THERAPEUTICS OF TUBERCULOSIS OH PULMONARY CONSUMPTION. BY WM. H. BURT, M.D. OF CHICAGO, ILLINOIS, AUTHOR OF " CHARACTERISTIC MATERIA MEDICA," A MONOGRAPH ON "POLYPORUS OFFICINALIS, POLYPORUS PIIICOLA, USTILAGO MADIS, AND CHINCHONA OFFICINALIS." BOERICKE & TAFEL, NEW YORK AND PHILADELPHIA; IIENRY TURNER & CO., OF LONDON, 77 FLEET STREET. 1876. Copyright, BOERICKE & TAFEL, 1876. LAKE SHORE PRESS, ROUSES POINT, N. Y. on JOHN MEYHOFFER, M.D., OF NICE, IN CONSIDERATION OF THE GREAT BENEFIT DERIVED FROM YOUR LABORS FOUND IN YOUR TREATISE ON CHRONIC DISEASES OF THE ORGANS OF RESPIRATION, I WOULD MOST RESPECTFULLY DEDICATE TO YOU THIS MY HUMBLE EFFORT, WITH GRATITUDE. THE AUTHOR. INTRODUCTORY. TUBERCULOSIS OR PULMONARY CONSUMPTION. It is estimated that more than one-eighth of the entire mortality of the human family is due to the fatal ravages of tuberculosis. It is, therefore, not only the most frequent of constitutional, but also the most common of all diseases. With these facts before the physician, it behoves him to make its treatment a life study. Tuberculous matter is an unorganized material, characterized by a soft, cheesy, pale or yellowish gray colored substance deposited into all the organs and tissues of the body, especially the lungs, accompanied by persistent cough, expectoration of mucus, blood and pus, dyspncea, asthma, hectic fever, emaciation, night-sweats, aphthae, diarrhoea, pain, bed-sores, general atonic condition of the body and debility. In perusing the works of various authors who have written elaborately upon the pathology and treatment of this dreaded disease, the writer's attention was directed to the catalogue of distinct characteristic symptoms of pulmonary tuberculosis, each of which presented itself as a subject for profitable study. Impressed with this idea, we have divided pulmonary tuberculosis into twelve of its most prominent characteristic symptoms, and given a plenary treatment of each symptom by it 8 INTRODUCTORY. self, believing that in so doing it would greatly aid the practitioner in successfully combating its fatal ravages. They are the following,1. General atonic condition of the body. 2. Emaciation. 3. Debility. 4. Heamoptysis. 5. Cough. 6. Asthma. 7. Hectic fever. 8. Night Sweats. 9. Aphthae. 10. Diarrhcea. 11. Pain. 12. Bed-sores. The pathology of the disease has been entirely omitted, it being so fully written up in our works on pathology, which are in the hands of every practitioner. In writing the treatment of each symptom, we have collected together from our text books and journals all that has been written on this disease, and put in such shape that the busy physician and student can grasp and utilize it at once, without having to search over his whole library whenever a case presents itself for treatment. The remedies have been so fully written, that not only the general indications are complete, but a Characteristic Materia Mfedica has been produced that forms a marked feature of the work, and we believe will be prized by the profession as invaluable; in it, the heart and soul of each remedy is put in such a concise shape that the labor of applying it to disease is made easy. We have aimed to put nothing in this work but actualpractieal, clinical experience, something that can be turned to by tke,student with the feeling that what he is wielding has been thoroughly tested andfound reliable. MEDICAL TREATMENT. 9 Medical Treatment.-Before giving the indications for our r'emedies, it will not only be interesting, but practical, to note down the remedies used in our standard works for this formidable disease. Dr. B. Baehr, in his science of Therapeutics uses forty remedies, namely: Aconite, Cannabis, Kali carb., Pulsatilla, Alumina, China, Kali nit., Plumbum, Arnica, Cuprum, Kreosote, Phos. acid, Belladonna, Causticum, Ledum, Spongia, Bryonia, Cod liver oil, Ly'copodium, Stannum, Bromine, Digitalis, Manganum, Silicea, Baryta carb., Ferrum,- Millefolium, Sulphur, Calc. carb., Hepar sulph., Morphine, Tartar emetic, Calc. phos., Ipecac., Natrum m., Veratrum alb. CQarbo veg., Iodine, Phosphorus, Dr. W. Hitchman, in his work on consumption gives us forty eight remedies, namely: Aconite, Cantharis, Gamboge, Oleum Ricini, Arsenicum, Conium, Hepar sulph., Pulsatilla, Arnica, Chelidonium, Ipecac., Plumbum, Antimonium Chininumsulph., Iodine, Phosphorus, crud. Coffea, Kali hyd., Phos. acid, Acid. sulph., Cocculus, Kali b., Rheum, Argentum, Chamomilla, Lachesis, Sulphur, Acid Nit., Camphor, Laurocerasus, Petroleum, Belladonna Cuprum, Lamium, Terebinth., Bryonia, Digitalis Mere. cor., Tartar emetic, China, Elaps, Nux vom., Veratrum alb., Cannabis, Ferrum, Opium, Zincum. 2 12 PULMONARY CONSUMPTION. Dr. Richard Hughes, in his "Therapeutics," gives seventeen remedies, viz: Arsenicum, Hyoscyamus, Kreosote, Phosphorus, Calc. carb., Iodine, Lycopodium, Stannum, China, Ipecac., Pulsatilla, Spongia, Drosera, Kali carb., Phos. acid, Sulphur. Dr. A. Charge, in his "Traitement Homceopathique, des Maladies des organes de la Respiration," in the section "Phthisic Pulmonaire, " gives forty-two remedies, and fifteen "Medicaments intercurrents," viz: Ammon. carb., China, Lachesis, Plumb. acet., Ammon. mur., Con. mac., Lycop., Sang. can., Ars. alb., Drosera, Lysirnach. Sepia, Ars. iod., Eryth. coca, numm., Silicea, Ars. nat., Ferrum, Mere. sol., Silphion, Bov. lycop., Hepar sulph., Natrum mur., Spong., Calc. carb., Iodium, Nitric acid, Stannum, Cale. phos., Kali carb., Pheli aq., Sticta pulm.,'Calc. sulph., Kali hydr., Phosph., Sulphur, Carbo veg., Kali nit., Plumb. Met., Thuya. Caustic, Kreosote, " MDICAMENTS INTERCURRENTS" Acon. nap., Bellad., Hyoscy. nig., Puls. nig., Actsea racem., Bryon., Lact., Sambucus. nig., Allium cepa., Digit., Laurocer., Tart. Emetic. Allium sativ., Hydroc. acid, Myrt. comm., Dr. J. Kafka, in his work on Therapeutics gives fifty-four remedies for tuberculosis of the lungs, twelve of which he has MEDICAL TREATMENT. 13 great confidence in, the balance has given him but little satisfaction; they are the following. The truly reliable remedies are: Calcaria carb., China sulph., Kali carb., Natrum m., China, Hepar sulph., Mercury, Silicea, Cod-liver oil, Iodine, Phosphorus, Sulphur. MINOR REMEDIES. Aconite, Conium, Lachesis, Sepia, Apis m., Hyoscyamus, Lycopodium, Stramonium, Arsenicum, Ignatia, Nux vomica, Thuya, Belladonna, Kali hyd., Pulsatilla, Veratrum alb. INCIDENTAL REMEDIES. Atropine, Colocynth, Lactucarium, Rheum, Arnica, Colchicum, Morphine, Sulphuric acid, Ammonium Carbo veg., Nitric acid, Secale 6or., carb., Digitalis, Opium, Sambucus, Bryonia, Ergotine, Phosphoric Sabadilla, Cannabis, Ferrum, acid, Tartar emetic, Chamomilla, Ipecacuanha, Rhus tox., The mineral springs. A careful study of the above remedies used by the Homnceopathic school, reveals the fact, that the real curative agents in consumption have for their starting point, or centre of action, the ganglionic nervous system, the cerebro-spinal remedies being only given for incidental symptoms, and not depended upon as the true curative agents by any of our school. This is strong evidence that the great sympathetic, or vegetative nervous system, is the great receptacle for that fearful destroyer, tuberculosis. Now if this disease has for its grand centre of action and starting point, the ganglionic nervous system, we 16 PULMONARY CONSUMPTION. met by employing the muscles in such a manner that while they are made to act with more or less force, no greater demand shall be made upon the nervous system than can be easily and healthfully responded to." "-The first thing to be attended to and never to be lost sight of for a moment, is the circulation of the blood. Feebleness of the heart's action, imperfect respiration, poor quality and small quantity of blood, and especially want of affinity between the blood and the tissues, all conspire to produce the livid countenance, cold extremities, and consequent pectoral congestion and oppression so characteristic of pulmonary consumption. It is advised to act almost wholly and very perseveringly on the extremities, by rotations of the feet, hands, arms, and legs, and by flexions and extensions of the same, but there should never be any attempts to expand the chest, till after the peripheric circulation has been improved. After a proper distribution of the fluid has been secured and maintained, improved health is sure to follow." For full and minute directions how to use these physical movements the reader is referred to works treating particularly upon gymnastic exercises. Breathing Tubes.-The use of breathing as a physical exercise for the lungs cannot be urged upon the patient too strongly. It is a good means of developing the muscles of the chest, and nothing is so beneficial as an habitual custom of taking deep and free inspirations. The use of breathing tubes will soon get the patient into the habit of deep and full inspirations. Health-Lift.-The use of the health-lift is, without doubt, the most important remedial agent that has been devised by man for the cure of a general atonic condition of the body. It is the most thorough, the most expeditious, the safest and easiest method of developing the whole muscular system that can be thought of, for it exercises almost all the muscles in the body simultaneously, at a minimum expense of mental effort. The chief recommendation of this means is, that the MEDICAL TREATMENT. 17 apparatus is so simple that the most fragile woman, if she can but stand up, can use it with perfect safety. From six weeks to two months exercise, spending each day, ten or twelve minutes in Health-lift exercise, will give her not only a strong muscular system, but health. Consumptives who have been treated by the health-lift have uniformly found their health and strength daily improved, cough and expectoration diminished, appetite improved, pulse slower and stronger, the capacity of the lungs greater, the mobility of the chest frequently doubled, and the circumference greatly enlarged, increase of weight, and all the appearance of returning health. The health-lift apparatus consists substantially of a table or platform, upon which the individual stands between two vertical iron rods, attached to a cross-bar below the table; from which cross-bar is suspended by a slogger joint, a notched shaft to which any number of fifty pound iron plates may be keyed. Each vertical rod hol Is, in a suitable socket, an inclined handle, so shaped to the hand as to give the greatest possible friction-surface, whilst its inclination is such as to throw most weight upon the fleshy cushion of the palm of the hand, rather than upon the more bony fingers. Standing thus between the vertical rods, directly over the centre ot the weight to be lifted, the heels are separated three or four inches, the toes turned well out, the hands adjusted to the handles, ana the knees bent to such an angle as that when the trunk and shoulders are perfectly erect, with the shoulders slightly thrown back, arms extended to their fullest limit, and chest expanded, the stature shall be from three to four inches below the usual height. In this position, the knees are slowly and gradually straightened, until the body is perfectly erect, when a line describing the centre of gravity would fall from the point of the shoulder through the hip, knee and ankle-joint. In this. way the greatest possible amount of muscular tissue is brought into use in its natural and symmetrical relation; no one muscle, or set of muscles, is unduly exerted, nor are any muscles?re 18 PULMONARY CONSUMPTION. laxed. It will be seen that in this way the spinal column is kept perfectly straight, there being no lateral twist or contortion, as in lifting with a cross-bar between the legs, which is the usual mode as practiced in the gymnasium. RULES FOR THE USE OF THE HEALTH-LIFT. I. —Exercise should be taken usually in the forenoon, about three hours after breakfast.-The reason for this involves the physiological law that exercise of function increases the supply of blood in the organs or tissues which is acting —perfect functional activity is impossible, indeed, without a free supply of blood, and, as during this exercise, the muscles "suck up blood like so many sponges," drawing it away from brain, stomach, liver, and every other organ, it is clear digestion would be interfered with by lifting too soon after eating. I. —Lift slowly.-This rule is. formed on the fact that the muscles do not contract simultaneously, but some much more promptly than others-depending upon the amount of use; and as the object is to get the greatest possible bulk of muscular tissue into contraction, it is obvious that this can only be done by giving the more slowly acting muscles time to come into play. This also prevents any undue expenditure of nerve-force,-economy of which, results in an increase of general vitality. III. —Lift regularly, and as nearly at the same time each day as practicable.-By lifting as nearly as possible at the same hour each day-or every other day —the system reaps the benefit of that compliance with habit which is of so much importance in the economy, and which obtains so largely in our daily lifegetting hungry, or sleepy, or waking at given hours, with an almost sentient regularity, and on which the hours of meals and sleep, etc., in health, are based. Hence it is of first importance that this stimulus to the tissue-changes, which only lasts a certain time, growing less with varying regularity until its effect is entirely lost, be renewed at regular periods. MEDICAL TREATMENT. 19 1 V.-Avoid competition, and do not strive to see how much you can lift. USUAL EFFECTS PRODUCED BY THE HEALTH-LIFT. Following the exercise most commonly, is a tingling glow over the whole surface of the body, with a sense of buoyancy and vigor which prompts one to want to do something-the exercise seems to have been entirely insufficient-there is a temptation to strike out from the shoulder, to seize the heavy dumb-bells, or " skin the cat " on the suspended rings. Instead of spending this increased vitality, however, you are cautioned against doing any of these things: you take it away with you to put it into your daily life and work: the pulse has fallen from five to eight beats per minute-you breath more deeply and fully, -the headache is gone,-if the feet were cold before, they are now warm. As the exercise is continued the weak spots develop themselves; the results of former illness or injuries remind you of their existence; probably you find it impossible to-day to raise the weight of yesterday, or even of a week or more previous, you have action where before was stagnation, you may have to go back in your weight, 50, 100, or even 200 lbs, whatever may be the limit of what is now your weakest spot, which is the measure of your strength. Gradually increasing again from this, usually at the rate of ten pounds a day, as you did at first, you reach your old limit and pass it with ease, and have demonstrated that you are a healthier man by so much as you have eliminated that element of weakness. Sometimes it is attended by pain or discomfort; the more thoroughly circulated blood-in itself healthier and more highly stimulating-arouses sensation in nerve-tissue hitherto dormant. Each one must be a law unto himself in this matter of weight; some men, and many women lift with benefit only every other day, or lift light and heavy weights on alternate 20 PULMONARY CONSUMPTION. days, and some absolutely need to lift heavy every day. Temperament, occupation, inherent vitality, etc., etc., all must be taken into consideration. No rule can be laid down for any given case, even by the most experienced. From fifty to eighty pounds will frequently tax the strength of the patient at first, but in the course of three or six weeks, three or four hundred pounds can be lifted with ease. From ten to twelve minutes [ealth-lift exercise once a day has been found, after years of experience, to be all that should be taken to get the full benefit of the exercise. For this atonic condition of the body, change of climate will often be of much value, especially if the patient will go to a place where the atmosphere is very much rarified, such as found in Colorado, New Mexico, and the mountainous portion of North Carolina and Virginia. Bathing. —Frequent bathing, followed by brisk friction with the flesh-brush, will be of much service. Cod-liver oil once a day will also be of great value at this early stage of the disease, if persevered in for a long time, especially if the patient is under the influence of such remedies as Calcaria carb., Lycopodium, Phosphorus, lodium, Silicea and Sulphur. EMACIATION AND DEBILITY.-These two symptoms are so closely united to each other that their treatment will be given together. The most useful remedies for this condition are Calc. carb., Arsenicum, Iodium, Iodide of Potash, Phosphorus, Silicea, China, Ferrum, Stannum, Sulphur, Kali Carb., Lycopodium, Zinc, Cod-Liver Oil, the Health-Lift, and a nutritious diet. CALC CARB.-Leucophleg- No remedy in the Materia Medica matic temperaments, prone to acts more profoundly upon the gangaffections of the mucous mem- lionic vegetative nervous system branes; dry flabby skin, and in than Calc. carb., and none is more children largeopen fontanelles, children largeopen fontanelles, useful in this destructive disease. with large drops of perspiration on the head during sleep. Pale In cases of emaciation and debility, and fair children, with soft where the secondary assimilation of EMACIATION AND DEBILITY. 23 disappeared under its use; and a diminution of the functional energy of the ovaries makes it probable that those are similarly affected." The most marked effects of Iodine are: "Over-excitement of the whole nervous system; ebullition of the blood and pulsations over the whole body, increased by every effort; trembling, tottering gait; great debility, atrophy; extreme emaciation; general edema; pulse accelerated, hard and small; hectic fever; variable appetite, either excessive or absent; digestion very feeble; dyspepsia; suffocation; out of breath on going up stairs, with violent palpitations and cramp-like pains about the heart on the least effort." Symptoms all greatly aggravated by motion. IODIDE OF POTASSIUM. —This remedy is so closely related to Iodine, that we will not in this place give separate indications, but simply state where we find the symptoms strongly pointing to Iodine, and the patient has been saturated with mercury, and has had syphilis, has many rheumatic symptoms, with much derangement of the mucous membranes, we would give the Iodide of Potassium the preference. PHOSPHORUS. - People When the disease is deeply seatwith meagre,slender form, fair ed, much emaciation accompanied complexion and strong sexual with great nervous prostration, and feelings. Sensation of weakness in the abdomen, that ag- more or less complicated, with gasgravates all the other symp- tric and intestinal disease, Phostoms. Stools long, narrow, hard phorus will be found of much and very difficult to void, or value. There is much anemia and profuse, watery, exhaustive deliquescence of the blood, with diarrhoea pouring away as from a hydrant. Profuse hmemorrha- f ges, anaemia, with profuse per- fluid blood. The emaciation is acspiration and great emaciation. companied with a dry, hard cough: the expectoration is frequently mixed with blood; the lungs more or less hepatized and much sanguineous infiltration of the parenchyma of the lungs. There is a great tendency to 24 PULMONARY CONSUMPTION. a watery, exhaustive diarrhoea, or much gastric irritability: the tongue is red at the tip and sides; nausea and more or less vomiting. SILICEA.-Emaciation ac LICA.-Emaciation ac In enaciation and debility where companied with more or less suppuration going on in the there are organic changes taking lungs. Profuse night-sweats. place, especially suppuration, it has Much perspiration about the an extraordinary control over the head and chest, especially in suppurative process, seeming to malittle children. Terribly offen- ture abcesses when desired, and sive sweating of the feet. Hungry, but cannot get down food, certainly reducing excessive supit is so nauseous. Great con- puration to moderate limits. stipation, the rectum has not This remedy is especially adaptpower to expel the stools, the ed to children that are inclined to stool recedes after having been rachitis, with large bellies and weak partly voided. Great want partly voided. Great want ankles; great difficulty in learning of vitality, always cold, takes a g cold at every change of the to walk. Emaciation, with ulceraweather. Greatly constipated tion of the lymphatic glandular before menstruation. system. The emaciation that calls for Silicea has been brought on by a lohg lasting organic disease of lungs, or some other organ undergoing suppuration. CHINA-In emaciation where In emaciation and debility from the system has been debilitahe system has been debiital - f profuse hemorrhages from the lungs, ted by the loss of vital fluids, especially blood, semen, over- or excessive suppuration, accomlactation, leucorrhcea, diar- panied with night-sweats, China rhoea, or profuse night-sweats. will be found of great value. Great distention of the abdomen, not relieved by eructa- The cases that especially call for tion or dejections. Debilita- China have many gastric symptoms, ting diarrhoea of undigested one of the most prominent of which food. Emaciation, where defood. Emaciation, where de- is.immense distention of the abdobilitv is the most prominent symptom, from loss of blood. men, it seems packed full of gas, not Anaemic people with frequent relieved by eructation or dejection, IODIDE OF POTASSIUM. 27 Chronic uterine haemorrhages, that seem to get almost well, and then return again and again. Menses thick and black, and so acrid as to make the vulva and legs sore. The child has great voracity, watches eagerly for everything it sees. Emaciation and debility, with hoarseness and roughness in the throat, and much mucus in the chest. Great dyspncea, shortness of breath and oppression of breathing, Asthma at night. Tearing pains in the outer parts of the limbs, in the muscles and joints commencing above and running downwards. Symptoms worse in the evenings, or after midnight. It will often rouse the slumbering vitality, if the proper medicines have failed to produce a favorable effect, especially in acute cases. KALI CARBONICUM. — In emaciation and debility where The characteristic of this reme- there is a dry cough, invariably dy in long diseases is stitching aggravated about 3 A. M., hectic pains, and the symptoms are fever and night sweats, with many all worse in tile morning, at 2 stitching, darting, shooting, cutting or 3 A. M. when at rest, better in the open air. Great liabili- pains, this remedy is invaluable ty to take cold at every change It seems to act on the system so as in the weather. Swelling over to produce dryness of the serous the upper eyelids in the morn- membranes, which give rise to the ing, looking like little sacks. stitching pains, the great leading characteristic of the remedy. Suppluration of the lungs, with great emaciation and debility, accompanied by profuse night-sweats, affecting more especially, the head and chest. Excessive dryness of the scalp, with falling off of the hair. Great liability to take cold at every change of the weather. Very irritable, with much anxiety, fear and tendency to start from the least noise. Rheumatic subjects. 28 PUMONARY CONSUMPTION. LYCOPODIUM.- Great In emaciation and debility, where quantities of red sand in the Lycopodium is indicated there will urine. Much pain in the back be found many dyspeptic symptoms previous to urinating, relieved present with an immense accumulaas soon as the urine begins to tion of gas in the stomach and bowflow. Constant sense of satiety. Great accumulation of flatus els, the stomach is often acid, and in the stomach and abdomen, the least quantity of food will seem much fermentation with sour to fill the patient full up to the vomiting. Chronic constipa- throat. Great emaciation of the tion, stools passed with great upper part of the body, while the difficulty. Loose rattling cough lower portion is enormously diswith much emaciation and debility. Constantly taking cold tended. at every change of the weather. Cough day and night, with expectoration of large quantities of muco-purulent matter. Night sweats, perspiration cold, clammy, sour, fetid, bloody and sometimes smelling like onions. The patient is very low-spirited, and melancholic; grieves constantly and is excessively irritable, Dr. Pope thinks there are but few medicines so valuable in consumption as this, when persistently used. The cough, gastric irritation, emaciation and debility are wonderfully mitigated by it. The symptoms are aggravated at 4 P. M., and night, or at 9 in the morning. ZINCUM. - Cerebral ex- In emaciation and debility, where haustion with mental and phys- there is great debility of the cereical depression, from anaemia of bro-spinal nervous system, this the brain. Tncessant and con- remedy is often of great value; it stant fidgety feeling of the feet; Z5,seems to be to the animal nervous must move them constantly. system, what Iron is to the blood. Many gastric symptoms, with distended abdomen, and dry, hard, small stools. Strong sexual desires. Much weakness and trembling of the hands. Profuse perspiration all night, with inclination to uncover one's self. OLEUM JECORIS ASELLI. 29 Most of the symptoms are aggravated after dinner. I now use the hypophosphorous zincum, with better results than in the metallic form. Oleum Jecoris Aselli.-Cod-liver oil. This is obtained from the liver of the common cod; the process is thus described by Dr. Garrod: "The livers are collected daily, so that no trace of decomposition may have occurred; carefully examined, so as to remove all traces of blood and impurity, and to separate any inferior livers; they are then sliced, and exposed to a temperature not exceeding 1800 Fahr. till all the oil is drained from them. This is filtered, afterwards exposed to a temperature of about 50~ Fahr., in order to congeal the bulk of the margarine,and again filtered, and put into bottles well secured from the action of the air." Cod-liver oil, being the only agent in which the old school have any confidence as a curative agent in tuberculosis, let us first see what the oil really contains. Dr. Jongh, found the principal constituents of these oils to be oleate and margarate of glycerine possessing the usual properties, but they also contained butyric and acetic acid, the principal constituents of the bile as fellenic, cholic and bilifellinic acids, and bilifulvin, a peculiar substance soluble in alcohol, a peculiar substance soluble in water, alcohol, or ether; iodine, chlorine, and traces of bromine; phosphoric, and sulphuric acids; phosphorus; lime; magnesia, soda, and iron. These were found in all the varieties, though not in equal proportions in all, yet it is quite uncertain whether the difference had any relation to their degree of efficacy. This analysis gives us a compound of twenty different remedies, all of which, it will be seen, act especially upon the great sympathetic or vegetable nervous system, the grand centre for the action of the tubercular poison, and, it will be seen, are the principal remedies used by our school for the cure of tubercular consumption. This analysis also gives us an explanation how cod-liver oil cures consumption. First it holds in solution a fine attenuation of lime, iodine, phosphorus, bromine, and OLEUM JECORIS ASELLI. 31 a healthier aspect, colliquative diarrhoea and sweats cease; the natural secretions become more copious, the pulse less frequent. It is difficult to comprehend how it can produce such marvellous manifold salutary effects." (Through the vegetative nervous system it produces these marvellous effects). " When we remember that in a teaspoonful of oil we are administering a dose of Iodine equal to a drop and a half of its 3d decimal dilution, and that we are generally giving it in cases to which the drug is thoroughly homeeopathic, can we doubt that it exerts' a curative action; if we disbelieve this, we have no reason for believing in the action of infinitesimals anywhere. Moreover were it the oleaginous matter per se which cures, why should all attempts to find a substitute for the oil of fishes be so unsuccessful?" In cases that are benefited by the use of cod-liver oil, the nutrition of the body is at fault, and we find the loss of flesh, or emaciation a'prominent symptom, with marked debility, or we may have enlargement of the lymphatic glandular system, and swelling of the cervical, or sub-maxillary glands. Such cases are sure to be benefited by the oil, especially if in little children. There are three varieties of oil in use; the dark-brown; a brown, and a pure, pale oil. The latter is the only kind that ought to be used for medicinal purposes. The strong smelling and dark-colored oils owe their offensive properties to the partial decomposition and putrefaction that has taken place before the oil is taken from the livers. Speaking about the various kinds of oil Dr. Williams says in his work on consumption: " It was not until the pure, pale oil was brought under my notice that the difficulties in administering it gave way; and during the. last twenty-five years, I have prescribed it (the pale oil) for between twenty and thirty thousand patients, and with such success that it was taken without material difficulty by about 95 per cent. of the whole number, and of those who thus took it, full 90 per cent. derived more or less benefit from its use. This experience, which is in accordance 34 PULMONARY CONSUMPTION. (5.) That it increases weight in favorable cases with singular speed, and out of all proportion to the actual quantity taken; that hence it must in some unknown way save waste, and render food more readily assimilable. (6.) That it sometimes fails to increase weight. (7.) That in the great majority of cases where it fails to increase weight, it does little good in other ways. (8.) That it does not relieve dyspncea out of proportion with other symptoms. (9.) That the effects traceable to the oil in the most favorable cases are: increase of weight, suspension of colliquative sweats, improved appetites, diminished cough and expectoration, cessation of sickness with cough, and gradual disappearance of physical signs. (10.) That in some cases it cannot be taken either, because it disagrees with the stomach, impairing the appetite (without being itself absolutely nourishing) and causing nausea; or because it produces diarrhcea. (11.) That in the former case it may be made palatable by associating with a mineral acid; and in the latter prevented from affecting the bowels by combination with astringents. (12.) That intrathoracic inflammations and haemoptysis are contra-indications to its use, but only temporarily so. (13.) Diarrhcea if depending on chronic peritonitis, or secretive change, or small ulcerations in the ilium is no contraindication to the use of the oil; even profuse diarrhcea caused by extensive ulceration of the large bowel, is not made worse by it. (14.) That the beneficial operation of the oil diminishes, caeteris paribus, directly as the age of those using it increases. (15.) That the effects of the oil are more strikingly beneficial when only a small extent of the lung is implicated in an advanced stage, than where a relatively large area is diseased in an incipient stage. (16.) That where chronic pleurisy, or chronic pneumonia exists on a large scale, the oil often fails to relieve the pectoral symptoms. CAUTION-EXHIBTTION. 35 (17) That it often disagrees, when the liver is enlarged and probably fatty. (18.) That weight may be increased by it, the cough and expectoration diminish, night sweating cease, the strength which has been failing remain stationary under the use of the oil, and yet the local disease be all the while advancing. "Singular proof," says Dr. Walshe, "of the nutritive power of the agent," and, we may add, of its inefficiency as a medicine. "This admirable exhaustive summary of the knowledge which is possessed of the subject to which it relates, confirmed, as it has been, by the conclusions of competent observers, shows a wide difference between the anticipations which were indulged respecting the virtues of Cod-liver oil and the sober realities of experience. But enough remains to prove that among the remedies that have been proposed for pulmonary consumption, none can be compared with this in efficacy. More than any other, it mitigates the symptoms of the disease, and delays its march; while in some cases it appears permanently to arrest the degeneration of tubercles already deposited, and so to improve the nutrition as to prevent the formation of new ones." -STIFLE. Dr. H. C. Wood says: "There can be no doubt that consumption often commences with catarrh, and is often developed slowly, as the result of frequently " catching cold." Whenever a patient is feeble, pale, somewhat anamic, complains of his liability to catch cold on the slightest exposure, even though no local disease exists anywhere, or rather because no local disease exists anywhere, there is cause for alarm; and it is of the most vital importance that the patient be put upon a tonic treatment whose basis is Cod-liver oil." Caution.-Cod-liver oil "should not be administered indiscrirninately during the persistence of acute febrile symptoms, congestion, hmemorrhages, or any active form of disease; digestion being then impaired, and the mucous membrane irritable, the oil is only likely to increase the disorder. The sphere of Cod-liver oil is to remove exhaustion and impart EXHIBITION. 37 scarcely tasted. The proper proportion is two to four tablespoonfuls of the oil to one pound of dough. Patients to whom we have recommended this method of taking the oil assure us that while pleasant and digestible, it is as efficacious taken in this as in any other way.' " Small pieces of ice in each dose of oil also render it almost tasteless." "' Its assimilation is promoted, and its beneficial action greatly enhanced, by the addition of ten drops of the first dilution of lodium to each pint of oil. This addition is especially recommended in Phthisis Pulmonalis, and Atrophy." 1" Claret is another vehicle for Cod-liver oil. The oil should be poured upon the wine, so that it does not touch the glass, but floats as a large globule; in this way it may be swallowed untasted." A correspondent of the Lancet suggests the following method of taking Cod-liver oil. "Take one orange and divide it into two equal parts; squeeze the juice of one half into a cup; pour the oil upon it, then squeeze the juice of the other half very gently on the oil. By swallowing the whole cautiously, not the least taste of the oil is experienced." Dr. Buchner, in his essay on " Air and Lungs," adverts to the fact that, in England they burn Cod-liver oil in several light-houses; and that a number of lighthouse-keepers, who had been threatened with phthisis pulmonalis, before entering upon the duty above-mentioned, and who inhaled day after day, the air of the lantern impregnated with the volatile parts of the oil, became fleshy and robust. I have acted on the above hint for five or six years past. In all my prescriptions of Cod-liver oil I have directed the inhalations of the vapors arising from gently heated (not burned or scorched), crude Cod-liver oil and have in more than one case, seen happy results. I direct my patient to fill a saucer with the crude oil, place the saucer over a tin dish, filled with sand, and heat the bottom of this either by a stone, or other convenient means. To some the effect is very soothing and grateful. I remember only one instance in which the inhalation of the fumes was at 38 PULMONARY CONSUMPTION. once very distasteful and nauseating, that of a young lady whose health fail d repeatedly whenever she lived in New Bedford (near salt water), and gained on her going west to Illinois." G. F. Matthes. New -England Medical Gazette, vol. 6, p. 6. I have tested the fumes of I he oil as given above, and am pleased with its action. Inhaling the fumes all night during sleep, will be found of much value in the first stages of phthisis. Latest Modification of the Cod-Liver Oil Emulsion.-We have several times called attention to an emulsion of Cod-liver oil and phosphoric acid. The last report of the Utica Insane Asylum contains a formula for an emulsion that has long been in use in th4t institution, and to which our attention was first called by Dr. Andrews. We have experimented considerably with various modifications of the original prescription. The latest formula, and one that suits us better than any other, is the following: E Cod-Liver Oil................... iv. oz. Glyconin....................... ix. dr. Glyconin is made by thoroughly triturating glycerine and yolk of egg, equal parts. Add to the glyconin thirty drops of the essential oil of bitter almonds; then add the oil to the glyconin very slowly, drop by drop, stirring vigorously all the time. The success of the emulsion depends on the thoroughness with which this task is performed. Then add Jamaica Rum........................ ii. ozs. (Jamaica rum seems to cover the taste better than sherry wine, which has usually been employed.) Dilute Phosphoric Acid.......... oz. ss. to oz. i. The average dose is one tablespoonful after meals, being regulated mainly by the phosphoric acid. The above combination is a most excellent brain and nerve food. If properly prepared it does not separate, keeps for a 40 PULMONARY CONSUMPTION. emaciation is a marked feature, with most marvelous effects; in fact with such success, that scrofula, and consumption are almost unknown to them, and travellers from all parts of Europe, suffering with phthisis, go into their country to submit themselves to a course of Koumiss, many of whom have returned in perfect health. The success in phthisis has been so great that the imperial government of Russia has established, and supports institutions devoted to the manufacture of Koumiss, and yet here, in progressive America, Koumiss, with all its virtues, is nearly unknown to the profession; but few things in nature have eluded the keen-eyed American, and wlhy has this? Fermenting milk is the most easily digested food known to the physician, and containing all the elements of pure milk, consequently contains about all the elements of the human body, it becomes us as physicians to thoroughly investigate all its properties, especially if it is of such value in arresting tuberculosis. Dr. Jarotzki, gives the following receipt to make Koumiss (Kumiss). 