRUAL SUPPRESSION, 853 Amenorrhoea, Menstrual Suppression. After the menstrual flow has become fully established, and makes its appearance.at the regular periods, the menses may be suppressed by a variety of causes, which may act either during or shortly before the actual flow. The flow may thus be suddenly arrested, or it may be altogether prevented. Some violent emotion, such as fear, fright, anger; a sudden disappointment may arrest the menses; physical exposure may operate a similar result, exposure to wet or dampness, a cold by the feet, starvation. The best medicines by means of which the restoration of the menstrual flow can be best effected, are ACONITE and PULSATILLA. ACONITE is particularly indicated by violent rush of blood to the head, palpitation of the heart, oppression, creeping chills and fever, headache, heat in the head, dizziness, sensitiveness to noise and light, depression of spirits, weeping mood, weariness, sickness at the stomach, etc. DOSE-One or two drops in half a pint of water, of which the patient may take a tablespoonful every three or four hours. In many cases of this kind, one or two drops of the tincture are much more efficient than the attenuations, especially if the suppression is owing to some sudden cause. PULSATILLA is one of our most reliable remedies for amenorrhcea, especially if caused by exposure to dampness or wet, and if the spirits have become depressed, the patient complains of vicarious symptoms of inflammatory pain, such as earache; shiverings and creeping chills are likewise present. DOSE.-Same as the attenuation of Aconite. Sometimes it is advisable to give these two medicines in alternation. BELLADONNA is appropriate, if the region of the womb feels sore, and the patient complains of great distress, 73 I _ _ 854 SPECIAL THERAPEUTICS. heaviness, crawling, and a feeling of stupefaction in the forepart of the head. DOSE.-Same as Aconite. OPIUM is recommended by some physicians, if the patient wants to sleep and lapses into stupor; we only use this agent, if the stupor, the accompanying symptoms of gastric derangement, and the menstrual suppression are occasioned by suppressed anger and mortified feelings. DOSE.-Same as Aconite, except a dose every hour or two hours, until a decided reaction has set in. HYPERICUM PERFOLIATUM may be of advantage, if the suppression is accompanied with a sensation as if the region of the uterus were compressed with a tight bandage. DOSE.-A few drops of the tincture in half a pint of water, of which a tablespoonful may be given every few hours. Any of these medicines may be given at any time, if the symptonms are very acute; all medication may cease, as soon as the patient feels decidedly better. The medicines may be resumed at longer intervals a few days before the regular period for the appearance of the menses comes on. A frequent cause of menstrual suppression is to bathe the feet in cold water during the flow. This is a pernicious practice. If ladies are in the habit of washing their feet with cold water every day, they may continue this practice during the presence of the catamenia without any injury. But the feet should simply be washed, not bathed. _ ~ ~I_~P~q~ ~__ IBM 85G6 SPECIAL THERAPEUTICS. DOSE.-Two or three drops of the attenuated drug, or one drop of the tincture in half a pint of water, of which the patient may take a tablespoonful every few hours. CHAMOMILLA, for discharges of dark clots of blood, with bearing-down pains, coldness of the extremities. DOSE.--A few drops, or ten globules, in ten tablespoonfuls of water, A tablespoonful every three or four hours. If Chamomilla does not help, a mild infusion of CINNAMON may be given in dessert-spoonful doses three times a day. IPECACUANHA is excellent, if the flooding is accompanied with much prostration and sickness at the stomach. DOSE.-Same as Chamomilla. PLATINA may be useful to females who complain of great nervousness in the uterus, such as intolerable titillation. DOSE.-A powder of the third trituration, dry on the tongue, every four or six hours. SECALE CORNUTUM is eminently adapted to menorrhagia with violent contractive bearing-down pains. DOSE.-Same as Chamomilla, or, if the attenuation is insufficient, give a drop of the tincture in the same quantity of water. FERRUM may be serviceable, if the patient is flushed and nervous during the menses, with palpitation of the heart, and tendency to cedema. DOSi.-Same as Platina. HYGIENIC REGIMEN.-Women who are afflicted with this weakness, should abstain from all stimulating food or drink, such as coffee, tea, rich chocolate, heating spices and spirituous beverages; all violent exercise and exciting novel-reading, social dissipation, dancing, nightrevels, theatre-going, may likewise prove injurious: a simple, moderate, light but nourishing diet, the internal -~-~- L PIINFUL MENSTRUATION., 857 and external use of cold water, daily ablutions and, in many cases, a wet bandage on the bowels, will facilitate the good effects of medical treatment. Dysmenorrhoea, Menstrual Colic, Painful Menstruation. The.appearance of the menstrual discharge is very often attended with violent pains in the bowels and uterus, cramps, bearing-down pains which may be so violent as to induce fainting. We often succeed in remedying this condition by giving CoccULUS, a few drops or ten pellets in twelve tablespoonfuls of water, giving a tablespoonful every hour or half hour during the paroxysm. This medicine is especially useful if the patient suffers with violent cramps in the bowels and uterine region, cold extremities, nausea, dizziness, previous to the actual appearance of the menstrual blood, which is thin, watery, and has a foul smell. If the cramps are accompanied with violent vascular excitement, flushed face, headache, palpitation of the heart, cold extremities, feeble and excited pulse, violent bearing-down pains, and the blood is bright-red, fluid or coagulated, we may give alternate doses of ACONITE and BELLADONNA, a few drops or ten pellets of each in ten tablespoonfuls of water, an alternate tablespoonful at.a dose every half hour, until relief is obtained. These three medicines are particularly indicated, if the menstrual discharge takes place every two or three weeks. If it delays longer than it ought to, we may give PULSATILLA, same dose, if the cramp-pains are attended with nausea, lowness of spirits. COFFEA is not inappropriate, if the menses appear with 73* 85& SPECIAL THERAPEUTICS. sharp, distressing cramps in the bowels and womb, and great nervousness. DOSE.-A dessert-spoonful of strong black coffee, sweetened with sugar, every ten or fifteen minutes. If this prove unavailing, we may try OPIUM, same dose as Cocculus, especially if the patient inclines to be either excessively nervous and wakeful, or drowsy and stupid. Should there be violent pinching and pressing-down pains in the womb, followed by the discharge of a little blood, or bloody coagulum, we may procure relief by giving SECALE CORNUTUM, same dose as cocculus. We must not omit mentioning MoscHus, which may be of great use, if the menses appear too soon, and are accompanied with crampy, drawing, pressing pains towards the uterus. DOSE.-A powder of the third trituration every half hour, dry on the tongue. HYGIENIC REGIMEN.-The same as for menorrhagia. Premature and Excessive Menstruation. If the menses are otherwise natural, and simply appear too frequently, or last too long, we may correct the difficulty by giving a few doses of ACONITE, NUX VOMICA, SULPHUR and CALCAREA CARBONICA. ACONITE is suitable in the case of plethoric females, who menstruate too frequently and copiously. DOSE.-A few drops, morning and evening, or ten pellets dry on the tongue, for two or three days, a few days after the menses had begun to flow. Nux voMICA is useful under similar circumstances, if the blood flows more or less all the time, is of a dark color; the bowels.are costive, or the patient is troubled with piles, or has frequent discharges of small, mucous ___________~_____~ 1 __ __ DELAYING AND SCANTY MENSTRUATION. 859 stools. This condition may have been induced by overwork, excessive use of coffee or ardent spirits. DOSE.-Same as Aconite; or, if the flow is constant, a few drops, or ten globules, in half a pint of water, of which the patient may take a tablespoonful every two or three hours. CALCAREA and SULPHUR may be given, an alternate dose of six globules every three or five days, if'the weakness is constitutional, and seems owing to the retrocession of the itch, or to the presence of some scrofulous taint. CHINA is not inappropriate, if the discharge is very weakening, the patients look feeble, pale, feel chilly, have little appetite. DOSE.-Same as Aconite, and a dose every two or three days between the turns. Delaying and Scanty Menstruation. If this condition requires any treatment, we may depend upon PULSATILLA, giving a few globules, or a drop, every week; and upon FERRUM, a powder of the third trituration, dry on'the tongue, every four or five days, if the patient is of a chlorotic habit, with tendency to oedema of the extremities, and shortness of breath. GRAPHITES and SULPHUR may be given, an alternate dose of a few pellets every week, if the difficulty does not yield to the above-mentioned treatment. Considering the unnatural manner in which young girls are educated at school, and have to confine themselves to close rooms, year in, year out, in order to earn a living, it is quite natural that the menstrual functions should become more or less deranged. Under these __ _ __ __ LEUCORRH(EA, WHITES, ETC. 861 though it is important that this irregularity should be corrected. A physician will have to take charge of such cases. We may principally depend upon SEPIA, PULSATILLA, FERRtU, ACONITE, BRYONIA, etc. The medicines may be given in doses of a few globules, every few days. GENERAL DISORDERS. Lencorrhaea, Whites. This is a discharge from the vagina, consisting of mucus, pus, blood, inodorous, or having a very offensive smell, acrid or mild, thick and viscid or watery. A discharge of this kind may be induced by various causes. It may be a symptom of general scrofulosis; it may be the remains of inflammation of the vaginal mucous membrane; it may also be induced by mechanical irritation, by the irritating action of worms; affections of the neck of the womb, or of the inner lining of the womb, may be the cause. We may arrange the discharges from the vagina under the following general heads: 1. Catarrhal discharges; 2. Scrofulous and strumous discharges; 3. Discharges resulting from disorganizations of the womb. 4. Vicarous discharges; 5. Gonorrheal and syphilitic discharges. Catarrhal discharges. These may consist of mucus, pus or blood. Tihe vagina feels sore, at times hot, the external parts may be irritated or inflamed. The discharge. is more or less 862 SPECIAL THERAPEUTICS. constant, at times very profuse, at others scanty, sometimes the remains of mismanaged or neglected vaginitis. Give ACONITE, to relieve the heat, soreness and symptoms of inflammatory irritation. DOSE.-A drop or two of the tincture of the root in ten tablespoonfuls of water, or a few drops of the attenuation, instead of the tincture, a tablespoonful every four hours. PULSATILLA, if the discharge is of a serous or purulent character, the female has a lymphatic temperament, and a delicate scrofulous appearance. DOSE.-Same as Aconite, using the attenuations. MERCURIUS VIVUS, if the discharge is purulent or mucous, with a great deal of itching. DOSE.-A powder of the third trituration every six hours, dry on the tongue. This medicine may be alternated with SULPHUR, same dose, if the discharge is itching and excoriating, with fetid smell. REGIMEN.-Keep the parts clean, and use frequent injections of cold or tepid water. Scrofulous and Strumous Discharges. Scrofulous females are more or less continually subject to discharges of mucus from the vagina; the discharge is sometimes acrid, excoriating, having an offensive odor, and a variety of colors and degrees of consistence, milky, watery, serous, purulent, yellowish, greenish. Give ARSENICUM for a thin, watery, corrosive, foul discharge. DOSE.--A powder of the third trituration, dry on the tongue, every six hours, or twice a day. I I_ VICARIOUS DISCHARGES. 863. SULPHUR: For a fetid, thick, yellowish, itching, and acrid discharge. DOSE.-Same as Arsenic. IODIDE OF MERCURY, same dose, may be alternated with Sulphur. SEPIA, for a discharge of mucus, increasing especially about the time of the menses, with itching and soreness in the vagina. Same dose as Arsenicum, or a few globules dry on the tongue, twice a day. PULSATILLA, six globules or a drop, may be alternated with Sepia, one drop of each every day Observe cleanliness and use frequent injections of water. Discharges resulting from disorganizations of the Womb. In all cases of obstinate discharges from the vagina, a careful physician must institute an ocular examination. The discharge is frequently owing to a disorganization going on in the neck of the womb, or to a torpid, subacute irritation of the inner membrane of this organ. The treatment should be directed against the cause of the trouble, whatever it be. If inflammation has to be removed, we may have to give ACONITE, BELLADONNA, SABINA, etc.; if a schirrous or other malignant disease is developing itself, we may have to give BELLADONNA, CARBO ANIMALIS, ARSENICUM, KREASOTUM, etc. Vicarious Discharges. Instead of the menstrual blood, a leucorrhoeal discharge will sometimes make its appearance at the time I' "-' --~~ 364: SPECIAL THERAPEUTICS. of the menses. This difficulty requires to be treated with PULSATILLA, NUX VOMICA, SULPHUR, and BELLADONNA. Give PULSATILLA, a few drops or ten globules every morning, a few doses before the menses appear. SULPHUR, if the patient is of a scrofulous habit of body, a few globules every week. BELLADONNA, if the discharge is attended with bearing-down pains and rush of blood to the head, fullness and pain in the forepart of the head. Under these circumstances ACONITE may be suitable, especially if the heart palpitates and the patient feels light-headed. DOSE.-Of each, a drop or ten pellets twice a day, during the term. Nux VOMICA, if the discharge is very copious, comes on frequently, in full-blooded, strong females. Same dose as Aconite. Gonorrhceal and Syphilitic Discharges. A gonorrhoeal discharge may require COPAIV.E BALSAMUM, five drops three times a day, if the discharge consists of thick, purulent, bloody mucus, in profuse quantity, with heat and soreness of the vagina. CANNABIS SATIVA, a few drops of the tincture three times a day, if the urinary organs are involved, with strangury, constant urging, soreness of the urethra and vagina, discharge of purulent mucus and blood. MERCURIUS SOLUBILIS, if flocks of mucus are discharged from the vagina, with itching. DOSE*-A powder of the third trituration three times a day, dry on the tongue. We may give FALLING OF THE WOMB. 865 IODIDE OF MERCURY, same dose, if the patient is scrofulous, or HYDRIODATE OF POTASH, six grains of the crude salt in two ounces of water, from fifteen to twenty drops three times a day. Observe cleanliness, frequent washing with cold or tepid water, and avoid all stimulating diet and straining exercise, lifting heavy weights, etc. Prolapsus uteri, Falling of the Womb. In this weakness the womb may either protrude from the vagina, in which case a surgeon has to replace it and apply the proper mechanical means for keeping the organ in its place; or the falling may only be partial, causing pressure upon the vaginal walls, upon the neck of the bladder (giving rise to frequent urging to urinate), and even upon the rectum (causing an urging to stool without ability to accomplish anything); this partial falling is characterized by a sense of weight in the lowest part of the bowels, a dragging sensation from above downwards, which is exceedingly distressing. The symptoms of prolapsus may sometimes exist, without any actual falling being present. A characteristic symptom in actual prolapsus is a numbness, and sharp, shooting pains down the thigh, caused by the pressure of the prolapsed organ upon the sciatic nerve. If the female is in a recumbent position, the symptoms of prolapsus either disappear or are greatly mitigated. Concerning the use of a pessary and uterine supporters in prolapsus, a physician has to be consulted. As far as treatment can remedy the trouble, whether imaginary or real (for it more often is imaginary than real), we may depend upon 74 __ I _ _ 866.SPECIAL THERAPEUTICS. Nux VOMICA AND BELLADONNA, in alternate doses, using a drop or six globules of each, once a day-Nux at night, Belladonna in the morning. If the symptoms of prolapsus are owing to excessive vascular engorgement of the womb, characterized by a feeling of unnatural warmth in the womb, a sense of fullness and heaviness, we may give ACONITE and BELLADONNA in alternation, same dose as Nux. If prolapsus is owing to a fall, give ARNICA, one or more drops three times a day, and use an injection of from forty to fifty drops of the tincture in half a pint of water. REGIMEN.-Avoid straining, going up and down stairs, lifting heavy weights, etc. Hip-baths in cold water may be of great use; shower-bath or even the douche on the lower part of the spine may do much good. Prolapsus of the Vagina. The mucous membrane of the vagina may sometimes become depressed, inducing a falling as it were of the vagina. For this weakness we recommend MERCURIUS VIVUS, Nux VOMICA, PULSATILLA and the same hygienic means that have been recommended for falling of the womb. Metrorrhagia, Haemorrhage from the Womb. If bhemorrhage is caused by a fall, blow or kick on the womb, we may arrest it by the internal use of ACONITE and ARNICA, giving from three to five drops of the tincture of each in ten tablespoonfuls of __ AILMENTS OF PREGNANCY. 867 water, an alternate tablespoonful every few minutes; at the same time ice may be applied to the region of the womb, and cold water injected through the vagina. The patient should be laid on the back, with the head slightly raised, and the lower limbs rested on pillows placed under the knees. If flooding occurs after confinement or during pregnancy-see this article; if during the menstrual period -see Menorrhagia." Ailments incidental to Pregnancy. In a normal condition of society and social life, pregnancy would be found to be a state free from all ailments. Pregnancy is such a natural order of existence for woman that, if she did not violate the laws of nature in other respects, her health during pregnancy would be found to, be perfect; all the physiological functions of the organism, digestion, sleep, circulation, would be carried on with the most harmonious regularity, and the condition of the mind would be characterized by tranquility and the joyful expectation of her future bliss. But in the present condition of the world, pregnancy, so far from being a source of bliss, is, for thousands of women, a source of anxiety, of disappointment and vexation. The poor laboring woman beholds an additional burthen in the impending addition to her family, and the fashionable woman does not wish to have her frivolous pleasures curtailed by the duties and physical necessities which a state of pregnancy necessarily imposes. Hence crime is resorted to for the purpose, of removing the cause of so much annoyance. The fetus is destroyed, as soon as the signs of its presence in the womb have become apparent; yes, destroyed by the hands of physicians even, which should shrink from 868 SPECIAL THERAPEUTICS. becoming stained by the blood that it is their mission to save and protect by all the resources of art. The time may come when it will be discovered that human life commences at the very moment of conception, and that a murder is committed every time when a physician consents to destroy an unborn child, even during the most rudimentary period of its intra-uterine existence. Among the ailments which may arise during preg-nancy, the following may require the interference of art. Morning-Sickness. Five or six weeks after conception has taken place, women are attacked with more or less nausea, generally in the forenoon; they vomit up bile and phlegm, complain of dizziness and distress in the head. These symptoms are sometimes so violent, especially in young females of a feeble constitution, and who are pregnant for the first time, that medical treatment may be required. If the patient throws up much bile and mucus, we may give IPECACUANHA, six globules every morning, dry on the tongue. If the patient vomits up mucus, with much retching give VERATRUM, same dose. If there seems to be a good deal of spasmodic irritation about the stomach, with discharge of mucus, give Nux VOMICA, same dose as Ipecacuanha. PULSATILLA, for sour, acrid vomiting, same dose. If no medicines seem to do any good, we may try CONSTIPATION, DIARRH(EA. 868:! CHLOROFORM, five drops in a spoonful of water, every day whenever the nausea becomes distressing. ACONITE will help, if the patient spits up a fluid sour as vinegar, or bitter as bile, or real bile. Constipation. This condition may be relieved with alternate doses of BRYONIA and Nux VOMICA, one dose of Bryonia in' the morning, and Nux vomica at night, six pellets of each. If there is much determination of blood to the head, drowsiness, the bowels feel torpid, give OPIum, a few drops of the tincture once a-day. The remedies for "Constipation," p. 673, may be consulted, and the patient may use cold water injections after breakfast. Diarrhoea. Consult the remedies for Diarrhoea," page 675. If! the diarrhoea is caused by a cold, give ACONITE or MERCURIUS, the indications for which may be seen pages 675 and 678. ARSENICUM and CHINA will relieve a weakening diarrhoea consisting of mucus and blood, giving a drop or six globules of each at a dose, an alternate dose every two or three hours. PULSATILLA will do for a slimy, strong-smelling diarrhoea, same dose as Arsenicum. A few drops of CASTOR OIL, e.very few hours, may arrest the diarrhoea. 74* 870 SPECIAL THERAPEUTICS. Vertigo, Headache, Fullness about the Head, The circulation being sometimes very much interfered with in pregnancy, cerebral congestions may take place, and the patient may be troubled with such symptoms as vertigo, headache, fullness about the head, palpitation, etc. We relieve this condition with ACONITE, a few drops morning and night. BELLADONNA will remove a congested condition of the forepart of the head, worse when stooping. Same dose as Aconite. If these medicines do not help, the patient may bathe her feet frequently in cold water, unless the water should otherwise cause unpleasant symptoms. If hysteric headaches supervene, the medicines for Headache, page 349, may be used; we may use with the best success, ACONITE, IGNATIA, IPECACUANHA, NUX VOMICA and PULSATILLA. A congested condition of the brain, during pregnancy may sometimes lead to convulsions, especially at a later period in the progress of pregnancy. These convulsions are termed Eclampsia, Puerperal Convulsions. In old school practice, these convulsions are sometimes sought to be arrested by resorting to artificial delivery. Copious depletions are an indispensable means of cure in the hands of old school practitioners. Homoeopathic physicians have no difficulty in arresting these convulsions by the alternate use of ACONITE and BELLADONNA, provided the accident is at all curable. Being in possession of such admirable means of cure, PUERPERAL CONVULSIONS. 8.1 we wonder that practitioners of our school can be found who still cling to the notion that bleeding is a justifiable remedy in puerperal convulsions. We see this remedy even recommended in the last edition of Dr. Pulte's Domestic Physician. Speaking of plethora, the doctor recommends the following treatment: "If, notwithstanding these dietetic rules, symptoms of plethora develop themselves, the patient should take, from time to time, Aconite and Belladonna alternately, every six, twelve or twenty-four hours a dose, (six globules,) which, better than bleeding, will counteract the above named plastic quality of the blood, the real cause of plethora. It is not a surplus of blood which forms the characteristic of plethora; such a thing cannot exist in the vessels limited to a certain quantity; this surplus, if it existed, would sooner burst the vessels in the nose and lungs than be confined in too small a room. The above idea has only obtained on account of the means which were used to counteract the evil. Bleeding was heretofore considered the only remedy for plethora, and as it certainly gives momentary relief, the physicians judge the disease by the remedy, or rather by the action which the remedy produced. Subsequent investigations have shown that the b6nefit of a venesection does not consist so much in the lesser quantity of blood remaining after it in the system, but in the nervous influence, and its reflection on the quality of the remaining blood.. Bleeding constitutes, therefore, a remedy for this form of disease, although its application is limited to but few instances, particularly where plethora threatens to give rise to that formidable disease called puerperal convulsions, one form of which is frequently occasioned by a state resembling plethora,. 872 SPECIAL. THERAPEUTICS. where an early venesection will be beneficial, if the head is very much congested at the time." Instead of bleeding the patient, it is far better to give the Aconite and Belladonna in tincture form. Mix two or three drops of the tincture of the root of Aconite, and one drop of the tincture of Belladonna in two separate tumblerfuls of water, holding about twelve tablespoonfuls each, and give the patient a small tablespoonful of each in alternation, an alternate dose every five or even every three minutes during an attack of convulsions, or every half hour, if a state of cerebral plethora should threaten. We admit that the attenuations will often leave the practitioner in the lurch in such severe cases; it is the onesided and dogmatic adherence to the use of attenuations that drives their partizans into such fanciful doctrines, as the recommendation of blood-letting in plethora. If we open a flood-gate to alloeopathic absurdities in this one particular, where is the nonsense to: end? we drive out one devil and he returns with seven others. The use of Aconite and Belladonna may be supported by the employment of cold water ablutions, sponging, sprinkling cold water on the spine and applying a cloth dipped in cold water to the head. If stupor and stertorous breathing should supervene, OPIUM maybe substituted for Belladonna. Females who are liable to puerperal convulsions, should abstain from sexual intercourse until their constitution has undergone a thorough change by careful treatment and a well-regulated hygienic regimen; it may, however, be impossible to accomplish such a result, if the patient is constitutionally predisposed to such accidents. It is of importance to secure a free motion on the bowels once a day; during a paroxysm, an injec __ i LONGINGS, SWOONS. 873 tion of tepid water, castor-oil and salt may be administered. Abnormal Cravings, Longings. Pregnant females sometimes have strange longings; some want to eat soap, others chalk, others have an unnatural appetite, (bulimy); at other times pregnant women experience a complete loathing of all food. We may afford relief by giving the following remedies: IPECACUANHA, a few globules, or one drop, twice a day. CHINA, same dose, for excessive appetite. PULSATILLA may be useful, if the loathing is attended with lowness of spirits, same dose as Ipecacuanha; this medicine may also be given, if the patient has a craving for unnatural things, such as soap. MAGNESIA CARBONICA, a powder of the third trituration, may be given for such unnatural cravings. SEPIA, same dose, is another useful remedy for this abnormal condition. CARBO VEGETABILIS, same dose, for loathing, with oppression and wind on the stomach. Swoons. An accident of this sort hardly ever requires medical treatment. Sprinkling the face with cold water, or holding a smelling-bottle under the nose, will dispel the swoon very speedily. If the pulse is very low, or slow and labored, we may stimulate the circulation by giving a dose of -r~LC---~II~I----~~I11---~1~-~1--------~ - _. I 87.4 SPECIAL THERAPPEUTICS. ACONITE, a few drops, or six globules, every few hours, until the necessity for medication has been removed. Swelling, edema of the Lower Limbs. Pregnant women may be troubled with this; difficulty. Its presence shows that the venous circulation, and the proper absorption of the lymphatic fluid, are embarrassed, and that they require to be stimulated. This may be done by active exercise, by frequently washing the feet with cold water in which a little brandy may be mixed, and, if necessary, by the internal use of CHINA, FERRUM, or ARSENICUM, two daily doses of each-of China, a few drops, or ten globules, at a dose, and of the other remedies, a powder of the third trituration dry on the tongue. If symptoms of fever; should be present, the cedematous parts feel sore, hot, andd look redder than the rest of the skin, we should not hesitate to use ACONITE, one drop of the tincture of the root in half a pint of water, giving a tablespoonful every three or four hours. Toothache. The toothache, with which pregnant females are sometimes troubled, will yield to Nux VOMICA, a few globules, dry on the tongue, at night. CH0AMOMILLA, if the side of the face, where the affected tooth is situated, looks flushed and swollen. If this remedy does not help, we may try BELLADONNA, same dose as Chamomilla; and if the E __ CRAMPS, ITCHING OF THE PARTS, ETC. '875 whole head feels hot, the face looks flushed, and the patient feels dizzy, ACONITE, same dose, will be an excellent remedy. Cramps. This trouble will yield to the alternate use of ACONITE and HAMAMELIS, an alternate dose of one drop, or six globules, every three or four hours, and rubbing the legs, during a paroxysm, with a mixture of twenty-five drops of the tincture of Hamamelis in a cupful of water. Pruritus, Itching of the Sexual Parts. On examining the parts, they may be found very much congested; the mucous lining of the vagina looks as if engorged with blood. If these appearances exist, the itching will yield to ACONITE, two or three doses, of six globules or one drop each, every day; if this remedy does not relieve, try MERCURIUS VIVUs, same dose, if the itching is accompanied with sexual excitement, and is made worse by rubbing. In most cases, we depend upon Aconite, because the itching is caused by an excited condition of the vaginal nervous capillaries, attended with engorgement of the capillary vessels. As a palliative means, we may use injections into the vagina of a solution of pearl-ashes and tepid water. Dyspepsia, Heartburn. Nux vb6MIC will relieve this complaint, if the patient complains of a load at the stomach after eating, with,.-- - -- __ 876 SPECIAL THERAPEUTICS. rising of an acrid fluid from the stomach, and occasional retching. DO8E.-A few globules, dry on the tongue, every night. PtrLSATILLA, same dose every morning, if the patient raises a greasy-tasting acrid fluid off the stomach. CARBO VEGETABILIS, for pressure at the stomach after eating, wind on the stomach, spitting up of a flat, insipid liquid. DOSE.-A powder of the third trituration, twice a day, dry on the tongue. ACONITE, for spitting up of a liquid sour as vinegar. DOSE.-Same as Nux. Varicose Veins.Use Hamamelis internally, a few drops of the tincture morning and night, and externally apply a bandage moistened with twenty-five drops of the tincture in a cupful of water. Piles, Hmemorrhoids. This affection is to be treated with the same medicines that have been recommended for piles, page 698. If the piles are flowing, with much burning, ACONITE, a few drops of the first attenuation three times a day, will relieve them. Frequent bathing with cold water is very soothing. Sciatica. This species of neuralgia is caused by the pressure of the head on the sciatic nerve. It may have to be borne for a time, but we may try to give relief by using INCONTINENCE OF URINE, STRANGURY. 877 COLOCYNTHIS, a few drops morning and evening. Incontinence of Urine. In consequence of the pressure which the head of the child may have exercised upon the neck of the bladder for an undue length of time, the sphincter may have become paralyzed, so as to be unable to keep the bladder closed and prevent the escape of urine. In order to remove this weakness, we should use both external and internal means. Internally give OPIUM, five drops of the tincture in half a pint of water, of which the patient may take a tablespoonful every four hours, and rub on the region of the bladder a solution of Opium, ten drops in a cupful of water, three times a day. If this treatment does not help in a few days, give CANTHARIDES, a few drops three times a day, and, if the sensibility seems to have disappeared and the urine passes off unconsciously, give ACONITE, two drops of the tincture in half a pint of water, a tablespoonful every two or three hours; it may be alternated with a powder of the third trituration of SULPHUR. The application of a cold-water compress to the region of the bladder may be useful; a current of electro-gl;vanism through the neck of the bladder, may be of great use. Strangury. If resulting from a cold, treat it with the medicines indicated on page 711; if resulting from pressure of the 75 I 878 SPECIAL THERAPEUTICS. head of the fetus upon the neck of the bladder, we may relieve the distress by means of Nux VOMICA, a few globules morning and night; or PULSATILLA, same dose, if the urine is emitted with a burning sensation in the urethra. APIS MELLIFICA, same dose, may help, if the other medicines fail. Miscarriage, Abortion. By miscarriage we understand in general every premature delivery of the fetus before it has attained a sufficient development for the purpose of maintaining an independent extra-uterine existence. A miscarriage may take place at any period after conception; it may, moreover, be accidental or voluntary. Accidental miscarriage may be due to various causes, violent bodily exercise, a strain, constitutional debility; if miscarriage is to be brought about by design, a conscientious and careful physician has to determine under what circumstances the operation may be legitimately required. Accidental miscarriages would not be near as frequent as they are, if women would be more careful during their pregnancy, and would be less forgetful of the sacred responsibility which every woman assumes when she is certain of becoming a mother. Poor women who have to work for a living, cannot always conform to the requirements necessitated by the healthy growth of the fetus. Most married women, however, are so situated, that they have it in their power to regulate their habits and domestic duties in accordance with the demands of the harmonious development of their expected offspring. Pregnancy being a most natural condition for every woman __1 MISCARRIAGE, ABORTION. 