1 ' ' J ■nn IBBmHBi 1| Wc i I iBU i IfVsnR mwm llHiil mm ■i illlHi // c *> V ^ <^''' ^ ,#' \ \V -■ r ' (P 'V ' \ v o ^ "*^» ^ A »* - 'W ^ * /•. an , & ' v 5 % - ' V > ^>- • v x -v Ho A^ S « ' ' ' ^ A^ 8 l \ -v. ■ - \ o °>°° * -^ 7* j* * CI o u $ V <5 ■ V y * .IV * v \ v V bi o ; r & \v ^\ «/- r a\ x ^, S^v* . w o ?> cV * i# t ^. * v ■' ^v ^ <^" & ^ ^* "*■ \i- KSaP ■*• '> •>*, v. *" f ' •>* A > oo x «*~ > ac f, c> v * * °' ^ v0 V «. "• * " / ^ - ^ -t> - <. A vV * A^ ' ^ a\ v ' r V'. * -> : rt \ *< aV THE J-Jomceopathic Treatment OF urgical Diseases, BY J. G. GILCHRIST, M. D., (Editor of the Surgical Department of The Medical Investigator^ D -1 .;- ■ ; CHICAGO: / C. S. Halsey, No. 72 State Street. New York: Bcericke & Tafel, 145 Grand Street, 1873. Entered according to Act of Congress, in the year 1873, by C. S. HALSEY, in the office of the Librarian of Congress, at Washington. PREFACE. At the time this little book was projected, so far as my know- ledge extended, there was not one line, outside of our periodical literature, that taught the application of our therapeutic principles to the treatment of so-called "Surgical Diseases." A work on this subject has been sorely needed, and our accumulated expe- rience demands a gathering together of this scattered material. Having had some years ago a case to treat in which a fibroid growth was a prominent symptom, I sought the advice of men grown gray in the service. Heretofore there had been no hesit- ancy on my part in cutting out such symptoms, supposing them to be the disease in esse. Dr. Guernsey had opened my eyes a little, hence a desire to cure this case, which could not have been done by an operation. One of those to whom I applied for aid, said, " Treat your patient, never mind the tumor," a maxim but half comprehended at the time. Another said, "Cut it out;" I knew more myself. A third, "I know nothing about it;" just my condition. Being thrown thus upon my own resources, the case was studied, the patient cured, and the tumor disappeared. This case led to further study and experiment, the results of which are found in the following pages. The attention of the profession has been directed to this study more persistently of late years, but the present work is the first attempt at a systematic treatise, I believe. Being, then, a I o Preface. " pioneer work," so to speak, there must be some imperfections; I trust but few inaccuracies. It may be objected (and I allow that the objection has weight) that works of this character are apt to encourage superficial study of the Materia Medica, and, perhaps, tend to perpetuate the absurd custom of treating diseases by name rather than symptoms. It has been the main object of this work to teach, unmistakably, that apart from mechanical injuries (and these are not diseases) there can be no such thing as a local disease. Tumors, ulcers, and all kinds of abnormal growths, are simply symptoms ; peripheral symptoms of a generally diseased organism. A man is wounded; the wound made with a non- poisoned, clean -cutting instrument. The wound does not heal, as it should, but an ulcer is produced. Can this be called a local disease? No! because in ninety -nine other identical cases no ulcer results. It indicates, as before said, a taint, diathesis, pre- disposition, or what you please to call it, latent in the system, only waiting for a favorable opportunity to be developed in some situation only to be determined by circumstances. If this is one object of the work, it may be asked, why not give fuller indications for the application of remedies instead of confining them to the local symptoms of the disease under dis- cussion? The answer is easy, and will dispose of the first objection as well. The student of homoeopathy finds one difficulty in studying the Materia Medica in connection with surgical diseases. Surgi- cal diseases may be called those which are chiefly recognized through objective symptoms. A new form of tumor is found, i.e., new to the student, and where in our bulky Materia Medica will he find its simile? It is not there. A remedy has never developed a tumor during a proving. Applying remedies for symptoms apparently unconnected with this tumor, we have now and then succeeded in causing a disappearance of the growth, and in time the fact creeps into the symptomatology as a " clinical Preface. 1 1 symptom." Many of these clinical symptoms are only to be found in our periodicals, and many more in private case books. It has been my task to gather as many of these as possible, and thus reduce the number of remedies to be consulted from four hundred in number to a very few. When the objective symptoms are found in the following pages, the Materia Medica must be consulted for those which are subjective, the union of the two making the true similar, which is the only agent that will cure. It is not enough to know there is a cataract to cure, for instance, but we must find a remedy that has a picture of the constitution and little mental peculiarities of our patient as well. I hope that this work will be found to be a guide to the Materia Medica, and in no sense a substitute for it. In closing my labors I feel under obligations to return my sincere thanks to Drs. T. C. Duncan and H. B. Fellows, of Chicago, for the valuable aid they have afforded me in seeing the work through the press. Without their aid it would have been almost impossible to have carried it to a successful ter- mination. Let me ask then, in the language of an "old play," " What of merit mav be found give to us three : what of blame give to me alone." J. G. G. yanuary I, 1873. CONTENTS. PAGE. Preface - - - - - - - -9 Introductory - - - - - - - -17 DISEASES OF THE MIND: 19 Shock ; Traumatic delirium. DISEASES OF THE HEAD : - - - - - -22 Injuries of Scalp ; Wounds of Brain ; Compression of Brain ; Her- nia Cerebri ; Concussion of Brain ; Fungus of the Dura-Mater ; Irritation of the Brain ; Fungus of the Cranium ; Traumatic Encephalitis. DISEASES OF THE FACE: 37 Wounds of the Face ; Salivary Fistula. DISEASES OF THE EAR: 39 Otitis ; Otorrhcea ; Deafness ; Various Diseases. DISEASES OF THE EYE: ------ 50 Foreign bodies in the Eye ; Wounds of the Eye ; Ophthalmia ; Stra- bismus ; Pterygium ; Opacity of the cornea ; Chemosis ; CEdema of the Lids ; Fistula lachrymalis ; Cataract ; Retinitis ; Iritis ; Malig- nant Tumors ; Various Diseases. DISEASES OF THE NOSE: 74 Epistaxis ; Lipoma ; Various Nasal Diseases ; Dropsy of the Antrum ; Suppuration of the Antrum. DISEASES OF THE MOUTH: '- - - - - 83 Glossitis ; Prolapsus of the Tongue ; Abscess of the Tongue ; Ranula ; Various Diseases of the Tongue ; Abscess and Ulceration of the Gums ; Epulis. '' DISEASES OF THE THROAT: 97 Wounds of the Esophagus ; Foreign bodies in Esophagus ; Stricture of the Esophagus ; Scalds of mouth and pharynx ; Injuries to the air passages ; Foreign bodies in the air passages ; Asphyxia ; Vari- ous diseases of Pharynx ; Cancrum oris ; Laryngitis ; Parotitis ; Enlarged Tonsils ; Bronchocele. 1 4 Contents. PAGK. DISEASES OF THE CHEST AND BREAST : - - 123 Injuries of the Chest ; Emphysema ; Pneumo - Thorax ; Traumatic Pneumonia ; Empyema ; Neuralgia of Breast ; Hypertrophy of the Breast ; Inflammation of Breast ; Suppuration of Breast ; Malig- nant Tumors of Breast. DISEASES OF THE SPINE : 133 Injuries of the Spine ; Caries ; Lateral curvature ; Spina - bifida ; Myelitis. DISEASES OF THE ABDOMEN: -. - - - - 148 Injuries to the Abdomen ; Injuries to Pelvic Viscera. DISEASES OF THE INTESTINES: 158 Hernia ; Intestinal obstructions. DISEASES OF THE ANUS AND RECTUM: - - - 169 Haemorrhoids ; Ulcer and Fissure of Anus ; Fistula in Ano ; Pro- lapsus Recti. v DISEASES OF THE PENIS : -. 181 Syphilis ; Phimosis ; Paraphimosis ; Balanitis ; Herpes of the Glans and Prepuce ; Warts on the Glans. DISEASES OF THE BLADDER AND APPENDAGES : - - 203 Diseases of the Prostate ; Perineal Abscess ; Urethritis ; Gonorrhoea ; Stricture of the Urethra ; Cystitis ; Tumors of the Bladder ; Paral- ysis of the Bladder ; Calculi. DISEASES OF THE SCROTUM AND TESTICLES. - - 235 Orchitis ; Hydrocele ; Varicocele ; Hematocele. DISEASES OF THE FEMALE GENITALS: - - - 245 Diseases of the Uterus ; Ovarian Tumors ; Vaginal Fistulae. DISEASES OF THE JOINTS: 266 Synovitis ; Arthritis ; White Swelling ; Anchylosis ; Hip - disease ; Enlarged Bursae ; Ganglions ; Wounds of Joints ; Dislocations ; Strains. DISEASES OF THE BONES: 288 Periostitis ; Osteitis ; Caries ; Hypertrophy ; Rickets ; Fragilitas Ossium ; Tubercles ; Exostosis ; Osteo-sarcoma ; Hydatids ; Osteo- aneurism ; Fractures. DISEASES OF THE NAILS: 297 Onychia ; In-growing Toe-nail. DISEASES OF THE BLOOD-VESSELS: - - - - 299 Phlebitis ; Varices ; Pyemia ; Aneurism ; Aneurism by Anastomosis ; Arteritis ; Fatty degeneration of Arteries ; Calcification of Arteries ; Nevus ; Wounds of Blood-vessels. Contents. 1 5 PAGE. DISEASES OF THE NERVES: 320 Neuralgia ; Neuritis ; Neuroma ; Tetanus ; Wounds of Nerves. SUPPURATION: - - 341 Abscess ; Sinus ; Fistula. ULCERS: - 351 GANGRENOUS DISEASES: - - - - - - 364 Mortification ; Bed-sores ; Sloughing phagedena ; Carbuncles ; Boils. TUMORS 375 Innocent ; Semi-malignant ; Malignant. EFFECTS OF HEAT AND COLD: 402 Burns ; Scalds ; Frost-bite. INDEX 415 THE HOMCEOPATHIC TREATMENT OF Surgical Diseases. INTRODUCTION. Among all the books treating on Surgery in our profession, there is not one presenting any thing more than the merest outline of treatment. On operative surgery, and pathology in general, we have, perhaps, books enough ; and it is time that we apply our system to the treatment of surgical affections. That we have not yet done so, in the fullest meaning of the word, is evident ; for in all our books a few lines are given to remedies, and pages and whole chapters to pathology and operative measures. I do not mean to undervalue these studies, but, rather to make them subor- dinate to therapeutics. Believing that what we now need is a work on surgical practice purely Homoeopathic, with the fullest indications for the use of the remedies, and that the law of similars, the single remedy, and the minimum dose, are just as applicable in surgery as anywhere else, the present pages have been written to help fill this demand. There being then nothing in our literature treating specially on surgical therapeutics, I had, at the suggestion of several of my professional friends, interleaved a copy of Erichsen, with indications for the selection of remedies, intending to procure, if possible ', permission to publish a Homoeopathic system of sur- gery based on his work. Circumstances operated against this, 1 8 Introduction, however, and the book was finally completed in its present &**.* ; therefore, whatever resemblance this may present to Erichsen's must be attributed to that fact. The object is simply to present reliable indications, gathered from my own clinical experience from well-authenticated reported cases, and confirmed symptoms from the works of Hahnemann, Lippe, Jahr, Bcenninghausen, Guernsey, Raue, and others. For the details of operations and measures of expediency there is no occasion here, as the works of Erichsen, Gross, Smith, and especially the labors of Franklin and Helmuth, have provided us with all that we need on those points; and I take pleasure in referring to the latter in this connection, and acknowledging how much we are indebted to them. SURGICAL DISEASES OF THE MIND. SHOCK— TRAUMATIC DELIRIUM. Shock. Shock is a state of depression or nervous prostration present after all mechanical injuries, and varies in intensity according to the gravity of the accident. The symptoms accompanying the immediate results are, cold- ness, faintness and trembling ; pulse small, weak and fluttering ; the mind is shown to be disordered by the face exhibiting mental disquietude, and by anxious and incoherent speech. Death may be the result of shock alone. Even in apparently trivial accidents, the patient may be in a state of physical or mental depression that is sufficient to render the mere shock fatal. Remote effects may not exhibit themselves until considerable time after the accident. A blow has been received, and weeks, or even in some cases months have elapsed, when neuralgia or in- flammation is developed, traceable directly to this blow. Therapeutics. — The treatment of shock may be moral or medicinal. Often, kind and encouraging words will rally the patient, without any other treatment. An operation should not be performed during the shock ; it is best to wait for a reaction. The rule is, in civil practice, wait for reaction ; in military, operate as soon as possible after the accident. Many Homoeopathic sur- geons ignore altogether the use of our remedies in the treatment of shock, depending entirely on stimulants. I have never given them for any disease, and trust I never shall. The remedies that will be found the most frequently indicated are Arnica, Camphor and Opium. Aeon., Ruta, Rhus, may be, occasionally. 20 Surgical Diseases of the Mind. Arnica is always more or less useful, and should be admin- istered even if you have to use stimulants. I find it the most useful where there is diarrhoea. Opium is indicated when there is coma; incomplete insensi- bility ; the patient will be aroused for a moment on addressing him in a loud tone of voice, and then relapses into stupor ; extremities and face bluish, or of a livid color ; loud, stertorous respiration, and coldness of the skin. Camphor is a valuable remedy, and will frequently produce an effect when Opium fails. Cold hands and feet, trembling tongue, trembling of the hands and feet on raising them up. These three remedies have acted beautifully in my hands. As I have had the privilege of treating a great number of cases of accident, they have had a fair trial. Therefore, I would advise : discard all notions of stimulation and stick to Homoeopathy. Traumatic Delirium. Traumatic Delirium is nothing more than Shock modified by existing circumstances. If an individual of a highly nervous or irritable disposition receive a great injury, the shock either degenerates into a delirium, or this condition is present from the first. This delirium is usually of the furious, raving form, though it may occur in almost any form. There is an another form, " irritative," or " nervous delirium," which occurs in persons of a broken-down constitution, and resembles very closely delirium tremens. Like this frightful mal- ady, it is chiefly confined to drunkards. Therapeutics. — In both of these forms we have a variety of remedies to choose from. Among the most prominent are Aeon., Bell., Bryonia, Cuprum acet., Cuprum met., Ferrum acet., Hell., Hyos., Ign., Lach., and Stram. A-COnite. Inconsolable lamentations; anguish; piteous howl- ings; reproaches from trivial causes; disheartening apprehensions; despair ; loud moaning, bitter complaints and reproaches ; palpita- tion of the heart; oppressed breathing; increased heat of the body and face; great weariness; apprehensions of approaching death : a strong tendency to be angry or frightened. Belladonna. Melancholy ; great anguish about the heart ; merry craziness ; sings and warbles an air; immoderate laughter; Special Therapeutics. 2 1 foolish manners ; violent weeping, moaning and howling ; fearful- ness; despondency; dejection of spirits; apathy; great irritability of the senses ; rage ; frenzy ; bites everything in his way ; shy craziness ; tries to escape ; violent redness of the face ; dark, red and bloated face ; shining, sparkling eyes. Bryonia* Apprehensions ; uneasiness, and dread on account of the future ; vehemence ; cold sweat on the forehead and head ; faintness and nausea on sitting up in bed ; has to lie down again *. bloated, red and hot face ; delirium about the day's business. (Compare Veratrum alb.) Cuprum acetic. Great absence of mind; tendency to start; the eyes are sunken, staring, as if riveted in the sockets ; cold sweat ; spasmodic distortion of the face. Cuprum metallicum. Anguish ; restless tossing about and constant weariness ; delirium ; attacks of craziness and vertigo ; slow pulse ; flushes of heat : colic ; red, inflamed eyes, with wild looks ; pale face. Ferrum acet.. Vehement; quarrelsome; anxiety; great lan- guor ; fainting spells ; coldness ; want of animal heat ; viscid, exhausting sweats ; livid or pale face and lips ; sometimes fiery red face. HellebOPUS nig. Silent melancholy ; involuntary sighing ; obsti- nate silence ; spasmodic rigidity of the limbs, with concussive shaking of the head ; general sweat ; dulness ; confusion of the head ; inability to reflect ; pale face. HyOSCyamUS nig. Indomitable rage; horrid anguish; com- plains of having been poisoned ; raging ; desire to go naked day and night; sleepless; screaming; repeated fainting-fits ; cold and sour sweat ; complete stupefaction ; loss of sense ; does not know his relatives ; red, sparkling eyes ; staring, distorted eyes ; open eyes, distorted in different directions ; bluish face ; cold, pale face ; or brown-red, swollen face. Ignatia. Great tendency to start ; boldness ; the slightest con- tradiction irritates; ill-humor and anger, impatience, irresolute- ness; quarrelsome; intolerance of noise; sadness; weeping and laughing almost in one breath ; sweat on the face ; face pale, red or bluish ; involuntary sighing. Lachesis. Feels sad ; discouragement and loathing of life mistrustful, suspicious, doubts everything; peevish, fault-finding malice ; hurriedness and uneasiness ; great nervous irritability 22 Surgical Diseases of the Head. excessive moaning and complaining of one's pains ; morbid talka- tiveness ; small and quick pulse ; distension of the face ; sunken face, showing great suffering ; pale face. Stramonium. Indomitable rage; talkativeness; great desire to bite ; fear ; convulsions ; weariness of the mind ; subsultus ten- dinum ; spasmodic movements ; strong pulse ; copious sweat ; swollen and red face ; sparkling, glistening eyes ; staring somno- lent eyes. SURGICAL DISEASES OF THE HEAD. Injuries of the Scalp — Compression of the Brain — Concussion — Irritation — Traumatic Encephalitis — Wounds of the Brain — Hernia Cerebri — Fungus of the Dura Mater — Fungus of the Cranium. Injuries of the Scalp in manufacturing districts are very common, and. although nearly every one knows something about their treatment, I have been surprised to see exhibitions of igno- rance that were truly lamentable and unpardonable. Contusions are the most common, and usually the most simple, of all these injuries. They are rarely accompanied with a wound, and require but the simplest treatment. Arnica, topically or internally, will, in. nearly every instance, effect a cure. When this does fail, use Con. in the same manner. When there has been much ecchymosis, and the effused blood seems to be firmly coagu- lated, it is an irresistable temptation to many to open it and turn out the clot. Never do this, as suppuration will surely follow. The only time when it would be at all admissible is when suppu- ration is already threatening ; then the removal of the clot may be useful ; not with the hope of preventing suppuration, but of lessen- ing the amount. It sometimes happens that although the blow was not sufficient to rupture the skin, yet concussion of the brain has followed. Arnica, in this case, is the most important remedy we have. (See Concussion.) Depression of the skull, with com- pression from it, as well as compression from effusion of blood, or Injuries of the Scalp. 23 lacerated brain, all have occurred with not only the absence of an external wound, but even with no signs of an injury to the skin. Lacerated wounds are the most common injuries in manu- facturing districts, being inflicted by belting of machinery. I have seen nearly the whole scalp torn up, and hanging down over the patient's face. Under our treatment, these wounds are most surely healed, with little or no disfigurement. Contused wounds are next in frequency, and are nothing more than bad contusions complicated by an external wound. The chief dread is that of gangrene and sloughing. Arnica, or per- haps Con., will, in nearly every instance, prevent this. Incised wounds of the scalp are rarely seen. Wounds, so-called, will often be found on examination to be either lacerated or con- tused. Should you have such a case, administer Staph., either internally or topically. Treatment. — The proneness of injuries of the scalp to sup- puration renders them a very interesting study. Allopathy has no means at her command to prevent suppuration that are at all certain ; hence she teaches the certainty of its appearance. They are prone to this termination, but seriously, I believe not more so than any other injury. Our remedies certainly act like a charm, and with their use I have had cases that actually suffered more from suppuration after amputations than from scalp wounds. I mean, of course, comparatively. Remove, first and always, all the hair, by shaving, for some dis- tance around the wound. If any arteries spout, close them by torsion. Ligatures act as setons, and greatly increase the forma- tion of pus. Wash the wound carefully with a weak solution of Calendula, Staphisagria or Arnica, according to the nature of the wound, i. e., incised, lacerated or contused, and then carefully inspect the part, to see if the bone has sustained any injury. Never enlarge a wound in this part for the purpose of making it a better shape, and, above all, never cut off any ragged pieces, no matter how small they may be — fit each one carefully in place. If you cut them off, suppuration will surely occur in that spot, and as the skin is very loosely attached, it may spread all over the head. Draw each little point into its proper place, and secure it there by hair-lip pins or silver-wire sutures (silk sutures are as objectionable as ligatures). The dressing of the wound is simple : support each stitch with narrow strips of adhesive plaster, cover 24 Surgical Diseases of the Head. them with a piece of soft linen, folded three or four thicknesses, saturated with a solution of the remedy required; retain the whole in place with a t or + bandage. Calendula is nearly always sufficient to prevent suppuration, but if it fails, open the wound partially to admit the escape of pus, otherwise the whole scalp may be dissected up. Compression of the Brain. Compression of the brain is a term used to designate coma, more or less complete ; coldness of the face, head and extremities ; clammy perspiration ; a peculiar " pumping " of the larynx and trachea ; stertorous respiration ; dilated or contracted pupils, but in either case immovable ; frequently frothing at the mouth. Cases have been recorded in which none of these conditions were present, the patient being in full possession of all his faculties, so that no suspicion of compression could be obtained. One of* four causes usually operates to produce this state : depressed fracture of the skull; extravasated blood, pus, or some effusion into the cavity ; the presence of some foreign body, as a bullet ; or the growth of tumors. Fracture of the skull may be simple or compound. Simple fractures are the most common, and the administration of Aeon., Am., Calend. or Symph. will aid in perfecting a cure. Compound fractures are to be treated on general principles; that is, cleanse the wound, tie the vessels, close it and apply the bandage ; use Calendula for the wound, which, as soon as it is healed, abandon for Symphytum. Comminuted fracture is frequently fatal, and, at the best, is a very serious lesion. The greatest drawback to a successful termi- nation is, that drunken people, or those who from dissipation are broken down in health, are the most subject to it. Some time usually elapses before you see the case, consequently the irritation of the fragments produces serious inflammation of the brain or its meninges. Again, the wound you are obliged to make to extract the fragments is almost sure to suppurate. If a wound is present already, the pieces of bone may be extracted through that ; and, if possible, avoid enlarging it any. If you have to make one, first shave the scalp closely over the place. After the pieces are all removed, the wound cleansed and bleeding stopped, close it, and Compression of the Brain, 25 administer Arnica internally, one dose either dry or in water every three or four hours. If the wound is one made by the same force that produced the fracture, continue the Arnica, topically and internally ; if it is one you have made, use Staphisagria 6 top- ically, one drop to the ounce, and the 6th or 30th internally. Extravasated blood may produce compression, either by being caused by the fracture or from the rupture of some vessel with no fracture. I say trephine over the place injured, and let it out. The same rule applies to suppurations, or any of the effusions, hydrocephalus excepted. The brain is peculiarly liable to extensive suppuration, and when once it commences, it is almost impossible to arrest it. Therefore, trephine, and let the pus or blood out. Foreign bodies must be extracted, if it can be done without injuring the substance of the brain too much. When the patient has no symptoms of compression, but has received a severe blow on the head, complaining of constant pain and uneasiness, a careful examination must be made ; and if no depression be found, the presumption is that there is an extravasation of blood. Arnica will usually produce an absorption of this ; sometimes, Conium. When, with the same absence of fracture, there are symptoms of compression, the same diagnosis may be made, but the indica- tions are to let the blood escape by opening the skull if relief does not follow the use of Arnica, etc. If after one or two days the pain has diminished, and suddenly there is a chill, followed by absence of pain or a gradual return to consciousness, succeeded by beating, throbbing and heat, it may be inferred that suppuration has set in, and the trephine will be needed to allow the pus to escape. Compression may exist without coma, and coma without fract- ure, as has been shown above. Therefore, be very thorough in examination, and if a depression positively exists, cut down, tre- phine, and elevate immediately. Here a little skill is necessary, to determine if what appears to be a depression is really one or not. A physician whom I assisted at one time was positive he had a depression to deal with, but on cutting down he found that it was merely a laceration (subcutaneous) of the temporal muscle, with the bone intact. Ecchymosis, or a torn muscle with a wide retraction of the edges, may often deceive. Dr. S. C. Williams, of North Vassalboro, Maine, told me that he had treated, suc- cessfully, four cases of depressed fracture of the skull with Arnica 26 Surgical Diseases of the Head. 30 alone. He claimed that there was elasticity enough in the membranes to raise this depression, if they were properly set to work. I give this for what it is worth. I believe it, A dose or two of Aconite, followed by Symphytum in a high attenuation, had better be used after the operation. If there are no ligatures used, Calend. had better be given to close the wound. Use no stitches unless they be of silver, but apply only adhesive strips and light bandaging. Keep the patient perfectly quiet, mentally and physically, and keep him on light diet. No stimu- lants, and no coffee. Watch him very carefully, for serious diseases of the brain are apt to follow. Concussion. Concussion of the brain, commonly known as stunning, may be caused by a fall, a blow, or a jar. The more constant symptoms are manifested in two stages; the first, ox primary group are, insen- sibility more or less complete ; the patient answering if spoken to in a loud voice, but soon relapsing into insensibility again ; pulse scarcely perceptible ; sphincters relaxed ; cold surface ; limbs relaxed ; dilated, immovable pupils. The secondary or reactionary stage, the circulation becomes re-established; the surface conse- quently warmer ; return of consciousness, and, generally, vomiting. After, this reaction goes on rapidly, and quite often goes too far, resulting in encephalitis, or some kindred affection, of which more will be said further on. The substance of the brain is frequently disorganized in severe concussions, and an autopsy reveals a dif- fluent mass. Sometimes simple rupture of this organ is produced, which, from the resulting haemorrhage, causes compression. In all bad cases it is best in forming the prognosis to consider that in grave cases some such lesion is apt to exist, and therefore ultimate recovery is very doubtful. Irritation. Irritation of the brain occurs very frequently in connection with injuries of the head. It is a very serious matter, and to irregular practitioners one that usually proves fatal. Even under our own treatment, the results are not as gratifying as we could Traumatic Encephalitis. 27 wish in every instance. It is often accompanied by laceration of the brain, and frequently occurs in connection with compression and concussion. Erichsen gives the briefest catalogue of symp- toms. " The patient lies in a state of semi-consciousness, unob- servant of what is going on around him, unless spoken to or aroused. He does not, however, lie quietly, but moans, turns himself about, and not unfrequently twists and curls himself for- ward, with the back bent, and the knees drawn up towards the chest. On being spoken to, he answers in a peevish, irritable manner, if at all, frequently frowning and distorting his counte- nance, and being evidently pained at any attempt to fix his atten- tion. He is occasionally convulsed, and at other times is seized with fits of violent delirium, shouting and screaming. The pulse is usually slow and feeble, skin cool, and the face pale, with total absence of all signs of inflammation." The treatment for all these lesions will be given together. Suffice it to say here, that no acute disease will be found so hard to treat as this ; you must expect failure. Traumatic Encephalitis. Traumatic encephalitis, in common with irritation, is pro- duced by injuries, the nature of which, with the extent of the lesion, determines the gravity of the case. It is extremely diffi- cult to diagnose, for what seems encephalitis may be suppuration. At all events, as Erichsen says, " the symptoms become so mixed up with those of compression and irritation as to make the exact diagnosis of the patient's condition far from easy." The more constant symptoms are coma, or constant delirium ; fullness and redness of the face and eyes ; beating and strong throbbing of the carotids and temporal arteries. A symptom more diagnostic than almost any other is an involuntary attempt to hold the head with the hands. The pain accompanying inflammation of the substance of this organ is not nearly so acute as that accompanying inflam- mation of the membranes. Vomiting is also present, and is quite constant and obstinate. Heat is complained of in the head, while the rest of the body is cool. Altogether, it is a very distressing and serious disease, but is not so fatal under our treatment as irritation. 28 Surgical Diseases of the Head. Wounds of the Brain. Wounds of the brain, of course, may be of any variety, but the lacerated is probably the most common. From them may proceed either irritation or traumatic encephalitis, or both, as well as compression. Close the wound in the skull, if such exist, and prevent inflammation, or inflammation running into suppuration. The best treatment to be pursued is to give Aconite to combat the immediate effects, followed by Calend. if the wound is punc- tured or lacerated, Arnica if contused, Staph, if incised. After all danger of encephalitis or suppuration has passed, the use of Symphytum will produce a reunion of the fractured bone, or a provisional closure of any opening that may exist. Hernia Cerebri. Hernia cerebri is a complication of fractured skull, which, in civil practice, is happily rare. Out of a great number of these cases, I have seen but one with this complication. When a large portion of the cranium is beaten in, and the portion of bone removed, or where there is a long fissure, with great gaping of the edges, a fungous-looking mass will be detected projecting from the opening, pulsating synchronously with the brain, and com- posed of disintegrated cerebral substance. This is a very dan- gerous complication, and the treatment is very unsatisfactory. In common with the old school, we are obliged to shave off the mass, and, as it returns, do so again. To this we add the use of Aeon., followed by Calend. Some claim perfect success ; my patient died. The fissure of the bone must be brought as near as possible together, and after all danger of encephalitis or suppura- tion is passed, Symphytum is to be given, to promote bony union. When a piece of the skull is entirely removed, bandage the head firmly, and place a compress over the opening saturated with a very weak solution of Calendula. Of course, the hair immediately surrounding the wound is to be all removed . Fungus of the Cranium. 