4" Take one tablespoonful of pure honey or golden syrup; eight ounces of brewer's yeast; four ounces of wheaten flour; mix thoroughly and add a cup of fresh, tepid milk; make a dough of it, and put it in a warm place, to remain over night. In the morning wrap it in a clean cloth, and place it in an earthen, or china vessel; add to it eight pints of tepid, fresh milk; cover the vessel with a woollen cloth and put it in a warm place, stir it thoroughly several times during the day with a wooden spoon, and in two or three days the fermentation will take place, and fresh Koumiss be produced. Take off for the first day's use two-orthree pints, and at the same time add the same quantity of fresh, tepid milk. Stir it thoroughly and let it ferment again. Repeat this process from day to day, until the taste becomes more acidulous and the fermentation ceases, when new yeast has to be made again. Koumiss is therefore a fermenting, and not a completely fermented milk." Since writing the above, I have succeeded in getting from 4 2 PULMONARY CONSUMPTION. phosphate of lime and 30 grains of mixed chlorides of sodium and potassium. The physical and chemical characteristics of Koumiss render it an aid upon which the physician can rely with great confidence, for the treatment of extreme debility, and all the phases of impending marasmus." Koumiss not only contains a large proportion of lactic acid, which is a prime constituent of the gastric juice, but holds the casein in that state of vitality which gives it the property of metamorphosing itself and the other constituents of the milk into healthy lymph and blood. " The process of double fermentation in the preparation of Koumiss does nearly all the preliminary work of digestion, that otherwise must be performed by the stomach. There is no other derivative of milk, or any other substance, that possesses the same advantages; for, containing all the elements of nutrition, and just in that proportion necessary to maintain healthy life, it may constitute a sole diet in cases of disease." Its great sphere of usefulness is in emaciation, similar to Cod-liver oil. Koumiss gives the best results in the first stages of consumption, with emaciation, shortness of breath, tiresome, loose cough, hzemoptysis, night sweats, diarrhcea and great debility. "The original Koumiss of the Tartars is made from mare's milk, but chemical research, and the experience of the last ten years proved that cow's milk is an equally good raw material, if not better, and there is no doubt that cow's milk Koumiss gives highly successful results in proper cases, as shown in the Koumiss cures of Odessa, Warsaw, Cracow, St. Petersburgh, Berlin, Dresden, London, &c." This sparkling and nourishing beverage should be taken like any other food, when the desire for it is felt, and in sufficient quantities to nourish the body. " The quantity to be taken at a time should be suited to the individual, age and condition of the partaker; if the stomach be irritable, as is generally the case in debilitated constitutions, EXTRACT OF MALT. 43 but a small quantity, for instance a wine glass full, should be taken at once, and this quantity frequently repeated, until as much as one-half or one quart bottle is consumed in a day. As the patient grows stronger and accustomed to this new diet, he will learn to relish the Koumiss and he will be able to take one-half, or one gobletful, or more at a time, and as much as two or three quarts in a day." Infants may be fed on Koumiss exclusively, and they soon learn to like it. How TO KEEP KouMIss. It has a sweetish sour taste; when at rest, sometimes it will separate in several layers. It then requires to be shaken before using, in order to mix all particles uniformly. If kept in a cool place, between 40~Fahr. and 50~Fahr., Koumiss will remain good for months. In a temperature exceeding 60~Fahr. it will soon become unpalatable, and unfit for use. In winter, spring or fall when the temperature of the atmosphere does not exceed 60~Fahr. it may be kept in a cool cellar, protected against frost; in summer, when the temperature is above 60'Fahr., Koumiss must be kept on ice. How TO OPEN A BOTTLE OF KoUMISS.-Koumiss being very effervescing, it requires careful handling in order to prevent waste or damage to surrounding objects. Shake it up well, then allow it to rest five minutes, the bottle standing; place a pitcher by the side of the bottle, cut the string, remove the cork quickly, and immediately hold the mouth of the bottle, the bottle itself being slightly inclined upward, over the pitcher, and let the liquid work out by its own force. When all the force is expended, set the bottle down, take from the pitcher what is needed for immediate use, and pour the balance back into the bottle. A more convenient way is to draw the Koumiss by means of a champagne tap. By using the tap, waste is obviated, and any desired quantity may be drawn at a time, and the full sparkling liquid is retained to the last drop. Hoping that this short notice of milk wine will be the means HEEMOPTYSIS. 45 changes are going on in the lungs that will eventually result in fatal tuberculosis. Passive heemoptysis is more intractable than active haemorrhage. When the hbemorrhage comes from the lung tissue itself, the symptoms are more violent, and may prove suddenly fatal. The principal remedies for hwemoptysis and pneumnorrhagia are Aconite, Veratrum viride, Hamamelis, Millefolium, Ipecacuanha, Phosphorus, Ferrum, Arnica, China, Belladonna, Pulsatilla, Crocus, Trillium, Sanguinaria and Sulphur. ACONITE.-Great restless- Active and sudden cases of haemness, agitation and fear of optysis or pneumorrhagia, when death, much congestion of blood to the lungs, with great there is much hyperamia of the anxiety. Symptoms aggra- lungs, after a violent fit of passion, vated at night; sleeplessness or severe exertion of the lungs. and constant tossing about; Animated people, with a plethoric especiallyif brought on in dry, habit of body, bright complexion, cold air; short, dry, titillating, and disposition to palpitation of the croupy cough. and disposition to palptaton of the heart. The blood is expectorated with a hacking, dry cough, which torments the patient continually; burning, stinging pains in the chest, the cheeks are flushed; pulse much excited, with great anguish and restlessness; copious discharge of bright red blood, sometimes without much coughing; the face is pale, with an expression of agony in the countenance. The disturbed condition of the mind, with great mental anguish, is the predominating symptom when Aconite is indicated. VERATRUM VIRIDE.-In- In sudden cases of haemorrhage tense hypermamia of the lungs, from the lungs, where the pneumowith a hard, full, quick, bound- gastric nerve is more or less impliing pulse; short rapid respira- cated. No remedy.has such absotions, accompanied by more or less gastric symptoms, sudden lute control over the circulation, by hbemoptysis. the use of large enough doses of Squibb's Fluid Extract, to produce slight nausea. Active haemorrhages can be controlled at will, but in passive haemorrhages 46 PULMONARY CONSUMPTION. it is not so useful. In active hemorrhages from the lungs, this remedy only has to be given to be appreciated. HAMAMELIS.-Especially In hmemoptysis this is well nigh called for in nervous, passive a specific. No remedy has given us hsemorrhages, the blood is e, the bloodissuch prompt and satisfactory redark and comes into the mouth such prompt and satisfactory rewithout any effort, like a warm sufts, in active or passive venous current out of the chest. Tick- haemorrhages from the pulmonary ling cough, with a taste of mucous membrane. blood on waking. For passive haemorrhages from the lungs, or any other organ, no remedy has given the profession at large such unvarying and brilliant cures. Dr. Hughes thinks "the hemorrhages it cures depend rather upon the state of the bloodvessels, than that of the blood." We believe it cures hmemorrhages by its specific action upon the muscles of the capillary blood-vessels, causing them to contract. When the blood comes from the pulmonary mucous membrane, this is well nigh a specific, but if the hemorrhage is due to a rupture of one or more blood-vessels from deep ulceration, Aconite, Veratrum viride or Millefolium will be more appropriate. MILLEFOLIUM. - Hemo- This remedy has a special action ptysis in tuberculosis, brought upon the vascular capillary circuon by violent exertions, either lation, controlling active or passive active or passive. hemorrhages to a marvellous extent. Hartmann says: "In almost every variety of hemorrhage, and likewise in pulmonary hemorrhage, Millefolium is a splendid and indispensible remedy. More especially in the case of robust and fleshy persons; the spitting of blood is unattended with cough, or the cough is very slight and is caused by the newly accumulating blood; at the same time there is bubbling up in the chest, with a sensation as if warm blood H}EMOPTYSIS. 47 were ascending in the throat, gradually increasing in intensity until blood is raised." Spitting of blood, with violent palpitation of the heart and much excitement, accompanied with a feeling of great oppression of the chest, active haemorrhages from deep ulcerations in the lungs. IPECACUANHA. — Hemor- For acute hkemorrhages, no remrhages from all the orifices of edy is used more frequently than the body, with great and long continued nauswith grea, aompani- Ipecac., and thousands of patients ed by great weakness and have been cured by this remedy aversion to food. Heemopty- alone. And the great key for its sis from the slightest exer- selection is great and long continued tion. Much rattling and bub- nausea. bling of blood and mucus in Spasmodic, suffocative cough; asthmatic breathing; blood very dark, and mixed with mucus. Much rattling of mucus and blood in the bronchi. Constant taste of blood in the mouth. The action of Ipecac in controlling hsemorrhages, closely resembles Digitalis; they both arrest the hsemorrhage through their action upon the par vagum. If there is any organic disease of the heart so as to cause obstructions to the circulation, Digitalis and especially its active principle Digitaline, should be preferred. Digitaline is a remedy of untold value in many pulmonary affections, especially if accompanied with a loose, rattling cough, and intermittent pulse. It should be given in the 3d. dec. or centesimal trituration. PHOSPHORUS.- Sensation This is one of the most valuable of weakness and emptiness in remedies we have in hsemorrhages. the abdomen, it is so distress- Dr. W. Arold, of Heidelberg says: ing that it aggravates all the other symptoms. Stools long, "; The changes occasioned by it in the narrow and expelled with great blood, and through the blood in the 48 PULMONARY CONSUMPTION. difficulty. Fatty degeneration whole organism, have been overof the liver, with much jaun- looked for a long time. In numerous dice. Strong sexual desire, or impotence from sexual cases of poisoning by means of Phosabuse. Tightness across the phorus-matches, and by Phoschest, with dry cough, or rusty phorus-paste, the changes in the spots raised with great difficul- blood are too conspicuous to remain ty. Hard, teasing, dry cough, unnoticed any longer. The facts with a sensation as if cotton was in the throat. Slight gained in this way were so often wounds bleed much. Tall, confirmed by numerous and oftslim, nervous temperaments. repeated experiments upon animals that now they are generally accepted. Almost all observers speaking on this subject, describe the blood as being dark, even black, and of fluid consistence. As a rule it is thin, flowing, more rarely of molasses-like, or of more thickflowing appearance. In a coagulated state it has been observed so rarely and exceptionally, and then only in a few single parts of the body that we are justified in assuming that the coagulation cannot be taken as an effect of the Phosphorus, but is dependent upon other conditions. Upon the whole the blood is more fluid if Phosphorus does not kill quickly, but has a chance to effect changes in the blood in consequence of a more lasting action for several days. These changes, however, frequently set in very rapidly, if Phosphorus has been taken in the form of a solution, as, for instance, in butter, fatty oils, or ether. " The results of microscopic investigations of the blood offer important disclosures. Phosphorus occasions an important change in the blood discs, their decrease in consistency and circumference is very conspicuous. They become smaller, more extensible, and consequently can assume different forms; they change their form in many ways, especially in their passage through narrow vessels, and in their proportion to each other. One might say, almost, that Phosphorus acts as a dissolvent upon the blood discs. This action touches the blood -cell-membrane more than the nucleus. Greater luster, a less,granular appearance, irregular and less distinctly defined outlines, these are the most conspicuous changes of the blood HAMOPTYSIS. 49 discs which can undoubtedly be ascribed to the direct action of Phosphorus. That these changes take place on account of immediate action, I have proved in this way: I let Phosphorus oil act upon the blood under the microscope, and thus I witnessed changes of the blood-discs, slighter in degree, it is true, yet entirely similar to those observed from the application of Phosphorus during life. In this way I was able to follow up the successive dissolution of the blood-discs. This dissolution was not as great as under continued action of the Phosphorus in the living organism, and undoubtedly, for the reason that not so intimate and lasting a contact with the blood took place. "Besides several other observers, Rummel testifies to a change of the blood, perceptible under the microscope. He could not find a single colored corpuscle, but only colorless discs in the blood of a hen, poisoned by Phosphorus, and Voit made the same observations on a dog, into whose vena cruralis he had injected Phosphorus. According to -Rummel, the destruction of blood-discs is the most essential phenomenon when Phosphorus has been introduced into the stomach, as well as when directly mixed with the blood by means of in jections. The blood-discs separate into heematine and globuline. The former floats as a purple coagulum in the plasma, or may according to the conditions present, even be dissolved therein, while the form of the latter is still preserved. Another observation of Rummel is very worthy of notice for the explanation of hkemorrhages after Phosphorus poisoning. If a rabbit, into whose vena cruralis Phosphorus oil had been injected, was held head downwards, he soon saw red colored plasma, which under the microscope was free from any blooddiscs, flow from the nose. The blood in this dissolved state had passed through the walls of the vessels. On opening a vessel, numerous well-preserved blood-discs could still be found. "To judge from the haemorrhages and ecchymosis, so frequently, and, we may say, almost constantly observed in Phosphorus poisoning, and from the often confirmed curative action HA3mMOPTYSIS. 51 hours, and then suddenly come on again. The man was so weak at the end of two weeks that he could not speak above a whisper. Aconite, Hamamelis, Millefolium, Belladonna and Ipecac. all had been tried faithfully and failed. After commencing the use of Phosphorus he had no more haemorrhage, and made a quick convalescence. He remained well one year, and then died with pulmonary tuberculosis, without any return of the hemorrhage. This confirms Raue's observation, "Profuse haemorrhage, pouring out freely, then ceasing for some time." It is particularly adapted to tall, slender people, with lively perceptions, and inclined to stoop over forward. FERRUM.-Weakly persons In those cases where the bloodwith fiery-red face; the least plasma isimpoverished the albumen emotion produces a fiery-red and red-corpuscles are decreased face, aneemia with great debility,pale face and lips. Heemop- and water in the serum sanguinis. ysis better when walking slow- Great paleness of the increased ly. Lienteria, undigestedstools, membranes, especially that of the without pain. Chlorosis; mouth. watery leucorrhea. Great The least mental emotion provariability of the mind. (Ered-flushed face. ema of the feet and legs, with bloated face, and great debil- Haemorrhagic tendency, with flyity. ing pains in the chest. " Always better from walking slowly about, notwithstanding weakness obliges the patient to lie down. Quick motion and talking brings on cough, with pain between the shoulders; the face has a yellowish tint; sleep is poor at night, and there is frequent palpitation of the heart." Bellows-sound of the heart, and anaemic murmur of the arteries and veins. Especially adapted to cachectic and leucophlegmatic individuals, and to diseases where the vegetative system is involved. "CEdematous swelling of the body; cool skin; constant HAIEMOPTYSIS. 53 BELLADONNA. —Hemmop- " This remedy is " particularly aptysis with a dry, teasing, plicable -in robust, plethoric individspasmodic cough. spasmodic cough. als, and for congestions towards Haemorrhage comes on sud- the head, without any cardiac denly, and is worse evenings. In robust, plethoric people, irregularities being complained catarrhal hsemoptysis, in pleth- of; also more particularly if the oric people. hsemorrhage was the result of an incipient catarrh." Baehr. In tubercular hsemorrhage Baehr has no confidence in Belladonna, but if it is vicarious, or at the critical age, he has great confidence in its medicinal virtues. Expectoration of bright-red blood, with great congestion of blood to the chest, aggravated by motion, with throbbing headache. PULSATILLA. - Mu c h Patients that are very tearful; chilliness with expectoration weeps at everything, whether joyof dark, coagulated blood, vi- fil or sorrowful. Hemoptysis, carious menstruation. Menses suppressed. Inclined to diar- with a loose, rattling cough, the rhea. Symptoms aggravated bronchi seem loaded with mucus in the evenings. Great crav- and blood. Hsemoptysis in women ing for fresh air, must have that have suppression of the menthe doors and windows open; ses. Sub-acute -emoptysis with feels like suffocating in a warm room. dark, venous blood, especially in females who are constantly chilly. More especially adapted to females, but acts well on both sexes. CROCUS. -- HRemoptysis Passive hbemoptysis is worse where the blood is dark and evenings. Acts better in women, stringy, with much mental de- subject to uterine hemorrhage of jection. On raising a clot of blood long strings drop from dark coagulated blood; as it is disit. charged it forms into long strings. Great debility and palpitation of the heart. 54 PULMONARY CONSUMPTION. SULPHUR. -- Frequent This remedy will be found of flashes of heat, which pass off great value in those cases that ofwith moisture and debility. The top of the head is contin-ten seem to get about well, when ually hot. Early morning relapses occur again aqd again, day diarrhoea, or obstinate consti- after day for a long time. pation. Stools acrid produc- The cough is loose and rattling, ing excoriation. Ichorous ing excoriation. Ichorous with a suffocating feeling, wants discharges from the nose, vagina or anus. Chronic hoem- the doors and windows open, optysis seems to get almost craves fresh air so much. Often well, when it returns again has weak faint spells about 11 A. and again for weeks. Has M.; cannot wait for dinner. many weak faint spells. Heat Bends forward when walking, in the chest with bloody exdoes not walk erect. pectoration. Mental symptoms, everything looks beau- Great disinclination to being tiful which the patient takes bathed. a fancy to, with happy dreams Diseases caused by suppressed constant heat in the soles of eruptions, especially the itch. the feet, puts them out of bed the feet, puts them out of bed Adapted to lymphatic constituto find a cool place for them, weak faint spells, cannot wait tions, disposed to constipation and for dinner. haemorrhoids, or to people with chronic morning diarrhcea. THERE are many more remedies that may be useful in haemoptysis, such as Trillium, Erigeron, Gallic Acid, Ergot, Ustilago Mades, Senecio, Aurnens, Carbo veg., Terebinth, Conium, Opium, Tartar emetic, Hyoscyamus, Drosera, Nitric Acid, Sulphuric Acid, Collinsonia, Apocynum, Sanguinaria, Cactus, Rhus tox., Lycopodium, Lycopus, Stannum, Calc. carb. and phos., Sepia, Lachesis, Ledum, Arsenicum, &c., &c. For the special indications of the above remedies, the reader is refered to the Materia Medica. Usually, however, one or two of the mentioned remedies will be all that is required. PRACTICAL EXPEDIENTS. — Dr. Ruddock says:"The subcutaneous injection of Morphia will control the haemorrhage almost instantly in a majority of cases." HIEMOPTYSIS. 55 The cautious use of cold water, or ice, in severe cases, we believe to be of much service. The ice should be put into a bladder so as to keep the patient from getting wet, and there should be a towel folded several thicknesses and laid upon the chest, and the bladder of ice placed upon the towel, and not on the chest. We have seen great benefit from the use of ice applied in this manner. Ice may be sucked freely, but the better way is for the patient to swallow small pieces of ice and let it dissolve in the stomach, in close contact with the lungs. Dry cupping has been found of signal service in profuse hbemoptysis. Its action is immediate and decisive. The cups should be applied over the chests and in the inter-scapular and scapular region. STYPTICS. -Such as Gailic Acid, Acetate of Lead, Tannic Acid, Sul!lhuric Acid, Alum, Perchloride of Iron, and Ergot of Rye, are the principal styptics depended upon in the old school practice. I have never used them and cannot judge as to their merits. The Hydrate of Chloral might be of much value as a palliative. The patient must be kept quiet in bed if possible, and his mind free from all excitement. The room should be cool, and his beverages should also be cool, and free from alcoholic stimulants. The diet should consist of cold beef tea, chicken broth, milk, cold tea, coffee, &c., &c. DIET. -A very important item in the treatment of phthisis is the diet of the patient. It should be very nutritious and of a non-stimulating nature. We believe that stimulating food, such as all kinds of liquors, are instead of a benefit, an actual injury to the patient. Stimulating drinks lash the digestive organs into an excited feverish state, when there is fever in the system already free from disease. A small quantity of nutritious, easily digested food, should be taken at a time, on account of the little gastric juice secreted, from the feverish condition of the system. 56 PULMONARY CONSUMPTION. "Dr. Beaumont observed that there is always disturbance of the stomach when more food has been received than there is gastric juice to act upon it; i. e., a condition induced similar to that which is present in fever, namely, that the gastric juice not being able to act on the undigested food, the stomach is irritated just as if the food had been introduced into the stomach when the system was in a febrile state. "If to these facts is added the fact already referred to, that the gastric juice combines with only a given quantity of aliment, it becomes apparent that in weak stomachs, and in persons laboring under disease, the supply of gastric juice being diminished by the state of disease, the evils of taking a large quantity of food must be indeed great." (Constipation, by J. Epps, M. D.) The patient cannot be too cautious with his diet. Hunger being dependent upon a state of the brain, itmay be so irritated as to cause a false hunger, and whatever is fancied cannot be indulged in, for serious results may follow, especially if the digestive organs are implicated. MILK is an article of diet we greatly prize in phthisis, and all writers on consumption esteem it highly, especially the milk of asses. Goats' milk has also gained considerable reputation. Many physicians recommend the use of lime water and milk. We believe the reason that milk has given such satisfaction in phthisis is because it is so easily digested. The intestinal canal cannot tolerate solid food, but the milk is assimilated into tissue with the greatest ease. Soups made from beef, mutton, veal, oysters, &c., &c., will also be found of great value. When milk disagrees the Koumiss will frequently be a luxury to the patient (see Koumiss). FISH is another article of diet of great value in this disease, and often ought to be indulged in, for we believe it builds up the nervous tissues, especially the ganglionic nerve HAEMOPTYSTS. 57 globules, which we believe is the starting point of this fatal disease. Fish eaters are " especially strong, healthy, and prolific. In no other class than that of fishers do we see larger families, handsomer women, and more robust and active men." Probably the most suitable fish for the consumptive to use are the white fish and trout, they contain but little fat, and are easily digested. To those who are called upon to put forth great nervous energy we would recommend fish once a day for supper. Especially would we recommend the smoked halibut. " Salmon stands pre-eminent as a delicacy, and more nearly resembles meat than other fish; fat is intermixed with the muscular fibre and underlies the skin, particularly of the abdomen; it is, therefore, rich, too rich for most invalids. Mackerel, Herring, Pilehard, Sprat and Eel are also fatty in their composition. These are less suitable than the white fish, for those whose powers of digestion are feeble. These are WThiting, Sole, Haddock, Flounder, Cod, Turbot, Brill, etc. Their flesh contains but little fat, except in the liver. Whiting, the chicken of fish, is the most delicate and easy of digestion. Sole possesses the same excellencies and deserves its popularity in the sick room. Haddock is firm, not so delicate, nor so digestible. Flounder is tasteless, but otherwise suitable. Cod is close, firm, tough, and indigestible by a weak stomach. Turbot has richer flavor, but does not stand high as food for invalids." " The quality of all fish is superior before the spawning, when it is' in season.'" " Fish caught from deep seas are better than those from shallow bays. Fresh water fish from deep clear water, with stony bottom, are better than those from muddy shallows." " For the invalid it should always be boiled or broiled, the fat added in frying renders the fish less digestible. Dried, salted, smoked, or pickled fish should not be seen in the sickroom."-Dr. Ruddock. As a rule, Shell-fish are unsuitable for the invalid, such as the Lobster, Crab, Prawn and Shrimp. They produce gastric irritation, etc., but the 5 58 PULMONARY CONSUMPTION. OYSTERS form an exception, they are not only nutritious, but easily digested, excepting the hard portion that was attached to the shell; that should not be eaten. They should be eaten raw and well masticated before swallowing. MEAT, as an article of diet, will be of great value in this disease, such as beef, mutton, and all kinds of game, including the various kinds of Poultry. These should be fresh and plainly cooked. All rich sauces, gravy, or stuffing, should be excluded. The diet should be often varied, by the introduction of fish, game and poultry, but butcher's meat, not overloaded with fat, should preponderate. The use of raw meat, where there is great emaciation, has often been invaluable. The French mix the raw meat with sugar, and it forms a palatable sweetmeat much liked by children. The French also practice drinking fresh lambs' blood. We have no doubt but the blood is really valuable, it being so easily assimilated, but it seems so disgusting we believe but few patients could be induced to use it. Fresh vegetables, and especially ripe fruits, should be used in abundance. CLOTHING.-Consumptive people are very susceptible to the process called " catching cold," consequently, should be warmly clothed, though not to such an extent as to produce much perspiration, or diseased fat. The extremities, especially, should be kept warm, to prevent congestion of blood to the lungs. The under-clothing is the most important point to be attended to, which should be of flannel, lambs-wool or silk, and should be worn the year round. In summer it neutralizes any variation of temperature, and prevents sudden cooling by evaporation. In the winter it prevents the loss of the vital warmth of the body. In the winter an addition of a chamois leather vest may be worn over the flannel. In the summer, during the warmest weather, a cautious change to thinner flannel of fine merino may be advisable. The circulation seems so easily chilled, he cannot be too cautious in cold wreathers by wrapping up warmly in furs and rugs, and if these do not keep his feet warm, extra heat should be used by means CLOTHING. —COUGH. 59 of a warm brick or flask of hot water to the feet. To prevent injury from the exposure of the chest to cold, every consumptive person should have a waistcoat buttoned to the chin, and should wear the beard long, and women should 9void low dresses, and have a shawl ready for protection at all times. COUGH. This being one of the most prominent symptoms of pulmonary phthisis, requires the most careful and critical attention of the physician. No one symptom causes the patient more anxiety of mind than cough, and it makes no difference whether it is due to organic lesions of the respiratory organs, or nervous irritation, caused by reflex action from some distant organ; the cough must be cured, or the patient will seek some other physician. We are, therefore, compelled to, include under this symptom all kinds of cough, and in doing so we most gladly and gratefully avail ourselves of the practical, clinical hints given us by Dr. B. Hirschel. He says: " A cough is a short, resonant, more or less forcible impul — sive expiration, with a more or less narrowed glottis, occurring generally after a deeper and more powerful inspiration. The cause of the different tones usually depends on the vocal formation. Expirations and inspirations often alternate.. A cough can be produced voluntarily and also directly from the spinal cord; generally it is a reflex action depending on conditions of the mucous membrane (inflammation, catarrh, collection of mucus, nervous excitement, foreign bodies, such as dust and the like) of the superior parts of the air-passages, especially of the larynx, and very often of the thoracic org~aa (bronchi, lungs). "Formerly a cough was looked upon as the most positive sign of a lung affection, but experience has taught us that it may be totally absent in such cases, even in pneumonia, and tuberculosis. On the other hand a cough may be present in conditions that have no connection with the thoracic organsa, viz., in many cerebral and spinal diseases, from an elongated 60 PULMONARY CONSUMPTION. uvula, from diseases of the heart, pharynx, cesophagus, stomach, uterus and intestinal canal, so that it may even simulate phthisis. "Likewise mechanical influences, such as tumors,, may produce a cough by pressing on the vagus, but as soon as there is a spot in the respiratory organs where the tissue has become destroyed, greatly compressed, paralyzed by exudations, or become callous, or the susceptibility has become deadened (Wunderlich) then the irritation which caused the cough vanishes. " The individual kinds of cough accord pretty definitely with certain forms of disease, so that from its tone, or kind, we can draw conclusions as to the seat and form of the disease. But we must be very prudent in thus drawing conclusions, so as not to be led into manifold and great mistakes. Thus we like to differentiate laryngeal, tracheal, bronchial, pulmonary coughs from their tone and depth, yet we cannot do this with,certainty. From its degree, from the periodicity of the attacks, some pretend to recognize, now a beginning tuberculosis, then a simple catarrh, or a pneumonia, or emphysema, or spasmodic cough, yet there is no certain criterion for all this. The most insignificant morbid process may cause a severe and exhausting kind of cough, such as is often the case in neuroses. " Our judgment must depend on the repetition of the cough, as also on the fact of its being by day, by night, and on its intermissions, which sometimes last for weeks, and on its being paroxysmal; inasmuch as the tone depends more on the condition of the larynx than on that of the more deeply lying thoracic organs, so it will be evident that it cannot be made use of for diagnostic purposes. " The kind of secretion is of very great importance. Dry, chronic coughs are always suspicious, unless they are purely.nervous. " The cough is dry at the commencement of the organic disease, and only gets moist when the secretions become moveable. If the secretion comes from far down, the condition is always more dangerous than when the cough is superficial, 62 PULMONARY CONSUMPTION. " d. Pneumonia-simple, croupous, intestinal, or hypostatic. III. With organic metamorphosis of the vocal and respiratory organs. "a.b. Laryngeal deformities and neoplasmata, helcosis laryngis, tuberculosis, polypi, carcinoma, stricture, stenosis, formation of diverticula, fistula of the larynx and of the trachea. "c.d. Tuberculosis (infiltrated and miliary), haemorrhage from bronchi and lungs, bronchiectasis, pulmonary emphysema, insufficiency and atrophy, cirrhosis, carcinoma, and other neoplasmata, ossifications, apostemata, gangrene of bronchi and lungs, pneumothorax. "~ Here we must further enumerate: 4"e. Affections of the pleura which excite pulmonary cough, either sympathetically or mechanically, as haemorrhages, serous and inflammatory exudations, tuberculosis pleurae; and, finally, " f. Cardiac affections which, by obstructing the reflux, produce pulmonary hyperaemia, and thus excite cough. IV. In neuroses. These arise either as primary forms from irritation of the vocal and respiratory nerves, or secondarily from central irritation, to wit: "a. Spastic, tickling, spasmodic coughs. "b. Pertussis (according to some a neurosis of the bronchi, according to others an affection of the vagus.) " c. As symptom of a nervous stenosis of the glottis in children and adults. " d. As symptoms of bronchial asthma of the nervous kind, or "e. Angina pectoris, cardiac spasm. Finally "f. As collateral phenomena of a central affection of the spinal cord, spinal irritation (hysteria.) " The physician has also the essential peculiarities of the cough itself to bring within his ken, if he intends to make a good choice of remedies. "1. The tone of the cough. "2. The subjective sensation, the kind of pain. CLOTHING.-COUGH. 6S " 3. The seat, the origin as far as the patient can define it, or the tone and depth which it gives. " 4. The repetition, time of occurrence. "5. The dryness, or the sputum, and its nature. "6. The exacerbation or amelioration by certain conditions, such as eating, drinking, lying down, moving about, rest, air, cold, warm, etc. "7. The concomitant phenomena, as fever, pains in other parts, complications. " Under these forms we believe we have exhausted all the kinds of cough which present themselves for clinical treatment. A more elaborate description, which may be found in all the hand-books of pathology, our readers will willingly spare us, as such is not the object of this treatise which has more especially to deal with therapeutics." Every case of cough we are called upon to attend, may vary at different hours, being sometimes dry and sometimes moist, but each one as a whole is either predominantly dry or predominantly moist. 1. Predominantly Dry. Aconite, Dry, Aggravated at night and by warmth. Ambra, " " evening, relieved by open air. Arnica, " " day and night. Arsenicum, " " by cold air and at night. Argentum, " " daytime. Atropine, " " day and night. Bromine, " " daytime. Bryonia, " " night, cold air and motion. Causticum, " " evening and by getting warm. Chamomilla, " " night and by cold air. Conium " " night, when lying down, and by deep inspirations. Coffea, " " night. Cuprum, " " day and night, and by cold, damp air. 64 PULMONARY CONSUMPTION. Drosera, Dry, Aggravated in the evening, after lying down, especially after midnight. Dulcamara, " by damp cold air and getting wet. Ferrum, " by cold air, and in the evening in bed. Gelseminum, " at night. Hyoscyamus," " at night, especially by lying down. Ignatia, " " by cold air, mental affections, motion and contact. lodium, " " by going up stairs, and warm air. Kali carb., " " by cold, damp air, and at night. Kali hyd., " " by rest and damp weather. Lachesis, " " by sleep, at night; cold, damp weather, and touching the larynx. Merc. sol., " " at night; by heat and damp, cool air. Nitric acid, " at night; by damp, cool air and getting wet. Nux v., " " 3, A. M., early in the morning; by getting cold and motion. Opium, " " especially at night, and by stimulants. Phosphorus, " " day and night; by change of weather, and cold air. Rhus tox., " " by cold damp atmosphere, getting wet, and at night. Rumex Crispus, " by inhaling cold air, and lying down at night. Sepia, " " all day, until midnight; by cold, damp east winds. 66 PULMONARY CONSUMPTION. Silicea, Moist, Aggravations, by cold air, even the slightest draft, and at night. Stannum, " " by rapid motion, and at night. Sulphur, " " by cold, or cold damp weather, afternoon till midnight. Tartar emetic, "' " in damp cold weather, and evenings. Veratrum alb., " " from cold to warm air, by damp cold weather; by eating ice cream. 3. According to the Seat of the Cough, Affections of the Larynx and Trachea. Acon., Chelid., Kali bich., Nux v., Bell., Coffea, Kali hyd., Opium, Brom., Dig., Kali brom., Phos., Bry., Dros., Lach., Puls., Conium, Gelsem., Lauroc., Rumex, Cham., Hepar s., Merc. iod., Sang., Calc. iod., Hyos., Mere. c,, Silicea, Carbolic acid, Ipecac., Merc. s., Sulph. and Carb. veg., Iodine, Morphine, Tartar emetic. Caust., Ignatia, Nitric acid, 4. Affections of the Bronchi and Lungs. Acon., Coral. rub., Kali carb., Sulphur, Ant. tart., Dig., Kali brom., Sang., Ars., Dros., Kreosote, Sarsap., Bell., Elaps, Lycopod., Silicea, Bryonia, Ferrum, Mere., Stannum, Cale. c., Hepar sulph., Phos., Tart. em., Cale. phos., Ipecac., Puls., Veratrum alb. Carbo veg., Iodine, Rhus tox., and Carbo an., Kali bich., Senega, Veratrum viride Cuprum, Kali hyd., Sepia, CLOTHING.-COUGH. 67 5. Stomach and Intestinal Canal. Sympathetic or reflex coughs usually call for a cerebrospinal remedy, such as Antimonium Carbo veg., Kreosote, Pod., crud. and Chamomilla, Lachesis, Quinine, tart., Digitaline, Lycopod., Robinia, Ars., Eupatorium, Mercury, Sang., Chelid., Hepar sulph., Nux v., Sulphur, and Cinchona, Ipecac., Puls., Veratrum alb. Kali bich., Phos., 6. Coughs from Cerebral Irritation especially call for the cerebral-centrics, type Bell. 7. Reflex Cough from Ovario-Uterine irritation most always demands cerebro-spinal remedies. 