879 who is capable of bearing children, no great art is required in order to secure a successful termination of this eventful change in a woman's existence. She may fulfil all the ordinary duties which the management of a household implies; she may go to market, dust her furniture, attend to the kitchen department within moderate limits, visit her friends and receive their visits, take moderate exercise in the open air on every fair day, and enjoy with becoming prudence the pleasure of social intercourse. It is only unnatural excitement, the wild revelry of immoderate dancing, violent concussions of the frame, heavy labor which strains the pelvis, and all exhausting mental excitement that should be avoided by a pregnant woman. Tight lacing is likewise injurious. During pregnancy it is of the utmost importance that the free circulation of the blood should not be interfered with; all undue pressure on the abdomen, and even tight boots or shoes should be avoided. It is likewise important that the abdomen should be protected from cold, from dampness and sharp winds. The feet have to be kept warm and dry; the thin soles which our fashionable ladies commonly wear, even when walking on the damp and cold pavement, are utterly condemnable; this kind of exposure, if it does not destroy the fetal life, must necessarily interfere with its vigorous growth. Habits of cleanliness should be kept up with the greatest care; daily ablutions with cold water in summer, and, in winter with water that has been standing in a warm room over night, or water that has the chill taken off by the addition of a little warm water, should be kept up with the most perfect regularity. The diet is likewise a subject of great concern to a pregnant woman. She had better avoid all exciting stimu __ _ _~ 880 SPECIAL THERAPEUTICS. lants; if she can do without coffee, the fetus will be benefited by this kind of abstinence. Fresh water is the most natural and wholesome beverage at all times, and more particularly for pregnant women. All fat meat should be discarded from the table of a pregnant female. Let not a morsel of pork or fat beef enter her mouth. Good lean meat, mutton, lamb, beef, poultry, venison, fish, are sufficient nourishment for any healthy appetite; vegetables and fruit may be enjoyed without stint, provided they do not otherwise disagree with the patient; good bread (none of your warm biscuits and heavy dough of any kind), may be eaten with fresh butter in moderate quantities; light cake may likewise be partaken of at times, but.all heavy and fat pastry is absolutely condemnable. In spite of a careful and proper mode of living, a miscarriage may nevertheless threaten. The first signs of impending miscarriage are: a bearing-down sensation in the uterine region which gradually increases to laborpains; the pains are mostly felt in the loins, a sort of cutting and drawing. These pains set in with creeping chills followed by slight fever. A slight discharge of blood takes place from the vagina; the blood is either bright-red or small coagula of dark blood may be expelled from the womb. If these symptoms are not speedily arrested, a miscarriage may take place in a couple of hours, or at the expiration of several days. As soon as these threatening circumstances set in, the patient must at once be confined to her bed; a hard mattrass is preferable to a soft feather-bed. Let her remain perfectly quiet; nothing should be said or done to disturb her mind. Whatever is done for her, let it be done quietly, without any unnecessary noise, and with. 1__ ~ __ MISCARRIAGE, ABORTION. 881 out the least appearance of hurry or excitement. Fresh air may be admitted into the room in such a manner that the patient is not exposed to a draught. She may take small swallows of cold water, and flannel dipped in this fluid may be applied to the bowels. At the same time we administer the following remedies internally. ARNICA, if the accident was caused by a mechanical injury, a fall, blow or any other violent concussion. DOSE.-A few drops, or ten globules, in ten tablespoonfuls of water of which a tablespoonful may be given every half hour, until the danger seems to be removed. ACONITE is suitable to strong, plethoric females, of a bilious or nervous constitution; the patient's face looks flushed, the skin is dry, rather hot, and the pulse, though soft, somewhat excited; bright-red blood is discharged from the vagina, with pinching, cutting and drawing pains. DOSE.-Same as Arnica; if the symptoms do not mend after a couple of doses, we substitute a drop of the tincture of the root in the same quantity of water, giving the same dose. IPECACUANHA is indicated by dragging pains, discharge of bright-red blood and sickness at the stomach. DOSE.-Same as Arnica; it may be alternated with Aconite, giving an alternate dose every twenty minutes, until the danger is past. SABINA is useful, if the bloody discharge is accompanied with heat and a feeling of soreness in the womb. DOSE.-A few drops of the tincture in a tumblerful of water, giving a tablespoonful every half hour. SECALE CORNUTUM, if the bearing-down pains are very marked, and every paroxysm of pain is followed by a discharge of blood. DOSE.-Same as Arnica, or sometimes a drop of the tincture instead of the attenuation. CRocus is sometimes useful, if a dark blood is discharged. 75,l _ ~ ~ ~ _ _ 882 SPECIAL THERAPEUTICS. DOSE.-Same as Sabina. Nux VOMICA may serve our purpose, if there is a constant oozing of blood, with swelling of the bowels and dragging-pain in the womb. DOSE.-Same as Arnica. This medicine may be alternated with BELLADONNA, if the face is flushed, the patient complains of much distress in the head, is delirious; same dose as Nux. If these remedies are not capable of preventing miscarriage, they will undoubtedly arrest the haemorrhage which sometimes accompanies such an accident. The symptomatic indications are the same; the doses may be repeated more frequently than we have suggested. After a miscarriage, the patient should observe quiet and the strictest diet for a week or more, lest the womb, in the high state of sensitiveness in which it must necessarily be, should become still more irritated and inflamed. Abnormal Labor-Pains, False Pains. False or spurious labor-pains may be readily distinguished from true labor-pains. True labor-pains come in paroxysms, and there is an intermission of pain after every paroxysm; they are felt in the lower part of the abdomen in front, thence passing to the lower part of the back; or the pains may be felt in the sacrum, a sort of pressing or bearing-down. False pains are uncertain pains, flying about in the bowels, pinching pains which have no regular paroxysms, last more or less all the:time; they make the patient very nervous and exhaust her strength. These pains may be removed by SPASMODIC AND AFTER-PAINS. 883 ACONITE, if the pains fly about, pinching pains, with flushes in the face, headache, nausea, wind on the bowels. DOSE.-A drop or six pellets, in eight tablespoonfuls of water, giving a tablespoonful every half hour. If this dose does not soon relieve, give CHAMOMILLA, same dose,, particularly if the patient is threatened with bilious diarrhoea; there is muchwind on the bowels which cannot escape. COFFEA and PULSATILLA are recommended for short tearing pains, making the patient nervous, and exhaust ing her, depriving her of rest. DOSE.-Same as Aconite. Spasmodic Pains. Labor-pains may be unnecessarily distressing, partaking of the character of spasm. The medicines that have been recommended for false pains, may likewise be of use here. Another remedy, which is particularly useful if the contractions of the uterus are unnecessarily severe and exhausting, is SECALE CORNUTUM, same dose as Aconite previously mentioned; we may also derive benefit from PULSATILLA, same dose, if Secale proves insufficient. After-Pains May require a little treatment, if they are severe, pinching, spasmodic, acute bearing-down pains, producing exhaustion and restlessness. Depend upon ACONITE, PULSATILLA and SECALE, and if there are any coagula remaining in the womb, remove them cautiously with the fingers, if necessary. ~ _ PUERPERAL PERITONITIS. 885 Child-bed Fever, or Puerperal Fever. In this fever, beside the usual suppression of milk and of the lochia, the peritoneum is more or less influenced, particularly the peritoneal covering of the womb. This inflammation often commences a few days and even weeks before parturition. The patient complains of a dull aching pain in the region of the uterus; the part feels sore to the touch; gradually the pain becomes more acute, spreading over the abdomen and invading a greater or less extent of the peritoneum. In many cases of ordinary child-bed fever, the peritoneal irritation may not transcend the limits of a simple congestion, and the treatment which we have indicated in the last paragraph, may be abundantly able to control the morbid action. The continued use of Aconite, even without any other medicine, may suffice, in all cases where the cerebral consciousness remains undisturbed, to effect a cure. In true Puerperal Peritonitis. As the severest forms of child-bed fever are termed, the disease sets in with severe chills, followed by heat and dryness of the skin, quick and full, bounding pulse, tenderness over the region of the womb, tympanitis, (drum-like distension of the abdomen,) flushed countenance, distress in the head. The inflammation of the peritoneum may spread from the region of the womb over the abdomen, and even affect distant portions of the peritoneal membrane. In many cases, symptoms of cerebral inflammation have been observed. The disease is often exceedingly malignant, and may even prevail as an _ _~ 886 SPECIAL THERAPEUTICS. epidemic disease in hospitals and entire communities. The atmospheric constitution and miasmatic influences have undoubtedly something to do with the development of the malignant or typhoid form. In this form of the disease, or puerperal typhus, a burning pain spreads from some spot in the abdomen, either from the umbilicus or womb, over the whole abdomen which is distended and exceedingly painful when touched. The breasts collapse, the secretion of milk and the lochial discharge soon cease, and, as the disease progresses, the nervous system becomes deeply involved. Stupor and muttering delirium set in. The skin is either burning-hot, dry and parched, with petechise; or cold and covered with a clammy sweat that has the odor of mouldy straw. In this condition of the skin miliaria breaks out on the abdomen consisting of white, limpid vesicles which are without any inflamed border and filled with a whey-like, watery fluid. The pulse becomes small, feeble, filiform; its frequency increases; the tongue has a brownish coating, is dry; diarrhceic evacuations take place, having a cadaverous smell, and finally becoming involuntary. This disease may attack females a few days after parturition; after the third or fourth week no danger of the disease need be apprehended. The breaking out of the disease may be favored by violent fits of passion, damp and ill-ventilated dwellings, exposure to draughts of air, and a peculiar epidemic constitution of the atmosphere. In the uncomplicated acute form of puerperal peritonitis, the inflammation may suddenly terminate in gangrene and consequent death. In the typhoid form, a post-mortem examination reveals the effusion of a I _ PUERPERAL PERITONITIS. 887 whey-like or milky fluid, having a peculiar, generally sour smell, and containing pus and flakes of coagulable lymph. The disease may be complicated with putrescence of the uterus, when the tissue of this organ will be found either partially or totally softened. This formidable disease is very fatal under alloeopathic treatment; under homoeopathic treatment the patient has a far better chance of recovery. We use ACONITE during the inflammatory stage, when the pulse is full, hard and bounding, the skin hot and dry, etc. DOSE.-One drop of the tincture of the root, in ten tablespoonfuls of water, of which a tablespoonful may be given every hour, until an improvement sets in, after which the same medicine may be continued every four hours. Aconite will often subdue the disease, if the purely inflammatory type prevails. If the nervous character of the disease becomes manifest, we may resort to BELLADONNA, if the following symptoms prevail: muttering delirium, stupor, hot and dry skin, excessive tympanitis (drum-like distension of the bowels), sensitiveness of the abdominal integuments to contact, costiveness, hot and red urine, quick, small, rather soft and compressible pulse. DOSE.-A few drops, or ten globules, or one drop of the tincture in a tumblerful of water, of which a tablespoonful may be given every two hours. ARSENICUM, a powder of the third trituration dry on the tongue, if the pulse becomes vibratory and filiform, the skin is dry, or covered with a mouldy perspiration; petechie or miliaria break out; a diarrhoea having a cadaverous smell, makes its appearance, the stools finally pass off unconsciously to the patient, the urine has a foul smell. Arsenicum is also indicated, if the sensibility of the abdomen suddenly ceases, and symptoms Lh~--- 888 SPECIAL THERAPEUTICS. of gangrene set in. This medicine may be given in alternation with HYOSCYAMUS, same dose as Belladonna, if the brain seems paralyzed, the patient looks imbecile, has a vacant stare, rolls her eyes sideways or upwards, grasps at flocks, picks at the bed-clothes, moans and mutters, etc. OPIUM may relieve a state of deep stupor, stertorous breathing, with labored, slow and intermittent pulse, or the pulse may be feeble, quick, wiry, irrregular; the bowels are costive. DOSE.-Same as Aconite. STRAMONIUM is not inappropriate, if the patient is troubled with oblique diplopia, as if she saw objects double, one a little sideways and higher up than its fellow; the abdomen is swollen, hard, and rose-colored petechial spots break out upon the abdomen. DOSE.-Same as Belladonna. RHUS TOXICODENDRON is indicated if symptoms of decomposition begin to show themselves; the bowels are loose; the thin, slimy or liquid stools have an offensive smell, look dark-brown, blackish or green, mixed with decomposed blood; the skin has a dry, parchment-like, at times clammy feel; miliaria breaks out, the tongue looks dry, parched, coated with a thick, dark-brown, blackish fur; the patient is very restless, especially at night. DOSE.-Same as Belladonna. BRYONIA may be useful at the commencement of the typhoid stage, when the skin is still hot and dry, the pulse rather full, soft, quick, the patient complains of shooting and burning pains in the bowels and distress in the head. DOSE.-Same as Belladonna. ~_ ~ __ PUERPERAL MANIA. 889.HYGIENIC TREATMENT.-The most absolute repose and quiet are indispensable in this disease; the diet should be throughout of the lightest kind; frequent changes of linen, and occasional sponging with tepid water areexceedingly soothing. Puerperal Mania. If this derangement of the mind occurs during pregnancy, it may not require any treatment, except a careful management of the general hygienic conditions of the patient. An affection of this kind may likewise occur during confinement, and may become so violent that treatment becomes necessary. It may arise from a sympathetic cerebral irritation induced by excessive uterine action; or the flow of milk may have been disturbed, the lochial secretion may have been interfered with, and a metastatic irritation of the brain may take place. We may control this affection by the use of ACONITE, BELLADONNA, HYOSCYAMUS and OPIUM; VERATRUM is likewise an excellent remedy for this disease. The symptomatic indications may be found for ACONITE, pages 213 and 227; for BELLADONNA, pages 215 and 228; for HYosCYAMUS, pages 215 and 228; for OPIUM, pages 213 and 228; for VERATRUM, page 228. In most cases of puerperal mania, the alternate use of BELLADONNA and VERATRUM will suffice to remove the cerebral irritation, especially when the condition is chareacterized by fitful mood, alternate depression of spirits and mirthfulness, whistling and singing; stupor and rage, paleness and redness of the countenance, solemn 76 ___ 890 SPECIAL THERAPEUTICS. and prayerful mood alternating with impudence and coarseness of language. DOSE.-A few drops of each, in a tumblerful of water, of which the patient may take a tablespoonful every two hours alternately. Nymphomania. This distressing affection may occur without pregnancy or during confinement. It may be brought on by various causes, excessive abstemiousness, improper gratification of the sexual passion, sudden suppression of the lochial discharge. Hahnemann has reported an interesting case which occurred in consequence of exposure to the sun's rays. The patient was a young girl of fourteen years. Itching eruptions on the sexual parts, organic diseases of these organs, and an abnormal nervous sensibility of the clitoris may likewise lead to this affection. According to Jahr's Female Diseases, most authors who have treated of this disease, have distinguished three periods. "In the first period, no external symptom reveals as yet the invasion of the disease, for the patients are still able to conceal the obscene ideas with which their imaginations are filled. Soon, however, relapsing into their amorous reveries in spite of all efforts to the contrary, the patients lose courage, seek solitary places, and finally abandon themselves to their unbridled fancies and desires, and sometimes even go so far as to gratify their passion by self-pollution. At this period we frequently observe a marked turgescence about the breasts and parts, with itching, tension, and a more or less copious leucorrhcea. In the second period, the patients abandon themselves without any restraint to their passions, and seize every opportunity of talking NYMPHOMANIA. 891 about amorous enjoyments; they lose all sense of modesty, inviting the men near them to have sexual intercourse with them; at the same time the patients try to inflame their desires by all sorts of means, reading lascivious novels, conversation, voluptuous songs, stimulating diet, touch. In the third period the disease presents a truly sorrowful aspect of human misery; the female is totally insane; she invites the first man she sees to have intimacies with her; she throws herself upon him, exciting him by words, improper attitudes, and, if he resists, she becomes raving, and tears and strikes whatever is within her reach. The most timid girl becomes like a mad prostitute; modesty gives place to wild lust, and the horribly excited fancy frequently leads patients to self-abuse. At this period other symptoms generally manifest themselves, such as convulsive movements, or burning thirst, dry and burning mouth; discharge of a thick froth from the mouth; fetid breath; spasms of the throat, with hydrophobia, sleeplessness, restless sleep, with distressing, heavy and lascivious dreams. Sometimes the- attacks are followed by a sort of prostration which it is of the utmost importance to arrest. Towards the close of the disease, the patients generally fall into a sort of slow fever, with colliquative diarrhoea and generally consumption, and thus they die with all the symptoms of a most violent acute or chronic malady; sometimes they succumb even during a violent spasmodic paroxysm of the disease, although such an occurrence happens very rarely." The principal remedies for this disease, are ACONITE, if the lochial discharge had become suddenly suppressed by a fright or in consequence of some violent emotion, altercation, etc. In this case the patient is __ 892 SPECIAL THERAPEUTICS. melancholy, absorbed in thought, with sudden starts, looking up suddenly as if she had awoke to consciousness, or staring at a fixed point; fitful mood, alternate depression and exaltation of spirits; change of color in the countenance, sudden redness alternating with paleness of the face; distress in the head, dizziness; moaning breathing, irritated pulse, irregular as regards volume and frequency. This medicine will only prove useful in the first stage of the disease. DOSE.-A few drops, or ten globules, in a tumblerful of water, of which the patient may take a tablespoonful every two or three hours. If this medicine should not have the desired effect, BELLADONNA may be given, if the symptoms are the same; if the patient indulges in amorous songs and lewd manners; and if the delirium betrays the crowding of sexual fancies upon the patient's mind; symptoms of hydrophobia may also be present. DOSE.-Same as Aconite. HYOScYAMUs is required, if the patient's conduct evidences lascivious desires; she wants to take off her clothes, commit improprieties, talks about sexual things. DOSE.-Same as Belladonna. OPIUM, for wild sexual excitement, showing itself in paroxysms which are followed by prostration and a condition bordering on stupor, with an expression of imbecility in the countenance. DOSE.-Same as Belladonna; a drop or two of the tincture in the same quantity of water, may sometimes be preferable VERATRUM is indicated by fits of melancholy alteriating with unbridled mirthfulness; she wants to hug and caress every body; she manifests symptoms of rage; tears her clothes. DOSE.-Same as Aconite. BAD MILK. 89S BAD MILK. 893 CANTtARIDES may be thought of, if the sexual irritation amounts to perfect fury, and the throat is spasmodically affected, as in hydrophobia. DOSE.-Same as Aconite, a drop of the tincture may sometimes be preferable. ARSENICUM, VERATRUM, OPIUM and BELLADONNA, will be found most suitable in the last stage of this disease. Bad Milk, Deterioration of the Milk. If the child refuses the breast, or throws up every time it is put to the breast, and the little being is otherwise well, we may rest assured that the milk is not of the right sort, and that its quality requires to be altered by proper treatment. The mother's diet may have something to do with it. Let her abstain from any kind of nourishment that might impart an unpleasant, bitter, or otherwise disagreeable taste to the milk. If the character of the milk has been altered by mental irritation, grief, anger, we have to restore the healthy quality of the milk by medical treatment. CHAMOMILLA, for instance, will be found serviceable, if the milk has been influenced by a sudden fit of passion. Give the mother a drop or six pellets morning and night for a few days. ACONITE will be found useful for the effects of violent altercations or sudden chagrin or fright. Same dose as Chamomilla. If milk has become deteriorated by excessive use of ardent spirits, we may correct it by a few doses of Nux VOMICA same as Chamomilla. 76* 894: SPECIAL THERAPEUTICS. SRHEUM, same dose, is recommended for yellow and bitter milk. CALCAREA CARBONICA, same dose, for thin, watery milk. The best method of improving and preserving the milk, is a careful, well regulated, diet and general mode of living on the part of the mother. A simple nourishing diet is the best; feeble mothers may take every day a glass of lager-beer, or good porter beat up with the yolk of an egg, provided this beverage agrees with them. Suppression of Milk. The flow of milk may be suddenly arrested by exposure, a cold, damp feet, a violent emotion. If a serious fever or cerebral disease should result from this suppression, see Milk Fever, Child-bed Fever, Puerperal Fever, etc. If the milk is suppressed in consequence of a fit of anger, give CHAMOMIILLA, a drop or six pellets in a small tumblerful of water, a tablespoonful every two hours. ACONITE, if the suppression is owing to fright or quarrelling, same dose. OPIUM, same dose, if o.wing to suppressed mortification of feelings. AGNUS CASTUS, a few drops of the tincture two or three times a-day, will cause the milk to flow, if the secretion of this fluid is delayed beyond' the proper period without any immediate cause, except perhaps an impoverished condition of the system. ACONITE and BELLADONNA in alternation, a few drops or ten pellets of each in ten tablespoonfuls of water, an NURSING SORE MOUTH. 895 alternate tablespoonful every two hours, will restore the flow of milk, if it had been suppressed by a cold. CAMPHOR, five drops of the spirits every three or four hours, may help, if the mammae are cold, remain flabby, and the sexual organs likewise are deficient in natural turgescence. Excessive Flow of Milk, Galactirrhoea. An excessive secretion of milk is evidence of debility or of a plethoric state of the system. In the latter case ACONITE and BELLADONNA, in alternation, one dose of Aconite (a drop or six globules) morning and night, and a similar dose of Belladonna in the middle of the day, will relieve this condition, especially if the breasts are very knotty, feel sore and aching. If a debilitated state of the system seems to prevail, give alternate doses of CHINA and CALCAREA, same as the former, two of China and one of Calcarea. PULSATILLA, a dose or two every day, may help, if the patient is habitually troubled with scanty and retarded menses. If it should be necessary, a little milk may be drawn out every now and then with the breastpump. Nursing Sore Mouth. Nursing females are sometimes troubled with sore mouth. The inner mouth looks inflamed, and is studded with aphthous exulcerations that sting and burn, and often secrete a whitish cheesy substance. Ptyalism very often accompanies this condition. We know by per 896: SPECIAL THERAPEUTICS. sonal experience and by that of other physicians, that the best remedy for this troublesome affection is ACONITE, tincture of the root, of which the patient may mix three drops in twelve tablespoonfuls of water, and take a tablespoonful every three hours. In other cases we have found a wash of the TINCTURE OF THE ACETATE OF IRON, about fifteen drops in a cupful of water, an excellent palliative. Sore ipples. The compression of the nipples produced by the suction of the child's mouth will sometimes render the nipples sore; they may even become fissured and bleeding. Every time the child is put to the breast, the nipples bleed; after a while they may even ulcerate to such an extent that it may become necessary to wean the child. Homoeopathic physicians recommend a wash of Arnica for this trouble. This may suffice in some cases, but in other cases it does not. A good wash is the tincture of Aconite-root, ten drops in half a cupful of water, with which the nipples may be bathed for five minutes every six hours, this will remove the soreness and gradually harden the nipple. If the nipple is fissured or ulcerated, the tincture of Aconite can no longer be depended upon. We may then paint the nipples with a solution of the nitrate of silver, say ten grains in one ounce of water. Previous to putting the child to the breast, the nipples have to be carefully washed with tepid water - ----------. --------^1I^I~I~I- I~-~C_ --~- I-~-~- -- ~ 898 SPECIAL THERAPEUTICS. nancy, in unmarried females, and likewise in males. Its characteristic diagnostic sign is a whitish, shining swelling of the limb. The disease generally occurs on one side of the body. The swollen limb is sensitive to pressure. The disease commences with pain in the groin, or rather a painful uneasiness which extends down the thigh. This pain is sometimes preceded by slight chills. Formerly it was supposedthat this swelling originated in a metastatic transfer of the milk to this part, in accordance with which diagnosis the disease was formerly called by the French " maladie laiteuse" or milk-disease. We now know, thanks to the researches of Drs. Robert Lee, Velpeau and others, that the so-called milk-leg is essentially an inflammatory affection, and that the crural and iliac veins are the seat of this inflammation. Hence, the swollen part may look red and have all the well-known characteristic signs of inflammation, including heat and tenderness. In some cases the inflammation partakes of the character of venous congestion rather than of that of acute phlogosis. In our practice we have specific remedies which, if used in time and with sufficient vigor, will scatter the inflammation without permitting it to terminate in the disastrous changes to which it sometimes leads, such as purulent suppuration, erysipelatous disorganizations, gangrene. We treat this disease with ACONITE, HAMAMELIS and BELLADONNA. ACONITE is indispensable, if the swelling is hard, red, hot and painful. It is absolutely necessary, if we desire to make an impression upon the disease and scatter the swelling successfully, to use the tincture of Aconite, from three to five drops of the tincture of the root in EXCESSIVE NURSING. 899 half a pint of water, giving a tablespoonful every two hours. This treatment may suffice in all cases where the symptoms of acute venous congestion prevail. After the inflammatory symptoms have in a measure subsided, and Aconite seems to have done all that can be expected from it, we may then give HAMAMELIS, same dose; it may be advisable to alternate these two drugs every two hours. BELLADONNA may be useful, if the swelling becomes hard, and the erysipelatous character of the inflammation becomes manifest. DOSE.-A few drops of the attenuated drug, or two drops of the recent tincture in half a pint of water, of which a tablespoonful may be taken every two or three hours. We have never had any trouble in combating this distressing affection, by pursuing the course of treatment we have indicated, It is advisable that the patient should keep the limb perfectly quiet, in a semi-horizontal posture, until the swelling has fairly subsided. Excessive Nursing Is sometimes the source of great distress to enfeebled women. Many are brought to the brink of the grave by such a constant and exhausting drain upon the system. If a young woman is too feeble to undergo the fatigue of nursing, she had better renounce the pleasure which, this fulfilment of a mother's duties affords. Both her own health and that of her offspring will be the gainers by such a course. A healthy wet nurse may be procured, or else the child may be brought up by hand. This latter method is troublesome, but far preferable to the use of impoverished milk, or to employing a wetnurse in whom one cannot have implicit confidence; 900 SPECIAL THERAPEUTICS. After the tenth month, a mother's milk is not as suitable to the child as it is during the first months of the child's life. The milk becomes buttery, and is not readily assimilated by the tissues of the infantile organism. By that time the organism is strong enough to digest other, more substantial food. It is utter nonsense to nurse a child that is a year old and is provided with teeth strong enough to masticate meat or bread. Excessive nursing may reduce women to a state of perfect emaciation, almost bordering upon consumption, with hectic fever, cough, night-sweats, etc. Such women may have their health restored by using ACONITE and CHINA in alternate doses, a few drops of each in a tumblerful of water, a tablespoonful every two hours. In addition they may use moderate quantities of ale and wine, ride out, use ablution with cold or tepid water; by pursuing this course for a week or two, the organism will recover its recuperative energies. DISEASES OF INFANTS. Many of the diseases to which children, and even infants, are liable, have been treated in previous chapters. It remains for us here to mention the treatment of a few affections and derangements to which infants are particularly subject. Swelling of the Head. After parturition, the scalp is often very much bruised and swollen. This is owing to the violent pressure ....... ~........ ~ CORYZA, SNUFFLES, COLIC. 901 which the head often has to undergo during its passage through the vagina. We may remedy this trouble by bathing the swelling every now and then with a mixture of ten drops of the tincture of Arnica in a cupful of water. Coryza, Snuffles. Infants at the breast are sometimes attacked with a species of dry coryza. They are unable to breathe through the nose, and hence they cannot nurse, because nursing chokes them. Homoeopathic physicians are in the habit of treating this trouble with a few globules of SAMBUCUS, two or three times a day, dry on the tongue. A little warm goose-grease may be rubbed on the nose. Colic. If a child cries violently, and at the same time draws up its legs, we may rest assured that it suffers with colic. Generally the attack is owing to wind on the bowels, bile or worms. If the extremities are cold, and the head hot, the cheeks flushed, we may mix ACONITE, six globules in four tablespoonfuls of water, and give the child a teaspoonful every few minutes during the attack. If the bowels are costive, the abdomen hard, and the passages have a bilious appearance, we may resort to CHAMOMILLA, same dose as Aconite, especially if the child or mother had had a fit of anger. MERCURIUS vIVUs, if the child turns pale and feels cold and clammy during an attack. Same dose. Worms, which often cause an attack of colic, have 77 902 SPECIAL THERAPEUTICS. been treated of on page 701; if they should cause colic, give CINA, a few globules, dry on the tongue, every fifteen minutes, and if the bowels are very hot, alternate -this remedy with ACONITE, same dose, until the attack is over. We may endeavor to ease the pain by applying flannel,. dipped in hot water, to the bowels. Crying. Children who cry a good deal, generally suffer with pain somewhere. A pin may prick them, or they may be inconvenienced by some cutaneous irritation. If the pain does not seem owing to any of these causes, we may give JALAPPA, a few globules morning and night; or COFFEA, same dose, if the children are wakeful and restless; -or RHEUM, if they are troubled with acrid, sour-smelling bilious stools. We would advise mothers to abstain from using paregoric and catnip-tea on every occasion, when the children have to be quieted. If the abovementioned remedies do not help, we may try CHAMOMILLA, a few globules dry on the tongue, two or three doses. Swelling of the Breasts. The breasts of infants sometimes swell, and look inflamed. Some. nurses try to squeeze out the matter or'milk which they suppose is the cause of the difficulty. This is an abominable practice. If there is much inflammation, give ~ -............ 904 SPECIAL THERAPEUTICS. in the joints. Cleanliness is not always sufficient to keep off this disorder. Besides appropriate external applications, a little soft cerate, hair-powder, etc., we may use internally ACONITE, if there is much inflammation, a few globules every six hours. CHAMOMILLA, if a yellowish moisture is secreted from under the skin, same dose. SULPHUR, a few globules may be given every other day, if the trouble threatens to become chronic. This trouble is sometimes attended with serious consequences. If the exhalation which takes place externally, should shift to the inner surfaces, the child is almost certain to die. Jaundice. Infants, a few days after birth, are sometimes attacked with jaundice. This condition may pass off again without any treatment; if it should prove troublesome, however, we may assist the curative efforts of nature by giving a few doses of ACONITE, if the infant seems feverish, and the skin looks very dark, a few globules, dry on the tongue, every six hours; or MERCURIUS VIVUS, same dose, if there is no fever, and the skin has a yellowish tinge. Aphthee, Thrush. This eruption which is often seen in the inner mouth of nursing infants, is so well known to nurses and mothers that it does not seem to require a particular _~_ APHTHAL, THRUSH. 905 description in this place. On examining this eruption, we find it to be a deterioration of the mucous membrane of the inner mouth, principally on the tongue and gums, characterized by the appearance of whitish little patches or flakes, which sometimes stud the above-mentioned surfaces so thickly that they look as if lined with flour. Before these so-called aphthae break out, the mouth feels hot, and is sore and dry, so that the little one is hardly able to nurse. The irritation may extend down the cesophagus, and even.affect the intestinal mucous lining, causing very serious and troublesome derangements of the bowels. This eruption is, by many, attributed to a want of cleanliness. It is supposed that if the mother washed her breast frequently during the day, or, at any rate, kept the nipple perfectly clean and cool; and if the child's mouth were likewise washed with a soft linen rag every time the little being had been nursing, the disease would not make its appearance. We have no doubt that a want of cleanliness causes this distressing malady in many cases; but we likewise feel convinced that, in many other cases, a peculiar taint or diathesis determines its developement; we allude to the scorbutic diathesis. Both aphth.e and the nursing sore mouth of mothers seem to us morbid conditions determined by this taint. We therefore recommend and resort to the.same treatment which we have indicated for the first or.inflammatory stage of scurvy, and nursing sore mouth. We depend in the first place upon ACONITE, one drop of the tincture of the root in six tablespoonfuls of water, of which we give from ten to fifteen drops every two hours, if the mouth looks red, inflamed, and is evidently sore and dry. This medicine may even be depended upon after the mucous degenera77 - 906' SPECIAL THERAPEUTICS. tion has actually taken place. At the same time the mouth may be frequently washed with cold water. If there is very little inflammation, and the eruption not very troublesome, we may get along with a solution of BoRAX, of which two grains may be dissolved in a cupful of tepid water; with this solution, after it has cooled, the child's mouth should be washed quite frequently. If the bowels are affected, and the stools are thin, slimy, mixed with flakes of disorganized mucus, we may give MERCURIUS VIVUS, a few globules in six tablespoonfuls of water, of which the child may take a dessert-spoonful every two or three hours. If the discharges are watery, very foul and weakening, ARSENICUM and CHINA may be given in alternation; same dose as Mercurius. A dose of Aconite may be interpolated every now and then, if the child seems feverish. Under all circumstances, the utmost cleanliness should be enjoined. If the child is fed with the spoon, let it be kept perfectly clean; the milk should always be fresh, not too much diluted, if at all; it may even be advisable, to frequently resort to soups made of barley or rice-flour, or even light beef or mutton-broth. It is a great mistake to suppose that infants have to be fed on farinaceous slops, or on milk all the time; the infantile stomach digests a little broth without fat quite readily, and the reproductive energies of the tender organism are agreeably stimulated by this kind of diet. - -- - - - RETENTION OF URINE, DIARRHcEA. 