29 Fungus of the Dura Mater. These fungi are tumors growing from some part of the dura mater, due generally to an injury, a fall or blow; sometimes, how- ever, they appear without any assignable cause. Sooner or later the bone covering the tumor is absorbed, and a protrusion of the mass is noticed immediately under the skin. Until this time there is no certainty in the diagnosis, and, for that matter, there is none even then. The position may be immediately over some one of the principal arteries, and its symptoms and appearance may readily lead one to suppose that he has to deal with an aneurism. There is perceptible pulsation, and the mass may be quite readily pressed back into the cavity of the cranium. There are no constant gen- eral symptoms. Usually, symptoms of compression are noticed, and as they, for the most part, occur prior to the absorption of the bone, you can not tell what may be the cause. Indeed, it is not until the bone is very much thinned, and there is considerable prominence at that point, that you can find anything to lead you to suspect the true cause of all the trouble. Indications of some grave cerebral disturbances are usually found, such as epilepsy, syncope, double vision, deafness, but occasionally no such symp- toms are seen, and until the tumor is fully developed nothing unusual in the patient's health may be noticed. When the bone is perforated, any attempt to push back the mass is accompanied by giddiness, syncope, and, sometimes, convulsions. The chances of effecting a cure are slight. Fungus of the Cranium. This is a growth similar in external appearances to the last variety, but differs from it in many essential points. It grows directly from the cranium, is devoid of pulsation, and can not be pushed back. It is vascular in structure, resembling the pulp of a red gooseberry, or broken down mulberry. The treatment by medicine offers better prospects than the preceding, but if reme- dies should fail, operative measures are reasonably certain. The remedies that may be found useful in fungi are mentioned here suggestively only, as I am not certain that a cure has ever been effected; in short, I know of no case in which the attempt 30 Surgical Diseases of the Head. has been made. Why they should not be curable, it is hard to tell. The remedies are as follows: Aeon., Am., Ars., Aur., Bell., Calc. c, Calc. ph., Con., Hep., Iod., Merc., Phos., Rhus, Ruta, Secale, Si/., Sulph., Thuja. Treatment. — The remedies for the different conditions may- be stated as follows : Compression. — Am., Con, Concussion. — Am., Bell., Calend., Cicuta, Con., Gelsem., Hyos., Rhus, Sir am. Irritation of the Brain. — Am., Con., Lach., Staph. Traumatic Encephalitis. — Aeon., Am., Bell., Cupr. acet., Hyos., Merc., Opium, Stram.j Ars., Bry., Hell., Lach., Rhus, Zinc. Fungus of the Dura Mater: Traumatic. — Aeon., Am., Bell., Con., Hep., Rhus, Ruta. Idiopathic. — Calc. c, Calc. phos., Phos., Sulph., Bell., Secale. Congenital. — Calc, Phos. Fungus of the Cranium. — Ars., Aur., Bell., Calc, Con., Hep., Iod., Merc, Rhus, Ruta, Sulph., Sil., Thuja. As but little can be learned from patients suffering with any of these diseases, if such they may be called, we shall have to con- fine ourselves as much as possible to objective symptoms. Aconitum nap. Sensitive irritability; fitful mood, changing from one thing to another ; sensation of fullness and heaviness in the forehead, with the sensation as if the whole brain would start out of the eyes, with nausea and giddiness ; aversion to, or great desire for light ; red and hot face ; red and pale alternately ; red- ness of one cheek and paleness of the other; when rising up the red face becomes pale; perspiration of the side of the face on which he lies. Worse in the evening and night ; also when lying on the left side, when rising, and when the room is warm. Better in the open air, or when he is in fresh air, with the win- dows open. Arnica mont. Declines to answer any questions ; giddiness and nausea when moving and rising; burning heat in the head, the rest of the body is cool ; sunken, pale face ; redness of one Fungus of the Cranium. 31 cheek; hot, red, shining swelling of one cheek; twitching of the muscles. Worse in the morning, evening and 'night; also from moving the head. Better from contact, even from noise. Arsenicum alb. Delirium; great prostration, with diarrhoea; tearing in the head, with vomiting when raising it up ; erysipelas of the head, with burning ; general weakness and coldness ; the eyes and lips are much inflamed; excessive photophobia; puffi- ness of the face, especially round the eyes ; pale, earthy face ; distorted features; death-like countenance; thirst for small quan- tities, often. Worse at night, after midnight, and in the morning ; also from cold, cold drinks, lying with the head low. Better from heat in general, and lying with the head high. Aurum fol. Melancholy mood, dejected, inclined to weep, and longing to die ; sensation as if a current of air were rushing through the head, if it be not kept warm ; the bones of the skull are painful, especially when lying down ; vertical half sight ; over sensitive to all pain, and to the cold air; hysterical spasms, with laughing and crying alternately. Worse in the morning ; also on getting cold, and while reposing. Better from moving, while walking, and on getting warm. Right side. Belladonna. Delirium ; disinclination to talk, or very fast talking; loss of consciousness; blood vessels on the head and neck enlarged ; boring into the pillow ; shaking the head ; smooth, erysipelatous, hot swelling, first of the face, then extending over the whole head, with stupefaction and delirium, violent headache and fiery eyes ; purple, red, hot, or yellow color of the face ; face pale and sunken, with distorted, anxious countenance ; alternate redness and paleness of the face. Worse in the afternoon, and at night, after midnight ; also on moving, from touching the parts, even softly. Better from leaning the head against something. Bryonia alba. Exceedingly irritable, and inclined to be angry ; heat of the head, with dark red face (dusky color of face) ; cold- ness of the rest of the body ; does not drink often, but much at a time; pain in the limbs on moving them; inflammation of the eyes with swelling of the lids; yellow, pale face; or hot, red, bloated face. 32 Surgical Diseases of the Head, Worse in the morning, and in the evening ; also from motion, and on sitting up in bed. Better while lying down, and on getting warm in bed. Calcarea Carb. Thinking is difficult; easily frightened or offended ; fullness and heaviness in the head ; internal and ex- ternal sensation of coldness on one side of the head, as if a piece of ice were lying there, with pale puffed face ; great weakness and debility from a short walk, or from talking; epileptic attacks at night ; fainting, with loss of sight and coldness ; sleepy the whole day, and in the evening ; falls asleep late ; sleeplessness. Worse in the morning, and in the evening ; also in the cold air, in the open air, and in wet weather. Better while lying down on the painful side, and after lying down. Right side. Calcarea phos. Vertigo and nausea; headache, with flatulency; dullness, painfulness and Tieavmess in the head, early in the morn- ing, on awakening ; painful feeling of fullness in the head ; -sensa- tion as if the brain were pressed against the skull. Worse in the open air, from motion, on being touched, from the warmth of the room, and on stooping. Calendula Off. Symptoms of compression, with no fracture. Cicuta, Concussion, followed by tonic spasms, and where the base of the brain is the chief point of suffering. Conium mac. Inclination to start, as from fright ; very forget- ful, can not recall things ; giddiness when looking around ; vertigo on turning the head in bed ; aversion to light, without inflamma- tion of the eyes ; things look red ; sickly, pale face ; pale, purple, bloated face ; heat in the face. Worse in the night ; also, from being uncovered, and from light. Better from wrapping up warmly Cuprum acet. Delirium ; incoherent talking ; the head is twisted to one side, falls forward; the head is moved from one side to the other ; eyes fixed, staring, sunken ; or protruded, glistening eyes ; eyes turned upwards ; distended muscles of the face ; fullness of the face ; changed features, full of anguish ; bluish face, with bluish lips. Worse from contact. Gelseminum. Paralysis, as one of the remote consequences, in persons of lax fibre. Glonoine, Giddiness when the head is moved ; fullness in the Special Therapeutics. 33 head, as if the brain was expanding itself, was moving in waves ; pulsative headache ; the more frequent the pulse the more severe the pains ; paraplegia. HelleborilS nig. Silent melancholy, with great anguish, much moaning, thoughtless staring, and inability to think ; loss of mem- ory ; stupefaction, and boring with the head in the pillow ; staring look ; photophobia, without inflammation ; pale, yellowish color of the face ; very dark urine, sediment like coffee-grounds. Worse in the evening ; also from cold air, and motion of the body. Better from waimth. Hepar Slllptl. Over sensitiveness, with irritability; quick, hasty speech ; fainting ; giddiness when riding in carriage, or when shaking the head ; cold, clammy perspiration, smelling sour, prin- cipally on the head and face, with aversion to be uncovered ; nodos- ities on the head, sore to contact; photophobia; objects appear red ; fainting from slight pains ; weakness in all the limbs, they feel bruised; restless and soporous slumber, with the head bent backward. Worse at night ; also from cold, from lying on the painful side ; from pressure, and on touching the parts ; from single parts getting cold. Better from warmth. Left side. Hypericum per. Convulsions from blows on the head; dull headache, on the vertex, or severe headache, with a beating (ham- mering) on the top of the head ; heat, with delirium ; wild, staring look ; hot head ; throbbing of the carotids ; bright red, bloated face ; moist hair on the head, and burning heat of body ; great oppression and anguish ; violent, excruciating pain from lacerated nerves. HyoSCyaniUS nig. Delirium, without consciousness; does not know anybody, and has no wants except thirst ; when spoken to, he gives proper answers, but speedily relapses into delirium and unconsciousness ; loss of memory ; pulsation of the arteries so violent that the head shakes ; the head is shaken or drawn to one side, with loss of consciousness and red, sparkling eyes ; contortion of the eyes ; heat and redness of the face ; swollen, brown-red face ; distorted, bluish face, with mouth wide open ; great pros- tration. Worse in the evening; also from being uncovered, and from moving. 34 Surgical Diseases of the Head. Better from wrapping up and from warmth. lodium. Restlessness, with an inclination to move about, not permitting one to sit or sleep ; throbbing in the head on every motion ; obscuration of sight ; double vision ; sensitiveness to noise ; hardness of hearing ; buzzing in the ears ; great debility, even talking causes perspiration ; great emaciation ; restless sleep, with vivid or anxious dreams. Worse in the evening, and at night; also, when lying on the painful side, from pressure, and from warmth. Better from cold. Right side. Lachesis. Nervous irritability; paleness, yellowishness or lead- like color of the face ; heat and redness of the otherwise pale face ; contraction of the muscles. Worse in the evening, and at night, before midnight ; also, after sleep, from moving, or changing the position. Better on shaking the head. Mercurius SOl. Continuous moaning and groaning; hurried speech; weakness of memory, forgets everything; vertigo, as if one were in a swing ; aversion to light ; inflammation of the scle- rotic ; eyes dim, and without lustre ; pale, yellow, earthy color of the face ; heat and redness of the cheeks ; profuse sweat, not reliev- ing the symptoms. Worse in the evening, and at night ; also, from being in a draught, and on getting warm in bed. Better in the morning, and when lying down. Opium. Stupefaction of the senses ; loquacious delirium, with open eyes and red face ; complete loss of consciousness and sensa- tion, with relaxation of the muscles ; pulsation in the head ; eyes half open, and turned upward; pupils dilated, and insensible to light : glassy, protruded, immovable eyes ; face is bloated, dark-red and hot ; face pale, clay-colored, sunken, with red spots on the cheeks; bluish face; the muscles of the face relaxed; the lower lip hangs down ; stertorous breathing. Worse when wrapped up warm. Better ? Phosphorus. Vertigo when rising from the bed in the morning, when rising from a seat, with fainting and falling to the floor ; sensation of emptiness in the head, with vertigo; sensation of coldness in the cerebellum, with sensation of stiffness in the brain ; mistiness of sight ; momentary loss of sight, as from fainting ; Special Therapeutics. 35 hardness of hearing, especially of the human voice ; roaring before the ears ; great emaciation ; nervous debility ; trembling in all the limbs from the least exertion ; sleepiness in the day-time ; long time in getting asleep ; wakes frequently. Worse in the evening and at night; also, when lying on the back, or left side, when rising from a seat, and from change ot weather. Better when lying on the right side, when rubbing, and after sleeping. Left side. Rllta grav. Anxious and low-spirited, with mental dejection; giddiness in the morning, when rising, when sitting and when walking in the open air; great heat in the head, with much rest- lessness ; the head is externally painful, as if bruised or beaten ; a green halo appears around the light in the evening. Worse during rest, and in cold, wet weather. Better by motion. Left side. Secale COr. Great anxiety ; fear of death ; stupefaction, and unconsciousness ; giddiness, as from intoxication ; double vision ; obscuration of sight ; humming and roaring in the ears, with occa- sional deafness ; tetanic spasms ; great sleepiness ; deep and heavy sleep. Worse at night ; also, from motion, from touching the part, when walking, from warmth, and from the heat of the bed. Better from cold, and while standing. Either side. Silicea. Desponding, melancholy, tired of life ; vertigo, as if one would fall forward, when stooping, riding, raising the eyes upward, ascending from the neck to the head, with nausea ; burn- ing in the head, with pulsations in and sweat on the head ; obscu- ration of sight, as from a gray cover ; aversion to light ; daylight dazzles the eyes; difficult hearing, especially of the human voice; over-sensitiveness of the hearing to noise ; epileptic attacks at night; frequent jerks and startings during sleep. Worse in the night ; also, in the open air, from cold, on getting wet, when lying on the painful side, from external pressure, and from change of weather. Better from warmth. Right side (?). Sulphur. Vertigo when sitting, stooping, when rising from the bed and in the morning, with vanishing of sight and inclination to fall on the left side ; he feels every step painful in the head ; feeling of coldness about the head; obscuration of sight, like 36 Surgical Diseases of the Head. gauze before the eyes ; humming in the ears ; hardness of hearing, or over-sensitiveness ; humming or buzzing in the head ; rouses from sleep or stupor in a somnambulic state ; great debility and trembling ; talking fatigues. Worse in the evening, and at night ; also, on getting warm in bed, on rising, from bodily exertion, on talking, while standing and on touching the part. Better during motion, when lying on the right side, from heat, and in dry weather. Left side. Ttlllja OCCi. Thoughtlessness ; forgetfulness ; vertigo on closing the eyes — disappears as soon as he opens them — or, on stooping or on looking upwards or sideways ; obscure sight ; weakness of the sight ; double vision ; in the dark, it seems as if there were luminous lights or sparks falling down alongside of the eyes — in the day-time, it is like dark drops ; noise in the ears, as if from boiling water; sleeplessness, on account of heat and restlessness. Worse in the evening, at night, and in the morning ; also, from cold and wet, and the heat of the bed. Better from warm wet. Left side. Rhus tOX. Absence of mind; illusions of the fancy; fullness and heaviness in the head, especially in the forehead, with sensa- tion as if a weight were falling forward on stooping, with heat in the face ; erysipelas of the head and face, with vesicles drying up, and forming burning-itching scabs ; erysipelas of the eyes, and of the skin around them ; aversion to light ; face pale and sunken, with blue rings under the eyes, and pointed nose. Worse in the morning, after midnight; also, from cold, cold water, and uncovering the head. Better from moving the parts, from warmth, and on wrapping the head up warmly. Staphisagria. Weakness of memory; rejects angrily whatever is put into his hand ; stupefying, pressing headache, as if the brain were compressed ; sensation as if the head would burst, particu- larly in the forehead ; countenance sunken ; nose peaked ; eyes sunken, and blue margins around them. • Worse at night, before midnight; also, on being touched. Better from warmth. Stramonium. Loquacious delirium and mania; insensibility to mental depressions ; stupefaction, with vanishing of vision and hearing, and convulsive movements of the head; red, inflamed Wounds of the Face. 37 swollen eyes; staring, glistening eyes; contortion of the eyes and eyelids; pupils dilated and insensible; objects appear blue; red, swollen, turgid face ; stupid, distorted countenance ; anxiety and fear is expressed in the countenance ; distortion of the mouth. Worse in the morning ; also on being touched, from looking at shining objects, and on being alone. Better from bright light. Zincum met. Morose, and indisposed to talk ; great aversion to the talk of others, and to all noise ; weakness of memory ; sensation of soreness in the head ; pressure on the eyes, they feel as if they were pressed into the head ; when lifting up the eyes, he sees numerous flakes ; paleness of the face. Worse in the afternoon ; also, in a warm room. Better from cool air. SURGICAL DISEASES OF THE FACE. WOUNDS OF THE FACE — SALIVARY FISTULA. Injuries to the face are of more importance than those of other situations, principally from the marring of the features from ugly and contracted cicatrices. To the female portion of the commu- nity, this is particularly important. Wounds of the Face. The most common injuries are wounds and bruises. Treatment. — The indications to be fulfilled are, 1st, pro- mote union by "first intention," if possible; 2d, if this fails, prevent the formation of pus ; 3d, if such an event should occur, make as neat a scar as circumstances will allow. The first of these indications can almost always be attained, if the patient applies to you early, by the use of the Homoeopathic remedy corresponding to the kind of wound. First, cleanse the wound thoroughly. Arrest the haemorrhage by acupressure or 38 Surgical Diseases of the Face. torsion. When the haemorrhage has ceased entirely, and the wound is perfectly dry, draw the edges together with fine hare-lip pins ; or, if the wound does not gape much, use no sutures ; only adhesive strips : choose of these, those of isinglass plaster. The edges must come together everywhere ; leave no part unsupported. Calendula will usually prevent the formation of pus, but sometimes fails. When this occurs, give Hep. 6 often, say once in two hours. As soon as the first sign of pus is seen, open the wound again. Here the rule of early opening is of particular force ; if it be neglected, injury to the bone, or sloughing of a comparatively large portion of the skin, will ensue. This early opening does not positively ensure a good scar; it only lessens the danger of a bad one. Salivary Fistula. Wounds about the face occasionally result in what is called "salivary fistula" "The parotid duct is cut across, in conse- quence of which the wound does not close, a trickling of saliva taking place on the outside of the cheek," the surface surround- ing it being puckered, and somewhat excoriated. Treatment. — Various remedies have been proposed to cure this, but I doubt their efficacy; they are Caust., Merc, Petrol. , Phos. and Sil. The question of an easy cure by any means depends upon the condition of the fistula. If the natural open- ing is closed, it must be re-established before a cure can result. This is best done by passing a small seton through the canal, and withdrawing it as soon as a passage is open for the saliva. When this has been accomplished, or the canal is open all through, freshen the edges, and close it by keeping up firm pressure. It may sometimes be necessary to dissect out the callous lining of the canal before it will close Otitis — Otorrkcea . 3 9 SURGICAL DISEASES OF THE EAR. OTITIS — OTORRHGEA — DEAFNESS — VARIOUS DISEASES. Otitis. Otitis is an inflammation of the external ear, characterized by one-sided headache, heat and throbbing; there is usually noise and throbbing in the ear. The terminations are, an abscess ; an intractable ulcer; or, what may be called "resolution." It has sometimes, though rarely, occurred that encephalitis results from this disease, when the symptoms are very severe. Otitis is either acute of chronic. The former is very readily cured, and is a simple inflammation, usually dryness of, and severe throbbing in the ear, accompanied by heat. The chronic form, says Dunglison, "is often incurable." This only applies, how- ever, to old school medication. We hear it spoken of, sometimes, as Otalgia. It is characterized by a profuse discharge from the ear, but, in other respects, is similar to otitis of the acute form, with the prominent symptoms, such as heat and pain, much modi- fied in severity. Otorrhgea. Otorrhoea is a disease peculiar to children of a scrofulous dia- thesis, and is characterized by a discharge of fetid, muco-purulent matter from the ear. We have two varieties here, that are due to inflammation of the mucous surface of the ear, resulting as sequelae, from colds, etc., also from a disease of the bones in the vicinity, necrosis commonly. If from disease of the bones, it is necessarily of a far more serious character, and the membranes at the base 40 Surgical Diseases of the Ear. of the brain become irritated, and convulsions and death usually eventually result. In some cases, phlebitis of the sinuses and of the cerebral veins ensues, and proves fatal (Erichsen.) Especially of inflammation of the dura mater resulting from otitis or otorrhcea of the internal ear, and of the petrous portion of the temporal bone, Watson says, "sometimes acute inflammation arises within the tympanum, when there has been no previous disease ; the patient has severe headache and earache; at length a gush of matter comes from the external meatus, but the pain does not, as it usually does in such cases, cease ; it continues, or even increases in intensity ; the patient begins to shiver ; he becomes dull and drowsy ; slight delirium, perhaps, occurs ; and, by degrees, he sinks into stupor. In some instances, no pus issues externally. More commonly, symptoms of the same kind supervene upon a chronic discharge of purulent matter from the ear. It is scarcely possible to sketch an accurate general picture of this insidious, but most dangerous, complaint." What we hear spoken of so frequently as " gathering in the head," is otorrhcea, and trifling as it is in many cases we have seen, it may be a very serious affair. Deafness. Deafness may be partial or complete, owing to one of the fol- lowing conditions: thickening of the inner cuticle of the ear, other obstructions in the external ear from disease, ulceration and perforation of the tympanum, paralysis of the acoustic nerve, and from obstruction in the eustachian tube. The causes that operate to produce these different conditions are the repercussion of eruptions, the result of measles, scarlatina, or small-pox ; from the abuse of mercury, and from the sudden arrest of a discharge from the ears, as in otorrhcea. Deafness not dependent upon some organic lesion of the organs of hearing, is known as either congestive, rheumatic or nervous* Toynbee, in his "Aural Surgery," speaks of many of the so-called cases of nervous deafness as quite curable, as they are due to inflammation of the lining membranes of the ear. In nearly all cases, save some few due to organic lesion, our remedies, properly applied, are capable of producing complete success. Special Therapeutics. 4 1 Various Diseases Various diseases, tumors, ulcers, polypi concretions, etc., are met with in the ear as often as in other locations, and need no farther mention. See " Tumors and Ulcers," if all that is needed for their treatment is not found here. Foreign bodies are frequently introduced into the ear, and give rise to considerable annoyance. They may prove the exciting cause for very destructive inflammations. They are quite readily removed, unless their long presence has caused thickening of the mucous membrane. In this case, that condition must be over- come, or, if it is chronic, the body must be broken up with a drill, and removed piece-meal. Therapeutics. — The remedies of service in these dis- eases are as follows : Aeon., Alum., Anac, Am., Asa/., Asar., Aur., Baryta, Bell., Borax, Bry., Calc. c., Calc. phos., Car bo v., Caust., Cham., Chin., Cieuta, Cistus caii., Coff., Colch., Dulc, Graph., Hep., Hyos., Kali c., Kreos., Lach., Led., Leptan., Lye, Mang., Menyan., Merc., Nat. m., Nit. ac., Nux vom., Petrol., Phos., Puis., Si I., Stan., Staph., Sulph., Verat. They may be arranged in the form of an index, as follows : Otitis — Aeon., Apis, Am., Asar., Bell., Borax, Bry., Calc., Caust., Cham., Chin., Dulc, Merc, Nux v., Puis., Sulph. Erysipelas of the Outer Ear. — Bell. Chronic Inflammation of the Ear. — Alum., Baryt., Con., Hep., Kali, Kreos., Lye, Phos., Stan. Ulceration of the Ear. — (See Ulcers.) Otorrhcea : with Polypi. — Calc. c, Calc. phos., Sulph., Staph. with Glandular Swellings. — Merc, Puis. with Cephalalgia. — Bell., Bry. with Fever. — Bell., Bry. with Orchitis. — Merc, Nux v., Puis. from Otitis. — Calc, Merc, Puis., Sulph. from Abuse of Mercury. — Asa/., Aur., Nit. ac, Sil., Sulph., Hep. from Abuse of Sulphur. — Merc, Puis. from Caries. — Aur., Nat. m., Sil. from a Chill. — Dulc, Merc. Catarrhal, or Mucous. — Bell., Merc, Puis., Sulph. .42 Surgical Diseases of the Ear. Otorrhcea : Purulent. — Bell., Hep., Merc, Puis., Sulph., Asa/., Calc, Lack., Nit. ac, Petrol., Sil. Foetid. — Aur., Carbo v., Hep. s., Sil., Sulph. Sanguineous. — Cicuta v., Merc, Puis., Sil. Scrofulous. — Asa/., Aur., Caust., Kreos., Sulph. after Exanthemata. — Puis., Mang., Bell., Colch., Hep. s., Lye, Menyanth., Merc. Effects of Suppression of. — Bell., Bry., Dulc, Merc, Nux v., Puis. Polypi in the Ear. — Calc. c, Calcphos., Sulph. Deafness — Congestive. — Aur., Bell., Graph., Merc, P has., Sil. Nervous. — Caust., Petrol., Phos. Catarrhal or Rheumatic, caused by a Chill. — Ars., Bell., Ledum, Merc, Puis. from Suppressed Eruptions. — Sulph., Caust., Graph., Mezer. from Measles. — Ca?'bo v., Puis. from Scarlatina. — Bell., Hep. from Small-pox. — Merc, Sulph. from Abuse of Quinine. — Calc, Puis., Carbo v., Hep., Nux v., Sulph. from Abuse of Mercury. — Asa/., Nil. ac, Staph. from Hypertrophy of Tonsils. — Aur., Merc, Nit. ac, Staph. from Fevers. — Am., Phos., Verat. from Suppressed Discharge from Nose or Ear. — Hep., Lach., Led., Bell., Merc, Puis. In giving the special indications, the symptoms of the ear alone will be given, as the general symptoms may embrace the whole Materia Medica. These should, however, also be consulted when the choice is not very clear. Aconite nap. Tearing in the left ear; roaring in the ears; hearing very sensitive ; noise is intolerable. Worse in the evening; also, when lying on the left side, when rising, and when in a warm room. Better in the open air, and when sitting still. Alumina. Stitches in the left ear, in the evening; one ear hot and red ; the ear feels as if it had become larger. Worse in the evening, and on alternate days; also, when sitting. Better in the open air. Special Therapeutics. 43 Anacardilim. Pressing in the ears, as from a plug; itching in the ear; hardness of hearing. Worse in the morning ; also, when lying on the side, and from rubbing. Better during dinner. Left side. Arnica mon. Stitches in and behind the ears; pains in the ears, as if from a bruise. Worse in the morning, evening, or at night ; also, on moving, from being touched, and from cold. Better from motion. Left side. Apis mel. Otitis, with stinging pains in the ear. Asafcetida. Hardness of hearing, with discharge of pus from the ears. Worse in the afternoon and evening ; also, when sitting still. Better in the open air. Left side. Asarum Elirop. Pressure and tension in the region of the orifice of the meatus auditorium ; pain, as if from contraction, behind the ears. Worse in the evening ; also, in cold and dry weather. Better from wetting the part with cold water. Right side ? Aurum fol. Caries of the mastoid process of the temporal bone; foetid otorrhoea; roaring in the ears; over-sensitiveness to the pain, and to cold air. Worse in the morning ; also, from cold, and while reposing. Better from moving, while walking, and on getting warm. Left side. Baryta Carb. Cracking in the ears when swallowing, when sneezing, and when walking fast. Worse at night ; also, when lying on the painful side, or when thinking of the disease. Better when walking in the open air. Right side? Belladonna. Inflammation of the external and internal ear, with discharge of pus; stinging in and behind the ears; humming and roaring in the ears ; paralysis of the auditory nerve. Worse in the afternoon and at night; also, from moving, on touching the parts but softly. Better while standing. Right side- Borax, Discharge of pus from the ears, with roaring and hardness of hearing in the left ear. Worse in the evening, from cold, and while lying down in bed. 44 Surgical Diseases of the Ear. Better from pressure, and from warmth. Left side. Bryonia alba. Sensation as if the ears were obstructed ; hum- ming in the ears ; intolerance of noise. Worse in the evening, from motion, exertion of the body, and from heat. Better while lying on the painful side, and on getting warm in bed. Left side. Calcarea carb. Deafness, as if caused by obstruction of the ears ; frequent humming and rolling, or tinkling, singing, and music in the ears ; frequent throbbings, with heat, in the ears ; constant dryness of the ears, or else purulent discharge ; pressive headache in the forehead ; stitches or pulsations in the ears ; inflammation of the external and internal ear ; polypus of the ear ; hardness of hearing, especially after the suppression of intermit- tent fever by Quinine. Worse in the morning and in the evening; also, in the cold, and in wet weather. Better while and after lying down, and from rubbing. Left side ? Calcarea phos. Has been used for polypi in the ear. Capsicum an. Aching deep in the ear ; swelling behind the ear; painful to touch. Carbo veg. Every evening, heat and redness of the external ear ; deficiency of wax ; foetid suppuration of the inner ear ; pulsa- tion in the ears. Worse in the forenoon and in the morning; also, in the open air, from poultices or pressure. Better after lying down. Left side. Causticum. Sensation of obstruction in the ears, with rumbling, roaring and humming in the head ; loud vibrations of all sounds, even of the patient's own voice, in the ear ; discharge from the ears ; rheumatic pains in the ears and limbs ; extraordinary sensi- tiveness to cold wind ; spasmodic pain in the ear, as if the inner parts were pressed out ; painful swelling of the external ear. Worse in the evening ; also, in the open air. Better in bed, and from heat. Either side. Chamomilla. Otalgia, with stitches and tearing; discharge of thin pus from the ears ; sensitive hearing. Worse at night ; also, from cold, and when lying down. Better after perspiration. Right side ? • China Off. Humming in the ears, with hardness of hearing; stitches in the ears ; heat in the outer ear. Special Therapeutics. 