8. Heart and large Blood-vessels, (reflex-cough) call for such remedies as Acon., Collinsonia, Opium, Spigelia, Ars., Dig., Iodine, Secale, Bell., Digitaline, Phos., Sulph., and Cactus, Lauroc., Spongia, Veratrum vir. 9. Cough from Acute Inflammation. First stages must be combated with a Cerebro-spinal remedy; second and third stage with organics, 10. Coughs from Influenza or Whooping Cough, are mostly always cured with Cerebro-spinal remedies, 11. Croupy Cough, demands at first such remedies as Acon., Rhus ver.; second stage, Spongia, Hepar, Iodine, Kali bich., &c. 12. Croup.-The acute stage demands a cerebro-spinal, the sub-acute and membranous forms are more successfully treated with the organic remedies. Ulcerations, Disorganizations, Pseudoplasmata demand the organic remedies. 13. Asthmatic, Suffocative Cough. Ars., Drosera, Kreosotum, Sulph., CLOTHING.-COUGH. 69 17. After Midnight. Acon., Chin., Hyosc., Nux. v., Bell., Dros., Kali, Sambucus. We will now endeavor to give the special indications of each remedy in alphabetical order. My best guide to the selection of a remedy is the nature of the cough, for you are all well aware that every cough is either predominantly loose or predominantly dry. This is my first inquiry; and my second is to know the nature of the expectoration; the third, the time of day, or night, and the fourth the concomitant symptoms. DRY. ACONITE. - Dry croupy This remedy is especially adapted cough, resulting from an exfrom an e to people of sanguine temperament posure to dry cold air, shlort, dry, titillating cough, and and a full, plethoric habit, where every inspiration seems to in- the primary or inflammatory stage crease the cough. The patient has not passed. If there is high is greatly disturbed in his sleep fever present it suits a loose, as by the cough, and as soon as he is fairly settled down to well as a dry cough; but as a rule sleep again, the cough recom- will be found to act best where mences, and so continually re- there is a dry cough, and aggravapeats itself. Uncontrollable ted at night. anguish with great fear of eanguish with great fear of 1"There is most always a tingling death. Sudden inflammation with high fever, great restless- sensation in the chest after coughness from exposure, whereby ing. There may be stitches in the the perspiration is suddenly chest and side, which are often so suppressed. Dry, tickling, severe as to interfere considerably night cough, in a restless, with respiration, can only get halffeverish patient; cough with active hemmorrhages, and great inch respirations; sometimes there fear of death. is an oppression of the chest, without pain, which keeps one from taking a deep breath, palpitation of the heart, with great anguish." In dry bronchial catarrh, in its most obstinate form, it is the most reliable agent we have. It is also of great value in these long fits of dry 70 PULMONARY CONSUMPTION. morning and evening coughs, so trying to the patient from their every-day recurrence. "Where the left lung is most involved, and the pleura is at the same time implicated, manifested by a sharp stitching pain on breathing, the cough which would be very hard were it not suppressed on account of the pain, is almost dry, it being extremely difficult to raise anything. The little that is brought up is tenacious, falling in a round lump, and of a dark cherry-red color. "Aconite 30th is assuredly the remedy." C. PEARSON, M. D. Aconite cough is aggravated in the evening, and more particularly in the night, and in a warm room. Amelioration in the open air, and when still. DRY. AMBRA. - Ambra-cough Highly hysterical women, cough has its seat in the spinal mar- with expectoration of grayish murow or indirectly in the uterine system, and is purely nervous, cus, and abundant eructations. originating in the nervous spi- Reflex cough, from spinal or nal centre. Hystericalwomen, ovario-uterine irritation, and not with constant hacking cough, from any organic lesions of the scraping and copious expec- respiratory organs. Worse eventoration. Lean, delicate, sick-looking peopleandelicate, ings and better in the open air. ly-looking people. MOIST. AMMONIUM MUR.- The ammonia cough is aggravaChronic catarrh of old people, ted in the mornimg and frequently with bronchiectasis, emrphysemaof the lungs with profuse, accompanied with sobbing and thick, whitish expectoration, hiccough. Speaking of Amm. the cough sounds much looser carb., Dr. Meyhoffer says: "We than it is; much mucous rat- have found it of great use in very tling without expectoration. Fat bloated and lax individuals chronic cases of copious bronchial who are indolent and sluggish. secretions, great difficulty of expectoration, and bronchial dilation. Low vitality and atony of CLOTHING. —COUGH. 71 the bronchial surface are leading indications. The hand and the ear will detect numerous coarse rattles, and yet the patient experiences no necessity to clear his chest of its morbid production, cachectic conditions and old age are its great indices. The second and third dilutions act unexceptionally." The cough is worse in cold, wet weather. DR Y. Arnica- Cough resulting For some unknown reason to me, from the bad effects of omecha ires b d our school hardly, if ever, prescribe sensation in any part of the Arnica for coughs,although it ought body; inflammation of the to be very valuable in a cough that skin and cellular tissue, with is predominantly dry, and worse extreme tenderness on pressure. nights, especially it' brought on The bed on which he lies feels from mechanical injuries, accomtoo hard, keeps changing from panied with much myalgia of the,place to place.. intercostal muscles. In organic cough, where serious exudation has taken place; dry cough and hoarseness from over-exertion; dry concussive cough, with difficult or bloody expectoration, etc., etc. MOIST. Antimonium Crudum - This is a splendid cough remedy, Thick, milky white coating on where the cough is predominantly the tongue; mucous mem- loose, and seems to have its startbranes are loaded with mucus, ing point from irritation of the with slow digestion; nausea with slow digestion; nausea mucous membrane of the stomach and vomiting; reflex cough from the stomach or abdomen; with much vomiting, diarrhoea and great emaciation, with exces- heavily coated tongue. Its great sive grief; eating, ever so lit- centre of action is upon the filatle, produces obstinate vomit- ments of the vagi that are distriing; aged people, with corns, buted to the mucous membranes of horny excrescences, and inflammation of the skin; aver- the lungs and digestive organs, sion to washing..especially the stomach. Like Tartar emetic its action hardly ever goes on to inflammation. 72 PULMONARY CONSUMPTION. A tubercular cough will not be much benefitted by it; for simple bronchitis, after the second stage has commenced, with a loose cough, this is a first class remedy. DRY. Arsenicum Album-Cough Dr. Hirschel's description of the that is predominantly dry, in arsenicum cough is most graphic, organic diseases of an incura- and to the point. He says it "apble and destructive nature; cough excited by a sensation plies in all kinds of coughs; precough excited by a sensation as if the fumes of sulphur were dominantly, however, in dry cough. inhaled; cough followed by in- In spasmodic cough it is indicated creased difficulty in breathing, only in its typical form. Whooping great exhaustion, with severe cough does not lie in its range. It dyspncea, aud nightly aggrava- is indicated in chronic affections of tions, rapid and great prostra- a torpid or dangerous nature, and tion, with sinking of the vital forces; burning pains, the in acute cases of the same nature, parts burn like fire; pains especially indicated for cough in orgreatly aggravated by rest, re- ganic diseases of an incurable or delieved by motion; extreme structive nature,either in the larynx afiguish and fear of death; bronchi, lungs, pleura or heart; cannot lie down for fear of suffocation; great thirst, drinks its choice depends upon others often, but little at a time. than coughsymptoms. These funcLymphaticpeople that are sad tional symptoms are: dyspncea, and irritable. asthma, suffocating spells, cyanosis, heart symptoms of all kinds, disturbed circulation, decomposition of the blood, exudations, decay and gangrene of organic substance, disorganizations, excessive pains. Constitutional indications are: exhaustion of life-power, collapse, high degree of weakness, syncope, anmemia, nervous irritability, disposition to ulceration, hydraemia and the like. Conditions are: typical forms, nightly aggravations, worse from lying down, drinking and change of weather." I cannot state anything more practical and to the point, in the use of this remedy in cough than is given by J. Meyhoffer, M.D., in his work on "Chronic Diseases of the Organs of Respiration." He says: "Arsenicum is, after aconite, one of the most im 74 PULMONARY CONSUMPTION. value. Anguish and despondency are prominent in cases that call for the use of arsenicum. ARSENATE OF SODA.- Dr. Ruddock gives the following Orgalic cases where the second indications for this remedy stage has set in with a loose cough, nigght sweats and diar- vere cough and profuse expectorarhoea. tion; hectic fever; night sweats; diarrhcea. Even when auscultation detects abscesses in the lungs, the disease may sometimes be controlled by this remedy." Aggravations, in the nighlt, after midnlight, in cold air, or getting cold; after drinking; from exertion; while lying down with the head low; from cold drinks; always wants to be wrapped up warm, and on going up stairs; relieved on lying with the head high; going down; from warm food or drinks, and near a stove. DRY. ARGENTUM NITRICUM. This remedy has a special and -A withered alnd dried-upper- specific action upon the cartilagyinson fromndisease. Pt'tientcan't ous system; in tuberculosis, with think, can't talk, can't walk, ulceration of the larynx and trachea, very dizzy; minutes seem hours to the patieut; tine with dry, racking cough, this remedy seels so long that the patient will be of great service, especially worries about everything. Is if there is a syphilitic taint in the il a g: eat hurry to do things. system. Great distention of the stomach Dr. J. ASeyhoffer says " Nitrate w-ith gas. Fluids seem to run straigllt through the intestinalf slver proves a lughly beeficial canill without stopping. U1- agent in all the stages of tuberculcerationi of the bowels with ous laryngitis. In the beginning diarrhoea. of the disease, when the throat and larynx are much inflamed, and with titillation in the latter, much hawking or spasmodic cough, and accumulation of plllegm in the throat. At a later period, when the edges of the ulcers are the seat of luxuriant granulations, the inhala CLOTHING.-COUGH. 75 tions of the stronger solutions of this salt produce excellent effects, as they reduce the morbid growths. In several instances we have ascertained incipient serous infiltration of the sub-mucous tissue in the last stage of laryngeal phthisis, and seen it give way to these solutions. They have, however, the drawback of blackening the skin or linen with which they come in contact; that can be only partly avoided by inhaling the steamn through a glass tube, or by otherwise protecting the exposed parts. Sometimes, therefore, when wishing to act with more energy, without employing the caustic in substance, we use insufflation into the larynx by a slightly curved glass tube, of one or two grains of the first decimal trituration of nitrate of silver. The frequent effect is a violent fit of coughing, but the growth is thoroughly acted upon, and the opera tion need not be repeated more than three or four times. Should the vegetations be extensive, however, or in cauliflower form, or if by their situation they should cause dyspncea, they must either be destroyed by the porte-caustique, or removed with the laryngeal scissors. The same operation is to be performed on the detached flaps of the mucous membrane; difficult and painful deglutition, with extensive ulceration of the epiglottis, is often only relieved by the direct application of the caustic. "WVe use Argent. nitric., in all its preparations; from the second and third potency, to the local application of the lunar caustic, and from one to six grains to an ounce of water for inhalations. " We have seen this mineral master inflammation and swelling of the posterior wall and lining of the larynx, attended by a sensation of a clog in the vocal organs, with hoarseness or loss of voice, continued and vain efforts to swallow, with pain and soreness in deglutition, and hawking, considerable mucopurulent expectoration, or titillation in the larynx, with dry spasmodic cough. Thlie third to the twelfth attenuations." 76 PULMONARY CONSUMPTION. MOIST. AURUM MURIATICUM. Acts decidedly upon the lymphatic -Suicidal monomania, accom- glandular system, much like mercpanied with extreme depression and is adapted to suffocative of spirits; dread of some im-atve pending calamity, unrefresh- coughs that are inclined to be loose, ing sleep, loss of ambition and in scrofulous subjects, especially if energy; disposition to dwell they have chronic nasal catarrh, upon some imaginary ailments with ulceration of the nasal bones; diminution of verile strength, so if the patient has been abused great difficulty of breathing during the night', violent pal- with mercury, or has the effects of pitation of the heart; nightly syphilis grafted upon him, with bone pains; Oziena..nightly bone pains, Aurum greatly resembles Arsenicum and Silicea. Suffocative cough with palpitation of the heart, and extreme despondency. " I have had cases of a dry spasmodic (or what I should call nervous) cough, peculiar to females, generally periodical, every night, commencing at sunset, and continuing through the night, going off with the rising of the sun, and freedom from it during the day. Aurum 200 cures every time. In the plain text, cough for want of breath at night." L. B. Wells, M. D. Aggravation in the morning, in the cold air, on getting cold; better from moving, and in the warm air. Its action is similar to that of Iodide of Potash. As an inter-current, where the Iodide has ceased to act, Aurum Mur. will be of great value. DRY. BELLADONNA-Pains come The primary or starting point of and go with great celerity. Fu- the affection is in the brain. A hard, rious delirium,wild look,wishes dry, teasing, spasmodic cough plreto strike, bite or quarrel. Face dominates, generally accompanied flushed, eyes red, rage, tears, with inflammation of the throat, bites, and shrieks; violent con- and difficult, painful deglutition. gestion of blood to the head. Dr. Hirschel says that Bell. has with strong throbbing of the carotids. Throbbing headache "great sensitiveness, in contradisworse from motion and noise tinction to the irritable Aconite. CLOTHING.-COUGH. 77 is intolerable. Eyes red and Vasomotory stimulation with inglistening; photophobia; great creased nervosity. The chief remedy, dryness of the mouth and dryness of the mouth and therefore, for sensitive persons, sfauce poss obrigh t red and women and children: for erethic swollen, spasms of the throat; symptoms worse evenings and inflammatory forms, not for croupy, at night. plastic ones, for spastic states, cough dry, barking, spasmodic, in paroxysms, with titillation in the trachea or bronchi; aggravation at night, and when continuous, sensation as of having swallowed dust; am.eliorationfrom anything cold, sensation of constriction in throat, difficulty of swallowing; congestion to the head; stitches in the chest. In simple catarrhs, in inflammatory forms with catarrhal character (larynx, trachea down to the lungs), specially in the first stage, more in bronchitis, especially capillary than in pneumonia in the beginning of whooping cough; influenza; in affections of the brain, spinal cord or heart; inflammation of parts adjacent to the respiratory organs. In stenosis of the glottis, in bronchial asthma, as an intercurrent remedy in chronic cases. Examination of the affected parts shows a pinkish, smooth redness in the pharynx, uvula, and fauces." Baehr says: " A disposition to perspire while the skin is very hot, with a dry, continual, distressing, spasmodic cough; short paroxysms of cough but very violent, especially towards evening, no expectoration, or else a yellowish, tenacious, bloodstreaked, scanty expectoration. Sensation of great fulness in the lungs without pain." Larynx exceedingly painful, with constriction of the trachea, hoarseness, paralytic aphonia, of a cerebro-spinal origin, that has come on very suddenly. As soon as the cough commences to loosen up the usefulness of Belladonna has passed and another remedy must be selected. Aggravation in the afternoon and at night, and by moving or touching the parts. Ameliorated, while reposing. 78 PULMONARY CONSUMPTION. DR'Y. Atropine.-This is a precious remedy for cough, but itstrue characteristics are not yet known with precision enough to separate them from those of Belladonna. All the symptoms are the same, excepting the vascular symptoms, the congestions and inflamlnation of Belladonna do not appear so prominently in the Atropine cough, but the neurotic elements predominate. This neurotic element seems to predoiminate in all diseases where Atropine acts better than Belladonna, the parts seem to be in a nervous, irritable state instead of a congested inflammatory condition. Many cases of cough have yielded most beautifully and rapidly under the influence of Atropine after Belladonna, which was indicated, had failed to entirely cure. In my opinion Atropine is of much more service to us in a dry hard, tearing cough than Bellaclonna, and ought to be employed much more frequently. I use -the third decimal dissolved in water. DRY. BROMIUM.-Croupy, dry, This remedy has not been given rough, barking or whistling' very often in cough, and its true cough. Tickling in the throat sphere is not yet fully known. Dry as if from sulphur vapor; sensation of coldness in the larynx cough, with suffocation, seens to for blondes rather than for be its indication; but Prof. Guernpersons of white, delicate skin. sey says, " with the croupy sound Has a remarkable action upon there is a good deal of loose ratthe glandular system, and res- tling 5n the larynx with the breathpilatory organs..n ing and coughing, but no choking in the cougfh as there is in Hllepar." In my opinion, Dr. Hirschel is about correct when he says Bromine is indicated " for swelling and hypertrophy of the mucous membrane (Iodine for the exudation), of the upper parts of the respiratory organs, of a catarrhal, inflammatory or organic origill; dry, croupy cougrh, with scraping titillation andc hoarseness, small follicles are found on the posterior mucous membrane of the pharynx, extending from there to the larynx and producing continued CLOTHING.-COUGH. 79 titillating cough. The larynx painful to the touch. Anatomically, we might say Sponyia is more suitable for stasis, simple inflammation; Bromine for swelling and hypertrophy of the' mucuous membranes; Iodine for exudation. Aggravation of the cough in the day time. DRY. BRYONIA ALBA. —Syrnp- Bryonia's great sphere of usefultoms greatly aggravated by ness is found in inflammatory affecmotion. Patient cannot sit up; tions of the respiratory organs, the lips dry and cracked; cannot lungs and their enveloping memsit up from nausea and faint- branes, that have advanced to the ness; everything tastes bitter. Diarrhcea from hot weather, stage of effusion, Dr. Hirschel or constipation, stools hard and says " Bryonia stands in close dry as if burnt; irritable head- relation to the chest. It frequently ache as if it would burst open. follows Aconite, to remove the debris, and is therefore in a certain way more powerful than Aconite, which acts more on the general state and less on the local, and vice versa in comparison to Mercurius, the latter acting more on the local state, whereas Bryonia affects the general state, Bryonia brings on resolution in catarrhs, resorption in inflammation, chiefly indicated in the second stage for slightly plastic but not highly graded inflammatory forms in croup. It is the chief remedy in bronchial affections (therefore in influenza); in catarrhal pneumonia only applicable where hepatization passes over in resolution, or where the pleura is at the same time affected, perhaps also in chronic pneumonia. The Bryonia cough is concussive by coming dry from the sternal region, as if the chest would burst, with scanty yellow, or blood-streaked thin mucus, frequently with vomiturition and vomiting, especially after eating, with status gastricus, difficulty of breathing,. pleuritic stitches, muscular pains, sensation of soreness in the throat and below it." Dr. W. H. Holcomb says: "Bryonia for a dry, concussive cough, producing pain both in the head and chest, with characteristic stitching pains." Dr. Guernsey says: "Bryonia cough at night 80 PULMONARY CONSUMPTION. in bed, compelling one to spring up and assume an erect posture at once. This seems an involuntary motion." A prominent indication for this remedy is rheumatic and braising pains in the muscles of the chest and back. Dr. Baehr says; " We wish to state, as an evidence of the healing powers of this drug that we scarcely ever notice under its administration a copious secretion of the so-called sputa cocta, and that the resorption of the infiltration takes place with very little, or perhaps without any expectoration, or, judging from the stand-point of pathology, taking place in its most perfect form." This is practical knowledge. " Where the cough and fever are very similar to those of Aconite, except that there being much less inflammation in the pleura and consequently less pain, the patient is enabled to cough much harder, raising, however, but little, which is tough, falling in a round jelly-like lump, but in color, much lighter, almost a yellow or soft brick shade, Bryonia 30th or 200th will scarcely fail to cure nine cases out of every ten." C. Pearson, M. D. Aggravation, in the evening and night; from cold air and motion. MO11S'. CALCARIA CARBONICA. This is one of the best and most -Constitutional diseases of useful remedies in the Mcateria scrofulous people, with lencophlegmatic temperament; Medica for consumption. It acts prone to affectionsof the muc- with great power, through the ous membranes imperfect assi- ganglionic system upon the lymphamilation of food to tissue. Dry tics, mucous mzembranes, skin and and flabby skin; children with osseous tissue, and we find it espelarge open fontanielles, and useful in diseases and much perspiration in drops on cally useful in diseases and indithehead,which wetsthepillow vidualities in whom the process of far around, during sleep. Ex- formation and reformation is imcessive debility; walking pro- perfectlyperforme d, as in childhood duces great fatigue; going up durino dentition, rachiis and in stairs, is out of breatli and has during dentition, r to sit down; feet feel as if they lymphatic constitutions. It is one had on cold, damp stockings; of the most useful cough remedies 832 PULMONARY CONSUMPTION. symptoms are not by any means wanting; the cough is almost always accompanied with a more oif less profuse expectoration, early putting on a purulent character. Amelioration from lying upon the back; aggravation from lying upon the sides. Calcatia, with us has shown a more marked control over the upper half of the right lung than over any other portion of either lung." Dr. C. Dunham says: "short, spasmodic cough, in brief, but frequently repeated paroxysms; excited by a tickling as if from feathers or down in the throat and trachea, in the evening and at night, without expectoration, but in the morning and during the day attended by copious mucous or purulent, yellow expectoration and is sometimes bloody, having generally a sour taste and an offensive odor." Agg Travation, In damp, cold atmosphere, from getting wet; from drinking, talking, lying down and during sleep; relieved in dry, warm weather. MOIST. CARBO VEGETABILIS, Diseases of the lungs, where great foulnessof the secretions, there is a great tendency of the patient wants more air, wants chest to perspire and the patient to be fanned all the time. The most innocent food disagrees. takes cold with the least change of Excessive accumulation of gas temperature. The Carbo veg. cough in the stomach and bowels, the is moist and loose in patients that gas is generated by the walls have become greatly enfeebled by of the viscera, rather than long lasting disease; the expectorafrom the fermentation of food, tion is copious, yellow, greenish, mnucll bleeding of the gums when eating or drinking', sen- and very fetid, accompanied with sation as if the stornmach or an extremely fetid breath. Baehr abdomen would burst. Icy says: " Cough in old peoples with coldness of the parts with a emphysema and hypertrophy of the livid, purple loo; Hippocratic lungs, heart and abdominal viscera face with cold breath, and o generall coldness of the whole are very much impeded, very sensibody. Long lasting hoarseness. tive to cold, worse at night, expectoration profuse, especially if the larynx is invaded. Dr. CLOTHING.-COUGH. 83 Reis says: "Chronic catarrh of the bronchi and stomach. Cough with copious expectoration at night and in the morning; tightness of the chest; sickly appearance, great sleeplessness at night, through the day pyrosis, with a great flow of water from the mouth." Dr. Guernsey says: "Respiration oppressed; having some kind of bad smell; quick cough with expectoration in the morning, and no expectoration in the evening; neglected pneumonia, with expectoration of a dirty yellow color, and smelling badly." Dr. M-eyhoffer says " Carbo veg. is the panacea for poor exhausted constitutions and aged people with great torpor of the bronchial lining, profuse muco-purulent sputa, or deficient power of expectoration with symptoms of imperfect oxidation of the blood; lips, and nails blue, extremities cold. The weaker the invalids the better the higher dilutions work." Dr. C. C. Smith says: " Frequent and easy epistaxis, generally worse at night, or in the forenoon, followed by pain over the chest, and pale face; sensitiveness to sudden changes of temperature; hoarsness towards evening, about 5 o'clock; pains in the chest burning." Carbo veg. is more strongly indicated if the larynx is involved. The patient is so greatly reduced, and the lungs so much involved, the remedy must not be expected to act immediately. Aggravations-Evening till midnight; by walking in.the open air; especially in damp, cold air, by passing from a warm into a cold atmosphere; by becoming cold, and by eating or drinking cold food or liquids, by butter or fat food and in the morning. MOIST. CARBO ANIMALIS. — Cirrhotic dyscrasia with swelling Scrofulous venous constitu- and ulcerations of the glands. This tions, with enlarged glands, remedy is adapted to chronic coughs great debility, with great disposition to perspire about the after they have reached the second thorax. Great disposition to or suppurative stage, the cough is take cold, patient feels corn-loose and rattling, expectoration 84 PULMONARY CONSUMPTION. pletely exhausted, can hardly profuse of thick, yellow, greenish, stand, if it is a woman, Ien- fetid sputa, with much fetor of the struation exhausts her, so that she can hardly speak. Earthy- breath, accompanied with debilitatcolored face, copper - colored ilg, profuse, night sweats. The spots on the face and body, constitution of the patient will have secretions acrid. much to do in the selection of this remedy, if the patient has inveterate and obstinate indurations of the glands, and the complexion is of a coppery color, and the disease is well advanced, the remedy will be found of great utility. Its indications greatly resemble those of Carbo ve.q. Aggravation of the cough in damp, cold air and at night. DRY. CAUISTICUM.-Scrofulous This is a remedy of great value people with yellow complexions Cannpeople withyelloe upper eyelids in the treatment of diseases of the Cannot keep the upper eyelids up, they are nearly paralyzed, respiratory organs. The great preand will fall down over the dominating symptom is a dry hoarse eyes, great melancholy, looks cough, with aphonia; for complete on the dalk side of everything. aphonia no remedy can equal it. If Constant sensation as if lime was being burned in tle the cough is loose, the patient is was being burned in tbe stomach, with flatulence and obliged to swallow what is raised, waterbrash. Catarrhal aphonia. cannot spit it out. Involuntary Dry hard cough with involun- passing of urine during the fit *of tary emissions of ureine. This coughing is a valuable indication, is the clergymen's remedy for l hoarsuess, and loss of voice from over-exertion. Inability amount of uric acid in the urine. to expectorate. Chronic morning hoarseness, with dry cough and much congestion of the fauces, catarrhal aphonia, weakness of the voice from over-exertion, phlegm in the throat that cannot be hawked up which produces nausea. HIard, dry, racking, hoarse, morning cough, with involuntary emissions of urine. "Dry hollow cough, with soreness in the chest, caused by tickling and mucus in the throat, with expectoration only at night, of acrid tasting mucus, which he cannot raise but has to swallow again." Jahr. Dr. Guernsey CLOTHING.-COUGH. 85 says: "Cough, after getting warm in bed, or after recovering the natural warmth from a colder state, cough relieved by a cold drink; spirti-g of urine with the cough." The larynx seems to the center for the action of causticum, notwithstanding it also affects all the respiratory organs. Cough is aggravated in the evening, and by getting warm. Relieved by cold air, Or taking a cold drink of water, and in damp weather. DRY. CHAMOMILLA. —Extreme- Through the cerebro spinal sysly impatient, cannot answer one tern Chamomilla acts upon the recivilly; pain makes hil:s furi- spiratory organs, producing a dry ons, andis out of patience with suffocative cough, that generally everybody; child is excessive- is worse at night and in children in ly fretful; must be carried all sleep. The predominating cough the time to keep him quiet; headstrong, even unto quarrel- of Chamoilla is a dry scraping ling; extremely sensitive to cough, with a snappish, ugly dispopain; one cheek red and the sition. other pale; severe flatulent Dr. Hirschel says: " Chamomilla colic, abdomen distended like is a grand anti-spasmodic, especially a drum; green watery diarin women and children. The pierheea, or like chopped eggs and spinach; nightly diarrhcea, ture of nervous bronchial asthma with severe colic, in children. is beautifully given in the symptoms; suffocative constriction of the chest as if the throat were throttled with constant desire to cough." In the first stages of cough in children, with over-sensitiveness of the nerves, this remedy exerts a happy influence. Aggravations at night, by anger, by cold air, especially a dry east and north wind. Relieved by becoming warm, and from warm drinks. MOIST. CHINA. —The system has This remedy is not what might been debilitated by the loss of be called a cough remedy, but for vital fluids, as blood, semen, peculiar states of the system it be 86 PULMONARY CONSUMPTION. diarrhoea, over-lactation, night comes a remedy of great value; for sweat and leucorrhcea; symp- instance,' in cases where the vitality toms aggravatedl every other has sunk very low, with great deday. The symptoms are aggravated by the slightest con- bility, and the disease is very dilatact; moving or touching the tory in character. Cough, when parts brings on intolerable the head is low, it must be raised; neural gia; long-lasting, con- violent cough after eating; cough gestive headache, with singing with jelly-like expectoration. Dr. and roaring in the ears; enormous distention of the abdo- Meyhoffer says: "China would be men with gas; diarrhoea of sadly missed, if not at hand in undigested food; debilitating chronic bronchitis with loud coarse night sweats; symptoms are rattles, great debility and weakintermittent, ness; anmemic and edematous swelling of the lower extremities. It is often the natural successor of arsenic." Baehr says: " China is indicated if the pulmonary affection seems to constitute the whole difficulty; but still more, if it commences with the symptoms of a severe hyperaemia of the liver, and if the patients very soon show a cachectic appearance. It is well known how often pains in the liver constitute symptoms of tuberculosis." Marcy and Hunt say: " It not only prevents destruction of nerve tissue, but, by its well-known effects on the functions of nutrition, contributes greatly to the reparative process. It may, therefore, be regarded as the great conservator of the nervous system in conditions of febrile excitement or nervous prostration. Drs. Kidd and Gedham spoke most highly of the results they had obtained from the pure tincture of china in the advanced stage of. phthisis. The power of China and the Sulphate of Quinine in arresting the destructive metamorphosis of tissue is only beginning to be appreciated." If the great symptom of exhaustion from loss of fluids be kept in the mind, it will bring the use of China in the last stages of cough to hold up the patient. Aggravations: in the evening, in damp, cold weather; from touching the parts; from eating and drinking, and lying with the head low. CLOTHING.-COvGH. 87 3110IST. C:HELIDONIUM. ConCHELIDONIUM. - Con- This is a trump card for acute stant pain under the lower inner angle of the right shoulder. cases of cough, with the lungs filled Long continued cough with the with mucus, from paralysis of the lungs filled with mucus; Pneu- vaogi, accompanied with mnany bilmonia of the right side, where ious symptoms and great desponthere is a great deal of mucus; deucy; agg ravat ions earl Many liver symptoms with the m in cough. mo DRY. CONIUM. —Sad, despondin, people; great vertigo, parin ole; geat vertigo, pr- This is one of o ur most valuable ticularly when lying down, and when turning over in bed. remedies in dry, teasing, spasmodic Much difficulty in voidingo cough, lasting a long time after lyurine, it flows and stops again ing down at night. The coniuml repeatedly, during urination; cough is always dry and greatly in women there is great ten- argravate by lit air.. Hirsderness of the breasts preced- 0 a ing menstruation, very painful chel says:' Its action takes in orin walkingl or the least jar. ganic metamorphosis. Its cough is Nocturnal, dry, hard spasmold- periodic, dry, caused by an itching, ic cough, greatly aggravated scraping titillation in the throat, or by lying downt. Yellown skin; under the sternum; short convulsive cancerous. scrofulous people couOh, excited by horizontal posiwith indurated glands; cough couh, exite by horizontal posiwith great irritation of the tion, speaking or laucyhiny. The two bladder. latter exciting causes of the cough are decisive for the choice of the remedy.'Thle irritation of the cough is seated in the trlachea or upper bronchi. In whooping cough it suits towards the end of the nervous stage, after Drosera, when speaking and laughing cause paroxysms, whose power and duration are already broken. Ini nervous bronchial asthma it shows good effects and certainly brings alleviation in organic cases." Its action on the laryngeal nerves and larynx is strongly marked in the provings, and has often been confirmedl in practice; its action on the lungys is less marked. Thie conliul COUGH. 89 chest. Especially indicative are the spasmus glottidis, the protrusion of the eyes, cyanosis and redness of the face, and the bleeding from the mouth, nose, and ears. In nervous asthma, with cough or spasms of the glottis, hoarseness, ringing turns of coughing, cyanosis, spasms of the respiratory muscles, abdominal breathing, cold perspiration, small pulse, convulsion during and vomiting after the attack." Aggravations, day and night, by inhaling cold air, and during north and east winds. Relieved by swallowing cold water. MOIST. DIGITALIS.-A very slow This remedy has a special action pulse or intermittent, never upon the vagi; its functions are inrapid, but excited by the least moemnt aasterferedwith, the bronchial mucous movement: anasarca and dropsy, in organic diseases of membranes become loaded with muthe heart. Exceedingly pros- cus; and we have a moist, loose, trated after coughing; cough rattling cough, with an abundance after eating, with vomiting of of mucous expectoration; cyanotic food. symptoms in the face and sensation of an excessive determination of blood to the lungs, which produces difficulty in breathing. Baehr says: "Digitalis is particularly adapted to galloping phthisis with intense hectic fever from the commencement; the patient complains of palpitation of the heart, coughs up blood frequently, has no appetite; the cough must not be dry; bowels constipated, and the pulse is exceedingly quick. Dig. is the most reliable remedy to moderate the hectic fever, but the dose must not be too small, nor should it be exceedingly large, because large doses are apt to excite the patient." I am in the habit now, of using nothing but the active principle, Digitaline in the third centesimal; it acts like magic. Meyhoffer says: " Digitalis is one of our most valuable medicines in passive congestion of the lungs and chronic catarrh resulting from a weakened, dilated heart; irregularity COUGH. 91 cles, a great portion of the liquid passed directly into the lungs and by its mechanical irritation producedwhat he supposed to be tubercles; clinical experience does not corroborate Drosera's power of producing tubercles, and all such experiments where the medicine enters the air passages through force must prove abortive. Aggravations, in the evening, after lying down, and especially after midnight. DRY. DULCAMARA.-Cough,fromn This remedy in my hands has damp,cold atmosphere, or from never given any satisfaction and I getting wet have finally ceased to use it, but other physicians claim to have good results from it, Hughes says: "They have to cough a long time to expel phlegm, especially in infants and old people, from threatened paralysis in the vagi." A catarrhal cough brought on by cold, damp weather. This remedy ought to be one of the first to choose, judging from the experience of physicians of high standing in the profession. DRY. FERRUM.