907 Retention of Urine. If children are troubled with this difficulty, and it is owing to a cold, give ACONITE, a few globules, dry on the tongue, every three hours. If this does not help, and the urging is great, give CANTHARIDES, same dose. A cold wet cloth may be applied to the region of the bladder. Diarrhoea. The medicines which have been indicated, page 675, are likewise applicable to the diarrhoea of children. In common diarrhoea of children, we may depend upon ACONITE, CHAMOMILLA, MERCURIUS and RHEUM. For the indications the reader is referred to the above chapter. Summer-complaint is fully treated page 683. If children are subject to frequent attacks of diarrhoea, it may be important to change their diet. In many cases, milkdiet is injurious to children, most probably because the mother's milk is not healthy. In all such cases, some other nourishment, broth, cracker-soup, etc., has to be substituted. The remedies which have been suggested for CONSTIPATION, page 673, are likewise applicable to the constipation of children. We may, principally, depend upon BRYONIA, Nux VOMICA, MERCURIUS, SULPHUR, and in some cases BELLADONNA. For the indications we refer the reader to the above chapter. In the case of infants, the dose need not be repeated as often, nor need it be as large. I_ _ _ _ _~1 908 SPECIAL THERAPEUTICS. Prickly-heat, Red-gum, Heat-spots. These are red pimples, a red rash breaking out on the neck and body of the child, and likewise on the forehead and cheeks. It may annoy the child a good deal on account of the itching and burning. If owing to overheating by clothes, etc., keep the child cooler, wash it with fresh water, and, if necessary, give ACONITE, a few globules morning and night. If the child is very restless, CHAMOMILLA, same dose, will be useful. Spasms, Convulsions. This subject has likewise been treated very fully, page 419. Little children are often seized with spasms *from various causes, the principal of which are: teething,,worms, irritated temper, indigestion, fright, a fall, constitutional cerebral irritation. Violent eruptive diseases, such as small-pox, scarlet-fever, measles, etc., are sometimes preceded by convulsions; they disappear as soon:as the eruption has made its appearance, and do not require any treatment, unless the eruption should not come out, in which case a dose of BELLADONNA may be required to assist the action of the brain. In all ordinary spasms it may be necessary to resort to various palliative means beside the regular medical treatment. For in-stance, if the head. is very hot, the face very red, and the symptoms indicate a good deal of cerebral congestion, it may be well to apply ice to the head. If the child is very cold during the attack, we may wrap it in flannel isoaked with hot water. The feet may be inserted in warm water in which a little mustard had been sprin SSPASMS, CONVULSIONS. 909 kled. If the child seems utterly unconscious, we may hold a little hartshorn under its nose. As far as medical treatment is concerned, we may depend principally upon ACONITE, BELLADONNA and CHAMOMILLA. The indications have been furnished very fully, page 419. If the spasm is caused by a fall, we may alternate ACONITE and ARNICA, giving a few globules of each every two or three minutes, commencing with Aconite. This medicine, in alternation with Belladonna, a few globules on the tongue every few minutes, will generally be able to arrest an attack of spasms, if the head is hot and the face red, and the child breathes heavily and seems quite stupid and unconscious, with the extremities cold as ice, and the pulse almost gone. In convulsions from teething, these two medicines are likewise main remedies. If they do not arrest the spasms, if caused by teething, give CHAMOMILLA, same dose. This medicine is a capital remedy for spasms caused by anger. In all recent spasms which have the form of epilepsy, with the thumbs clenched and opisthotonos, we may give IGNATIA, same dose as above, and, if this does not help, Nux VOMICA. This medicine will prove admirable, if the convulsions are accompanied by, or seem to depend upon obstinate constipation. In this case OPIUM, same dose, may likewise prove eminently useful. Spasms caused by pain in the bowels, will yield to CHAMOMILLA or MERCURIUS, a few globules of each, and if the bowels are very hot, hard, distended, to ACONITE or BELLADONNA. Spasms caused by worms, yield to ACONITE and CINA, same dose. _C 910; SPECIAL THERAPEUTICS. Teething, Dentition. The process of teething is sometimes troublesome and requires the assistance of art. If there is much fever, give ACONITE, a few globules morning and night. This medicine is excellent, if the gums are swollen, in-flamed, hot, and the child keeps up a constant dribble. BELLADONNA may be used alternately with Aconite every two or three hours, if the head is hot and the child starts a good deal. Mix a few globules of each in six tablespoonfuls of water, and give dessert-spoonful doses. If the child looks feverish, one cheek red, the other pale, is very fretful, starts, cries out, kicks a good deal, and the bowels are very loose, having an offensive smell, we may give CHAMOMILLA, a few globules dry on the tongue every six hours. CALCAREA may prove useful, if the child is scrofulous, and subject to loose bowels; it may be alternated with Chamomilla, same dose, every four or six hours. If spasms threaten, the treatment recommended for spasms in the previous chapter may be instituted. If the gums feel very hard and seem very much stretched, parents sometimes insist upon having them lanced. If the homoeopathic practitioner cannot dissuade the parents from having this operation performed, and it seems at all admissible under the circumstances, we advise him to lance the gums by all means, without, however, neglecting the internal treatment. Diarrhoea from teething will yield to ACONITE, CHAMOMILLA and CALCAREA: ACONITE, if the discharges have a fetid smell, look dark, and are even mixed up with a little blood; TONGUE-TIED, LIVER-GROWN. 91. CICAMOMILLA, if the discharges have a bilious appearance, and seem to be attended with a good deal of irritation in, the bowels; CALOAREA, if the diarrhoea is more slimy, consisting of mucus, blood, and some facal matter. DOSE.-Mix a few globules, or a drop of any of these remedies in six tablespoonfuls of water, and give a dessert-spoonful every two hours. Tongue-tied. The fr2enulum under the tongue requires to be cut; else the child would be unable to nurse. This operation may be performed by a nurse, if no physician is at hand. Lay the child on your lap; with the index and middle-finger of the left hand raise the tongue, which should rest on the inner side of the fingers,, and with the right hand which holds a pair of scissors with sharp edges and without points, depress the lower jaw, which may be done with the scissors, and cut the fraenulum cautiously, so as not to wound the tongue. Liver-grown. Little children, when exposed to a draught, may take cold, and the abdomen, in the region of the liver, may feel sore in consequence; the children look bloated, cannot bear the least contact, feel feverish. This condition arises from exposure and suppression of the cutaneous exhalations. Common people call this " liver-grown;" they fancy that something around the liver has grown fast. We correct this trouble without much difficulty by giving a few doses of ACoNITE, a few globules in ten tablespoonfuls of water, _ ______ ~ 912 SPECIAL THERAPEUTICS. of which the child may take a dessert-spoonful every two, three or six hours, for a few days; the perspiration will soon be restored and the trouble ended. Cynanche, Croup, Angina membranacea. This frightful disease is, in reality, an inflammatoryspasmodic irritation of the mucous membrane of the larynx. Some children have a constitutional predisposition for croup. Children with fat and short necks are particularly liable to this disease. Authors distinguish the simple inflammatory and spasmodic form of croup from the malignant form, which is characterized by the formation of a false membrane in the larynx. During the attack, a lymphatic exudation takes place from the mucous membrane of the larynx, which coagulates and fills up the larynx, so as to cause death by suffocation. An attack of croup sets in with fever, which, after having lasted over night, leaves the child comparitively easy during the day. Next night the attack sets in again with renewed force, and the child not unfrequently falls a victim to this dreadful disease, thirty-six hours after the first symptoms of sickness were noticed by the mother. If an attack of croup sets in with slow fever and vomiting, followed by prostration, and attended with an anxious expression of the countenance and great irritability of temper, we may apprehend danger. With every succeeding paroxysm, the respiration becomes more wheezing, sawing, panting, until finally the vital strength is entirely exhausted, and the last flicker of life's lamp becomes extinct. In some cases, catarrhal symptoms, a little hoarseness _ ____1_____________11____IC_ PYNANCHE, OROUP, ETC. J913 towards evening, slight fever, may precede the attack for some days; at other times the attack comes on quite suddenly. Shortly before midnight, the children wake up with a peculiar crowing sound, a sort of howl, having a metallic ring, or at times resembling somewhat the bray of an ass. This peculiar sound is caused by a spasmodic constriction of the larynx; the inspirations are long-drawn and wheezing; the expirations are short, the air is expelled with a sudden jerking effort. The pulse is hard, full, tense, hurried. This condition of things may continue for one or more days, even a week. An inspection of the inner mouth reveals -symptoms of a most acute inflammation, a fiery redness ascending towards the velum and tonsils. As the paroxysms increase, symptoms of suffocation set in every now and then; the children stretch their necks, in order to have relief from the dreadful suffocative panting, which is at times interrupted by an attack of dry, barking, spasmodic cough, which sometimes terminates in the hawking up of a little blood-streaked phlegm. The pulse continues jerking and hurried; the tongue is slightly coated, thirst agonizing, the urine slightly reddened. Gradually the suffocation becomes agonizing. The children seek relief by.bending their heads backwards; they are so prostrated that they have to lie on their backs; they even refuse being carried. The face begins to look pale, bloated, the eyes protrude from their sockets, the lips are bloated, and have a purple look. The children grasp at the throat, and seek to hold on to anything near them. They scratch their faces, thrust their fingers in the mouth in order to remove the difficulty, and finally perish in unspeakable agony. Homoeopathic physicians possess admirable means 78 ~ 914 SPECIAL THERAPEUTICS. of cure for this terrible malady. If they were always called in time, the probability is that most children could be saved. But a physician is generally not sent for until the disease is fully developed and the exudation of the coagulable lymph has already fully set in. In our practice we always commence the treatment with ACONITE, of which a few drops may be mixed in a small tumblerful of water, giving the child a dessertspoonful every fifteen minutes, if the danger is imminent, or every hour and two hours under ordinary circumstances. Thousands of cases of croup have been cured with Aconite alone. In some cases it may be advisable to use a drop of the tincture instead of the attenuation. If Aconite produces a profuse, warm perspiration and the spasmodic breathing still continues, give SPONGIA, of which we always prefer the tincture, same dose as Aconite. These two medicines may be given in alternation. If Spongia seems powerless, and the spasmodic wheezing continues, we may try IODINE, same dose. HEPAR SULPHURIS is often given, if the wheezing is a prominent symptom. Give a powder of the third trituration dry on the tongue every two or three hours. BROMINE is to be used in the last stage, when the false membrane seems in full process of development. DOSE.-A drop in half a tumblerful of water, a dessert-spoonful every twenty minutes. KALI BICHROMICUM, same dose as Hepar, is recommended by some physicians in the place of Bromine. In this disease, we have found that if Aconite and Spongia leave us in the lurch, the chances of recovery are very slim indeed. An excellent palliative is the wrap i WHOOPING COUGH, PERTUSSIS. 915 ping of a flannel bandage dipped in hot water around the throat; the flannel should be kept hot all the time. If the patient recovers, the utmost care should be taken of the child, lest exposure to a draught or dampness should bring on another attack. Whooping-cough, Pertussis. This disease often prevails as an epidemic in connection with measles. The character of whooping-cough is a spasmodic irritation of the bronchial mucous membrane. We may distinguish three stages: 1. the catarrhal or inflammatory stage; 2. the spasmodic stage, 8. the stage of resolution or convalescence. A characteristic sign of whooping-cough is the paroxysmal character of the disease. The disease derives its name from the peculiar sound or whoop which accompanies the inspirations. The disease varies from a couple of weeks to several months. Under favorable circumstances it requires hardly any treatment; nevertheless the distress of the child may be mitigated by judicious management. Between the paroxysms the child often feels quite well, is playful as usual, and eats with a hearty appetite. If the catarrhal symptoms are very troublesome, the child has a good deal of fever, is restless at night, irritable, we may afford relief by giving ACONITE, a few drops in ten tablespoonfuls of water, a dessert-spoonful every three or four hours. CHAMOMILLA may afford relief, if the cough is very tight, with spasmodic stricture across the chest; same dose as Aconite. DROSERA was recommended by Hahnemann as a specific; but it helps only in a few cases, when the cough is 1~ 916 SPECIAL THERAPEUTICS, exceedingly barking, tearing and causing pain and soreness in the larynx. Same dose as Aconite. BELLADONNA is considered by some as a capital remedy for whooping-cough, especially when the spasm is very distressing and sends the blood to the head. The celebrated Hufeland used this as a favorite remedy for pertussis. He ground up one grain of powdered Belladonna with a drachm of loaf-sugar, and divided the whole into eight powders, of which he gave three a day to children from two to four years old. Smaller doses may produce an equally favorable result. IPECACUANHA and VERATRUM are recommended by some physicians, same dose as Aconite, if the cough is spasmodic and terminates in retching and vomiting. While the disease lasts, the patient should not be exposed to draughts of air, dampness, or to any influence that might induce inflammation of the respiratory organs. Complications of this kind are exceedingly dangerous. If they should arise, the inflammation has to be treated according to the instructions that have been communicated in previous chapters on Bronchitis, Pneumonia, and Pleurisy. The medicines which have been recommended for ( Cough," page 739, may likewise be used in whoopingcough. Some homoeopathic guide-books have swelled the list of medicines to be employed in whooping-cough to.four or five pages; this frightful array of drugs seems to us an utter waste of homoeopathic ammunition. Vaccination. Infants should be vaccinated two or three months after birth. Professor Bedford's remarks on the best VACCINATION 91 VACCINATION. 917 mode of Vaccinating are so practical that we take the liberty of transferring them to our pages from his eminently practical and interesting work on Diseases of Women and Children: "Vaccination is a simple operation, but yet.it requires some care. So far as the ultimate result is concerned, it matters not on what part of the body the virus is introduced, but, as a general rule, the arm is selected just below the deltoid muscle. It is customary with some practitioners, more particularly among the Germans, to insert the vaccine virus into both arms at the same time, or, if confined to one arm, to make several incisions at a little distance from each other, in order to insure a number, say three or four vesicles; and it is even asserted by high authority that consecutive small-pox never occurs in cases in which there are over four cicatrices from the first vaccination. All that I can say on this subjet is, that, according to general experience, I believe it will be found that if the matter be genuine and fresh, and it be properly inserted, the system will be abundantly protected by one vesicle; and with the latter, the constitutional as well as the local disturbance, will be much less than when there are several punctures, and, consequently, several vesicles. The matter employed for this purpose may consist of the lymph taken from the vesicle between the sixth and tenth day, though the lymph is considered purest and most fit for use when taken between the sixth and eighth day; or a paste may be made of the scab, which exfoliates and falls off between the eighteenth and twentyfifth day. The scab I much prefer to the lymph, for it is more under control, and may be preserved for a longer time, and with less difficulty than the lymph. If the latter be employed, the following is the mode to be 78* _~ __ 918. SPECIAL THERAPEUTICS. adopted: The point of an ordinary lancet is to be gently introduced into the vesicle between the sixth and tenth day, and then the lymph is received on the convex surface of small pieces of quill prepared for the purpose. Some practitioners, however, prefer introducing the lancet into the vesicle, and having both sides of the point armed with the virus, make a small puncture in the arm of the infant to be vaccinated; this, though an old mode of vaccinating, and one still in fashion, is not thorough. I much prefer, if the lymph be used, to have it on the quill, and then with the lancet a very slight scarification of the arm should be made, crossing the lines at right angles; as soon as this is done, the convex portion of the quill should be gently rubbed over the scarified surface-the matter in this way is more perfectly absorbed. If the scab be employed, it is first to be made into paste with cold water, and then introduced upon.the scarified surface. After the vaccination,, the arm should be exposed to the air, in order that the surface may become dry, and also that the virus may not be removed by the friction of the dress. After this, all that is necessary is to place loosely around the arm a small bandage of old linen." If there should be much fever, and a high degree of inflammation during the formation of the pock, a few doses of ACONITE may be required in order to allay the irritation. If unhealthy matter is used, disease may be entailed upon the child which may require medical treatment. If the pock looks angry, black and is filled with corrosive ichor, we have to give ARSENICUM, a few globules morning and night. If the virus was taken from a child affected with syphilis, syphilitic disorganizations may develop themselves which may entail lasting ___ ZOSTER, ZONA, SHINGLES. 919 suffering upon the patient in spite of the best treatment. Some homoeopathic physicians have proposed to sub. stitute the use of Thuja or some other medicine, for the process of vaccination. Such proposals should be regarded as the offspring of a diseased brain. In conclusion we will add that it is eminently proper to re-vaccinate children or full-grown persons every fourteen years, except during the prevalence of epidemic smallpox, when it is best to re-vaccinate at once. Zoster, Zona, Shingles. (Addenda to page 459, Erysipelas.) This eruption consists of vesicles which are seated on an inflamed base, and are filled with a transparent fluid, which gradually assumes a dirty-yellowish color, and a thicker consistence. The breaking out of the vesicles is often attended with febrile motions, although the eruption may likewise develop itself without fever. The vesicles with the inflamed skin form a sort of band, and may break out upon the abdomen, chest, or neck. The eruptions may be preceded by frontal headache; a little delirium, slight chills, followed by more or less fever, may be present; oppression and palpitation are often troublesome, if the eruption appears on the chest. The vesicles burn and sting, cause restlessness and deprive the patient of sleep. This troublesome eruption is managed without any ditficulty, by a homoeopathic physician who knows how to treat it. We have never failed in curing this disease, whether with or without fever, with _ ~ 920 SPECIAL THERAPEUTICS. ACONITE, a few drops of the tincture of the root in a tumblerful of water, a tablespoonful every two or three hours. In very few cases it may be necessary to give afterwards RHUS TOXICODENDRON, same dose as Aconite, except that the attenuations are preferable. These two medicines may be given in alternation. This eruption may be looked upon as a form of vesicular erysipelas. It is not a dangerous disease, nor does the treatment present any difficulties except in cases where complication with constitutional scrofula or with herpes arise. Improper management of the disease may likewise lead to unfavorable results, such as phagedenic ulcers and gangrene. If no fever is present, and the vesicles are not too thickly studded, the disease may be cured in a few days; if the groups are thick and inflamed, with fever, new groups of vesicles may break out a few days after the first have disappeared. Under homoeopathic treatment this is hardly ever the case; the inflammation is speedily controlled by the tincture of Aconite; the vesicles. dry up, and form dark, blackish scabs, which fall off in a few days. Milk-crust, Crusta lactea. Upon a red surface in the face, (cheeks, and chin,) yellowish-white pustules break out, which discharge in a few days, forming yellowish crusts. The eruption burns and itches, and attacks infants seven or eight months after birth, or during the first period of dentition. We treat it with ACONITE, six globules three times a day, if the child is feverish and restless; CHAMOMILLA may also prove useful. A few doses of BELLADONNA may be given, if the brain is affected; HEPAR SULPHURIS, morning and night, if the eruption becomes chronic. ___ ~ 922 SURGICAL DISEASES. and the formation of matter, which finally escapes by an ulcerated opening through the cheek or integuments of the lower jaw, which will not close unless the tooth is extracted, thereby removing the source of. irritation. Similar results flow from the growth of nails of the toes in the surrounding tissue, in consequence of pressure produced by wearing shoes that are either too narrow or too short. Both shoe and nail must be removed before a healthful condition can be produced. Foreign bodies lodging underneath the eyelids, hecome a source of irritation to the delicate membrane that lines the eyelids, and covers the anterior portion of the eyeball. At first there is increased sensibility around -and underneath the eyelids, and a redundant flow of tears, accompanied with a burning sensation as if hot water was flowing over the cheek; this is followed by increased sensibility amounting to pain; the vessels become engorged, discoloration of the membrane takes place, which soon terminates in inflammation, and all the succeeding steps of the deterioration of the tissue, unless the eyelids be raised and an exploration made to find the cause of irritation, which, when found and removed, arrests the further progress of the untoward consequences which have threatened the integrity of the organ. In the foregoing examples indicating local irritation, there is not any disturbance beyond the tissue or organ involved. If, however, the cause of irritation be not removed, the local disturbance will continue until other organs having a sympathetic relation with the one diseased also become involved and a general irritation is awakened, which will endanger the life of the invalid IRRITATIN 923 IRRITATION. 923 unless by judicious interference the irritating influences shall have been allayed. There are other causes of general irritation however, which are not dependant upon mechanical local irritation, but arise from specific and independent causes. A slight blow over the region of the stomach will often cause immediate dissolution; although no traces of organic injury can be found after death. The introduction of a catheter for the first time into the urethra, causes a degree of irritation which produces sickness, pallor of the countenance, and the invalid without resistance faints and falls at your feet. On examining the pulse, you find it weakened-almost powerless, cold perspiration bedewed the face and body, and unless you elevate the head and shoulders, using gentle friction over the region of the heart, and apply some diffusible stimulant to the nostrils and face, resuscitation may never take place. Dentition often excites fever, and from too great determination of blood to the brain, convulsions or paralysis of an arm or leg is frequently the consequence. The bowels too, from the same cause, are preternaturally excited, causing dysenteric evacuations, which, if not cautiously and judiciously controlled, sap the constitution of its vitality; reaction to the brain with capillary engorgement of the smaller blood-vessels ensue, and finally effusion of water into the ventricles causes compression of the brain, when convulsions and death put an end to the little sufferer's agonies. The untoward consequences which too frequently flow from teething in children, are familiar examples to almost every mother; and the sad issues, over which she has too often been called to mourn, have awakened many -- -- 924 SURGICAL DISEASES. a one to a more thorough examination of the symptoms that first annunciate this critical period of infancy, as well as the treatment so often illy judged and misapplied by Heroes of the Regular Practice, and enables her by her quick and almost infallible intuition to count upon its chances and its hazards and decide, with the remnant of her little army to leave this battle-field of error and destruction, for grounds where calmer judgments and more enlightened intellects administer the good gifts with which God has enabled them to assist, not oppose Nature's laws, and combat and conquer the insidious enemy of health. The most severe and formidable forms of constitutional irritation however, arise from mechanical injuries. The shock following such severe injuries as conipound fractures of the skull or extremities, produces great constitutional depression of all the vital organs, and when reaction is about to take place, general irritation is proportionally great. Under such circumstances the invalid, firstly, manifests restlessness of position, then a sensation of uneasiness about the loins, followed by pain in the back, extending along the spinal column towards the head; the restlessness increases, followed by an anxious and bewildered expression of countenance; the tongue at first is coated with a whitish fur, but as the irritation increases, changes to a yellow hue; and in a more advanced and aggravated state assumes a dark brown coating; derangement of the stomach also manifests itself by loss of appetite, nausea, and vomiting. All the secretions are now diminished or completely suppressed; the bowels are constipated, the secretion of bile is diminished, the kidneys have almost suspended their functions; urine is voided in diminished quantities, IRRITATION. 925 and of a deep yellow or turbid color; the skin becomes hot and dry, and no longer emits its healthful transpiration. As these symptoms accumulate and grow in intensity, the pulse quickens in its pulsations, becomes harder, more irregular, and ultimately intermits; corresponding changes takes place in respiration; at first, a little quickened and irregular, and finally hurried and laborious. If relief is not obtained before this critical condition manifests itself, the functions of the brain become disturbed, the spinal chord and nerves become influenced and -changed, spasmodic action of the muscles ensuing; the brain, impressed by the slightest sound, becomes irregular, and incoherent in its mental manifestations, and at length sinks into a state of low muttering delirium. The grand sympathetic nerve now becomes more severely involved; the abdomen becomes tumefied or distended from intestinal disintegration; vomiting and purging follow, and hiccough that unerring precursor announces that irritation has done its work of destruction. Thus in constitutional irritation, whether from injury or disease, internal or external; every part may become involved, and according to the constitutional idiosyncrasy of the invalid, the character of the organ involved; on the nature and extent of the injury, and finally, the clear and comprehensive diagnosis, coupled with the true selection of remedial agents, will depend the issues of life or death. There are three different modes in which death is produced by injuries. Firstly, where the injury is not severe, yet continued constitutional irritation is kept up, which gradually undermines the system of its vitality 79 926 SURGICAL DISEASES. Examples of this kind may be found in scalds arid burns, and mental emotions. Secondly, by causing an excess of action when the nature of the injury has been more severe; inflammation or congestion takes place in some one of the vital organs, and death speedily follows, either from mortification or compression. Thirdly, when a yet more severe shock on the nervous system depresses the vital forces to a degree that will not admit of reaction; amputations, severe blows, concussions, and gun-shot wounds, are sad examples of the destructive power of some of these unnatural extraneous influences. TREATMENT.-The treatment of irritation will depend on the causes which have provoked it, and the constitutional effects that follow. When constitutional irritation arises from local causes, these causes must first be removed or lessened before any of the general effects can be mitigated. If from the invasion of a foreign body, local or constitutional effects manifest themselves, the simple removal of the source of irritation, will arrest any further develop. ment. If, however, irritation is kept up, whether it be local or constitutional, by a vitiated state of the system, then the remedies must be selected for this specific.condition; for, not until the constitutional derangement is regulated, will the local affection wholly disappear. It must however be borne in mind that constitutional irritation under certain conditions, evinces nature's efforts in endeavoring to restore the healthful condition of her functions, and must therefore not be too rashly interfered with in attempting to control her actions; but carefully watch her struggles, and if necessary mitigate IRRITATION. 927 excessive action, or render more potent her enfeebled powers. He only is a true mariner who does not attempt to quell the storm, but by judicious management guides his bark in safety through it. There are other causes beside those already referred to, operating upon and influencing the fatal progress of the disease,-the destructive power of which, the guardians of health have not duly estimated. I allude to some of the passional elements of our mental and physical constitution; such as fear, anger, grief, and the baleful effects of abused sexual instincts. The almost universal ignorance that pervades the minds of both medical and non-medical men, in this department of knowledge is truly deplorable. Man is regarded by a vast majority, as a mere mechanical machine, governed solely by physical laws, and regulated by physical forces. In the consideration of deranged vital action, the influence of man's mental over his physical constitution, is not properly estimated, and, therefore, either left wholly out of consideration in the plan proposed for the treatment, or if at all considered, is regarded merely as some of the effects, and not the cause of disturbance. Disease is supposed to be engendered by some tangible morbific agent, and, therefore, requiring tangible forces for its expulsion; hence, the adoption of emetics and cathartics to expel it through the alimentarycanal, or the opening of some channel of the circulation (supposing it to have taken up its residence in the blood,) or both; or else by some chemical agent, making the human stomach a crucible which is to amalgamate a variety of agents, so as to render them more potent and effective, for the fiery ordeal. _ ~ 928 SURGICAL DISEASES. Similar principles are adopted in the culture and treatment of our moral constitution. Physical force is the specific which is to excite and strengthen inherent moral deficiency, or repress and control all inordinate manifestation. Flagellation has been, and still is, the great catholicon which is to cure all those unnatural proclivities in infantile life, before reason has taken its seat, and yet incapable of appreciating the force and power of denunciation, that tutor and regenerator of moral obliquity in the more advanced stages of progressive development. Manhood finally arrives, and with it all the sad consequences which error and wrong entail Inflammation. Inflammation is regarded, in the surgical acceptation, as a process by which nature repairs local injuries; and hence, has been termed, the restorative principle. Inflammation cannot be regarded as a healthful principle. It is the result of prolonged irritation, either arising from extraneous or mental influences, causing an undue determination of blood and heat to a part, and from the excess of both the blood and heat, deterioration and death follow, unless arrested and controlled by the inherent powers of nature; or artificial aid giving assistance to the impotency of her efforts. Inflammation is the reactive force consequent upon vital depression, and is characterized by four specific indications:--pain, redness, heat and swelling. Each one of these several indications may exist independent of each other; but all combined, constitute inflammation. Inflammation may be acute, or chronic. When acute, it is characterized by a greater ___~ INFLAMMATION. 