45 Worse at night ; also, from touching the parts softly. Better in the room. Either side. CiCllta virosa. Sore pain behind the ear, as after a blow ; haemorrhage from the ears; detonation in the right ear when swallowing; hardness of hearing; burning, suppuration on and around the ears. Worse in the afternoon ; also, from cold. Better while in bed, and from warmth. Right side ? CistllS canaden. Discharge from the ears of water and bad- smelling pus ; inner swelling of the ears, with discharge ; tetters on and around the ear, extending to the external meatus. Worse in the evening, at night, and in the morning ; also, from cold air, when lying down, and from motion, Better in the fresh air. CofTea Crilda. Music has a shrill sound to the ears ; sense of hearing more acute ; the pains are felt intensely, driving one to despair, with inclination to weep. Worse in the morning, and at night ; also, in the open air, and from cold. Better from cold water. Either side. Colchicum. Discharge from the ears, with tearing in the ears after measles ; stitches in the ears, in the evening ; dryness of the ears. Worse in the evening and at night ; also while walking, and on being touched. Better while reposing, or sitting. Right side ? Cotlium mac. Stitches in and around the ear; accumulation of ear wax, looking like decayed paper, and mixed with purulent mucus ; blood-red cerumen ; roaring and humming in both ears. Dulcamara. Dragging pain in the ear, with nausea; stitches in the ears ; tingling in the ears ; pricking in the ears ; complaints brought on by taking cold or getting wet. Worse in the evening ; also, when at rest, from cold air, and in wet weather. Better from running about, and from warmth. Left side Graphites. Great dryness in the ears, or purulent otorrhcea; difficulty of hearing, which is sometimes removed from the motion of a carriage, or cars ; singing, whistling and tinkling, or humming and thundering in the ears, especially at night ; sensation as if the 46 Surgical Diseases of the har. air penetrated to the eustachian tube ; herpes and scabs about the ears, and on different parts of the body. Worse at night ; also, from cold. Better on getting warm. Left side. Hepar Slilph. Darting pain in the ears; itching of the external ear ; discharge of fcetid pus from the ear ; scurfy eruption on and behind the ear ; whizzing and throbbing in the ears, with hardness of hearing; detonation in the ear when blowing the nose. Worse at night ; also, from cold, when lying on the painful side, and when touching the parts. Better from warmth. Right side. HyOSCyamilS nig. Hard hearing, as if stupefied; buzzing in the ears. Worse in the evening ; also from cold, and after lying down. Better on rising, and from warmth. Right side ? Kali Carb. Stitches in the ears, from within to without ; inflam- mation and suppuration of the ear ; itching and tickling in the ears ; redness, heat and violent itching of the external ear ; crack- ing in the ears ; discharge of yellow liquid cerumen or pus from the ears ; inflammation and hard swelling of the parotid glands ; dullness of the hearing ; singing, whizzing and roaring in the ears. Worse in the morning ; also, in the room, after walking, from cold air, and when lying on the side. Better on getting warm, and on walking in the open air. Right side. KreOSOte. Stitches in the ears ; itching in the ears and the soles of the feet ; humid herpes on the ear, with swelling of the cervical glands, and livid, gray complexion ; inflammation of the left outer ear, red, hot, swollen ; burning proceeding from a pimple in the concha, with stiffness and pain in the left side of the neck, shoulder and arm. Worse in the morning ; also, in the open air, and on moving. Better from warmth. Lachesis. Dryness, with want of wax, and hardness of hear- ing ; cerumen too hard and pale, or white, and like pus ; painful pulsations, cracking or humming, rolling or drumming noise in the ear, with loud reverberations of all sounds. Worse in the afternoon ; also, while lying down. Better from moving. Right side ? Ledum palustre. Roaring in the ears, as if from wind; ringing Special Therapeutics. 47 and whizzing in the ears ; hardness of hearing, as if the ear were obstructed by cotton ; confusion and giddiness of the head, on the side affected ; sensation of torpor of the integuments, especially after suppressed discharge from the ear, nose or eyes. Worse in the evening and at night ; also, from heat. Better from cold. Right side. Leptandria. Jahr recommends it, but I can find no symptoms that are at all reliable. LyCO podium. Over-sensitiveness of hearing; music and sounds affect the ear painfully ; roaring, humming and whizzing in the ears ; sensation as if hot blood rushes into the ears ; congestion of blood to the ears ; humid, suppurating scurfs on and behind the ears ; ulceration and running of pus from the ears ; hardness of" hearing, the ears being closed, with whizzing singing in the ears, as from boiling water. Worse in the evening, and at night ; also, while lying down and when at rest. Better from cold, and in the open air. Right side. Manganum. Pains extend to and concentrate in the ear from other parts ; stitches in the ear when talking, laughing, swallowing and walking; hardness of hearing, as if the ears were closed up; they open on blowing the nose, and are affected by the change of weather ; cracking in the ears on blowing the nose, and on swal- lowing ; whizzing and rushing in the ear. Worse at night ; also, on stooping, and when the parts are touched. Better from pressure. Either side. MenyantheS, Stitches in the ears ; cracking in the ears when masticating; feeling of coldness in the ear; running of the ears after exanthemata. Worse in the evening ; also during rest and when lying down. Better from motion, and from pressure on the affected part. Either side. MercurillS. Inflammation of the internal and external ear, with stinging pain ; soreness of the internal ; fungus excresence in the ear ; discharge of pus from the ear, with ulceration of the external ear; pulsative roaring in the ears; hardness of hearing; all sounds vibrate loudly in the ears ; the ears feel obstructed, but open when swallowing or blowing the nose ; buzzing, roaring or ringing in the ears ; ears obstructed from enlarged tonsils. 48 Surgical Diseases of the Ear. Worse in the evening and at night ; also, from the heat of the bed, during perspiration, and when exercising. Better when at rest, and when lying down. Left side. Mezereum. Deafness, and thickening of tympanum after sup- pressed eruptions of the scalp. Natrum mur. Stitches in the ears ; pulsation and beating in the ear ; swelling, burning and heat in the ears ; hardness of hearing; discharge of pus from the ears; humming, ringing and singing in the ears ; painful cracking in the ear when masticating ; itching behind the ears. Worse in the morning, and at night ; also from talking. Better after lying down, and when lying on the back. Either side. Nitric acid. Stitches in the ear; suppuration and discharge of pus from the ears ; hardness of hearing, especially from swelling of the tonsils from Mercury j cracking in the ears when masti- cating ; beating and humming in the ears ; echo in the ears of one's own speech ; caries of the mastoid process ; steatoma at the lobe. Worse in the evening and at night ; also, on awaking, and on touching the parts. Better while riding in a carriage, and on getting warm. Right side. NlJX Vomica, Otalgia, with tearing, stinging pains ; when he raises his face, tension in the ears ; painful, sharp shocks and stitches in the ears, especially in the morning, in bed ; pain in the ear on swallowing, as if it were pressed outward ; strong reverbe- rations of sound in the ears. Worse in the morning, and at night ; also, from a slight touch, and from motion. Better from strong pressure. Right side. Petroleum. Troublesome dryness of the internal ear, or dis- charge of blood or pus ; tinkling, or rolling and humming in the ears ; hardness of hearing ; humid soreness behind the ears. Worse in the morning and in the evening ; also, after a walk in the open air. Better from warmth. Right side ? Phosphorus. Hardness of hearing, especially of the human voice ; roaring before the ears ; reverberations of all sounds, but more particularly words in the ears. Worse in the evening, and at night ; also, from lying on the back or left side. Special Therapeutics. 49 Better while lying on the right side, and from rubbing. Right side ? Pulsatilla. Otalgia, with darting, tearing pains ; inflammation ot the external and internal ear, with redness, heat, and swelling ; flow of mucus, or thick pus from the ear ; hardness of hearing, as if the ears were stopped up, especially from cold, from having the hair cut, or from suppressed measles ; hardened black cerumen ; humming and tingling in the ears. Worse in the evening, and at night ; also from warmth, and while lying on the left or painful side. Better from cold. Right side ? Silicea. Otalgia, with stitches out of the ears ; itching in the ears ; stoppage of the ears, which open at times with a loud report ; difficult hearing, especially of the human voice, and during the full moon ; over-sensitivness of the hearing to noise ; swelling of the external ear, with discharge of pus from the ear ; aches behind the ear ; increased secretion of very thin cerumen. Worse in the night, also from cold, from wet, and from external pressure. Better from warmth. Right side. Stannum. Ulceration in the ring-hole in the lobule ; screaming in the ears when blowing the nose. Worse in the evening, also when lying on the painless side, after moving, and from talking. Better when lying on the back. Left side ? Staphisagria, Hardness of hearing, with swelling of the tonsils, especially after the abuse of Mercury. Sulphur, Stinging in the left ear; wabbling in the ears, as if water was in them ; discharge of pus from the ears ; humming in the ears ; hardness of hearing ; over-sensitiveness of hearing ; itching of the external ear ; frequent closing up of the ears. Worse in the evening and at night ; also on getting warm in bed, from bodily exertion, when talking, on touching the parts, while at rest, and when swallowing food. Better during motion, from heat, and in dry weather. Right side ? Veratrum. Hardness of hearing, as if the ears were stopped up ; roaring in the ears, as if from wind ; aching in the meatus auditorius. 4 50 Surgical Diseases of the Eyes. Worse in the morning, also during perspiration, after drinking, and after sleep. Better after perspiration, and from warmth. Right side. The only operation is for polypi, and that need not detain us here. (See tumors). SURGICAL DISEASES OF THE EYES. Foreign Bodies in the Eye — Wounds of the Eye — Ophthalmia — Strabismus — Pterygium — Opacity of Cornea — Chemosis — QEdema of Lids — Fistula Lachry- malis — Cataract — Retinitis — Iritis — Malignant Diseases and Various Diseases. Here a word of explanation seems to be necessary. Every physician can readily see that it is almost impossible to treat at length the therapeutics of the eye, in such a work as this, for modern science has almost made ophthalmic practice a distinct profession. Of course the diseases mentioned in this place will only be those that are most frequently met with, and that we know are amenable to treatment. One thing must be remembered in this connection. The chief reason why we have not a more extensive literature on this subject is, that patients are unwilling to resort to a long course of treatment for cataract and other diseases, when so much is promised them by operation, and it is only occasionally that we can keep them under our treatment long enough for them to perceive improvement. Again, until recently, few of our physicians have devoted any special attention to the eye. Foreign Bodies in the Eye. Sand, ashes, wood, particles of percussion caps, and iron are the substances oftenest found in the eye, and, if allowed to remain, may occasion very serious mischief. In scrofulous or cachectic persons, the inflammation resulting may assume a very obstinate Wounds of the Eye. 51 and serious form. If the particles penetrate the ball, cataract, iritis, opacity, irido-choriditis, and even pan-ophthalmia, may follow, dependent upon the extent of the injury, the structures implicated, and the character of the foreign body. The cornea is so thick, much more so than many would suppose, that pieces of steel from mill-picks or anvils, may be literally dissected out, and if the operation is carefully performed, and followed by the admin- istration of Aeon., but little scarring need be apprehended, and if the patient be young, and of good constitution, the opacity may entirely disappear. Ars. or Sulph., according to indications, will promptly relieve the irritation felt after the substance has been removed. If the body is on the inner surface of the lids, it must be wiped off with a soft substance, as a camel's-hair pencil, and not by subjecting the sensitive membrane to harsh rubbing with a coarse pocket-handkerchief. Use no local applications in this or any other ophthalmic affection, unless it be water, and then prefer hot to cold. Wounds of the Eye and Lids. Wounds of the cornea that are extensive enough to allow the aqueous humor to flow out, but do not displace the vitreous humor, nor injure the iris, or capsules of the lens, are not very serious; i.e., not as much as is generally supposed. Close the lids, keep them covered with a light bandage. Frequently Aeon., followed by Staph., will suffice, in nearly every case, to restore the cornea, and the aqueous humor will be found to be also reproduced. If the hyoloid membrane is ruptured so that a portion of the vitreous humor is displaced, there will certainly be iritis, and perhaps cataract. More care in the treatment is now required, as the displaced portion is very slowly, if ever, restored, and whatever remains in the anterior chamber has to undergo absorption, unless removed through the wound. Total rest of both eyes is indispen- sable, as the uninjured organ will generally suffer from sympathetic ophthalmia. Keep both eyes covered, and confine the patient to a darkened room. Aeon., Am., Ars. and Sulph., are the remedies generally indicated, and if iritis supervenes, Bry., Bell., Apis., Mere., Rhus, or Calc, may be called for. Wounds of the lids are serious on account of the disfigurement that may follow, and the alterations in the lachrymal canal. They 52 Surgical Diseases of the Eyes. should be closed with fine wire sutures or hair-lip pins, and if the canal is involved, a fine silver wire had better be passed through it by way of the puncta. Wounds of the conjunctiva must be closed with fine wire, or the denuded sclerotic coat may suffer. If not closed, small tumor-like fungoids may spring up, as occasionally after strabismus operations, and be very annoying. Should this happen, the best way is to snip them off with sharp scissors. Ophthalmia. Ophthalmia is an inflammation of the eye ; when it involves the lids and conjunctiva, it is called conjunctivitis. The names given it do not indicate so much the peculiarities of the variety, as the cause. Thus it may be gonorrhceal, syphilitic, strumous, scor- butic or rheumatic. In general, the symptoms may be said to be injection of the conjunctiva, swelling of the lids, disordered vision, pain more or less severe in the head, purulent discharge and perhaps ulceration of the cornea. The symptoms vary according to circumstances, and are often found exceedingly intractable. Local applications, except water, are to be strictly forbidden ; and darkness, and perfect bodily rest, enjoined in the worst cases. Very many cases are seen that present peculiar difficulties, from the injurious effects from nitrate of silver and sugar of lead. Recent cases are very readily relieved if care be taken in the selection of a remedy. A cure may often be effected in from 12 to 24 hours. The causes are manifold ; exposure to cold, irritating applications to the eye, inoculation from some specific virus, and a constitutional predisposition to purulent inflammation. Strabismus. Strabismus is an obliquity in the axis of the eye, caused by a shortening in one of the recti-muscles, either spasmodically, from disease or nervous shock, or existing so congenitally. It may be internal or external, single or double. In congenital cases, it will occasionally be found necessary to operate, but in those resulting from disease, it will scarcely ever be required. In congenital cases, treatment is sought to rectify the deformity, as vision will rarely be impaired ; but in the other variety, the obliquity must be overcome, Pterygium — Opacity — Chemosis, etc. 53 or serious trouble may ensue. Some little tact is occasionally necessary to determine which eye is effected, and as it requires too much space to enter into it here, I refer the reader to Walton, or in our own school to Angell, or to the forthcoming work of Dr. Allen. Pterygium. Pterygium is a hypertrophied condition of the conjunctiva, assuming the form of a fly's wing, hence its name. It is usually seen in the inner angle of the eye, extending out to the corneal margin, and sometimes beyond. Occasionally you will find two or three in one eye, when they are apt to cover the whole cornea, in time, and of course destroy the sight. If the patient can be retained long enough, a cure may be accomplished by remedies, and if this is found impossible the operation usually employed is simple and efficacious. Opacity of the Cornea. The cornea frequently becomes opaque from infiltrations, con- sequent upon inflammation, or from injur)? - . When the opacity is caused by scalds or burns, the condition is hopeless. Ulceration frequently leaves small specks of opacity, which can be sometimes removed by medicine. Under all circumstances, however, these cases are very troublesome. Chemosis. Chemosis is only seen in connection with ophthalmia. It is a pufflness of the conjunctiva, which resembles a ring around the cornea, which latter appears to be sunk into the eye in conse- quence. Should remedies not act promptly, a small puncture may be made, which will answer the purpose temporarily, but it will soon fill up again. (Edema of the Eyelids. (Edema is almost a constant accompaniment of some form of ophthalmia, is sometimes present with other diseases, and does not 54 Surgical Diseases of the Eyes. differ from oedema in other situations. Care must be taken, however, not to confound it with a collection of pus. Fistula Lachrymalis. The lachrymal canal may become narrowed by swelling of the lining membrane, or by the deposit from some inflammatory action. Caries of the bones of the nose very frequently produces this; the fluid being unable to pass through the duct, is collected at some point, usually just at the inner angle of the lower lid, pro- ducing considerable swelling, with an exudation from the canal of a few drops of pus on pressure. Should the calibre of the duct not be soon restored, this swelling gives way, and a fistula results. Of course the fistula cannot be cured as long as the duct is imper- vious, and hence you must not look for any sudden closure of it. After the swelling has commenced to discharge is the time you will most frequently see such cases, and it is advisable to make a thorough exploration of the canal before commencing treatment. Sometimes a calcareous body will be met by the probe, which is to be pushed out, and after the inflammation consequent upon the operation is subdued, the fistula will soon close. Under good treatment there is but little occasion to resort to the style to open the tube, and perhaps if called early enough, it may never be needed. Cataract. Cataract is an opacity of the crystalline lens, or of its capsule, or of both ; the former variety known as lenticular cataract, that of the capsule as the capsular variety, and the latter as capsulo- lenticular. This classification is not as valuable as is generally supposed, as they indicate merely progressive stages of the same disease. That is, in time a lenticular cataract will be a capsulo- lenticular one. We have a further division into the hard and soft, open to the same objection; as I believe nearly all cataracts com- mence as soft, and become hard in proportion to their duration. The only benefit to be derived from this last division, is in making choice of an operation ; most surgeons preferring needle operations in the soft variety, and extracting in the hard. The appearances, however, are striking in each variety. The soft Retinitis — - Iritis. 5 5 cataract can hardly be distinguished, unless in a very good and favorably directed light. They have a bluish cloudy appearance, with whitish spots here and there. The hard kind have a brown- ish-yellow appearance, are very distinct, but have been confounded with glaucoma. They are more peculiar to old age, although in accordance with my views, it might better be said that cataract becomes hard quicker in old age than in youth. Capsular cataract is of a dull, chalky-white color; and in the intermediate stages, the lenticular variety is also white, but more glistening, and not such a decided white. You will find more trouble in keeping such cases under treatment than any others. Out of thirty, I have only treated to a conclusion three cases ; the rest I operated on, after as long a delay as possible. The causes are injury to the lens, long continued inflammation, or an heredit- ary predisposition. When from inflammation of the iris, you will generally find an adhesion of this membrane to the capsule, which will materially complicate an operation for extraction. Iritis is apt to follow any operation, but Aeon., or Bry., or Rhus, will generally control it. Retinitis. Inflammation of the retina is rarely seen occurring inde- pendently of ophthalmia. When it does, the most characteristic symptoms are deep-seated pain in the ball, intolerance of light, and confused sight ; sometimes the ball seems swollen, and protruding. The treatment must be prompt, or the sight will be lost. Iritis. Inflammation of the iris rarely occurs unconnected with ophthalmia, unless it be the result of injury, or a complication in some specific disease, as syphilis. Operations for cataract are frequently followed by iritis, more particularly in the case of needle operations. There is pain in the eye, more or less acute, change in the color of the iris, loss of mobility, the iris may be either dilated or contracted, oftener the latter, and is irregular in shape, with serrated edges, the points shooting out over the lens ; ordinarily there is also photophobia, conjunctivitis, and aberrations of sight. If allowed to continue long unchecked, suppuration 56 Surgical Diseases of the Eyes. ensues, which may result in loss of the eye. Frequently there is considerable lymph poured out, which fills both chambers of the eye, looking as if the ball were filled with milk. Sympathetic inflammations of the sound eye are common, hence an additional reason for* dispatch, which is only to be assured by a careful selection of the remedy. Malignant Diseases. Cancer of the eye, and its appendages, does not differ materi- ally from cancer elsewhere ; but as the diagnosis in some respects is difficult, it will be well to enter into a somewhat lengthened description. I shall draw liberally from the work of Mr. Walton. The forms of cancer most frequently met with in this situation, may be set down in the order of their frequency, as follows : encephaloid, melanosis, epithelial, and scirrhous ; the colloid form has never been seen in the eye. The first variety is seen- at all ages, but most frequently in children, the others in middle life : old age being particularly obnoxious to scirrhous. Encephaloma : In the earlier stages of this disease there is a yellowish shining, and deep-seated reflection from the bottom of the eye, resembling the appearance of a cat's eye in the dark, or as if a piece of metal were lying there. The iris looks darker than the other, pupil sluggish, and dilated, and vision extinct ; there is some external inflammation at ' times, though not by any means constant. As the disease advances, this metallic appearance is seen to be caused by a tumor springing up from the back of the eyes, " of an irregular rounded form, generally divided superficially into two or three lobes, and traversed by one or two small blood-vessels, which ramify on its suface ; in color it varies from a deep orange hue to nearly white, the most usual, perhaps, being a bright canary color. This growth gradually increases in size, approaches the front of the eye, causing absorption of the vitreous humor, and presses upon the lens, which becomes opaque, and in most instances is ulti- mately absorbed." As the disease progresses, the distension of the coats of the eye by the pressure of the growing mass causes the most excruciating pain ; the cornea becomes very thin, and the second stage is completed by the rupture of some of the coats, and the external appearance of the tumor. It may break through posteriorly, through the cornea, or the anterior part of the sclerotica. When Ma ligna nt D is eases. 5 7 appearing in the orbit posteriorly, the eye is displaced in almost any direction, and in time the growth appears around the edges of the orbit, and soons covers and obliterates the eye. In the last stage the condition as described by Walton is as follows : " On its first escape it is soft, and generally of a light red or yellowish color; this appearance, however, is rapidly changed as it increases in bulk ; the surface becomes irregular, and covered with ulcerations, which discharge profusely; large, livid, and fungoid granulations form, which bleed freely on the slightest touch ; interstitial hemor- rhage takes place, forming clots in the interior of the growth, while large masses are detached from its surface by sloughing, giving rise to fresh bleeding, in some instances so profuse as to prove the immediate cause of death. No diminution in the size of the tumor ensues on the separation of the sloughs ; on the contrary, the growth seems to take place with increased vigor, and is limited only by the length of time that the patient survives. * * * * The skin of the distended eyelids, and of the adjoining parts of the face, assumes a dark livid hue, and is traversed by large varicose veins; and the glands of the neck, and under the lower jaw, are enlarged, and, in exceptional cases, proceed to ulceration." Death is due to exhaustion, deposits in some of the viscera, or hemorrhage. It is the most formidable disease to treat that I have any knowl- edge of, and failure is oftener the result than success. Melanosis is very difficult to detect until the tumor is forced through the sclerotica. In the commencement there is loss of vision with no apparent morbid growth, nothing to distinguish it from amaurosis, although sometimes there can be seen a small slate-colored tumor deep in the eye. The tumor, when it has burst through the distended eye, is dark, almost black in color, and sloughs, and bleeds just as encephaloma does. The progress and termination are about identical, only differing in the size of the growth, which rarely, if ever, attains the size of the former. Scirrhous is rarely seen in the eye-ball, though deposits occur in its immediate neighborhood, e. g., in the orbit, and ultimately involve the eye, although the well-known resistance of cartilaginous structures to scirrhous infiltration, offers a long interval between the first appearance of the tumor, or of displacement of the eye, and the final involvement of the whole organ. The same applies to epithelioma. So much for cancer as connected with the eye; in 58 Surgical Diseases of the Eyes other respects the symptoms are identical with those to be described in the Chapter on Tumors. Various Diseases. Of other diseases we can speak but briefly, making it more a dictionary than anything else. Thus Amaurosis is blindness, with no apparent structural change. Aneurisms, and Varix, differ in nothing from the same condition in other situations. The same is true of Caries of the orbit, and Abscess. Other diseases are of no interest in this connection, as it is extremely problematical whether they can be cured by medicine. Among these we may class Ectropium, and its opposites, Trichiasis, Ptosis, etc., notwithstand- ing we are told they are curable. I have tried frequently, and, at the best, have seen little more than a " slight improvement." Until we are more assured by success, I prefer to consider it doubtful. Treatment — In these diseases, above all others, -what is called " constitutional treatment " is the only course to pursue. Topical treatment is useless, and as those who practice it generally use crude medicines for that purpose, I have no hesitancy in saying it is also positively hurtful. While a strenuous advocate of the high attenuations, I deem it a matter for " private judgment " in gen- eral practice, merely suggesting their advantages, but in these cases, I deprecate the use of any other preparations. In acute cases, give a dose of the proper remedy once in two, three, or four hours, until an effect is produced, then cease for as long as improvement continues. In chronic cases, give a dose but once in five or seven days, until improvement commences, then discontinue the medi- cine as above. As said in another place, the difficulty experienced in keeping patients under our treatment in these diseases, has operated against our having as much clinical experience as the subject demands. This seems to make it incumbent upon each one of us to contribute whatever knowledge he may have, so that homoeopathic ophthalmology may occupy the same exalted position held by other departments of our art. The remedies most frequently called for, are arranged in the customary " Index " form, and whatever there may be of meagre- ness in the indications, is owing to the neglect of our school in working this field. I must again refer to Drs. Angell and Allen all who are desirous of a thorough knowledge of the subject. Special Therapeutics. 59 Wounds of Eye: Conditions resulting from. — Aeon., Am., Ars., Sulph. Iritis from. — Apis, Bell., Bry., Cale., Mere., Puis., Rhus. Inflammation: Whole Eye. — Aeon., Ars., Croc., Merc., Puis., Sulph. Cornea. — Ars., Cale., Euph., Hep., Sulph. Sclerotica. — Merc, Sulph. Conjunctiva. — Ars., Bell., Puis., Merc, Sulph. Ophthalmia : Of the New Born. — Aeon., Cale, Dulc, Euph., Lye, Merc, Nit. ac, Rhus, Sulph. Chronic. — Ars., Cale, Euph., Sep., Sulph. Arthritic. — Aeon., Bell., Cale, Cocc, Coloc, Lye, Spig. Catarrhal. — Ars., Bell., Euph., Hep. s., Mere, Nux v., Puis. Gonorrhceal. — Aeon., Chin., Nit. ac, Puis., Apis, Sulph. Rheumatic. — Aeon., Bry., Euph., Merc, Puis., Rhus, Spig., Sulph., Verat. Scrofulous. — Bell., Cale, Hep., Graph., Merc. Nit. ac, Puis., Sulph. Strabismus. — Alumin., Bell., Hyos. Pterygium. — Zinc, Apis, Ars., Sulph., Rhatan. Cornea : Opacity of. — Apis, Cale, Euph., Nit. ac, Sulph. Spots on. — Euph., Nit. ac, Sulph. Thickening of. — Cale, Cann., Nit. ac. Staphyloma of. — Apis, Lye Ulceration of. — Aeon., Ars., Cale, Caust., Hep., Graph., Lye, Merc, Nit. ac, Sil., Sulph. Chemosis. — Apis, Ars., Bell., Nux v., Sulph. CEdema of Lids. — Apis, Ars., Bry., Merc, Rhus, Sulph. Obstruction of the Lachrymal Duct. — Aeon., Apis, Ars. % Bell., Cale, Euph., Sep., Sulph. Fistula Lacrymalis. — Sulph., Bell., Cale, Lye, Nat. m., Puis., Stan., Sil. Cataract. — Sulph., Cale, Cannab., Con., Euph., Lye, Magnes., Sarsap., Sil. Retinitis. — Aeon., Bell., Bry., Cale, Merc, Puis., Rhus, Sil., Sulph. 