-The least emo- This element in the constitution tion, or exertion produces a of our tissues acts in the twofold red flushed face Face becomes character of pabulum and medicine. suddenly fiery-red,with vertigo, ringing in the ears, palpita- In the present state of science it tion of the heart and dyspnocea; is often impossible to determine the Anaemia, with great paleness exact limit where the nutritive acof the mucous membranes, es- tion ceases, and the medicinal begins. pecially that of the mouth; Strictly speaking, Iron is not what muscles feeble, easily exhausted from slight exertion. Loud we would call a true cough remedy bellows-sound of the heart but it is so valuable in peculiar from anaemia. Lienteria, stools states of the system that we class of undigested food without it among our most valuable reme 92 PULMONARY CONSUMPTION. pain! (Edematous swelling dies. Dr. Rueckert has giveni us of the body, constant chill- an admirable picture of its indicainess; evening fever similarto tions. He says: hectic. Hoemorrhagic tendency. hectic. orrhagic tendency "1. Relaxation and weakness of Diseases,coincident with dropsical conditions,coldness of the the entire musculature and emaciawhole body, especially nights. tion, weakness of digestion, coldness of the extremities. "2. Anaemia under the mask of plethora and congestion, accompanied by a whitish color of the mucous membranes. " 3. Pulmonary tuberculosis, especially in young florid subjects with a remarkable erethism of the vascular system, inclination to congestion towards the chest. But we will remind here of the property of Iron, in larger doses, to occasion hsemorrhages, a reason for which allopathic physicians do not give it in tuberculosis with inclination to hasmorrhage. "4. Aphonia, very distressing. "' 5. Chronic, watery diarrhcea in children, usually soon after eating and drinking, without pain and effort, mostly containing undigested substances. "Iron is the remedy also indicated after previous abuse of Iodine (likewise after arsenic and china), and what scrofulous patients have not already been overfed by Iodine ( or a compound thereof ) when they are transferred to us from allopaths." Dr. Meyhoffer says: " Iron ( acetate or perchloride)-Dry cough, from vascular congestion, with difficult and oppressed breathing, diminished or rough vesicular murmur and fine sibilant ronchi, spitting of blood or bronchial haemorrhage. Small weak pulse; palpitation of the heart on the least muscular exertion, deficient gastric secretion; the food lies heavy on the stomach; bowels relaxed and discharging undigested food; suppressed menstruation or profuse flooding." The cough of Iron predominates dry, but in the morning the expectoration may be copious, either mucous or purulent matter, with oppressed, short breathing, worse in cold air, and better in warm air. COUGH. 93 Dr. Pope says: "The cases in which Ferrum is especially valuable are those in which " the patient is usually between twenty and thirty years of age; family history is free from any hereditary taint or tubercle; he is of a sanguine temperament, of a florid complexion, with an active circulation, and an easily excited nervous system; the disease has been excited by neglected catarrh, causes which originated mal-nutrition with frequent inflammatory attacks upon the pulmonary organs; epistaxis, hemoptysis, headache, congestions in various parts, easily excited; hectic fever runs high, and the loss of strength is very rapid, there is dyspncea, vomiting of food, or lienteria. For this form of phthisis Dr. C. Mifller very confidently recommends the Perchloride of Ferrum, in doses of one to three drops, of the first to the sixth decimal dilution. Marcy and Hunt prefer the Pyrophosphate in the third trituration; this latter is my preference also. In conclusion, we would add the practical remarks of Dr. C1. Miiler: "Cough, dry at night in bed, loose, and more frequent when walking; chest painful above and behind the sternum, with burning after cough. The cough is appeased by eating. The night cough is most oppressive, and sometimes attended with spitting of blood; at other times, this occurs on rising in the morning. Tobacco and brandy cause aggravations, or increase the muco-purulent expectoration; dryness in the chest, but transiently relieved by drinking, with copious secretion of mucus. Shooting pains, and a sense of' tightness between the shoulders, impeding movements of the joints. Shooting and tearing in the shoulder joints, the chest feels full and tight,with sanguine congestion; painful oppression which obliges one to be seated, and sometimes amounts to a constrictive spasm; the respiration is noisy, as in sleep; the breathing, slow and painful, is ameliorated in walking, or in speaking, and when most preoccupied in reading or writing; it is most troublesome when in bed, and in the evening; the pains are worse after eating, I cannot better characterize the sphere of iron in phthisis, than in affirming its indication by those very states in which allopathists have found counter COUGH. 95 MOIST. HEPAR SULPHUR Great After the first stages of a cough disposition to takecold; sweats have passed, and we commence to day and night without relief, have a loose, hoarse, rattling cough, especially about the chest, with especiallaboutthchestwith no more useful remedy in the maa sour smell; cannot bear to be teria medica can be found. Dr. uncovered; coughs when any part of the body is uncovered; Hirschel says: " Hepar sulphuris suppuration inevitable; second suits those cases which are so far stage of cough, after it has be- advanced by Acon., Bry., Brom., come loose; hoarse, rattling Merc. Iod., or Spongia, that they croupy cough; laryngo-tracheal croupy cough; laryngo-trachel have passed into the stage of rescatarrh with much hoarseness; great sensitiveness to cold air; olution. abuse of mercury. It is our most important remedy where, in acute forms, this resolution has been prepared, or in moist coughs, resting on a catarrhal or organic base, in the upper as well as in the lower respiratory organs. In croup, as well as in pneumonia, it can only be indicated in the second stage. It suits tuberculosis far less than cheesy and chronic pneumonia. It may also be indicated in gastric and intestinal catarrhs or complications, or in sympathetic cough, or in such ones extending from inflammations of adjacent parts of the mouth and fauces. Hoarseness, scraping irritation in the larynx or in the lower parts, mucous rales, are important indications for this remedy, acting on the plasticity of these processes." Dr. Guernsey says: "Hepar sulphur-Rattling, choking cough; it seems as if the patient would choke in coughing; in croup, whooping cough, or in catarrh, usually worse towards morning, and after eating." Dr. Holcomb says: "When there is hoarseness and soreness 6f the chest, and a cough moderately moist and then dry again." Marcy and Hunt say: "Hepar is an important specific for the following characteristic symptoms; anxious, hoarse, and wheezing respiration, much aggravated on lying down; attacks of suffocation, which force the patient to throw the head 98 PULMONARY CONSUMPTION. Aggravations at night, especially when lying down; by cold air, and by eating and drinking. Relieved by sitting up, and warm atmosphere. DRY. IGNATIA.-Diseases brought Cough in patients who are sufferon from deep grief, with much ing from suppressed grief, where sighing, and sobbing; cannot there is not much organic disease sleep from deep suppressed of the air passages. They may be grief, entirely absorbed in grief; faint, all gone feeling termed a hysterical, spinal reflux in the pit of the stomach (so..- cough, always dry in nature. Iglar plexus); hysterical element nIatia will be of much service. Dr. predominates; excessive flat- Hirschel strikes the true key for its ulence; convulsive twitching; use when he says: "Ignatia is only symptoms change often from joymptoms c hange often from suitable for coughs of central orijoy to sadness; dry, bard spasmodic cough (globus hysteri- gin, as from spinal irritation (hysCus). teria), or where hysterical persons, catarrhal, laryngeal, and tracheal affections take on a nervous character. Perhaps, also, in bronchial asthma, angina pectoris of such patients; the cough is tickling, dry, as from dust or sulphur-vapors, constriction in the pit of the throat, with the globus hystericus and similar symptoms." Dr. Guernsey says: "Ignatia has a very troublesome cough, usually dry, arising from some irritation in the pit of the stomach. Aggravations. Like Nux, the symptoms are aggravated by contact, motion, open air, mental affections, anger and grief. Relieved by changing position, and in warm air. DRY. Iodine. Remarkable sense The physiologico-pathological of weakness and loss of breath centre for the action of Iodine is in going up stairs; low cachectic, scrofulous people; in upon the glandular system. Small women, great emaciation of doses increase their secretions, and the mammoe, with copious sometimes intense salivation has COUGH. 99 menstruation, or long lasting followed its exhibition. Atrophy uterine hemorrhages; enlarged of the mammse and testes are promglands, especially the thyroid. Dry cough predominates. Dark inent symptoms of Iodine. Its hair and eyes. specific action upon the thyroid gland and upper portion of the air passages, are very marked and prominent, and of great practical utility. Dr. Hirschel says that "Iodine, Bromine and Spongiahave this in common; that they especially cure the affections of the upper parts of the respiratory organs; that they correspond to dry cough, if of catarrhal, inflammatory or organic origin. All are deeply penetrating and reliable remedies. Spongia might be considered the most volatile and dynamic; Bromium is materially incisive, forcible, and helps quickly; Iodine is the strongest, but most slow in action. They are the chief remedies in the affections of the larynx and trachea (catarrhs, inflammations, especially croup, changes in texture); also in stenosis of the glottis. Iodine alone has also some relations to the bronchi, and even to the pulmonary tissue. According to the symptoms we find in Bromium dry, croupy cough with scraping titillation and hoarseness; the latter is a special indication for Bromium. Where small follicles are found on the posterior mucous membrane of the pharynx, extending from there to the larynx, and producing continued titillating cough, Bromium is specific; also in swelling of the mucous membrane of the fauces and pharynx. The larynx is painful to the touch. In Iodine the cough is also dry, croupy, with the well-known sound, with titillation; sensation of soreness in the larynx, barking, with gray or white, salty, sweetish expectoration; shrill whistling and rattling in the chest, sawing, hissing respiration and oppression. The subjective sensation of soreness and pain frequently extends to the upper third of the sternum. Hoarseness, difficult speech, expectoration of tough mucus. I have frequently witnessed from Iodine splendid effects in long standing laryngeal catarrhs with the above symptoms. It alleviates in tuberculosis; in croup it is our last anchor, where Spongia and Bromium fail. It is not an easy matter to select from these 100 PULMONARY CONSUMPTION. three remedies; each may be indicated according to circumstances. The more plastic the exudation, the more Iodine is indicated. Anatomically, we might say Spongia is more suitable for stasis, simple inflammation; Bromium for swelling and hypertrophy of the mucous membranes; Iodine for the exudation. Spongia, whose indications generally correspond to those of Iodine (whistling, short, dry, barking cough at night and also in the day time, with painful sensation in the larynx), is, in the main, the most important remedy at the outset of croup; frequently cuts it short, and acts specifically and in the shortest time in pseudo-croup, or in the closely related inflammatory or highly catarrhal forms; also in influenza. On account of its volatile action, it suits far less the organic and chronic forms of cough than the related Bromium and Iodine. Dr. Meyhoffer says: " The effort to give precise clinical indications for Iodine seems to us a difficult one, as the horizon of its curative action appears to widen with the progress of therapeutical knowledge of it. Though the pathogenetic phenomena of this metalloid are most extensive, they give a priori, in numerous instances, no clue to the vitalizing manifestations it operates in disease. For example, as regards the respiratory surface, we meet within the range of its salutary influence the dry, congestive catarrh, profuse bronchorrhcea and catarrhal pneumonia, with all the intermediary morbid conditions. Still one link exists which binds all these so contradictory symptoms together, and this is irritation. Torpidity and atony of the ventilating apparatus does not lie within its range." "Iodine has, in common with Cod-liver Oil, the property of being exquisitely adapted to delicate constitutions, with quick pulse, tendency to bronchial and pulmonary congestion, and haemorrhage. For the same reason it is also an excellent remedy for over-grown lads, with weak chest and dry cough, subject to spitting of blood and cardiac palpitation. The cough which this substance relieves is always more or less severe, he the. expectoration scanty or copious; fine or coarse COUGH. 101 rattles and sibilant ronchi give way to its influence. Swelling of the cervical and bronchial glands, nocturnal sweats, great weakness and progressive emaciation, notwithstanding a good appetite and regular functions of the bowels are important confirmative indications for the exhibition of Iodine. We use it in the third and higher dilutions; the Iodine of Potassium from the first to the third. The latter appears to act better when the affection of the air-tubes is connected with or complicated by rheumatism." Dr. Baehr says: " Iodine is undoubtedly one of our most important remedies in confirmed phthisis; it only suits, however, after the expectoration has become purulent. This remedy effects more frequently than any other, curative results, provided we do not obstinately insist upon giving only small doses. Iodine 6x. sometimes has a good effect, but Iodine 1x. is often indispensable; nor need any unpleasant effects be apprehended from the use of such large doses. Iodine is more particularly indicated if tuberculosis is the result of scrofulosis, in the case of young and robust individuals; if diarrhcea is present, Iodine does not act favorably as a rule." " Chronic catarrh of scrofulous and mercurialized individuals, or remaining after croup or other acute affections, or complicated with chronic pharyngeal catarrh, are affections lying within the range of Iodine. The most prominent symptomatic indications are the following: Disposition to take cold, and long duration of the acute stage; the larynx is painful when pressed upon; burning, sore pains in the larynx confined to a definite spot, felt especially during cough; embarrassed respiration; wheezing inspirations, causing real attacks of dyspncea, especially at night; a good deal of hawking, with difficulty in bringing up tenacious mucus; a high degree of hoarseness, even aphonia; tickling in the larynx frequently causing paroxysms of cough without expectoration, or else with scanty expectoration of a tenacious mucus, sometimes mixed with streaks of blood. The general organism is very much affected by the disease. The presence of ulcers points more particularly to Iodine." COUGH. 103 During the vomiting the face assumes a bluish hue, and bleeding from the nostrils may take place. A slight degree of spasm of the glottis is not unfrequent and there may be convulsive twitchings or even spasmodic rigidity of the body of the child. Sometimes in spite of the mucous rales the cough is dry; though, as Baehr remarks, this is certainly not according to its physiological symptoms. As to the dose, Dr. Meyhoffer remarks that a low dilution is essential to obtaining prompt relief, and Baehr remarks that, at any rate, we know from experience that a smaller dose than a grain of the second trituration does not produce a reliable effect." I have used the remedy extensively and have had excellent results from the twelfth decimal trituration of the root which is a very different thing from the twelfth dilution of the tincture. Baehr says: " If the cough had lasted for some time and been neglected, the indications for Ipecac are tolerably precise and unmistakable. If, instead of the usual tenacious and scanty mucus, a large quantity of simple catarrhal mucus accumulates, so that the cough is preceded and accompanied by loud rales; if every paroxysm of cough is attended with vomiting, not at the end, but at the commencement; if a paroxysm is excited by the ingestion of every trifling quanti.ty of food or drink, Ipecac deserves a preference over every other remedy." Aggravations at night, also in the morning, by exertion; in the warm air of a room, and on stepping into the open air. MOIST. K KALI BICHROMICUM.- For sub-acute and chronic tedious Cough, with expectoration of cases of cough, where the large tough, stringy mucus; inflam- bronchi, trachea, larynx and fauces mation of the pharynx and are involved; where the cough fauces, parts smooth and red; adapted to the second stage, seems to be loose, and what is exadapted to the Second stage, especially in tedious cases, pectorated is very sticky and ropy. where the mucus appears to Dr. Meyhoffer says: "Inhalations 104 PULMONARY CONSUMPTION. be loose, but it sticks to the t and the internal use of Kali bi. form parts very tenaciously, and can our standard course of treatment in be drawn out in long strings; those numerous cases of common chronic catarrh of the nose and bronchitis vacillating between the fauces; light hair and eyes. acute and the torpid inveterate character of the disease. A certain degree of irritation, vascular congestion, and moderate muco-purulent expectoration marks the morbid state ready to give way to the specific working of this salt. Inhalations, however, do good service in bronchial dilatation with fetid breath and expectoration. The sputa soon undergo a favorable change of aspect, while they lose at the same time their offensive odor and diminish in quantity. If the catarrh be attended by periosteal, or rheumatic pains of a chronic character, all hesitation as to the selection of this medicine must subside." Dr. Hirschel says: " Kali bi., with its dry, titillating cough, expelled at short intervals, and ulcerative pain in the larynx, is related to Bromine, Spongia and Iodine, but suits better medium and tedious cases. Its characteristic symptom is a smooth or follicular inflammatory redness of the pharynx and fauces." Dr. Lilienthal says, speaking of croup: "Suits best fat, chubby children, onset gradual and insidious; constant hoarse voice; cough at intervals, hoarse, dry, barking, metallic; deglutition painful; tonsils and larynx red, swollen; covered with false membrane, difficult to detach, with expectoration of tough, stringy mucus." Dr. Nichol says: "Where the sputa is difficult and tenacious, and comes up in long strings of opaque white mucus, the preference should be given to Kali bich. This indication of Kali has been verified over and over again, and we owe it to Dr. Drysdale." Baehr remarks: " Very seldom, however, a favorable effect will be witnessed in cases where emphysema has already set in, for this reason the remedy is better adapted to chronic catarrhs of recent origin, that had taken the place of acute disease, than to inveterate cases." COUGH. 105 Dr. Guernsey says: " Kali b. cough, with expectoration of tough, stringy mucus; it sticks in the throat, causing a choking sensation, sticks to the tongue, teeth and lips, and in attempting to remove it from these parts, it will be drawn out into long strings." Aggravations, after eating, on awaking, and on inspiration. DRY. KALI CARBONICUM.- For old, very hard, chronic, dry,. Cough brought on from cold racking coughs, with stitching and damp weather; very vio- pains in the chest and back; worse lent, mostly dry cough, com- in cold, damp weather, or brought. mencing at 3 A.M.; if mucus is dislodged it is not raised, but on by cold and damp, and agfallsbackinthe stomach; severe gravated about 3 A. M., Kali stitching pain is the most char- carb. is the remedy. Dr. Meyhoffer acteristic symptom of this re- says: "Kali carb., in a very low medy; all the symptoms act re- dilution, proves a useful auxiliary gularly worse about 3 A.M.; in those chronic forms of bronchitis swelling over the upper eyelid in the morning, looking like a which only fall under the physilittle bag; chronic organic cian's observation when cold and coughs; acts on lower portion damp have induced vascular irritaof right lung. tion. A severe, sometimes spasmodic cough, torments the patient day and night, and the effort to bring up a few lumps of grayish mucus often deter — mines retching and vomiting. The breathing, usually easy,. becomes difficult and labored after the frequent paroxysms of coughing. The general health of such persons is good, the nutrition nowise disturbed, and should they belong to the working class, they do not even leave off their employment during such attacks." Dr. Rafka says: " Kali carb., 6x, is indicated by a dry titilla — ting cough, with stinging in the larynx, pains in the chest, choking, violent headache, exhaustion after the attack, which commonly sets in at night, is useful for titillating cough during, the menses, and in incipient tuberculosis." 8 106 PULMONARY CONSUMPTION. Aggravations, at night, especially after midnight, on motion; by cold damp air, or becoming cold; while eating; from deep inspiration and from lying on the side. Relieved by warm dry air. MOIS T KALI BROMATUM.-Not Having never used this remedy -much cough, but great hyper- for cough frequently enough to secretion of muco-purulent form a correct judgment upon its matter, with dyspncea; great merits, I will give the practical depression of the nervous cen- experience of others who have used tres, with loss of memory and it. Dr. Meyhoffer says the "Bromgeneral lethargy; inertia of the genital organs; great atony of ide of Potassium, somewhat resemthe larynx; confluentacne; ner- bling Iodine in its action upon vous spasmodic cough; chronic scrofulous diseases, differs, how-.and sub-acute cases. ever, as much from it as sub-acute:inflammation does from passive congestion. We have experienced the efficacy of the Bromide in that form of bronchial catarrh which is characterized by almost total absence of cough, with great hyper-secretion of muco-purulent matter, and dyspncea caused by muscular exertion. The diminished or suspended reflex motor action of the bronchial nerves belongs especially to the pathogenesis of Bromide of Potassium, and unless the larynx be involved in the morbid process, this salt will rarely bring relief." Dr. E. M. Hale, in speaking of croup, says: "But no remedy acts so promptly palliative in all cases, and curative in many, as the Kali brom. in spasmodic croup; the symptoms are at once arrested." " Whooping cough-the spasmodic action disappeared in about five days, leaving a simple bronchial catarrh. It removes the anxiety and the vomiting; improves the appetite, and increases the strength."-Dr.Beaufort." "Nervous Cough during pregnancy-threatening abortion; the cough was dry, hard and almost incessant; Opiuam, Bell., COUGH. 107 etc., were tried for two months, without benefit. Bromide of Potash, 30 grains a day, cured in a few hours." —D)r. Cerson. The spasmodic element seems to be a prominent symptom in the cough of Kali brom. DRY. KALI HYDRIODICUM.- The action of this remedy is Very fatiguing, dry, hard very similar to Iodine, especially cough; walking or going up in scrofulous swellings of glands, stairs causes great shortness of breath; syphilitic subjects, and goitre, hut differs in many with glandular swellings; points. Oppressive, dry, painful mercurial or syphilitic rheu- cough, frequently accompanied matism; syphilitic, aphthous with asthma, is the great sphere sore mouth; phthisis, with ex- for the use of Iodide of potash. pectoration of green mucus;-, Dr. Meyhoffer says: "The lower rheumatic pains in the limbs, Meyhoffer says: "The lower worse nights; very sensitive dilutions, 1st and 2nd, from four to the least cold air; old to eight drops daily, form one of syphilitic subjects; syphilitic our standard prescriptions, whenor scrofulous skin diseases; ever no special symptoms indicate asthma. the use of another drug. In glandular swellings it cannot be omitted. Dry, irritating cough, with scanty and rather frothy than mucous expectoration, or none at all; obstinate tickling and irritation in the trachea; prolonged expiration with sensation of tightness of the chest, and shortness of breath, are the leading symptoms for the selection of this remedy." Dr. W. H. Hitchman says: " Kali hyd. is beneficial, indeed, often of great service in those cases where there exists a considerable degree Qf irritation in the bronchial tubes, especially the larger channels, with hollow dry cough, day and night, but worse towards evening; or cough with scanty, viscid, ropy expectoration; heat in the chest; burning, tickling irritation in the larynx; quick, anxious, laborious respiration, with hoarseness; slight abdominal pains, often scarcely noticeable, but at the same time most insidious, dangerous, and fatal in their ultimate results. They are augmented by pressure; 108 PULMONARY CONSUMPTION. fulness and tension of the belly, particularly a deep seated tightness, as if the integument and muscles glided over the too tightly stretched and thickened peritoneum or serous membrane; coughing and deep breathing are painful, and there is feverishness with emaciation." Dr. Baehr says: "If the influenza left the patient with a troublesome cough and a gray, sweetish-salt expectoration; wheezing and rattling in the chest, IKali hyd. proved an admirable remedy. This remedy is likewise excellent for the remaining hoarseness or even aphonia, but should not be given in too small doses." Patient is very apt to have chronic nasal catarrh, excited and aggravated by cold; severe bone pains, where the bones are swollen; violent headache, with hard lupus. Most symptoms appear during rest, especially in cold damp weather, and are relieved by motion. Rheumatic pains are much better during motion. MOIST. KREOSOTUM. - Putrid In organic affections of the mudiseases, with great acridity of cous membrane of the bronchi, this the secretions; livid complex-is a remedy of great value. ion; disposition sad and irritable. CEdema and fetid sweat symptoms are very similar to those of the feet; paroxysmal moist of Pulsatilla, the distinction being cough, the lungs seem loaded this: the cases that are adapted to with mucus, but cannot ex- Kreosotum are more deeply seated, pectorate without long and have lasted longer, and if in the continued coughing. In women the menses are too frequent case of a woman, the menses are too and too profuse, and last too often, too profuse, and last too long, long. whereas in Pulsatilla, the menses are apt to be delayed and are too scanty. Kreosote is adapted to coughs that have passed from the dry, first stage, and the second stage has fully set in; the cough sounds very loose, the upper bronchi being loaded with mucus, but expectoration is very difficult. The cough has much of the nervous element about it, which makes. it paroxysmal in character. Marcy and COUGH. 109 Hunt say of Kreosote: " Constant, spasmodic, violent cough, accompanied by violent retching; the expectoration copious, mucous and purulent; the patient cannot lie down without great distress; stitching pains in the chest; bitter taste in the mouth; cadaverous breath; frequent greenish, watery diarrhcea; hectic fever; copious secretion of the mucous membranes, and abscesses which are excessively offensive in character, accompanied with depression of nervous power. In these conditions, says Dr Kurtz, Kreosote is much more effectual than Arsenic, which is usually prescribed,-(' Hygeia.')" Cough with pain in the chest and sternum compelling to press the hand on it; great sleepiness and profound sleep; frequent desire to take a deep breath on account of a sensation of heavings on the chest. Shortness of breath, with sensation of heaviness on the chest; stitches in the chest, above and in the region of the heart, with oppression of breathing, in the right side, extending under the shoulder-blade, arresting the breathing. The chest feels bruised, especially in the sternum.* Aggravation in the open air: morning and evening; by motion and from eating cold food. DRY. LACHESIS.-Very unhap- This remedy is more suitable py and distressed after sleep; to a neurotic, reflex-spasmodic throat exceedingly sensitive, cough, than to those with an orcannot bear the least touch of the finger; she cannot bear ganic base. any pressure, not even the Dr. Guernsey says: " Cough exclothes, upon the uterine re- cited by pressing, even lightly upon gion. Hot flushes atthe climac- the larynx; clothing must be removteric, with frequent fainting ed from about the part-its pressure spells. When anything touches the excites the cough. Coughas soon larynx the latter is not only as one falls into a sound sleep, often * " Dull pain under the sternum every morning when turning over in bed: hyperaesthesia of bronchial mucous membrane during bad weather, with occasional bloody sputa. The 30 x cured. "-DR. REYNOLDS. 110 PULMONARY CONSUMPTION. sensitive, but it is as though with choking, as if suffocation were it would suffocate him: touch- inevitable. In croup cough excited ing the throat causes a dry by a sensation, as if a crumb of bread hacking cough; dry spasmodic cough, worse nights, with a were sticking in the throat, or some choking sensation in the other substance, with frequent throat; greatly aggravated by hawking and swallowing." sleep; empty swallowing is Dr. Holcomb says: "Lachesis perfectly agonizing. acts beautifully for tickling, worrying night cough with sensation of a lump in the throat, sensitiveness of the larynx, and especially when after a long, dry paroxysm, there is suddenly a profuse expectoration of frothy mucus." Dr. Meyhoffer says; "Lachesis and Naja, always contribute to allay the harassing cough, secondary either to nervous palpitation or organic alterations of the heart. Deficient nervous influence of the par vagum, dilatation and fatty degeneration of the heart, constitute the sphere in which these poisons display their restorative influence. The contingent symptoms of the concrete morbid process must decide on the preference of the one or the other of these remedies. They are valuable auxiliaries of Arsenic, Phosphorus, and Digitalis, and when properly employed, contribute largely to maintain the equilibrium between the function of the heart and the capillary circulation." Aggravations after every sleep; at night; touching the throat or larynx; damp cold weather and from acids. MOIST. LYCOPODIUM.-Excessive This is a grand remedy for cough, accumulation of flatulence in the stomach and bowels: con- and greatly resembles Pulsatilla, stant sensation of satiety; the Hepar sulphur. and Kreosote. least morsel of food causes a The cough is loose, rattling, but a sensation of fulness up to expectoration not easy, sounds the throat; much borborygmus, very loose, but remains in the especially in the left hypochondrium; constant sense of fer- lungs very tenaciously. The spumentation in the abdomen, like ta is thick, yellow, or greenish. COUGH. 111 a pot of yeast working; ob- Dr Meyhoffer says: "A long time stinate constipation; great ex- was necessary to conquer my recess of lithic acid gravel in the urine, so much that the urine seems filled with it; cold dium, excited by the exaggerated clammy, night sweats; great laudations of its medicinal virtues disposition to take cold at every which I had been condemned to lischange of the weather; loose ten to; now I have, on the conrattling cough, with great trary, to guard against falling into difficulty in breathing during the paroxysm of cough: per- the same error myself. The fact spiration only of the chest and is, since I learned to appreciate its head, with great debility in efficacy in chronic pneumonia, I diseases of the lungs. Fan- have not failed to observe also its like motion of the aloe nasi. vitalizing influence in those forms of bronchitis characterized by copious muco-serous, or mucopurulent secretion. These morbid phenomena being habitually the result of more or less serious alterations, it follows that Lycopodium acts favorably in emphysema, dilatation of the air-tubes, and senile catarrh. Constant tickling cough, worse at night, numerous loud mucous rattles, with rare and scanty sputa, are symptoms lying especially within the range of its action. But the varieties of bronchitis above mentioned are often attended or complicated by the phenomena of abdominal vascular obstruction and atony of the alimentary canal or by those of the acid diathesis. The signs which arise in such circumstances, as congestion of the liver, flatulency, obstinate constipation, cachectic complexion, red gravel in the urine, and acid dyspepsia, are all within range of the influence of Lycopodium. Low dilutions of it are not ineffectual, but higher ones work better." Baehr says: "Lycopodium is suitable for old people, if emphysema and marked changes in the bronchial mucous membrane have taken place; there is constant tickling in the throat, loud rales with scanty or unfrequent expectoration of a gray color and saltish taste, nightly exacerbations. Usually lycopodium is indicated in moist mucous, or muco-purulent coughs, but Dr. C. Wesselhoeft has had fine results with it in dry cough, day and night, in feeble, emaciated patients, the cough being worse nights. COUGH. 113 ened, the patient raising a whole mouthful of mucus at a time, which in color is a light rust, not much unlike that of Bryonia, but not so thick, more stringy and easily separated, and if, in addition, there should be present "fan-like" motion of the alao of the nose. Lycopodium, 200th, will almost certainly afford relief within twelve hours."- C. Pearson, M. D. In prescribing Lycopodium its action on the digestive canal and liver should never be lost sight of. The dyspeptic symptoms, such as flatulence and constipation, are nearly always one of the most prominent indications for this remedy. " Lycopodium is a most effective remedy in obstinate cough, aggravated at night, with constant tickling in the throat, shown by the restlessness of the little patient, with constant handling of the front of the neck —loud rales with scanty expectoration, of tough salty mucus and grayish color. The respiration of Lycopodium is predominant with moist sound, while the respiration of Pulsatilla, Sepia and Silicea are marked by the predominance of the dry sound."-iT. Nichol, M.D. Aggravations, evenings from four to eight o'clock, and again at midnight; from exertion, lying down, from cold drinks, from deep inspiration and from high winds. Relieved, usually, in warm atmosphere, and warm food. DRY. MERCURIUS SOLUBI- This remedy is adapted to a dry LIS.-Symptoms greatly ag- cough, that is passing into a moist gravated at night, and in cold, damp weather. Spongy gums cough, after the primary symptoms damp weather. Spongy gums that bleed easily; salivation; have been nearly subdued by Acon., thick yellow coated tongue, Bell., or Bryonia, and is greatly with very fetid breath, aphthoe aggravated at night. In chronic of the mouth and fauces; en- bronchitis Mercury is also of great larged glands, especially those of the mouth. Much iaerspi- value where there is a copious seof the mouth. Much perspiration, that does not relieve; cretion of mucus, or muco-purulent jaundice; muco-sanguinolent expectoration with exhaustive night stools, or serous diarrhcea; sweats, &c. 114 PULMIONARY CONSUMPTION. high-colored urine; hectic Dr. Hirschel says: "How the fever. Dry cough, with rough- Allopaths, and more still their paness and burning down to the sternum, showing that the tients, are to be pitied, that their mucous membrane is inflamed; school should lack a knowledge of ropy sputum. mercurius (sol.,) as a cough remedy. Where is there a more certain, a more specifically-acting remedy for the appropriate kinds of cough of a catarrhal, inflammatory, organic nature, running from the fauces through the trachea and down to the finest bronchi, decisive in acute affections, ameliorating in the chronic, slime-loosening resolvent, restorative! Where roughness, burning, feeling of soreness from the fauces down to the sternum, hoarseness of voice, dry cough, raw, concussive, exhaustive, naturally exacerbated; sputum ropy, watery, spittle-like, nasty, bloody; catarrhal headache, coryza, diarrceha, fever, non-ameliorating night sweats-here is the real province of liercurius. Its place is somewhere after Aconite, before Bry., or Pulsatilla, or Hepar, or Tart. em.; also ushering in the turning-point, critically intervening, so that the last-mentioned may finish the affair. Mercurius is the sovereign remedy for bronchitis, and of the inflammatory bronchial catarrh." Dr. T. Nichol, speaking of capillary bronchitis, says: " Merc. sol. is an excellent remedy for this form of bronchitis. The cough is dry, racking and violent, especially in the evening and until midnight, and is excited by a tickling, or sensation of dryness in the chest, with expectoration of yellowish, tenacious mucus, sometimes tinged with blood. Each paroxysm of cough is preceded by anxious oppression, with hoarseness and coryza; violent fever, with disposition to perspire, without relief from it; the tongue is thickly coated, and the alternate chills and heat are succeeded by exhausting sweats. This remedy acts best in repeated doses of the fourth and fifth trituration, dry on the tongue." In chronic bronchitis, " paroxysms of cough at night, with coldness during the paroxysms and distress for breath; there is a good deal of yellow muco-purulent expectoration, or there is raising of sweetish or saltish mucus and blood; soreness and ulcerative pain, in the COUGH. 