929 degree of constitutional disturbance, as well as local intensity of all the indications which constitute inflammation; terminating either favorably or unfavorably in a few days. Chronic inflammation manifests a milder type of symptoms than the acute form, and is more protracted in its determination. The chronic form is the result either of acute inflammation, or from some idiosyncracy of the constitution; such as occurs in persons of intemperate habits, or those who are the subjects of deprivation and toil, or who are the victims of grief, anxiety, and disappointment. The acute form is best exemplified in a bile, or the inflamed breast after confinement in child-bed. In both the symptoms augment quickly, and the disease runs its course in a few days. The termination of the acute into the chronic form may be witnessed in inflammation of the eye; the pain, redness, heat and swelling, if not relieved by medicine, in part subside and are followed by a discharge of vitiated secretion, which is kept up for an indefinite.period of time, unless the proper treatment is adopted for its restoration. Inflammation terminates either by adhesion, suppuration, ulceration, or gangrene. When it terminates by adhesion, as in a simple incised wound, the separated vessels throw out a plastic exudation from the lips of the wound; these cohere, and become organized, by a continuation or prolongation of the divided blood-vessels and nerves, and the injured part is restored to its natural state. When it terminates in suppuration, the plastic exudation does not become organized as in the former instance; for it has deteriorated in character, which will not admit 79* 930 SURGICAL DISEASES. of a healthful organization, and the vitiated secretion is formed either on the surface of the lips of the wound, or underneath the skin, whichever place may have been the seat of inflammation. Ulceration is the result of a still lower grade of vital integrity; the parts involved gradually die, and the deteriorated animal matter is either thrown upon the surface of the ulcer or absorbed by the vessels that still maintain their integrity, and are rendered more active by the irritating influence of this foreign agent. Gradual destruction of all the tissues is the result, if not controled by proper treatment. Gangrene is the total destruction of the life of a part from excessive inflammatory action; the vessels become over-distended with blood, and inflamed, contractility ceases, stagnation follows, the vitality of the blood and vessels is destroyed, and death of all the tissues supervenes. Inflammation is common or specific. The first has already been described with its several terminations. The specific form is of a peculiar character and needs special consideration. There are two kinds of this peculiar form of inflammation. One is produced by constitutional causes, such as excess in eating and drinking, and all the luxuries attendant on sumptuous living, which enervate the digestive organs, and excite the disease known by the name of Gout. When this disease develops itself, in a man who has thus become the victim of sensuous excesses, he feels severe pain in the joints of the fingers, knees, toes, sometimes extending along the spine to the head, and he experiences sensations and pains like those produced by electric shocks. Inflammation succeeds, the INFLAMMATION. 931 joints become enlarged by a deposition of earthy matter around and within the ligaments that connect and form the joints, which finally become rigid and immovable, and undergo an entire structural change. The development of cancer and scrofula are other forms of specific inflammation, and will be specially considered in their appropriate places. The second form of specific inflammation arises from the application of peculiar poisons, such as the.bites of rabid animals, the inception of syphilitic and small-pox virus, each developing their peculiar characteristic symptoms. CAUSES OF INFLAMMATION.-These are constitutional, and can be known only when the symptoms that have been awakened by some exciting cause are carefully and minutely analyzed. The exciting causes are usually some disturbing forces from without; such as unnatural pressure, contusions, wounds, fractures, and mechanical injuries of every description and character. CONSTITUTIONAL SYMPTOMS.-These are manifested by general restlessness, the pulse is accelerated, ranging from ninety to one hundred and twenty beats per minute; less compressible and fuller than in its normal state; the skin is hot and dry; urine scanty and deeper colored; bowels torpid, and the evacuations small and unfrequent; the face is expressive of anxiety, and sometimes of fear; at times an acute or throbbing headache, the tongue is covered with a whitish fur, and the general aspect of the invalid indicative of universal derangement. When an injury has been inflicted on an important organ, these constitutional effects will become apparent, and the severity of the symptoms will depend on the 932 SUPGICAL DISEASES. extent of the injury inflicted, the idiosyncracy of the constitution, and the importance of the organ involved. TREATMENT.-This may be local and general. The local treatment has reference to the application of remedies immediately to the part injured, and the removal of all foreign sources of irritation, so far as may be compatible with the security of the invalid. The general treatment consists in the administering of remedies internally, with the view of repressing all inordinate action, and the restoration of deranged secretion, superinduced by the local injury, and which characterizes the inflammatory condition, whether local, general, or both combined. ACONITE is indicated in the primary stage of the inflammatory process, before over-distention of the minute termination of vessels, or, in other words, capillary engorgement, has taken place. The symptoms which characterize this stage are, general restlessness, accelerated pulse, darting, transient pain in different parts of the body; the skin is hot and dry, or at times alternate with perspiration; the tongue is covered with a whitish fur; the mental faculties are more impressible, and an expression of apprehensive fear marks the progress towards localization. BELLADONNA must now be given, in alternation with ACONITE, when this stage arrives; the symptoms indicating its appropriateness are local; darting pains, increased heat, redness and tumefaction of the part affected, the pulse becomes fuller, more frequent, and less.compressible; the capillaries are permanently engorged; the circulation through them entirely obstructed, and unless relief is afforded at this stage, the engorged capillaries lose the power of retaining their contents, effusion __ INFLAMMATION. 983 takes place in the surrounding cellular tissue, circumscribed inflammation, with increased tumefaction, follows; the character of the pain changes to a dull, pulsating sensation, the color of the inflamed part changes from a bright red to a darker hue, and pressure soon reveals, by an indistinct fluctuating sensation, the disintegration of tissue and the formation of matter. We have now what is termed, in surgical language, an abscess. These are the general indications to be observed in the early stages of acute inflammation, and in a majority of instances, when these medicines are promptly administered in their true spheres, a few drops of the first dilution in a tumbler of water, and a spoonful given every one or two hours, will suffice to avert the destructive tendency, and none other will be required. When, however, from some untoward circumstances, they prove inefficient, and the destructive tendency increases and is hurrying. along through the several stages of a more wide-spread destruction, ulceration and mortification, then other remedies are indicated, and they will be premised in their appropriate spheres, when specific forms of diseased organization are under consideration. LOCAL OR TOPICAL TREATMENT.-This consists, after the removal of all foreign irritating influences, in the application of remedial agents, to the parts immediately affected. The character of these remedies and the peculiar method of application, have ever been among surgeons a mooted point. Stimulating embrocations, warm.fomentations, hot poultices, cold water, ice, leeches, cupping, all have had their advocates and are still enforced by a large majority. Under certain conditions, we regard some of these _ __ 934 SURGICAL DISEASES. agents of great value. The application of cold and hot water to an inflamed surface may, and does appear to the uninstructed contradictory; yet when rightly viewed, each has its appropriate sphere of action and usefulness. In the early stages of the inflammatory process, before permanent capillary engorgement has taken place, and the circulation is. yet. unobstructed,-their contractility not yet destroyed, and the nervous impressibility acute, giving rise to more or less irritability, both local and general, the application of cold water to the irritated part causes the minuter vessels to contract, giving tone to their enfeebled coats, while at the same time acting also by its peculiar tranquilizing power upon the nervous filaments that every where accompany the minutest ramification of blood-vessels; thereby enabling" them mutually to maintain the integrity of the tissues involved, and prevent permanent capillary engorgement. Under such circumstances the continued local application, of cold water is an indispensable adjuvant to nature's efforts, and at the same time, acting in concert with the remedies that are being administered internally. The occasion for the application of cold water can be but transient, and must therefore be carefully watched and constantly applied, that a uniform temperature may be kept up; and if it act thus favorably, the normal condition of the parts will be soon restored. If, however, this happy result is not attained, and repletion of the capillaries, with increased heat, redness and tumefaction succeeds,-then the application of warm water of a temperature endurable to the invalid, will be the appropriate application:-this will accelerate the suppurative pro-.cess which has now become inevitable, and thereby prevent prolonged suffering, and a more wide spread INFLAMMATION. 935 destruction of tissues. Circumstances may arise, where, the application of some peculiar quality of poultice will be requisite, and these will be considered at the appropriate time. The use of stimulating embrocations, blistering, leeching, cupping and scarifying, under all circumstances are highly pernicious, and ought not to be applied. POSITIOx.-in the treatment of inflammation, position is an important consideration, and cannot be overlooked with impunity. The circulation all tends to the extremities of the body, and the more remote from the heart, (the centre of circulation,) the weaker is the power of contractile resistance of the depending vessels. Whenever an arm or a leg is involved, they should be placed in an inclined position, that the circulation may gravitate towards the heart, thereby, in a degree opposing a controling arterial turgescence, which is supplied directly from the heart, and facilitating veinous circulation which returns the blood to the heart when it is no longer capable of affording nutrition. REST.-This also is of great importance, and must not be disregarded in the treatment of accidents or disease. Entire repose of both body and mind must be enjoined, and all outward influences tending to disturb the equanimity, so much to be desired, aggravates the disease and prolongs the period of convalescence. DIET. -A strict attention must be observed in the administration of food in the treatment of all inflammatory disease. Stimulating articles of diet must be wholly avoided, and every thing that taxes the powers of digestion;-Farina and Tapioca gruels, Rice and Barley water, are the appropriate articles of food during the active stages of inflammatory excitement.. As a bever ~~c~~~---------~--------~--~~-----~I--- ~ 936. SURGICAL DISEASES. age, cold water, toast water and black tea, are admissible. When the activity of the disease abates, and evidences of convalescence manifest themselves, a more nutritious diet must be admitted; all these have been fully pointed out in another part of this work. Abscess. An abscess is a collection of matter resulting from inordinate Tnflammatory action; circumscribed in its character and enclosed within an adventitious membrane denominated a Cyst. The danger of abscesses depends upon several circumstances, from their size, number, situation; and from their pressure on important parts. The danger resulting from a large abscess does not depend so much on the amount of matter formed, as upon the difficulty nature finds in reproducing the destroyed tissue, superinduced by the pressure of matter in attempting to find an outlet. They become dangerous when their number is very great; as is frequently the case in small-pox, extensive suppuration of the skin takes place; the denuded surface is exposed to atmospheric influence, increased irritation is the consequence, and the invalid dies from determination of blood to some one of the vital organs-usually to the brain. They prove dangerous also from their situation. Abscess of the brain and heart generally prove fatal. When on the lungs or liver they are less dangerous. Abscesses may become dangerous although not situated in organs of vital importance; as when they press upon parts essential to life. Thus an abscess may form in the throat (pharynx,) from the FURUNOULUS OR BILE. 937 lodgement of some foreign body, and by' its pressing upon the valve of the wind-pipe (epiglottis), may produce suffocation and death. Farunculus or Bile. This is one of the most familiar forms of abscesses, and has its seat in the sebaceous glands of the skin. Biles scarcely ever result from local defects alone, but more frequently have their source in constitutional derangement. Imperfect assimilation of food may be regarded as the most fruitful source of these troublesome and painful abscesses. They develop themselves by a circumscribed more or less prominent and deep red inflammatory swelling; exceedingly painful, and terminate in a slow and sometimes imperfect suppuration. As the tumor increases or matures, it presents upon its apex a whitish or livid pustule, and underneath this the abscess is situated. The maturation of the tumor is seldom attended with arterial disturbance, unless there are several forming at the same time, or a very large one is situated in a sensitive part of the body. The suppurative process is usually very tardy, and seldom if ever perfect. The matter formed is tinged with blood, and this must first be discharged before the affected part will suppurate kindly, and put an end to this painful disease. TREATMENT. -- The immediate treatment consists chiefly in lessening the local inflammatory action, and promoting suppuration as speedily as possible. Biles never terminate in resolution, but always in suppuration. ACONITE, BELLADONNA and SILICEA, are the principal 80 938 SURGICAL DISEASES. remedies to be relied upon to lessen the local inflammatory action, and promote suppuration. ACONITE must be given in the commencement, when an uneasy sensation is first perceptible, gradually increasing to a distinct sharp, cutting pain, with increased heat, redness and swelling of the tumor. A few drops of third dilution, to be added to a tumbler of water, and a dessert-spoonful to be given every two hours. BELLADONNA, same quantity must be given in alternation with. ACONITE when the character of the pain changes to a more lancinating, deeper-seated pain, amounting almost to a pulsating character, which is indicative of approaching suppuration. SILICEA, twelfth potency, every four hours must be given when the character of the pain assumes a throbbing or pulsating sensation, and the apex of the tumor changes to a whitish or livid color. This medicine will hasten the suppurative process, and, in a great degree prevent its extension. SA poultice of Flaxseed or Slippery Elm bark must be applied as soon as Silicea is indicated, and should be continued until suppuration is completed. After which, a compress of lint and roller must be applied, which is all that is required for the restoration of the affected part. In order to prevent a recurrence of.these troublesome and unwelcome visitors, attention should now be directed to the constitutional causes that have created them. If they arise from gastric derangements, due attention should be paid to the quality and quantity of the patient's diet. Abstinence from all kinds of meats, beverages, gravies, condiments, pastries, sweetmeats, etc., must be strictly enjoined, and an occasional dose of ANTIMONIUM CRUDUA, sixth, in the morning, and one ANTHRAX OR CARBUNCLE. 839 of Nux, third, at night, will be all that is required to effect an entire restoration. A. correct and judicious regimen, cleanliness, and' healthful exercise, will do more to correct the varied ills that "flesh is heir to," than all the medicine contained in the Materia Medica. For without these physical observances, medicines themselves are impotent; and with a due regard to these, a few medicines only will be required as adjuvants. Nature is the truest physician, understand her laws, listen to and obey her voice, and she will require but little at your hands. Anthrax or Carbuncle. This form of abscess has some characteristics peculiar to a bile, yet differing essentially in its specific nature and locality. A carbuncle has its origin in the cellular tissue, lying immediately underneath the skin; and its development is marked by the following symptoms: intense pain, great heat, and a deep-seated indistinct circumscribed swelling in some part of the body on which arise several vesicated spots, attended with almost intolerable itching, and a burning heat. As the swelling becomes more distinct and elevated, the vesicles assume a dark brown color, and when broken down by rubbing or scratching, as is ordinarily the case, a dark bloody fluid is discharged, and an eschar is formed over them. Several of these small blisters are formed upon one tumor, and as the inflammation progresses, destruction of the skin takes place at these points, which emit a green or bloody matter. After this fluid has been discharged, there pro 940 SURGICAL DISEASES. trudes through these openings a substance resembling tow, which is adherent and cannot be removed through the aperture by ordinary traction. This substance is deteriorated cellular or areolar tissue, and in which the disease has its origin. As the destructive influence progresses, mortification of the tissue follows, and a separation takes place at the line where nature has produced adhesion, in the healthy part, for the purpose of arresting its progress; and a deep cavity is formed by the removal of the portion that was mortified. Writers have made two distinct characters of carbuncles, the benign and the malignant. We have never been enabled to see the propriety of this distinction. They all arise from a vitiated condition of the system, caused by sensual excesses, debauchery, deprivation, toil, mental suffering, etc., and the degree of virulence is proportionate to the peculiar character of the exciting cause, and the inability of the vital forces to control these destructive influences. The degree of peril may generally be estimated by the size and situation of the tumor, the age and temperament of the invalid, and the number of the swellings that exist at the same time. The state of the constitution, in aged people, is not unfrequently so shattered and feeble, that death soon follows the development of a tumor of this character, though it be of an ordinary size. Death does not follow so certainly in consequence of the disease itself, as from the inability, on the part of the constitution, to supply the reaction necessary to maintain the process of reparation. TREATMENT.-The first consideration in the treatment should be the removal of all causes that have conspired to develop this disease. The second is, to maintain the 942 SURGICAL DISEASES. matory action, and a dark, livid appearance of the integuments, showing unmistakeable signs of putrescence. Third trituration, every five hours, must be given, until the general condition of the system indicates improvement, and the carbuncle assumes a more healthful character. The local treatment is highly important, and consists in early fomentations over the diseased part; and, as soon as vesication has manifested itself, a poultice of slipperyelm bark or flaxseed must be applied, and continued until suppuration calls for aid from the knife to liberate it. As soon as fluctuation, is perceptible, although yet indistinctly apparent, an incision must be made around the entire circumference of the tumor, that the opening may be large enough to allow a free discharge of the fluid and deteriorated areolar tissue, which often extends far underneath the integuments that have not been involved. If the tumor shows early signs of putrescence, a yeast poultice, sprinkled over with a little CARBO VEGETABILIS, first trituration, must be applied, and kept on the part until separation of the dead tissue has taken place. When all has been removed that the cavity contained, a compress of surgeon's lint and a bandage must be firmly applied over the affected part, to support the muscles and contract the cavity, that nature may have less labor to perform, in her granulating process, to fill the cavity and restore the integrity of the affected part. Whitlow or Felon. This is a very familiar form of abscess at the end of the finger. There are several varieties of whitlow mentioned by different writers; their only point of difference WHITLOW OR FELON. 943 however arises from the tissues involved. The simplest form attacks the outer tissue, and vessication first appears at the root of the nail, after a slight inflammatory action, scarcely attended with pain. The matter is situated immediately under the cuticle, and is easily removed by a slight incision. Sometimes the abscess forms under the nail, and the suppurative process is attended with a greater degree of pain, extending upwards toward the wrist, and then the period of maturation is more protracted. In another variety the inflammation arises in the cellular substance, immediately underneath the skin, and attacks the extreme end of the finger. When it occurs in this situation, the inflammatory symptoms (especially the pain) are far more aggravated, the formation of pus very tardy, and the sense of fluctuation very indistinct. This condition is undoubtedly owing to the peculiarly hard and unelastic character of the tissues at the end of the fingers. When inflammation attacks the tendons at their insertion into the ends of the fingers, the pain is still more aggravated and excruciating; and instead of the swelling and pain being confined to the end of the finger, it runs along the course of the tendons to the body of the muscles, and the pain is severely felt at the wrist and over the entire fore-arm, and not unfrequently extends to the arm and even into the shoulder joint. When suppuration has taken place, it is never discovered at the end of the finger, but is often distinctly perceptible in the hand and wrist, and at times has made its way underneath the body of the muscle of the fore-arm. In this form of abscess there is always some constitutional dis 944-.SURGICAL DISEASES. turbance, considerable swelling of the whole arm, and an entire inability of motion. The last form of this variety of abscess is, when it attacks the membrane (periosteum) that covers, protects, and nourishes the bone. The peculiarity which distinguishes this form of abscess from those already considered, is, that although the pain is most excruciating, and at times almost unbearable, yet there is scarcely any external swelling of the affected part, nor does the pain extend beyond the second joint of the finger. SThe causes of whitlow are generally of an external character, and are the result of contusions, pricks of some pointed instrument, the sudden changes of local temperature, from extreme heat to severe cold, or the introduction of some poisonous or acrid matter into abrasions or scratches on the finger.. It frequently occurs that no cause can be assigned for the development of this severe and often very troublesome affection. TREATMENT.-In the simplest forms of this disease no general treatment is required; they run their course very rapidly, and as soon as matter has formed it should be liberated by a simple incision; after which, little or no inconvenience will be felt. When the matter forms under the nail, it must be extracted either by an excision of a portion of the nail covering it, or by an incision through the integuments around the nail. This should be done early, or the nail will be destroyed. When the abscess is situated underneath the tendons and sheaths of the muscles, constitutional treatment will be required. In the formative process, Aconite in alternation with Belladonna, third attenuation, every two hours, are the principal remedies to control the pain and inflammatory action. During the administration of 946 6URGICAL DISEASES. disease, and suppuration is prevented. When the first sensations of pain are felt, and there is no discoloration of the outer surface, this medicine will sometimes avert the disease, and nothing further will be required. When, however, this happy result does not follow the administration of this medicine, the local pain and suffering rapidly increase, destruction of the membrane follows; matter is formed, and unless an early and free incision be made down to the bone, and the matter liberated, the disease will extend to the bone itself, and destruction of the first joint inevitably follows. In this form of whitlow there is no time to be lost in administering remedies internally, or in the local application of poultices, with the view of arresting the tendency to suppuration; or even of hastening its approach nearer to the surface. This will not occur until destruction of bone has taken place, and the entire joint is involved in a common ruin. To tamper with symptoms and remedies under such circumstances, would be criminal; and finds no palliation in the puerile chimeras that are too frequently substituted for sense, by the mere symptomatologists of our school, who seek a different remedy for every sensation and pain, without regard to pathological conditions, and vainly hope that by chasing each in quick succession through their erratic wanderings, to overtake and exterminate them ere they shall have inflicted their death-dealing blow upon their agonized victim, and vanquished him. These symptoms and their antidotes are too often." meteors of the brain," and like the phosphorescent spangles that are turned up by the ocean-wave in the track of the noble bark as she courses onward, leave no mark to 7 PSOAS, LUMBAR ABSCESS.,947 warn the mariner of the sunken rock, no beacon-light to guide him safely through the perils of an angry sea to his destined haven. The characteristic symptoms of disease are based upon pathological conditions; each organization has a language peculiar to itself, both in health and when diseased; and when this language is correctly understood, it will be found simple in its character, and unerring in its import. They only are confused or confounded, who do not or cannot comprehend the sympathetic relation of organs, and the character of those sensations that are awakened through this peculiar relation, when a distant organ is invaded by disease. We must comprehend this great physiological law; (the sympathetic relations between different organizations,) -before we will be. enabled to discriminate between the stentorian voice of disease and the plaintive tones of sympathy. Psoas, Lumbar Abscess. This form of abscess is situated within the abdominal cavity, anterior to the lumbar vertebrae, or that portion of the spinal column commonly called the small of the back. It has its origin in the synovial bursa that underlies the body of the psoas magnus muscle, and covers the anterior portion of the iliacus muscle, both of which have their origin within the abdominal cavity and from the anterior surface of the lumbar vertebra; the one from the superior, and the other from the inferior portion, and pass out to be inserted into the superior extremity of the thigh-bone. The office of these muscles is to flex the thigh upon the abdomen, and to bend the body forward. In the almost constant action of these PSOAS, LUMBAR ABSCESS. 949 development of the whole system. The intellect is prematurely developed, and peculiarly impressible; the eyes are blue, with a lustrous and quick expression, and both thought and motion are indicative of preternatural apprehension and activity. The early development of this disease is marked by a little irascibility of temperament upon the slightest provocation; impatience in restraint, which manifests itself in weeping or petulant resistance; this is succeeded by more or less indifference, disinclination to motion, seeking repose in reclining or lying upon any comfortable couch or lounge that may be near, or even on the floor, in the absence of an object of a more comfortable character. These manifestations are succeeded by more or less arterial disturbances, the pulse is slightly accelerated, one or both cheeks at times are flushed, wearing something of a hectic appearance; the appetite grows indifferent to food, thirst increases, and the invalid now complains of uneasiness and languid sensations about the loins, extending down the thigh. These are soon followed by rigors, alternated with flushes of heat in the face, increased fullness and acceleration of the pulse, pulsating sensition deep in the loins, extending forward, towards and in the groin, where, finally, the true nature of the disease announces itself by tumefaction and indistinct fluctuations in one or other of the situations already pointed out. TREATMENT.-The early indications point to ACONITE, which should be given in the third potency every three hours, until the peculiar sensitiveness both of body and mind shall have been allayed, or succeeded by langor and indifference to motion. CHAMOMILLA may be given at night if the invalid is 81 -... 950 SURGICAL DISEASES. restless and wakeful, twelfth potency in water, and a teaspoonful to be given early in the evening, and another at bed-time. This medicine may prove useful during the day, and may be given in alternation with ACONITE every three hours. It should never be given in the present indication lower than the twelfth potency, and sometimes the thirtieth will act more soothingly than a lower attenuation. ARSENICUM is the principal remedy when the symptoms that have indicated ACONITE have passed, and are succeeded by languor, increased pallor of the countenance, thirst, and all the evidences that mark the progress toward general vital depression. In fact it is the only remedy upon which any reliance ought to be placed in this stage of the disease. A few drops of the thirtieth potency should be added to a tumbler half filled with water, and a dessert-spoonful to be given every six hours. SILICEA must be given when the above stage has been succeeded by a pulsating sensation, the local appearance of tumefaction, and the presence of matter. This medicine should be given the same as Arsenicum, and continued until the abscess has been opened, and the pus discharged. CHINA will now be indicated for extreme prostration, following the discharge of matter, which has hitherto served as a stimulus by its foreign irritating character; when it no longer provokes this excitement, reaction and prostration follow. This medicine should be given, third potency, every four hours. It should be borne in mind that CHAMOMILLA may be given throughout the entire progress of the disease, either alone or in alternation with any of the above remedies, when symptoms indicating its use demand it. PSOAS, LUMBER ABSCESS. 951 LOCAL TREATMENT.-This consists simply in opening the abscess as soon as fluctuation has developed itself, and must be suffered to discharge in amount proportionate to the size of the abscess. If an abscess contains a large quantity of pus, a portion only should be discharged at a time. If this precaution is not observed deleterious effects will follow. The sudden discharge of a large amount of pus has similar effects upon the constitution as the abstraction of blood; producing fainting and great vital prostration, from which the invalid does not recover as rapidly, in consequence of the general enervation superinduced by the influence of a protracted disease. The matter should be allowed to escape from time to time, closing the aperture with a dossil of lint at each evacuation, and when all has been discharged it will no longer be required. In a disease of this character especial attention must be paid to diet, cleanliness, well ventilated apartments, cheerfulness, and all those healthful, invigorating influences that cheer, elevate, and strengthen our entire nature. If, under the foregoing treatment, the invalid does not recover, the disease will assume a more complicated character. Some latent dyscrasic may develop itself, or the osseous structure may become involved, and then other remedies will be indicated; such as CALOAREA CARBONICA, CARBO ANIMALIS, SULPHUR and some of the preparations of MERCURY; this will require all the acumen and judgment of a physician who has had some experience in this form of disease, to be enabled to select the proper remedies. In fact, this disease is of such a character that a layman ought scarcely to hazard his own diagnosis and judgment in attempting to pursue a correct and judi __ 952 -SURGICAL DISEASES. cious course of treatment in any of its several stages. Yet the invalid may be so situated, as not to be able to command the aid of an educated and intelligent homoeopathic physician, and will be compelled to be treated by some intelligent friend, who is thoroughly imbued with the truth of our science, and in some degree familiarized with its general application, until such times when better council can be had. Better, far better, run this hazard than fall into the hands of some pseudo homoeopathist; or a Sangrado of the Regular practice. Even nature left to her own unaided efforts will do better than either of these. Ulcers. Ulceration is a process by which a portion of the animal body is destroyed; absorption takes place, and a chasm is formed, called a sore or ulcer. The phenomena of ulceration are distinct from that of any other process by which destruction of tissue is induced. In mortification the part dies either by excessive inflammatory action in the coats of the vessels themselves, or by a change in their structure, disqualifying them from conveying a sufficient amount of arterial life to nourish the parts they are intended to supply. In ulceration, the vessels themselves are not independently or completely involved, so as to prevent a certain amount of vital deposition; but this deposition deteriorates, or is reabsorbed so rapidly that disintegration of the tissues follows; the removal of which forms a cavity in the part in which this change has taken place, and continues to enlarge unless some aid is given to restore the equilibrium between secretion and absorption. 954 SURGICAL DISEASES. in the progress of any one of the above specific forms of ulcer. Cutaneous Ulcer. This form of ulcer is confined to the skin, and seldom extends beyond its superficial boundary. It results ordinarily from a want of cleanliness of the body, and irregularity in the ordinary habits of life. A proper regard to these considerations will usually restore the system to its normal condition, and little else will be required. The'body should be sponged daily with tepid water, and then gently rubbed with a towel, until the surface is perfectly dry. The ulcer should in the same manner be cleansed twice or thrice daily, and dressed with pledgets of dry lint, and snugly confined with strips of adhesive plaster. The lint will absorb the vitiated matter that collects on its surface, and the adhesive plaster will support and bring in closer proximity the edges of the ulcer, thereby abridging the process of cicatrization, the method nature adopts in the reformation of the integuments. Strict attention should also be given to the diet, which must be simple in its character, and free from all stimulating ingredients. SILICEA, thirtieth potency, may be given once a day, and continued until the ulcer shows indications of improvement, when it may be discontinued. Sinuous Ulcers. Whenever an abscess is deep-seated, and the matter has to travel a greater or less distance to find an external __.SINUOUS ULCERS. 955 outlet, it forms a channel, which from its peculiar situation is unable to close;-the walls of this channel continually secrete matter throughout their entire surface, which discharges from the external aperture until granulations fill up the canal, or their walls can be made to approximate and adhere to each other. This is called a sinuous ulcer. TREATMENT.