60 Surgical Diseases of the Eyes. Iritis. — Aeon., Ars., Am., Bell., Bry., Cale., Con., Dulc., Euph., Merc, Nux v., Puis., Rhus, Sep., Sil., Sulph. Amaurosis. — Aur., Cale., Chin., Dros., Merc., Nat. m., Phos., Sep., Sil., Sulph. On page 77 of Hempel's edition of Jahr's "Forty Years' Prac- tice," he (Hempel) says: "In purulent ophthalmia of new-born infants it is absolutely necessary to apply a feeble solution of Nitrate of Silver." With the greatest respect for Dr. Hempel's learning, I must say here that I consider that he is in error. If Nitrate of Silver is not indicated homceopathically, a cure can not follow its use ; and if it is indicated, the potentized remedy will more speedily produce the desired effect. I have cured many a case with two doses of Aeon. 200, and never saw one yet when it was " abso- lutely necessary " to use a wash of this kind. Aconite nap. Eyes red and inflamed, with deep redness of the vessels ; intolerable pains ; acute ophthalmia ; profuse lachrymation ; frightful inflammation of eyes, with lachrymation ; transitory blind- ness in many cases ; heat and burning in eyes, with pressive and shooting pains, especially on moving the balls ; swelling of the eyes; dilated pupils; dryness ; heaviness and pressure of the upper eye-lids ; inflammatory swelling of the lids, especially in the morn- ing; eyes sparkling, convulsed, and prominent; look fixed; excess- ive photophobia ; or a strong desire for light ; black spots and mist before the eyes. Worse at night ; also from taking cold, wine, or heated food ; and from sun-light. Better when sitting. Left side. Alumina. Stitches in the eyes; congestions in; sensation of coldness in the eyes and lids ; swelling of the lids ; inclination to stare; squinting; spasmodic contraction of eyelids at night with violent pain on opening them ; dim-sightedness as from a mist, compelling him to rub the eyes ; lachrymation during the day, agglutination at night. Worse in the afternoon, and on alternate days; also when sitting in the room. Better from moderate exercise, and in the open air. Right side. Apis mel. Quivering and twitching of the left eyeball, especially at nights ; burning stinging in the right eye, commencing with a dull heaviness, causing flow of water; stinging, itching in the eyes, eyelids, and around the eye; slight agglutination of the eyes at Special Therapeutics, 61 night, has to pick them open in the morning ; soreness, redness of the eyes and lids, secretion of mucus and agglutination of the lids, attended with nettle-rash over the surface ; eyelids erysipelatously inflamed; weak eyes for several days, with photophobia; cedema- tous swelling of the lids ; sensitive to light ; smoky opacity oi cornea, occasioning almost entire loss of sight ; redness and smarting of lids ; puffy swelling of the lids, and around the eyes, with sensation of burning, and stiffness of the integuments; acute pain in the eyeballs ; slight inflammation of the lachrymal sac ; conjunctivitis with burning pain, increased flow of tears, and sensitiveness to light. Worse at night ; also from heat. Better from cold. Left side principally. Argent nit. Itching and smarting of the canthi ; aching pain, deep in the eye, early in the morning; pressure in the eyes as if too full, heat and pain in the ball when moving or touching it ; mucus flocks, impeding sight ; redness of the eye, with feeling as if from a grain of sand; sees through a mist; swollen puncta; cluster of intensely red vessels extend from the inner canthus to cornea ; con- junctiva is puckered and interstitially distended; conjunctiva of lids (and eyes?) as red as blood; conjunctiva is swollen, red and congestive around the cornea towards the inner canthus ; letters become blurred, and sight vanishes when reading or writing ; fiery bodies and flashes before the eyes in the morning and in the dark ; a large part of the cornea is covered with a white, opaque, apparently dense, but not very deeply penetrating spot ; contraction of pupil. Worse in the evening ; also from heat. Better from cold open air. Left side? AmiCcl mon. Faint, dim eyes, without luster; contracted pupils, with cloudiness of the head ; slight protrusion of the right eye ; painful, dull, intermittent pressure in the margin of the left orbit ; eyes half closed ; ophthalmia from mechanical injuries ; obscuration of sight. Worse in the morning, evening, and at night ; also when moving, from touching, and cold. Better from warmth. Arsenicum alb. Pains in the eyes, which oblige him to lie down ; lacerating in the ; stinging-burning in the eyes ; burning in the; ophthalmia violent, with intense redness and conjunctivitis, 62 Stcrgical Diseases of the Eyes. and dark redness and congestion of the vessels ; inflamed eyes from having stood in the water ; specks and ulcers on the cornea ; violent inflammatory swelling of the lids, with oedema; faint protruded staring eyes, without luster, and turned upward ; dryness of the lids, especially the edges, with pain on moving them, as if they rubbed the eye ; profuse lachrymation ; the tears are acid and corrosive ; nightly agglutination ; spasmodic closing of the eyes, especially when looking into the light ; photomania ; obstruction of sight. Worse in the early morning ; also from cold, lying on the painful side, and from sun-light. Better from warmth. Left side. Aurum met. Pressure in the eyes as from some foreign body ; tension in the eyes, with diminished sight; red swelling of lids in scrofulous persons, with styes ; distended, protruded eyes ; indistinct sight, as if black gauze were drawn over the eyes ; half sight as if the upper part of the eyes were covered with a dark body ; double sight ; fiery sparks before the eyes ; specks on the cornea. Worse in the morning ; also on getting cold, and while reposing. Better from warmth. Left side. Belladonna. Entropium? throbbing pain in lower lids, towards the inner canthus, the spot is swollen and inflamed ; after waking in the morning, the eyelids close again spontaneously; itching stitches in the inner canthi, which only go off while rubbing; inner canthi of the left side is very painful, even when lightly touched ; smarting in both eyes ; salty water continually runs from the eyes ; feeling of burning dryness in both eyes ; pain and burning in the eyes; photophobia, with spasmodic movements of the eyes, occa- sioned by the light; interstitial distension of the sclerotica; specks on, and thickening, and ulcers of, the cornea; haemorrhage and ecchymosis of the eye; stitches in the eye, from without inwards; tingling and pressure in the eyes, they feel as if full of sand ; pain in the orbits ; the eyes feel as if being torn out, (sometimes as if pressed in) ; lacerating in the eyes, extending from the inner can- thus; dilated immovable pupils, they remain dilated even when the light is held quite near; vision is at times extinct, at times only diminished, with enormously dilated pupils ; things look dim and black; cannot read anything printed ; dimness of sight, alter- nating with cramps of the hands and feet ; when reading the letters look blurred, and blue and gold colored ; ring around the light, of Special Therapeutics. 63 several colors, more particularly red ; double sight ; inverted vision ; eyeballs turn convulsively in a circle ; spasm of eyes. Worse in the afternoon and at night ; also from softly touching them when walking in the wind, when looking at glistening objects, and from candle light. Better while lying down. Right side. Borax. Soreness in the external canthi; burning in the eyes ; the eyelashes turn themselves inwards into the eye, especially in external canthus, inflaming it. (?) Inflammation of the borders of the eyelids, in infants ; at night the eyes close with a hard, dry gum, which irritates the eyes, like sand. Bryonia alba. The eyes are painful when touching them; pressure in the eyes, as if pressed out of the head ; pressure in eyes as of sand or smoke, particularly early in the morning, on awaking; lancination in the eyes ; burning in the eyes, and in the edges of lids, with biting and itching; redness and inflammation of the lids, with swelling, pressure, heat, and nightly agglutination (particu- larly of upper lids) ; painful swelling of one eye, without redness, with discharge of pus, and dark-red puffed conjunctiva; furfur- aceous herpes on upper lip, with burning itching; frequent lachry- mation, particularly in the open air, and when the sun shines brightly, with dim vision ; obscuration of sight, or else flames before the eyes ; stitches in' the eyes; eye feels too large for the orbit, and painful on turning. Worse at night, and in the morning ; also from heat, in the open air, from motion, and from light of sun. Better on getting warm in bed, and when sitting quiet. Left side. Calcarea carb. Pain as if pressed in, in the eyes ; pressure in eyes in evening ; stitches in the eye and head (during menses) ; cutting in eyes and lids, when reading by candle-light ; itching in eyes in evening ; itching in canthi ; pain as from excoriation in the lower lid ; feeling of heat in the eyes, with heaviness in upper lids ; burning in the eyes when closing the lids ; swelling and redness of the lids, becoming agglutinated every night; in the day time eyes full of gum, with feeling of excoriation, heat and sore- ness, and lachrymation ; lachrymation when writing ; eyes look watery, and lids are agglutinated every morning ; slight twitching in upper eyelids, with feeling as if eyes were moving spontaneously; dilatation of pupils, a darkness or sense of blackness sometimes 64 Surgical Diseases of the Eyes. shoots across the eye ; sensation as of feathers before the eyes ; sensation as of a gauze before the eyes, in inner canthi; dancing wavelets of light, or fiery sparks, before the eyes, on awaking early in the morning ; dimness of cornea ; bright light dazzles the eyes. Worse in the morning or evening ; also from light of any kind. Better from warmth. Right side. CaustiClim. Ophthalmia resulting from repelled cutaneous affections ; eyelids feel weak and tired, can hardly open them : warts about eyes, or on the lids ; burning and itching of the eyes and eyelids ; acrid lachrymation ; painful stitches darting into the head from around the eyes ; momentary obscuration of sight when blowing the nose, or at other times ; dim-sightedness as from a mist or veil before the eyes, increased by rubbing them, and can not be rubbed away ; sight wavering and confused ; when the eyes become painful, colored wheels or green halo are seen about the light; movements before the eyes as of a swarm of insects, dimness of sight as from an incipient cataract, with periodical attacks of excruciating neuralgia, each seeming to increase the dimness of vision. Cannabis Sat. Cornea becomes opaque; specks and pellicle on the cornea ; sensation of spasmodic drawing in the eyes ; weakness of the eyes, and diminished vision ; pressure with lacerating in the upper eyelid. Worse in the forenoon, and at night; also during motion or exercise. Better from rest. Right side. China Off. Pressure in the eyes, as from drowsiness; pressure in the margin of the orbit, from without inwards ; pressure as from sand in the eye, when moving the ball ; itching in the lids ; redness of the eyes, with heat and burning with pressure ; lachrymation, with painful tingling on inner surface of lids ; yellowness of con- junctiva ; dim appearance of the cornea, and smoky feeling in the bottom of the eyes ; faint, protruded eyes ; the pupils incline to contract, or else they are very much dilated and insensible; flicker- ing before the eyes, and black motes ; dimness and weakness of sight ; when reading the letters look pale, with a white border, and confluent ; incipient amaurosis, particularly in drunkards (or after loss of animal fluids?); photophobia; sensitiveness to bright sun- Special Therapeutics. 65 (pain in the eyes, worse from a slight touch, relieved by strong pressure. G.) Worse at night ; also from a light touch, and sunlight. Better in the room, and fronvstrong pressure. Left side. CoCClllllS ind. Pressure in both eyes, as if from dust ; dim sight ; flies and black spots before the eyes, moving as the eyes move, yet without impairing vision ; dilatation of pupils ; pain in the eyes, as if torn out of the head ; aching of the eyes, which can not be opened at night ; when reading a short time the print is all blurred ; obscure vision ; dryness of the eyelids. Worse at night ; also, after reading. Better in the house or room. ColOCynthis. Burning-cutting in the eye, also, in the lower lid of the right eye, when at rest ; cutting, as with knives, in the right eyeball, extending to the root of the nose ; discharge of an acrid fluid from the eyes ; sensitive pressure in the eye, especially when stooping. Worse in the afternoon and evening ; also, when bending over. Right side. Coilium mac. Itching and piercing pains in the canthi, or a smarting as if some acrid substance had been introduced into the eye. Pressure in the eyes, especially when reading; feeling of coldness in the eyes during a walk in the open air ; drawing pain and redness of the eyes ; heat and burning in eyes ; inflamed lids, with incipient styes in some places, and frequent winking ; yellow- ish color of the eyes ; tremulous look, as if the eyes were trembling ; dazzling of eyes from light of day ; photophobia, with pale redness of the eyeball, or partial congestion of the conjunctiva; obstruction of sight ; red appearance of objects ; dark points and colored streaks in the room ; short-sightedness increases ; aversion to light without inflammation of the eyes ; abundant acrid tears, overflowing the lid ; aching in the eyeballs, increased by reading in the evening, and by closing the eyes. Worse in the morning and at night ; also, from light, more par- ticularly of the sun. Better in the dark, and when moving about. Right side. DrOSera rot. Itching and agglutination of the eyelids ; pus- byopia, with weakness of the eyes, and sudden and repeated vibrations before the eyes ; gauze before the eyes, with blurred 5 66 Surgical Diseases of the Eyes. and pale appearance of the letters when reading ; eyes dazzled by light ; stitches in the eyes when stooping. Worse at night, toward morning ; also, from candle-light, or sun- light. Better when standing erect. Left side ? Dulcamara. Contractive pain in the margin of the orbits ; complaints of the eyes from being wet ; pressure in the eyes, made worse by reading; twitching of the eyelids in cold air; sparks before the eyes ; sees things as if through a gauze ; sensation as if fire were darting out of the eyes when walking in the sun or in a room. Worse in the evening; also, when at rest; from cold; in cold, damp weather. Better from warmth, and when in motion. Euphrasia Off. Smarting in the eyes as from sand; stinging in the eyes from bright light ; inflammation and ulceration of the margin of the eyelids ; inflamed cornea ; blueness and obscuration of, and pellicle over, the cornea ; swelling of the eyelids, particu- larly the lower; fine eruption around the eyes; burning and smarting lachrymation, particularly in the wind ; photophobia, and pain from looking at the light ; gum in the canthi ; purulent, with nightly agglutination ; rheumatic ophthalmia, almost blinding him ; dryness and pressure in the eyes ; stitches in the eyes from a bright light ; acrid lachrymation, with mild coryza. Worse in the evening ; also, in the wind, in daylight, and the light of sun. Better from warmth ? Right side ? Graphites. Pressure in the lids, as from sand; pressure in the right eyebrow, extending through the whole eye ; violent stitch through the right eye ; smarting, with heat in the eyes ; coldness over the eyes ; redness of whites of eyes, with lachrymation and photophobia ; redness and painful inflammation of the lower eye- lid and internal canthi ; swelling of lids and lachrymal gland ; frequent lachrymation of the eyes, with pressure in them, and stinging; agglutination early in the morning; intolerance of light; light dazzles the eyes. Worse at night; also, from cold, and light, daylight particularly. Better from warmth. Right side ? Gelseminum, Eyes feel bruised ; great heaviness of the eyelids, can not keep them open; eyes much inflamed, and weak, with Special Therapeutics. 67 great flow of tears ; pricking pains, extending into or from the ball and adjacent parts ; double vision, controllable by the strength of the will, or when looking sideways, not when looking straight forwards; distant objects look obscure (asthenopia); dimness of vision, like smoke before the eyes; aversion to light, more to candle-light. Hepar Slllph. Pressure in the eyes, especially when moving them ; pain in the eyes, violent, as if pulled out of the head ; dull stitch in the eye ; boring pain in the upper bones of the orbit ; redness, inflammation, and swelling of the upper eyelid, with aching and stinging ; erysipelatous inflammation of the eyes, with soreness and bruised pain of the lids on touching them; inflamma- tion of the meibomian glands ; suppuration ; styes ; little pimples surround the inflamed eye ; lachrymation ; specks and ulcers on cornea ; protruded eyes ; obscuration of sight when reading ; twinkling before the eyes ; eyes ache from the bright light of day when moving them ; spasmodically closed eyes at night ; objects appear red, after abuse of Mercury. Worse at night ; also, from cold, daylight, pressure, or on being touched. Better from warmth. Left side. Lycopodium. Pressure as from dust in the eyes; bruised pain in the eyes ; tensive pain in the left eye ; stitches in the eyes, without any redness ; itching in the canthi ; smarting, burning in eyes ; inflamed aching lids, with nightly agglutination in outer canthi; hordeolum ; purulent gum in eyes, with smarting pain ; mucus in eyes; dryness of eyes in the evening; dim, hot eyes; spasmodic twitching of lower lid ; sight weak ; black spots hover before the eyes at a short distance ; twinkling before the eyes when going to bed ; sparks before the eyes in the dark ; blackness before the eyes ; sensation of vibration before the eyes ; stitches and soreness in eyes when looking at light in the evening ; sight obscured, as if from feathers before the eyes ; half sight, perpendicular ; eyes wide open," fixed, and insensible to light. Worse in afternoon and evening; also, when lying down, from wet warmth, and from artificial light. Better from cold. Right side. Magnesia Carbon. Pressure around the-eyes towards evening; lacerating in the eyes, followed by lachrymation; burning and stinging in the eyes, which look injected; agglutinated lids early 68 Surgical Diseases of the Eyes. in the morning ; obscuration of cornea ; mist before the eyes ; black motes before the eyes; swelling of the eyes; dryness of the eyes. Worse at night ; also, when at rest, and from light of day. Better during motion. Left side ? MerCUrillS SOL. Swelling of the eyelids ; they are covered on the edges with scurfs and ulcers ; much purulent matter under the lids, which pours out on opening them. Pressure in the eyes, as from sand ; stitches in the eyes ; cutting under the lid, as from a sharp body ; itching in the eyes ; heat in the eyes ; burning in the eyes ; inflammation of both eyes ; a number of red vessels become visible in the sclerotica; injection of outer canthus ; lach- rymation of both eyes in the morning ; considerable redness and swelling, with constrictive closing of the lids ; pustules on the con- junctiva ; ulcers on the cornea ; scurfs around the eyes ; eyes dim, without luster ; dilated pupils ; black points before the eyes ; com- plete vanishing of sight for five minutes ; mistiness before one or both eyes ; dim-sightedness ; illusions of sight ; pain in the eyes, intolerable, which is not relieved by either hot or cold applications, which, on the contrary, seem to increase the pain ; aversion to light, and to looking into the fire. Worse at night ; also from the heat of bed, heat in general, and from artificial light. Better from cold ? Right side. Natrum mur. Sensation as if sand were in the eyes ; pain as from excoriation in the eyes ; violent burning of the eyes in the evening ; boring pain in the eyes ; redness and inflammation of the white of the eyes, with sensation as if the balls were too large, and pressed ; ulceration and great redness of the lower lids ; lachryma- tion in the open air ; acrid tears in the eyes early in the morning, making the canthi red and sore ; viscous matter in the outer can- thus ; dry feeling in the eyes, as after long weeping ; spasmodic closing of the eyelids ; dimness and obscuration of sight ; dim sight in the morning; gauze before the eyes; letters and sewing stitches become blurred when looking at them ; objects are seen through feathers, particularly white objects ; vanishing of sight ; diplopia ; black points before the eyes, and streaks of light ; a small fiery point before the eyes, which remains wherever she looks ; sees a fiery zig-zag appearance around all things ; one half the object is visible, the other half dark. Special Therapeutics. 69 Worse in the morning, and in the evening ; also, when stooping, walking, reading, writing. Better when at rest. Right side. Nitric acid. Pressure in the eyes, as if pressing on an ulcer; stitches in the eyes ; smarting sensation in the eyes ; burning in the eyes and left temple ; swelling of the lids ; suppuration of eyes ; dark spots on the cornea ; lachrymation ; paralysis of the upper lid ; difficult contraction of pupils; photophobia; obscuration of sight when reading; sight becomes dim, objects appearing dark; in the open air suddenly becomes as if blind deranged; gray spots before the eyes ; muscae-volitantes ; sparks before the eyes ; double vision. Worse in the evening, and at night ; also, when walking ; from the touch ; and from candle-light. Better from warmth ? Right side. NlIX Vomica. Nightly lacerating in the eye; pressure on the upper eyelids, especially early in the morning; pressure in the eyes on opening them and looking at the light; burning and twitching of the lids ; suppurating canthi ; painless ecchymosis in sclerotica ; exudation of blood from the eyes ; intolerance of the light of day early in the morning, with obscuration of sight; yellowness of the lower part of the eyeball ; streaks like lightning before the eyes ; burning and smarting in the eyes, as if from salt. Worse in the morning; also, from light of sun. Better from strong pressure. Left side. Phosphorus. Determination of blood to the eyes ; inflammation of eyes, with heat and pressure, as from a grain of sand ; inflamed red eye ; swelling of the lid, with itching and pressure ; tumor on the border of the orbit; agglutinated lids in morning, on awaking; secretion of gum during the day ; difficulty of opening the lids ; sees every thing as through a gauze; short-sighted; blackness before the eyes; darkness at candle-light; frequent attacks of sudden blindness in the day time, with sensation of a gray color hanging over the eyes ; black passing spots before the eyes ; halo around the candle ; pains in the bones of the orbit ; sight misty, dim. Worse in the evening, and at night ; also, in the open air, in the wind, and from candle-light. Better in the dark, and from cold. Right side. Pulsatilla. Pressure in the eyes, as if from sand, especially when reading; sticking in the eyes when shaking the head; Jo Surgical Diseases of the Eyes. pressure in eyes when looking at light; inflammation of the eyes; inflamed margin of lids, with swelling; inflamed meibomian glands ; swollen red lids ; styes ; obscured corner ; dry eyes ; lachrymation in open air, with dimness of sight ; dim sight, as if through mist ; dim sight, on getting warm from exercise ; fiery circles before the eyes, increasing in size towards noon, and going off in evening ; feeling as if sight darkened by some onhanging mucus, which has to be wiped away ; like a veil before the eyes. Worse in the evening; also, from warmth and light of sun. Better from cold, and rubbing the eyes. Left side. Ratanhia. Inflammation of the whites; dim-sightedness ; temporary relief from wiping eyes ; white specks before the eye, impeding sight ; pterygium crassum. Worse in the evening, by candle-light. Rhus tOX. Ball of the eye feels sore on turning it, or when pressing upon it ; pressure in the eyes, as if from dust ; burning of the eyes ; inflamed lids ; swelling of the lids ; lachrymation, with burning pain in the evening; lachrymation with cedematous swelling around the eyes; objects look pale; pain in the eyes pre- venting motion, yet better when the eyes are kept in motion (pain on beginning to move the eyes, going off by continued motion.) Worse in the morning ; also, from cold, cold wet, and from light in general. Better from warmth, and continued motion. Right side. Sarsaparilla. Continued burning in the eyelids, sometimes alternating with aching pain ; inflamed, dry eyelids ; lachrymation ; agglutination in the morning; dilated pupils; dim sight, as if seeing through a fog, or as if the eyes were covered with a gauze ; stitches in the eyes; pain in eyes from light of day; internal corners of the eyes are bloated, and are of a blue color ; white paper looks red in the evening. Worse in the afternoon ; also, from cold. Better from warmth. Sepia. Pain in the eyes, with headache, and heat in eyes; pain in eyelids on waking, as if too heavy ; itching of the lids ; pricking pain in both eyes in the evening; burning of eyes in morning; inflammation of eyes, with red sclerotica, and stinging and pres- sure ; swelling of eye, with headache on same side ; swelling of both eyes in the evening ; pustules on the cornea ; glassy appear- ance of the eyes; jerking and twitching of the lids, inability to Special Therapeutics. 71 open the lids at night ; paralysis of the lids ; dimness of sight when writing ; sight impeded by a fiery zig-zag before the eyes ; a num- ber of black spots before the eyes, or white luminous vibrations, or sparks of fire, or gauze, or streaks of light ; yellowness of the sclerotica ; green halo around the light of the candle ; pustules on the cornea. Worse in the forenoon and evening; also, from light of day, and from mental exertion. Better from warmth, and after violent exercise. Left side. Silicea. Smarting or heat in the eyes ; red sclerotica, with aching pain ; redness of eyes, with biting in canthi ; ulcers on cornea ; twitching of eyelids ; sparks or black spots before the eyes; dazzled by light; objects look blurred; obscured sight, as if looking through a gray coat ; paroxysms of sudden blindness ; paleness of sight when reading; swelling of tear gland ; letters run together when reading. Worse in the night ; also, from light of day, in open air, from cold and from getting wet. Better from warmth. Right side. Spigelia anth. Nervous pain in the eyes; pain in and above the eyes, deep in the orbits ; pain of eyeballs during motion, as if too large ; intolerable pressure in both eyes, worse when turning them ; sticking in the right eye, especially during motion ; digging- sticking in eye ; sticking with boring, penetrating to the interior of the head ; tingling in the eyes ; inflamed and ulcerated margins of lids ; sclerotitis ; dim and faint eyes ; upper lids hang down as if paralyzed; sight indistinct, as if the eyes were full of water; flashes before the eyes ; weakness of the eyes, in whatever direction they are turned they remain ; farsightedness. Worse in the night ; also, from bending down ; the least move- ment ; on touching the eye, and from light in general. Better when lying down. Left side. Sulphur. Violent pressure on moving the eyes; bruised pain in the eye ; painful dryness of the eyeball ; feeling of heat in the eyes; sensation as if the eyes were full of blood; burning in eyes; burning in the interior of the eyelids, which are red and inflamed : swelling and inflammation of conjunctiva; swelling of lids, with interstitial distention ; tubercles in the lids ; a little white vesicle on the sclerotica close to the cornea; ulcerated margins of lids; obscured cornea; specks and ulcers on the cornea; dryness of 72 Surgical Diseases of the Eyes eyes ; purulent mucus in eyes ; trembling of eyes ; optical illusion, as if the skin were yellow ; like gauze before the eyes ; halo around the candle. Worse in the evening; also, from light in general, particularly sunlight, from touching the eye, from water, and on getting warm in bed. Better from motion, heat, and in dry weather. Left side. Veratrum alb. Inflamed right eye; diplopia; hemeralopia, commencing at twilight ; pressing in eyes ; heat in the eyes ; eyes look yellow or blue ; blindness at night ; paralysis of lids ; tremb- ling of the upper lids. Worse in the morning ; also, during perspiration, after sleep, and the light of the sun. Better after perspiration. Right side. ZinCUITI met. Soreness in inner canthi; the upper lids are lame, and droop ; constant weariness of the eyes ; whirring mo- tions before the eyes ; yellow, blue, and green wheels before the eyes ; fiery balls hover before the eyes in large semi-circles ; when lifting up the eyes he sees luminous flakes ; pterygium. Worse in the evening ; also, in a warm room, and sunlight. Better in open air. The same difficulty experienced in writing the first part of this section exists here; if all the remedies were mentioned that have eye symptoms, the list would embrace the whole Materia Medica. Only those have been recorded, therefore, that are most commonly required, and the student of ophthalmology knows the task of selection is one of no little magnitude. Operations. The temptation is strong to devote more space to this division of our subject than heretofore, for two reasons : First. It is com- paratively but imperfectly understood ; and, second, to argue some of the propositions here laid down. Let me say here, however, that the apparent dogmatism is owing to want of space, and noth- ing is said that I am not prepared to maintain. Strabismus is relieved by a division of the rectus muscle con- tracted. Never fix the eye with a sharp hook ; raise a small fold of the conjunctiva with fine forceps, and make an incision only Special Therapeutics. 73 large enough for the admission of the blunt hook freely, with which draw out the muscle and divide with scissors. Give Aeon., three or four doses, after the operation, and keep a light shade over the eye. If a fungous appear at the incision, snip it off with scissors. Pterygium, cut across at the middle, or nearer the apex than the base, and the same treatment pursued. Give Zinc, or Ratanhia, according to Hughes, a fair trial first. Staphyloma operations necessarily destroy the eye; seize the cornea with rat-toothed forceps, and remove the whole front of the ball by a rapid incision, extending four or five lines around the corneal margin. If the whole eye is removed there is not as good a stump left for an artificial eye. Dress lightly, and use Aeon. * In obstructed lachrymal duct, push a fine probe through the puncta, and if the obstruction is not overcome, take a small teno- tome, with a round shoulder, and push it through the skin into the nasal duct, and insert a style, which is to remain until the tears find a natural passage. Cataract may be removed by one of two kinds of operations, either the needle, or knife ; of the two, prefer the knife ; but if a needle operation seems to be called for, prefer one through the cornea, to one through the sclerotica and posterior chamber. Extraction may be practiced either by an inferior, oblique, or lateral section of the cornea ; the last, or a modification of it, is the best for obvious reasons. Couching is out of date, and reclination also ; laceration of the capsule, to produce absorption of the lens, is all that is attempted with the needle now. Soft cataract is oftener operated on in this way than the hard. My reasons for preferring extraction are as follows : 1 st. More speedy results. 2d. Less danger of destructive inflammations, and consequently, 3rd. More certainty. ♦Have lately restored good and almost perfect sight, by an operation for Staphyloma, removing the upper part of the cornea. 74 Surgical Diseases of the Nose. SURGICAL DISEASES OF THE NOSE. EPISTAXIS — LIPOMA — VARIOUS NASAL DISEASES — DROPSY OF THE ANTRUM — SUPPURATION OF THE ANTRUM. Epistaxis. Epistaxis is a hemorrhage from the nose, and may be either active or passive ; traumatic, or from some other causes. Usually this hemorrhage is of trifling importance, but occasionally it is very severe, and may even result in death. In slight cases I let it alone, as it seems to be a natural process ; but in serious cases it must be arrested. If remedies fail, the posterior nares must be plugged ; unless due to the division of some artery by cancerous degeneration, or as the result of injury, the remedies will not usually fail. In all cases the recumbent posture, and warm water applications, will be valuable aids. Lipoma. Lipoma is a term ill-bestowed, as it is apt to be confounded with tumors of the encysted variety. In this instance it is a chronic hypertrophy of the structures of the tip of the nose, and appears as a large, reddish-blue, soft, tremulous mass. They may be of all shapes, and of almost any size, from a mere clubbing of the end of the nose, to a large pendulous tumor. As Erichsen says, the sebaceous glands and crypts appear to be the structures chiefly implicated. Various Nasal Diseases. Other diseases occurring in other situations may be met with as affecting the nose; as lupus and cancer, tumors, calculi, abscess of the frontal sinuses, inflammation and abscess of the nose. Various Nasal Diseases. 