115 air passages, especially during the cough, and the cough may give rise to nausea and actual vomiting." One of the most prominent indications for this remedy is a constant alternation of chills and fever; the fever is often very high, with a remarkable sensitiveness to the most trifling changes of temperature; thick, yellow-coated tongue and diarrhcea, with great longing for icy cold drinks, although they aggravate the cough. In pneumonia Dr. Miiller says: "The hepatization of a portion of lung continues, and the critical sputa are entirely wanting; the cough is dry, not frequent, very rough and fatiguing, with violent irritation and urging to cough; the dyspncea remains unaltered, the fever is continuous and lentescent, with profuse and exhausting sweats; the urine is scanty and dim, the color of the skin sallow, grayish, the patient is troubled with gastro-intestinal catarrh. Under these-circumstances Mercury is indicated so much more if the disease is seated in a scrofulous or dyscrasic organism." Dr. Baehr says: "The selection of Mercury in bronchopneumonia may be justified by its admirable action in bronchitis; for it cannot be denied that the greatest danger proceeds from this quarter, and that, after the removal of the bronchial symptoms, the remaining pneumonia is comparatively insignificant. A third form of pneumonia, which is particularly adapted to ilercurius, is the catarrhal form or lobular pneumonia, which has an entirely different meaning from the former. As soon as we have reason, in a case of bronchitis, whooping-cough, etc., to suspect theformation of small foci of exudaation, Mercurius will first commend itself to our judgment as a remedial agent, and we shall have before our eyes an image of epidemic influenza. In tubercular pneumonia we have never noticed any good effects from Mercurius. "In Phthisis caused by syphilis, Hartmann says: "I have cured several cases of it perfectly. I commenced the treatment with several doses of Mere. sol., when syphilitic ulcers were still visible in the throat, extending deep down, involv 118 PULMONARY CONSUMPTION. cers in the mouth and throat; larynx and bronchi; in pneumonia fetid breath, parotid and sub- which tends towards phthisis; in maxillary glands swollen; maxillary glands swollen;t cirrhosis of the lungs and especially bloody saliva; complete aphonia; mouth full of fetid in chronic catarrhs combined with ulcers, affecting the fauces and angina pectoris or diseases of the nares; chronic looseness of the heart." bowels; urine smells like that Dr. Meyhoffer says: "Nitric Acid, of horses, extremely offensive; 3 3x and 6x in great irritation, redtake cold very easily; sensation as if a sharp splinter was ness and ulceration of the epiglottis being stuck into the affected and larynx, with difficult and painpart; colliquative night sweats ful deglutition, violent dry cough that are very offensive; great and nocturnal perspiration. The emaciation; constipation. inhalation of 5 or 10 drops, of the first dilution to an ounce of water, has mitigated rapidly the troublesome throat symptoms in tubercular laryngitis.' In syphilitic laryngitis, with hoarseness, aphonia, ulceration of the buccal mucous membrane, complete obstruction of the nose, or fetid yellow discharge,with nose inflamed and swollen; coryza; dry cough, etc., Nitric Acid is well nigh a specific." Dr. HIolcomb says: " Nitric Acid, 1st cent. trit., frequently succeeds with those obstinate, dry coughs, after Atropine has failed." Dr. Bayes says: " Nitric Acid is indicated in specific ulcerations of mucous surfaces, using 3rd dilution, but changing to lower forms if a favorable change does not speedily supervene; also in a certain form of chronic laryngeal cough, dry, with stinging or smarting sensation, as if from a small ulcer, generally felt on one side." Aggravations, in the evening by deep breathing, reading aloud, or talking, damp, cold air, or getting wet. DRY. NUX VOMICA. —Very irri- Cough that is curable with Nux table and given to scolding; Vomica is of recent origin, of a dry symptoms aggravated in the early morning, about 3 A. M.; scraping character, and not founded suffers much from dyspepsia, on an organic base, but of a simple COUGH. 119 especially those that live high, catarrhal nature, or of a reflex charor take intoxicating liquors; acter, from the digestive organs, or greatly troubled with acid. D stomach, constipation, and fre- spinal. Dr. Hirsehelsays: "Nux quently with haemorrhoids; Vomica has only a limited applicamuch flatulent colic, with in- tion in cough, especially where the effectual urging to stool; dry, pharynx and fauces are affected. racking cough, withgreat sore- The cough is scraping, rough, with ness of the stomach. irritation in the throat or under the upper sternal parts, with difficult expectoration of tough mucus, on awakening from sleep in the morning, renewed or aggravated by vomiting and eating. Dry coryza, influenza, or general simple catarrhs." Dr. Baehr has no faith in this remedy in acute bronchitis and pneumonia; but in chronic bronchitis he has some confidence in it, he says: "if the cough sets in with particular violence between midnight and morning, is dry, spasmodic, very persistent and racking, so as to cause pails in the bowels, is easily excited by a change of temperature, and is associated with a continual titillation in the chest and trachea; only in the morning, mostly after, very seldom before rising, a loose cough sets in, with easy expectoration of a simple mucus. While coughing a sensation of soreness and roughness is sensibly felt down the middle of the chest. The condition of the digestive organs greatly facilitates the selection of the right remedy. In contradistinction to Sulphur, Nux Vomica is much better adapted to comparatively recent cases without any serious complications, and otherwise more particularly suitable for patients with vigorous and otherwise sound constitutions." Aggravations.-After midnight and early in the morning; in the open air; by becoming cold; from motion and vexation. Relieved from warm air and warmth in general; in damp, wet weather, and from lying down. 120 PULMONARY CONSUMPTION. DRY. OPIUM.-Dry, teasing, tit- For a dry, spasmodic, teasing, titilillating cough, day and night, lating cough aggravated at night, of but especially at night; cough a cerebro-spinal origin, Opium will of a cerebral origin, especially be found of great value, but if deep fright;face swollen and purple with soporous sleep and ster- organic changes have taken place torous breathing; constipa- another remedy will have to be setion, stools composed of round, lected. hard, black balls; much per- Dr. Hirschel says: "Opium-Spasspiration that is cold and modic cough with continued dry, clammy; bed feels so hard he cannot lie upon it; frequent titillation, allowing no rest either by cannot lie upon it; frequent hot flushes. No pains are found day or night. In every other case, in the opium cough. as in the cough of phthisical patients, where it keeps off nightly paroxysms, it acts only palliatively by its narcotic quality; but for such a purpose strong allopathic doses are necessary."' Baehr says: " Never give opium in cough, with profuse expectoration of mucus, or it will tend to great dryness." " The desire to cough is followed immediately by arrest of respiration and blue face."- Guernsey. In the treatment of chronic bronchitis Baehr says: "It is erroneous to suppose that the narcotic effect of Opium suspends the desire to cough only for a short time, for there are many forms of cough where Opium only aggravates, and does not afford any relief, or affords relief only when administered in very large doses, to be followed afterwards by an increase of the cough. In our opinion Opium is admirably homceopathic to a spasmodic, dry, paroxysmal, titillating cough, which is especially tormenting at night, and has but a scanty expectoration. The fact that we have often cured a cough of this kind permanently by means of a few doses of Opium, entitles' us to the belief that Opium is something better than a mere palliative in this affection. In the later course of tuberculosis, after suppuration had really set in, we have obtained speedy and real relief by means of small doses of Morphine, one-twentieth, or one-fiftieth of a grain at a dose, COUGH. 121 nor have we ever hesitated to avail ourselves of the narcotic properties of this agent." Where Opium is indicated there is no pain attending the disease. Aggravations from brandy; anxiety; during sleep and especially at night. DRY. PHOSPHORUS. This is For deep-seated organic affections truly a lung remedy, and affects more favorably slender people of the air passages, with a rough, with fair skin, sanguine ter- short, tight, dry cough, Phosphorus perament and very sensitive is of inestimable value. Dr. Hirdisposition; deep-seated organ- schel says: "The indications for ic diseases, where death is in- Phosphorus in nervous cough are evitable; sensation of weakness and emptiness in abdo- similar to Opium, and may also be men; this distresses and aggra- compared with Belladonna and vates all the other symptoms, Drosera. In Opium one might say and is the ruling key for the the titillation is the chief indicause of Phosphorus. Stools, tion; in Phos., the cough is more slim, hard and dry, evacuated with great difficulty, looking tormenting. The irritation from like a dog's; diarrhoea, which Phosphorus is not so continuous as pours out in great quantities that of Opium. In Belladonna, like water from a hydrant, also, the cough is more mild-not so with a weak, gone sensation deeply seated. The similarity with in the whole abdominal cavity; Dr a consists hard, tight, rough, short, dry roser in this, that in cough; heat or burning in the both the cough comes in paroxysms back between the shoulders; with intervals. The cough in Phos. obstinate, profuse haemor- is cut off short; rough, short, dry; hages; cold feet and legs; cold, between every single coughing clammy sweats; emaciated p eople, who t ake cold very easi- sound is a short interval, which is ly and are very sensitive to wanting in the Drosera cough, cool air. where thev follow one another in quick succession; the cough does not begin with deep inspiration, but the expiration prevails; the patient keeps coughing when lying down, without any necessity to sit up for it, and the fit does not terminate with expectoration or vomiting 9 122 PULMONARY CONSUMPTION. of mucus, but ceases gradually. Neither does the Phosphorus cough come so apparently from the depth of the abdomen; the patients rather point to the upper or lower respiratory organs (larynx, bronchi, lungs). It is quite certain that in such nervous coughs Phosphorus is a grand remedy, hence its splendid effects in stenosis of the glottis, in coughs from bronchial asthma, in angina pectoris (cardiac cough). Phosphorus is of equally great value in catarrhal, inflammatory, or organic diseases of the respiratory organs. We find it everywhere in laryngeal, tracheal, bronchial, pulmonary catarrh up to inflammation, even in the most croupous form, or terminating in pseudo-plasmata and disorganization of the tissue. The painfulness of the larynx to the touch; the different pains, soreness, stitches, burning; the expectoration of foamy, sticky, purulent, salty, sweetish, brown, rust-colored, bloody mucus; the cough aggravated by speaking, laughing, eating, motion; hoaiseness and aphonia; shortness of breath and orthopncea; the great debility and prostration, the fever —all of them prove the deeply-penetrating action of this remedy, still showing its power in emphysema and tuberculosis. In a fit of coughing during measles, where the child for twelve hours steadily felt irritation to cough, and expectorated a little foam and blood, after all other remedies failed, a single dose of Phos. 2nd. stopped it permanently. In pneumonia it always remains our sheet-anchor, and it prevents in croup, paralysis and narcosis through the carbonized blood." C. C. Smith says: "Phosphorus.-Goneness in the region of the stomach; hoarseness and aphonia in the evening; tormenting cough, tight, and worse before midnight; painless diarrhoea; puffiness around the eyes; night sweat, especially during sleep; cough worse from eating and drinking; cough, with bursting feeling in head; aphthous patches on roof of mouth and tongue." "Especially when there is sensitiveness and dryness of the larynx, with a feeling as if it was lined with fur, and inability to utter a word, every effort to do so being painful; nervous COUGH. 123 exhaustion; suspected atrophy of nerve tissues."- W. H. Holcomb, M. D. Baehr says: " Phosphorus, according to our own experienc e is less adapted to phthisis as a whole than to single symptoms. It has to be used with caution, for no other medicine causes hlemoptoe as easily as Phosphorus. No other medicine disagrees so completely in the long run. The chief indications for Phosphorus are: continued hoarseness, with a distressing, dry cough, sore feeling in the larynx and trachea; pain in the stomach after every meal; also retching and vomiting of mucus; continual diarrhcea, which is excited by eating, and after every meal; excessive excitement of the sexual passion." Meyhoffer says: " Phosphorus will rarely much benefit the chronic catarrh of persons otherwise healthy; but it is admi — rably suited to the intercurrent acute or subacute attacks of bronchitis in emaciated, cachectic or young, overgrown inva — lids. The tendency to pulmonary congestion and catarrhal pneumonia, so often, under such circumstances, either the proximate cause or complication of bronchial irritation, are additional and important indications for Phosphorus. It is also one of our chief remedies in broncho-pulmonary catarrh resulting from dilatation or fatty degeneration of the heart. I am as yet unable to give an opinion as to the dose, the 3d and 30th having served me equally well." Dr. T. Nichol says: "Phosphorus is the principal remedy in bronchitis of any kind, when the inflammatory irritation threatens to attack the parenchyma of the lungs, and it is customary to administer it after the more acute symptomshave been subdued by Aconite. The cough is dry and hacking, with burning and tickling in the air-passages, and stitches in the chest. It is aggravated by speaking, laughing or drinking, and is followed by expectoration of a bloody and frothy mucus. There is also painful sensitiveness of the larynx, with hoarseness or complete aphonia. The respiration is loud and panting, indicative of great oppression, and the pulse is hard and hurried, or rapid and feeble. Phosphorus seems 124 PULMONARY CCNSUMPTION. useful in almost any dilution, but the 6th to the 12th seem to be the most successful." "In incipient as well as confirmed phthisis, in persons of meagre, slender form, fair complexion, and strong sexual feelings; when in the lower lobes and of an asthenic type, in children and young people (girls) of delicate constitutions, with dry, short cough, shortness of breath, great emaciation, tendency to diarrhcea, or perspiration, it is useful. It is no specific for phthisis, but acts usefully on certain states of lowered nervous energy." " Violent pneumonia with sticking pains in chest, excited or aggravated by coughing or breathing, also in pleuro-pneumonia, when they are violent and extend over a large surface, when.a large portion of the lung is inflamed, with dyspncea, the cough is dry, and the sputa rust-colored. Phosphorus is in many cases the only remedy, and it affords relief in four or eight hours. Give three drops of the third dilution every two or three hours." "Where the cough is not so loose and rattling as for Lycopodium, or so close and tight as for Bryonia, the secretion also being much less, but more profuse than for either Bryonia or Aconite, and in color somewhat like that of Lycopodium, but being of a more dirty appearance resembling pus but thinner, and when falling on any hard, smooth surface will break and fly like thin batter, Phosphorus 30th or 200th will remove the whole trouble with remarkable promptness." C. Pearson, M. D. Aggravations, cough day and night, but especially at night; from cold air, or from change of weather; and from motion or laughing. Relieved by warm air; in the dark; and after sleeping. MOIST. PULSATILLA.-Very affec- This is a grand remedy for the tionate females with blueeyes, second stage of catarrhal coughs, yielding disposition and easily not depending on an organic base COUGH. 125 excited to tears; symptoms the cough is loose, with copious aggravated in a close, warm mucous expectoration, accompaniroom; craves fresh, cool air; ed with great soreness of the episymptoms very changeable, symptoms very changeablastric region, and if in a female well one hour and sick the gastric region, and if in a female next; especially affects the urine is emitted at each cough. It posterior spinal nerves; has is apt to be very loose through the constant chillness, coldness and day, and tight at night. paleness of the skin; weeps Dr. Hirschel says: "Pulsatilla very easily, can hardly give is similar to Hepar; when given too her symptoms without weeping; always has a very bad early, even in the third dilution, it taste in the morning with will produce aggravation and renthickly coated, white or yellow der the cough dry after resolution tongue; sour stomach, from sets in. Pulsatilla, like Hepar, suits the least digression in diet, only moist cough with copious muespecially bad effects from coUs expectoration especially when rich, fat food; inclined to mucous diarrhoea, worse at night; yellow, whitish, salty, towards the women that are inclined to be end of catarrhs, or in chronic cafleshy, with delayed and scanty t4arrhs. Pulsatilla encroaches not so menstruation; loose, rattling, deeply upon the metamorphosis as hard, racking cough, that makes the stomach sore, and Hepar, and is, therefore, only a emissions of urine at every palliative in chronic organic cases. paroxysm of coughing. It is especially indicated for mucous rales, where asthmatic disturbances arise from the accumulation of phlegm (emphysema), with catarrhal irritation in the throat; amelioration in the fresh air; aggravation in the evening and at night. It is a specific in those cases where the cough is moist during the day, with dry, titillating cough at night in a recumbent position." " What could we do without Pulsatilla in presence of copious muco-purulent expectoration in lymphatic and anmemic females? There is no remedy which corresponds so well with the irregularities of function in the reproductive organs, as well as with the symptomatology of the bronchial affection, so common to this class of women, as the meadow anemone. Nocturnal paroxysms of dyspncea, gouty or rheumatic pains, flying about from one part of the body to another, worse at night, fix as characteristic symptoms to the selection of this 126 PULMONARY CONSUMPTION. remedy. I never used a higher dilution than the 3d." —MeyDr. T. Nichol says: " Pulsatilla is the leading remedy when hoffer. an attack of acute bronchitis threatens to assume a chronic form." "Pulsatilla is much more useful in chronic than in acute bronchitis, if the following symptoms prevail: Cough, principally at night, excited by itching in the trachea, with copious expectoration of mucus; the mucus is mostly white, but frequently mingled with yellowish or greenish lumps that impart to it an oily, offensive taste. There must not be any emphysema, whereas the presence of tubercles as cause of the disease points to Pulsatilla. Pulsatilla is next to indispensable in the bronchial catarrh of chlorotic patients which almost always, although not in every case, depends upon tubercles. If in the case of children, an acute catarrh gradually changes to the chronic form, Pulsatilla is a remedy of the first importance." Baehr. The cough of Pulsatilla is at first dry, but it subsequently becomes moist, with considerable expectoration of a saltish or bitterish phlegm, or of phlegm tinged with blood, or of a yellowish or whitish appearance. The cough is attended with stitches and pain in the chest, with soreness of the throat and palate, and it proceeds from a tickling, or itching in the larynx; or by scraping dryness in the trachea, accompanied with fatiguing pains in the abdomen, and stitches in the back, shoulders, side or chest, and it is relieved by rising up in bed. The racking cough exacerbates at night, and in a recumbent position, and is accompanied by rattling of phlegm, nausea, or even vomiting, and sensation of being stifled, with feeling of soreness or contusion about the belly, in the act of coughing. Hoarseness or even complete aphonia may be present, and coryza with yellowish, greenish and fetid discharge is not rare. Marcy advises the 1st to the 6th potency, but I have seen the best results from dilutions ranging from the 12th to the 30tl. COUGH. 127 Aggravations, evening till midnight; from warmth, especially a warm, close room; from lying down; from fat, rich food, and from tobacco smoke. Relieved, in the open air; by cold air, and in a cool place; by cold drinks: with head high, and by walking. DRY. RHUS TOXICODENDRON. For acute cases of cough, with -Coughs brought on by cold much prostration of the whole sysdamp weather; patient can- tem, and for dry, racking, hard, not lie long in one position, rheumatic coughs, greatly aggravahas to shift about constantly to obtain relief, which lasts ted at night, Rhus tox. will be found but a short time, when he has of great value. The case is apt to to move again; patient always take on a low typhoid form, where gets worse after midnight; Rhus is indicated. great stiffness of the limbs great stiffness of the limbs Rhus is in its place if the local before a storm; great lameness and stiffness, and pain on affection is so disguised by the confirst moving after rest; relieved stitutional disease that we rather by continued motion; fiery seem to deal with typhus complicared tongue; putrid taste, after ted with bronchial catarrh. The the first mouthful; has no use of the remedy is suggested by appetite; looseness of the bowels, worse at night, with great debility, a prostrate condition bowels, worse at night, with great exhaustion; involuntary of the whole organism, symptoms of stools; cough brought on by violent reaction, such as a rapid repeated drenchings in the rain; pulse, burning heat, dry skin and terrible cough, which seems as tongue, delirium, sopor; a short, if it would tear something out of the chest; brick-dust ex- distressing, dry cough, mostly at pectoration, raised with great night, and excited by motion, and difficulty; vesicular eruption by every little cold current of air; on the skin, with erysipelas. tickling and a feeling of dryness in the throat, down the trachea; the symptoms abate for awhile after a swallow of warm water or tea, but soon reappear again in the same degree, accompanied by tearing pains in the extremities, especially if they set in at the same time as the cough, in consequence of the patient being exposed to the influence of a damp and cold air, or getting soaking wet; the 128 PULMONARY CONSUMPTION. paroxysms occur in the night, attended with complete sleeplessness; the cough is complicated with coryza and frequent spasmodic sneezing, or in case of influenza, with typhoid symptoms."-Baehr. " Rhus tox.-Worse in the evening, at night, and with perfect rest. Symptoms lessened by rising from the bed and walking about. On the other hand they are aggravated by external cold, while frictions and warm applications relieve them. Though gentle exercise relieves them, they are aggravated by all rough movements or severe exertions." —Marcy and Hunt. "Acute catarrh; the nasal, laryngeal, tracheal and bronchial passages seem stuffed up; commencing at about sunset, with sneezing, and dry, hard, tickling cough; continuing very severe, until midnight, when all the sufferings are relieved; renewed next morning." —Dr. Boyce. In pneumonia, expectoration of brick-dust or bloody sputa, raised with great difficulty; accompanied with low typhoid symptoms. Aggravations, by cold bathings, or getting drenched with rain; in cold, damp weather; from taking cold after being heated. In the evening, until midnight, the cough is quickly aggravated by cold air, or uncovering a single part of the body, a hand or foot, and by drinking cold water or beer. Relieved, by warm air, and after having moved awhile. DRY. RUMEX CRISPUS.-Es- This remedy has a powerful and pecially acts upon the mucous specific action upon the larynx and membrane of the larynx and trachea, and for dry, hard, teastrachea. Violent and incessant, dry, fatiguing cough, with lit- ing, nocturnal cough, that is greatly tle expectoration, aggravated excited and aggravated by cool by pressure, talking and espe- air, Rumex will give the most comcially inspiring cool air, and at plete satisfaction. I cannot refrain night; cannot bear the cold from giving the precise and pracair, covers up the head to ex-. C. Dunham in ude it; sense ofexcoratiocal remarks of Dr. C. Dunham in clude it; sense of excoriation behind the sternum; complete this remedy. He says: "I have aphonia. used the Rumex chiefly in acute COUGH. 129 catarrhal affections of the larynx, trachea and bronchit. In these cases it seems to me to present a close analogy in its action to Belladonna, Lachesis, Phosphorus and Causticum. Rumex c. diminishes the secretions, and at the same time exalts in a very marked manner the sensibility of the mucous membrane of the larynx and trachea, exceeding in the extent of this exaltation any remedy known to us. The cough, therefore, is frequent and continuous, to an extent quite out of proportion to the degree of organic affection of the mucous membrane. It is dry, occurs in long paroxysms, or, under certain circumstances, is almost uninterrupted. It is induced, or greatly aggravated, by any irregularity of respiration, such as an inspiration of air a little colder than that previously inhaled; by irregularity of respiration, and motion of the larynx and trachea, such as are involved in the act of speech, and by external pressure upon the trachea in the region of the supra-sternal fossa. The subjective symptoms are: rawness and soreness in the trachea, extending a short distance below the supra-sternal fossa, and laterally into the bronchi, chiefly the left; and tickling in the supra-sternal fossa, and behind the sternum, provoking the cough; this tickling is very annoying and very persistent, and is often but momentarily, and sometimes only partially relieved by coughing. The cough occurs chiefly, or is much worse in the evening after retiring, and at the time the membrane of the trachea is particularly sensitive to cool air, and to any irregularity in the flow of air over its surface, so that the patient often c6vers the head with the bed-clothes to avoid the cold air of the apartment, and refuses to speak, or even to listen to conversation, for fear his attention should be withdrawn from the supervision of his respiratory acts, which he performs with the most careful uniformity and deliberation, and all in the hope of preventing the distressing tickling and the harassing cough which would ensue from a neglect of these precautions. I have frequently witnessed this state of things during the last three years, and have invariably given prompt relief with Rumex. In the group of remedies in which 132 PULMONARY CONSUMPTION. of the cheeks; croup, mem- it in a certain troublesome harassbrane difficult to detach; con- ing cough without marked inflamstant and incessant dry cough on lying down at night, relieved matory action, when you are uncerby sitting up. tain whether you are dealing with a chronic bronchitis or an incipient tuberculosis. I use the 1st centesimal trituration of the resenoid. I have been astonished at the power of this remedy in such cases. It has done me more good in pulmonary diseases than any other single remedy. Calcaria 200th, one powder before breakfast, and one powder of Sanguinaria 1st an hour or two after each meal, for chronic bronchial diseases, has procured me more reputation and business, than any other one prescription I have ever made." In moist cough he says: " Sanguin., 3d cent., trit. steadily persisted in for several days, will arrest this catarrhal disease in almost any of its forms, although when there is headache, sore throat, red cheeks, pains in the breast, offensive breath and expectoration; or symptoms threatening pneumonia, it proves of very great efficacy." Dr. C. C. Smith says: "Sanguinaria.-Emptiness of stomach, worse after eating, flushes to face, followed by hectic spots upon cheeks; constant tickling at entrance of larynx, causing constant cough, with a crawling sensation down behind the sternum; chest sore and painful to touch; hot streamings from chest to abdomen; cold hands and blue nails; breath and sputa offensive even to patient; extreme dyspncea; desire to take a deep breath, which is followed by intense pain in right side of chest, lassitude mornings, aversion to motion; stools predominantly loose; cough relieved by passage of flatus upward or downward; syphilitic patients." In pseudo-membranous bronchitis, Dr. T. Nichol places this remedy next to Kali bichromium, and finds it difficult to give the differential diagnosis between the two remedies. "When the sibilant rale predominates and the faint and almost absent mucous rale shows that the pseudo-membrane is closely adherent to the wall of the bronchial tubes sanguinaria should be given; should the sibilant rale be less violent and the mucous rale indicate a less tenacious membrane, Kali bi. 134 PULMONARY CONSUMPTION. MOIST. SENEGA. Profuse secretion of mucus in the lungs, "Senega has great power of aidwith loose, rattling cough; ing the expectoration of tough hydrothorax, ascites and an- phlegm in torpid states of the larasarca; sensation of trembling, yngeal and bronchial mucous memwith no visible trembling; brane, as we find it in old persons; great burning in the chest, ither before or after cough-, in lax phlegmatic constitutions and either before or after coughing; much pain and soreness in chronic catarrhal difficulties, in in the chest, worse during rest.' emphysema, in asthma senile, in bronchiectasis, in tuberculosis. It aids in removing the catarrh with long-continued coughing spells, or where in the hepatization of acute pneumonia resolution is tardy, or in chronic cases with cheesy infiltration." —Dr. Hirschel. " Constant accumulation of phlegm in the bronchial -tubes, with irritation in the bowels, tending to diarrhoea; the irritation may alternate from the chest to the bowels, and vice versa."-F. W. Ingles, M. D. "Twentieth day of pneumonia in a woman at fifty-six, right side, violent stiches, sinking of the strength, small, scarcely perceptible pulse, short, rare cough, without expectoration, great rattling of mucus in the chest, somnolence, dejected features. After the second dose of Senega, expectoration began, and recovery took place. In the same place it was also recorded that a parish doctor had saved the lives of about one hundred patients afflicted with adynamic pneumonia, with Senega. It is also said to be an excellent remedy in the mucous cough of old people who bring up a great quantity of watery mucus." —Dr. ilallenbach. " Senega has no small merit when, in copious accumulation of mucus in the air-tube, the latter causes by its adhesiveness to all the organs through which its passage lies the greatest, often the most ineffectual, efforts of coughing and hawking for its expulsion."- Dr. Meyhoffer. Aggravated, worse in the evening and at night, during rest, in a warm room. Relieved in cool air. 136 PULMONARY CONSUMPTION. owing to the multitude of symptoms, to present a characteristic group." —Baehr. " The cough of Sepia is sometimes dry and spasmodic, attended with nausea, and resulting in bilious vomiting, but is generally accompanied with abundant expectoration of greenish or yellowish matter, purulent or even bloody, and of a putrid or saltish taste. The cough exacerbates in the evening, and also in the late evening hours, accompanied by soreness and weakness of the chest, and a marked degree of dyspncea is present. Baehr points out that Sepia is not adapted to bronchial catarrhs, accompanied with bronchiectasis, emphysema, etc. Sepia acts best in the 30th dilution, and I have had fine results from the 12th trit." —Dr. T. Nichol. Aggravations, forenoon and evening until midnight, from cold damp north-east winds, and from repose. Relieved in warm, dry air. In chronic cough, sepia follows well after Pulsatilla. MOIST. SILICEA.-TDeep-seated or- No remedy in the materiaganic coughs; where the nu- medica controls the suppurative trition of the tissue is assailprocess equal to Silicea. In organic ed; great lack of vitality, cannot keep warm even when diseases of the air-passages, where walking; great disposition to suppuration has taken place, with take cold, even from the a suffocative, racking, loose cough, slightest draft of air; ten- with copious expectoration of dency to suppuration, has won- thick, yellow, greenish pus, accomderful power over suppuration, much perspiration upon the panied with hectic fever, great dehead and chest; children with bility and profuse night sweats, largeopenfontanelles and who this remedy will be our sheet wish the head covered up; anchor. rachitis, with slow dentition. Dr. T. Nichol savs: "Silicea is In women great coldness dur- particularly suitable for lymphatic ing menstruation; constipation; stools dificult; as the or sanguine individuals, and as a rectum had not power to expel remedy for chronic bronchitis, it is them; the stool recedes after only second to Sulphur." coyGa. having been partially expelled; Meyhoffer says: "I think it profuse, very fetid foot-sweat; hardly possible to overcome radidebilitating night-sweats etc.; caries of bones; fistulous ulcer- cally the catarrh pituiteux of ations; excessive debility. Laennec without the intervention of Silicea. In this form of bronchial disease no other agent contributes so largely towards recovery. Not less beneficial are the effects of Silicea in bronchial affections of rachitic children." Hughes thinks that Silicea may find its place in chronic bronchitis with puriform expectoration, while Teste coldly says: "Silicea is recommended in chronic bronchitis." Silicea is one of the principal remedies in obstinate or seveee cases, characterized by racking cough, with copious expectoration of transparent purulent matter. The cough is suffocative, with oppression at the chest, and aggravated at night, and is sometimes accompanied by sore throat, with loss of breath when lying on the back and when stooping. All unite in prescribing the higher dilutions, and Baehr says that "we have never derived any advantage from alcoholic attenttations, but always from the higher triturations." Marcy and Hunt say: " This remedy embraces most of the symptoms that belong to the phthisical dyscrasia, consequently it is a remedy of value for the constitutional condition in congenital or hereditary cases. The dyspeptic symptoms pecnliar to consumption are also nearly the same as under Hepar. The symptoms that show themselves in the respiratory system are: roughness and sore feeling in the larynx, with dry hacking cough, causing soreness in the chest; hoarseness with cough, suffocative night cough; excessive, continual cough, with discharge of translucent or bloody mucus; vomiting of purulent matter when coughing, ulceration of the lungs, discharge of clear, pure blood, with deep, hollow cough; the chest painful as if bruised; shortness of breath felt on walking or exercising; weakness and oppression of the chest, with chilliness of the surface; oppressive heaviness in the region of the heart and palpitation when sitting still." Aggravations, in the evening and at night; from cold air, from any single part of the body becoming cold; getting 10 138 PULMONARY CONSUMPTION. cold after sweating; change of temperature before a thunder storm. Relieved in warm air or a warm room. DRY. SPONGIA TOSTA.-Es- Spongia corresponds to affections pecially affectsthe larynx and of the upper part of the respiratrachea: dry,hard,tight, hollow, tory organs, especially the larynx croupy cough; great hoarseness; loss of voice; great dryness of and trachea. The cough is croupy, thelarynx; withhoarse, hollow dry, sibilant, sounding like a saw wheezing cough; symptoms driven through a pine board, each aggravated by lying down with cough corresponding to a thrust of the head low; goitre. the saw. Baehr says: "Spongia is characterized by a hollow, barking, dry, seldom moist cough, continuing all day, and likewise all night, in long-lasting distressing paroxysms; at the same time labored, crowing, wheezing inspirations, sometimes accompanied by rales. The remedy is most appropriate for children, more particularly if the disease set in as laryngitis and gradually extended to the lungs. It is an excellent remedy in croupous bronchitis." "Often the patient is quite convalescent, when on very slight exposure the cough returns with redoubled violence-the most pressing dyspncea, sibilant ronchi and violent convulsive cough. When this relapse occurs, Spongia is pre-eminently the remedy, even though it had not been previously indicated." Dr. Nichol. The first inflammatory symptoms should be subdued by Aconite. This remedy is not used as much as it ought to be in those hard, tough cases of what might be called dry bronchitis. There is an absence of inflammatory symptoms, but the patient has a terrible hard, dry, racking cough, slight expectoration and much dyspncea. The triturations will give the best satisfaction. 140 PULMONA RY CONSUMPTION. trachea, with scratching rising up into the throat; exhausting fits of cough, which produce a bruised sort of pain in the pit of the stomach; oppression of the chest when coughing; scraping in the throat, with greenish expectoration of a disagreeably sweetish taste, more violent in the evening before going to bed; hoarse speech; after every cough (with irritation in the lower part of the trachea) sore feeling in the chest and trachea; horrid cough, with expectoration and spitting of blood; yellow discharge from the trachea, having a putrid taste; salty expectoration; fit of asthma, short breathing and anguish in the evening, obliged to breathe hurriedly for a long time, until he succeeds in drawing a deep breath, when the shortness disappears."-Hahnemann. Aggravations by rapid motion, reading aloud, and at night. MOIST. SULPHUR.-Constant heat This remedy is the back-bone of on the top of the head; has on the top of the head; has our School, and but few diseases looks pretty which the patient can be treated without its aid, and,takes a fancy to; excoriation about all kinds of cough yield to about the anus and vagina; its power, but particularly chronic morning diarrhoea that drives bronchial catarrh,with excessive col-.the patient out of bed in great lection of mucus or muco-purulent haste, can't wait, must go to stool as soon as the desire is matter, with loose, rattling cough, felt; obstinate, chronic con- and easy expectoration, especially stipation, stools dark, hard and in the day-time. At night the mudry, expelled with great strain- cus is more tenacious and raised.ing, accompanied with piles with difficulty, but becomes easy that bleed much; all the sein the morning. Baehr says: " Sulcretions are exceedingly acrid, and excoriating; very faint and phur is utterly useless in phthisis, weak at 11 A. M., cannot wait and cases where it has done good for dinner; chronic hsemor- have been cases of chronic pneurhages; patient gets almost monia." well when it returns again and In chronic bronchitis, he says: again; great deal of burning in the palms of the hands and " Sulphur is undoubtedly the most COUGH. 