-A variety of methods have been adopted by different surgeons with the view of healing the ulcer, and prevent the secretion of matter. Stimulants, injections of Sulphate of Zinc, Cantharides, Port Wine, etc., have been resorted to from time to time, but they have seldom accomplished that which was anticipated from them. Whenever a sinuous ulcer is so situated that pressure can be made sufficiently complete to approximate the walls of the entire canal, adhesion will follow, and a perfect cure will be accomplished; but when this cannot be done, the channel must be opened through its entire length, and the recent wound must be kept open until granulation springs up from the bottom of the ulcer, and fills the entire channel. Medicines in this form of ulcers are of little avail, and therefore ought not to be tampered with; yet scarcely a book has been written that does not recommend a dozen or more remedies for every form of ulcer; every sensation, must have an antidote;-every change in the external appearance of an ulcer must have a corresponding change in the remedy. It would be far better for both book and invalid, if the general characteristics of all diseases were more closely observed and understood, and the remedies prescribed in accordance with them. - - -- -- - -- -- - 958 SURGICAL DISEASES. This medicine is indicated when there is general pallor of the countenance, wearing a chlorotic hue; great languor and prostration of muscular power; palpitation of the heart, difficulty in breathing on making the slightest exertion, gastric depression, loss of appetite, suppression of the menses, wholly or in part; fullness and oppression of the brain, and bleeding from the ulcer.on the near approach of the regular menstrual period. Five drops of the first attenuation should be given three times a day during the menstrual interval. KALI HYDRIODICUM is indicated when the system gives evidence of a scrofulous diathesis. Under such a condition the skin is blond, the hair light, the eyes blue, the muscular system relaxed, the subcutaneous glands about the neck, in the arm-pit, or in the groin, become enlarged and are sensitive to the touch during the menstrual period, and not in the interval; or some may have suppurated and discharged a pale, bloody fluid during this period and cease immediately after it has passed, and the ulcers then are of a pale, flaccid, uncleanly appearance. In such habits the catamenia are not entirely suppressed, but the fluid is scanty and almost colorless. One grain of the third trituration should be given morning and evening, during the menstrual interim. ALOES is an important remedy and must not be disregarded in the treatment of some forms of amenorrhoea. It is indicated when there is entire suppression of the catamenia; if they make their appearnce at all it is but for a short time, perhaps a few hours, and of a very dark appearance, and is preceded for a day or two with severe pain and spasms in the loins and womb. This medicine should be given during the menstrual interval, every VARICOSE ULCERS. 959 six hours during the day, five drops of the first dilution added to a tumblerful of water, and a dessert-spoonful at a dose. BELLADOIN'NL should be given during the paroxysms of pain; if these pains are accompanied with a full, quick pulse, and more or less oppression and pain about the head, third potency every two hours. CHAMOMILLA should be given when the pains and spasms are sharp and transient, the pulse small and quick, and the mind irritable, and the brain unoppressed, twelfth potency every four or six hours. LOCAL TREATMENT,---consists in keeping the ulcer in a cleanly condition by the frequent application of tepid water and Castile soap, a lint compress and the application of arnicated adhesive strips. These should be snugly. applied over the ulcer, which frequently facilitates the granulating process, by bringing the granulations in closer proximity, and enable their points to cohere. Varicose Ulcers. These ulcers are the result of over-distension of the veins, and are generally confined to the lower extremities. The veins return the blood from the extremities of the system to the heart, and are so formed by a valvular arrangement on their internal surface, that instead of supporting an unbroken column of blood, its continuity is interrupted at intervals of two and three inches, by the interposition of these valves. Whenever overdistension in any of the larger branches occurs from undue pressure, interrupting the free circulation,, these valves no longer approximate, and the vessel is obliged to sustain an entire column of blood which soon renders it incapable long to withstand the inordinate r~-~------------------------- II 960 SURGICAL DISEASES. pressure, and the overloaded vessel gives way, destruction of the integuments follow, hemorrhage takes place, and an ulcer is the consequence. Constipation is one of the great causes of varicose veins pressure from imparted faeces, in the larger intestines upon the illiac veins, retards the circulation through veins of the lower extremities, and produces venous congestion. Pressure also of the gravid uterus upon the same parts produces like results, and we not unfrequently find the veins of the inferior extremities of females, who have borne many children, in a varicose state, and who in old age suffer severely with these ulcers. TREATMENT.-The treatment in varicose ulcers consists in the removal, as far as may be practicable, of the immediate causes which retard venous circulation. If it arises from constipation of the bowels, the impacted faeces must be removed by injections of warm water, and a solution of Castile soap. When the bowels have been relieved of this superabundant accumulation, medicines must be given to prevent a similar recurrence. Nux vOMICA, third trituration, every night, is the proper remedy when constipation is the result of indigestion, and an enervated condition of the muscular contractility of the intestines, particularly of the colon and rectum. This medicine, with a rational amount of exercise and a well-regulated diet, will obviate all further irregularities of the digestive functions, promote regular alvine evacuations, and prevent all obstructions in the venous circulation in this situation. HAMAMELIS has acquired considerable reputation as a remedy in venous hemorrhage, and hence, from its specific action upon the contractile tissue of these vessels, _~ VARICOSE ULCERS. 961 it ought to exert a controlling influence in enabling them, under the force of inordinate pressure from venous turgescence, to maintain their integrity, and prevent the tendency to ulceration. It should be given in doses of five drops of the first dilution, three times daily. If this turgescence of the veins arises from pressure of the gravid uterus, little can be done that will afford relief until the parturiant period has passed. During this period, however, the veins should be supported and moderately repressed by the application of a roller from the foot to the knee, or by a laced or elastic stocking, which is far preferable,-and are made for this special purpose. These supporters are of essential service, and if applied early will prevent the formation of these troublesome ulcers. It will be noticed that the foregoing treatment has reference, as much to the prevention, as it has to the cure after the ulcer has been formed. This treatment must not be disregarded, even while special attention is being directed to the local treatment, for the healing of the ulcer, although it did not prevent its formation. The causes may still be operating, and it would be a futile attempt to cure the effects, while the causes that produced them were still in full force. Should the turgescence of the veins not be relieved by this treatment, an opening may be made into the tumor, and the blood abstracted; this will relieve the pain and the engorgement of the vessels, and hasten the period of recovery. The amount of blood that not unfrequently follows this operation is very great, yet it is surprising how little constitutional disturbance is produced by its ab82 _ ~ _ __ __ 962 SURGICAL DISEASES. straction. This results doubtless from the fact, that the blood in varicosed veins has become stagnant; consequently thrown out of the general circulation, and no longer belongs to the systemic mass of blood. Yet fatal consequences have followed the loss of blood, when these tumors have been accidentally ruptured; and, therefore, great precaution is necessary whenever this operation is to be decided upon. It should never be attempted without the advice of a surgeon. Under the most favorable circumstances, there is little to be hoped from the most judicious treatment, for a permanent cure of varicose veins, and consequent ulceration. Much may be done, however, to relieve the suffering, and bring comparative comfort to the unfortunate victim of this troublesome disease, by enforcing the above suggestions. Scrofulous Ulcers. This kind of ulcer is usually situated in the absorbent glands of the body, particularly about the neck, and is the result of a specific dyscrasia, provoking chronic inflammation in these glands, which eventually terminates in an imperfect suppuration. Scrofulous ulcers usually develop themselves between the age of three and seven years; not unfrequently, however, they occur at a more advanced period of life, and are then situated in the spongy part or ends of the bones, and the bursa around the joints; when thus situated has received the appellation of white swelling, in consequence of the colorless appearance of the skin in its incipient stages of development. This peculiar kind of inflammation is marked by a soft swelling of the SCROFULOUS ULCERS. 93 affected parts, whether it occurs in the glands, or at the epiphysis of the bones. The swelling, although attended with considerable increase of heat, is unattended with the ordinary discoloration of the affected part, and the pain is seldom acute, although always present to a greater or less degree. The integuments covering the swelling are considerably thickened, and have a doughy feeling. As the swelling increases, the doughy feeling changes into an elastic or fluctuating sensation, and a firm, unyielding, circumscribed margin marks the base of the tumor. If the tumor be punctured at this period little or no fluid escapes, the lips of the wound rapidly inflame and stand apart, exhibiting an unhealthful, sloughy-looking substance within. If, however, the tumor is not interfered with, the elasticity soon changes to a soft, flaccid sensation, and fluctuates freely; the skin assumes a light purple hue, and small veins, very blue in color, may be seen traversing the surface. As the disease progresses, the integuments grow thinner and darker at one particular spot, which finally opens and discharges a wheyey fluid, in which floats a flocculent or curdy matter. The redness of the skin abates in some degree, but the aperture enlarges as the volume of the tumor decreases, and a scrofulous ulcer is formed. The edges of this kind of ulcer are generally tumefied, of a smooth, purple color, and overlap most of the cavity. The discharge is thin, copious, and at times ropy and flocculent. The pain is inconsiderable. Under favorable circumstances the healing process becomes established as the discharge diminishes, and changes to a more consistent character, which hardens into a dirty white or __ 964 SURGICAL DISEASES. yellowish-colored elevated scab. This scab remains on the part for a considerable length of time, when it finally falls off; and its place is supplied by a delicate purplecolored cicatrix. These are the general characteristics of the simple forms of scrofulous ulcers. When the inflammation attacks the epiphysis of bones, or the bursa about the joints, the symptoms vary, are more aggravated during the progressive steps to ulceration, and the result is much more serious. Ulceration in these situations is seldom arrested before the integrity of the joint is destroyed. When scrofula does not develop itself until after the period of puberty, the distinguishable constitutional features that mark -the hereditary predisposition are to a certain extent clearly characterized. This disposition in question is marked by a peculiar softness and laxity of muscular fibre; the hair is of light flaxen color, very fine and soft; the eye-lashes are long, the eyes large, and usually of a deep blue color, and the pupil largely dilated. The skin is ordinarily very delicate, soft in texture, and beautiful in appearance; when compressed between the fingers it feels much thinner than in a healthful child, and delicate veins may be seen pervading and meandering underneath it; the upper lip is usually thick and prominent, and the tumefaction often extends into the nostrils and give a nasal sound to the voice. The extremities of the fingers are broad and flat, and the joints wear a. similar appearance to those observed in gouty or rheumatic habits. Scrofula is not unfrequently complicated with rickets, but it does not follow from this that this disease is the result of scrofula, or that this complication proves them to be one and the same disease, which in our humble opinion is not the case. _ SCROFULOUS ULCERS. 965. TREATMENT.-There is perhaps no disease to which "flesh is heir," in which there has been and still is so much discrepancy, both in the old and in the new school, as in the treatment of scrofula. Both sects have sought, the one in theory, and the other in symptoms, for the true specific that is to combat and conquer this hitherto invincible foe. To us it appears that they must be forever baffled, and suffer an ignominous defeat, if they continue to look in this direction for the aid they so much need. The allopathic treatment has hitherto consisted principally of mineral water, bark, sarsaparilla, iodine, mercury in their different preparations, and a multitude of other remedies indiscriminately administered in ponderous doses, yet mercury stands in the front rank, at the head of these formidable combatants, and marshals them only to her aid when she perceives that her own powers are becoming impotent. Our own school, instead of looking at the true pathology of the disease, and the constitutional peculiarity of the invalid, are content to dabble with mere symptoms and sensations, (in this disease their name is Legion,) for each of which they find a special antidote, until our catalogue has become even more formidable in point of numbers than that of our more heroic brethren. Yet even with this apparently formidable array, deso lation does not follow in our-footsteps, thanks to the law of attenuation. When medical men shall learn to regard medicine in its true relation to disease, and know too that there is a higher law, restraining and mitigating the evils incident to humanity, their duties will become simplified, their confidence in the efficiency of drugs less arrogant and 82* 966 SURGICAL DISEASES. prejudicial, and a ray of intellectual light will shed its benignant and heaven-borne influence around the couch of the unfortunate victim of disease and suffering, enabling him to escape the torture and penalties that ignorance and misguided zeal so often inflict. Having thus apparently taken our seat upon the throne, as umpires for the unfortunate victim of this dire disease, what shall be our decision in his behalf? Simply this;-the principal treatment should have regard to his physical and mental condition;-the general health must be sustained by the aid of a good animal diet; beef, mutton, venison, poultry, and broths made from these as may best please the palate of the patient. The food should not be too much cooked, and without pepper or spices. Vegetables in their season may be moderately indulged in,-those only however that do not require any adventitious aid to render them agreeable. The home of the invalid if practicable, should be inland, elevated, with pleasant scenery, and a dry invigorating atmosphere. The sleeping apartments should be capacious, well ventilated, and the bed not made of feathers; these tend to enervate, and are at all times prejudicial. Cheerful companionship, the reading of books that leave a pleasant impression on the mind and tend to elevate and invigorate the higher instincts of thought and being; moderate exer6ise daily in the fields and forests, gymnastics, horseback riding, if the strength will admit should be indulged in moderation, sponge bathing with moderately cold water on rising in the morning, which should always be at five in the summer, and seven in the winter; and the body should be gently rubbed 968.SURGICAL DISEASES. any of the glands about the throat, neck, axilla, groins, etc. The best result, however, that we have witnessed from the action of this medicine, has been when the ulceration has been principally confined to the glands of the throat. This medicine should be given in the third trituration, one grain every night on retiring, and continued for several days; if favorable effects do not follow its administration, it should be discontinued. KALI HYDRIODICUM, should be given when the above medicines have proved inefficient and the ulceration is confined to the external glands, the salivary, the axillary and the inguinal, and should be given in the third dilution, five drops, every six hours during the day; improvement in most instances follows the action of this remedy in a short space of time, if all the physical and mental indications have been rigidly adhered to. Whenever symptoms of improvement manifest themselves after either of the foregoing remedies have been administered, their repetition must be less frequent, and wholly discontinued as soon as the natural power of the system gives evidence that their aid is no longer necessary. Should this disease assume a more formidable aspect, and attack the spongy heads of the bones, and the structure in and around the joints, some other remedies will be indicated, and these will require a very critical discrimination in their selection and administration. Among those most prominently indicated are Silicea, Calcarea carbonica, Phosphorus and perhaps some of the preparations in which Iodine is commingled. LOCAL TREATMENT.-This consists in keeping the ulcer in a cleanly condition, by the application of warm water two or three times daily, with a soft sponge, dry ~II 970 SURGICAL DISEASES. more concentrated, as if a STAB had passed into the affected part. This pain, however, is not constant, but alternates with sensations of a pricking, tearing, burning character, and the invalid at times describes the pain as though the nerves were being severed with the breast from their attachments. These pains sometimes extend to the shoulder and almost paralyze the arm; and, as the swelling or tumor gradually increases, there is a longer intermission of pain; once in about ten or fourteen days. Prior to menstruation the breast grows fuller, and much more painful, although it had previously been tranquil. Immediately after the menses begin to flow the tumefaction and pain subside. As the.disease advances the nipple retracts, inflames, and not unfrequently ulcerates. The retraction of the nipple is doubtless owing to the contraction of the lactiferous tubes, in which structure, in our opinion,.the disease first develops itself. A change also occurs in the skin in consequence of the retraction of the nipple; it becomes puckered and wears the appearance of having been ulcerated, and a cicatrix had formed. If the tumor be now examined, it will have acquired a hard, unyielding and unequal surface, usually from two to three inches in diameter; yet it may sometimes involve the entire gland. Scirrhous tubercles seldom increase to any considerable size, and this circumstance is one of its unmistakable criteria. The absorbent glands in the vicinity now also become implicated, the cellular tissue inflames and thickens; little tubercles form in the absorbent vessels underneath I SCIRRHOUS, OR CANCEROUS ULCER. 971 the integuments, and finally involve the glands in the axilla or arm-pit. Months and even years often elapse before the ulcerative process is fully established; when this is about to commence, the skin changes to a livid redness, the pain increases, and seldom intermits, until an indistinct fluctuation or yielding is perceived in the tumor, which at length opens and discharges a bloody serum. Pus is never produced upon the surface of a truly malignant cancer; it usually feels hard, like the original tumor, and is almost insensible to the touch; the edges of the ulcer become everted; considerable bleeding often occu.rs on the removal of the dressings, or from cleansing the surface, which is at times quite profuse, and will not cease in consequence of the non-contractile power of the vessels when in a diseased condition; pressure, however, over their bleeding mouths, will soon arrest it. The ulceration continues; a deep excavation is formed which sometimes exposes the muscles of the breast, the arm on the diseased side begins to swell, constitutional irritation increases, the complexion grows sallow, the countenance dejected, general emaciation follows as the disease augments; respiration becomes difficult, the invalid cannot lie in bed, or rest only upon the diseased side; spasms and vomiting succeed, and the wretched victim of this fell disease at length gradually sinks under its devastating and uncontrollable power. The progress of this disease to its final termination is always slow, and may develop itself at any period of life after puberty, up to the age of seventy. When this disease occurs in advanced years, it does not generally abridge life, but the invalid lives as long as she would 972 SURGICAL DISEASES. have done though it had not occurred, and dies, not unfrequently, of some other disease. The causes of this disease have usually been attributed to an accidental blow, or external injury of some kind, inflicted on the breast; and hence has been inferred to be of a purely local character. If this logic were founded upon a solid basis, then every unnatural impression made upon the organ liable to this disease, would be likely to produce it. A wound made into the mammary gland for the removal of a scirrhous tumor, heals as readily as a wound made in any other part of the body; but a wound made into a scirrhous tumor, produces a scirrhous ulcer which never heals. This disease sometimes develops itself in several members of the same family, and in different generations of the same family, which is almost indubitable evidence that its cause is inherent and constitutional, and is at times developed by some of these external influences, and at others without them. There are predisposing causes, other than those of an external character, that exert a far greater influence in developing this disease. Anxiety, disappointment, grief, and the suppression of some of the secretions, particularly of the catamenia, lay the foundation, but too often, upon which, not only this unconquerable foe, but hosts of others alsb as insidious and implacable, erect their bat teries and commence their work of desolation. TREATMENT.-It will be readily inferred from what has previously been said of the nature and character of this disease, that little benefit will result from any treatment that is not directed to the controlling of constitutional causes; and even this, however judiciously and i_ i SCIRRHOUS, OR CANCEROUS ULCERS. 973 persistingly directed under the guidance of both schools, has had few triumphs to record. Sad and discouraging as our experience has been, much can be done to mitigate the poignancy of suffering, and perhaps in some instances arrest the progress of this fell destroyer. Among the remedies that have acquired the largest reputation in controlling this disease, are Iodine, Mercurius corrosivus, Conium maculatum, Arsenicum album, Thuya occidentallis, and Collinsonia. The last named remedy has as yet been only empyrically employed. The same may in truth be said of all the others; for there are few symptoms in scirrhous cancer that point to either of these as the true similimum. Yet may we not hope, that among the many zealous and intelligent followers of our immortal Hahnemann some one may have revealed to him by his proving upon himself and others, the true specific in this, as it has been in a multitude of other diseases. IODINE, in some form appears to be the most appropriate remedy in the incipient stages of scirrhous, when the tubercle is first discovered, and before its has attained to any considerable size; and where there is an apparent disposition in the sub-cutaneous glands in any part of the system, to a sympathetic enlargement. This medicine should be given night and morning, sixth potency, in five drop doses. And also applied locally to the part, first dilution, with a camel's hair brush, every alternate night. CoNIUM should be given after ulceration has commenced, and the system has not as yet manifested much constitutional disturbance, the ulcer secreting a sanious, or pearly-colored inoffensive matter, and the general 83 974 SURGICAL DISEASES. character of the ulcer in an apparently healthful condition. This medicine is more decidedly indicated, when the womb is the seat of the disease. It should be given three times daily, in five drop doses of the first attenuation; and the same should be applied to the ulcer with saturated lint, after it has been cleansed, with warm fomentations. When the ulcer is upon the mouth, or neck of the womb, the application may be made with a soft sponge. MERCURIUS CORROSIVUS is indicated when the ulcer is fully established, the edges calloused and everted, the discharge more or less muco-purulent, offensive, and the constitutional effects are becoming apparent; one grain of the third trituration should be given daily. ARSENIOUM is indicated when the system has become generally involved, marked by great pallor of the countenance, extreme prostration of the nervous system, a burning sensation in the ulcer, the discharge very offensive, and a great tendency to rapid extension; five drops of the twelfth dilution to be added to a tumbler of water, and a teaspoonful to be taken every six hours. THUJA OCCIDENTALIS has been given when the disease has developed itself in the lips, or in the rectum, and (if the reports are reliable) has achieved some splendid victories, which has led us to hope for its universal applicability in this disease. It has been administered in doses of five drops of the tincture, three times daily, and the same applied externally to the ulcer. This medicine requires some further trials before we can hope confidently for its superior virtues in this disease, and in our opinion ought to be given in the higher attenuations. COLLINSONIA has been given in several cases, when _ ~ ~_ ~ VENEREAL ULCER. 975 the disease was confined to the liver and mesenteric glands, with decided effects, and has led many to hope that it may possess powers that are yet imperfectly known. It should be given in the twelfth potency, night and morning. LOCAL TREATMENT.-The application of poultices are prejudicial to this form of ulcer, and ought not to be applied either in the formative stages, or after ulceration is fully established. The external applications that have already been indicated in the general treatment are all that should be applied, or that will prove in any degree beneficial. The propriety of extirpating the tumor with the knife, at any of its stages, is a matter for serious consideration, and can be determined only, in individual cases; and may demand it. The practice, however, so frequently resorted to by vagrants of the medical profession, in applying local ascharotics in the form of ointments, and plasters, with the view of exterminating the disease, with the removal of the tumor, is highly pernicious, and reprehensible in the severest degree. These incubi that foster and fatten on ill-gotten gain extorted from the deluded victims of misfortune, require an actual cautery to exterminate them from a noble and humane profession. Venereal Ulcer. This ulcer is produced by a specific poison, the product of uncleanliness of the sexual organs. The nature of the morbid action of the peculiar poison, which produces a venereal ulcer, is wholly unknown. This is also C_ 97.6 SURGICAL DISEASES. the case so far as regards the virus itself, which, like the morbific principle of all other diseases, developed by inoculation, is beyond the reach of human observation. The ulcer usually makes its appearanee, in from five to ten days, after the infection, and appears in the form of a small itching pimple rising from some part of the external organ of generation. After the lapse of a few days, a pustule is formed which ulcerates at its apex, and discharges a peculiar colored matter, which, with the rapidity of the inflammatory process to suppuration, is a strong diagnostic mark of the character of the ulcer. The general appearaces of the ulcer are characteristic, yet their physical marks are seldom all present in the same ulcer, which results from the peculiar acrimony of the virus, and the constitutional idiosyncrasy. of the invalid; hence some assume an inflammatory character, or an irritable state which runs into the phagedenic form, in which the ulcer extends with great rapidity, destroying the surrounding tissue, so that in the course of a day the sore increases to twice its size. In the inflammatory state, when the action becomes excessive, it rapidly terminates in gangrene, and irreparable mischief is the consequence. Venereal ulcers are primarily of a purely local character; yet one of the chief characteristics is their tendency to contaminate the whole system in a very short period of time, if not arrested in the incipient stage. The first perceptible constitutional effect is noticed in the enlargement and rapid suppuration of the inguinal glands; from thence it extends to the throat, affecting the tonsils, palate, and finally the spongy bones of the nose; and thus it progresses, attacking every structure of the body, if left to indulge its rapacious and insatiable appetite. _~ 978 SURGICAL DISEASES. until the cure is completed; and, as improvement advances, it must be less frequently repeated, and in a higher trituration. KALI HYDRIODICUM must be given as soon as the inguinal glands begin to inflame, and there are evident signs of constitutional contamination. This medicine must be given in solution, one grain dissolved in four ounces of water, and a tablespoonful administered three times daily. It is also appropriate after the glands have suppurated. MEROURIUS IODATUS is the appropriate remedy, when the contamination becomes more general, and the throat shows a disposition to inflame and ulcerate. AURUM METALLICUM, is indicated when the spongy bones of the nose have become affected, and a fetid discharge passes continually from the nostrils. A few drops of the twelfth dilution to be added to a tumblerful of water, and a dessert-spoonful to be given night and morning. Due regard must at all times be paid to the invalid's general health, for unless this is in a healthful and active state, all the treatment directed to the local condition of the affected part will not be effectual, and this in many instances is the cause of the ill-success that not unfrequently attends our treatment in this as well as in a multitude of other diseases. The failure is usually attributed either to the error of our law directing the treatment, or to the inefficiency of our potentized remedies, and not where it properly belongs-to the ignorance and neglect of the medical attendant. - -- - I - - - Is --. --- _ _ 9801 SEURG1CAL DISEASES. TREATMENT.-The primary and most essential consideration in the treatment of mercurial ulcers, is to remove, as far as may be practicable, all those influences that tend to depress the energies of the system and to correct the functional disturbance, which these influences may have induced. The medical treatment must have reference to the selection of such medicines as may have a specific relation to the tissues involved, and the antidotal power they are supposed to possess over this drug. KALI HYDRIODICUM, is indicated when the ulcers are superficial and confined to the mouth, throat and subcutaneous glandular structure. It should be given in grain doses of the third trituration, night and morning. NITRIC ACID should succeed the above remedy, whenever the ulcers show a disposition to extend themselves into the posterious passage of the nos', or down into the pharynx. It is also the appropriate remedy when the membrane covering the bone (periosteum) is the seat of the disease. The bones of the nose and the anterior surface of the leg (shin), are the most familiar points of attack. The symptoms which reveal their development in this structure, are deep-seated, intense cutting pains, followed by a tumefaction of the membrane and tissues covering it, more or less sensitive on pressure, and, if not arrested in this stage, progress to increased sensitiveness, inflammatory discoloration, and finally to imperfect suppuration, and ulcers are formed which will be very difficult to heal. This medicine should be given in five-drop doses of the first dilution, three times daily. AURUM NITRICUM, is the appropriate remedy when INCISED WOUNDS. 983 strips of plaster to be placed between the stitches. The next step to be taken is to apply linen lint over the wound, to absorb whatever may exude therefrom; over this a roller must be applied, and the part kept at rest, until adhesion has taken place. The wound should be dressed after the third day, and fresh lint applied. The stitches must be removed in about six days from the time of the accident, and in about two weeks the arm of the thread which secures the artery may be gently pulled, and if they are detached, must be removed. Nothing remains now but the healing of the small openings through which the threads have passed, which is speedily accomplished, and all is well. If the wound is of sufficient depth to sever a muscle transversely, the position of the limb must be so placed that the divided ends of the muscles may be enabled to approximate, or they will not reunite. Thus, if the wound is on the anterior part of the arm, severing the muscle that bends the arm, the forearm must be flexed or brought at right angles, and kept in this position until the wound has healed. If the wound is on the back part of the arm severing the muscles that extend it, the forearm must be extended and confined in this position until the muscle has reunited. The method in which nature accomplishes reunion, is, by the effusion of plastic lymph or fibrin from the mouths of divided vessels, which forms a cement that connects the lips of the wound. This plastic exudation becomes organized by the penetrating growth of bloodvessels and nerves into it, from the adjacent tissues; and thus the structure of the parts is restored, and little or no deformity follows. All the parts that have been severed are reproduced 984 SURGICAL DISEASES. except muscles, and these reunite by tendinous structure; consequently, abridges in some degree their free contractility, if the wound has been extensive; for cartilaginous structure has little power of contractility. It is therefore of great moment that the divided ends of a muscle should be brought in close proximity, thereby pre. venting the formation of a wide link of tendinous union. Parts that have been entirely divided, again reunite if applied soon after the separation has taken place. We were once called to see a little lad who had his index finger cut off by his brother while playing with a hatchet. The portion of the finger that was cut off was quite cold when we arrived, and covered with blood and dirt. With a sponge and cold water both dirt and blood was removed, and then carefully joined to the other extremity and confined with some sutures and adhesive straps; over the whole was applied a narrow roller; it soon reunited, and is now as perfect as any finger he has. It is therefore of great importance that this fact should be borne in mind by laymen; and in the absence of a surgeon, when time is of great consequence in such cases, any man with a little mechanical dexterity, and a fair share of self-possession, may be enabled to save a member of the body that cannot be spared without some feelings of regret if not great inconvenience. After a wound has been properly dressed, it should seldom be interfered with. The anxiety that usually pervades the minds of both invalid and friends, as to the favorable or unfavorable condition of the wound, induces them often to disturb the dressings in order to look at the wounded part, and see if it is doing well, thereby tearing asunder the adhesion that has as yet only partially taken place, exciting undue inflammation, __ __ __ ~ LACERATED WOUNDS. 