75 Lupus and Cancer are frequently met with, and from the deformity they occasion, appear to be particularly destructive. The treatment does not vary from that for the same diseases in other locations. Tumors, of different construction, occasionally appear here, and from the fact of their usually being pendulous, and filling up the nostrils, the word polypi is used to designate them all. Several well-established cases are recorded where a perfect cure followed the persistent use of remedies. Absorption of the bones is not infrequent, and without the tumor being at all malignant, great destruction of the parts may ensue. Calculi, or Rhinoliies, are " found in the nasal fossa, where they simulate a foreign body ; and here extraction may be practiced with a pair of forceps; sometimes these rhinolites are situated under the mucous membrane." Abscess of the Frontal Sinus may form with much pain and expansion, and possibly caries of their anterior walls, attended by inflammations, and with danger of extending to the membranes ot the brain. Inflammation of the Nose, or rather of the mucous membrane, often occurs. In the case of strumous young people, it may become chronic. Usually the membrane covering the turbinated bone is affected, and becomes much thickened, soft, and vascular, and is seen projecting like a broad fringe; in color it is usually bright red, and the surface is covered by mucus and pus. Wet weather increases the difficulty so much that serious obstruction of the breathing ensues, but at all times the voice is "nasal." Abscess of the Nose is a common disease, and an exceed- ingly painful one. The mucous membrane, or the septum, may be the seat, and upon the situation the gravity of the case depends. Necrosis of the nasal bones or cartilages frequently follows. When the abscess is followed by necrosis, depression of the bridge of the nose, foetid discharge, and similar symptoms, syphilis is probably the cause, and the disease then takes the name of ozozna, and is characterized by the additional condition of ulceration of the interior of the nose, forming hard crust. The deformity resulting often requires the aid of surgery to restore somewhat the sym- metry of the organ. 76 Surgical Diseases of the Nose, Dropsy of the Antrum. Dropsy of the antrum is really but an accumulation of mucus here, owing to the canal leading into the nose being obstructed. As this opening is a little above the floor of the antrum, there is at all times a little mucus therein, but when, from some cause, the duct becomes closed, the accumulation may be sufficient to cause very much inconvenience. Then the expansion of the walls will cause the cheek to be more prominent, and the roof of the mouthy to bulge out. This condition may be suspected when the cheek is found to be semi-elastic, and on pressure gives rise to the "crackling or egg-shell noise." It is doubtful whether remedies will exert much influence on such a condition," but as they have been used, with alleged success, we should try them. Suppuration of the Antrum. Suppuration of the antrum may be due to some injury to the face, the irritation of a carious tooth, or other causes. Pus may form in the antrum, giving rise to pulsation, pain, and if not allowed to escape freely, may result in caries, or necrosis of the bones. It may find vent through the natural duct, or through the socket of a tooth, into the mouth. It is highly important that this discharge should be facilitated, for if, as in dropsy of this cavity, the canal leading to the nose is obstructed, the danger of caries or necrosis is greatly increased. Therapeutics. — These diseases will yield very readily to one of the following remedies, unless it be dropsy of the antrum, and that may prove just as tractable as the others. The remedies are : Aeon., Alum., Apis, Am., Ars., Aur., Baryta, Bell., Bry., Calc., Car bo v., Cham., Chin., Cera., Con., Crocus, Dulc., Erigeron, Ferr., Gran., Graph., Hep., Lach., Lye., Merc., Nit. ac, Nux vom., Phos., Puis., Rhus, Sabina, Sep., Secale, Sulph. They may be indexed as follows : Epistaxis: Erigeron can. From Congestion. — Aeon., Bell., Chin., Crocus, Con. During Coryza. — Ars., Puis. From Worms. — Cina., Merc., Gran. From loss of Fluids. — Chin., Secale, Carbo., Cina., Ferr, Special Therapeutics. 77 Epistaxis : From Overheating — Aeon., Bell., Bry., Nux v. From Liquor. — Aeon., Bell., Bry., Nux v. From Physical Exertion. — Am., Bry., Calc., Puis., Rhus, Sulph. From Contusion. — Am. With Feeble Catamenia. — Puis., Seeale, Sep. With Profuse Catamenia. — Aeon., Calc., Croc, Sabina. — With Amenorrhcea. — Bry., Puis., Sep. Frequent, without apparent cause. — Calc,, Carbo v., Sep., Sil., Sulph. Inflammation of the Nose. — Apis., Ars., Baryta, Calc, Dulc, Hep., Lye, Merc, Puis., Sil., Sulph. Abscess of the Nose. — Apis, Ars., Bell., Calc, Hep., Lye, Merc, Puis., Rhus, Sil., Sulph., Aur., Con., Merc, Nit. ac, Sil. Lipoma: From Contusion. — Arn., Con., Rhus. From abuse of Mercury. — Aur., Bell., Hep., Sulph. From abuse of Liquors. — Ars., Calc, Nux v., Puls.,Sulph., Bell., Hep., Merc. From Scrofula. — Aur., Calc, Hep., Merc, Puis., Sulph., Bry., Lach. s Phos. Aconite nap. Bleeding of the nose, especially in plethoric persons ; vertigo when rising, with nausea, vanishing of the sight, and bleeding at the nose ; crampy sensation over the root of the nose ; it feels as if he would lose his senses. Worse in the evening, and at night ; also when rising, and in a warm room. Better in the open air, and when sitting still. Alumina. Soreness and scabs in the nose, with discharge of thick yellow mucus ; swelling and redness of the nose ; frequent attacks of coryza. Worse in the afternoon, and on alternate days ; while sitting in a room. Better during moderate exercise, and in the open air. Apis mel. Inflammation of the nose, externally and internally, with puffy, shining redness, and burning-stinging pain. Worse in the morning, evening, and at night; from heat, especially in the warm room. Better from cold water. 78 Surgical Diseases of the Nose. Arnica montana. Tingling in the nose and bleeding; traumatic hemorrhage from the nose. Worse in the morning, evening, and at night; also on being touched, and from cold. Better on motion Arsenicum alb. Swelling of, and burning in the nose; ulcers in the nose ; cancer of the nose ; profuse, fluent coryza of sharp, burning, excoriating water, with hoarseness and sleeplessness; drawing stitches here and there in the face. Worse at night, also from cold Better from heat in general. Alirum fol. Caries of the nose; discharge of foetid pus from the nose ; foetid odor from the nose, very sensitive smell. Worse in the morning ; also from cold. Better from warmth. Baryta Carb. Scurf under the nose; troublesome dryness of the nose ; fluent coryza. Worse at night ; also when sitting. Better when walking in the open air. Belladonna. Inflammatory swelling and redness of the internal and external nose ; bleeding of the nose, with redness of the face ; over-sensitiveness of the sense of smell; putrid smell from the nose. Worse in the afternoon, and at night ; also from touching the parts but very softly. Better while lying down. Bryonia alba. Fullness and heaviness in the forehead, as if the brain were pressed out, with bleeding of the nose, and red, bloated face ; swelling of the nose, with very sore pain when touched ; bleeding of the nose, especially in the morning, with suppressed menstruation. Worse in the evening; also from motion, and from heat. Better on getting warm, in bed. Calcarea Carb. Inflamed, swollen and red nose; dryness of the nose ; nostrils ulcerated and scabby ; bleeding of the nose in the morning ; polypus of the nose ; stench before the nose, like manure, gunpowder, or putrid eggs ; stench from the nose ; smell diminished. Worse in the morning, evening, and night ; also from cold. Better from warmth. Carbo Ve[|. Frequent and continuous bleeding from the nose, Special Therapeutics, 79 especially in the morning, or after straining to stool, with paleness of the face before and afterwards ; the tip of the nose is red and scabby ; itching around the nostrils ; coryza, with hoarseness. Worse in the morning and forenoon ; also in the open air, and from pressure. Better after lying down. Chamomilla. Wrinkled skin on the nose, ulcerated nostrils; sensitive smell. Worse at night ; also from cold, when lying down. Better on rising. China Off. Redness and heat of the nose ; tearing in the dorsum of the nose ; frequent bleeding from the nose ; hemorrhage from the mouth and nose ; bleeding of the nose after blowing it ; dry coryza, with toothache and lachrymation ; headache from sup- pressed coryza. Worse at night ; also from touching the parts softly. Better in the room. Cina. Bleeding from the nose and from the mouth, with burn- ing in the nose ; disposition to bore in the nose ; sneezing violent, with stitches in the temples; stoppage of the nose in the evening; fluent coryza at noon ; the nose burns. Worse at night ; also from pressure. Better after lying down Conium mac. Excessively acute smell, purulent discharge from the nose ; frequent bleeding from the nose when sneezing ; cancer of the nose. Worse in the morning, and at night ; also when lying down. Better from motion. CrOCUS Sat. Discharge from one nostril at a time, of tenacious, thick, dark-black blood, stringy, with cold perspiration on the forehead. Worse in the morning. Better in the cool, open air. Dulcamara. Bleeding from the nose, the blood is bright red and very warm, accompanied with a pressure above the nose ; dry coryza, aggravated in cold air. Worse in the evening ; also in cold air, and in wet weather. Better when moving about. Erigeron Can. In cases of epistaxis, of almost any kind, this remedy has never but once failed me. I use the strong tincture, So Surgical Diseases of the Nose. and administer it by olfaction. One or two smells of it has always sufficed. Ferrum met. Bleeding from the nose in the evening; the nose is continuously filled with clotted blood. Worse in the morning ; also when at rest. Better from s-low exercise. Granatlim. Tingling-itching in the nose; burning, heat, and dryness in the nostrils, or else accumulation of tenacious mucus ; alternation of fluent and dry coryza. Graphites. Painful dryness of the nose; bleeding at the nose; black, sweaty pores on the nose ; dry scurfs on the nose ; frequent discharge of thick, yellowish, foetid mucus from the nose ; coryza as soon as he becomes cold ; smell too sensitive ; cannot bear the smell of flowers. Worse at night ; also from cold. Better from warmth, and when getting warm in bed. Hepar Sulph. Inflammation, redness, and heat of the nose; the nose feels sore as if bruised; sore pain on the dorsum of the nose when touching it ; very sensitive smell ; coryza with inflammatory swelling of the nose, which feels sore as a boil. Worse at night; also from cold, from pressure, and on touching the nose. Better from warmth. Lachesis. Redness of the point of the nose, bleeding from the nose, of dark blood, and blowing of blood from the nose, especially in the morning ; discharge of blood and matter from the nose ; coryza, with discharge of thin water, and with red nostrils ; scabs in the nose. Worse in the evening; also after sleep, in the open air, and in the cold air. Better from warmth ? Lycopodium. Over-sensitiveness of the smell; bleeding from the nose, principally in the afternoon; scurf in the nose; nightly closing of the nostril by pus ; dryness of the nose ; obstruction about the root of the nose ; can only breathe with mouth open ; dryness of the posterior nares ; coryza with acrid discharge, making the upper lip sore ; violent coryza, with swelling of the nose ; fan- like motion of the nostrils; sneezing without coryza. Worse in the evening; also on lying down, and when at rest. Better from cold. Special Therapeutics. 81 MerClirillS. Red, shining swelling of the nose, with itching; greenish foetid pus is discharged from the nose ; swelling of the nasal bones ; blackish nose ; scurfy nostrils, bleeding when they are cleansed ; bleeding of the nose during sleep, or when coughing ; profuse fluent coryza, with profuse discharge of watery corrosive mucus. Worse at night ; also from warmth, and from the heat of the bed. Better from cold ? Nitric acid. Stitch in the nose, as from splinters, when touch- ing it ; the tip of the nose is red, and covered with scurfy vesicles ; itching herpes on the wings of the nose ; bleeding of the nose, the blood is black and clotted ; disagreeable smell in the nose on inhal- ing air ; foetid yellow discharge from the nose ; foetid smell from the nose; condylomatous excrescence on the nose; soreness, burning and scurf in the nose ; unsuccessful attempt to sneeze ; the nose is dry, and stuffed up; complete obstruction of the nose, with dropping out of water ; dry coryza, with dryness of the throat and nose, the wings of the nose, inflamed and swollen ; fluent coryza, with obstruction of the nose, the mucus is only discharged through the posterior nares ; coryza, with dry cough, headache, hoarseness, and stitches in the throat. Worse in the evening, and at night ; also on touching the parts. Better on getting warm ? NlIX Vomica. Sensitiveness and inflammatory redness of the internal nose ; bleeding from the nose in the morning ; smell before the nose, like old cheese or brimstone ; coryza fluent during the day, and dry in the evening and at night ; dry coryza, with stop- page of the nose; acrid discharge from the obstructed nose. Worse in the morning and at night ; also from motion, and on being touched. Better from strong pressure. Phosphorus, Bleeding of the nose, during stool; blowing of blood from the nose; swelling and redness of the nose; painful dryness of the nose ; bad, foul smell from the nose ; over-sensitive- ness of smell ; readily-bleeding polypus of the nose ; profuse dis- charge of green or yellow mucus from the nose, without coryza ; freckles on the nose. Worse in the evening, and at night ; also from strong smells and when lying on the back. Better while lying on the right side. 6 82 Surgical Diseases of the Nose, Pulsatilla. The nose feels sore, internally and externally ; ulcer- ation of the external wing of the nose, emitting a watery humor; bleeding from the nose, of coagulated blood, with dry coryza; green and foetid discharge from the nose, like old catarrh ; smell before the nose, as from old catarrh ; coryza, with loss of smell and taste, or of long-standing, with a heavy yellowish-green discharge. Worse in the evening, and at night ; also in a warm room, and from warmth. Better in the open air, and from cold. Rhus tox. Redness of the tip of the nose, with soreness when touched; inflammation of the nose; the nose feels sore internally; bleeding of the nose at night, or when stooping, of coagulated blood; discharge of green offensive pus from the nose; puffiness of the nose; spasmodic sneezing; discharge of mucus from the nose, without coryza; dryness of the nose. Worse in the morning and at night ; also when at rest, when getting wet, and from cold. Better from warmth. Sabina. Has been recommended for epistaxis, but I can find no symptoms. Secale COr. Useful in hemorrhage from the nose, accompany- ing feeble catamenia. Sepia. Nose swollen and inflamed, especially on the tip ; tip of the nose scurfy ; ulcerated nostrils ; stoppage of the nose, dry coryza ; violent bleeding from the nose, and blowing of blood from the nose ; loss of smell, or foetid smell before the nose ; ozcena, with blowing of large lumps of yellow-green mucus, or yellow and green membranes, with blood from the nose. Worse in the forenoon, and in the evening ; also when at rest, and when bending down. Better from warm air. Sulphur, Blood comes from the nose whenever blowing it; bleeding of the nose, with vertigo, afterwards it feels sore when touched ; swelling and inflammation of the nose ; dry ulcers or scabs in the nose ; smell before the nose, as from an old catarrh ; freckles and black pores on the nose; herpes across the nose like a saddle ; burning coryza in the open air, obstruction of the nose in the room ; dryness of the nose. Worse in the evening, and at night ; also from bodily exertion, on touching the affected parts, and on getting warm in bed. Better from motion and from heat. Surgical Diseases of the Mouth. 83 Operations. The operations are very simple. When pus forms in any of the cavities, perforate the bone with a small trocar, or a perforator made for the purpose, and give free exit to the pus. In epistaxis, when the hemorrhage cannot be controlled by remedies, the pos- terior nares are to be plugged with lint, or raw cotton. Bellocq's nasal sound and canula is the instrument to be used. When not at hand, I have often succeeded by introducing a piece of lint wet with the tincture of Erigeron into the nostril, and pushing it up and back, as far as is required, with a probe. SURGICAL DISEASES OF THE MOUTH. GLOSSITIS — PROLAPSUS OF THE TONGUE — ABSCESS OF THE TONGUE — RANULA — VARIOUS DISEASES OF THE TONGUE — ABSCESS OF THE GUMS — ULCERATION OF THE GUMS— EPULIS. Glossitis. Glossitis is an inflammation of the tongue, being the result, in general, of mercurialization. The tongue becomes enormously swollen, enlarged by the infiltration of serum; the increase in size, in some cases, having been known to threaten death by suffo- cation. The accompanying symptoms are, profuse salivation, ina- bility to swallow, or even speak, with the organ hanging out of the mouth, as in prolapsus. The difference is this, in glossitis there is a comparatively sudden invasion, whilst the latter is gradual. Our remedies, particularly Apis, act like magic in these cases, and the harsh allopathic procedure of slitting the tongue is seldom if ever called for. 84 Surgical Diseases of the Mouth. Prolapsus of the Tongue. This is a condition in which the tongue hangs out of the mouth permanently. The patient has no power to retain it in the mouth any length of time. Prolapsus may be congenital, or acquired. The teeth, and even the jaws, are frequently pushed forward, the edges of the teeth meeting at an angle very similar to that noticed in the horse. Should this condition be allowed to remain unim- proved, the jaw will be permanently distorted. There are cases of evident hypertrophy of the whole organ, but the fault usually seems to lie in a want of power in the retractor muscles. The tongue is of a dark or purplish color, dry, much swollen, and there is a constant dribbling of saliva. I am not certain that this is a disease (if such it may be called) that is curable by medicines alone, but think operative measures will have to be conjoined with the other treatment. Still, it being a case in which there is no great urgency, time enough may be taken to test the remedies. This is one of those diseases which are of so rare occurrence, and the results of which are so very unsatisfactory, partly from the fact of but few being willing to give time enough to properly test the matter, that we know but little about the effects of remedies. We have to reason by analogy, and such reasoning in medicine is far from being reliable. I am not cognizant of a single case having been reported where a perfect cure followed the use of remedies. Abscess of the Tongue. This is also a very rare disease, and is not easily diagnosed when seen. Like all other similar diseases, the pus must be evacuated at once. Erichsen speaks of a case in which " there was an elastic fluctuating tumor of slow growth, about the size of a small plum, situated deeply in the center of the tongue." I never saw a case, but have been informed that as the tongue is not discolored it is not at all easy to tell whether it be an abscess or a tumor from some other cause. Dr. T. C. Duncan had a case of abscess of the tongue. The abscess was situated in the center of the tongue. It was about the size of a large pea and presented a red base ; cause, a cold ; remedy, Hepar. Ranula. — Various Diseases. 85 Ranula. Ranula is a most interesting form of tumor, found under the tongue, to one side of the frenum. There are two varieties, first, a cyst, containing a fluid, and often as large as a walnut. The fluid is serous and of a glairy nature ; the walls of the cyst are very thin, almost transparent, and small vessels can be distinctly seen rami- fying on the surface. Many consider this a simple dilatation ot Wharton's duct, but that is not the general belief. Some patholo- gists, among them Paget, think many of these ranulae, " are proba- bly formed by dilatation of the sub-maxillary duct, obstructed by calculi or otherwise ; others by abnormal development of distinct cysts, or possibly of bursae between the muscles of the tongue." The second form is that of a true encysted tumor, the contents ot more or less consistency, and walls firmly adherent to the adjacent parts. Various Diseases. Tumors of all varieties are found in this situation, but do not need any special mention ; they should be treated according to the indications. Fissures or cracks in the tongue are found on the sides of the organ, and are usually dependent upon the irritation caused by the root of a molar tooth ; at other times they are the product of dys- pepsia, syphilis, etc. In cases where the general health is low, or the system is tainted with syphilis, struma, or scorbutis, these cracks are converted into large and foul ulcers, which extend rapidly, attended by offensive breath, and constant flow of offensive saliva; in fact, they are true phagedena. The surrounding parts of the organ are swollen and puny, and of a dusky-red color. Death frequently results from the excessive discharge, and the inability to take food, though in many cases rupture of the artery is the cause. I11 Psoriasis the tongue becomes shriveled and dry, much indu- rated, with the surface covered with cracks ; with patches, also, on the surface, of a dirty-white color, irregular in size and shape, vary- ing from an inch in diameter to the size of a pea. This condition is sometimes met as a manifestation of secondary syphilis, and certainly, to the eye, looks as much like a purely local disease as 86 Surgical Diseases of the Mouth, such a thing can be. Another syphilitic condition is one that has not been named, to my knowledge, and is described by Erichsen in the following manner : " A glazed and warty appearance, as if covered with a layer of boiled sago, the mucous membrane being cedematous, elevated, and papillated, yet at the same time glassy and semi-transparent, and without induration." Syphilitic tubercle is an indurated and irregularly circumscribed tumor, situated deep in the substance of the tongue, usually near the center of the tip, and feels round to the touch. The integu- mentary cover of the tumor is of a coppery or dusky-red color, surrounded by cracks, but it does not ulcerate, discharge, or destroy the organ. Cancel- of the tongue so closely resembles some of the syphilitic affections of this organ that great care must be exercised in forming a diagnosis. One thing worth remembering is, that the syphilitic tubercle differs from the cancerous in being situated deeply in the substance of the part, while the latter is more superficial and is found about the edges and tip. (See Ulcers.) Ulcers. — There are the phagedenic, the syphilitic, and the can- cerous, and may be distinguished by attention to the following signs : Phagedenic, or sloughing, rapid progress, eroding action, and no induration at the base. Syphilitic, indurated base, elon- gated, or irregular in shape, and does not rapidly extend. Cancer- ous ulcers are, circular shape, " eroded edges," and spread rapidly. These are the main characteristics. The microscope should not be neglected, however, in examining sores in this region supposed to be cancerous. The cancerous ulcers produce all the dreaded symptoms and accompaniment of cancers elsewhere, and are very fatal. Joined to the proper cancerous disease is the inability to eat, which renders the condition of the patient more deplorable. Abscess of the Gums. Abscess of the Gums is caused by the roots of decayed teeth, cold, or some other inflammation, resulting in the formation of pus. It is of trifling moment, although it gives rise in many instances to considerable suffering. Remedies act very well. Evacuate the pus. Special Therapeutics. 87 Ulceration of the Gums. Syphilis, scrofula, cancer, or any of the conditions operating to produce similar lesions in the mouth and on the tongue, may have the same effect here. Epulis. This is a tumor of a fibrous character springing from the perios- teum and edge of the alveolus, and implicating the osseous walls, growing up between and loosening the neighboring teeth, which it displaces and envelopes in its structure. It is most frequently met with in the lower jaw, and commonly about the molar teeth. This tumor is red, smooth, and lobulated, at first hard and semi-elastic, like the ordinary structure of the gum, but after a time softening by disintegration, and ulceration on the surface, with a purulent or sanious discharge ; it appears to be simply a circumscribed hyper- trophy of the gum. Malignant Epulis is soft, purplish, very vascular, grows rapidly, and is specially reproduced after removal. They are principally found in men advanced in life. Therapeutics. — The remedies in common use are : Aeon., Alum., Ambra, Apis, Arn., Ars., Bell., Bry., Cale., Carbo an., Carbo v., Caust., Clem., Dulc., Graph., Hep. s., Kali., Lach., Lye., Merc., Nat. mur., Nit. ac., Nux vom., Petrol., Phos., Rhus, Sep., Sil., Staph., Sulph., Sulph. ac., and Thuja. Tongue: Prolapsus of. — Ars., Caust., Calc, Dulc, Euphr., Graph., Hep., Lach., Nux, Sulph. Glossitis. — Aeon., Apis, Am., Ars., Bell., Lach., Merc. Abscess. — Apis, Ars., Calc, Hep., Merc Psoriasis. — Bry., Calc, Dulc, Led., Lye, Sep., Sulph. Fissures. — Alum., Calc, Hep., Lye, Merc, Petrol., Rhus, Sulph. Syphilitic tubercle. — Apis, Ars., Calc, Hep. s., Merc, Nit. ac, Rhus, Sil., Sulph., Thuja. Ranula. — Ambra, Calc, Merc, Thuja. Cancer, open. — Ars., Sil., Sulph., Bell., Calc, Hep., Lach., Merc, Nit. ac, Sep., Staph., Thuja. Induration. — Bell., Sep., Sil., Carbo an., Carbo veg., Nux v., Phos., Staph., Sulph. 88 Surgical Diseases of the Mouth. Gums : Abscess of. — Calc, Caust., Si/., Staph., Sulph., Nat. tnur. Ulceration of. — Alum., Carbo v., Kali, Lye, Merc, Nat. m., Staph., Sulph. ac. Epulis : Calc. c, Carbo v., Lach., Sil., Ars., Clem., Graph. Hep., Nit. ac, Phes., Sep., Staph., Sulph., Thuja. Aconite nap. Dryness of the mouth, and of the tongue ; prick- ing and burning in the tongue; tongue coated white; trembling and stammering speech ; taste bitter ; everything tastes so except water ; aversion to food ; burning, ungovernable thirst for beer. Worse at night ; also from cold, and after drinking. Better in the open air, and from warmth. Left side. Alumina. Pains in the jaws, with sensation as if the teeth were elongated ; ulceration at the root of every tooth ; bleeding of the gums, and swelling; dryness of the mouth in the morning, fol- lowed by increased secretion of saliva, with an astringent sensa- tion in the mouth, and a musty, or putrid smell ; constant secretion of saliva in the mouth ; tongue feels rough, and is coated white, but with a good taste ; or, yellowish-white coating, with a bitter taste. Worse in the afternoon; also when chewing, and when drinking cold water. Right side. Ambra gHsea. Bleeding of the gums, especially of the right lower jaw; the gums are painful and swollen ; foetid smell from the mouth ; smarting in the mouth, with sensation as if the parts were excoriated, and with inability to eat anything solid, on account of the pain ; vesicles in the mouth, with a burning pain ; insipid, rancid taste in the mouth. Worse in the morning, and in the evening; also on awakening, after having swallowed the food ; when talking, and from eating warm things. Better while eating, when swallowing, and from cold food. Either side. Apis mel. (Great thirst; drinks often, but little at a time, G.) Extreme sensation of rawness and scalding all around the tongue, as if it had been scalded, and small pimples on the edge; followed by rawness, burning, and blisters along the edge of the tongue, which are very painful, accompanied by stinging; dryness and heat in the mouth and throat, and feeling in the tongue as if it had been burnt. Special Therapeutics. 89 Worse in the morning, and in the evening ; also from heat. Better from cold water. Left side. Arnica mon. Tingling in the gums as if they had gone to sleep ; during mastication the gums are painful, as if from subcu- taneous ulceration ; biting sensation in the tongue ; foetid breath from the mouth ; tongue coated white, but has a good taste and appetite. Worse in the morning, evening, and at night; also, on awaking, after drinking, on moving the tongue, from talking, on touching the tongue. Better from warmth. Either side. Arsenicum album. Gums bleed readily ; tongue bluish ; coated white ; tongue, red and dry, or brown, or blackish ; cracked and trembling tongue ; insensible tongue as if burnt, having no taste ; foetid smell from the mouth; great dryness of the mouth and tongue; frequently accompanied with a violent thirst, drinking often, but little at a time ; aphthae in the mouth. Worse in the morning, and at night ; also from cold. Better from warmth. Right side. Belladonna, Painful swelling of the right side of the gums, with fever and sensation of chilliness ; vesicles on the gums, pain- ful like burns ; the tongue is painful, especially to the touch ; it is red, hot, and dry, with red edges, and white in the middle ; cracked tongue, white-coated; feeling at the tip of the tongue as if it had a vesicle upon it, painfully burning, when touched; tremor of the tongue ; the tongue is covered with a quantity of yellowish- white, tough mucus. Worse in the afternoon, evening, and at night ; also, when drinking, when swallowing fluids, when talking, and from eating warm things. Better when lying down, and from cold food or drink. Left side. Bryonia alb. Gums painful, as if sore and raw; the gums are spongy ; tongue coated white or yellow ; dry tongue ; rough, dark- colored tongue ; burning vesicles on the border of the tongue ; flat, insipid, sweetish, or disgusting taste in the mouth ; putrid taste ; bitter taste even of the food; aversion to food, at other times excessive hunger. Worse in the evening, and at night; also on chewing; while 90 Surgical Diseases of the Mouth. drinking, when swallowing the food, from talking, and when eat- ing or drinking warm things. Better from cold food or drink. Either side. Calcarea Carbonica. Swelling of the gums; swelling of the gums painful, and without toothache there is swelling of the cheek, which is painful to the touch ; pustules on the gums over one of the molar teeth ; bleeding of the gums ; knotty swelling of the right cheek in the mouth, with drawing and lacerating pain every evening; blisters in the mouth, which form ulcers; the tongue is painful on the border, and its under surface, especially when chew- ing, swallowing, and spitting; violent burning of the tongue and mouth ; thick, white coating of the tongue, with sensation as if it were without any skin, and sore ; swelling of one side of the tongue ; little blisters on the tongue, with burning pain, and heat in the mouth ; bad, sour taste in the mouth ; loss of appetite ; at times the hunger is ravenous. Worse in the morning, evening, and at night ; also, on awaking, and from talking. Better on lying on the painful side. Right side. CarbO animal. The gums are pale, and painful as if ulcerated ; the teeth are so loose that the softest food gives pain ; gums red and swollen, and very painful ; drawing pain in the gums ; bleed- ing of the gums; burning at the tip of the tongue, and roughness in the mouth ; mouth and tongue are immovable, with difficulty ; drawing and very low speech ; bitter or sour taste in the mouth ; thirst, with aversion to cold drinks ; no appetite. Worse in the evening, and at night ; also, in the open air, and when awaking. Better when lying down. Left side CarbO Veg. Bleeding of the gums when cleaning the teeth; the gums are painful, and sensitive when chewing; drawing pain in the gums ; heat in the gums ; soreness of the gums in the day time; pustules on the gums; the gums recede from the teeth; increased flow of saliva ; bitter mucus in the mouth, early in the morning. Worse in the morning, and in the forenoon; also, in the open air, on getting heated, from pressure, and from eating or drinking warm things. Better from cold food and drink. Right side. Special Therapeutics. 