141 soles of the feet; hot flushes important remedy we have in this with faintness; patient feels disease, because it corresponds to suffocated, wants the doors and suffocated, wants the doors and the worst and most inveterate cases. windows open; much rattling If emphysema is present, this remof mucus in the lungs; excessive sensitiveness of the edy may never yield any marked skin, every trifling change in results; even its palliative effect is the temperature causes an ex- questionable. Brilliant results acerbation, even if the patient may, however, be obtained in cases remains in his room; he is powerfully affected bycllanges of chronic catarrh of long standin the weather. ing, if the mucus is secreted in large quantities, or is very tenacious, and the symptoms point to a decided thickening of the mucous membrane. An eminent indication for Sulphur is the excessive sensitiveness of the skin, so that every trifling change of temperature causes an exacerbation, and that even if the patient remains in his room he is still powerfully affected by changes in the weather. Only this hyperoesthesia must not be caused by pulmonary tuberculosis; the tubercles at least must not be in a state of suppuration. What we have said shows that the symptoms may be distinguished in two series. The cough is either loose, the mucus easily detached, but only at times, so that at night, for instance, there is a good deal of dry cough, whereas in the morning and during the day the cough is moist. The expectoration is mostly white, compact, but mixed with a number of yellowish or green lumps, showing that the mucus had been secreted in the bronchia for some time before being coughed up; it has a foul taste and even a bad odor, and the accompanying hoarseness and sensation of rawness, show that the larynx and trachea have become involved in the pathological process. Or else the cough sets in in more violent paroxysms with considerable dyspncea, is dry and spasmodic, with wheezing in the chest; it occurs most generally late in the evening and in the night, and it is only towards morning or after rising that a tenacious glassy mucus is brought up after a slight coughing spell. The digestive symptoms and the condition of the liver, which generally appears very much enlarged in chronic catarrh, confirm the 142 PULMONARY CONSUMPTION. selection of Sulphur. It has always seemed to us that the triturations of Sulphur did not act as well in this disease as the attenuations prepared from the alcoholic tincture, and that, as a rule, higher potencies act better than the lower. Finally, we have to observe that in the case of decrepit, and more especially old individuals, Sulphur seldom does any good." Dr. Hirschel says: " Sulphur allows a far more extensive application in chronic forms; less, perhaps, by its specific relations to cough than by its vasomotory effect, and by its power of causing a reaction in the metamorphosis. It acts favorably where the course of the disease is slow, without coming to any decision in acute cases, as in catarrh or inflammation (Sulphur effectually developes hepatizations), as well as in chronic diseases of the respiratory organs and of the heart. Sulphur shows in the proving all sorts of coughs and different expectorations, but the constitution of the patient and the adjectiva of the disease give us hints for its selection. Wherever a dyscrasia is on hand, the physician remembers Sulphur." "Burning of the feet at night, with desire to uncover them; flushes of heat to the face; early morning diarrhcea; cramps in calves of legs at night, or in feet while walking; sudden arrest of breathing while turning over in bed; better while sitting up; sense as if the lungs touched the back while coughing; throat rough and dry, with burning; hoarseness in the morning."-Dr. C. C. Smith. " Great desire to cough, but is partially suppressed; does not amount to a full, free cough; in whooping cough."-Dr. W. H:. Guernsey. " Complete aphonia, with hoarse, suffocating cough, and smarting in the chest. Sulphur 10m. cured in two days."Wm. H. Holcomb, M.D. "Sulphur.-Dry cough with retching, vomiting and spasmodic constriction in the chest, chiefly in the evening, or at night when the patient is lying down; loose cough, with exipectoration of much thick whitish or yellowish mucus, some-,times only during the day, with dry cough at night; obstinate 146 PULMONARY CONSUMPTION. "Copious accumulation of mucus in the air-passages, deficiency of aSration caused by its presence, numerous moist rattles, severe spasmodic suffocative cough. Tart. emetic is more adapted to subacute than to chronic affections of the air-tubes; hence its frequent application in bronchial catarrh for children and aged persons. Infants especially sometimes exhibit in the course of chronic bronchitis sudden and alarming symptoms of suffocation, and mechanical irritation of the fauces is not always convenient or tolerated. In such cases a vomiting dose of this salt does much good and cannot do harm. A solution of one grain of the first decimal trituration to half an ounce of water, administered by teaspoonfuls every ten minutes, suffices to produce after the second or third dose, the ejection of the accumulated mucus. This proceeding is only to be adopted when a high degree of asphyxia demands immediate relief. Afterwards the 3d and 4th triturations act all the more favorably on the affected parts, as better oxidized blood contributes its share to an improved nutrition of the bronchial lilling.'"-Meyhoffer. In capillary bronchitis, "Tartar emetic is unquestionably the great remedy for this dangerous form of bronchitis, and all who have used it can endorse the recommendation of Dr. Hughes:' perfectly homceopathic to both the local and the general condition. I have almost invariably relied upon it singlehanded, and have seen desperate cases recover under its use.' Kreussler says that he has'found it very efficient in the last hours, when the patients struggled hard.' Baehr remarks that,' it is really the second stage of the catarrhal process which is adapted to the curative action of this drug,' but my experience is that it should be given promptly and without delay, as soon as the disease is diagnosed. Aconite is the only remedy which can compare with it in value in this disease, and Aconite has almost always been given in the earlier stages of the malady. It is indicated by severe spasmodic suffocative cough, with wheezing respirations and marked dyspncea; also by rattling cough which ends with vomiting of thick white' mucus: also when the cough suddenly ceases, COUGH. 147 from weakness or from other causes. The actions of the patient seem to show that he is suffering from oppression at the chest, and the mucous ronchus, indicating a very copious accumulation of mucus in the bronchial tubes, is one of the leading features of the case. This accumulation forms a mechanical obstruction to respiration, and accordingly we have a group of symptoms of carbonic acid poisoning more or less pronounced, great anxiety and agitation, pale and bloated face, coma or delirium with coldness of the extremities. Profuse cool sweat not followed by relief, and a disposition to vomiting and diarrhcea would be additional indications. The cough is aggravated by speaking, eating and the recumbent posture. Acts best in 3d and 4th triturations."-T. Nichol, M. 1). Aggravations, in the evening; in damp, cold weather, and from getting warm in bed. Relieved, in the open, cold air. VERATRUM ALBUM.- This is a special irritant to the The spasmodic element pre- vagus, and through it produces a vails in the cough. Cold sweat hard, l o ose spasmo dic cough, cons on the forehead; exhausting hard, loose spasmodic cough, consewatery diarrhcea, with cold quently is not called for until the sweat on the forehead; great second stage of catarrh has comdesire for cold drinks; great menced. irritation of the cceliac plexus, with fainting, great prostra- Baehr says: "Veratrum alb. is tion, nausea and vomiting, not often enough made use of in with cold perspiration; asth- bronchitis. It is not suitable in the ma, with suffocation, blue face, first stage, but on the passage into and anguish; second, or plastic stage of catarrh, with loosethe second stage, if mucus is serattling cough. creted in copious quantities which cannot yet be coughed up. This causes a constant titillation deep in the chest, with desire to cough; wheezing and coarse rales, but no expectoration; the depressing paroxysms of cough occur principally at night, with violent determination of blood to the head. The general failing of strength, the increased frequency or even irregularity of the pulse constitute additional indications for Veratrum, which is evidently suitable to old people rather than children." 148 PULMONARY CONSUMPTION. Hirschel says: "Just as Veratrum shows great similarity to Ipecac., in affections of the stomach and intestines, so also in cough. The titillation in Veratrum is only somewhat lower down, with a sensation of constriction in the throat; the oppression, the nausea, the vomiting of food and mucus is stronger after Veratrum, and the paroxysms approximate more to the forms of Belladonna or Drosera, with longer intervals. We might say, that in Veratrum the spasmodic element prevails; in Ipecacuanha the catarrhal one; thus the frequently decisive action of Veratrum in influenza, in simple spasmodic cough, in whooping-cough, next to Belladonna, Drosera, Conium, Cuprum, in nervous bronchial asthma, in stenosis of the glottis, or in angina pectoris." Aggravations, coming from cold into a warm atmosphere; growing warm in bed; change of weather; damp, cold weather; eating and drinking cold things, as water, ice-cream, &c.; morning and late in the evening. PRACTICAL EXPEDIENTS. DEMULCENT BEVERAGES, of Barley-water, Gum-water, Ricewater, or Toast-water often are of much service. They should be prepared as follows:Barley- Water.-One tablespoonful of pearl barley washed clean in cold water; then pour off the water and add the rind of one lemon, the juice of half a lemon, one teaspoonful of sugar; pour on one quart of boiling water, cover the vessel and let it stand two hours; then strain. If the patient desires, the lemon can be omitted, and sliced liquorice, orange-juice or currant-jelly used instead. Gum- Water.-Dissolve one ounce of clean gum-arabic, one half-ounce of white sugar, in one pint of hot water. If desired the juice of lemon or orange can be added for flavoring. This is often very soothing to the cough. Linseed Tea.-Take one ounce of bruised linseed; halfounce of sliced liquorice-root, to two pints of boiling water; macerate in a covered vessel before the fire, for three hours, then strain through a piece of muslin. This is a very soothing 150 PULMONARY CONSUMPTION. pressure on the top of the mouth inside, or by strong exercise of the will. Rosin. In loose bronchial coughs we have used inhalation of the fumes of burning rosin, with pleasing effects. A small quantity of the fine rosin is put into an old tea-pot and set on fire with a few burning coals, and the vessel set upon the patient's lap, when the fumes can be inhaled with great ease. Or it can be burned in a close room. I like the tea-pot the best, for pure air can be given the patient constantly, which cannot in a small, close room. Cavities in the Lungs. A peculiar method of treating pulmonary cavities in phthisis, pursued by Prof. Mosler, of Wiesbaden, is described as consisting in the injection of certain drugs through the wall of the chest, and leaving the canula in, so as to repeat the operation at discretion. He has even made an incision into the walls of the cavity, inserted a silver tube or elastic catheter, and succeeded in drawing away the secretion and in disinfecting the pyogenic walls by means of weak carbolic acid lotion. It is stated that no difficulty was experienced in the operation, and the condition of the patient was improved, the cough becoming less troublesome, and the febrile symptoms apparently moderated. One point, at least, is regarded as settled-and it is certainly of great importance -so far as could be by a few experiments of this character, namely, that the local treatment of pulmonary cavities is undoubtedly practicable, and that the lung is really more tolerant of external interference than has been generally believed." -American Journal of Homceopathic Materia-l edica, Vol. iii. page 414. ASTHMA.-This is a constitutional affection, consisting in spasmodic narrowing of the bronchial tubes, from contraction of the circular muscular fibres, with difficult expiration, great wheezing and dreadful sense of constriction in the chest. In the majority of cases, it is the expression of perverted nervous action (Neurosis), but not always a purely nervous disease. There are often organic diseases of the lungs, heart, ASTHMA. 151 brain or medulla oblongata, which produce the most obstinate cases of asthma, especially tuberculosis of the lungs. We believe the cryptogamic theory of hay-fever to be a phantasy. This autumnal catarrh is a constitutional affection, and no one can become affected by it, excepting those having this peculiar constitutional dyscrasia, and it requires no different treatment from common asthma. TREATMENT. This is one of the most difficult and trying diseases the physician is called upon to treat. Notwithstanding Homoeopathy can boast of some brilliant cures of this disease, medical treatment is often unsatisfactory and uncertain. Remedies for the Acute Attack.-The most valuable and first to be studied are Ipecac, Veratrum Viride, Digitaline, Arsenic and Stramonium. Second: Such remedies as Aconite, Acid Hydrocyanic, Ambra, Belladonna, Bryonia, Chain., Coffea, Cannabis Sat., China, Camphor, Gelseminum, Hyoscyamus, Lobelia, Lachesis, Morphine, Opium, Musk, Nux v., Pulsatilla, Sanguinaria, Sabadilla, Tartar Emetic, Tobacco and Veratrum Album. CHRONIC ASTHMA.-The most useful remedies are, Arsenicum, Calcarea Carb., Cod-liver oil, Ferrum, Glanderine, Iodine, Kali hyd., Lycopodium, Mercury and Sulphur. Second: such remedies as Argentum nitr., Aurum, Ammonium carb., Bromine, Causticum, Carbo veg.,Graphites, Hepar Sulphur. Kali nitr., Kali bich., Kali brom., Mercury, Nitric Acid, Natrum Mur., Phosphorus, Spongia, Sepia, Stannum, and Zinc. We will now give the leading indications of the most valuable of the above-mentioned remedies in alphabetical order. In this way we hope to be able to cover all kinds and cases of Asthma. ACONITE. —Great fear, and This remedy is more especially anxiety of mind, with nervous useful to subdue the acute attack. excitability; high fever, full Its sphere of usefulness is soon bounding pulse, and agonized passed. Cases that Aconite is 152 PULMONARY CONSUMPTION. tossing about; great fear of adapted to are young plethoric peodeath; sure he will die; ver- pie, with cerebral hyperoemia, actigo on sitting up in bed; companied with intense fear; conasthma brought on from change of temperature from gestive nervous asthma. Dr. E. H. warm to intenselycold weather; Ruddock says: "The striking dry cough. Sanguine, pleth- power of this great remedy in aforic people, who are very fections of the pneumogastric irritable and sensitive: symp- nerve, cha toms greatly aggravated at night, especially after mid- and labored breathing, has sugnight. gested its use in spasmodic asthma, during the paroxysms of which we have often administered it with marked and speedy relief. It is especially indicated by oppressive anxiety, dyspnoea, and labored action of the heart It is the best palliative in bronchitic asthma." Dr. T. Nichol says: "For the last fifteen years the writer has been in the habit of looking upon Aconite as one of the very chief of our anti-spasmodic remedies, and of late years the same view has been taken by some of our best writers." Hempel asserts that in " spasmodic Asthma, when resulting from exposure to keen wind, or from the retrocession of some acute eruption, acute nettle-rash, or the like, Aconite. will be found invaluable; the orthopncea of Aconite is equivalent to an attack of spasmodic asthma." Dr. Hughes says: "When the asthma is bronchitic, I agree with Drs. Russell and Blandell in considering Aconite the best palliative. It might have been added, that the remedy is curative as well as palliative. Aconite, then, is the appropriate remedy when the patient is of full plethoric habits, when the asthma results from a sudden cold; also in cases in which the attack follows the suppression of an acute rash. Oppressive anxiety, dyspncea and labored action of the heart are leading indications, and unless these are present, but little good need be expected from it. The cough often comes on at night, and is rough, spasmodic, croaking, as if the patient would suffocate, with hoarse barking voice, and spasmodic constriction of the chest and throat; respiration short, anxious ASTHMA. 153 and difficult, with open mouth and inability to utter a single word distinctly. There seems to be a constriction of the chest present, and as the spasm relaxes the expectoration is yellowish or blood-streaked. During the attack the patient is peevish, restless and irritable, and even in young children the characteristic dread of death is seen. The pulse is small, irregular and intermittent, and the heat of the surface is considerable. All dilutions have cured, but I prefer the triturations from the 4th to the 12th given in repeated doses." ARSENICU1[. —Rapid and For chronic organic cases Arsenigreat prostration, with sinking of the vital forces; burn- cum is one of the most useful re ing pains; the parts burn like medies we have for this trying fire; intense thirst; drinks lit- disease. My friend, Dr. T. Nichol, tle, and often; craves warm has given such a practical resum6 air; great anguish, restless- of its action in his article on " The ness, and fear of death; excessive restlessness, cannot lie Respiratory Affections of Childstill; relieved by motion; great hood," that I cannot do better than emaciation; cannot lie down give it in full. He says: "Opinfor fear of suffocation; highest ions differ very much as to the degree of dyspncea; sad and value of Arsenicum in asthma. Dr. irritable; anasarca of the Bags, whose bright book is one of whole body; obstinate nausea and vomiting; cadaverous the most readable that has appeardiarrhcea, with great enerva- ed of late years, says that'in asthtion; cold night sweats. ma I have seen occasional good results from Arsenicum, but have never seen it cured by this medicine'; while Dr. B. Baehr, whose great work entitles him to rank as an authority of the first class, avers that' Arsenicum is undoubtedly the safest remedy for asthma. It not only corresponds to the simple, spasmodic, uncomplicated asthma, but likewise to the secondary forms of asthma, which owe their existence to the most diversified affections of a more primary character.' Kreussler asserts that,' in cases of years' standing, Arsenic affords only temporary relief, although it is perfectly adapted to the severest of recent asthma'; while Ruddock, at least of equal value as an authority, says' that it is especially useful in chronic asthma;' and Dr. Hughes says 11 154 PULMONARY CONSUMPTION. that' Arsenicum is the best medicine where bronchitic asthma tends to become, or has become, chronic.' Dr. Laurie considers that in confirmed asthmatics, it forms a most important remedy. In my own practice I have repeatedly seen radical cures of both acute and chronic asthma with this remedy, though I agree with Dr. Ruddock that it is of especial value in the chronic form." Arsenicum is an invaluable remedy when the asthma results from.suppressed eruptions, and when it also attacks children of feeble and impaired constitutions. It is also of great service when the asthma-which is here merely symptomatic, not idiopathic-depends on disease of the heart, or upon pulmonary emphysema or cedema, or upon chronic bronchitis. Dr. Nuniez, of Madrid, affirms that Arsenicuni is curative in the nervous asthma, resulting from the suppression of dry eruptions, such as lichen on the palm of the hand. All experienced practitioners can confirm Baehr's remark, that, " in the asthmatic paroxysms of tuberculous patients, Arsenic has always left us in the lurch." Baehr says: "We dispense with the enumeration of individual symptoms, since every somewhat violent attack of asthma corresponds to arsenic." Baehr is one of the first minds in our school, and he has perhaps no greater admirer on this side of the Atlantic than the writer, but I most emphatically dissent from a statement which strikes at that individualization of cases which is the essence of homoeopathy. Is Arsenicum adapted to all cases of asthma, without exception? Surely not. If not, then we must diagnose the remedy as well as the disease. "The Arsenicum asthma, as a general rule, attacks fiercely and soon reaches its acme. The more the patients seem on the point of suffocating, the more painful and distressing the restlessness; the more wheezing and louder the respirations, the more Arsenicurn will be found appropriate."-Baehr. Laurie remarks that this remedy is indicated when the paroxysms of asthma are most liable to occur when retiring to rest, or before midnight, the patient being disturbed from ASTHMA. 155 sleep by a sense of spasmodic constriction in the chest and upper part of the windpipe, which is soon followed by laborious panting and whistling respir: tion, with gasping for breath. The respiration is attended with extreme agitation, restlessness and moaning; extreme anguish and exhaustions, as if at the point of death, with cold perspiration. The dyspncea is difficult and stifling, with suffocative attacks, recurring in paroxysms. The cough is frequent, dry, and exhaustive, and is attended with constriction in the trachea, and followed by suffocative fits. There is often an accumulation of thick phlegm, and the paroxysms grow lighter on the appear — ance of cough with expectoration of mucus or viscid saliva. There are also present violent palpitations of the heart, with small, quick, and intermittent pulse, together with dry, burning heat, alternating with cold perspirations. The prostration is extreme, and children who are old enough complain of the, well-known burning heat in the chest. The face is pale or bluish, with an anxious or desponding expression. The consequences of the paroxysm remain for a long time, and prostration and nervous debility are peculiarly prominent. The asthmatic paroxysm to which Arsenicum corresponds is excited by active exertion, even by getting into bed; by talking or laughing; by changes in tbhe atmospheric temperature, and also by warm or tight clothing. The paroxysm is aggravated by lying down, and relieved by sitting erect and by bending forward; to which Hartmann adds, that "the patlient cannot speak a word without making the asthma 2worse." Arsenicurnm is well known to be adapted to night paroxysms, but it is likewise suitable to attacks coming on during the day. As to the dose, Marcy says that " the first to the third trituration may be employed, regulating the repetition according to the urgency of the symptoms." Drs. Marcy and Hunt give still larger doses, and advise the exhibition of a preparation of Arsenic seldom used in Homceopathic practice, "the Liquor Arsenicalis, which is said to be much more efficacious 156 PULMONARY CONSUMPTION. than the Ars. album. It seems to be more prompt and energetic when Arsenicum is indicated. It should be prepared with distilled water instead of alcohol. The most efficacious and satisfactory method of treating asthma is with the Arsenical solution-1st dilution, and Kali hyd., first decimal trituration, in alternation, every hour or two, or three times a day, as circumstances demand. Baehr judiciously remarks: "During the apyrexia the remedy had better be administered at long intervals and in the higher attenuations, although the success which'old school' practitioners have attained with Fowler's solution, justifies the conclusion that massive doses are likewise conducive to a cure. The danger is that massive doses may affect the stomach injuriously. My own experience is in favor of the administration from the 12th trituration to the 30th dilution during the interval, giving the 6th to the 12th decimal trituration, during and immediately after the actual attack. I have had no experience with Fowler's solution." My experience with Fowler's solution has been so favorable that I do not hesitate to state, that it is twice as useful as the Arsenicum alb. I use the first three attenuations (decimal scale), and sometimes the pure solution in drop doses. Twice I have given the 1,000th (Tafel's) attenuation of Arsenicum alb., with immediate and lasting curative results. AURUM. -Great melanl- Chronic organic cases, with percholy; the mind constantly fect despair and loathing of life. tends towards self-destruction; " Where it is not certain whether utter despair; swelling, and the heart is primarily or secondarily exostosis of the skull-bones; involved in the attack, the attack nightly bone pains; syphili- sets in with violent palpitation of,tico-mercurial affections; oversensitiveness to pain and cold the heart, great anxiety and marked air; indurated glands; worse symptoms of pulmonary hyper.e-;in warm air and wet weather. mia. ASTHMA. 157 AMMONIUM CARB.- Organic cases. Hartmann says: Weak, nervous people, or lym- 4" Asthma with repeated palpitation phatic, venous temperaments. of the heart, considerable cedema of The mornent he falls asleep he the feet, and an asthmatic state is aroused again for want of breath; great hemorrhagesevery evening, continuing unt scurvy;worseevenings auddur- midnight, relieved by the open air; ing wet weather; anasarca; dyspncea with palpitation of the hydrothorax; bronchorrhoea. heart when moving; heaviness and burning in the chest, aggravated in wet weather, relieved by warmth and dry weather. ARGENTUM NIT.- Severe organic cases that are Time passes too slow; every- much worse at night. The attacks thing done seems to be done commence suddenly, with very distoo slow; excessive flatulence; tressing shortness of breath; tenstomach nearly ready to burst as if a band was around the with gas; fluid seems to run straight through the intestinal praecordia; very short breath, with canal without stopping; diar- deep sighs, and violent palpitation rhoea from ulceration of the in- of the heart, or oppressed panting, testines. quick, sibilant breathing, inability to lie down, obliged to lean forward to get breath, with rumbling of gas in the chest and bowels. From the first to the third decimal will be found of great utility. A M B R A. - Hysterical, Asthma in nervous, hysterical nervous females; spasmodic, women. As a palliative Ambra is of choking sensation in the great use, Hartman says: "I have throat, with frequent fainting throat, w ith frequent fainting found Ambra, second or third tritufits; dry spasmodic cough; aggravated in the evening; re- ration, an useful remedy in asthma lieved in the open air; loud siccum and senile, particularly eructations of gas. when the oppression was principally felt in the left chest, extending from the heart to the back and between the shoulders, attended with palpitation, anguish, arrest of breathing. It likewise proved useful in asthmatic ailments of scrofulous subjects." Greatly aggravated at night, and in a warm atmosphere. 164 PULMONARY CONSUMPTION. tion and sense of fulness in the stomach and bowels; pressure, anxiety, and fulness in the region of the heart; short wheezing respiration; great restlessness; dry irritating cough; bad taste; tainted breath." —Marcy $ Hunt. CHINA.-The system has This is not a true asthmatic been debilitated by the loss of remedy, but may be a valuable one vital fluids, especially blood, semen, over-lactation, diar- in cases that assume an intermitrhcea, or leucorrhcea. Patient tent type, in debilitated, cachectic worse every other day. Inter- subjects, living in a malarious atmittant neuralgia, greatly ag- mosphere, The digestive organs gravated by the slightest touch. are in a debilitated condition as Much congestion of blood to the head, with ringing in the is shown by excessive flatulence; ears. Loss of appetite, with the abdomen is distended with gas longing for acids. Dirty yel- like a drum; there is diarrhcea and low coating upon the tongue. excessive debility. Pale, sallow Acid stomach, with much flat- countenance; the paroxysms come ulence. Abdomen seems ulence. Abdomen seems on worse after midnight, and in packed full of gas, not relieved by eructations or dejections. wet weather; the patient has exDiarrhoea, of undigested food hausting night sweats, especially or water, without pain. Jaun- affecting the chest. Oppression of dice. Dark, scanty urine. the chest,from excessive flatulence. Metrorrhagia aud menorrhagia. Debilitating night sweats. Suffocative fits, as from mucus in gia. Debilitating night sweats. Intermittent congestion of the the larynx. Symptoms aggravated lungs. by a draft of air or the slightest contact. CAMPHOR.-Sudden pros- For the first stage of suffocative tration of the vital forces, with asthma, where there seems danger excessive coldness of the ex- of paralysis of the vagi, Camphor tern al surface. Long-lasting is of chills. Skill cold as marble, is of great value; but its stage of yet cannot bear to be covered. usefulness is soon passed, and we extremities cold and blue, with must find another remedy. cramps. First stages of catarrhal affections. Involun- Hartmann says:'Camphor is tary diarrhoea. Retention of likewise a palliative, but only in urine. Humid asthma. certain cases. I use it in asthma ASTHMA. 165 humidum with very irritable nerves, and particularly when the larynx and bronchial tubes are so filled with mucus that the patient is almost suffocated, which is easily inferred by the movement of the patient's hands and by the spasmodic contortion of the facial muscles." In the so called " Hay asthma," Dr. Holcomb has used the 1st cent. trituration with marked effect. COD-LIVER OIL.-For asthma, in young, growing children, to eradicate that peculiar dyscrasia, that lays at the foundation of asthma, we have no better remedy than Cod-liver Oil, and no long-standing, organic case ought to be treated without its use. I have seen good results from its use, but believe, however, that it is more useful in young people than in the aged. I have derived great benefit from the oil in chronic, humid coughs in old people when other remedies have entirely failed. For its action and use the reader is referred to the first part of this work. CUPRUM.-Sudden par- I oxysms of dyspncea. Strong The main sphere of Cuprum is to metallic taste in the mouth. eradicate the tendency to asthma; Spasmodic affection generally. is not of much value to relieve Sudden, severe vomiting. When drinking the fluid de- the paroxysms. scends with a gurgling noise. " The remedy is suitable to inChlorotic symptoms. Chronic dividuals with nervous, irritable, asthma. enfeebled constitutions, who are moreover, disposed to spasms, whereas Arsenic is suitable rather to vigorous and plethoric persons. Or it is suitable to children, especially if the spasms set in at night, or in consequence of exerting the respiratory organs, as for instance, after a coughing fit: the paroxysm very speedily reaches the acme of its intensity; other muscular bundles are involved in the convulsive attack; the attack is accompanied by a constant hacking, which aggravates the asthma, and it terminates by vomiting; pallor of the countenance, with cold perspiration. 166 PULMONARY CONSUMPTION. The apyrexia is not perfect, but a slight degree of dyspnlcea remains, or violent paroxysms of an almost dry cough set in, which likewise end in vomiting. We have never known Cuprum to be of any use for the paroxysm itself, so that we now limit the use of this drug exclusively to the intervals between the paroxysms."-Baehr. "Cough; painful contraction of the chest; losing of breath; great weakness and relaxation of body; emaciation; loss of spirits; anxiety; fits of anguish and fear of death; when trying to take a deep breath, cough with whistling breathing; dyspncea in spasmodic fits, almost suffocating; aggravation at night, also when coughing, when leaning backwards, and after drinking." —Dr. LH. Goullon. DIGITALINE.-The great This remedy, in all probability if key-note for this remedy is an the active principle.Digitaline is intermittent pulse, or where ntermittent p ulse, or where given, has no superior in our the least movement produces violent palpitation of the heart; materia medica, not only to relieve dropsy of the pericardium, in the paroxysms, but also to radically organic heart diseases; feeling cure the disease. I no more use of goneness in the stomach as the Digitalis, it being not more than as if he would die with deathly nausea andful as the Alkaloid, Digior ashcolored stools; spermator- taline, and always use it in the rhcea; bloating and paleness of second or third centesimal triturathe face; anasarca; humid tion. This, I regret to state, was asthma, with great rattling of omitted in my " Characteristic Mamucus in the lungs; cyanosis, teria Medica," and has been the and fainting. Paroxysms come on early in the morning, and cause of several communications in in cold weather. our journals. I hope physicians will make a note of this. Dr. B. Baehr says: " In a variety of cases we have witnessed remarkably favorable results from the use of Digitaline. With this remedy alone we have radically cured frequentlyrecurring paroxysms of asthma of less protracted duration; in inveterate cases all that we have been able to accomplish with this agent, has been to diminish, in some cases, although ASTHMA. 167 to a considerable extent, the intensity and frequency of the paroxysm; it is, therefore, with a good conscience that -we can recommend this medicine for further trials in asthma, provided the following circumstances are kept in view: The asthma is altogether a primary affection; it is the purely nervous form, a genuine spasm of the bronchia. In such a case Digitaline will have the best effect as long as no catarrh, emphysema or structural change of the heart supervenes. Digitaline is, however, suitable even if these complications exist, to which it is, indeed, preeminently adapted, more especially to structural alterations of the right ventricle. A high degree of sanguineous stasis in the veins of the head, especially a violent throbbing-pressing headache during and after the attack; palpitation of the heart, especially if the attack is preceded by them. The asthma attacks irritable individuals with weak nerves, more particularly persons who have been guilty of sexual excesses. We do not simply mean persons who have been addicted to self-abuse, for we have known a married man who contracted asthmatic attacks in consequence of excessive sexual intercourse, and who was decidedly benefitted by Digitaline. The influence of Digitaline over the male sexual organs is extraordinary, and in this case, we effected a truly radical cure, as is likewise evident from what we stated when speaking of the male sexual organs. The influence of Digitaline over the female sexual organs, especially in its bearing upon the nervous system, is so difficult to define that we are as yet without any decided data regarding this matter. We always administer this remedy in the second or third trituration, giving never more than one grain of the former in the morning before breakfast, never at night, for the reason that sleep is generally disturbed by Digitaline. (I cannot subscribe to this. I am in the habit of repeating it every two or three hours, and it greatly quiets the patient instead of producing restlessness.) Nor is it necessary to give a dose every day; a dose every two or three days is sufficient. These precautions are important to avoid medicinal effects and homceopathic aggravations. Unless these precautionary measures are adopted, a remedy, the 168 PULMONARY CONSUMPTION. great importance of which has not yet been sufficiently recognized, might easily fall into discredit." Hartmann says: " This medicine is useful in asthma complicated with thoracic disorganization. It is supposed that Digitalis is indicated by a disturbed action of the heart and slow pulse; but I have always employed it with success when the disturbed action of the heart manifested itself equally in the pulse. The increased action of the heart depended upon incipient disorganization of that organ and its vessels, and the asthma caused by that disorganization was characterized by the following symptoms: Roughness in the trachea, which had existed for some time previous, accompanied with a short, hacking cough, and gradually leading to labored breathing, which increases to a spasmodic constriction of the larynx and chest, with suffocative anguish, which is particularly troublesome early in the morning, on waking and obliges one to sit up. Digitalis is, therefore, an excellent remedy for asthma cardicum, organicum, metastaticum, hydrothoracicum." "Digitalis is indicated in those cases where the respiration is slow, pulse slow, or intermitting the third, fifth, or seventh beat; face of a bluish red color; sweat on upper part of the body and tendency to diarrhoea. The paroxysms come on early in the morning, especially in cold weather."-RAuE. FERRUM. —Weak, chloro- In cachectic leucophlegmatic intic, ansemicpeople. The least dividuals, where there is great emotion, or exertion, produces anaemia and the blood-making ora red flushed face; very pale, gans are completely prostrated, Feranemnic people, the least motion produces a bright, red rum will be found the main remedy face; great paleness of the in our hands to build up again the mucous membranes, especially debilitated organism. It does this that of the cavity of the mouth; by entering the circulation, and muscles feeble and easily ex- there stimulates the organic nerves hausted from slight exertion. which preside over the blood-makl Always better from walking slowly about, notwithstanding ing organs until sanguineous process weakness obliges the patient to goes on in a normal manner. Iron ASTHMA. 