985 and compelling nature to retrace her efforts, that have been so injudiciously interfered with, in order to reproduce that which curiosity has averted. Lacerated Wounds. These wounds differ in some respects from incised wounds, yet in their general characteristics they are not dissimilar. In lacerated wounds the fibres of the tissues are torn asunder by violence, and the edges of the wound are jagged and uneven. In general there is little bleeding, although large and important blood-vessels have been divided. The effects on the nervous system is often very great. Spasms of the limbs and even tetanus follow lacerations of the hand or arm. Erysipelatous inflammation often follows lacerated wounds of the scalp, and requires great attention for the reason that it may extend within the skull, and attack the brain or some of its membranes. TREATMENT.-The local treatment of these wounds is the same as that indicated in incised wounds; yet greater vigilance and care is necessary in detecting and controlling the first premonition of approaching spasmodic or inflammatory excesses. If the wound has been caused by the parts having been dragged over the ground, as is frequently the case in lacerated wounds of the scalp, there will be found lodgments of dirt and gravel underneath the torn edges of the wound; these must be carefully washed away and the wounds thoroughly cleansed of all foreign matter before their tattered edges are approximated. If high inflammatory action supervenes, this must be subdued by the internal administration of ACONITE, first 84 _ _ _ __ I_ __~ ~ I_ __ __ 986 SURGICAL DISEASES. attenuation, five drops in six tablespoonfuls of water, and a dessert-spoonful to be taken every two or three hours, as the violence of the inflammatory action may demand. If spasmodic action of the muscles manifests itself, CHAMOMILLA, sixth attenuation, is indicated, and must be given in quantity and repetition the same as Aconite. If indicated, these remedies may be given in alternation. We have said that little bleeding followed wounds of this character; as a general result this is the case; yet cases do occur in which bleeding after reaction does follow to a profuse extent. And therefore great caution is to be observed in the dressing of the wounds before reaction is established, as fatal consequences may follow if the wound has been dressed, and the vessels left unsecured. The wound should be carefully sponged with warm water, and a reasonable time allowed to elapse before the dressings are applied. The first dressing should not be removed until after the third day, and when removed great care must be observed that the wound be not torn apart, and re-open the mouths of vessels that have become almost permanently closed. Contused Wounds. These wounds are caused by blows or falls, and are accompanied with more or less disorganization, according to the amount of violence that has attended the accident. In wounds of this character, there is little or no hemorrhage, in consequence of the extravasation that follows disorganized tissue, making pressure upon the divided vessels. Inflammation and mortification to a considerable extent are ordinarily produced. The dead parts slough I _C II _I _ _ I _~ __ _ _ PUNCTURED WOUNDS. 989 the wound, the peculiar character of parts involved, and the extent of the injury. The local treatment usually adopted by surgeons has been to convert a punctured wound into an incised one, by laying open its channel, and either introducing pledgets of lint to promote suppuration, or bring the lips of the wound immediately in coaptation after the incision has been made, and attempt to promote union by what is termed the first intention. This is barbarous treatment and never to be adopted. The danger does not depend, as many writers suppose, on the narrowness of the orifice of the wound, and the inability of applying local application to its entire surface. The irritation that arises from the infliction of this form of wound, and the tetanic spasms which so often threaten the life of the invalid, are in consequence of the injury done to the tendons, nerves, and lymphatics, which lay along the track of the instrument. And when any of these structures are injured, from whatever cause, the effects are always more formidable and uncontrollable than when any other structure of the body is involved. The local treatment consists, simply in applying a compress, moistened with ARNICA, over the mouth of the wound, and over this a roller, gently compressing the walls of the track; this in many instances will enable them to fnite, and all further difficulties will be obviated. If, however, it terminates not so favorably, and irritation and inflammation follow, the remedies must be the same as premised in the other forms of wounds. ACONITE, BELLADONNA, CHAMOMILLA, SILICEA, etc. If matter forms underneath the tendons of muscles, 84* ~I _ TETANIC SPASM. 991 most excruciating pain at the lower end of the sternum, in the region that is usually denominated the pit of the stomach, darting from this point towards the spine; as soon as this pain is experienced, the spasm of the muscles about the neck becomes extremely violent and painful; the head is either drawn backward, forward or laterally, but in the majority of instances the head is drawn backwards, as is also the trunk, and as the contraction increases in force, the body frequently assumes the form of a bow, resting upon the feet and head alone. The muscles of the lower jaw, which were more or less rigid in the beginning, now become firmly locked against the upper jaw, and a total inability to motion obtains. This last condition has received the appellation of Lockjaw. TREATMENT.-It is not surprising that, from the peculiar and complicated character of the symptoms which characterize this disease, there should have arisen such discrepancy of opinion, as regards the proper method of treatment among the writers of both schools of medicine. As the object of this work would not be attained by entering into an elaborate disquisition upon the philosophical and scientific merits or demerits of their varied opinions, we will simply premise the remedies, which, in our opinion, have a truer relation to the symptoms and general condition, than any other, they are ACONITE and Nux voMICA. These remedies should be given in alternation, and in strength proportionate to the severity of the-symptoms, from the third potency down to the mother tincture, in doses of five drops every half hour, until favorable impressions have been produced. The local application of warm fomentations, and if _ ___ 992 SURGICAL DISEASES. suppuration has been established, the application of flaxseed or slippery-elm poultices may be of service. Poisoned Wounds. These wounds are inflicted by the bites of venomous serpents, rabid animals, and from poisons generated by animal decomposition. For the constitutional treatment, we refer the reader to the chapter on Poisons, in another part of this work. The local treatment, if at all useful, must be instituted immediately on the inception of the poison; for, after constitutional symptoms have developed themselves, local treatment will be unavailing. LOCAL TREATMENT.-This consists in the application of suction by the mouth or with an air-pump, or what is more simple and effective, when properly applied, a wine or egg-glass, having previously exhausted the air by throwing a lighted taper into it; the moment it is extinguished apply the glass over the wound, and it will adhere with great force, and withdraw both blood and poison before it has entered into the circulation. After this has been accomplished, the mouth of the wound may be cauterized with nitrate of silver or caustic potash, and then dressed with simple lint and roller. Where the poison has been absorbed into the system, and constitutional effects begin to manifest themselves, we are unacquainted with any antidote that will neutralize its destructive effects; the constitutional symptoms rapidly augment; the wound assumes an aggravated character in every particular, and death soon relieves the victim from his agonized sufferings. Aconite, Belladona, Hyoscyamus and Opium, in from five to ten drop WOUNDS OF THE THORAX. 993 doses of the tincture, has been given with a view of mitigating the pain and suffering. Wounds of the Thorax. The thoracic cavity occupies a middle space between the head and abdomen. It is bounded superiorly by the bones of the neck, anteriorly by the sternum, latterly by the ribs, posteriorly by the vertebree of the back, and inferiorly by a muscular septum called the diaphragm. In the structure of the thorax we find both solidity and mobility combined in a degree so perfect, that its entire framework serves the office both of protection and respiration. The cavity formed by this structure contains the organs of respiration;-the lungs, and their investing membranes (pleura), the heart, with its investiture, (pericardium), and membranous duplicatives, (mediastina) with their contents. The external walls of the thorax are protected by the common integuments, and muscles, and the intercostal spaces are also guarded by narrow slips of muscles arising from the superior border of a rib, and inserted into the inferior edge of its fellow, and aid in affecting the bellows' action in the act of respiration. There are two kinds of wounds of the thorax:-the first is when the parieties are only involved, and do not penetrate any of the organs within the cavity; a wound in this situation is unattended with danger, and requires only the coaptation of the lips of the wound by adhesive straps or sutures to promote adhesion and close the external orifice. Bleeding sometimes proves troublesome from wound 994: SURGICAL DISEASES. ing one of the intercostal arteries. These arteries run along the inferior borders of the ribs and are liable to be severed when a wound penetrates the intercostal muscles; should this accident occur, the bleeding can be checked by introducing the index finger into the wound, and making pressure for a time over the mouth of the divided vessel. Wounds of the Lungs. When this occurs it may be known by the invalid discharging a quantity of florid, frothy blood in the act of coughing; by free bleeding from the external orifice of the wound, if of sufficient size to permit its escape; by great difficulty in breathing, and irritation and tickling in the throat. The danger to be apprehended from wounds of the lungs, arises from two sources. The first is.from hemorrhage when a branch of the pulmonary artery has been wounded; and the second from inflammation in the lungs and effusion into the cavity of the pleura. If effusion follows, it is usually the result of neglected inflammation, or in not having allowed the external wound to remain open a sufficient length of time to enable the blood to escape. In the first instance, the effusive fluid is purulent secretion, and in the other, it is bloody serum. TREATMENT.-Whenever a wound penetrates the cavity of the thorax, the invalid should be placed immediately in a recumbent position inclining towards the wounded side; this will enable the blood to escape and prevent extravasation. The invalid should not be allowed to speak or move, and as soon as the bleeding _ __ ___ WOUNDS OF THE HEART. 995. has ceased from the external wound, a pledget of lint should be applied over it, and a bandage rolled tightly around the chest so as to prevent deep inspiration. MILLEFOLIUM should be given internally in doses of five drops of the first dilution every hour until the bleeding ceases. ACONITE must be given as soon as reaction has taken place, and a greater or less degree of constitutional irritation warns of approaching inflammation, five drops of the first dilution to be added to a tumbler of water, and a dessert-spoonful given every hour. BELLADONNA should be given in alternation with ACONITE, when inflammation has fully developed itself; which may be known by a full accelerated pulse, florid face, but dry skin, deep-seated pain in the region of the wounded lung, and more or less disposition to cough, sometimes accompanied with a bloody expectoration. The dose the same as ACONITE. DIGITALIS PURPUREA should be given when effusion has taken place, which may be known by a dull, muffled sound, imparted to the ear, upon percussion over the seat of effusion, and a sense of fluctuation in attempting to inflate the lungs, or in compressing the parieties of the thorax. This medicine should be given, five dropdoses of the first dilution every six hours, for several days, and if absorption does not take place, which rarely is the case, an operation must be resorted to in order to remove it. Wounds of the Heart. Wounds of the heart seldom occur, and when they do, prove so suddenly fatal as to preclude the possibility of affording relief. -- ~ 996 SURGICAL DISEASES. Wounds of the Abdomen. The abdominal cavity is bounded superiorly by the diaphragm, anteriorly and latterly by the muscular parieties, posteriorly by the lumbar vertebrae, and inferiorly by the pelvis, and contains the liver, gall-bladder, spleen, stomach, intestines, kidneys, bladder, and uterus in the female. Wounds occurring in this region are dangerous proportionate to their extent, and the character of the viscera they involve. A simple incision through the muscular parietes of the abdomen is seldom attended with any.great degree of danger, even though the wound be sufficiently large to permit the protrusion of the intestines. Incisions are now fiequently made into the abdominal cavity for the removal of tumors, the tying of arteries; they are the dernier resort for the removal of the fetus, when malformation or other causes render it impracticable to remove it through its natural channel. TREATMENT.-The treatment of a simple incision into this cavity consists in replacing the protruding intestines within the cavity, and bringing the lips of the wound together, and confining them by sutures and adhesive plasters. The sutures should penetrate all the muscles, care must be taken, however, not to include the membrane (peritoneum) lying immediately underneath, and being inflected over the intestines. When this membrane is wounded either, by an incision or by puncturing it with a needle, it readily inflames. and serious consequences may follow. The sutures should be about half an inch apart, and firmly tied, in order to secure perfect adhesion along the 998 SURGICAL DISEASES. Wounds of the Viscera. These wounds are of extremely rare occurrence, which in many instances, doubtless, is owing to the peculiar circumstance of their mobility, gliding away from the sharpest instrument, and escaping injury. The danger is much lessened if the injured viscera protrudes through the external wound; for, if they do not, extravasation either of blood or fieces, or both, into the abdominal cavity excites inflammation, and death speedily follows. Wounds of the Stomach. Wounds of the stomach are of very rare occurrence, yet cases have occurred where extensive incisions have been made into this viscus and no untoward consequences have resulted therefrom. The stomach is one of. the principal organs of digestion and occupies the upper part of the abdominal cavity. It is directed obliquely downward to the right side, and a little forward, this direction affords some explanation why personrs during sleep, usually lie on their right side, and also why sleeplessness is induced and digestion rendered difficult in those who are at times compelled to lie upon the left side. Changes in the direction of the stomach depend upon the same causes as changes in its situation. Thus enlargements of the liver or spleen, displacements of the small intestines, and the pernicious practice of females of wearing too tight-laced stays, affect the direction of this organ and produce more or less disturbance in the functions of digestion. When a wound is inflicted into the stomach it is T~ 1000 SURGICAL DISEASES. given in grain doses of the first trituration every hour until the spasm of the stomach is allayed. ACONITE, is the proper remedy when the reaction is too great and symptoms of inflammation supervene, five drops of the first dilution should be added to a tumbler of water and a teaspoonful given every hour until the inflammatory tendency subsides. The administration of food by the mouth must be strictly prohibited as every thing taken into the stomach under such circumstances will be instantly rejected and produce spasmodic action. If the lips are parched and dry and the invalid complains of thirst, the lips and mouth may be moistened with cold water, but none allowed to pass into the stomach, as fluids of any description will produce similar effects to food of a more solid character. The strength must be sustained by injections of ricewater and chicken-broth in the early part of the treatment, and as the wound begins to heal and all inflammatory indications subside, beef tea, and mutton broth may be substituted and increased in strength and quantity proportionate to nature's demands. Rest, during the entire period of convalescence must be strictly enjoined; so too in regard to the position of the invalid; the deviation in position must be barely sufficient to afford him relief from weariness. These are important considerations, and cannot be overlooked with impunity. From the tenth to the fourteenth day after the injury the invalid may be allowed to swallow some light chicken-broth; this should be continued for a few days, when it may be exchanged for beef-tea or mutton-broth. This kind of food should be continued for two weeks, YI _ WOUNDS OF ARTERIES. 1001 when a moderate quantity of animal food may be allowed once a-day. The invalid ordinarily suffers great inconvenience from constipation, which will be relieved by a dose of Nux voMUIA, third trituration, at night. Wounds of the Intestines. Wounds of the intestines require very peculiar treatment; the minutiae of which cannot be entered into in a work of this character. The only suggestions that may be pertinent in this place, are, that when the external wound is of a size to allow the intestines to protrude in any considerable quantity; they should be gently replaced after the blood has been sponged from them, and the lips of the wound should be brought in coaptation, having first secured the wounded intestine, and retaining it at the external opening, until the surgeon shall have arrived. Wounds of Arteries. These accidents: frequently occur to mechanics and laboring men whose avocations oblige them to use cutting or pointed instruments; under such circumstances should an artery of an arm or leg be wounded or divided, it may be well to know the points where pressure should be made, in order to arrest the bleeding (which is always very profuse) or death will speedily follow if left unrepressed. 85* 1002 SURGICAL DISEASES. When an artery is divided, the blood is florid, and flows from the wound, if the artery be large, with a hissing sound, and in pulsations obedient to the action of the heart. Fainting soon follows the loss of blood from an artery; the brain ceases to be supplied with blood, the heart lessened in force and frequency of pulsation, sensation and volition become suspended, the blood from the wound 'is diminished in quantity or is entirely suspended, and all consciousness is lost. If reaction takes place and the artery is not secured, blood again flows from the wound, but the patient soon sinks to his former unconscious state from which he does not recover. When an artery of the Fig. 1. arm or forearm is wounded, or divided, pressure must be made on the inside of the upper third of the arm. (Fig. 1.) At this point the pulsation of the main artery may be readily detected, and if the index and middle finger be firmly pressed over this point the circulation to the hand will be entirely arrested, and the bleeding from the wound 'li instantly checked. If an artery of the thigh or leg be wounded, the pressure must be made on the upper and inner portion of the thigh immediately below the brim of ~~C~~ZL-~~--~IICII~I~~---L-~--ill 1004 SURGICAL DISEASES. made, until a surgeon can be called who is able to tie either the mouths of the bleeding vessels, or the main branch of the Fig. 3. artery that feeds the wound. Tourniquets, Fig. 3, are used by surgeons for this purpose, and are composed of a pad, about three inches in length,, a strap and buckle, and a fulcrum screw, which will enable a surgeon to create any amount of pressure required to arrest the circulation. The method of its application is to place the pad over the artery as represented in Figure 4, if it be the arm, and then the strap is buckled sufficiently tight to secure the pad to its place. The screw is now applied with considerable force, and continued until a sufficient amount of pressure is produced to arrest the bleeding. If the arteries of the thigh or leg be wounded,, the tourniquet must be placed in the situation as represented in Figure 5. In this situation a large amount of force will be required upon the screw, as the artery lies deeper than in the arm, and the muscles surrounding it are more abundant and larger. When accidents of this kind occur, it is rarely that _ ~ - i WOUNDS OF ARTERIES. 1005 a tourniquet can be obtained immediately, if at all, until the surgeon arrives, and it is then indispensable that Fig. 4. some other treatment or method be devised that will accomplish the same object. This is readily obtained by rolling firmly a piece of muslin, three inches in width, to two and a-half inches in diameter, and placing it over the artery, which may be secured by a gentleman's suspender that has a buckle attached to it; this can be buckled sufficiently tight so as to produce all the pressure requisite to arrest the bleeding. If a suspender of this description cannot be had, a silk handkerchief folded about three inches in width, may be tied loosely around the limb, and a lever twisted around this, which will enable any one to apply a sufficient amount of pressure to effect the object in view. WOUNDS OF THE VEINS. 1007 portant branch is divided; if, under such circumstances, the constitution should be unhealthy, inflammation may arise and life be jeopardized. Inflammation usually develops itself in a few hours after a vein has been wounded; if the wound be in the vein of the arm, the parts along the course of the vein at first become sensitive to the touch, which is soon followed by a colorless tumefaction of the limb; great pain in moving or bending it, and the plexus of veins on the fore-arm becomes swollen, hard, and very painful. Constitutional fever ensues; and, if the invalid has sufficient constitutional power, abscesses form in the veins of the fore-arm, which, when opened early, afford instant relief from pain and suffering. If, however, the constitution is feeble and has little power of resistance, matter which is formed by the suppurative inflammation does not find an external outlet, but remains in the veins, producing excessive constitutional irritation, which eventually destroys life. TREATMENT.-The first consideration in the treatment of a wounded vein, is to place the limb in a position which will facilitate the gravitation of the blood towards the heart; that the vessels may be unburthened of their contents, and at the same time prevent an accumulation of blood and consequent distension of the vessels. To effect this object, the limb must be placed upon an inclined plane. The second consideration is, to make:gentle pressure from the extreme end of the limb to the wound with a roller, in order to approximate the sides of the vein, and prevent for a time a full circulation through it. The bleeding soon ceases, the wound closes, and then the ~------------------~ 1008 SURGICAL DISEASES. dressings must be slightly relaxed, that the circulation may be permitted to flow in its usual volume. ACONITE must be given, if the slightest indication of inflammatory action makes its appearance; and continued until it shall have wholly subsided; five drops of the first attenuation should be added to a tumblerful of water, and a teaspoonful may be given every two hours. CHAMOMILLA should be given in the after part of the day, in alternation with ACONITE, every two hours, if there is much restlessness and disinclination to sleep at night, a few drops of the twelfth attenuation to a turnblerful of water, and a teaspoonful to be given at a dose. SILICEA must be substituted for Aconite, when all hope of averting suppuration has fled and the general circulation no longer requires restraint, a few drops of the 12th potency may be added to a tumbler of water, and a teaspoonful administered every four hours. It may also be alternated with Aconite or Charomilla, if the condition calls for their aid. LOCAL TREATMENT.-In the early stages of inflammation when the limb is tender and tumefied, the roller that has been first applied to the limb, should be satu rated with cold water, and continued until the inflammation has subsided, or suppuration cannot be averted; when this condition arises, the bandage must be removed and the cold application exchanged for warm fomentations; this will facilitate suppuration, and as soon as fluctuation is discovered it must be liberated by an early and free incision. The roller must now again be applied, and the system supported by a generous diet and by a dose of China, third potency, every four hours, until suffi _~) ~ ~ _;_~_ WOUNDS OF THE JOINTS. 1009 cient strength has been acquired to enable Nature to carry on her own work unaided by artificial means. Wounds of the Joints. These wounds are ordinarily of trivial importance; but when they occur in aged and enervated persons, serious consequences not unfrequently follow. Improper treatment also, may lay the foundation for difficulties which subsequent attention, however judiciously directed, cannot control. The greatest danger to be apprehended in wounds of the joints, arise from their liability to pass rapidly into the suppurative form of inflammation and ulceration, in consequence of the peculiarity of the structure forming the joint; which being organised with little vitality renders them incapable of resisting to any great extent all unnatural influences which violence, or disease; impose. Recovery from these injuries, when inflammation has followed; is either by adhesion of the surfaces of the membranes (synovial) forming the joint, or by granulation, when a partial or complete ossific immobility is the result. TREATMENT.-In treating these wounds, the first step should be to extend the limb; then bring the lips of the external wound together, and confine them:with. the glover's stitch, by using a fine needle, with colorless silk, and passing it through the skin only, avoiding the membrane that forms the joint. When this is accomplished, saturate some lint with blood, and place it over the wounds, and confine it with adhesive plaster. The limb must now be permanently extended by placing it. 86 L loil SURGICAL DISEASES. upon; a splint, which must be secured above and below the joint by a-rollerj so: as to prevent the slightest' mti6ni. ARNICA should be applied locally, on the second day after the accident with a sponge, saturated with one part of ARNICA to eight 6of watier and continued until the wound has healed. ACONITE shUoidu be given if the local pain is severe,, the pulae accelerated, and general restlessness portends inflammatoty action. YFive drops: of the first ditutio'n may be:added to a tumbler of' water, and a spoonfil administered every, two -hours, or every hour, if the urgency of the symptoms should demand it. SIl CEA, twelfth potency is indicated if the inflammation should -terminate in suppuration; the adhesive plaster should be removed, and the wound dressed with dry, lint repeatedly during the day. Should fungous granulations form in; the woundthey must not be disturbed, for it is a process of nature to close the aperture, and. if interfered with, increased, irritation will be produced.; The; wound should, not beinter-fered with until 'after the eighoth day, unless some special indications demand iti; the stitches-should then be cut and gently removed: with a pair of forceps, observing great care that the lips be not torn apart' by using too much force. The' subsequent, dressing should donsist of adhesive plaster alone, and, in about.three'weeks, the splint may be removed, and: gentle'motion allowed, by placing the invalid on a high table and suffering, him to flex and extend' the limb for sbme length, of time. This will prevenr t;iimmobilitly when the joint, is not altered- in form; but if ossific granulations have been th.rownr out, tmotionr will be entirely: lost. __ i__ 1012 SURGICAL DISEASES. ARNICA should be applied externally when, after the accident, the limb is partially paralyzed, disability to move the joint and unattended with much pain. It may also be given internally, first attenuation, every two hours until reaction develops pain and tumefaction. ACONITE, first dilution, should follow Arnica, when the joint becomes swollen and painful, with or without constitutional disturbance, and persistently continued until the pain and swelling have abated, then give it at longer intervals until all is well. It should also be applied externally in full strength; by keeping the roller constantly saturated with it. A variety of other remedies have been recommended in sprains and inflammation of the joints, by writers and practitioners of our school; yet, not having realized the propriety of calling into service, remedies that are not pathologically indicated, we are constrained to recommend those only, which, in our hands, have never disappointed us or our patients. Whenever the pain and swelling subside, the joint should be liberated and gentle motion allowed; but the invalid must have great care in attempting to walk, as the slightest misstep may reinduce the same difficulty, from which he will not so readily recover. URINARY CALCULI, These concretions are formed in the kidneys, uterus, bladder, and urethra; and are the result of constitutional causes. When they form in the kidneys, their presence is known by an obtuse pain in the back, immediately below the ribs extending forward towards the navel, ~_ ~_ 1014 SURGICAL DISEASES. der. The pain, under such circumstances, is of the most intense character, extending from the loins, over the upper part of the pelvis, down to the bladder. The pain, at the commencement, has remissions, and the invalid is flattered with the hope that the sufferings have ended; but, after a few moments, they return with increased power; the countenance grows pallid, nausea and vomiting are excited, and cold perspiration bedews the forehead and face of the sufferer; when, after repeated attacks, the stone escapes into the bladder. TREATMENT.-The treatment during the attack consists in the local application-of hot fomentations over the abdominal region, and the internal administration of remedies that will tend to allay the spasmodic action of the ureters, and enable the stone to descend into the bladder. CHAMOMILLA is the most appropriate remedy to effect this object, and should be given every fifteen minutes, in five-drop doses of the first dilution, until relief is obtained. CANTHARIDES, twelfth dilution, should be given every two hours after the stone has passed into the bladder, if soreness and pain are felt in urinating. ACONITE, third dilution, should be given every hour, if the pulse is preternaturally accelerated, the skin hot and dry, and a sharp, cutting pain is felt in the region of the ureters. Bleeding from the arm, nauseating doses of the Tartrate of Antimony, Opium, etc., are the popular prescriptions of the old-school practitioners in this disease, and, vwe are sorry to say, have been resorted to by the Sangradoes of our own school. This treatment is reprehensible in the highest degree, - 3 -- 1 STONE IN THE BLADDER. 1015 but more particularly so in those of our own school who have the temerity to adopt it. Under proper treatment, the invalid soon recovers from one of these attacks, and feels no further inconvenience, until a re-attack awakens him to a consciousness that there must be some constitutional cause subjecting him to these repeated sufferings. Stone in the Bladder. After the stone has passed the ureters and fallen into the cavity of the bladder, it either remains there, or passes with the urine through the urethra, and may be found deposited in the bottom of the vessel that contains the urine. When examined, they will be found to vary in size and appearance; some are smooth, round and polished, and as large as a pea; others are about the size of the smallest shot, with rough, uneven surfaces; it is this form that creates such intense suffering in the passage through the ureters. When of this size, they are designated by the name of gravel. If one of these stones remain within the cavity of the bladder, it serves as a nucleus for the growth of a stone of much larger size, which cannot be voided with the urine, and will require, at some future time, an operation for its removal. A stone may form in the bladder independent of these deposits from the kidneys. SYMPTOMs.-The symptoms which reveal the presence of stone in the bladder, are: frequent inclinations to urinate, sharp cutting pain running along the whole length of the urethra, and a peculiar stinging sensation 101Q SUIRGICAL DISEASES. at 'the glans penis, hich iremiains after -'the urine' has been discharged. This paint is always greater after than before, or at the time the, rine is being voided. As the stone increases in size, the bladder becomes more irritable, and is incapable of retaining much urine in conse quence of its diminished size. Often, as the urine is flowing freely, a sudden check is produced to the stream, attended with violent pain, in consequence of the stone falling forwards and closing the passage through-the neck of the bladder; as the forde of the bladder's coritr-action lessens, the stone falls back, and the urine again escapes in a free stream. Patients void their urine more easily in a recumbent position, as the stone does not encroach upon the neck of the bladder. The appearance of the urine is unalterted in the early stages ofXthis disease, and therefore canhot aid in the diagnosis; but when the disease has existed for a onsiderable: length of time, and the invalid is compelled to severe exerciqe in walking or riding on horseback, the irritation becomes very severe) and blood in mixed with the urine. As the disease advances the irritation incteases, and the constitution begins to Thow marks of enervating influenobs;-.the urine is loaded with mucus, and a grayish sediment is perceptible, mixed with flakes of adhesive matter thtown out by the membrane.of the bladder, which has become inflamed by the continued iiritation which has' been Ikindled -by the frictioni of the stone- alnaost constantly against its surface. This stage is often attended with. more orf less feter' of an intermittent character, and not unfreq'ueitly matter:is discharged with 'the urine. When this: ocburs it is an' evidehee 'that d'uloeration has commeliced %irn the mucous menmbrane, which sooa STONE IN THE BLADDER. 1017 involves the other structures \of the bladder, and the patient soon sinks under its prostrating influence. A person afflicted with this disease walks with great caution, fearful lest a false step or a quickened motion should produce a sudden shock, which causes severe pain and excites spasmodic contraction of the bladder. So, also, in lying down he observes care, as a quickened change of position is liable to alter the location of the stone, which produces irritation and suffering. TREATMENT.