91 CaUStiCUITI. The gums are painfully sensitive, without tooth- ache ; swelling and painfulness of the gums before and behind ; swelling of the left side of the gums, with great sensitiveness when eating, and a spasmodic pain in the evening; fistula dentalis; par- alysis of the tongue ; a good deal of mucous saliva accumulates in the mouth; accumulation of water in the mouth, having a rancid taste. Worse in the evening, and at night ; also, on awaking, and when lying on the painless side. Better from warmth. Left side. Clematis erecta. Jerking, shooting and drawing toothache in the left upper jaw, at times in one, at times in another tooth; the pain affects all the teeth, without one being able to point out the tooth affected; a decayed tooth pains, and feels longer than the others ; increased secretion of saliva ; small blisters on the tongue and in the throat, which soon become ulcers. Worse at night ; also, from contact. Better from cold water. Either side. Dulcamara. Gums loose and spongy; dry tongue; paralysis of the tongue; swelling of the tongue, with impeded speech and breathing; hunger, yet with an aversion to food; violent desire for cold drinks. Worse in the evening, and at night ; also, when lying down, and from talking. Better from warmth in general. Either side. Graphites. Sore pain in the gums; ulcerated pain in the gums; itching corrosion of the gums ; swelling of the gums, and dryness of the mouth; white tongue; burning vesicles on the lower sur- face, and tip of the tongue ; painful tubercles and vesicles on the back part of the tongue; unusual thirst; appetite is variable. Worse at night ; also, on getting heated, before falling asleep, on awaking, from talking, and from eating or drinking cold things. Better while lying down on the painless side, and from warm food or drink. Left side. Hepar SllSphur. The gums bleed readily ; jerking in the gums ; inflammation and swelling of the anterior and inner por- tions of the gums ; ulcer on the gums ; burning pain on the tip of the tongue ; putrid taste in the mouth ; canine hunger, Worse in the morning, forenoon, evening, and at night; also, q 2 Surgical Diseases of the Mouth. before falling asleep, on lying on the painful side, from pressure, when swallowing the food or saliva, and on being touched. Better from warmth. Left side. Kali Carbon. Painful inflammation of the anterior gums ; swelling and soreness of the gums ; swelling of the tongue ; pain- ful vesicles on the tongue and gums ; putrid, bitter, or sour taste in the mouth ; little appetite ; violent thirst. Worse in the morning, evening, and at night ; also before falling asleep, on awaking, and on getting heated ; from eating or drinking warm things. Better from cold food or drink. Left side. Lachesis. The gums are raw and sore ; readily bleeding gums ; swelling of the gums, with blue-redness and great sensitiveness ; thick, yellowish coating on the tongue ; black tongue ; tongue feels stiff, with difficulty of moving it when swallowing ; red, sore spots, rhagades, and large, red papillae on the tongue ; gangrene of the tongue ; inflammation of the tongue, with titillation, causing cough ; offensive, bad taste in the mouth ; bitter taste ; loss of appetite ; sometimes great hunger. Worse in the evening, and at night; also in the open air, and from pressure. Better while eating. Left side. LyCOpodilim. Heat and pain in the gums; swelling of the gums over the front teeth, with swelling of the upper lip ; numb- ness of the inner mouth and tongue ; tongue painful and swollen ; tubercles on the tongue ; ulcer under the tongue ; ulcer under the tongue from holding the tip of cigar there; bitter taste in the mouth ; absence of thirst ; great and excessive hunger ; sometimes no appetite ; aversion to solid food ; aversion to bread. Worse in the afternoon, evening, and at night ; also, on awaking, when lying on the painful side, from pressure, and when eating or drinking cold things. Better from warm food or drink. Left side. MerClirillS. The gums recede from the teeth ; the gums are sore and swollen ; ulcerated gums ; burning pain in the gums at night ; bleeding of the gums when touching them ; foetid smell from the mouth; the tongue is coated as with fur; brown or blackish tongue; swelling of the tongue; inflammatory hard swell- ing of the tongue ; ulcerated edges ; hollow, ulcerated tongue, with swelling; tongue feels as if burnt; bitter, putrid, salt, sweet, or Special Therapeutics. 93 sour taste in the mouth ; excessive appetite and hunger ; loss of appetite ; thirst, violent and burning, day and night. Worse in the evening, and at night ; also from warmth, and in getting warm in bed, and when swallowing. Better from cold. Right side. NatrillTI mur. Extreme sensitiveness of the gums to cold and warm things; inflammation and swelling of the gums, with swell- ing of the cheek; painful swelling of the gums, readily bleeding; scorbutic, putrid inflammation of the gums; ulcer on the gums, painful day and night; vesicles on the tongue; painful burning and smarting of the gums when eating; swelling under the tongue, with a stinging pain ; chronic sensation as of hair on the tongue ; heavy tongue; loss of taste; bitter, putrid, or sour taste in the mouth ; excessive appetite ; constant thirst. Worse in the morning, forenoon, and at night ; also when eating, from chewing, and from pressure. Better while and after lying down. Right side. Nitric acid. Itching of the gums; white swollen gums; bleed- ing of the gums ; vesicles on the tongue, and edge of the tongue, with burning pain when touched ; sour, bitter, or sweet taste in the mouth; variable appetite. Worse (the whole day alike ; a little easier in the forenoon) ; also when lying on the painful side, from pressure, and from swallow- ing, particularly the food. Better when lying on the painless side. Either side. NlIX Vomica. Swelling of the gums; swelling of the gums with pain, and a throbbing sensation as if an ulcer would burst out ; putrid, bleeding, swelling of the gums ; tongue black and cracked, with bright red edges ; dry tongue ; white or brownish tongue ; tongue coated with white or yellow mucus ; painful vesi- cles on the tongue; sour, putrid, or bitter taste in the mouth; food has no taste ; hunger, yet aversion to food. Worse in the morning and at night ; also, in the open air, when lying on the painful side, when swallowing the food, and from eating or drinking cold things. Better when lying on the painless side, and from warm food or drink. Left side. Petroleum. Swelling of the gums, with stitching pain when touched ; vesicle on the gums ; tongue is dotted with yellow spots ; White-coated tongue; rawness of the tongue and palate; foetid 94 Surgical Diseases of the Mouth. odor from the mouth ; slimy, flat, or putrid taste in the mouth ; hunger causing nausea. Worse in the morning and in the evening ; also in the open air, and when swallowing the food. Better from warmth in general. Right side. Phosphorus. Inflammation and soreness of the gums; ulcer on the gums, with swelling of the lip ; bleeding of the gums at the slightest touch ; swelling of the root of the tongue ; dry tongue ; white mucus on the tongue, with slimy mouth ; furred tongue ; a number of small, red, bleeding tips on the anterior surface of the tongue ; slimy taste in the mouth ; loss of taste ; hunger, particu- larly after a meal. Worse in the morning, evening, and at night ; also when chew- ing, while drinking, while lying on the painful side, from pressure when swallowing, and when eating or drinking warm things. Better in the open air, and from cold food or drink. Left side. RhllS tOX. Intolerable burning, sore pain in the gums~; accu- mulation of water in the mouth ; the tongue is not coated, but is very dry ; parched, red, or brown tongue ; nightly discharge of yellow or bloody saliva from the mouth ; mouth feels better all day : complete loss of appetite ; excessive hunger. Worse in the morning, evening, and at night ; • also when chew- ing, when lying on the painless side, when swallowing the food, and when eating or drinking cold things. Better from warm food or drink, and from warmth in general. Left side. Sepia. Drawing in the gums ; bloated, dark, red gums, with painful beating, as in incipient suppuration ; painful swelling of the gums ; swelling of the gums, with painful soreness ; sore, ulcerated gums ; sore pain in the tongue ; white tongue ; pain in the tongue, as if burnt ; absence of thirst ; no appetite ; everything tastes too salt ; ravenous hunger ; much thirst. Worse in the morning, forenoon, and evening ; also before fall- ing asleep, or chewing, while lying down on the painless side, from swallowing the food, and when talking. Better from cold water. Right side. Silicea. Painful sensitiveness of the gums to cold water; pain- ful inflammatory swelling of the gums; sore gums; the gums bleed readily; coated tongue; tongue coated with brown mucus; Special Therapeutics. 95 numbness of the tongue ; bitter or acrid taste in the mouth ; loss of taste; not much hunger, but thirst. Worse in the forenoon, afternoon, evening, and at night ; also in the open air, when lying on the painful side, from pressure. Better when lying on the painless side, from warmth in general, and in the morning. Left side. Staphisacjria. Burning-swelling of the gums, with heat in the cheek ; gums pale, blanched, and ulcerated, or painful and swollen, with tendency to bleed ; fungus excrescences on the gums, and in the mouth ; ulcerations, or numerous vesicles in the mouth or on the tongue ; swelling of the glands of the neck, and of the follicles under the tongue ; extreme hunger, even when the stomach is full. Worse in the morning, forenoon, afternoon, and night ; also on awaking, on chewing, from pressure. Better when swallowing. Either side. Sulphur. Swelling of the gums, with throbbing pain: hard swelling of the gums, discharging pus and blood ; burning pain on the surface of the tongue; dry tongue in the morning; brown, parched and rough tongue ; cracked and vermillion tongue ; putrid or bitter taste in the mouth ; complete loss of appetite ; thirst. Worse in the evening, and at night ; also on falling asleep, when swallowing the food or saliva, on talking, and from eating or drink- ing cold things. Better from warm food or drink. Left side. Sulphuric acid. Ulcers on the gums: vesicles on the inner sides of the cheeks ; dry tongue ; hunger, but no appetite ; putrid, flat, or pappy taste in the mouth. Worse in the forenoon, afternoon, and at night; also in the open air. Better from heat. Either side. Thuja OCCi. Swollen and sore gums; darting through the gums of the posterior molar teeth ; sore feeling in the gums ; toothache, with a sort of hacking or sharp beating in the gums ; considerable swelling of the gums and tongue; the tip of the tongue is sore to the touch ; rough, scraping feeling on the surface of the tongue ; ranula, transparent, jelly-like, blue-red or grey ; desire for cold drink. Worse in the afternoon, evening, and at night ; also on chewing, on getting heated, and when swallowing the saliva. Better from rubbing, and from cold ? Either side. 96 Surgical Diseases of the Mouth. Operations. The whole tongue, or a part, is sometimes removed for cancer, hypertrophy, or prolapsus, by excision, or ligature. If required to operate, use the knife in preference to anything else : it is more certain, and more under your control. Ranula is to be removed as other tumors. Epulis should be removed by operation as soon as you are satisfied that the remedies are futile. A portion of the jaw is to be removed with a saw, and the whole of the visible diseased part taken off. Leave enough of the alveolus at each end of the incision to support the teeth, and endeavor to leave enough of the jaw to preserve somewhat the shape. In children, the ecraseur, or any instrument that can be used to ensure as little hemorrhage as possible, should be used, as in their mouths it is a difficult matter to secure the vessels. Foreign Bodies in the Esophagus. 97 SURGICAL DISEASES OF THE THROAT. Wounds of the Esophagus — Foreign Bodies in the Esoph- agus — Scalds of the Mouth and Pharynx — Injuries of the Air Passages — Foreign Bodies in the Air Pas- sages — Asphyxia 7- Various Diseases of the Pharynx — Cancrum Oris — Laryngitis — Stricture of Esoph- agus — Parotitis — Bronchocele — Enlarged Tonsils. Wounds of the Esophagus are not common, chiefly occurring in the case of suicides. Wounds of this canal are almost sure to be complicated with similar injury to the trachea and large vessels. When the carotids are wounded, of course there is but little chance for anything being done. The wound in the esophagus must be closed with wire stitches, and the external one kept open until the other has healed. Every effort must be made to prevent esoph- agitis ; inflammation will be readily excited, and, by inducing suppuration, prove fatal. Calendula™, given about four times a day internally, will, in most cases, prevent this ; but when the first symptoms of inflam- mation appear, administer Aconite™, in the same way. Foreign Bodies in the Esophagus. Foreign bodies, such as fish-bones, needles, etc., are quite com- monly met. The long esophageal forceps are generally sufficient to extract them, though it may be necessary to operate. This operation is one of great danger. The incision is made in the neck, to one side of the trachea, and between that and the large vessels of the neck. Never make the opening larger than is absolutely required to extract the substance. The same rules apply here for the prevention of esophagitis. For more particular treatment, see " Special Therapeutics of the Throat." „ 7 98 Surgical Diseases of the Throat. Scalds of the Throat. Scalds of the mouth and pharynx are often met with among children. The effects are severe ; oedema of the glottis, inflam- mation of the whole buccal cavity, and death from suffocation unless speedily relieved. More special treatment will be given further on. The best remedy I have ever tried is Urtica urens, but not used as Laurie recommends, in the form of tincture gargle. I use the 6th, sometimes the 3d, in water, one dose about once an hour. Usually this remedy will suffice ; but if a decided improvement does not take place in six hours, something else is needed. If neither Apis™ nor Aeon, suffice, and Opium and Kreos. fail, the only thing remaining to be done is to perform tracheotomy. When there is loss of substance, Calendula is to be used; and when sloughs form, Arsen. or Lack. When the oedema of the glottis is so great that respiration is embarrassed, and this increases without any remedy making an impression, the operation is the only resort. Before doing so, however, by making incisions into this oedema, relief may be obtained. The remedies will act if you get the right one ; so try all palliative measures to give you more time, before resorting to the very dangerous operation of trache- otomy. Injuries of the Throat. The larynx and trachea are frequently injured. There may be wounds, dislocation of the cartilages, or concussion of the larynx. Wounds in this region are generally the result of suicidal attempts ; they are more of the lacerated than the contused variety. A spe- cies of bronchitis, or actual pneumonia is sometimes set up, and in connection with the wound makes a very bad complication. One of the most serious symptoms or conditions is the appearance of food, entering the mouth, being ejected from the wound. When the esophagus is uninjured this is owing to a paralysis of the glottis. The treatment is that for ordinary wounds. Prevent the too early closure of the wound, until at least there is no danger of a non- closure of the one in the trachea or larynx. Suicides usually cut Foreign Bodies in the Air Passages. 99 too high, thereby escaping the carotids ; should these vessels be wounded, you will probably lose the patient unless you are right on the spot. Should there be much gaping of the wound, apply a firm bandage around the head, and another around the body ; by means of tapes passing from one to the other, the head may be fixed in such a manner that much of the strain will be taken off of the stitches. Remedies. — Aconite, Calendula, and the usual treatment in wounds. Light diet and perfect quiet are essential. It occasionally happens that a blow is received on the neck, which results in an actual dislocation of one or more of the rings of the trachea. The accident is rare, and is quite serious. Replace the ring, throwing the head well back during the manipulations. Arnica or Co?iium are the remedies to be used. Bronchitis or pneumonia may likewise result from this injury. Another rare and fatal accident is paralysis of the larynx from concussion. This usually proves fatal, and there is little opportu- nity or time to use remedies. Arnica and Conium are the ones to be borne in mind. Foreign Bodies in the Air Passages. These accidents are not common. The symptoms are usually feeling of suffocation, great distress, "difficulty of breathing, violent fits of spasmodic coughing, and not unfrequently vomiting. Unlike the same obstruction in the esophagus, it must never be pushed down, but must come out of the mouth, or through an opening in the trachea or larynx. If the body be small, and one that will readily be dissolved, no treatment may be required ; but if hard, and not soluble, it must be removed. The operation of trache- otomy is a serious one, but under homoeopathic after-treatment little need be dreaded. Some may ask, Why operate at all, when it sometimes happens that the foreign substance is expelled through the glottis? Although, as Erichsen says, the foreign body may make its exit through the opening at which it entered, yet there is only one chance in ten, that, without operation, it will come away at all ; but should the operation be performed, it is reduced to a certainty, almost, that it will be expelled through one opening or the other. Should the foreign body be engaged, in the rima glot- ioo Surgical Diseases of the Throat, tidis, the forceps may be able to bring it away. Should the opera- tion be unsuccessful as regards the involuntary expulsion, the forceps can reach the body through the artificial opening. Place the patient lying en the back, with a pillow under the shoulders, so that the head is thrown well back ; local anaesthesia to a moderate degree, with rhigolene, may be employed ; but I prefer no anaesthetics. Make the incision through the integument, carefully avoiding all vessels, veins and arteries, for there should be no bleeding. Therefore, use the fingers and handle of the knife as much as possible. When the trachea is reached, wait for all bleeding to stop ; if any vessels are wounded, tie them at once. When the hemorrhage has ceased, take a sharp hook and fix it firmly, with one motion, through the tissue between the rings. Then taking the knife by the blade with the finger and thumb, so that only about a quarter of an inch is exposed, divide three of the rings by cutting upwards. Relief will be instantaneous. Should the foreign body be small, and passing up and down the trachea, much inflammation may exist, and oedema of the glottis supervene. In those cases, leave the wound open until this condition is cured. In other cases, close it at once with sutures and strips, and use, as indicated, Staphisagria, Calendula, Aconite, etc. Asphyxia. Asphyxia is a condition of suspended life from any cause, and may result from exposure to cold, starvation, drowning, noxious gases, strangulation, or, may be that of the newly-born. Of the Newly Born. — Various methods of resuscitation have from time to time been published, but none of them have been so universally employed as that of Marshal Hall. Another con- venient method is to raise the child repeatedly and regularly from the supine to the sitting posture. From Noxious Gases. — Remove the body into a cool, fresh current of air; dash cold water frequently on the neck, face and breast ; and if the body be cold apply warmth, either by heated bricks, friction or mustard. Inflate the lungs by artificial respira- tion. After life has been restored, Opium or Aconite will be useful, as indicated. From Strangulation. — Hering says : '" Remove all tight cloth- Asphyxia. 101 ing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently but constantly with cloths; give one injection of a dozen or two globules, or a drop of Opium, dissolved in a half pint of water, and inject slowly; this may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Put warm clothes on ; hot stones wrapped in blankets between the thighs, to the feet, to the sides, neck and shoulders. If, in an hour, no change is pro- duced, take a bitter almond, pound it fine, mix it with a pint of water, put a few drops into the mouth, or into the nose, and use the rest as an injection." Other physicians add to this treatment, subsequent administration of Aconite, A?'nica, or Ruta. From Drowning. — Resort to Marshal Hall's ready method, familiar to all, as found in all "Visiting Lists." In connection Lachesis or Solanum mam., in the form of injection, and also on the tongue, have been recommended by Hering and Laurie. In two cases that I have had, both of these remedies were tried, and nothing for good or evil resulted, though they may be useful in the subsequent treatment. From Cold. — When an individual is found in a state of frost- bitten asphyxia, remove him, with great caution, to a place of shelter, or unheated apartment, protect him from the slightest draught. He should then be covered over with snow, to the height of several inches, the mouth and nostrils alone being left free. Put the patient in such a position that the melted snow will run off readily, and its place be supplied by fresh. When there is no snow, a cold bath, the temperature of which may be reduced by ice (or a bath of cold or salted water*) may be substituted, and the body immersed therein for a few minutes. When every part has lost its frozen rigidity, the patient is to be undressed by degrees, or the clothes cut off. As the muscular or soft parts become pliable, they may be rubbed with snow until they become red, or the body is to be rubbed perfectly dry (if snow is not to be had), placed in flannel, in a moderately warm room, and rubbed with the warm hands of several persons simultaneously. In the event of no signs of returning animation, small injections contain- ing Camphor may be administered every quarter of an hour. . s soon as any symptoms of approaching restoration become per- *Salted water or salted snow must be used with the greatest caution. 102 Surgical Diseases of the Throat, ceptible, small injections of luke-warm black coffee (coffee without milk) may be thrown up ; and as soon as the patient is able to swallow, a little coffee may be given, in the quantity of a tea- spoonful at a time. Against the excessive pain which is generally experienced when life is restored, Carbo v. should be supplied in repeated doses, and if it fail to relieve the sufferings, Ars. may be given. — Laurie. There are some remedies in common use for these accidents, which alone are of no avail, but in connection with the mechanical operations mentioned above, are of great value. They may be given in any of the three forms usual, i. e., by the mouth, nose or rectum, and may be classed as follows : Asphyxia, from a Fall — Am., Con., from a Fall and Loss of Blood — Chin. from Strangulation — Opium. from Suffocation — Opium. from Noxious Gases — Aeon., Bell., Opium. from Drowning — Lack., Solan, mam. from Freezing — Aeon., Ars., Bry., Carbo v. from Lightning — Nux v. of New-born Infants — Chin., Opium, Tart. em. In addition to the remedies cited for Asphyxia from lightnings bury the patient in the earth, all but the face, towards the sun, and dash cold water over him. Various Diseases of the Pharynx. Inflammation of the Pharynx is often of an erysipelatous nature, and then, if not arrested, terminates in suppuration or gangrene. The mucous membrane becomes thickened and tumefied, and gives rise to many unpleasant symptoms. When gangrene or suppura- tion succeeds the inflammation, it is necessary to keep the part clean, and hence the use of #/zmedicated gargles is requisite. Abscess of the Pharynx : The posterior wall of the pharynx is often the seat of abscess, and the presence of a tumor increasing in size more or less rapidly, and evidently fluctuation on palpation, may nearly always be considered an abscess. If in no other situ- ation in the body, this one should always be opened. The neglect Carter um Oris. 103 to do this may result in the pointing of the abscess almost any- where, as the pus burrows under the loose tissues in this part of the body to almost any extent. Tumors of the Pharynx are usually of two varieties — either cancer or polypi. They are both malignant, as the polypi in this situation is malignant in its cause and termination, if not cancerous in structure. However, the tr e cancer is the most common, so much so that many authors speak of them as being the only tumors in this situation. From the peculiar structure of this part of the body, these tumors grow with great rapidity, and unless very early removed cause death by suffocation, from the obstruction to the air passages. Cancrum Oris. Cancrum Oris is common to childhood, and is apt to occur about the period of the second dentition, or during convalescence from some of the eruptive fevers. When caused by foul air, living in damp cellars, or insufficient or bad food, the insides of the lips, cheeks, or sometimes the gums, are found to be dotted with small, foul, gray ulcers ; the gums are spongy ; foetid odor from the mouth, and many of the symptoms consequent upon salivation. This constitutes a mild form, and change of living or air will often produce a complete cure, unaided by treatment of any kind. But there is a graver form, the " true cancrum oris," and it is very offensive, and often fatal. One of the cheeks becomes swollen, tense and shining, being excessively hard and presenting a red patch in the center. It is often difficult to open the mouth; in the inside will be seen a deep and excavated foul ulcer, opposite to the external swelling, covered with a brown, pulpy slough. The gums are turgid, dark and ulcerated; the saliva is mixed with putrescent matter, and as the ulceration in the mouth extends, the swelling sloughs, and a large, dark, circular and gangrenous cavity forms in the cheek, opening through into the mouth. It is a terri- ble disease, and makes us think of washes and lotions, but they are just as hurtful here as any other disease, and must be rigor- ously excluded from the treatment. Trust attenuations alone. 104 Surgical Diseases of the Throat. Diseases of the Larynx. Laryngitis is spoken of as acute, or oedematous. The former is that in which the mucous membrane and cartilages are the seat of the disease. The latter is when the sub-mucous cellular tissue is involved. Inflammations of the larynx are always of a dangerous character. The danger lies in the liability to occlusion of the rima-glottidis, from swelling of the lips of the glottis, from plastic effusion, or from oedema. Spasms of the larynx and trachea are also to be taken into consideration, and are, to say the least, exceedingly unpleasant concomitants. The symptoms of the acute form are those indi- cating inflammation, and an obstruction to the proper performance of respiration. There is also some difficulty in swallowing, and tenderness of the larynx on pressure, more particularly on the pomum Adami. These symptoms speedily assume an alarming type, and result in death. (Edematous laryngitis presents many of the same symptoms, only in an intensified form. The fauces are seen to be swollen, dusky and pulpy; early dyspnoea, the voice becoming hoarse, rough, and eventually extinct ; much difficulty in swallowing. There are usually spasms of the larynx ; but, unlike the acute form, there is but little, if any, tenderness on pressure. As the disease progresses, we have a quick, small pulse, convulsive breathing, restlessness, clammy, pale face, dead-looking eyes, and stupor, fol- lowed by death. In the oedematous variety of laryngitis it is sometimes absolutely necessary to perform tracheotomy. Aphonia is a general term applied by allopathists to designate diseases of the larynx which they are pleased to call " incurable chronic," that are characterized by permanent alteration of the voice, and in some instances an almost total loss. Long-continued use of the voice in public (more especially in those not accustomed to it) will produce it, and as many ministers, from some reason or another, are so affected, it is commonly spoken of as "clergyman's sore throat." The term aphonia, however, is in this case misap- plied, as we have accustomed ourselves to using it as distinguishing a total loss of voice, and not a mere alteration. The portion of the Stricture of the Esophagus, 105 throat usually affected is the rima-glottidis, which will be found to be chronically inflamed. In many instances, however, this inflam- mation extends some distance lower, and may even involve the vocal cords. The posterior nares, palate and fauces are found simultaneously affected. A secretion of thick puriform matter will be found hanging in a broad streak down one side of the posterior wall of the pharynx. Necrosis of the Cartilages is a death of the cartilages of the lar- ynx, due to one of the preceding diseases, but is most commonly noticed in cases of secondary or congenital syphilis. The more symptomatic indications are expectoration of large quantities of foetid puriform sputa, mixed with blood quite frequently, and occasionally containing portions of the dead cartilage. Abscesses often occur in connection with necrosis particularly, and they usually open externally. They may, however, from bur- rowing, dissect up the tissues for a long distance before pointing. When they open over the necrosed spot, aerial fistula will form, through which bubbles of air escape during respiration. Stricture of the Esophagus. Two kinds of stricture are noticed by surgeons : first, spasmodic, and second, the organic. Spasmodic Strictitre : This form is peculiar to hysterical women in a great measure, but is often produced by the irritation caused in the canal, consequent upon the procedure necessary in the removal of foreign substances that have become arrested here ; the constric- tor muscles of the pharynx seem to be the seat of the trouble As proof of its hysterical nature, it has been noticed that the attacks are periodical, and are brought on by attempting to swallow certain food, and occurs at some particular time of day. Not unfrequently it appears to be a variety of the globus hystericus. The Organic Stricture, unlike the preceding, is a veritable stricture. Either end of the canal may be the site, although the usual situation is that immediately back of the cricoid cartilage in the upper portion. The first difficulty experienced is an ineffectual attempt at deglutition, or that food returns to the mouth after having been partially swallowed. Death may result from one of 106 Surgical Diseases of the Throat. two causes : either the patient dies from actual starvation, or else an abscess forms around the constricted place. A bougie, or pro- bang with the sponge removed, is absolutely necessary to forming a perfectly correct diagnosis. If the stricture be decided, a diffi- culty will be experienced in attempting to pass the instrument beyond that point. Diseases of the Parotid. Parotitis is readily cured. Suppuration but rarely occurs, and the only sequel to be dreaded is metastasis. The testicle and the mammary gland, as said in another place, are the choice seats of its re-appearance. Tumors here are of rare occurrence; that is, where a tumor grows from the gland, without the whole of the gland being included. They are of a fibrous nature, often encysted, hard, deeply attached, but movable. They are round, and often a very great size, up to that of a cocoa-nut even. They frequently send prolongations under the lower jaw, and then occupy the whole of the space between its angle and the mastoid process. When firmly bound down, they involve the blood-vessels and nerves of this important region, coming into relation with the styloid process and its muscles, and even pressing upon the pharynx. In consequence of the large size that these tumors may attain, they have a tendency to produce atrophy of the parotid, and often, by interfering with the cerebral circulation, occasion congestive symptoms. The paro- tid may undergo cancerous infiltration, the tumor presenting the characters and running the course of the ordinary forms of malig- nant disease. It is of importance to make out early the diagnosis between the malignant and non-malignant varieties. In the fibrous tumor there is always mobility, and although the attachment may be deep, the skin is not involved, and the outline of the mass is usually well defined, square, and somewhat lobulated. In the scirrhous growth, there is no mobility, but the mass is solidly fixed, its outline is ill-defined, the skin soon assumes a reddish-purple color, brawny, and presents the usual characters indicative of sub- jacent malignant action. When the tumors are medullary, they grow with considerable rapidity, feel soft, pulpy, and are ill-defined Bronchocele. — Hyp ertroph zed Tonsils. 