169 lie down; acid, sour vomiting, is not a remedy with which to ar — lienteria, obstinate, painless rest the paroxysm of asthma, but diarrhcea, excoriating and exhausting. In women,menses will be of great value to build hausting. In women, menses too frequent, too profuse, and, up the worn-out organism between last too long; watery leucor- the paroxysms. If the attack comes rhcea; hemoptysis, and gen- on after midnight, driving the patieral hemorrhagic tendency; ent out of bed, and is relieved by rheumatism of the deltoid muscle; general anasarca; walking about slowly, iron will be cold extremities, strongly indicated. Also, if there is great congestion of blood to the head, with puffiness around the eyes; throbbing headache; vertigo and roaring in the head; walking produces faintness; anxiety and oppression proceeding from the pit of the stomach; tightness in the chest, as if constricted; difficult and anxious breathing, most violent when lying or sitting still, relieved by walking slowly, or talking. "A child, aged one year and a-half, suffered with repeated attacks of Kopp's asthma, so that he often became unconscious. His digestion was good, but his muscles weak, so that he could not stand or walk; fontanelles unusually large. Cured by Ferrum sulph., internally and in baths."-FRANK. Anaemia and debility are the great signals for the use of iron, especially if there is a tendency of congestion of blood to, the chest, emaciation and cold extremities. GELSEMINUM —Nervous, This remedy is adapted to what. hysterical females and onan- might be called neurotic, hysterical ists, intense congestion of blood tothe headl; great heavinessof asthma, the nervous or hysterical the eye-lids; amaurosis; sper- element predominating. It has a matorrhoea, with great languor specific action on the nerves of the and irritability; hysterical larynx and on the asthma of Miller spasms; nervous ~:sthma, with (laryngismus stridulus), it is one, profound prostration of the profwhole musculand prostration of the of our most useful and reliable: whole muscular system, constant sneezing. remedies. 12 170 PULMONARY CONSUMPTION. GRAPHITES.- Females This remedy is only useful to inclined to obesity and a dis- eradicate the peculiar dyscrasia position to delaying menstru- lying at the foundation of asthma, ation, menses too late, pale andin scanty; obstinate constipation; in people prone to obesity, and in excessive flatulence; eruptions women there is a great tendency to on the skin, oozing out a sticky delaying and scanty menstruation. fluid; acrid secretions, the skin The asthmatic paroxysm comes on becomes excoriated; every in- in the evening; there is great senjury of the skin tends to suppurate; burning on top of the sitiveness to cold air and a liability head and of the feet; great de- to take cold at every change of the bility; suppressed eruptions. weather. " Suffocative paroxysms every night since 17 years in a man mat. 70. The paroxysms waken him out of sleep, usually after imidnight; he has quickly to jump out of bed, must hold himself fast to something, and quickly eat a piece of bread. After this the paroxysm passes off; and he can sleep. He had no,other spell after Graphites 30th although he lived 8 years longer." -Dr. Landesmann. Glanderine. — Dr. O. P. Baehr says that Glanderine is the true simillimum, if it can be obtained pure. He does not give the indications for the kind of asthma, and never having used this remedy I cannot supply the want, but should judge that it might prove useful in the humid form, where there:is much bronchial inflammation attended by profuse expect-,oration, accompanied with chronic catarrh. HEPAR SULPHUR. - This is one of the most useful,Organic cases attended with remedies we have in chronic cases suppuration, and a rattling chokof asthma, where the attack comes ing cough. Much hoarseness, with laryngo-tracheal catarrh, on in the night, with constriction cannot bear to be uncovered, of the chest and suffocating breathcoughs when any part of the ing; the patient has a choking body is uncovered; constant cough, and a large collection of tendency of the head and chest mucus in the bronchi. Tuberculto perspire; sweats day and night without relief, especially osis, or chronic bronchitis is at the about the chest; sour smelling foundation of the asthma. perspiration; symptoms worse " Hepar sulphur. must not be for ASTHMA. 171 during cold north-west winds, I gotten in those cases which awaken relieved by warmth; system the patient from a sound sleep. has been abused by mercury' During the paroxysm the face beglandular swellings, especially of the tonsils. The skin is comes blue, the saliva is increased, very sensitive to the slightest and the patient complains of dust touch, even the clothes irritate in the lungs; smoking (tobacco), him; great sensitiveness to and throwing the head back amelieverything; cannot bear the orate; the expectoration after the slightest draft of air, nor the attack is frothy." Raue. slightest noise. Not of much value to relieve the paroxysms, but of great value to eradicate the peculiar dyscrasia, that lays at the foundation of asthma. IPECACUANHA. - Continuous and unavailable desire To arrest the paroxysms of asthma, to vomit; constant nausea; no especially in little children, Ipecac relief obtained by vomiting; is equal to any drug we have in the great paleness of the face; the materia medica. Dr. T. Nichol has chest seems full of phlegm, but dchest yiseems full of phlegm, buf given us such a practical r6sum6 of does not yield to coughing; suffocation threatens from con- its indications in asthma that I canstriction in the throat and not serve the profession better than chest; worse from the least mo- to give his remarks in full. He tion; loses breath with the says: " Ipecacuanha is one of the cough, turns pale in the face, a s first remedies of which we think in and stiffens; incessant sneezing large secretion of mucus in the an attack of acute asthma, and it is nostrils. worthy of the place which it holds. It is a leading remedy in recent cases, particularly in young children, and it is likely to be indicated in cases caused by the suppression of miliaria or urticaria, and also by the inhalation of dust or irritating vapors. Dr. Hughes remarks:' It is in this variety (the bronchitic) that I consider Ipecac homoeopathic, and not, as Dr. Russell seems to think, to pure nervous cases. It is especially indicated where there is much cough." Dr. Laurie says: " During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in children or adults." Almost the only unfavorable testimony the writer has seen is from Dr. Bayes, who, in the frank manner which gives such a peculiar charm to his 172 PULMONARY CONSUMPTION. writings, says:' In asthma, Ipecac, has disappointed me, I have seen some benefit from its use; but far less than I was led to expect from its pathogenesis." "The leading indications for this remedy are spasmodic constriction of the air-passages and accumulation of mucus in them; feeling of tightness in the chest, which may be quite distinctly made out even in very young children by stripping them and noting the motions of the chest, with rattling and panting in the windpipe which is full of mucus; the cough is short dry and troublesome, with quick and laborious breathing, and a good deal of gasping for breath; sometimes the cough appears to be excited by a tickling commencing in the upper part of the throat and extending to the extreme ramifications of the bronchial tubes; at other times, the stethoscope shows that the spasmodic constriction of the bronchial tubes is the essence of the morbid state; nausea with cold sweat on the forehead is also present, with small and slow pulse, or nausea before the attack and vomiting, mostly bile, during, or nausea before or after the attack; the tongue is coated and the appetite is deficient. The face is pale and cold, and this state sometimes alternates with heat and redness; the hands and feet are cold and in aggravated cases, there is tetanic rigidity of the body, with lividity or bluishredness of the face; the mind is anxious and morose, or irritability, impatience and fear of death are present. As to the dose, practitioners vary greatly. Caspari advises the third attenuation, either one drop in water, or in the form of globules, repeating it every two or three hours, as its action is soon over; and Hale for all the remedies he mentions for this disease, directs a dose of three or four globules to be given every three hours. On the other hand, Rouff gives a drop of the first attenuation every evening; and Marcy gives from the first to the third attenuation. Ruddock gives a dose every ten or fifteen minutes during an attack; afterwards every three or four hlours, and this is what I have been in the habit of doing for many years past, using the lower triturations, say from the third to. the sixth decimal, during the attack, and the twelth during the interval, I would add that I have found ASTHMA. 175 flamed; fetid odor from the Hunt do not mention it when speakmouth, from ulceration of the ing of asthma. mouth and fauces; ptyalism; chronic nasal catarrh in its Dr. W. B. Casey says of the worstform; mucous discharges Iodide of Potassium: "For a year from the urethra of both sexes; past I have looked through the degeneration of the mucous various journals, in the expectation membranes; mucous phthisis; of seeing some notice of the subject purulent expectoration; exhausting night - sweats and of this article, but have not up to diarrhoea; asthma in young this time met with but a mere incipeople that are growing rapid- dental mention of the fact that ly, that have many rheumatic Hydro-iodide of Potash has been emsymptoms. The best remedy ployed with some benefit in asthma. we have for chronic organic e havel for chronic srganic I therefore send you my experience asthma; all forms of scrofula, swellings of the glands, chronic with it, trusting that the statement skin diseases, severe nightly which I make will excite the attenbone-pains, profuse, purulent tion of our profession and lead to a secretions. trial of the remedy on a more extensive scale. Some two years since Prof. Mutter, of Philadelphia, mentioned that he had accidentally discovered the fact to which I am now endeavouring to draw attention. I immediately commenced its use with a number of patients suffering under this distressing and intractable complaint, and, to our mutual delight, they were all more or less speedily relieved. I have now made use of the medicine in some twenty-five or thirty cases of asthma, some of them very severe and aggravated; and so far, where a fair trial has been made, it has not failed to afford unequivocal and decided relief. These facts I have stated at our county medical meetings, and have urged the adoption of the practice upon many of our neighbouring physicians; and so far as I can ascertain the result, all who have tried the remedy will indorse my statement of its value. I am happy to add the testimony of Dr. North, an eminent physician residing at Saratoga Springs, who informs me that he has experienced in his own person great relief from the use of the medicine, and has witnessed the samhe effect in others. As a general rule, the patient is benefitted after a few days' employment of the drug, but some 176 PULMONARY CONSUMPTION. cases will require more time, perhaps weeks, before they improve; in one of mine, a very severe case, of over twenty years duration, I persevered for nearly three months before there was any decided amendment. I feared at the outset that the medicine would prove to be merely a palliative (and even then it would be invaluable), but further experience warrants my belief that, in mild cases of recent date, a cure may be effected. In almost one-fourth of my cases relapses have occurred after discontinuing the remedy; this occurrence, however, was in most of them owing to severe attacks of catarrh, or to errors in diet, and consequent derangement of the digestive organs, which, by the way, should never be overlooked in the treatment of asthma. I may mention in this connection that most of my patients, while using this medicine, had an excellent appetite, and gained flesh rapidly. A long continued use of the Iodide of Potassium will, in some subjects, occasion an eruption, generally of a pustular form (almost always ecthema); and I have twice been disposed to attribute to it the occurrence of a slight conjunctivitis; the omission of the medicine for a few days, together with a few doses of Rhubarb and Soda, will be found sufficient for the removal of these inconveniences. It would scarcely be worth while to offer, at the present time, my explanation of the Modus operandi of this medicine in asthma. From two to five'grains of Iodide of Potassium, given three times a day, dissolved in water or some syrup, as for instance that of Sarsaparilla or Tolu, will generally be found sufficient for ordinary cases of this disease. Its continuance must be regulated by the circumstances of each case; of course no intelligent practitioner need be reminded of the attention requisite as regards diet, clothing and exercise. It may not be uninteresting or irrelevant to mention that the Hydro-iodide has been given to several horses troubled with the heaves, and in all, while under the influence of the medicine, the disease was suspended. Hydro-iodide of Potassium is the basis of Whitcomb's notorious remedy for asthma." Notwithstanding this is old school testimony, I thought it ASTHMA. 179 in the pit of the stomach; in arresting spasmodic asthma of dysonocea with a feeling as if recent origin. Cases especially there was a lump in the oesophagere was a lump in the mouth- calling for Lobelia are of the huphagus, rising into the mouth; excessive nausea and vomit- mid form and spasmodic in nature, ing, with complete prostration with great irritation of the vagi. after vomiting; sensation as if Dr. T. Nichol says: "Lobelia. a thousand needles were pricking the skin; chronic vomit- -The practitioners of our school ing in paroxysms. by no means agree as to the true sphere of this remedy in asthma, Dr. Marcy says that it' is a remedy of great value in cases of spasmodic asthma induced by humidity, and certain other conditions of the atmosphere,' and Dr. Hughes states that'in pure nervous asthma uncomplicated with bronchial irritation, Cuprum and Lobelia are most effectual.' Dr. Ruddock, who has had much experience in the disease, prescribes Lobelia in pure nervous asthma. Dr. Hempel thinks that it is undoubtedly homceopathic to some forms of spasmodic asthma; and Dr. Noack has arrived at the conclusion that its operation is peculiarly directed to the pneumogastric nerve, an opinion which is strongly supported by both its pathogenesis and its curative effects. On the other hand, Hartmann, who is a great authority with the middle-aged physicians of our school, says that' this remedy seems to be principally adapted to asthma, depending upon degeneration of the bronchial mucous membrane, occasioned by chronic inflammation of the air-passages,' while Baehr, a weighty authority, curtly remarks that'Lobelia is more adapted to emphysema than to asthma.' Ruoff seems to be of the same opinion, for he directs Lobelia to be used in cases characterized by constant dyspncea ilncreased by slight exertion, and aggravated by slight exposure to cold. My own experience is that the low dilutions meet the form of spasmodic asthma, to which the drug is homnceopathic, while the medium and higher dilutions are adapted to the variety of the malady resulting from chronic inflammation of the air-passages." Hempel thus gives the key to the use of Lobelia: " Asthma, with irregular jerking respiration, oppression, suffocative anxiety, as if the patient would die." 180 PULMONARY CONSUMPTION. The attack is preceded or accompanied by a kind of prickly sensation through the whole system, even to the extremities of the fingers and toes; constrictive pain across the chest, and laborious breathing, with disposition to keep the mouth open to breathe; oppression of the chest, causing a deep breath to be taken to relieve the pressive pain in the epigastrium, extending upwards to the chest, with or without cardialgia or pyrosis; muchmucusin the throat; short, anxious and wheezing respiration, with spasmodic cough; nausea and vomiting, with great prostration, trembling of the limbs, with intermittent pulse and cold sweat; burning sensation in passing urine, which is of a deep red color and deposits a copious red sediment. Many of our practitioners use the mother tincture exclusively, but Marcy recommends the potencies from the third to the sixth-a dose every two to four hours, as the symptoms require, and remarks that "I, myself, in common with many other practitioners, have seen very satisfactory results from Lobelia, not given as an emetic or depressant, but from the 2nd to the 6th dilution." I have already given my views as to the dose. LYCOPODIUM.-Constant For long standing organic cases sensation of satiety, the least of humid asthma, where the digesmorsel of food causes a sensa- tion is greatly perverted, with extion of fulness up to the throat; riono fulness up to the throath cessive accumulations of flatus in Great distention of the stomach the stomach and abdomen,'no remand bowels with gas; much borborygmus, particularly in edy is of more value. The Lycothe left hypochondrium; long podium asthma might well be called continued constipation, accon- flatulent asthma, and the paroxysm panied with much flatulence; is generally relieved by excessive copious sediment of red sand eructations of flatus, or by a stool. in the urine; humid asthma, there is much expectoratio In all probability the excessive mucus, or muco-purulent mat- asthmatic sufferings are reflex in the ter; night sweats and debility. majority of cases; the great difficulty being caused by indigestion; but in tuberculosis Lypodium is often the remedy. ASTHMA. 181 MERCURIUS.-Scrofulous In many cases of asthma, where peojple, with induration of the there is a deep-seated organic disglandular system; chronic na- ease at its foundation, Mercury will sal catarrh; profuse perspira- be found of great value, and estions that do not relieve; teeth sore, loose, and the gums pecially if there is a long-standing bleed easily; tongue coated bronchitis present. With great diswhite, thick, and heavy, with charge of mucus from the lungs, intense thirst; fetid breath; the Iodide of Mercury will be found profuse flow of saliva; ulcera- an absolute specific in such cases. tion in the mouth and fauces; mucous, or muco-sanguineous Hartmann says "Asthmatic stools, stools of blood; symp- paroxysms originating from the intoms especially aggravated at halation of the vapor of arsenic are night and in cold, damp removed by no other remedy with weather; nightly bone-pains; wI b s more certainty than by Mercurius much jaundice; secondary 3d in repeated doses. syphilis. 3d in repeated doses. " Mercurius is also of great benefit in those cases where smoking tobacco and cold air lessens the attack.-RAUE. The Cyranuret of Mercury will often be the most useful form to use, especially where the bronchi are loaded with tough mucus. MOSCHUS.-Nervous, hys- This remedy is adapted to nerterical asthma; Neuroticpalpi- vous, suffocative asthma, in hystertation of the heart. Spasmodic ical subjects. hiccough; profuse urination; much thirst and great emacia- Dr T. Nichol says; "Moschus is much thirst and great emaciation: patients inclined to be useful in the acute asthma of chilconstantly cold and chilly. dren, caused by exposure to cold, especially when the patient is of a nervous temperament. There is a violent feeling of constriction in the throat as if the glottis were involved in the attack, with sense of spasmodic constriction in the windpipe and upper part of the bronchial tubes, and this constriction increases until it becomes a suffocative spasm of the lungs which drives the patient to despair. Sometimes there is no cough present, but merely a little irritation at the commencement of the paroxysm occasionally the cough is more marked. Noak and Trinks recommend Moschus ASTHMA. 183 especially of the mouth and throat: Putrid breath: tenden- Dr Hartman says " Nitric acid is cy to diarrhea: Fissures of an excellent remedy to eradicate thd anus that produce great the asthmatic disposition. It is suffering during stool: Intoler- particularly useful in delicate conably offensive urine, smells like stiutions, persons with sensitive that of horses: bad effects of mercury; people with dark cor- nerves and irritable temperaments, plexion, black hair and eyes, particularly when the organism has with great tendency to take been weakened by mercurial treatcold; ulcerations, that have a ment, or by syphilitic, scrofulous sensation as if a sharp splinter or hepatic diseases. The patient was being run into the ulcer at the slightest touch. Aggra- complains of fluent coryza, roughvations in the afterpart of the ness of the throat, husky voice: night. as the coryza diminishes, the chest feels oppressed; if the coryza disappears entirely, the oppression increases to complete loss of breath, attended with palpitation of the heart and anxiety on ascending an eminence: or the patient complains of constant dyspncea; he is scarcely able to breathe, worse on leaning backward: sometimes the dyspncea is attended with anxiety, particularly when walking fast: when reaching the most violent degree, the disease in creases to a spasmodic oppression of the chest, with rush of blood to the heart, languor, anguish, which is excited by the least emotion." NUX VOMICA. -Choleric Nux vomica asthma, might well sanguine, malicious, irritable be termed a dyspeptic asthma, for people, who make great mental the gastric symptoms always preexertions; Asthmatics who have usexer tions; Asthmaticswho hae dominate, and the asthma is of a used to excess stimulating drinks, highly seasoned food, dry, spasmodic nature depending and lived a sedentary life; upon reflex excitability of the frontal headache as if the eyes vagi. would be pressed out of the head, Dr T. Nichol says: " Nux vomica with great irritability, every- is decidedly the leading remedy thing offends: very dyspeptic thing offends ery dyspepticy, when the innervation of both bransour acid stomach oonstantly, much flatulency; constipation, ches of the pneumogastric nervewith frequent, but ineffectual its gastric as well as its pulmonary 184 PULMONARY CCNSUMPTION. urging to stool: afflicted con- portion-is alike vitiated, and then stantly with hmmnorrhoids; the dyspepsia and the asthmatic dry coryza- dry spasmodic dryvoughzwi mc soessofi affections are inseparable parts of cough with much soreness of one whole. Here as Dr. Satter the epigastrium: symptoms greatly aggravated at 3, A. M. remarks, the dyspeptic symptoms are the manifestations of the gastric portion of this deranged innervation and the asthma of the pulmonary portion of it, and in such cases Nux vomica is at once suggested to the mind of the practitioner. Dr. Ruddock remarks: Nux is probably the best anti-spasmodic remedy. It is homceopathic to that condition of the digestive system which is the most common cause of irritation which results in bronchial spasm. Nux vomica is about the best curative medicine we have for simple spasmodic asthma, where there is no bronchial lesion, but a standing reflex excitability of the pneumogastric to impressions from without or through the stomach. One of the early cases which made Hahnemann famous, was of this kind, and the Nux was given in material doses. Dr. Kidd also states that he considers it our best anti-asthmatic." While the gastric origin of the Nux asthma is often unmistakable evident, the paroxysm itself often depends upon congestion of the lungs, and it is a characteristic symptom that the oppression is more troublesome than the spasmodic symptoms. The attack is almost invariably preceded by symptoms of congestion of the lungs; nightly attacks of suffocative tightness especially in the lower part of the chest, accompanied by disagreeable or anxious dreams; shortness of breath on moving; constriction of the chest, with want of air on going to bed; hacking pain and anguish in the region under the heart and in the region of the hypochondria; tension and pressure in the chest, which seems to be constricted in its transverse direction. The cough is short and hacking with difficult expectoration, which becomes looser toward morning, or the cough may be dry and concussive. It is a characteristic sign that the lower part of the thorax is almost immovable, while the abdominal respiration is quite marked. The abdomen, especially in the region of the stomach, is much distended with flatulence, ac ASTHMA. 187 with a great deal of difficulty; troubled with a weak, gone sensadiarrhoea which pours out in tion in the epigastric region, with a great quantities like water from a hydrant, very exhaust- strong phthisical habit. ing, with a weak, empty, or Dr. T. Nichol says: "Phosphogone feeling at the pit of the rus, to the mind of the homceopathic stomachn with this gone sen- practitioner, calls'up the idea of sation in the stomach there is often great heat between the pneumonia rather than asthma, but shoulders; hard, tight dry it is really a valuable remedy against cough, whic) racks the patient the latter malady. Ruoff and Pulte and is very exhausting; great both give the pathological indicasexual desire or impotence; tion'phthisical habit' —and this obstinate haemoptysis; slight wounds bleed much; degener- e leading idea of Phosphorus ation of the brain and lique- in asthma of children. The breathfaction of the spinal cord. ing is noisy and panting, and the dyspncea is marked; the oppressive breathing and oppression of the chest are aggravated in the evening and morning, also, when sitting or during exercise; great oppressive anxiety in the chest; stridulous inspirations in the evening, when falling asleep; nightly suffocative paroxysm, as if paralysis of the lungs was threatened; spasmodic constriction of the chest; hoarse cough with saltish or sweetish expectoration, which is. often blood-streaked; stitches and sticking pains in the chest, with heaviness, fulness and tension. Constant chilliness is pre — sent, with languor and debility. In the cases in which Phos — phorus has succeeded in my hands, the stethoscope revealed the presence of congestion to the thorax as a result of the spasm. of the bronchial tubes and partial paralysis of the lungs. I have seen fine results from all preparations, from the 6th to the 200th, but feel surest of success when giving the 12th to the 24th dilution." PULSATILLA.-Very af- Humid asthma, especially in wofectionate females, with blue men with menstrual disturbances, eyes, blonde hair, inclined to. is the great field for the use of Pulbe fleshy and easily excited to tears; symptoms all aggravated in a close, warm room, and Hartmann says: "' If an asthmatic relieved in the open air; symp- spasm be caused by the vapor of ASTHMA. 189 S TAN NUM. - Profound This remedy is useful in chronic prostration of strength; cases of humid asthma, with so patient must drop down, but patient must drop down, but much debility that the legs are not can get up very well; goes up stairs well, but becomes faint able to support the body, complion coming down; talking or cated with chronic bronchitis, with reading aloud produces great an abundant secretion of mucus, or exhaustion; symptoms all re- genuine tuberculosis, second stage. lieved by menstruation; loose Baehr says: " Stannum may be rattling cough, with copious yellow or greenish expector- tried if the attack supervenes durtion, with a very weak feeling ing the existence of chronic catarrh, in the throat and chest. and the decrease of the attack is attended with a copious secretion of mucus." Dr. T. Nichol says: " The precise phase of the malady for which Stannum has been thought suitable is when the attack supervenes during the existence of chronic catarrh, and the decrease of the attack is attended with a copious secretion of mucus. Oppression at the chest with mucous rhonchus, and this oppression, which seems to be principally due to the large amount of mucus, is worse especially in the evening and at night, when lying down, also in the day time during every exercise, and frequently attended with anguish and desire to remove the clothes. The cough is attended by copious expectoration of viscid or lumpy, or transparent and watery, or yellowish phlegm, of a sweetish or saline taste. Noack and Trinks recommend one grain of the 2nd, 3rd or 6th trituration, once or twice daily." SPONGIA. --- C h r o n i c In organic cases of dry, spasmlodhoarseness; dry, sibilan i~ asthma, with severe dyspncea cough, with great dryness of the larynx; every secretion is on lying down; exertion produces perfectly tight and dry, with- great exhaustion in the chest; sudout any mucous rattling den weakness while walking; much sound, with suffocative breathing; must have the head high; chilliness in the back; symptoms ing; must have the head high; goitre; indurated glands. aggravated in a warm room, Spongia will be found of great value, in the 2nd and 3rd decimal trituration.s. 190 PULMONARY CONSUMPTION. Baehr says: " Spongia has so far been found useful only in asthma depending on tuberculosis, but it has never effected a complete cessation, only a marked diminution of the frequency and intensity of the attacks. The paroxysm is characterized by a marked contraction of the glottis, a wheezing respiration, with complete loss of voice. In a few hours the patient hawks up a substance resembling soaked sago." S U L P H UR. - Constant Chronic cases of asthma, comheat on the top of the head; plicated with eruptive skin disrush of blood to the head, with vertigo; has happy dreams, eases; rheumatism or some conwakens singing; feels very stitutional taint; it may be either weak and faint at 11 A. M., humid or dry, but generally the cannot wait for dinner; feel- breathing and cough is neither ing of goneness in the pit of loose nor dry, but half way bethe stomach; chronic constipation frstom abdominal ple- tween, of a wheezing character; pation from abdominal plethora, accompanied with bleed- there seems to be much mucus in ing hemnorrhoids; stools hard the lungs, but none, or only a and knotty; excoriatingmorn- trifle, is expectorated; sensation, ing diarrhoea. In women, as if the lungs touched the back menses too early, too profuse, menses too early, too rofuse, while coughing. Sulphur is adaptand last too long; acrid, ex- o i a coriating leucorrlcea; catar- ed to nearly every kind of asthma, rhal symptoms become worse but is the most useful in the humid and worse; feels suffocated, form. wants the windows and doors open; much rattling of mucus Dr. T. Nichol sums up its action in the lungs; plastic pleurisy; as follows: " Sulphur is, according frequent hot flushes, with to Hartmann,'a most universal faintness; much burning of remedy for asthma. There is the soles of the feet, puts them out of bed to get thern scarely a cas e where Sulphur is cool; vesicular eruption upon not used. It suits almost every the skin; chronic rheumatism. constitution and temperament, and antidotes the bad effects of a number of metallic poisons.' Pulte says that'it may be given in almost any acute or chronic attack of asthma, if several other remedies were insufficient;' and Hughes remarks'that in a great number of cases you will discover, on inquiry, gouty inheritance or pro ASTHMA. 191 clivity, or, what is almost the same thing, some form of cutaneous disease alternating with the dyspnoea. In these cases you will get most satisfactory results from Sulphur.' The paroxysms of asthma, almost suffocating, occur mostly at night, with fulness and weariness, burning or spasms in the chest; sometimes the asthma occurs in the day time, even when walking in the open air; contractive pain around the chest; periodical constrictive spasms in the chest, with blue face and short breath, particularly in the evening, in a warm room; wheezing, mucous rattling; rhonchus in the chest; oppressed breathing and suffocative fits, especially at night; suffocative cough, with spasmodic constriction of the chest and urging to vomit; difficult expectoration of whitish mucus, or else copious yellow, expectoration; spasms in the chest, with compressive sensation and pain in the sternum; bluish-red face, short breath and inability to speak. Kreussler remarks that'Sulphur is suitable to scrofulous, rickety and psoric individuals, especially with a warm skin, internal heat and hurried pulse; whereas Calcarea has a cool, brittle skin, and a sluggish pulse.' As to the dose, Hughes says that'you may send your patients to a sulphurous spring, and Dr. Russell recommends the same; but I think they will do nearly as well at home under the usual potencies of the drug, of which I prefer the lowest."' My experience is the opposite of this. Among the few cases of medicinal aggravations which I have seen, were several of asthma, aggravated by the use of sulphur in doses of the 3rd and 4th decimal triturations, and I have noticed the finest results from the 12th trituration to the 30th dilution. T A R T A R EMETIC. — This is a very valuable remedy Large collections of mucus in in acute cases of humid asthma the bronc'hial tubes, expectorated with great difficulty, in- complicated wit h catarrh of the dicating approaching paraly- lungs. My friend, Dr. T. Nichol, sis of the vagi; coughing pro- says: "Tartar Emetic has been 192 PULMONARY CONSUMPTION. duces a sound as if there was comparatively little used in asthma, a mouthful of mucus about to run over in the lungs; paraly-yet both Jahr and Laurie remark sis of the lungs, with great that it is frequently of great serdysploea and fits of suffoca- vice in the asthma of children, tion; cedema of the lungs; while Hartmann says that plethoric much nausea and vomiting of mucus; very thirsty; colliqua- asthma is perhaps the more imtive diarrhoea; lumbago. mediate sphere of action for this agent. The suffocative distress, with anxious oppression and shortness of breath, depends partly upon constriction of the air-passages and partly upon a low grade of inflammation of the bronchial tubes, accompanied by an excessive secretion of mucus_ The malady is aggravated in the evening or in the morning, in bed, and is relieved by sitting up. Choking and retching are also present, and nightly paroxysms of suffocation are accompanied by loud wheezing and rattling in the chest. Congestion of blood to the lungs is a frequent pathological state with palpitation of the heart, and the anguish is sometimes increased by sudden, violent beats of the heart, as if it would start out of its place. Hartmnann remarks that though there is occasional palpitation between the paroxysms, yet no organic disease could be discovered, showing that Tartar Emetic suits asthma with or without organic affections of the heart. As to the dose, Noack and Trinks advise one grain of the 1st, 2nd or 3rd trituration, to be given once or twice daily. In my own practice I have usually dissolved a grain of the 3rd or 4th decimal trituration, in 12 teaspoonfuls of water, and given a teaspoonful every half hour during the attack, and every two hours during the interval." VERATRUM ALBUM. — The action of this remedy is Great drops of cold sweat quite similar to Tartar Emetic, and upon the forehead, with an- is especially useful in cases of guish and fear of death; cerebral congestion, with a bloated humid asthma of great violence, the bluish face; much vertigo; oppression and suffocation being of cold, collapsed, pinched-up such intensity that it would seem face, violent nausea, and vomn- as though the patient must die. ASTHMA. 193 iting, exhausting diarrhoea Dr. Nichol says: "Veratrum with violent colic; intense album is a well-known remedy for thirst for cold water; cold inveterate asthma, especially when tongue and breath; brought on by ice cream and cold drinks; the spasmodic symptoms predomigreat prostration. nate. The asthmatic symptoms arevery violent, even when sitting erect and during exercise, with pains in the side and hollow cough. Great prostration is present, with small, slow, intermittent pulse, coldness of the skin, especially of the nose, ears and feet; nausea and vomiting before and after the attack, which is accompanied by cold perspiration. Laurie makes the remark that Veratrum should be administered four hours after the third dose of China, when the last named medicine has been productive of inadequate benefit (a phantasy), and several authors point out that it suits well after Ipecac and Arsenicum." VERATRUM VIRIDE. — As a palliative in violent, acute Intense cerebral congestion, cases of spasmodic asthma, accomfeeling as though the head panied by intense congestion of would burst open; with nauwould burst open; with nu- blood to the lungs; the oppression sea, vomiting and singing in the ears; livid color of the of the respiratory organs being so face;nose pinched, cold and great that the patient cannot lie blue; cold sweat on the fore- down for days, for fear of suffocahead; sudden nausea andvom- tion, with a wheezing, rattling, iting of glairy mucus; the least quantity of food produces loose cough, but the sputa is raised violent vomiting; intense and with great difficulty. No remedy violent spasmodic asthma; in the materia medica can equal myalgia. veratrum viride, and to get its best effects, it must be given in nauseating doses, of Squibb's Fluid Extract, two drops at a dose every half hour, until three to six doses are given, and then one drop at a dose every one or two hours to the point of relief, when an organic remedy should be substituted that is homceopathic to the case. If the patient is a child, the medicine should be given just half as strong. I have just cured a case of spasmodic asthma, in a gentleman who has been subject to the disease every fall and winter NITRATE OF POTASH.-CHLORFORM OR ETHER. 195 be practised upon the first warning of a paroxysm, when relieved, morning and night, will be often enough for a few days. NITR ATE OF POTASH.-The smoke of burning nitre is one of the most useful palliatives we have. " A piece of blotting paper about the size of the hand, previously saturated in a solution of nitrate of potash, may be placed on a plate and ignited, when the fumes will be diffused throughout the room, their influence soon becoming evident. A warm saturated solution of saltpetre, into which the patient can dip the paper himself, answers the purpose equally well. Many patients go to sleep habitually amid these nitrous fumes with a certainty of a sound, undisturbed rest; others have the papers in readiness wherever they go, and usually obtain relief from a few minutes inhalation of the fumes. Inhaling the fumes of nitrate of amyle is another means which sometimes gives speedy relief. But in adopting any of these expedients, ventilation must not be neglected; the windows should be regularly thrown wide open to renew the air of the apartment." —Dr. Ruddock. TOBAcco. —In some few cases, smoking tobacco, if the patient is not accustomed to its use, will be found of service. The smoking should be continued until it produces slight nausea and faintness, but not continued long enough to produce vomiting. CHLORAL HYDRATE.