-With respect to the medical treatment of stone in the bladder, nothing can be done to bring relief other than that which has reference to the mitigation of suffering. CHAMOMILLA will be of essential service in allaying the irritability and restlessness which so constantly attends the progress of this disease. It should be given during the night; twelfth attenuation in water every two hours until the invalid is tranquil. APIS MELLIFICA, thirtieth attenuation should be given if there is frequent desire to urinate, and a burning sensation accompanies or follows the discharge of urine. This medicine should be given every three hours if the symptoms are urgent, and at longer intervals if they abate. ARSENIOUM is an important remedy when there is great nervous prostration, pale countenance, general emaciation, quick irritable pulse, and a constant desire to drink cold water. This medicine should be given in the thirtieth potency every four hours during the day, and Chamomilla should be given at night, same potency. KALI HYDRIODICUM, NATRUM MURIATICUM, ACIDUM NITRIcUM, and ACIDUM MURIATICUM are the medicines principally indicated in the constitutional treatment to prevent or arrest the disposition to calculous deposit. cr~ I 1020L SURGICAL DISEASES, adventitious covering, an external incision through the urethra must be made for its removal. Should there arise, spasmodically, an entire obstruction of the urine, a small sized catheter must be introduced if possible into the bladder, and the urine will be allowed to escape. APIS MELLIFICA may be given, if there is constant irritation at the neck of the bladder, with urgent desire to void the urine. This medicine will allay the irritation, and tend to relax temporarily the spasmodic contraction which the pressure from accumulated urine produces. A radical change can only be accomplished by the removal of the exciting cause. If this obstructionshould occur suddenly, which it not unfrequently does, a layman, in the absence of a surgeon, should introduce a catheter, and attempt to force the stone by gentle pressure back into the cavity of the bladder, unless it should be sufficiently near the external orifice to permit him to press it forward with his fingers and remove it. If the stone be allowed to remain in this situation for twelve or twenty-four hours, an accumulation of urine may take place in a sufficient quantity to rupture the bladder. The introduction of a catheter into the bladder by an inexperienced operator, is not readily accomplished, and never should be attempted by him unless imperative necessity demands it. I-, -~ -I j 1022 SURGICAL DISEASES. pain. The swelling does not occupy equally all sides of the joint, nor greatly impair its motion. When the limb is flexed the tumor becomes harder and broader, fluctuation is less distinct, and more prominent at the side; when extended, the tumor is less prominent, softer, and fluctuates freely. In examining the tumor, the fluctuation will be more distinctly felt by placing both thumbs over the most prominent part of the tumor, and pressing, alternately, with the thumbs, while the fingers grasp the joint and hold it firmly. If the knee-joint be the seat of the affection, the kneepan will be pushed forwards, very movable, and, as it were, floating in the fluid. When it is pressed backwards, and the limb is in an extended position, it can be felt moving in a certain direction until it is arrested by its articular attachment; and in removing the pressure it immediately returns to its former position. These are symptoms by which hydrops articuli is readily distinguished from rheumatic enlargement of the capsular ligaments, tumors of the bursa, ganglions in front of the knee-pan, and various other affections peculiar to the joints. TREATMENT.-The successful treatment of this affection must depend in a great degree upon the nature of the causes which have conspired to develop it. If it be of a purely local character, the treatment will consist in the application of those medicines that are calculated to rouse the absorbents, and remove the fluid by absorption. This may be accomplished by friction over the tumor and around the joint, either with the hand, a moderately soft brush or dry flannel; this should be continued from five to ten minutes, and repeated two or three times a 1024 SURGICAL DISEASES. As the disease progresses, it involves the entire organization of the joint, producing ulceration of the cartilages and destruction of the cancellated structure of the bones. As the name of this disease implies, the skin is unaltered in color. In the commencement of this disease there is a slight degree of stiffness and tumefaction, with an occasional deep seated, dull, heavy pain, not increased on motion; and, if the knee or elbow-joint is the seat of the affection, the invalid keeps it;in a bent position, and never fully extends it. As the:disease gradually advances the joint enlarges, motion is impeded, the. pain increases, and if the fingers of one hand are pressed upon the tumefied part, a soft and elastic sensation is produced, which is sometimes mistaken for the fluctuation of matter; the deception is easily detected by employing both hands on each side of the tumor, when the absence of fluid will at once be apparent. The progress to ulceration is very slow, and the morbid joint in the course.of time acquires a vast magnitude. The enlargement, however, generally seems greater than it really is, in consequence of the: emaciation of the Ilimb both above and below the joint. When ulceration is fully established, constitutional effects begin to manifest themselves by an accelerated pulse, a hectic flush on the cheek, and the invalid gradually sinks, unless the further progress of the ulceration is arrested by proper constitutional treatment, or the removal of the limb, which in some instances -may become necessary. TREATMENT.--As the disease arises from a scrofulous diathesis, the treatment must be directed to this peculiar condition of the system, which has been fully treated of in the chapter on Scrofula in another part of this work. ___ _ _~___ WHITE SWELLING. 1025 When the disease has resisted the general treatment, and the ulcerative stage appears inevitable, KALI HYDRIODICUm should be given, in ten dropdoses of the first dilution, three times a day, and a local application of the tincture of IODINE every night. The IODINE should be cautiously applied with a camel'shair brush over the entire surface of the enlarged joint, after which a roller should be snugly applied, and the limb kept in a quiet, easy position. As soon as ulceration has been established, these medicines must be discontinued. SILICEA must now be given, twelfth dilution, three times a day, by adding five drops to a tumblerful of water, and a dessert-spoonful at a dose. CALCAREA CARBONICA must be given when the ulceration has extended to the cancellated structure of the bones, which may be known by introducing a blunt probe into the ulcer, and if the bone is affected a rough grating sound will be imparted to the fingers. This medicine should be given in grain doses, of the third trituration, three times a day, for ten days; when it should be discontinued and another remedy substituted. PHOSPHORUS will be the most appropriate remedy after CALCAREA, in ulceration of the bones, and should be given in five drop-doses, of the third dilution, three times daily, for a period of ten days, and then CALOAREA should be resumed. These medicines must be continued in alternation for a reasonable period of time, even though no apparent improvement should follow their administration. Their influence must, from the nature of the disease, and the character of the parts involved, be very slow; for it is only by a persistent adherence to the fundamental prin87* __ ~ 1026, SURGICAL DISEASES. ciples which determine the appropriateness of a remedy that a hope can be sustained of ultimate success.. Due regard must be paid to the diet of the invalid, which should be liberally, given, and nutritious:in character. The ulcer should be cleansed daily with tepid water and Castile soap, and afterwards dressed, with pledgets of dry lint. Poultices should not be applied, as they are always pernicious in this form of ulcers; they tend to relax the parts and provoke a continuance of the ulcerative process. Morbus Coxarius. Hip-disease. This disease.is confined to the hip-joint and is analogous to the White Swelling of other articulations. Like the latter disease, it is generally of a scrofulous origin; yet it not unfrequently arises from other causes; such as sprains, contusions, and various other, outward influences that tend to excite inflammation of the synovial membrane or the cartilages. of the joint. When this affection has a scrofulous origin,,it.usually develops itself before the age of puberty; but no age or sex, nor condition in life is exempt from the possibility of being afflicted with this disease. The approach of the disease of the hip-joint is much: more insidious than the White Swelling.. More or less pain is always present in the latter affection, with tumefaction and difficult mobility of- the joint;--which is not the case in the disease under consideration. Almost the first symptom that attracts the attention, is pain in the inside of the knee, which induces the belief in the mind: of an inexperienced or careless observer that the seat of the difficulty is in the knee-joint, when in fact the pain: HIP-DISEASE. 1027 is only a sympathetic suffering; and we have known instances where poultices have been applied to the knee, while a diseased state. of the hip was not at all suspected. Such a mistake may prove fatal to the invalid; not from any injury that may result from the application of a poultice to the knee, but by allowing the incipient stage of the disease to pass unrecognized; for it is in this stage that remedies may prove efficient in arresting and controlling its farther extension, thereby preventing a vast amount of pain and suffering, and perhaps the loss of life itself. The symptoms of the disease of the hip-joint, when sought for only in the vicinity of the joint, are very obscure and trivial. If the disease attacks a child, the mother first discovers a sort of tripping or halting gait. whenever the child walks over an unequal surface; or, if the toe of the affected limb strikes some: unnatural elevation in its path, causing it to stumble and fall. If the joint be now examined, by placing it in a recumbent position, and pressure be made deep in the groin, immediately over and anterior to the head of the thigh-bone, tenderness and pain will be experienced, if the disease is in the capsular ligament of the joint. If it be in: the round ligament, or in the cartilaginous structure that lines the cavity which receives the head of the thighbone, or that which tips the head of the bone itself, pain will be excited if the limb be pushed up into the socket, and at the same time gently rotated; the, pain is elicited in consequence of the friction and pressure made by the head of the bone upon the inflamed parts, which is soon increased by the ordinary motion of the joint: in walking. The inflammation, if not arrested, soon passes into the ulcerative stage; when, in conse _ ~ HIIP'- DISEASE. -1029 given the same as AcONITTE,.and alternated with it if the symptoms are of a mixed character. RHUST TOXICODENDRON is the more:appropriate remedy after AGONITE, when the integuments covering the joint:are more or less discolored and sensitive to the touch. This medicine should be given the same as Aconite, and in alternation with it, if indicated. SULPHUR is indicated in the scrofulous form of this affection, and should never be given in a lower attenuation than the thirtieth attenuation. Five drops may be added to a tumblerful of water, and a dessert-spoonful -administered every twelve hours. If this medicine is appropriately administered in the developing stage of the scrofulous form of this affection, it seldom fails to arrest its progress, and arrest those sad consequences which so often result from neglect or error in treatment. SILICEA, ARSENIOUM, CALCAREA CARBONICA, PHOSPHORUS, etc., may be indicated after ulceration is established and an abscess has formed. Medical treatment, however, will be of little avail in any form of this disease, unless perfect rest of the limb is enjoined. The invalid should be kept in a reelining position most of the time, and when allowed to walk for recreation, should be aided by a pair.of crutches, so that the diseased limb will not be compelled to bear the least amount of the weight of the body. In the rheumatic form, the diet must be simple and non-stimulating. In the scrofulous form, it must be the reverse. Every healthful ifluence that tends to invigorate and strengthen the enervated energies of a scrofulous diathesis, must be freely administered; for, unless these can be elevated by hygienic means, medicines, how - 1030 SURGICAL DISEASES. ever appropriately given, will fail to accomplish their object. The invalid should never be restrained in physical freedom by the application of splints and bandages to the affected limb. Peremptory restraints, whether of a physical or mental character, have in all forms of disease always a pernicious influence; they excite irritability of the temperament, general irritation, emaciation and hectic fever, which soon destroys all hope of a successful issue. Similar results follow the application of blisters and moxas; the introduction of issues and setons around the affected joints which ever has been, and still is the popular practice of the allceopathic school, not only in this, but in every other form of chronic disease; and, although victim after victim has been followed to the grave, who has fallen a martyr to science, how few of these learned disciples ever question the solidity of those principles which govern their practice, or even suspect the cause why so many go about clad in the habiliments of mourning. It is well for humanity that the sun of scientific truth has well nigh mounted to its zenith, and will soon dispel the cimerian darkness that has so long enveloped the medical world. Rickets, Rachitis. This disease seems to arise from a want of firmness in the bones, in consequence of a deficiency of earthy matter in their structure. It is mostly met with in children between the age of seven months and two years. In some cases, however, it has been known to _ 1034 SURGICAL DISEASES. ments more rapidly. Women are more subject to it than men. The causes of bronchocele are unknown; although many writers have attributed this disease to local climatic influences. There appears some foundation for opinions of this kind, as there are certain places where the disease is so general that scarcely an inhabitant is unaffected by it. In Larray's travels through the valley of Maurienne, he records that almost all the inhabitants were affected with goitres of different sizes, whereby the countenance was so deformed that in many cases they were frightful to behold. And Postiglione, in his Memoirs, remarks, that in Savoy, Switzerland, the Tyrol and Carinthia, there are villages in which all the inhabitants, without exception, have enlargements of the thyroid gland, which, from their position and regularity, are regarded as attributes of beauty. By many, however, they are regarded in a far different light, and great care is observed in wearing the apparel in such a manner as wholly to conceal them. Yet in many instances this cannot be done, as we, in several instances, have observed on some of the inhabitants of the valleys of the Alps and Appenines, where they have grown to a size so enormous that no form of clothing could conceal them. Bronchocele is not confined to Europe; it is met with in every country and climate on the globe-though in this country it seldom, if ever, attains to that frightful size so familiar in many trans-atlantic regions. Barton, in his travels among the Oneida Indians, met with many and severe cases of bronchocele. He mentions one case of a pendulous form in an Indian woman, which extended __ _ 1036 SURGICAL DISEASES. A favorite prescription with some of them, used to be composed of, R. Burnt sponge, gr. x. Burnt cork, gr. x. Pummice-stone, gr. x. These powders were mixed together and made into the form of lozenges, by the addition of a little syrup, and several of these were put under the tongue and allowed to dissolve. Whatever results have followed either of the above methods, certain it is they have recorded few triumphs. Nor can more be claimed by any other method or medicine. IODINE, both internally and externally, will sometimes arrest the growth of the tumor, and has in some instances reduced its rise and rendered it permanently stationary. Accident has sometimes excited suppurative inflammation in the tumor, and reduced it to almost its normal state, and it is this fact, doubtless, that first suggested the idea that the introduction of a seton might effect similar results. Change of locality has also been recommended, and cases are recorded of entire cures being effected in observing this advice. Instances are recorded by Alibert in his Natural Nosology, of several Swiss ladies who had bronchocele, visiting Paris for a length of time, who were wholly restored. In our hands dry friction over tumours has not unfrequently been attended with beneficial results. Persons endowed with a large magnetic sphere have a powerful influence in controlling this affection. Where the tumor has attained an enormous size, so as to interfere with respiration and jeopardize life, extir. i -~- I - --- -- BURNS AND SCALDS. 1037 pation of the gland has been hazarded, not always however with success. Burns and Scalds. The diversified appearances so frequently met with in burns of similar kinds, depend generally upon the violence attending the causes which produce them, and the amount of tissue destroyed. Burns which produce entire destruction of the skin, are essentially different from those that only irritate it. The former present a very different aspect, and are far more formidable in their effects when they involve muscles, tendons and ligaments, producing contractions and deformities frightful to behold. The worst form of burns that are met with in practice, result from the explosion of gunpowder, metallic substances and inflammable gases. Scalds, being produced by boiling fluids, affect only the cuticle, producing vesication, and unless a large extent of surface is involved, are in themselves of trivial import. When, however, it is extended,over a wide surface, and the temperature of the fluid has been very intense, death speedily follows. In all cases of burns the amount of injury depends on the sensibility of the part involved; the degree of temperature of the burning material, and the duration and extent of its application. The parts may either inflame and terminate in mortification from the effects of the fire, or they may be killed at the moment of its application. TREATMENT.-The constitutional effects of burns ma nifest themselves in more or less general irritation, and local inflammatory action, which is liable to terminate in ulceration or mortification. 88* BURNS AND SCALDS. 1038 variety of other local applications have been recommended by different surgeons; yet we are fully per, suaded that the above applications, if properly enforced, will do more to allay pain, and hasten recovery than any other. If the parts show a disposition to gangrene, the local application of a yeast poultice, sprinkled over with a little Carbo vegetabilis, first trituration, will facilitate the separation of the mortified part, and arrest its further extension. The ulcer must then be dressed with surgeon's lint, moistened with a little fresh cream, or alcohol. PosITIoN.-During the progress of the case due attention must be paid to the position of the affected part; for unless this is closely observed severe and irreparable distortions will occur. If the neck and face are involved, an apparatus must be worn that will sustain the head in an erect position, and must be kept on for many months. after the parts are entirely healed, or contraction will recur after the extending force has been removed. The accompanying plate illustrates anp instrument that is well adapted to accomplish this end, and was invented for the purpose of correcting the deformity in the distortion called wry neck. We once had the misfortune as well as the mort-ification, to witness, in our own practice, a frightful deformity follow a burn on the side of the face and neck, from neglecting the above important considerations. An operation subsequently restored the contracted integuments, and the application of the subjoined apparatus, after the operation, restored the head and neck to their natural position. CONCUSSION OF THE BRAIN. 1043 Concussion of the Brain. This condition of the brain arises from blows directly upon the skull, by falls, or by a sudden and severe jar of the whole body in jumping. The effects that follow concussion are severe in proportion to the amount of violence that has been inflicted. In the simplest form, momentary insensibility and general prostration of the muscular system are the result. As consciousness returns, more or less nausea and vomiting supervene, attended with a greater or less degree of pain in the brain, from the effects of which the invalid recovers in a few days by proper treatment. In the severer form there is apparent mental and physical insensibility, yet, when you approach the invalid, you find him breathing as calm as though he were in a tranquil sleep; but if you attempt to rouse him, he manifests little sensibility, and if spoken to, his answers are incoherent and unintelligible. If, while in the attempt to rouse the invalid, you place your fingers on the pulse, it will be very small and accelerated, and as soon as you desist, the pulse becomes tranquil and natural in its pulsations. From this condition, the patient often recovers; but if the result terminates not so favorably, all the symptoms become aggravated; the breathing grows more laborious, and finally stertorous; the pulse fuller and more labored in its pulsations; the stools, hitherto suppressed, now pass involuntarily, and death follows by compression from extravasated blood between the skull and the brain. TREATMENT.-In the milder forms of concussion, little artificial treatment will be required; rest, a mild liquid 1044 SSURGICAL DISEASES. diet, and freedom'from all excitement are important considerations. ARNICA may be given internally every half hour, by adding a few drops of the first dilution to a tumbler of water, and a dessert-spoonful administered until reaction has ztaken place. ACONITE should be given if reaction is followed by an accelerated pulse, pain in the head, and general restlessness; five drops of the first dilution should be added to a tumbler of water, and a dessert-spoonful administered every hour or two, as the urgency of the symptoms may demand. Should inflammation of the brain supervene, the appropriate treatment will be found in the chapter on inflammation of that organ in another part of this work. LOCAL TREATMENT.-If the scalp be wounded, the hair must be closely shaved and the lips of the wound brought in coaptation and retained by adhesive plaster, Sutures must not be used, as they are liable to excite erysipelatous inflammation; should it arise, however, it must be treated by: the appropriate remedies for this disease in its idiopathic form. When the external wound shows indications of suppuration a poultice. made of slippery-elm, bark or bread and milk, must be applied and retained by a bandage, (as represented in the accompanying plate.):This.bandage is made of a piece of muslin a yard in length and a quarter of a yard wide, split at each, end to within about three inches of the centre. The body of the bandage is then placed on the top of 1048 SURGICAL DISEASES. the point of the shoulder or on the bone itself; the arm is rendered immovable, the shoulder falls a little:forward, and if you run your finger along the length of the bone, you will readily detect depression, and crepitation if the shoulder be elevated and drawn backwards. TREATMENT.- The'shoulder must be elevated and drawn backwards, which will bring the ends of the fractured extremities of the bone in coaptation. A large and firm wedge-shaped pad must now be placed in the axilla, (as in the accomrpanying plate), and secured by firm pieces of tape. The next step is, to take a roller six inches in width and ten yards in length, and wind it round the chest in five turns of the roller, the last two must be carried over the sound shoulder and' armipit; then, bring the arm down to the side over the pad, and --iU FRACTURE OF THE COLLAR-BONE. 1049 roll the whole length of the upper arm of the injured limb, in the folds of the same roller; this will keep the elbow in close proximity V to the side, whilst the pad in the axilla will force the shoulder upwards and outwards, and restrain the tendency to fall inwards upon the chest. The dressings must not be interfered with before the expiration of 'the third week, unless circumstances should arise rendering it necessary to remove them before that time. If this fracture should occur in warm weather, the above dressing would be very uncomfortable, and could not be borne without great suffering, and therefore, after the expiration of eight days the roller may be removed, and the dressing as represented in the annexed plate may be substituted. This dressing is composed simply 89* 1050 SURGICAL: DISEASES. of a leather buckled belt, lined with soft buckskin, and padded so as to make it pliable and easy to: the arm; this is buckled around the -body, including the lower portion of the' injured limb, and sufficiently firm to fix the elbow closely to the side and render it. immovable. The arm must then be put into a sling as in the accompanying illustration, which will be all that is required, and reunion will readily take place. Fractures of the Long Bones. These fractures occur at so many different points, and many of them of a nature so complicated and difficult, that to enter into a detailed account of their character and treatment, would be irrelevant to the object the present work has in view. We shall, therefore, conclude what we have to offer in regard to fractures, by laying down this principle of action: on the:part of laymen, when force of circumstances places them in situations where their aid is demanded. Whenever a fracture occurs of the arm, under such circumstances, the fractured ends of the- bones must be brought in coaptation by extension and counter-extension. The extension must be made above the elbow-joint, and counter-extension at the shoulder. When the fractured ends are approximated, a roller about two inches and a half in width should be applied lightly over the arm from the elbow to the shoulder; over this four padded splints made of shingles or thick p aste-board, about two and a half inches in width. Allow one splint to pass snugly up' in the.axilla,: and then secure them by 'reyerse turns of the 'same roller, After which, bend the fore-arm at right pangles, and retain it in this position by a sling. FRACTURE OF THE FORE-ARM AND THIGH. 1051 Fractures of the Fore-arm. The same principle in reduction of these fractures must be observed as in fractures of the arm. There must be but two padded splints for fractures of the fore-arm, a graduated compress placed in the intercostal space, or between the bones, and a roller must be applied from the fingers to the elbow; the roller is to be put only around the splints, and not firstly around the arm, as in fractures of the arm. The fore-arm must then be placed at right angles and secured as in the above. Fractures of the Thigh. Whenever a fracture occurs at this bone, the pain and constitutional irritability are often very great. It is therefore highly important that the broken fragments should be brought into coaptation as soon as possible after the fracture, and so secured that they will not again be misplaced. The patient must be. placed on a firm mattrass, and extension and counter-extension.made steadily and per, sistently by two able-bodied men. A third must stand at the fractured point, 'and, grasping the limb with both hands, will, by pressing gently, discover when the fractured ends have joined:; as also by observing the length of the injured limb when compared with the sound one;: this point being gained, two splints wrapped in firm muslin upon which the leg rests, must now be applied; the one on the inside, and the other on the outside of the'leg; the inside splint to extend up to the perineum or crotch, and the other to the hip-joint, (as in the annexed illlustration Fig. 1.) _~ ~ 1052 SURGICAL DISEASES. These splints must be from five to six inches in width, well padded with bags of bran, so as to fill up all inFig. 1. -aa equalities between the leg and splint. A foot board must be fixed to the lower end of the splint, and the foot fastened to it by a laced boot, this will keep up permanent extension, and prevent the limb from becoming displaced. Around the whole, broad pieces of tape must be tied, at intervals of about eight inches, which will keep the splints snugly and immovably adjusted. Several other kinds of splints have been devised for fractures of the thigh, and are, in some respects, preferable to the one just described. The double inclined plane, as represented in the Fig. 2, possesses several Fig. 2. advantages over the straight splint: one in particular is, 1hat this splint allows the patient to assume different angles in the recumbent position, affording great comL._.....- - DISLOCATIONS. 1055 Dislocations. A dislocation is a displacement of the articular extremity of a bone from the surface upon which it moves. An accurate knowledge of the structure of the joint is necessary, in order to detect the nature of many dislocations, and enable the surgeon to re-adjust them. The immediate effects of a dislocation are, to change the form of a joint, and the ordinary length and position of the limb. If left unreduced, for a length of time, immobility of the joint is produced. TREATMENT.-The treatment of dislocations, is, in many respects, similar to that of fractures; the coaptation of the displaced surfaces; and, in order to effect that object, the application of extension and counterextension. In dislocation of the finger, or of the wrist, a layman may be able to replace a disjointed bone; but in most instances, dislocations are so complicated, and difficult to detect, as well as to re-adjust, that no time should be lost in calling the aid of a surgeon to do a work which sometimes baffles the most capable and experienced. After a dislocation has been reduced, all motion must be prohibited, by confining the limb in a similar manner as in simple fracture. ARNICA must be applied to the joint, and continued until the inflammation has subsided; after the expiration of ten days, the limb should be gently exercised daily, and then replaced as before. This practice should be continued until motion becomes painless and easy; when it may be left to perform its accustomed work. LIST OF MEDICINES Used in this work, together with the names of the diseases for which they are recommended. (The numbers indicate the pages where the medicines are mentioned.) ACONITE, Wolf's-bane, a medicine derived from the leaves and root of a plant which grows in several European countries. Hypochondria, 219. Hysteria, 222. Loss of memory, 230. Fright, 231. Excessive exertions, 233. Sunstroke, 235. Consequences of a fall, 241. Starvation, 241. Asphyxia by strangulation, 242. Lightning, 243. Asphyxia by freezing, 253. Asphyxia of newborn infants, 254. Simple fever, 257. Catarrhal fever, 257. Inflammatory fever, 258. Gastric fever, 261. Mucous fever, 266. Bilious fever, 270. Congestive fever, 274. Typhoid fever, 291. Yellow fever, 312. Lentescent fever,. 316. Rush of blood, 322. Vertigo, 323. Sea-sickness, 324. Apoplexy, 327. Meningitis, 331. Congestion of the brain, 340. Catarrhal headache, 343. Arthritic headache, 344. Bilious headache, 345. Nervous headache, 315. Gastric headache, 346. Menstrual headache, 346. Congestive headache, 347. Myelitis, 367. Spinal irritation, 380. Neuralgia, 386. Cramp in. leg, 390. Paralysis, 395. Fainting, 404. Vertigo, 405. Epilepsy, 408. Chorea, 412. Tetanus, 415. Convulsions, 419. Catalepsy, 422. Nervous debility, 423. Marasmus, 426. Palpitation of heart, 429. Lumbago, 432. Rash, 487. Hives, 438. Nettle-rash, 439. Measles, 441. Rubeola, 444. Purplerash, 446. Scarlet-rash, 447. Small-pox, 452. Chicken-pox, 459. Erysipelas, 460. Purpura haemorrhagica, 462. Mumps, 465. Itching, 466. Itching of Scrotum, 468. Freckles, 469. Soreness, 469. Eczema, 474. Scaldhead, 479. Baldness, 483. Rheumatism, 485. Periostitis, 494. Stiff-neck, 495. Gout, 496 Scrofulosis and Tuberculosis, 507. Infantile 90 1057 LIST OF MEDICINES. 1059 Liver-grown, 911. Croup, 914. Whooping-cough, 915. Furunculus, 937. Lumbar abscess, 950. Inflammation of wounds, 989. Calculi of the ureters, 1014.) Hernia, 1040. Concussion of the brain, etc. AGNUS CASTUS, Chaste-tree, a bush growing in the south of Europe; we use the seeds. Deficiency of milk, 894. ALOES, A resinous product of the Aloes-tree. Nervous headache, 345. Menstrual headache, 346. Dysentery, 697. Menorrhagia, 855. ALUMINA, Alum. Constipation, 674. Painters' colic, 839. AMBRA GRISEA, An oily concretion obtained on the shores of the Baltic, Suppressed herpes, 477. ANACARDIUM, Malacca-bean, the seed of a tree growing in the Indies. Loss of memory, 231. ANTIMONIUM CRUDUM. Gastric fever, 262. Intermittent fever, 282. Nettle-rash, 440. Warts, wens, 464. Gout, 496. APIS MELLIFICA. Ophthalmia, 531. Anasarca, 577. Strangury, 712 Urethritis, 718. Ovaritis. ARGENTUM NITRICUM. Epilepsy, 411. Itching at anus, 467. Caries of the teeth, 601. Cardialgia, 634. Summer-complaint, 686. ARGENTUM. Coryza, 728. AMMONIUM CARBONICUM. Scurvy, 575. Hydrothorax, 580. Hoarseness, 735. ARNICA. Excessive exertions, 233. Fall, 240. Intermittent fever, 282. Typhoid fever, 292. Typhus, 296. Apoplexy, 328. Hydrocephalus, 332. Paralysis, 396. Tetanus, 415. Ma __ 1060 LIST OF MEDICINES. rasmus, 426. Lumbago, 433. Small-pox, 454. Corns, callosities, 464. Rheumatism, 485. Hydrocele, 520. Foul breath, 603. Haematemesis, 632. Enteritis, 659. Haematuria, 716. Orchitis, 721. Chafing of sexual organs, 723. Epistaxis, 732. Pneumorrhagia, 750. Pleurodynia, 767. Menorrhagia, 855, Prolapsus of womb, 866. Metrorrhagia, 866. Miscarriage, 881. Swelling of the head of infants. ARSENIOUM, Arsenic. Melancholia, 226. Mucous fever, 262. Bilious fever, 270. Congestive fever, 274. Intermittent fever, 280. Typhoid fever, 291. Typhus, 296. Yellow fever, 313. Lentescent fever, 316. Sea-sickness, 322. Bilious headache, 345. Nervous headache, 345. Spinal irritation, 380. Paralysis, 402. Epilepsy, 408. Tetanus, 416. Convulsions, 421. Nervous debility, 424. Marasmus, 426. Palpitation of heart, 430. Rash, 437. Nettle-rash, 439. Measles, 441. Scarlet-rash, 448. Small-pox, 454. Erysipelas, 461. Itching, 466. Eczema, 474. Herpes, 476. Scald-head, 479. Scrofulosis, 510. Infantile remittent fever, 512. Ophthalmia, 521. Weak eyes, 536. Amblyopia, 539. Deafness, 546. Ozmena, 548. Tabes meseraica, 552. Anasarca, 577. Hydrothorax, 580. Hydro-pericardia, 581 Dropsy of the ovaries, 583. Ascites, 583. Stomacace, 606, 607. Malignant sore throat, 616. Indigestion, 620. Dyspepsia, 623. Spitting up food, 628. Vomiting, 6,0. RHematemesis, 631. Bilious colic, 637. Bloating, 642. Gastritis, 650. Enteritis, 636. Peritonitis, 660. Hepatitis, 662. Jaundice, 668. Diarrhoea, 678. Summer complaint, 686. Cholera-morbus and cholera, 687. Coryza, 727. Influenza, 736. Cough, 741. Pneumonia, 761. Asthma, 778. Pulmonary phthisis, 792. Consumption of bowels, 80L. Heart disease, 08. Pericarditis, 810. Delirium tremens, 829. Leuncorrhcea, 862. (Edema of lower limbs, 874. Puerperal peritonitis, 889. Anthrax, 941. Lumbar abscess, 950. Cancer, 975. ASAFETIDA, a Gum-resin. Caries of bones, 517. AURUM, Gold. Melancholia, 226. Palpitation, 430. Scrofulosis and tuber. culosis, 508. Ozmna, 548. Foul breath, 603. Mercurial stomacace, 607. - -' - -~ 1066 LIST OF MEDICINES. Hydro-pericardia, 581. Hydrometra, 582. Hepatitis, 663. Jaundice, 663. Asthma, 778. Pericarditis, 810. Cyanosis, 810. DROSERA, Sundew, moor-grass. Laryngeal phthisis, 785. Whooping-cough, 915. DULOAMARA, Bitter-sweet, a climbing plant. Myelitis, 373. Rash, 437. Hives, 438. Nettle rash, 439. Measles, 442. Itch-like eruptions, 473. Tetter, 477. Scald head, 479. Rheumatism, 486. Tuberculosis and Scrofulosis, 507. Caries of bones, 517. Anasarca, 578. EUPATORIUTM PERFOLIATUM, Bone-set, an indigenous plant. Intermittent fever, 281. EUPHRASIA, Eye-bright, a European plant. Ophthalmia, 521. FERRUM METALLICUM, Iron. Intermittent fever, 284. Scrofulosis and Tuberculosis, 509. Anasarca, 578. Bloating, 642 Menostasia, 845. Chlorosis, 851. Delaying menses, 859. Vicarious menses, 861. (Edema of pregnant females, 874 FERRUM IODATUM, Iodide of Iron. Tuberculosis, 565. Pulmonary phthisis, 792. FERRUM ACETICUM, Acetate of Iron. Canker-sores, 605. Bloody cough, 745. Menorrhagia, 858. FILIX MAS, the Boot of a Fern. Tape-worm, 705. GRAPHITES, Black Lead. Herpes, 477. Scaldhead, 479. Sweaty feet, 498. Hydrocele, 519. Delaying menses, 859. Change of life, 860. GUAJACUM, a resinous substance obtained from the Guaiac tree in the West Indies. Rheumatism, 488. HAMAMELIS VIRGINICA, Witch-hazel, an indigenous plant. Purpura hemorrhagica, 458. Orchitis, 722. Varicose veins, 876. Phlegmasia alba dolens, 898. Varicose ulcers, 960. ---~ LIST OF MEDICINES. 