107 in their outline, especially under the ear, and by the ramus of the jaw. Tumors of the Neck. — One variety is peculiar to this locality, and is called hydrocele of the neck. It is a cystic tumor, appearing in the posterior triangle, and is a large bladder-like mass, and may be single or multilocular. The cysts are filled with a fluid of any shade of color from that of water to black ; or of any consistency from limpidity to a semi-solid form. They attain an immense size, and impede deglutition and respiration. Bronchocele. All tumors, as well as simple hypertrophies of this gland, have, of late, received the incorrect name of "goitre." M. Maumene, a French chemist, contends that goitre is caused by the presence of the fluorides in the water. He gave a dog Fluoride of potassium for some time (five months), and at the end of that time had suc- ceeded in producing a swelling of the gland, that, though small, was quite distinctive. The tumor so formed, whatever be the cause, may include a por- tion or the whole of the gland, and is often, apparently, in two distinct sections. When large, they are a source of danger from the pressure exerted on the windpipe. Ex-ophthalmic Goitre is an abnormal condition noticed in con- nection with these enlargements, and although no distinct connec- tion has been as yet traced between the prominent eyes and palpitating heart and the tumor, yet they are so frequent a coinci- dence that it is impossible not to regard them in the light of cause and effect. There is usually also a pale and anaemic countenance, with the unusual prominence of the eyes. In London, pale and bloodless girls are quite commonly affected with bronchocele in a greater or less degree. I have had two cases like this, and in each, whenever the patient became excited, particularly from grief, the tumor would increase perceptibly in size, and pulsate very strongly. Hypertrophied Tonsils. This enlargement is met with in all degrees, from a simple inflammatory condition to a chronic hypertrophy and induration. 108 Surgical Diseases of the Throat. Struma is usually the cause of chronic enlargement, though when the glands have been once swollen, they readily become so again. Excision is a favorable allopathic remedy, but I never practice it. Therapeutics. — The remedies to be employed in the treat- ment of these diseases are as follows: Aeon., Alum., A?nm. c, Ant. c, Apis, Ars., Aur., Bapt., Baryta, Bell., Brom., Cale., Canth., Capsic., Carbo v., Caust., Cham., Cistus e., Coff., Con., Dule., Dros., Gelsem., Hepar, Hyos., Ign., Iod., Ipee., Kali bich., Kali e., Kreos., Lach., Led., Lye., Mang., Merc., Nat. c., Nat. m., Nit. ac., Nux vom., Petrol., Phos., Phytol., Podoph., Puis., Rhus, Samb., Sang., Senega, Sepia, Sil., Spong., Staph., Stram., Sulph., Tart, em., Thuja, Verat. The index may be arranged as follows : Tonsilitis: Baryta, Bell., Hep., Ign., Lach., Merc, Nit. ac, Nux v., Sulph. j Calc, Canth., Cham., Lye, Sep., Thuja. with Suppuration. — Baryta, Bell., Ign., Lach., Lye, Merc, Nit. ac, Sep., Hep. s. with Ulceration. — Baryta, Bell., Ign., Lach., Lye, Merc, Nit. ac, Sep. Pharynx: Simple Inflammation of. — Aeon., Bell., Canth., Lach., Merc, Phytol. Polypi in. — Ars., Calc, Lach., Merc. Esophagus : Spasmodic Stricture of. — Bapt., Bell., Hyos., Lach., Stram., Verat. ; Con., Lye, Merc, Nux vom^ Also study Aeon., Ars., Cicuta, Hydrop., Mezer., Natr. mur., Nit ae y Plumb. Organic Stricture. — Calc, Canth., Merc, Nux vom. Laryngitis; Acute. — Aeon., Hep., Spong. ; Cham., Dros., Lach., Merc, Ipee, Phos., Senega. (Edematous. — Apis, Ars., Calc, Carbo v., Caust., Cistus can., Phos.; Dros., Hep., Iod., Kreos., Led., Mang., Nit ac Aphonia : Ordinary. — Arum, Cham., Carbo v., Dule, Mere, Nux, Puis., Rhus, Samb., Sulph. j Bell., Calc, Capsic, Dros., Hep., Mang., Natr., Phos., Tart. em. Complete. — Ant. c, Bell., Caust., Merc, Phos., Sulph. Chronic. — Carbo v., Caust., Hep., Mang Petrol.. Phos., Sil., Sulph. j Dros., Dule, Rhus. from a Chill. — Bell., Carbo v., Dule, Sulph. Necrosis of Cartilages of the Larynx: Ars., Calc, Dule, Hep. s., Lach., Merc, Rhus, Sil., Sulph. Special Therapeutics. 109 Parotitis : Merc, Aur. Erysipelatous. — Bell., Hyos. from Mercury. — Carbo v. Metastasis. — Carbo v. Bronchocele: Amm. c, Calc. c, Caust., Hep., Iod., Lye., Nat. c, Nat. m., Spong., Staph, j Bromine. Cancrum Oris: Ars., Aur., Borax, Capsic., Carbo v., Dulc., Lach., Merc., Nat. m., Nit. ac., Nux v., Staph., Sulph., Sulph. ac. Aconite nap. Tingling in the esophagus; acute inflammation in the throat, palate, tonsils and fauces, with high fever, dark red- ness of the part, and burning and stinging in the fauces ; stinging in the throat when swallowing and coughing; almost entire inability to swallow, with hoarseness ; inflammation of the larynx and bronchia; short, dry cough, from titillation in the larynx; expectoration of bloody mucus. Worse in the evening, and at night ; also during inspiration, and from cold in general. Better in the open air, and from warmth in general. Left side. Alumina. Sensation of constriction in the esophagus when swallowing ; sensation as if the esophagus were contracted when swallowing a small morsel of food ; the passage of the food is felt until it enters the stomach ; great dryness of the throat ; dry, short cough, especially in the morning, with dyspnoea; cough, with expectoration, in the morning ; hoarseness, especially in the after- noon and evening. Worse in the afternoon ; also on chewing. Better in the open air, and when eating, especially when eating or drinking warm things. Right side ? Ammonia Carb. When swallowing, sensation of a foreign body in the throat ; scraping and soreness in the throat ; hoarseness, and inability to speak a loud word, or swallow, or open the mouth ; cough dry, produced by a sensation like tickling in the throat pro- duced by dust ; cough, with spitting of blood, with previous sweet taste, and great dyspnoea; hard swelling of the right parotid gland after taking cold. Worse in the afternoon ; also when chewing, from cold, when eating, and from wet poultices. Better in the open air, from pressure, and from warmth in gen- eral. Right side. no Surgical Diseases of the Throat. Antimonilim Crud. Fine pinching in the region of the palate all night, especially painful during deglutition ; rough voice ; extreme feebleness of voice ; loss of voice whenever he became hot, return- ing when resting himself; sensation as of a foreign body in the throat; violent spasm in the larynx and pharynx. Worse in the morning, afternoon, evening and at night; also from wet poultices. Better in the forenoon, and in the open air. Either side. Apis mel. Dryness in the throat without thirst; burning-sting- ing in the throat ; inflammation of the throat, with swelling red- ness, and stinging pains; hoarseness in the morning. Worse in the morning, evening, and at night; also from heat, especially in the warm room. Better from cold water. Left side ? Arsenicum album. The mouth is reddish blue, inflamed and burning; secretion of abundant, tough, foetid and bloody saliva; painful, difficult deglutition, from constriction of the esophagus; burning in the throat ; dryness, burning and constriction in the larynx; respiration oppressed, anxious and short. Worse in the evening, and at night ; also from cold, on cough- ing, after drinking, while lying down. Better from warmth. Right side. Arum triph. Constant hawking; profuse secretion from pos- terior nares and fauces; voice uncertain, continually changing; hoarseness from talking ; submaxillary glands swollen ; foul, acrid secretion from nose and mouth excoriating lips and mouth ; corners of mouth sore, cracked and bleeding. Worse when attempting to drink or swallow. Aurum met. Painful swelling of the submaxillary glands; caries of the palate from abuse of mercury ; suffocating attacks, with suffocating oppression of the chest ; putrid cheese-like smell from the mouth ; (metastasis of parotitis to the testes ; the scrotum is swollen, hard, red and shining, hot, and covered with white scales. — G.) Worse in the morning, and at night ; also from cold. Better from warmth. Left side. Baptisia. Esophageal stricture; great aversion to open air, inability to swallow anything but liquids. Baryta Carb. Swelling of the submaxillary glands, with indu- ration ; inflammation of the throat, with swollen inflamed tonsils; Special Therapeutics. ii i sensation as from a plug in the throat ; sensation of smoke in the larynx ; hoarseness and loss of voice, from tough mucus in the larynx and trachea. Worse at night ; also from cold, when eating, from pressure, and on swallowing, from suppression of sweat of the feet. Better from warmth. Either side. Belladonna. Swelling and inflammation of the submaxillary glands ; inflammatory swelling and redness of the inner mouth and soft palate ; inflammation of the throat, with sensation of a lump, which induces hawking, with dark redness and swelling of the velum palati ; burning and dryness in the esophagus ; stinging in the esophagus and in the tonsils ; the esophagus feels contracted ; spasms in the throat not permitting one to swallow; the drink returns through the nose, continual inclination to swallow ; tonsils inflamed and swollen, with ulcers rapidly forming on them ; larynx very painful, with anxious starts when touching it; constriction of the trachea; voice rough, with a nasal sound ; hoarseness and loss of voice ; painful swelling of the glands of the neck. Worse in the evening, and at night; also when drawing the breath, from cold in general, on coughing, from wet poultices, when swallowing drink, and when talking. Better from warmth in general. Right side. Bromium. Swelling and hardness of the left parotid gland ; inflammation of the throat, which is red and looks like a net, with corroded places ; burning from the mouth to the stomach ; heat in the mouth and esophagus; hoarseness, aphonia; soreness and roughness in the throat; tickling in the trachea during an inspi- ration ; two encysted tumors on both sides of the neck. Worse in the evening ; also in the warm room, and when at rest. Better from motion. Right side. Calcarea Carbonica. Inflammatory swelling of the parotid gland ; painful, hard swelling of the submaxillary glands ; spas- modic contraction of the esophagus ; inflammatory swelling of the palate, with blisters on it; stinging in the throat when swallowing; swelling of the tonsils ; hoarseness ; sensation as if something were torn loose in the trachea; ulceration of the larynx; tickling cough, caused by a sensation of dust in the larynx; thick, struma-like swelling of the thyroid gland. Worse in the morning, evening, and at night ; also while draw- \ 1 2 Stirgical Diseases of the Throat, ing in the breath, on coughing, during and after eating, from wet poultices, and from talking. Better when lying down, and in dry weather. Right side ? CantharideS. Burning in the mouth, extending down the phar- ynx and esophagus in the stomach; inflammation of the mouth and pharynx; inflammation and suppuration of the tonsils, with inability to swallow; painless inability to swallow; burning and stinging in the larynx, especially when attempting to hawk up the tough mucus ; hoarseness ; weak and indistinct voice. Worse in the afternoon, and at night ; also while drinking, from wet poultices, and when swallowing the drink. Better while lying down. Either side. Capsicum an. Burning blisters in the mouth; spasmodic con- traction of the throat ; inflammation, with dark redness and burn- ing', as from pepper in the throat. Worse in the evening, and at night ; also, while drawing the breath, from cold, when coughing, when lying down, from pressure, and when not swallowing. Better while eating, when swallowing, and from warmth in gen- eral. Either side. , Car bo veg. Swelling of the parotid gland; sensation of con- striction in the throat ; feeling of coldness of the throat ; burning, roughness, rawness of the throat ; the throat is full of mucus, that can be hawked up readily; swelling and inflammation of the uvula, with stitches in the throat ; hoarseness ; roughness of the throat causing cough ; soreness and ulcerative pain in the larynx and pharynx; loss of voice at night, or while talking; glands swollen and indurated. Worse in the morning and forenoon ; also in the evening or open air, during eating, from wet poultices, from pressure, and from talking. Better after lying down. Right side. CaUStiClim. Accumulation of much mucus in the mouth and throat ; constant disposition to swallow ; pain as if a tumor were in the throat; audible cracking in the throat; sensation as if some- thing cold were rising in the throat ; burning and roughness in the larynx; hoarseness and roughness in the larynx; swelling like goitre on the throat. Special Therapeutics. 113 Worse in the evening, and at night ; also from cold in general, while and after eating. Better from warmth in general. Left side. Chamomilla Vlllg. Inflammatory swelling of the parotid gland; inflammation of the soft palate and tonsils, with dark redness ; sen- sation of a plug in the throat ; inability to swallow solid food ; sore throat, with swelling of the parotid and submaxillary glands ; wheezing and rattling in the trachea ; hoarseness from tenacious mucus in the trachea ; catarrhal hoarseness ; stitches and burning in the larynx, with hoarseness ; hoarseness and cough, from rattling mucus in the trachea ; inflammatory swelling of the glands of the neck. Worse in the evening, and at night ; also in the open air, during inspiration and from wet poultices. Better from cold. Either side. CistllS Can. Swelling of the parotid glands ; sensation of cold- ness in the tongue, larynx, and trachea, the saliva and breath feel cool ; dryness and heat in the throat, with constant swallowing of saliva to relieve it ; periodical itching in the throat ; fauces inflamed and dry, without feeling dry ; hawking up of thick, gum- like, tasteless phlegm ; stitches in the throat, causing cough when- ever mentally excited ; feeling as if trachea was not wide enough ; pain in the trachea ; feeling of rawness extending from the upper part of the chest into the throat ; glands of the neck and throat are swollen ; scrofulous swelling and suppuration of the glands of the throat. Worse in the evening, night, and in the morning ; also in the cold air, when lying down, from drinking coffee and from motion. Better in the fresh air. Right side. Coffea CPUda. Swelling and painfulness in the throat ; short, dry cough, as from constriction of the larynx. Worse in the morning and at night ; also when in the open air. Better from cold water. Either side. Conium mac. Induration of the parotid gland; pressure in the esophagus, as if a round body were ascending from the stomach ; spasmodic constriction of the throat ; swelling of the glands, with stinging and stitches after contusions and bruises ; hard swelling of the glands. Worse in the morning, and at night ; also in the open air, from cold ; when eating ; when lying down. ii4 Surgical Diseases of the Throat. Better from pressure and from warmth. Either side. Dulcamara. Continual hawking up of very tough saliva, with much rawness in the fauces ; cough, with expectoration of bright blood ; hoarseness ; swelling of the glands of the neck. Worse at night ; also, from cold, when lying down, and in wet weather. Better from warmth, and in fine weather. Drosera rot. Sensation of dryness in the throat ; ulceration of the velum palati ; stinging in the throat during deglutition ; sensa- tion in the pharynx as if crumbs had remained behind ; difficulty in swallowing solid food, as if the esophagus were contracted ; scraping in the throat from eating salt food; hawking of green or yellow mucus ; continuous dryness and roughness in the larynx ; inflammation of the larynx and pharynx, causing pain when talk- ing ; deep, cracked voice ; laryngeal and tracheal phthisis. Worse in the morning, at night, and towards morning ; also during expiration, when lying down, from talking and from warmth in general. Better from cold. Right side. Gelseminum. Dryness and burning in the throat ; dryness of the throat, with hoarseness ; sensation of heat and constriction in the throat; burning in the mouth, extending to the throat and stomach ; sensation as if a foreign substance were lodged in the throat ; difficult deglutition ; voice weak, paralysis of the glottis, with difficult deglutition ; spasm of the glottis in the evening, threatening suffocation ; roughness in the throat ; raw, as if ulcer- ated in the larynx ; hoarseness, with dryness of the throat ; burn- ing in the larynx, descending into the trachea. Hepar SUlph. When swallowing, sensation as if there were a plug in the throat, or as if a splinter were sticking in it ; scraping in the throat when swallowing the saliva ; swelling of the tonsils and glands of the neck ; dry throat ; stitches in the throat, extend- ing to the ear ; wheezing, and painfulness of a small spot, in the larynx ; swelling below the larynx ; roughness in the throat ; hoarseness. Worse in the morning, forenoon, evening, and at night ; also during inspiration, from chewing, from cold, when coughing, when eating, from pressure, and when swallowing the food or saliva. Special Therapeutics. 115 Better in damp, wet weather, and from warmth in general. Left side. HyOSCyaiTlUS nig. Constriction of the throat, with inability to swallow, especially fluids ; parching dryness of the fauces ; elonga- tion of the uvula ; rough voice, from mucus in the trachea and larynx. Worse in the evening ; also when chewing , from cold in gen- eral ; when drinking. Better from warmth ? Either side. Ignatia am. Redness, inflammation and soreness of the inner mouth ; stitches in the soft palate, extending to the ear ; stitches in the throat, when not swallowing; sensation as of a lump in the throat when not swallowing ; when swallowing, sensation as if he swallowed over a lump, with soreness and crackling noise ; inflamed, swollen and indurated tonsils, with small ulcers on them ; pain in the submaxillary glands when moving the neck ; sensation of soreness in the larynx ; constrictive sensation in the trachea and larynx ; low voice ; painless glandular swelling in the neck. Worse morning, afternoon, evening, and in the night ; also during -. C ^ O.aj'o; £ 2 -* O r- «+H -G 2e££o o srS-s aS cu cj cJ i; cu £ ccs ;-( 3 CU W rQ o O in en (- CJ '+-' X J-, « o . 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CU jT " P.O sirs cu cu en O cu u M cS 13 c u xi cut; cu cu ceS CU ° s -2 g 4-> CO cu o g > cu G C cS 5 c O J-i CX._£JJ cd rG X cu ctS G - 1 O CU G o ftS w a Special Therapeutics. 217 The causes are obscure, and Erichsen rightly supposes they are constitutional. They seem to be more frequently met with in certain countries and regions than in others. People so dis- posed are liable to have the most trivial things culminate in stone. Thus, a clot of blood has served as the beginning for stone ; so, also, the fragments remaining after crushing a stone in lithotripsy, form, in some cases, perfect stones again. Treatment. — In regard to the treatment of the diseases mentioned in this chapter, I would say that they are all amenable to treatment with the higher potencies, just as other diseases are, with two exceptions. I refer to organic stricture, and stone. Many of our most eminent practitioners claim the same amount of success in their treatment however, as in any other, and I am unwilling to give a positive opinion pro or con. My own belief is, that in the case of stone, remedies may prevent the increase in size of an already existing stone, but cannot produce or promote a re - absorption. It would be well if those who attempt to deny this would consider the difficulty in telling positively when a stone is present ; for how can a man say he has cured stone when he cannot be certain there was ever a stone in the bladder? The remedies to be employed in these diseases are as follows : Acetic ac, Aeon., Ant. c, Apis, Am., Ars., Aur., Baryta, Bell. Borax, Bry., Calc. c, Cann., Cann. ind., Canth., Capsic, Carbo. v., Caust., Cham., Chin., Cinnamon, Clem., Cocc, Coff., Coloc, Con., Copai., Dig., Dulc, Erig. can., Pert ., Gelsem., Graph., Hell., Hepar., Ham., Hyos., Ign., Iod., Kali c, Lach., Lye, Merc, Nit. ac, Nux v., Opi., Petrol., Petros., Phos., Plat., Plumb., Puis., Rhus, Sarsap., Secale, Selen., Sil., Stan., Staph., Stramon., Sulph., Thuja, Verat., Zinc A clinical index of them may be arranged as follows : Prostatitis : Aeon., Apis., Cann., Lye, Merc Gonorrhoeal : Aeon., Calc, Canth., Cap., Graph., Merc* Puis., Rhus. Prostate : Abscess of : Hep., Merc, Sil. Tumors of: Aeon., Aur., Con., Cap., Merc, Nit. ac, Puis., Sulph., Thuja. Hypertrophy of: Aeon., Am., Cap., Merc from a stricture : Aeon., Bell., Bry., Hep. s., Merc y from a blow : Am., Con., Staph. § 218 Surgical Diseases of the Bladder. Prostate: Hypertrophy of: from mercury: Aur., Carb. v., Hep., Nit. ac, Thuja. from scrofula : Baryta, Calc, Sulph • idiopathic : Am., Plat., Sulph., Calc, lad., Staph. Urethretis: Aeon., Puis., Canth., Lye, Rhus, Bell., Apis. Gonorrhoea : Aeon., Apis., Am., Cann. ind., Capsie., Copai., Gel., Merc., Petros., Rhus., Selen. [Hale says : Cauloph, Hyd. Hamam., Iris, Erigeron, Senecio.] Gleet : (see Gonorrhoea), [Hale adds : Collinson, Hydrastis, Erigeron can., Silphium, Eupat. pur.~\ Stricture : Spasmodic : Canth., Carbo. v., Clem., Con., Cap., Dig., Lach., Lye., Nux v., Puis., Sulph. Spasmodic, in drunkards : Hum. lup., Nux v., Bell. Organic : Borax, Ars., Calc., Carbo. v., Graph., Petrol., Rhus, Sulph. Congestive : Aeon., Am., Bell., Canth., Con., Mere. [Hale : Hydrast. can.] Cystitis : Aeon., Ars., Calc, Canth., Dig., Dulc, Hyos., Nux v., Puis., Sulph., Ant. c, Caps., Carbo. v., Hell., Kali, Mere., Phos., Verat. [Hale : Hydrast., Erigeron, Verat. vir.] Tumors of. the Bladder: Acetic ac, Calc, Carbo. v., Secale. Hematuria: Am., Calc, Cinnam., Con., Erigeron, Staph. [Hale: Eupat., Hamam.] Paralysis of the Bladder: From a blow: Am., Con., Staph. From passion : Aeon., Cham., Coloc, Hyos.. Ign., Nux v., Phos., Puis., Staph. From fright : Aeon., Ign. From joy: Coff., Puis. From grief: Ign., Staph. From apoplexy : Am., Baryta., Bell., Nux v., Stan., Zinc. From debility, or loss of fluids: Baryta., Chin., Ferr., Sulph. From over - distension : Ars., Am., Canth. With incontinence : Caust., Puis., Rhus. With retention : Arn., Canth., Lye, Stram. With gangrene : Ars., Lach., Secale. With constipation : Bry., Carbo. v., Caust., Cocc, Hyos., Kali, Nux v., Opi., Plumb., Secale, Sulph., Zinc. [Hale: for paralysis in general : Gelsemin.] Calculi: Aeon., Am., Ars., Con., Hep., Lye, Sarsap., Sulpha Calc. c [Hale: Eupator. purpur.] Special Therapeutics. 219 Acetic acid. This remedy should not be introduced, perhaps, but as said in one or two former chapters, it is highly spoken of by those who have used it empirically, in the treatment of cancer. I used it in one case of open cancer of the breast, but could not see that it exerted any curative influence. Aconite nap. Painful, anxious urging to urinate ; difficult and scanty emissions of urine; brown, burning urine, with brick - colored sediment ; burning and tenesmus of the neck of the bladder; itching of the prepuce; pinching and piercing in the glans on urinating; pain in the scrotum, as if contused; tingling of the genitals ; increased sexual desire. Worse in the night; also, when in a warm room. Better in the open air, and when sitting still. Antimonilim Crild. Increased and frequent discharge of urine at night, with discharge of mucus, burning in the urethra, and pain in the small of the back. Worse at night; also, after eating, from bathing, and in the sun. Better during rest, and in the open air. Apis mel. Strangury; urine scanty, and high-colored; too profuse discharge of urine ; burning and smarting in the urethra, as if it were scalded ; burning and stinging in the urethra ; sexual desire increased. Worse in the morning, evening, and at night; also, from heat, especially in a warm room. Better from the application of cold water. Arnica montana. Tenesmus from spasms of the neck of the bladder; involuntary discharge of urine at night, when asleep, and during the day, when running; urine brown -red, with brick -dust sediment ; bloody urine ; frequent micturition of pale urine ; pain- ful swelling of the spermatic cord, with stitches in the abdomen. Worse in the morning. Better from motion. Arsenicum alb. Suppressed, or difficult micturition ; urine is bloody and burning ; involuntary discharge of burning urine ; urine is turbid and greenish ; dark brown urine, which is turbid when leaving the bladder, and does not become clear by standing; sometimes deposits a slimy sediment ; hcematuria during mic- turition ; burning during micturition, sometimes at the commence- ment only ; contracting pain in the left groin ; biting and tearing in the urethra; corrosive itching of the penis ; excessively painful 220 Surgical Diseases of the Bladder, swelling of the genitals, with inflammation ; discharge of prostatic fluid during stool ; useful in threatened gangrene, or the invasion of suppuration. Worse at night ; also, from cold. Better from warmth in general. Alirum met. Painful retention of urine, with pressure in the bladder; passes more urine than corresponds to the quantity of water he drinks ; increase of sexual desire ; suicidal monomania is very marked (in gonorrhceal orchitis). Worse in the morning, and at night ; also, from cold, and while reposing. Better from moving, when walking, and on getting warm. Baryta carb. Supposed by some to be useful in tumors of, and hypertrophy of the prostate, but I have never derived the least benefit from its use. Belladonna. Retention of urine ; difficult discharge of urine, and then a discharge of a few drops of bloody urine only ; urine is scanty, fiery -red, or dark and turbid; continuous dropping of urine ; paralysis of the sphincter vesicae ; stricture of the urethra ; stitches in female sexual organs, with dryness of the vagina. Worse in the afternoon, evening, and at night ; on moving, on touching the parts. Better while standing. Borax. Frequent discharge of acrid - smelling urine ; very much used in organic stricture of the urethra. Bryonia alba. Diminished secretion of hot, red urine; white and turbid urine; burning in the urethra when not urinating; cutting in the urethra, or sensation of constriction when urinating ; while sitting, stitches in the testicles. Worse in the evening; also, from motion, and from heat. Better while lying down, and on getting warm in bed. Calcarea Carbonica. Chronic cystitis; dark -brown urine, with white sediment; burning in the urethra during urination; urine with a bloody sediment ; bloody urine ; fetid or pungent smell to the urine, which is very clear and pale ; acrid smell to the urine. Worse in the morning, and in the evening ; also, in wet weather, and in the cold air. Better from drawing up the limbs. Cannabis sat. Painful discharge of drops of bloody urine ; Special Therapeutics, 221 lacerating as if in the fibers of the urethra ; itching, tingling stitches in the fore part of the urethra; burning stitches in the back part of the urethra during urination ; pain during micturition from the meatus to the bladder ; darting stitches in the urethra when standing ; the urethra is painful on touching it, through the whole length; priapism, and chordee followed by stitches in the urethra ; painful discharge of mucus ; no sexual desire ; the prepuce itches, and is dark - red, hot, and inflamed ; continuous burning of the whole prepuce and glans ; when walking the penis feels sore and burnt ; sense of pressure in the testicles, a sort of dragging when standing ; corrosive burning and stinging of the outer parts of the prepuce, edges of the glans, and of the meatus ; tensive pain in the spermatic cord when standing, with contraction of the scrotum. Worse in the forenoon, and at night ; also, when standing, and on urinating. Better when lying down. Cannabis indica. This remedy I have used a great deal, and with good success, when the symptoms were as follows : gonor- rhoea, unaccompanied by pain ; slight tingling, with inflammation around the meatus ; also a slight burning during micturition ; the discharge is yellowish - white, and very profuse. These symptoms are those that I have often cured with the remedy, and are given on my own authority. To them I would add one that does not often occur in gonorrhoea, but is a good " key - note " for the remedy : a feeling of intoxication, light - headedness, inability to fix the mind upon anything; objects appear distinct, out as if a long way off. CantharideS. Violent cutting in the urethra, before and after micturition, so excessive that the patient is obliged to bend double and scream ; haemorrhage from, with violent cutting pain in the urethra ; painful emission of a few hot drops of urine ; violent and excessive pain in the bladder ; heat and burning in the bladder ; pain in the neck of the bladder; paralysis of the neck of the bladder; suppression and retention of urine ; constant and violent desire to urinate, with a painful emission of only a few drops ; tenesmus and strangury of the bladder, with discharge of drops of blood; frequent micturition, sometimes scanty, sometimes pro- fuse discharge ; red, or bloody urine ; painful passage of urine, with much tenesmus, and either mixed with sand, full of mucus or hot and turbid ; bloody discharge from the urethra. 222 Surgical Diseases of the Bladder. Worse in the afternoon, and at night; also, from drinking coffee. Better when lying down. Capsicum an. Tenesmus of the bladder; frequent unsuc- cessful desire to urinate ; burning urine, with burning-smarting in the urethra after urinating; the urethra is painful to the touch; urine deposits a white sediment ; violent erections and white sedi- ment in the morning early; chordee which can only be appeased or subdued in cold water ; purulent discharge from the urethra ; impotence. Worse in the evening and at night ; also on beginning to exercise. Better from continued exercise. CarDO Veg. Greatly diminished emission of urine ; great desire to urinate, the urine, however, passing off very slowly; dark-red urine, as if mixed with blood ; burning or smarting in the urethra when urinating; lacerating or drawing in the urethra after urinat- ing; acrid smell to the urine; reddish turbid urine; the urine deposits gravel, or red sediment. . Worse in the morning, and forenoon ; also from cold, and in wet weather. Better from lying down, and on loosening the garments. CaUStiCUITl. Frequent and urgent desire to urinate, with thirst, and scanty emission; involuntary emission of urine by day and night; at night when asleep, when coughing, sneezing or walking, an involuntary emission of urine; burning in the urethra when urinating ; itching of the orifice of the urethra . Worse in the evening ; also in the open air. Better from heat, and when in bed. Chamomilla. Ineffectual urging, with anguish during micturi- tion; the urine is hot, with flocculent sediment; turbid urine; smarting pain in the urethra, during micturition ; itching, stinging pain in the margin of the prepuce ; soreness of the border of the prepuce ; excited sexual desire. Worse at night ; also from the heat of the bed, and after taking cold. Better after perspiration, and on rising from the bed. China Off. Urine is dark, turbid and scanty; scanty urine, of a greenish-yellow color, and with a brick-dust sediment; frequent micturition; burning at the orifice of the urethra, especially pain- ful if the clothes rub against the parts; stitches in the urethra; Special Therapeutics. 