-Will often act like a charm. Given in doses large enough to produce sleep, generally fifteen or twenty grains, and repeated once in four hours, this remedy will be found quite efficacious, but its action must be watched by a careful physician. CHLOROFORM OR ETHER.-These remedies will relax the contracted muscular fibres with great rapidity, and give immediate relief. No one but a physician should administer them, as, if entrusted to the patient, their use will be too frequently indulged in, and the patient's life may be sacrificed. In the use of chloroform it is not requed to produce a high 198 PULMONARY CONSUMPTION. 1. The most useful and first to be thought of are: Arsenicum, G(alcarea carb., China, Carbo Animalis and Veyetabilis, Hepar Lycopodium, Mercury, Silicea, Sulphur, Sulphuric Acid, Phosphoric Acid, Nitric Acid. 2. Aconite, Bryonia, Belladonna, Cod-liver Oil, Ferrum, Iodine, Graphites, Crotalus horridus, Morphine, Sambucus, Sepia, Staphysagria, Rhus tox., Polyporus off., Muriatic Acid, Psorin and the Oxide of Zinc. ARSENICU M.-Great In the last stages of Phthisis, prostration; symptoms ag- with profuse debilitating night gravated at night, especially after midnigt; great emacia- sweats, of alternating with a dry, tion; wants to be in a warm hot skin, or with profuse sweatroomn; cannot lie down for ing, Arsenicum will prove of great fear of suffocation; highest value. It will also be of much degree of dyspncea; great an- service in the night sweats of deguish and restlessness; pains bility, especially if there is malaria worse during rest, and burn like fire; great thirst for cold at the foundation of the disease. drinks; drinks little but often; In phthisis, the sputa is excessively constantly licking the dry, fetid, cough inclined to be hard cracked lips; tongue dry, and dry. Cold air is very disabrown or black; gangrenous aptho; hot burning like fire; grecable to the patient. Anasarca apthse; hot burning like fire; obstinate nausea and vomit- and dyspnoea are prominent symping; watery diarrhoea, with a toms. cadaverous smell, scenting the whole room; acrid, corroding diarrhoea or leucorrhcea; general anasarca, waxy pale skin, with great debility; aggravations from cold air, relieved by warmth. CALCAREA CARBONICA. This is one of the most valuable -Scrofulous leucophlegmatic remedies we have in profuse night people prone to diseases of the mucous membranes. TImperfect sweats from suppuration, especially assimilation of food to tissue. if the perspiration predominates Dry, flabby skin, great emacia- upon the upper portion of the body, HECTIC FEVER. 199 tion, with constant tendency to and is brought on from the slighttake cold. Children with large est exertion. The skin is extremeopen fontan dlles, with much ly sensitive to cold air, the slightperspiration standing in large drops on the head, wetting the est draught producing chilliness pillow thoroughly during sleep; with goose skin. Hectic fever with great fatigue in going up stairs, glowing heat and redness of the is out of breath and has to sit face; much thirst, with burning in down. Feet feel constantly as if he had on cold, damp stock- the palms of the hands and soles of ings. Women who menstruate the feet. Tightness of the chest, too often, too profusely, and with frequent necessity to take a lasting too long; cannot bear full breath. Profuse sweat early cold, damp winds, takes cold in the morning, one after the other, constantly. Profuse night sweats when suppuration is iS very weary and anxious before abundant. the sweat breaks out. The great characteristic of the Calcarea sweat, is that it is always more abundant early in the morning and is very exhausting. CHINA. —The system has This is a remedy of great value, been debilitated by the loss of probably one of the most useful we vital fluids, such as blood, have for night sweats and hectic semen, diarrhcea, leucorrhcea, or over-lactation; symptoms fever. The patient is greatly debilor over-lactation; symptoms. are intermittent, worse every itated, either from malaria, or supother day. Touching t';e af- puration and he wakes up every ected parts, or motion pro- morning with his linen soaked with duces intense neuralgia; long- perspiration, but it affords no relief. lasting congestive headache, n With the debilitating sweats there aggravated by a draft of air, in the open air, and relieved by is much thirst. And from the great pressure. Yellow coated tongue loss of fluids, there is great sensiwith loss of appetite and long- tiveness of the skin, has a chill, foling for acids, or canine hun- lowed by long-continued heat and ger; abdomen feels as if full of gas, and eructations giving no relief; acid stomach, nightly diarrhoea of water, or undigested food; jaundice, anasarca, intermittent neuralgia, aggravated by touch, cold air or motion. 204 PULMONARY CONSUMPTION. the glandular system; teeth and intestinal tract, this remedy is very soft, loose, and feel too the most useful and reliable one long; Inuch bleeding of the gums; salivation, with exces-that the physician can command. gums; salivation, with excessive fetor of the breath; red The perspiration isgeneral, cold and tongue; the mucous membrane clammy, leaving a yellow stain on of the whole buccal cavity and the linen, continues most of the tongue covered with apthous time, but much worse at night, ulcers, salivary glands greatly especially during sleep; accomenlarged, accompe w especially during sleep; accomenlarged, accompanied with profuse flow of saliva; intense panied with heat and chilliness thirst; mucous, serous or bloody alternately, and the sweat is apt to diarrhcea; jaundice; nocturnal be very offensive. The mercurius bone pains. solubilis and vivus act best upon women and children, and the corrosivus upon men. Practical Expedients.-BATHING, the use of water in arresting night sweats cannot be omitted by the physician, for the beneficial result which follow bathing and friction of the skin are so prompt and marked that the patient after commencing its use could not be induced to omit his bath; as a rule a warm bath is to be preferred, the temperature of which should be 90~ to 95~, F.; if above this, 980 to 112~ it will have the opposite effect, producing profuse perspiration and great prostration, but if taken from three to six degrees below the normal temperature of the body, once or twice a day, followed by vigorous friction with a crash towel or flesh glove to get up complete reaction, it will not only arrest the tendency to night sweats, but forms the best protection we have against the liability to frequent colds. Its duration should be from fifteen to thirty minutes according to the strength of the patient. Many patients cannot bear the shock of fresh water; in such cases, a handful of common salt or sea salt, thrown into the bath will obviate the chill, and the patient will be greatly benefited by the bath; the saline matter which the water holds in solution acting as a stimulant to the skin, enlivening the feeble circulation, relieving the cold hands and feet and general chill condition of the body. In strong, vigorous patients, the cool bath, lasting from three to five minutes, HECTIC FEVER. 205 in water at a temperature of 60~ to 75~, will tone up the body with great rapidity; but if continued too long, instead of tonic effects, great depression, will follow, and much injury be done; when the patient is too weak to take a full bath, sponging the body three or four times a day, with salt and water, soap and water, vinegar and water or alcohol, followed by vigorous friction, will not only be a great comfort to the patient, but of much value in arresting the night sweats and toning up the functions of the glands of the skin. The external use, in water, of the remedy homeopathic to the case will often be of great value in aiding the action of its medicinal effects. Bathing the body immediately after eating should never be practised, but the bath should be taken one hour before eating or four hours after, so as not to interfere with the process of digestion, by drawing the blood from the digestive organs to the skin. A warm glow and exhilaration of spirits after the bath indicate its beneficial action and on the contrary, chilliness and depression are indications of harm, and the bath should not be taken. Dr. C. J. B. Williams in his work on consumption, treating of night sweats says: "When the perspiration is only slight, sponging the chest with toilet vinegar or dilute sulphuric acid at night is sufficient; when more profuse a night draught of half a drachm of dilute nitrohydrochloric, or sulphuric acid, in glycerine and water, will often answer the purpose. Gallicacid in ten grain doses, once or twice a day, is an excellent emedy, and sometimes the addition of the tincture of perchloride of Iron or the sulphate of Quinine, to the daily tonic, will have the desired effect, but these two last drugs are apt to increase the cough, and must therefore be given with caution. The medicine we have found to act almost as a specific on night sweats, is the Oxide of Zinc, in doses of two or three grains in the form of a pill at night. This we have given ourselves, and seen other physicians give to thousands of patients, and the good results have generally been so prompt, and lasting, that only in a few cases has it been necessary to continue its use for any length of time." 206 PULMONARY CONSUMPTION. Hot alcohol or brandy is often of great service and comfort to the patient, used in the form of a sponge bath, followed by friction with a crash towel, coarse flannel or the flesh brush. If the perspiration is very profuse and debilitating, the addition of Cayenne pepper, salt or mustard, will so stimulate the skin, that the night sweats will be soon controlled. Lime water, If used externally, especially of Calc. c. is homceopathic to the case, will be found of great value. Skim milk, a tumblerful taken at bed time, has often arrested night sweats, probably due to the lactic acid contained in the milk. Koumiss, In all probability, fermenting milk will be found the most useful practical expedient the physician can resort to it being the most nutritious and simple food the patient can take, it is absorbed into the blood almost as soon as taken; we believe that it alone, will cure the majority of cases we are called upon to treat; it should be used as a diet, from one to four pints daily. (See Koumis3.) APHTH2E, In some cases of consumption this symptom gives the patient much suffering and requires the special attention of the physician. For its treatment the following remedies deserve notice. 1.-Mercurius, Chlorate of Potash, Borax, Argentum nit., Nitric acid, Sulphuric acid, Muriatic acid and Arsenicum. 2.-Nux vomica, Sulphur, Aurum mur., Carbolic acid, Gallic acid, Pbosphoric acid, Calc., carb., Hydrastis, Natrum, m. Iodine, Kali hyd., Lycopodium, Alum, Baptisia, Hepar sul., Carbo veg. Staphysagria, Ammonium carb., Cantharis and Kreosotum. MERCURY.-Affects espe- This is one of the most reliable cially the mucous membrane remedies we have for aphthous of the mouth; gums bleed and ulceration of the mouth, not only are inclined to ulcerate about the teeth, very fetid breath; when found in consumptives but in red tongue with much burning all cases where its characteristic and great thirst, mouth filled symptoms are prominent, such as with aphthous ulcers. Profuse spongy, easily-bleeding gums; swol HECTIC FEVER. 207 ptyalism, salivary glands great- len and painful, burning ulcers on ly swollen, stools of mucus and the inside of the cheeks and tongue. blood, much perspiration that does not relieve. Aggravated Ptyalism, very fetid breath; geneat night and in cold damp ral emaciation and prostration of weather. strength, especially in the last, stages of consumption, internally and locally. The first trituration of Merc. sol. used locally will give great satisfaction. KALI CHLORICUM. - This remedy is as nearly a speciHas a special and specific ac- fic for stomatitis or aphthous sore tion upon the buccal mnucous tion upon the bucca mucous mouth as can be found in the mamembrane and mucous follicles of the mouth. Follicular teria medica. If used locally and ulcers upon the inside of the internally, but few cases will resist cheeks and tongue. Aphthous its action. My favorite way of adulcers cover the whole mucous ministering it is to let the patient surface of the mouth; mouth surface of nsta th a; mouth put a small crystal in the mouth glands enlarged and sore; and suck it until all dissolved. By gums inflamed and bleed; using a small crystal this way, burning, stinging blisters on every hour or two, the majority of the tongue and buccal cavity; cases will, in from one to three great heat in the mouth. days, be effectually cured. BORAX.-Aphthae appear- This is a remedy of much value, ing suddenly; the whole buccal cavity covered with white when in the first stage of phthisis fungous growths, limited to aphthae suddenly make their apthe month and fauces; great pearance, completely filling the heat and dryness of the mouth; mouth in twenty-four hours. The profuse mucous diarrhoea; cannot bear downward motion; remedy may not only be given insymptoms all aggravated in ternally in the first three trituradamp weather. tions, (I prefer the first two decimal triturations) but also used topically,-for a child, four grains to the ounce of water, and for an adult, ten grains to the ounce, applied locally every two hours, will be found a serviceable application. Locally the first decimal trituration is of great value. 208 PULMONARY CONSUMPTION. A good way to use Borax is to mix it with Glycerine, using from thirty to forty grains of Borax to one ounce of Glycerine; apply with a soft brush. AR G E N T U M NITRICLARGE G eNTU UM N ITRI- In the last stages of tuberculosis CUM.- Patient seems all withered and dried up; patient this will be found of great value in can't think, can't walk, can't the malignant form that has resisttalk, he gets so giddy; time ed all other remedies; the remedy seems hours to him, when it has not only to be given internally, has only been a few minutes; but every second or third day the is in a great hurry to do things; much flatulence, the solid stick should be used thoroughstomach seems as if it would ly over the entire diseased surface, burst; fluids seem to run especially if there is any deep straight t:rough the intestinal ulceration. The caustic effect, in canal without stopping; green deep aphthous ulceration of the fetid dbiarrha; much ema- mouth, seems to have the power to ciation and debility, particularly in the lower extremities, set up at once healthy action in with much chilliness. the diseased surface, and the ulcers heal rapidly. NITRIC ACID. -If the The great field for the use of disease is engrafted upon a Nitric Acid is in people who have person afflicted with mercurial been mercurialized; in such cases or syphilitic poison; broken down constitutions from mer- no remedy can equal it. The curial or scrofulous miasms; aphthous ulceration spreads rapidold people with much debility ly, and is of the most fetid and disand diarrhcea; salivation and gusting nature; the slightest touch ulceration of the mouth from causes theulers to bleed profusecause s the ulcers to bleed profuseabuse of mercury; spreading ulcers in the mouth and ly; gums spongy and bleed easily; throat; much bleeding of the teeth loose; the slightest touch gums; putrid smelling breath; causes a sensation in the ulcers as mouth filled full of fetid ul- if sharp sticks were being thrust cers; bloody saliva; chronic into them; great dryness and heat inflammation of the fauces, in the mouth and throat; tongue extending up into the nose, with discharge of thin, puru- looks red, like a piece of raw beef. lent matter'; fissures of the I use the first and second deci HECTIC FEVER. 209 anus, with chronic diarrhcea; mal dilutions, prepared in water, intolerable fetor of the urine, five drops every two or four hours, it smells like horses' urine; and of the same every suitable to lean people broken and agargle of the same every down with mercury, and very hours. liable to take cold. SULPHURIC ACID.- Mouth filled with aphthous ulceraGreat exhaustion from some tion, which is exceedingly painful deep seated dyscrasia; great to the patient, attended with greatdebility, with sensation of tre- the patient, attended with greatmor all over the body, without ly increased secretion of saliva. In trembling; profuse perspira- the last stages of tuberculosis, tion, with great debility; cold where the mouth is covered with relaxed feeling in the stomach aphthae, sulphuric acid, applied twice with great debility, constipa- a day, a few minutes at a time, with tion, with pricking pains in the anus during stool; hoemor- a spray producer, will be found of rhages of black blood from all great value and a comfort to the the outlets of the body; cons- patient; or it can be mixed with tant flushes at the climacteric, glycerin e and applied with a camels' with a tremulous sensation all hair pencil dilute sulphuric acid over the body; menses too early and too profuse, always and water used as a gargle will preceded by a distressing night- also be of much value; internally I mare; patient feels as if every- use the second and third decimal thing must be done in a great attenuations prepared in water. hurry. MURIATIC ACID.- Acts This acid is of great value in especially upon the mouth and aphthous ulceration of the mouth anus; excessive dryness of the anus; excessive dryness of the in the last stages of consumption mouth and tongue, tongue is heavy and paralyzed; exces- accompanied with great debility. sively foul breath, from slough- The aphthous ulcers of the mouth ing ulcers in the mouth and and throat slough and tend to run throat; salivary glands inflam- together. Apthee in the last stages ed, tender and swollen; diar- of tuberculosis denote great debility, rhcea, the anus is so tender it cannot be touched; watery and are often the harbinger of disinvoluntary stools; putrescence solution; consequently what we do of the fluids of the body; low has to be done at once. These 210 PULMONARY CONSUMPTION. fevers. In women, menses too mineral acids seem to tone up the early, too profuse, accompanied body so rapidly that often a cure with great sadness; great sen- be made sitiveness to damp weather. seem impossible. They should always be used locally as well as internally, especially if the disease is parasitical. ARSENICUM. —Great pros- This remedy is adapted to the tration, with rapid sinking of most malignant forms of aphthae, the vital forces; burning pain, might be called gangrenous, extendthe parts burn like fire; great anguish, restlessness and fear ing through the whole intestinal of death; intense thirst for tract, attended with much burning cold water, drinks often but distress, thirst, vomiting and exlittle at a time; cannot lie down hausting diarrhoea. for fear of suffocation; wants Marcy and Hunt say: " Stomato be in a warm room; pains titis occurring in patients in malaworse during rest, relieved by motion, great loss of flesh; rious districts, most of whom have anasarca and general dropsy; been injured by Quinine; or where cadaverous diarrhoea, with the water is more or less stagnant, great tympanitis, abdomen and impregnated with the common burns like fire. causes of malarious fever. There is a depraved condition of the system analogous to typhus, the local eruption is vessicular in character; the edges of the tongue ulcerated, apthae; violent burning pains; swollen and readily bleeding gums, looseness of the teeth; debility; sinking. Practical Expedients.-A nutritious, but easily digested diet, to promote the general health of the patient, is the first thing to be done. Vegetable acids as found in oranges, lemons, apples, are often of great utility. Where digestion is greatly at fault, Koumiss, one quart a day, will be found just what is wanted to restore the patient to health and strength again. Dr. Ruddock says: "As a rule the patient's diet sl: ould be restricted for some time to milk and soda-water in equal proportions, which is both nourishing and digestible, and may be taken without adding to the patient's discomfort." HECTIC FEVER.-DIARRH(EA. 211 Dr. R. J. McClatchey has unbounded faith in " Hydrochloric acid applied with a camels'-hair pencil." Locally the Permanganate of Potash, will be found of great utility. Prof. Wood in his work on " Practice" says: " I have found nothing so useful as a solution of sulphate of zinc, inthe proportion of fifteen or twenty grains to the fluid ounce of water, applied twice or three times a day to the ulcer by means of a camels'-hair pencil, and continued until the yellowish white exudation is removed, and the surface assumes a reddish hue. With this application I have in no instance failed to effect a cure. It is highly probable that strong solutions of Sulphate of Copper, or nitrate of silver, which have been recommended would prove equally effectual." Any of the mineral acids, diluted with honey or glycerine, and applied with a camel's hair pencil, will be found valuable adjuncts. Pulverized borax and sugar in equal parts, used locally, has often been of great value. Glyceroles of Hydrastin used locally has done good service for me. In desperate cases the parts should be touched daily with a pencil of nitrate of silver. Calendula, locally, has done good service. Sulphate of Copper, in substance, applied twice a day, has a fine curative effect. Glycerine will often prove beneficial, especially if the inside of the cheeks and tongue become dry, with much thirst. DIARRH(EA. Diarrhcea, when not occasioned by intestinal tubercles, is treated of fully in our text books, but when it is produced by tubercular lesions it is a formidable symptom to contend with, and the physician will often be disappointed with the action of his remedies in this form of diarrheba. Generally it takes 212 PULMONARY CONSUMPTION. place in the last stage of the disease, and cannot well be treated alone, there being so many other prominent symptoms with it. We will, therefore, simply name the most prominent and useful remedies for this form of diarrhcea:1. Calcarea phos., Phosphorus, Arsenicum, Mercury, Sulphur, Nitric Acid, China, Carbo veg., Phosphoric Acid, Ferrum and Argentum Nitricum. 2. Nux v., Pulsatilla, Colocynth, Terebinth, Baptisia, Collinsonia, Ipecac, Rheum, Antimonium crud., Podophyllum, Cuprum and Veratrum Alb. Practical Expedients. —Rest in the recumbent posture. The extremities and the abdomen should be kept warm, the latter by flannel worn over it. Severe griping pains may often be relieved by flannel heated, or wrung out of hot water, and applied as hot as can be borne. A heated dinner plate applied to the abdomen will often be of much comfort to the patient. If the pains are very severe nothing serves me so well as mustard mixed with the white of an egg. It will not blister in this form, and can be left on for hours. An abdominal compress, six to nine inches wide, and long enough to go round the body, made out of two or three thicknesses of linen, wrung out of cold water and covered with oiled silk, and worn day and night, will often be of great service in controlling the diarrhcea. Injections of water often do good. Mucilaginous enemata of flax-seed, or flax with a few drops of opium added, often give great relief and quiet rest to the patient when everything else fails. I have used as an injection a weak solution of the Sulphate of Copper with fine results, also the Sulphate of Zinc. Morphine, internally, in the last stages, when all other means fail us, will be found a great comfort to the patient, and should never be denied. DIET.-During the attack of diarrhcea, food should be given sparingly, consisting of gruel, rice, arrow-root, sago, or milk. Milk and lime-water, as recommended by T. K. Chambers, is often of great value; it alone will frequently arrest the diarrhoea, and soda water may occasionally be substituted for the lime-water. This alkaline diet should be taken frequent 214 PULMONARY CONSUMPTION. Our school does not value cupping as it should; in many diseases nothing will help the patient with greater rapidity. BED-SORES. In the last stages of Phthisis, the patient is very apt to be greatly troubled with bed-sores, from being confined to bed. They are generally situated about the sacrum and along the spinal column. Internal medication can seldom be resorted to, the patient at the time using other remedies for Phthisis; consequently we will have to depend upon Practical Expedients.-The first thing to be done is to lessen the amount of pressure, and this is best obtained by the use of circular air-or down-cushions, the bed-sores being bathed twice a day with a weak solution of arnica or calendula, and then dressed with carbolated calendula cerate. Dr. Brown-Sequard's treatment has been pronounced successful by those who have tried his method; it consists in applying sponges alternately wetted with hot and cold water to the bed-sores, each sponge remaining upon the parts about one minute. Alternately for ten or fifteen minutes, each treatment. Galvanism has been recommended by Crupel, of St. Petersburgh, and Spencer Wells; and Dr. Hammond has greatly extolled its use. He says: " During the last six years I have employed it to a great extent in the treatment of bed-sores caused by diseases of the spinal cord, and with scarcely a failure, indeed, I may say, without any failures, except in two cases where deep sinuses had formed which could not be reached by the apparatus. A thin silver plate, no thicker than a sheet of paper, is cut to the exact size and shape of the bed-sore, a zinc plate of about the same size is connected with the silver plate by a fine silver or copper wire, six or eight inches in length; the silver plate is then placed in immediate contact with the bed-sore, and the zinc plate on some part above, a piece of chamois skin soaked in vinegar intervening; this must be kept moist or there is little or no action of the battery. Within a few hours there is a perceptible change, and in a day or two the cure is complete in a majority SPIROMETER AN Instrument for measuring the capacity of a man's lungs, in cubic inches, in health and disease. The spirometer is the most valuable aid that Science has placed in the hands of the physician for detecting diseases of the respiratory organs in their incipiency, and a physician's armamentarium without this instrument is not half filled. The London Lancet says: "This mode of distinguishing consumption at an earlier period than by any other means, has been actually proved." Dr. Hall, of London, who has made diseases of the lungs a specialty, says the stethoscope is a mere toy compared to the spirometer; his language is: " I consider the stethoscope and plessimeter as mere toys, which do well enough to excite the credulous, but I must confess they never gave me any satisfaction; I never could learn anything by them. * * * In forming an opinion in a case of consumption the main foundations are: 1st. The condition of the pulse. 2nd. The degree of emaciation. 3rd. The measurement of the lungs (with the spirometer). 4th. The sounds given to the ear when it is laid on thet patient's breast, while standing, or back when stooping. Referring to the Spirometer in detecting the early existence of consumption, the London Lancet says:" It is proven by actual experiment with the Spirometer that a man's lungs, found after death to have been tuberculated to 220 PULMONARY CONSUMPTION. he has ascertained, by actual mathematical measurement, their capacity of action at the time of examination. All else is indefinite, dark conjecture, the great and most satisfactory deduction in all cases being this, that if, upon a proper examination, the lungs of any given person are working freely and fully, according to the figures of the case, one thing is incontrovertibly true, demonstrably true, that whatever thousand other things may be the matter with the man, he certainty has nothing like consumption; and the announcement, and certainty that it is not consumption, brings with it a satisfaction, a gladness of relief, which cannot be measured." "On the other hand, just in proportion as a person is habitually breathing less air than he ought to do, in such proportion he is falling fast and surely into a fatal disease. This tendency to consumption can be usually discovered years in advance of actual occurrence of the disease." Dr. Flint, in vol. 1, of his Physiology of Man, has a most valuable article on the Spirometer, from which I make the following extract: "Extreme Breathing Capacity.-By the extreme breathing capacity is meant the volume of air which can be expelled from the lungs by the most forcible expiration, after the most profound inspiration. This has been called by Dr. Hutchinson the vital capacity, as signifying "the volume of air which can be displaced by living movements." Its volume is equal to the sum of the reserve air, the breathing and the complimental air, and represents the extreme capacity of the chest, deducting the residual air. Its physiological interest is due to the fact that it can readily be determined by an appropriate apparatus, the Spirometer, and comparisons can thus be made between different individuals, both healthy and diseased. The number of observations on this point by Dr. Hutchinson is enormous, amounting in all to little short of five thousand." The extreme breathing capacity in health is subject to variations, which have been shown to bear a very close relation to the stature of the individual. Hutchinson commences SPIROMETER. 221 with the proposition that in a man of medium heiqht-(5 feet, 8 inches), it is equal to two hundred cubic inches. He has shown that the extreme breathing capacity is constant in the same individual, and that it is not to be increased by habit or practice, (without there is a diseased condition of the lungs.) The most striking result of the experiments of Dr. Hutchinson, with regard to the modificationss of the vital capacity, is that it bears a definite relation to stature, without being affected in any very marked degree by weight, or the circumference of the chest. This is especially remarkable, as it is well known that height does not depend so much upon the length of the body, as the length of the lower extremities. It has been acertained that for every inch in height, between five and sixfeet, the extreme breathing capacity is increased eight cubic inches. The following table shows the mean results of the immense number of observations on which this conclusion is based: Progression of the Vital Capacity Volume with the Stature. o 0 Height. c..... - U)0 0 0 First result. Second result. 5 feet 0 inches 15 feet 1 inch.... 175.0 176.0 174.0 5 2,, 5,, 2,, 15,,3 188.5 191.0 190.0 5 4 5 4 6, " 5,, 206.0 206.0 206.0 5,, 6,, " " 5,, 6,,, 7,, 222.0 228.0 222.0 5,, 8,, 5,'10,, It,, 59,, 237.5 246.0 238.0 5 10 I s 5,,1 254.5 258.0 254.0 Mean of all heights............ 214.0 217.0 214.0 Age has an influence, though less marked than stature, upon the extreme breathing capacity. As the result of 4,800 observations (males), it was ascertained that the volume in 222 PULMONARY CONSUMPTION. creases with age up to the thirtieth year, and progressively decreases, with tolerable regularity, from the thirtieth to the sixtieth year. These figures, though necessarily subject to certain individual variations, may be taken as the basis for examinations of the extreme breathing capacity in disease, which frequently give important information. Of course, the breathing capacity is modified by an abnormal condition which interferes with the mobility of the thorax, or the dilatability of the lungs. Of all diseased conditions, phthisis pulmonalis is the most interesting in this connection. With regard to the significance of the variations in this disease, Dr. Hutchinson has arrived at the following conclusions: "It has been found that ten cubic inches below the due quantity, i. e., 220 instead of 230 cubic inches, need not excite alarm, but there is a point of deficiency in the breathing volume, at which it is difficult to say whether it is merely one of those physiological differences dependent on a certain irregularity in all such observations, or deficiency indicative of disease. A deficiency of sixteen per cent. is suspicious. A man below fifty-five years of age, breathing 193 cubic inches instead of 230 cubic inches, unless he is excessively fat, is probably the subject of disease. "In phthisis pulmonalis the deficiency may amount to 90 per cent., and yet life be maintained. The vital capacity volume is likewise a measure of improvement. A phthisical patient may improve so as to gain 40 upon 220 cubic inches." "Herbst has shown that the extreme breathing capacity is diminished by obesity; that it is proportionally less in females than in males and in children than in adults." Dr. Hall gives us a fine illustration of the practical workings of the spirometer in page 167 of his work on Bronchitis and Kindred Diseases, by giving twelve fatal cases of phthisis: Case 1. Had lost five-tenths of her lung measurement, and died in twelve days. " 2. Had lost five-tenths, and died in eight months. SPIROMETER. 227 of intoxicating liquors, even ever so slight if indulged in daily, greatly diminishes the lung capacity. Also a full stomach. The Spirometer should not be used directly after eating., Heretofore the iSpirometer has not been utilized by the mass of practicing physicians, for the simple reason all that have been put into the market have been so large and bungling, that their use had to be confined to the office, and then the use of one took up so much valuable time that the practitioner could not afford to use it. To illustrate it more fully, I will take Dr. G. W. Brown's valuable Spirometer, in all probability as good an instrument as can be found in the market. To take it down, adjust it, fill it with water (and it takes several gallons), use it, take it apart again, wipe it all dry to keep it from rust, about one hour is consumed. This hour to the physician is worth from two to five dollars, and he cannot charge that much for his services, consequently he cannot afford to use it, and then if his patient has to be visited at his residence, the Spirometer cannot be used at all, because of the great trouble of transporting it from house to house. To get the Spirometer in small enough compass, so as to be carried constantly in the physician's pocket, has been a source of constant study to me for the last two years, and it gives me great pleasure in being able to announce to the profession that I have succeeded in producing an instrument whose action is perfect as a Trtermometer, can be carried in the pocket, taken out and used, and replaced in the pocket in two minutes, and only costs a mere trifle, compared to those now in use, at once utilizing this greatest of all instruments for diseases of the lungs. INDEX. Aconite, 45, 151. Chloroform, 195. Acid Hydrocyanic, 158. Charge, Dr. A., Remedies, 12. Ammonium Carb, 157. China, 24, 52, 85, 164, 199.. Ammonium Mur., 70. Climate, 20. Ambra Gresia, 70, 157. Clothing, 58. Antimnonium Crudum, 71. Cough, 59; Dry, 63; Moist, 65; Asthmatic, 67; Aphtha, 206; Practical Expedients, 210. Catarrhal, 67; Croupy, 67; Morning, Argentum Nit., 74, 157, 208. 68; Evening, 68; Night, 68; After MidArnica, 52, 71. night, 69; Inflamatory, 67; Whooping, Arsenicum Alb.. 21, 72, 153, 198, 210. 67; Seat of Cough, Larynx, 66; TracArsenate of Soda, 74 hea, 66; Bronchi, 66; Lungs, 66t; Asthma, 150; Acute Attack, 150; Chronic, Stomach,67;Heart and Blood-vessels, 151; Remedies, 151; Practical Exped- 67; Practical Expedients, 148. ients, 194. Jod Liver Oil, 29, 165. Asthmatic Cough, 67. Coffea, 88. Atropine, 78. Counter Irritation, 197. Atonic condition of the body, 15. Crocus, 53. Aurum Muriaticum, 76, 156. Cuprum, 88, 165, 211. Baehr, Dr. B., Remedies, 9. Cupping, 55, 196. Bathing, 20. Diet, 55, 212. Bed Sores, 214; Practical Expedients, 214. Digitalis, 89. Belladonna, 53, 76, 158. Digitaline, 47, 89, 166. Blood Cure, 216. Diarrhcea, 211; Practical Expedients, 212. Borax, 207. Drosera, 90. Bromine, 78, 160. Dulcamara, 91. Bryonia Alba., 79, 159. Electricity, 196. Breathing Tubes, 16. Epps, Dr., Remedies, 11. Carbo Animalis, 83, 200. Ether, 195. Carbo Ve,., 82, 163. Emaciation and Debility, 20. Causticum, 84. Ferrum, 25, 51, 91, 168. Cannabis Sativa, 162. Fish, 56. Camphor, 164. Gallic Acid, 205. Carbonic Acid Gas, 196. Gelseminum, 94, 169. Calendula, 211. Graphites, 170. Calcaria Carbonica, 20, 80, 161, 198. Glanderine, 170. Cerebral Cough, 67. Glycerine, 211. Chamomilla, 85, 163. Hsemoptysis, 44; Practical Expedients, 54. Chloral Hydrate, 195, 215. Hamamelis, 46. 230 IND EX. Hastings, Dr., Remedies, 11. Moschus, 181. Health Lift, 16; Effects of, 19; Rules for its Muriatic Acid, 209. use, 18. Naja Tripudians, 182. Hepar Sulphur, 95, 170, 201. Nitric Acid, 117, 182, 203, 208. Hectic Fever, 197, Practical Expedients, 204. Night Sweats, 197; Practical Expedients, Hitchman, Dr. W., Remedies, 9. 204. Hughes, Dr. R., Remedies, 12. Nux Vomica, 118, 183. Hyoscyamus, 97. Oleum Jecoris Aselli, 29; Caution, 35; ExHydrastin, 211. hibition, 36. Ignatia, 98. Opium, 120, 185. Insuffiation in Asthma, 196. Ovario-Uterine Cough, 67. Introductory, 7. Ozonized Water, 196. Iodine, 22, 98, 173. Pain, 213; Practical Expedients, 213. Iodide of Potash, 23, 107, 174. Phosphoric Acid, 202. Ipecacuanha, 47, 102, 171. Phosphorus, 23, 47, 121, 186. Jahr, Dr. C. H. G., Remedies, 10. Pulsatilla, 53, 124, 187. Kafka, Dr. J., Remedies, 12. Raue, Dr. C. G., Remedies, 10. Kali Bichromicum, 103. Rhus Toxicodendron, 127. Kali Bromatum, 106. Rumex Crispus, 128. Kali Carbonicum, 27, 105. Rum, 196. Kali Hydriodicum, 23, 107, 174. Ruddock, Dr. E. H., Remedies, 11. Kali Chloricum, 207. Sanguinaria, 131. Kali Nitricum, 195. Sarsaparilla, 197. Kreosotum, 108. Sepia, 135. Koumiss, 39, 206. Senega, 134. Lachesis, 109, 178. Silicea, 24, 136, 201. Lime Water, 206. Spongia, 138, 189. Lobelia, 178. Spirometer, 217. Lebenswecker, 197. Stramonium, 184. Lycopodium, 28, 110, 180, 200. Styptics, 55. Malt Extract, 44. Stannum, 26, 139, 189. Marcy & Hunt, Remedies, 10. Sulphur, 26, 54, 140, 190. Meat, 58, 216. Sulphuric Acid, 202, 209, Milk, 56; Skim Milk, 206. Tartar Emetic, 145, 191. Millefolium, 46. Tobacco, 195. Mercurius Sol., 113, 181, 203, 206. Veratrum Album, 147, 192. Mercurins Proto-Iodatus, 116. Veratrum Viride, 45, 193.