1067 HELLEBORUS NIGER, Black Hellebore, a European mountain plant. Melancholia, 226. Intermittent fever, 284. Hydrocephalus, 332. Dropsy after Scarlet-fever, 448. Anasarca, 578. Hydrothorax, 580. HEPAR SULPHURIS, Sulphuret of Lime, a combination of sulphur and lime Erysipelas, 460. Chapped hands, 470. Itch, 473. Rickets, 515. Blepharophthalmia, 534. Tuberculosis, 565. Gumboils, 602. Ulceration of jaw, 610. Abscess in liver, 666. Cough, 741. Laryngitis, bronchitis, 757. Asthma, 777. Laryngeal phthisis, 785. Pulmonary phthisis, 792. Mastitis, 845. Croup, 914. HYDROCYANIC ACID, Prussic acid, a deadly poison. Paralysis, 402. Cholera, 694. HYDROPHOBIN, the poison of a mad dog. Hydrophobia, 818. HYOSOYAMUS, Hen's-bane, the seeds of a poisonous plant. Melancholia, 226. Mania, 228. Intermittent fever, 284. Typhus, 296. Meningitis, 331. Myelitis, 373. Epilepsy, 410. Convulsions, 420. Amblyopia, 539. Amaurosis, 540. Toothache, 596. Stomacace, 606. Cough, 739. Consumption of bowels, 801. Hydrophobia, 818. Puerperal peritonitis, 885. Puerperal mania, 889. Nymphomania, 892. HYPERICUM PERFOLIATUM, Hypericum perforatum, St. John'swort, a vegetable medicine. Menstrual headache, 355. Amenorrhoea 854. IGNATIA, St. Ignatius' Bean, the seed of a tree growing in the East. Grief, 232. Intermittent fever, 284. Lentescent fever, 318. Ignatia, 345. Myelitis, 375. Epilepsy, 410. Chorea, 412. Palpitation of heart, 430. Itching, 467. Rheumatism, 486. Sore throat, 613. Prolapsus of anus, 707. Convulsions of infants, 909. IODINE, a substance obtained from sea-weeds and the motherlye of salt-works. Marasmus, 429. Rheumatism, 492. Gout, 496. Tuber 1068 LIST OF MEDICINES. culosis and Scrofulosis, 507. IHydrocele, 520. Dropsy of the ovaries, 583. Dropsy of the knee-joint, 584. Cankersores, 604. Stomacace, 606. Mercurial stomacace, 607. Ptyalism, 609. Laryngitis, bronchitis, 757. Laryngitis phthisis, 786. Pulmonary phthisis, 792. Iodine, 840. Croup, 914. Schirrus, 973. IPECACUANHA, the root of a South American shrub. Gastric fever, 262. Mucous fever, 262. Congestive fever, 274. Intermittent fever, 280. Gastric headache, 346. Nervous headache, 355. Neuralgia, 388. Convulsions, 421. Rash, 437. Nettle-rash, 440. Dyspepsia, 625. Spitting up food, 628. Nausea, 630. Vomiting, 630. Haematemesis, 632. Bilious colic, 637. Cholera, 694. Cough, 740. Asthma, 774. Asthma Millari, 781. Menorrhagia, 856. Change of life, 860. Morning-sickness, 868. Miscarriage, 881. Whooping-cough, 915. JALAPPA, the tuberous root of a Mexican plant. Summer-complaint, 686. Crying of infants, 901. KALI HYDRIODICUM, Hydriodate of Potash. Ozena, 548. Mercurial stomacace, 607. Laryngitis, 163. Laryngitis phthisis, 786. Leucorrhea, 865. Ulcerated glands, 965. Chancre, 978. Mercurial ulcer, 980. KALI BICHROMICUM, Bichromate of Potash. Canker-sores, 604. Water-brash, 627. Laryngitis, 757. Laryngitis phthisis, 785. Croup, 914. KALI CARBONICUM, Carbonate of Potash. Cough, 568. Pulmonary phthisis, 793. KALI NITRICUM. Gonorrhoea, 720. KREASOTUM, Creasote, obtained from smoke, tar, etc. Disorganizations of the neck of the womb; leucorrhoea, 863. LACHESIS, the poison of the Trigonocephalus, a South American serpent. Apoplexy, 328. Small-pox, 454. Stomacace, 607. Malignant sore-throat, 617. LAUROCERASUS, Cherry-laurel, a South European tree. Convulsions, 421. Hydro-pericardia, 581. /~.~ j i ~I ^ 1070 SLIST OF MEDICINES. swellings after scarlet fever, 449 Small-pox, 452. Mumps, 465. Itching, 467. Itching of penis, 468. Freckles, 469. Soreness, 470. Chapped hands, 470. Itch, 472. Eczema, 474. Herpes, 476. Scaldhead, 479. Baldness, 483. Rheumatism, 487. Periostitis, 494. Sweaty feet, 498. Scrofulosis, 509. Caries of bones, 517. Hydrocele, 520. Ophthalmia, 532 (also Solubilis). Otitis, 542. Discharges from the ears, 544. Deafness, 546. Ozena, 547. Bad smell in nose, 548. Inflamed face, 548. Anasarca, 578. Dropsy of the ovaries, 583. Toothache, 596. Gumboil, 601. Caries of the teeth, 601. Foul breath, 603. Canker sores, 604. Stomacace, 606. Ptyalism, 609. Ulceration of the jaw, 609. Glossitis, 610. Ranula, 612. Sore throat, 613. Dyspepsia, 623. Vomiting, 630. Cardialgia, 633. Bilious colic, 637. Bloating, 642. Congestion of bowels, 643. Gastritis, 650. Enteritis, 656. Peritonitis, 660. Hepatitis, 662. Abscess in liver, 666. Congestion of liver, 657. Jaundice, 668. Bilious, 669. Weak bowels, 672. Constipation, 673. Diarrhea, 678. Summer-complaint, 685 Dysentery, 696. Piles, 699. Worms, 703. Itching of anus, 706. Prolapsus of rectum, 707. Strangury, 711. Enuresis, 713. Diabetes, 714. Hmmaturia, 716. Urethritis, 717. Gonorrhcea, 721. Orchitis, 722. Hardness of the testicles, 723. Eruptions on sexual organs, 724. Inflammation of the penis, 724. Emissions, impotence, 726. Coryza, 727. Hoarseness, 734. Influenza, 736. Cough, 739. Bloody cough, 743. Laryngitis, 763. Congestion of lungs, 769. Laryngeal phthisis, 786. Pulmonary phthisis, 793. Consumption of bowels, 801. Vaginitis, 843. Mastitis, 845. Leucorrhea, 682. Prolapsus of vagina, 866. Thrush, 905. Chancre, 977. MERacRIUS PRERCIPITATUS RUBER, Bed oxide of mercury. Gonorrhoea, 721. MEZEREUM, Spurge-olive, the bark of a European bush. Intermittent fever, 283..Neuralgia, 387. Caries of bones, 517. Toothache, 596. MILLEFOLIUM, Yarrow. Haemorrhage, 568. Hematemesis, 631. Pneumorrhagia, 749. MosHUS, Music. Fainting, 404. Tetanus, 416. Catalepsy, 422. Loss ot LIST OF MEDICINES. 1071 memory, 231. Emissions, 7'26. Asthma, 775. Dysmenorrhoea, 858. MURIATIC ACID. Typhus, 296. Scarlet-rash, 448. Small-pox, 454. NATRUM MURIATICUM, Common salt Intermittent fever, 284. Constipation, 674. NITRI ACIDUM, Nitric acid. Intermittent fever, 285. Typhus, 297. Scarlet-rash, 448. Ophthalmia, 533. Ozoena, 548. Canker-sores, 604. Mercurial stomacace, 607. Malignant sore-throat, 616. Waterbrash, 627. Diarrhoea, 682. Enuresis, 713. Urethritis, 717. Laryngeal phthisis, 786. Consumption of bowels, 801. Mercurial ulcer, 980. PHOSPHORI ACIDUM, Phosphoric acid. Intermittent fever, 285. Typhus, 296. Rickets, 515. Diarrhoea, 682. Cholerine, 695. Diabetes, 714. Seminal emissions, 726. Cough, 740. Consumption of bowels, 801. PHOSPHORUS. Hysteria, 222. Intermittent fever, 285. Typhus, 296. Neuralgia, 388. Marasmus, 428. Scarlet-rash, 448. Smallpox, 454. Herpes, 477. Rheumatism, 489. Gout, 496 Scrofulosis and tuberculosis, 509. Rickets, 515. Ophthalmia, 533. Tabes meseraica, 552. Gumboil, 601. Gastritis, 650. Diarrhoea, 682. Summer complaint, 685. Cholerine, 695. Suppressed catarrh, 730. Influenza, 736. Cough, 741. Bloody cough, 743. Apoplexy of lungs, 750. Pneumonia, 741. Pulmonary phthisis, 791. Consumption of bowels, bOl. Mastitis, 845. PLATINA. Hysteria, 222. Nervous headache, 359. Hydrometra, 582. Dropsy of the ovaries, 583. Menorrhagia, 856. PLUMBUM ACETICUM and METALLICUM, Lead. Paralysis, 396.. Tetanus, 417. Marasmus, 429. Caries of the teeth, 601. Constipation, 674. Nux VOMICA, Strychnos nux vomica, the seed of a tree growing in the East. Hypochondria, 219. Melancholia, 226. Loss of memory, :.... -...~. ~ -- ~::: 1074 - LIST OF MEDICINES,, SABINA, Savin, an indigenous shrub. Hydrometra, 582. Toothache 598. Menorrhagia, 855. Miscarriage, 881. SAMBUCUS, Elder-berries. Intermittent fever, 286. Asthma Millari, 780. Coryza of infants, 901. SQUILLA' MARITIMA, Squills, the tuberous root of a plant growing on the shores of the Mediterranean. Tuberculosis, 565. Ascites, 578. Hydrothorax, 580. Hydrometra, 582. Bloody cough, 743. Pleurisy, 767. SECALE CORNUTUM. Chorea, 412. Convulsions, 421. Cholera, 693. Menorrhagia, 856. Dysmenorrhcea 858. Miscarriage, 881. Spasmodic pains, 883. SEPIA, the ink of the Cuttle Fish. Hysteria, 222. Nervous headache, 361. Itch-like eruptions, 473. Herpes, 476. Toothache, 598. Gum-boil, 601. Caries of the teeth, 601. Constipation, 674. Change of life, 860. Vicarious menses, 861. Leucorrhcea, 862. SILICEA, Silex. Myelitis, 367. Spinal irritation, 383. Epilepsy, 411. Wens, ganglia, 465. Baldness, 483. Scrofulosis, 510. Rickets, 515. Caries of bones, 517. Hydrocele, 519. Dropsy of the knee-joint, 584. Gum-boil, 601. Mastitis, 845. Furuncles, 437. Lumbar abscess, 950. SOLANUM NIGRUM, Black Night-Shade, a poisonous European plant. Tetanus, 417. Ascites. 578. SPIGELIA, Annual Worm-Grass, Pink-Root. Intermittent fever, 286. Nervous headache, 362. Neuralgia, 386. Itching, 467. Hydrothorax, 580. Hydropericardia, 581. Toothache, 598. Worms, 703. SPONGIA TOSTA, Burnt Sponge. Tuberculosis and Scrofulosis, 508. Deafness, 546. Larynigitis, bronchitis, 757. Laryngeal phthisis, 785. Pulmonary phthisis, 792. Croup, 914........-; ~ -.;.- -- --L:7 P~Y P--~ - -.................., 106LS FMDCNS 1076 LIST OF MEDICINES. SWEET SPIRITS OF NITRE. Typhus, 296. TABACUM, Tobacco. Sea-sickness; nervous headache, 363. TARAXACUM, Dandelion. Nettle-rash, 439. TARTARUS EMETICUS, Tartar Emetic. Gastric fever 262. Congestive headache, 347. Tetanus, 418 Scarlet-rash, 448. Small-pox, 452. Eczema, 474. Indigestion, 620. Cholera, 673. Pneumonia, 761. THUJA OCCIDENTALIS, Arbor vitce, an indigenous shrub. Nervous headache, 345. Warts, wens, 464. Rheumatism, 489. Ranula, 612. Schirrus, 975. Mercurial ulcer, 982. VACCININE, the matter of cow-pox. Small-pox, 452. VALERIANATE OF ZINC. Lumbago, 433. YALERIANA, Wild Valerian, a European plant. Palpitation of the heart, 430. VARIOLIN. Small-pox, 452 VERATRUM, White Hellebore, a European plant. Mania, 228 Intermittent fever, 286. Typhoid fever, 291. Typhus, 307. Yellow fever, 314. Lentescent fever, 316. Sea-sickness, 322. Hydrocephalus, 332. Congestive and nervous headache, 364. Nervous debility, 424. Marasmus, 428. Scrofulosis, 510 Toothache, 599. Nausea, 430. Vomiting, 630. Cardialgia, 634. Bilious colic, 637 Enteritis, 656. Peritonitis, 660. Diarrhoea, 678. Cholera-morbus and cholera, 687. Asthma, 774. Consumption of bowels, 801. Delirium tremens, 829. Morning-sickness, 868. Puerperal mania, 889. Nymphomania, 892. Whooping-cough, 915. ZINCUM METALLICUM. Hydrocephalus, 335 Itching at anus, 468. Chapped hands, 470 Hydrocephalus, 592. - - -- - - -- I - - -- -- - -L~ c ALPIIABETICAL' INDEX OF THE SUBJECTS TREATED OF IN'THIS WORK. ABDOMEN, dropsy of....... 578 Abortion,............... 878 Abeess.. 0............. 936 Abscess of liver......... 665 Abscess, Ilumbar......... 947 Abscess, psoas..........947 Acne.................... 478 After-pains.........-... 883 Ailments incidental to pregnancy,aS..............' 867 Aliments allowed.s....... 121,'prohibited...... 123 Alopecia............. 482 Alvine evacuations........ 181 Amanrosis....s....es.*. 539.Amblyopia.-............. 37 Amenorrhoea........... 853 Anasarca.v -...-..,.... 577 Anger, consequences of.... 231 Angina fancium........612 "..tonsillaris....... 612 'I uvularis......... 612 ' mem~branacea..... 912 " pectoralis, seeasthma 77 ~Anorexia.............. 618 Anosmia............... 548 St. Anthony's fire....... 459 Anthrax............... 939 Anus, itching of........ 706 " prolapsus of... '. 707 '.. soreness of..... 706 Aphthe........... 904 Apnoea..7............. 71 Apoplexy........... 326,390 Apoplexy of lungs......... 749 Apparent death......... 236 Sby drowning.... 243 " frqv4f ll....... 240 y., by fol air... 252 S by freezing,... 251 ' gases, noxious... 252 ' hunger........ 241 " of new-born infants 254 " starvation... 2. 241 1' strangulation.... 242 " stroke oflightning 242 Appette, loss of,...... 618 5. r.OIOU~s.1..., 618 Arthyriti,,,,,,,9...,.. 495 Ascitw,,,,,,,,,,.,.., 578 A1%10.. 'a, 236 _771 1illari........779 * senile........778 S thymicum........ 781 Atrophy...4...........425 (1077) -........,---~.--.~-.---`F I _ _ 1078 ALPHABETICAL INDEX. Bad taste in mouth........ 603 Baldness................ 482 Bath, plunge............ 155 Sshower............. 155 S drop.............. 158 " sitz..............158 " foot................ 159 Bathing................ 146 Bed-sores................ 798 Bile or boil............. 937 Biliousness...............669 Bladder, hiemorrhage from. 715 " hemorrhoids of... 715 " inflammation of... 709 Blindness.............. 539 Bloating............... 639 Blue disease............ 810 Boil or bile............. 937 Bowels, consumption of.... 800 " acute inflammation of............. 654 " chronic.......... 657 Brain and nervous system condition of the..... 188 " congestion of the.... 339 " dropsy of........329, 586 " in little children, inflammation of the.. 326 " inflammation of the... 329 Bronchia, inflammation of... 755 Bronchitis, acute.......... 755 Bronchocele............ 1033 Breath, fouli........... 602 Bulimy................ 618 Burns.................. 103-7 Calculi, urinary.......... 1012 Callosities...,......... 463 Cancrum oris............ 604 Canker, sores in mouth.... 604 Carbuncle.............. 939 Cardialgia................ 632 Carditis..................804 Caries of teeth............ 600 Catalepsy................ 422 Catamenia, see Menses.... Catarrh of children, suffocative........... 779 S............. 727 " suppressed....... 729 Cephalalgia............ 341 Change of life........... 860 Chapped hands......... 470 Chemical theory........... 21 Chest, condition of the..... 197 " dropsy of the....... 578 " oppression of....... 770 " spasm of........... 771 Chicken-pox............ 458 Child-bed fever........... 885 Chlorosis............... 850 Cholera, Asiatic......... 689 " asphyxia.......... 689 " infantum......... 683 " morbus.......... 687 Chorea.................... 412 Circulation of blood....... 32 Clothing................ 129 Cold in the head.......... 727 Colic.................. 634 " bilious.............. 636 " of infants........-.... 901 " menstrual............ 857 Color of the skin, eyes, etc.. 195 Concussion of the brain, etc.1043 Condylomata............ 464 Congestion of bowels, passive 639 S. " acute.. 643 I I~ ~ __ _ _ 1082 ALPHABETICAL INDEX. Hydrophobia............ Hydrothorax............. Hygiene................ Hypochondria,.......... Hysteria.................... 817 578 95 216 221 Impotence.............. 725 Incontinence of urine...... 712 Incontinence of urine during pregnancy.............. 877 Indigestion............... 619 Inflammation............. 928 S of bladder,... 709 " of bowels, acute 654 " " chronic 657 " of brain...... 329 S of the brain in " little children 336 " of breast..... 844 of bronchia... 755 S of the conjunctiva...... 523 " of cornea.... 525 " of diaphragm. 644 S of the ear,.... 539 " of the eyes,... acute,...... 523 " of face...... 549 " of heart...... 804 " of the iris...d. 526 " of kidney..... 708 " of the kneejoint....... 584 S of larynx..... 751 " of liver, acute, 661 " chronic 663 " of lungs...... 759 " of the mesenteric glands 551 Inflammation of the nose... 547 " of ovaries.... 837 " of penis...... 724 4"... of perioardium 809 " of the perios teum...... 493 " of the peritoneum.....659 S of pleura..... 766 " of retina..... 528 " of the sclerotica........ 529 " of the spleen.. 671 " of the spine.. 366 " -of stomach, " acute... 647 " chronic... 652 " of the testicles 722 " of the tongue. 610 " of trachea.... 751 " of the urethra. 716 " of vagina.... 842 " of vulva..... 844 " -. vertebral column...... 366 " of enveloping membranes 369 "...of spinal marrow itself.. 371 ' of womb..... 840 Influenza.............. 736 Innervation, deficient..... 425 Insolation................ 234 Insult to one's feelings, consequence of,.......... 231 Inter trigo 469 Intertrigo................ 469 " of infants....... 903 Iris, inflammation of the.... 256 Iritis................. 526 - - -- ' - - ~ - II --- I ALPHABETICAL INDEX.. 1083 Irregularities, menstrual... 846 Irritation.............. 921 ' -spinal........... 377 Ischuria................. 711 Itch.............. 471 Itching-of anus.......... 706 " of sexual parts duSring pregnancy... 875 Itching of the skin........ 466 Jaundice.............. 667 Jaundice of infants........ 904 Jaws, ulceration of........ 610 Kidneys, inflammation of... Knee-joint, dropsy of...... " ' inflammation of Sthe.......... 708 584 584 Labor-pains, abnormal..... 882 S-. false....... 882 <" spasmodic... 883 Laryngitis.....;..;.751, 753 Larynx, inflammation of... 751 Laws of Nature converge in vital functions.......... 28 Leucorrhoea.............. 861 S. -catarrhal....... 861 Leucorrhoea, resulting from disorganizations........ 863 Leucorrhoea, gonorrhceal and syphilitic.......... 864 Leucorrhea, scrofulous.... 862 " vicarious..... 863 Lids, falling of the......... 536 Liver, abscess of.......... 665 Liver-complaint........... 663 Liver, congestion of....... 667 " acute inflammation of 661 Liver, chronic inflammation of.......... 663 Liver-grown.............. 911 Liver-spots,.(see Hepaticspots)................... 468 Lochia, bad quality of,..... 897 ".. suppression of..... 897 Lock-jaw............. 413 Longings of pregnant females............... 873 Lumbago................ 431 Lumbar abscess........... 947 Lungs, apoplexy of....... 749 ". congestion of...... 768 " hemorrhage from... 747 " inflammation of.... 759 " rheumatism of..... 765 Mammae, inflammation of.. 844 Mania.................. 227 Mania-a-potu, see (Delirium tremens)............... 829 Mania, puerperal......... 889 Marasmus............... 425 Mastitis.................. 844 Measles................ 440 Medicines, names of.......1056 Memory, loss of......... 1056 Memory, loss of........... 230 Meningitis............. 329 Meningitis spinosa........ 369 Menorrhagia............. 855 Menostasia............... 847 Menses, retention of....... 847 Mesenteri glands, inflammation of............ 558 Menstrual colic. *.......... 857 Menstrual irregularities.... 846 Menstruation, delaying and scanty................. 859..I I _ 1084. ALPHABETICAL INDEX. Menstruation, excessive.... 855 S " painful...... 857 Menstruation, premature and excessive..........858 Menstruation, vicarious.... 860 Metritis................. 840 Metrorrhagia............. 866 Mind, diseases of the...... 211 Mind and spirits, condition of the.................. 190 Milk-crust.............. 920 Milk, deteriorated......... 893 " excessive flow of.... 895 " fever............. 884 " leg................. 897 " suppression of...... 894 Miscarriage............... 878 Monthly sickness, (see Menses).............. Morbus coxarius......519, 1026 Morning-sickness of pregnant females............ 868 Mouth, decay of inner...... 605 Mumps................ 465 Mussels and oysters, poisonous. a................ 814 Myelitis................. 366 Myelitis vera............ 371 Names of diseases........ 202 Nasitis, scrofulous......... 547 Nausea.................. 629 Nausea and vomiting...... 194 Nephritis................ 708 Nervous system, diseases of the................... 318 Nervousness.............. 422 Nettlerash............... 438 Neuralgia.............. 385 Nipples, sore............. Noises in the ear....... Nose, discharge from...... " inflammation of the... " bleed............... Nursing, excessive........ Nursing sore mouth....... Nymphomania............. 896 545 730 547 732 899 895 890 Odontalgia............... 594 Oophoritis............. 837 Ophthalmia, acute........ 532 Ophthalmia of infants, purulent................... 903 Ophthalmia, scrofulous.... 521 Oppression............... 197 Oppression of the chest.... 770 Orchitis.................. 722 Otalgia................ 545 Otitis, scrofulous.......... 539 Ovaries, dropsy of........ 582 " inflammation of... 837 Ovaritis................. 837 Over-heating............ 234 Ozwena............... 547, 730 Pain................. 172 Pain in chest............ 197 Palliatives................. 47 Palpitation of the heart.... 429 Paralysis, general and partial................... 395 Paralysis, cases of........ 396 Pericarditis.............. 809 Pericardium, dropsy of..580, 511 Pericardium, inflammation of..................... 809 Periosteum, inflammation of 493 Periostitis............... 493 _ _ ALPHABETICAL INDEX. 1081 Syphilis, (see Ulcer, veneral.) Twitchings............422 Typhus................. 293 Taenia,................. 704 Tabes meseraica.......... 551 Tape-worm.............. 704 Taste................... 193 Teeth, caries of.......... 600 Teething................. 910 Testieles, hardness of-...... 722 ",inflammation of the 722 Tetanus............ 413, 990 Tetter..................... 475 Thirst.in phthisis.........799 Thrush.............. 904 Tic douloureux........... 385 Tinea capitis............. 478 Tongue, inflammation of... 610 Tongne-tied............ 911 Toothache............. 594 '. of pregnant females 874 Torticollis.......,e......1..... 494 Trachea, inflammation of.. 751 Tracheitis........... 751, 755 Tremor of the heart....... 429 Trismus................. 413 Tubeicles, pulmonary..... 556 " menstrual...... 557 " puerperal..... 557 " from cold drink. 558 (" exanthematic... 559 " impetiginous... 559 " arthritic....... 560 " hereditary..... 560 " in the brain..... 562 " in spinal marrow 563 " in the liver..... 563 Tuberculosis......... 498, 555 " treatment of... 564 Tumor albus............ 519 Ulceration of jaw........ 610 Ulcers.................. 952 " cancerous........ 969 " cutaneous.......... 954 " menstrual.......... 954 " mercurial.......... 979 " scrofulous......... 962 " schirrous.......... 969 " sinuous............ 954 " varicose.......... 959 " venereal............ 975 Unhealthy skin............ 466 Urethra, inflammation of the 716 Urethritis................ 716 Urging to stool,, constant.. 672 Urine.................. 184 " bloody............. 715 Urine, purulent...0....... 716 Urine of infants, retention of.................. 907 Urine, incontinence of..... 712 " inability to pass.... 712 Urticaria................ 438 Uteritis............... 840 Vaccination............. 916 Vagina, inflammation of.... 842 Vaginitis.............. 842 Varicella............... 458 Varicose veins of pregnant females............. 876 Variola................. 451 Varioloid............... 458 Ventilation.............. 133 Vertigo...........,323, 404 " of pregnant females. 870 -~ -- -- -- -- -- 1088 A1LPHABETICAL INDEX. St. Vitus' dance.......... Vomiting................ " of bile.......... " of blood........ Vulva, inflammation, of.... Vulvitis................. 412 629 629 631 844 844 Warts................... 464 Watching, consequences of. 233 Water, use of............ 138 Waterbrash.............. 627 Water injections.......... 162 Watery eyes............ 536 Weak bowels............ 672 " eyes7............... 535 " stomach........... 621 Weakness of sight........ 537 Wens................... 464 Wet bandage............. 160 White swelling.......519, 1023 Whites................ 861 Whitlow................. 942 Whooping-cough......... 915 Wind on stomach......... 625 Womb, dropsy of......... 581 " falling of the..... 865 " hemorrhage from.. 866 " inflammation of.... 840 prolapsus of the... 865 Worm fever.............. 701 Worms.................. 701 Wounds............... 981 " contused.......... 986 " lacerated........... 985 " poisoned......... 992 " punctured........ 988 " shot............. 983 " of viscera and vessels............ 993 Wry neck............. 494 Zona................ 919 Zoster................ 919 ----~ I _ ~ CATALOGUE OPF HOMUEOPATHIC BOOKS, PUBLISHED BY WILLIAM RADDE, No. 635 Arch St., Philaelphia. The Homoeopathic Materia Medica, arranged Systematically and Practically by A. TESTE, M. D. Translated from the French, by CHARLES J. HEMPEL, M. D. (634 octavo pages.) 1854. Bound, $2.50. This work is a valuable contribution to the literature of our School in more than one respect. It is the work of an original thinker, who is at the same time one of the most distinguished practitioners of Homoeopathy in France. In this work the principal drugs composing our Materia Medica are arranged in groups, each group containing those drugs which resemble each other in their effects upon the healthy body. This is a novel feature of the work, which will prove eminently suggestive to inquiring minds and sim, plifies to an astonishing degree the study of the drug-symptoms, which the Homceopathic: physician has to depend upon as therapeutic indications, and which, in our present manuals and repertories, are not presented with sufficient clearness and practical simplicity. In Teste's work, the symptoms are no longer mixed up in one confused mass, but they are presented to the mind in a certain logical order, based upon pathological as well as pharmacodynamic analogies. 1 _ I _ __ CATALOGUE OF BOOKS PUBLISHED BY The work is moreover distinguished by an extraordinary amount of valuable information concerning the history of every drug, and its use in alloeopathic practice. Teste shows, by the evidence of allaeopathic authorities, that where ever a medicine exhibited striking curative virtues in a given disease, they were invaTiably traceable to its being Homoeopathic to the disease in the sense in which this term is understood by Hahnemann and his disciples. The introduction to Teste's work is a brilliant composition, full of sound reasoning, clearness of views and characterised by correctness and domprehensiveness in all its statements. We unhesitatingly commend this work to the profession as a most useful, instructive and eminently suggestive production. To the student of Homceopathy this work will prove an invaluable guide to an intimate and philosophical acquaintance with our Materia Medica; in Teste's work the student will find combined in a clear and logical order, and with an unexceptionable simplicity, the symptomatic indications which are scattered with many repetitions through a whole series of volumes in Hahnemann's Materia Medica, or in Jahr's Symptomen-codex., The work is printed on beautiful paper; type and binding are perfect. Organon of Specific Homoeopathy; or, an Inductive Exposition of the Piinciples of the Homceopathic Heal-, ing Art, addressed to Physicians and intelligent Laymen. By CHARLES J.:HEMPEL, M. D. (246 octavo pages.) 1854. Bound, $1.00. This is a handsomely bound volume, in large 8Svo. of 216 pages, printed on paper of a superfine quality and in beautiful type. The work is divided in three parts and an introduction. The first part is a philosophical synopsis of Hahnemann's Organon:and his doctrine of chronic miasms; the second part is a searching and comprehensive, but exceedingly consistent and logical review of the existing. doctrine and practice of Homoeopathy; and the third part contains an inductive exposition of the fundamental principle of Homoeopathy as founded in nature and in man's intellectual and 2 WILLIAM, RADDE, NO. 635 ARCH ST., PHILA. physical organism. No one who has a knowledge of the leading works of our School, will deny that in point of deep and rigorous reasoning, beauty and vigor of composition and intensity of enlightened faith in the truths of Homoeopathy, this work holds a deservedly high, and, in some respects, the highest rank. It is a work.that should be studied with the most careful attention by every physician or student of medicine who is anxious to see the doctrine of Homoeopathy, divested of all human adulterations, presented to the mind in its genuine purity, as an imperishable and infinite science. This work is not written for a day or for a clique, but for all time and for every generous and independent lover of truth. The Homoeopathic Guide, in all Diseases of the Urinary and Sexual Organs, including the Derangements caused by Onanism and Sexual Excesses; with a strict regard to the present demands of medical science, and accompanied by an appendix on the use of Electro-Magnetism in the treatment of these diseases. By WM. GOLLMANN, M. D. Translated, with additions, by CHARLES J. HEMPEL, M.D. (309 octavo pages.) 1854. Bound, $150. This important work is one of the most interesting volumes that has latelybeen published. No Homceopathie work of this kind is superior to it. All the diseases of the urinary and sexual organs are described in this volume with scientific accuracy, and their treatment is indicated with the most minute precision, The dose of the various remedies recommended in this book is likewise carefully pointed but. The history of the most interesting diseases, such as syphilis, &c., is likewise furnished, affording room for philosophical thought and materially heightening the interest of this remarkable.work. As regards treatment, it may be said that every thing known on this subject, both as respects remedies and general hygienic management, has been carefully and comprehensively stated. 3 C --'--- ~ -- WILLIAM RADDE, NO. 63, AERH ST., PHILA. Manual of Homoeopathic Practice;6for the uise of Families. By A. E. SMALL, A. M., M. D., Professor of Physiology and Medical Jurisprudence, in the.Homoeopathic Medical College of Philadelphia, etc. (Fourth edition, 852 pages.) 1856. Bound, $2,00. This is the best work of domestic practice now in print. Its author is a gentleman of acknowledged experience in the homceopathic treatment of diseases, and of a high order of scientific attainments. The work may be used by physicians as well as by laypractitioners. It is entirely free from all Greek and Latin technicalities; every disease is described in plain English, although the general style of the work satisfies all the demands of elegant diction. It is a work which may either be consulted as the occasion requires, or it may be studied from beginning to end with pleasure and profit by any one who takes the least interest in medicine generally, and in homoeopathic medicine in particular.' Besides giving a correct and lucid description of the diseases which physicians are called upon to treat, this work likewise furnishes the reader an opportunity of becoming acquainted with the fundamental facts and principles of physiology, anatomy, and general hygiene, including many practical.suggestions, regarding:exercise, bathing, clothing, diet, etc., which cannot but prove valuable to all who use this work as a guide in practice: It must be universally conceded that the object which the author has sought to attain in arranging this book, has been achieved to the full satisfaction of an impartial and enlightened public. Medicine, and more particularly homoeopathic medicine, has been rendered accessible to the simplest understanding, so that, with this book before them, every intelligent parent will be able to prescribe for his or her family, if sickness should occur amongst them, and they should not wish to send for a physician, or be deprived of the opportunity of employing one. A characteristic feature of this work is not only to give a full account of every medicine that may have to be used in a case of sickness, but likewise to mention the dose of every remedy with minute exactness, and to indicate the diet which should be pursued in every case. We feel warranted in recommending this work, above every similar work of the kind, to all the friends of homceopathic practice. 29 5 CATALOGUE OF BOOKS PUBLISHED BY The Pocket Manual of Homeopathic Practice, abridged from the" Manual of Hom'eopathic Practice" of A. E. SMALL, M. D., by JAcoB F. SHEEK, M. D.,:126 pages.) 1856. Bound, 37S cents. This is an abridgment of Small's larger manual of homdeopathic practice, 'containing all that is immediately important and essential to practice, i -a condensed form. As its name indicates, it may be conveniently carried about in one's pocket, together with a case of medicines corresponding to it. The dose of every remedy is carefully indicated, and altogether this little work will be found admirably adapted to those who do not wish to take the -trouble eof consulting larger works. Diseases of Females and Children and their How meopathic Treatment, by WALTER WILLIAMSON, M. D., Professor of Materia Medica and Therapeutics in the Homoeopathic Medical College of Pennsylvania. Second improved and enlarged edition. Containing also a full description of the dose of each medicine. (Over 250 pages.) 1854. Bound, 75 cents. This is an admirable little volume, arranged by a gentleman who is amply able to do justice to the subject of which it treats. Dr. Williamson has enjoyed the most extensive opportunities df accumulating a vast amount of experience in the treatment of female diseases, and likewise of the diseases of children; and he has availed himself of this experience for the purpose of presenting the homoeopathic treatment of these diseases to professional as well as layminds, in a simple and concise, but nevertheless sufficiedtly 'comprehensive form. The indications for the use of every remedy are clear and precise, and the dose is likewise indicated with tmuch miniutenuess in every case. To married females and moathers 'who have children to bring up, or 'who are in delicate circumstances and subject to the various ailments incident to the process of t Lero-gestation, this 6 CATALOGUE OF BOOKS PUBLISHED BY together pwith Dr. Lauries oiwn eminienttly prtactical and lucid observations, make this workl one of the most desirable treatises on the diseases of infancy and childhood, and their homoeopathic treatment, that our school can biost of.. -***--C---- 'Caspari's Homaeopathic Domestic Physician, edited by E. BHARTMANN-, M.D., author of" The Acute and Chronic Diseases." Translated from the Eighth German edition, and enriched by a Treatise on Anatomy and Physiology,. embellished with 30 illustrations;by W. P. ESREY, M.D. With additions and a preface by C., HERING, M.D. Containing also a chapter on.Mesmerism and Magnetism; directions for patieritsliving some distance from a Homoeopathic physician, to describe their symptoms; a Tabular Index of the medicines and the diseases in- which they areused; and a Sketch of the Biography of Dr.,Samuel Hahnemann, the Founder of Homceopathy. (475 pages.) Third thousand. 1856. Bound, $1 00. This volume deserves the especial attention of the profession as well as of the laity. Its authors are men of the highest standing, in the homceopathic ranks. -spari, Hartmann and; ering, whatever may have 'been their peculiarities as practitioners or theorists, it is an undeniable fact that these names are deeply interwoven in the framework of Homceopathy. The diseases of which this volume treats, are arranged in alphabetical order, and will be found described as fully and with as many characteristic symptoms as is required for a lucid comprehension of the nature and phenomenal character 'of the disturbance. It is hardly necessary to add that men of such vast experience and so' thoroughly acquainted with the Homoeopathic Materia Medica as Caspari and Hartmann undoubtedly were, could never stoop to get up a work even for the people that was 8 ~~o - CATALOGUE-- OF BOOKS PUBLISHEDI BY may be 'read 'and studid 'chapter by chapter, and the more it is studied the more benefit will be derived from the use of this and other kindred works. The work is got up in superior style, and at a very low price. It is needless to say that the notes which have been added by the American editor, enhance the value of the work, and render it as perfect as such a work can well be. For the convenience of the lay-practitioner the dose has been indicated with great care and minuteness in every case. Laurie, Dr. J. Elements of Homoeopathic Practice of Physic. 1852. (642 pages.) Bound, $2.00. This is the same work as the former, without the notes, by Drs. A. G. Hull and J. S. Douglas. Materia Medica of American Provings. By C. IIERING, M. D., J. JEANES, M. D., C. B. MATTHEWS, M.D., W. WILLIAMSON, M. D., C. NEIDAHARD, M. D., S. R. DUBS, M. D., C. BUTE, M. D. Containing the Provings of-Acidum benzoicum, Acidum fluoricum, Acidum oxalicum, Elaterium, Eupatorium perfoliatumr, Kalmia latifolia, Lobelia inflata, Lobelia cardinalis, Podophyllam peltatum, Sanguinaria canadensis, and Triosteum perfoliatum. Collected and arranged by the American Institute of IHomoeopathy. With a Repertory by W. P.ESREY, M. D. Second Thousand. (300 pages.) 1853. Bound, $1. This volume was prepared and published under the auspices of the American Institute of Homoeopathy, and contains the provings of some of the most important homoeopathic remedies. The work is interspersed with a variety of practical suggestions and observar tions concerning the use of the medicines proved, and may be con10