223 sexual desire excited, with lascivious fancies ; impotence, with excited lascivious fancy. Worse at night ; also from touching the parts, however softly. Better on rising from the bed. Cinnamon. This remedy is used in haematuria a great deal by some, but, I believe, its use is altogether empirical. Clematis erecta. Long-lasting contraction, and constriction in the urethra; spasmodic stricture, in which the urine is only emitted drop by drop ; frequent micturition, but little at a time ; great burning at the commencement of urination ; painful drawing in the spermatic cord, when urinating; the urethra is painful to the touch. Worse at night ; also from the heat of the bed. CoCCUlllS ind. Tensive aching pain in the orifice of the urethra, between the acts of micturition; also itching and stinging near the fossa navicularis; frequent desire to urinate, with small dis- charges ; watery, pale urine ; increased excitability of the genitals in men. Worse in the evening; also from eating, and sleeping. Coffea Crilda. The sexual organs are very much excited, but without emission of semen ; emission of a large quantity of urine at midnight. Worse in the morning, -and at night ; also in the open air. Better from cold water applications. ColOCynthis. Frequent tenesmus vesicae, with but small dis- charges; urine is foetid, soon thickens, and is viscid, like jelly; abundant micturition ; urine of a faint, flesh color, with a white- brown, flocculent, transparent sediment, depositing on the chamber small, red, hard, solid crystals, which adhere firmly to the vessel ; itching of the orifice of the urethra, with desire to urinate ; burn- in the urethra after micturition ; retraction of the prepuce behind the glans during sleep ; impotence. Worse in the afternoon, and in the evening ; also from motion. Better from bending double, and (temporarily) from drinking coffee. Conilim mac. Urgent desire to urinate, every half hour; cutting pain in the urethra when emitting the urine ; sharp pressing in the bladder, and burning in the urethra ; strangury ; the flow of urine suddenly stops, and continues after a short interruption ; the urine is thick, white and turbid ; bloody urine ; after urinating, burning 224 Surgical Diseases of the Bladder* in the urethra, and pressure in the neck of the bladder with stitches ; pressure on the bladder; frequent micturition during the night, it cannot be retained. Worse in the morning, and at night ; also while standing, when at rest, and from masturbation. Better from moving, and when walking. Copaiva Off. Constant weakness of the sexual organs ; loss of sexual desire; burning and sensation of dryness in the region of the prostate gland, and in the urethra ; induration of the prostate gland, and great pain in it on urinating ; yellow purulent gonor- rhoea; itching, biting and burning in the urethra, both before and after urination ; constant, though ineffectual desire to urinate ; retention of urine. Digitalis piirp. Pressure on the bladder ; violent unsuccessful desire to urinate; continued desire to urinate, only a few drops being emitted each time ; the urine is dark-brown, hot, and burns on being passed ; contractive pain in the bladder during micturition ; pressing and burning in the centre of the urethra on urinating ; acrid urine ; alternation of diminished secretion of urine, with copious secretion of watery urine; enuresis with vomiting and diarrhoea. Worse from getting heated, and on moving. Better when sitting down. Dulcamara. Urine turbid and white; strangury; painful micturition ; chronic cystitis ; constant desire to urinate, with an unpleasant sensation of bearing down towards the vesical region and urethra; emission of urine, drop by drop, which deposits a slimy sediment ; urine mixed with sanguinolent corpuscles ; turbid or white urine ; sediment in the urine sometimes white, and again red ; red and burning urine ; enuresis. Worse in the evening; also when at rest, from cold, and in wet weather. Better from moving about, and in a warm air. Erigeron Can. An excellent remedy for haemorrhages from the bladder or urethra. Like many of the " New Remedies," it has only been used empirically. Ferriim met. Discharge of mucus from the urethra after a cold; involuntary micturition, particularly in the day time; noc- turnal emissions ; swelling and indurations in the vagina. Worse in the morning, and the latter part of the night; also when at rest. Special Therapeutics. 225 Better from slow exercise. Gelseminum nitid. Frequent micturition; genitals (in men) cold and relaxed ; involuntary emissions with erections ; painful redness of the urethra; Dr. Douglas, of South Carolina, records a case in the " Review," of gonorrhoea of several months stand- ing being cured by this remedy ; as it has been copied in every- thing written on this subject since that time, it is unnecessary to quote it here. It is used empirically a great deal. Graphites. Anxious, painful desire to urinate, with discharge of small quantities of brown urine in drops, with a stitch in the urethra when emitting it ; sour-smelling urine ; the urine becomes very turbid, with a reddish sediment ; during micturition pain in the os sacrum ; wetting the bed at night ; nightly desire to urinate ; frequent micturition ; in men, tension and lascivious feelings in the genitals ; voluptuous irritation of the genital organs ; immod- erate sexual desire, with violent erections ; dropsical swelling of the prepuce and scrotum ; soreness of the vagina. Worse at night ; also from cold. HelleborUS nig. Frequent desire to micturate, emitting but a small quantity ; dark urine, feeble stream ; a large quantity of pale, watery urine is emitted; suppressed sexual desire. Worse in the evening; also in the cold air, and from bodily exertion. Better in the warm air. In the open air he feels better, but as if he had been sick a long time. Hepar SUlph. The urine is passed slowly, with difficulty, and drops out perpendicularly; sharp, burning urine, corroding the prepuce ; burning in the urethra during micturition ; urine dark- red, hot ; bloody urine ; stitches in the urethra ; inflammation and redness of the orifice of the urethra ; discharge of mucus from the urethra; wetting the bed at night; itching of the glans and frenu- lum ; diminished sexual instinct, with feeble erections ; discharge of prostatic fluid after urinating. Worse at night; also from cold air, from pressure, and on touching the part. Better from warmth, and wrapping up warmly. Humulus llip. Has been used with good success in retention of urine in drunkards, particularly in beer-drinkers. Hyoscyamus nig. This remedy is particularly useful in the beginning of an attack of cystitis, when, although there is of course 15 226 Surgical Diseases of the Bladder, some inflammation of the organs, the principal trouble is a diffi- culty in urinating from a spasmodic constriction of the neck of the bladder. The symptoms in other cases and diseases, are as follows : frequent desire to urinate, with scanty discharges ; invol- untary micturition, as from paralysis of the bladder; retention of urine, with pressure in the bladder; frequent emission of urine, clear as water. Worse in the evening ; also after eating or drinking, and during menstruation. Better on stooping. Ignatia amara. Sudden and irresistible desire to urinate; frequent discharge of watery urine; pressure to urinate from drinking coffee ; burning and smarting in the urethra during mic- turition ; itching in the fore part of the urethra ; violent itching of the genitals in the evening, relieved by scratching ; lasciviousness without erections; contractions of the penis, it becomes quite small ; perspiration on the scrotum. Worse in the afternoon and evening ; also from tobacco, coffee and brandy. Better by lying down (on the back) or changing the position. lodilim. Retention of urine; urine yellowish-green, or acrid; dark, turbid or milky ; or, with a variegated cuticle on its surface ; increase of sexual desire. Worse at night, and in the evening; also from pressure or warmth, and when walking quickly. Better from cold. Kali Carb. Frequent micturition, with discharge of small quan- tities of fiery urine; burning in the urethra, during and after micturition; the urine is discharged slowly; after micturition, discharge of prostatic fluid ; sexual desire excessive, or deficient. Worse in the morning: also from cold air. Better on getting warm. Lachesis. Burning during micturition ; frequent micturition, with a copious emission of foaming urine ; yellow urine ; sensation as if a ball were rolling in the bladder ; great excitement of the sexual desire; redness and swelling of the pudenda, with dis- charge of mucus; sexual desire strong (in women.) Worse in the evening; also after sleep, and from alcoholic drinks. Lycopodium. Frequent emission of foamy urine ; dark urine, Special Therapeutics. 227 with burning; hemorrhage from the urethra, without pain, also with lameness of the lower limbs, and constipation; burning in the female urethra during micturition; itching in the urethra during or after micturition ; violent, but short, pain of a drawing character, in the forepart of the urethra ; stitches in the bladder ; dark urine, with diminished discharge ; stitches in the neck of the bladder, and in the anus, at the same time; renal colic; sexual desire increased, or suppressed; impotence, the penis being small, cold, and relaxed ; feeble erections ; itching of the internal surface of the prepuce; dryness of the vagina; burning in the vagina during coition ; varices on the genitals of women. Worse in the afternoon and evening ; also when lying down or sitting, from cold food or drink, and from pressure of the clothes. Better on getting cold, and from warm food and drink. MerCUrillS. Constant desire to urinate, with no emission, or red and brown urine, extremely turbid, and smelling sour ; scanty fiery-red urine, or dark urine, as if mixed with blood ; greenish gonorrhceal discharge, especially at night; inflammation of the prepuce, with considerable swelling, and burning pain, as if it were distended with water or air; drawing pain in the groin, and a similar pain in the spermatic cord ; hard swelling of the testicle, with shining redness of the scrotum ; hemorrhage from the urethra. Worse in the evening, and at night ; also from the heat of the bed, and when exercising. Better when at rest, when lying down. Nitric acid. Nightly desire to urinate, with cutting pain in the abdomen ; foetid or greenish urine ; burning in the urethra during micturition, with violent pain after ; smarting pain in the urethra, or sore pain in the meatus during urination ; yellowish or bloody gonorrhceal discharge ; frequent itching of the glans ; inflam- mation and swelling of the prepuce, with burning pain ; violent itching of the scrotum, with violent pain in the testicles ; deficient sexual desire ; chordee ; erections with burning or stitches in the urethra ; suppression of urine, without pain ; stricture resulting from gonorrhoea or syphilis ; discharge of bloody mucus from the urethra. Worse in the evening, and at night; also from touching the parts. NlIX vomica. Pressing pain in the meatus, between the acts of micturition, accompanied by shuddering ; sharp pressure as with 228 Surgical Diseases of the Bladder. a cutting instrument, in the forepart of the urethra, also at the bladder, perineum, and anus, with contractive pain between the acts of micturition, and discharge of mucus ; painful ineffectual desire to urinate ; nightly urging to urinate, terminating in dis- charge of blood, and severe burning ; burning and lacerating pain in the neck of the bladder; burning in the urethra (or itching) during micturition ; contractive pain in the urethra, after urinating ; the urine is discharged drop by drop; discharge of pale urine, which is followed by thick, whitish, purulent matter, with a burn- ing pain ; reddish urine, with a brick-dust sediment. Worse in the morning ; also from motion, and being touched. Better from strong pressure. Opium. Suppression of urine, as from contraction or paralysis of the bladder; scanty, dark-brown urine, with brick-dust sedi- ment ; excitement of the sexual organs, and violent erections ; haematuria; impotence. Worse at night ; also from brandy or wine, and after sleep, Petroleum. Frequent micturition ; burning urine, with a white sediment ; burning in the neck of the bladder when urinating ; a very violent contraction in the region of the bladder; burning pain in the urethra ; constant dripping of urine ; frequent mictu- rition, with scanty emission of brown, foetid urine ; soreness of, and moisture on the female genitals. Worse in the morning, and evening ; and also after walking in the open air. Better in warm air. Petroselinum. Agglutination of the orifice of the urethra by mucus; albuminous yellow discharge from the urethra; during micturition, burning and tingling from the perineum through the whole urethra ; drawing, afterwards itching, in the fossa navicu- laris ; tingling in the urethra, followed by pressure in the region of Cowper's glands ; priapism, but without chordee. Phosphorus. Increased secretion of watery pale urine; fre- quent micturition, but a small quantity each time ; haematuria ; urine whitish, like curdled milk, soon becoming turbid with brick- dust sediment, and with a variegated cuticle on the surface ; twitching and burning in the urethra, with frequent desire to urinate ; involuntary discharge of urine ; sexual desire increased, with irresistible desire for coition ; impotence ; stiches upward in the vagina, into the pelvis. Special Therapeutics. 229 Worse in the evening, and at night; also when lying on the back, and on rising from the seat. Better from rubbing, after sleeping, and from eating something cold. PlatinutYl met. Frequent micturition, with slow flow of urine; red with white clouds, or turbid with red sediment; the sexual desire is unnaturally increased, with violent erections, especially at night ; in women, painful sensitiveness of the genitals, inter- nally and externally; unnatural excitement of the sexual desire, with voluptuous tingling in the internal and external sexual organs. Worse in the evening ; also when at rest. Better during motion. Plumbum met. Difficult emission of urine, only by drops; strangury ; hematuria ; genitals swollen and inflamed ; increased sexual desire, with violent erections. Worse at night. Better from rubbing. Pulsatilla. Strictures of the urethra, from suppressed gonor- rhoea ; retention and incontinence of urine ; frequent desire to urinate, with drawing in the abdomen ; colorless, watery urine ; cystitis which is due to suppressed menstruation; painful and scanty emission of slimy and sanguinolent urine, which deposits a purulent-looking sediment ; burning and cutting pains in the hypogastrium, with external heat, and tumefaction ; suppression of urine; thick gonorrhceic discharge from the urethra; sexual desire too strong ; itching-burning on the inner and upper side of the prepuce ; burning in the testicles without swelling. Worse in the evening; also from imprudent eating, and from warmth. t Better from cold, and when in the open air. Rhus tox. Retention of urine; discharge of drops of bloody urine, attended with tenesmus ; hot, dark urine ; diminished secre- tion of urine, although he drinks much ; the urine is emitted in a dividing stream ; swelling of the glands and prepuce ; prepuce dark-red ; stinging-itching on the inner surface of the prepuce ; violent erections at night, with urging to urinate ; soreness and stitches in the vagina. Worse in the morning; also when at rest, from change of weather, and from cold. Better from motion, and warmth. 230 Surgical Diseases of the Bladder. Sarsaparilla. Frequent ineffectual urging to urinate ; dimin- ished secretion of urine ; tenesmus of the bladder, with discharge white, acrid, pus and mucus : painful constriction of the bladder ; frequent profuse discharge of pale urine, without any sensation in the urethra; burning in the urethra during every micturition; urine red and fiery, or turbid, containing long flakes; at the end of micturition some blood passes ; sand in the urine in large quanti- ties ; bad effects from gonorrhoea suppressed by mercury. Better from warmth. Secale COP. Suppression of urine ; pale, watery urine ; hemor- rhage from the urethra. Worse at night ; also from touching the parts, from warmth, and on getting warm in bed. Better in the cold air and when standing. Selenium. Red, sandy, coarse-grained, or brick-dust sediment in the urine; itching of the scrotum; erections, with much itching in the urethra ; diminished sexual desire, or impotence with sexual desire. Worse in the afternoon, and- at night; also after sleep, and from salt food. SHicea. Desire to urinate, with scanty emission and smarting in the urethra ; pressure on the bladder when urinating, with sub- sequent burning; redness of the prepuce near the corona, as if excoriated ; desire to urinate, with sometimes scanty emission, and again a copious flow; sediment of red sand, or deposit of yellow sand; increased sexual desire, with frequent violent erections. Worse in the night ; also in the open air, from cold, from exter- nal pressure, and from drinking wine. Better from warmth. p Stannum met, Scanty secretion of urine ; the urging to urinate is wanting, as if there were no sensation in the bladder, only a sensation of fullness indicates the necessity to urinate ; increased sexual desire. Worse in the evening; also during rest. Better when walking. Staphisagria. Frequent urging to urinate, with scanty dis- charge in a thin stream ; or discharge of dark urine by drops ; profuse discharge of watery, pale urine with much urging; during, and after micturition, burning in the urethra; after micturition urging as if the bladder were not emptied; excitement of the Special Therapeutics, 231 sexual instinct; in women, painful sensitiveness of the sexual organs, especially when sitting. Worse in the morning, forenoon, and at night ; also from touch- ing the parts, and from tobacco. Stramonium. Suppressed secretion of urine ; involuntary urina- tion ; the urine is only discharged in drops, with constant painful urging. Worse in the morning; also from being touched. Sulphur. Retention of urine; frequent micturition, especially at night ; discharge of urine only by drops ; involuntary discharge of urine only at night ; burning in the orifice of the urethra during micturition ; foetid urine, with greasy pellicle on it ; hemorrhage from the urethra; stitches in the bladder; cutting pain in the urethra when urinating ; redness and inflammation of the orifice of the urethra; discharge of mucus from the urethra; secondary gonorrhoea; coldness of the penis, with weak sexual powers, and impotence; stitches in the penis. Worse in the evening, and during the latter part of the night ; also from bodily exertion, on getting warm in bed, when standing, from touching the parts, and from water and washing. Better during motion, from heat, and in dry weather. Thuja OCCi. Frequent urging to urinate, with profuse secretion of urine, especially towards and in the evening ; foaming urine, the foam remaining long on the urine ; dropping of urine after having urinated ; the bladder feels paralyzed, having no power to expel ; sediment of brown mucus ; burning, or biting-itching in the urethra ; urine contains sugar ; bloody urine : swelling of the prepuce, with inflammation of the glans ; copious watery dis- charge from the urethra ; stitches in the urethra, with urging to urinate; sensation as if a drop were running through the urethra; nightly painful erection ; impotence after gonorrhoea. Worse in the evening, and at night ; also in cold, wet weather, and from the heat of the bed. Better in warm, wet weather. Veratrum album. Suppressed urinary secretion ; continuous urging to urinate; involuntary flow of urine; dark-red urine, dis- charged frequently, but in small quantities ; green urine ; frequent micturition, with violent thirst and hunger, headache, nausea, colic, constipation, and coryza. 232 Surgical Diseases of the Bladder. Worse in the morning ; also after sleep, and when he is wrapped up warmly. Better after perspiring. ZitlCUm met. Pressing, stinging and soreness in the kidneys ; violent pressure of urine in the bladder ; retention of urine when beginning to urinate ; can only pass urine (which she must do every hour) in a sitting posture ; excessive desire to urinate at night ; urine is turbid, in the morning loam-colored ; frequent micturition of pale-yellow urine, which later deposits a white, flaky sediment ; discharge of blood from the urethra after painful urination ; burn- ing during and after micturition ; cutting pain in the orifice of the urethra; involuntary discharge of urine when walking, coughing and sneezing ; stones in the kidneys and bladder ; great falling oft of the hair on the genitals ; nymphomania, with great sensitiveness of the genitals ; violent long-lasting erections. Worse in the afternoon and evening ; also from wine, and in the warm room. Better in the open air. There are one or two additional remedies, and, as they are of importance, I do not know how I came to omit them. They are ; Agnus cast., Amnion, ntur., Argent nit., Merc, cor., Mezer., Rhus rad., and Sepia. AgnilS castUS. Yellow purulent discharge from the urethra, after the inflammatory symptoms of gonorrhoea have subsided; gonorrhoea with suppressed sexual desire ; itching of the genitals. Ammonia mur. Diminished secretion of urine ; slow flow of urine, more abundant during stool; frequent urination, especially towards morning; sediment like clay. Worse in the morning and afternoon. Better in the open air. Argentum nit. Frequent and copious emission of pale urine ; inflammation, and violent burning or shooting pains in the urethra, with increased gonorrhoea; priapism' with bleeding from the urethra ; sexual desire wanting, the genitals become shriveled. MercurillS COr. Tenesmus of the bladder, suppressed urine; increased discharge of urine ; the urine is only passed in drops, and in great pain ; urine scanty, brown, with brick-dust sediment ; itching in the forepart of the urethra; gonorrhoea, first thin, then thicker, then smarting pain when urinating, with stitches in the Special Therapeutics, 233 urethra ; burning in the urethra, more before micturition ; violent erections during sleep. Worse in the evening, and at night ; also from cold ? Mezereum. Diminished secretion of urine; in the morning and forenoon, frequent discharge of large quantities of pale urine ; the urine becomes flaky, and has a red sediment ; hematuria ; sticking in the kidney, and pain as if torn ; after micturition, itch- ing at the prepuce; discharge of mucus from the urethra; heat and swelling of the penis ; violent erections, and increased sexual desire. Worse in the evening, and at night ; also from being touched, and from motion. Better when walking in the open air. Rhus rad. Symptoms are almost identical with those of Rhus tox.; when thecase and the remedy agree, but the tox. produces no effect, I have often succeeded with this remedy in effecting a cure. Sepia. Frequent urging to urinate, from pressure on the blad- der ; frequent micturition, even at night has to rise often ; burning in the bladder, and in the orifice of the urethra ; smarting in the urethra when urinating ; urine turbid, with sediment of red sand ; blood-red, with white sediment, and a cuticle on the surface ; very offensive, with much white sediment ; continued erections at night ; violent upward stitches in the vagina; redness, swelling, humid itching eruption on the labise. Worse in the forenoon, and in the evening; also from washing in water, and on bending down. Better from warm air, and violent exercise. Operations. Perineal abscess. — When practicable they should be opened by an oblique incision, by entering the knife through the skin at a distance from the abscess. Organic Urethral Stricture. — It often happens that remedies fail to reach these cases. When such is the case, a catheter (made for the purpose), with a knife-blade concealed, can be intro- duced as far as the stricture, and then made, by the action of a spring, to sever it. Other methods are often used, such as gradual 234 Surgical Diseases of the Bladder, dilatation by means of graduated bougies, one of which is some- times used constantly. Calculi. — These serious diseases are remediable by operative procedure, in two manners. The cutting operation, and the crushing. The first is called lithotomy, and the last lithotripsy. Of the first we have a choice of three methods: ist. The median; 2d. the high : 3d. the lateral operation. The last is the one most used in this country. In this, an instrument shaped like a catheter, but having a deep groove along the curved border, called a " staff," is introduced into the bladder, and held by an assistant. The surgeon makes the incision from the raphe of the perineum, obliquely downwards, as far as the upper margin of the anus, though terminating at the distance of an inch and a half or two inches from it. This incision may be three inches long. When it is deep enough to reach the staff, the point of the knife is engaged in the groove of that instrument, and pushed into the bladder. The finger being inserted into the opening thus made, a pair of forceps made for the purpose, are then passed in, and the stone brought away. The staff must not be withdrawn until the operator has his finger in the bladder. Previous to commencing, the blad- der is to be injected with tepid water, and this allowed to run out when the stone is removed. The bladder is then to be washed out, and the wound left open to heal from the bottom. Pass a gum-elastic catheter into the bladder through the wound, and leave it there until the urine begins to come from the urethra. When operating by the crushing method, care must be taken above all things to have a perfectly good instrument, as if one of the jaws should break off in the bladder, the case will be very much complicated. The instrument used, is about the diameter of a large catheter, and is made to open and close two powerful con- cealed jaws by means of a screw in the handle. The size of the stone is acurately told by a scale cut into the handle of the instru- ment. When the stone has become engaged in the jaws of the lithotripe, it must be crushed slowly; the bladder injected with tepid water, and the utmost care exercised to ensure the expulsion of every particle of stone. The smallest piece remaining may (and nearly always will) serve as the nucleus for a new formation. These operations are both of them very serious ones, and it must only be after the most careful and persevering use of reme- dies, that either of them are resorted to. The mortality under Orchitis. 235 old school treatment is fearful,and we have every reason, judging from our past experience, to believe that the time will come when it will never be necessary to cut for stone. But let it be borne in mind, that inasmuch as a stone in the bladder is the hardest thing in the world to diagnose, it behooves us to be very cautious, at least, when we assert that we have cured them. DISEASES OF THE SCROTUM AND TESTICLES. ORCHITIS — HYDROCELE — VARICOCELE — HEMAT- OCELE. Orchitis is spoken of, as " blenorrhagic epididymitis," from the fact that in gonorrhoea or blenorrhcea, the epididymus is often affected; hernia humoralis and swelled testicles, are among the common names. Gonorrhoea suddenly suppressed by quack medicines, cold, or injudicious treatment frequently causes it. But cold, without the existence of gonorrhoea, a bruise, straining from heavy lifting and the like, often produces it. When a cure is effected there may be a hard, button-like swelling at the lower end of the affected testicle, that will remain. The symptoms are, swelling and hardness of the whole, or only one side of the scrotum ; red, painful and hot ; sometimes the surface is covered with small blisters, which burst, dry up into small scales and fall off; the least touch, even the weight of a single sheet, or the slightest motion, laughing or talking, will generally greatly increase the sufferings ; the pain is of a dragging character, and usually extends up along the spermatic cord of that side. The patient usually is found lying on the back, with the head high, knees drawn up and widely separated. The so-called "constitutional" symptoms are, fever, thirst, restlessness, often headache, urinary difficulties, and generally constipation, some- times diarrhoea ; at other times the bowels are not at all affected. 236 Surgical Diseases — Scrotum and Testicles, Hydrocele. Hydrocele is an effusion of fluid, either into the scrotum, or the coverings of either the testicles, or the spermatic cord. When in the cellular tissue, it is " external hydrocele ; " the opposite condition is " internal," and is divided into several other varieties. When it is contained in the envelope of the testicle, it is called "hydrocele of the tunica vaginalis;" and if communication between the abdomen and the interior of the sac is unobstructed, it is called " congenital." When the membranes of the spermatic cord are the seat of the disease, we speak of two varieties, the "encysted," and "diffused." In shape, the tumor thus formed is oblong, larger below than above, and, when examined in a dark room by transmitted light, the testicle can be clearly seen at the back of the scrotum. The operation of tapping may have to be resorted to, but as it is merely palliation, often aggravating, it should be seldom performed. Orchitis, according to Velpeau frequently causes this disease. It is usually found in a chronic form. Pain or inflammation rarely exists though some tenderness of the testicles may be met with. In old cases, in which some (or many), structural changes have taken place, many of the most essential symptoms to founding a correct diagnosis are wanting, and as light cannot be trans- mitted, the nature of the disease is sometimes very obscure. We may confo nd the disease with hoematocele, or any enlarge- ment of the scrotum. An exploring needle will generally settle the matter. The fluid is usually of a light straw-color, but when the case is of long standing, by the disintegration of the blood globules, the fluid will be of a dark-turbid appearance, and may incline one to think it is hoematocele. This, joined to the thickening of the walls, will obscure the diagnosis very much. The fluid may accumulate in any quantity; sufficient to distend the scrotum from the size of an egg, to that of a large cocoanut. The swelling is also, not always even and oblong, sometimes assuming an hour-glass form, and again looks like a multilo- cular cyst. Varicocele. Varicocele is simply a varixed condition of the veins of the scrotum and spermatic cord, and has been confounded with scrotal tfcematocele. 237 hernia. The veins of both the scrotum and the cord may be affected, or of only one of them ; those of the cord are generally found to be the ones involved. It is a soft, doughy, compressi- ble tumor, having a knotted, unequal surface, situated in the course of the spermatic cord, and increasing in size from below upwards. After lying down the tumor diminishes in bulk, and on standing up or walking increases in size again. In the scrotal variety the size seems to be greatest at the bottom, while all the other signs (except that following the course of the cord), are the the same. When both cord and scrotum are involved, the size is nearly uniform, top and bottom. The disease is easily diagnosed, and requires the simplest treatment. Debility of the genital organs, and frequent seminal emissions accompany varicocele quite frequently, from the fact that the disease is often referable to venereal excesses. One fact must be borne in mind : When the left spermatic veins are varicosed, and constipation accom- panies it, or is the natural condition of the patient, the cause of the varix is, in many cases, pressure exerted by fecal matter, accumulated in the sigmoid flexure of the colon, on the veins ; one of the first indications in such cases, is to remove this mechanical obstruction to the flow of the blood. HEMATOCELE. Hematocele is a simple effusion of blood (from an injury, gen- erally) into one of the tunics of the scrotum, and, of course, apart from the character of the fluid, it presents many of the charac- teristics of hydrocele. Many suppose it to be an effusion of blood into the cellular texture of the scrotum ; others, an effusion into the tunica vaginalis ; still others, into the tunica albuginea itself. The first is the common belief, but I incline to the second, viz., that it differs from hydrocele only in the character of the effusion, as regards seat or external appearances. Although the disease is usually produced by an injury, yet it has often occurred sponta- neously. When tapping for hydrocele, it has sometimes resulted from the point of the trocar wounding one of the vessels of the scrotum. Trifling as it may appear in its immediate and remote effects, it is many times a very formidable accident, and requires very prompt treatment. If our remedies are acting slowly, or do not 238 Surgical Diseases — Scrotum and Testicles. act at all, do not waste time, but operate at once. Of the two varieties, the traumatic and spontaneous, the last is the rar^t and much the most formidable. From some cause or another, perhaps varix, one of the spermatic veins becomes enlarged, bursts, and pours out blood in quantities, the scrotum usually w staining a greater size than when it has a traumatic origin. Rather than have the effused blood become disorga lized, with all its attendant evils, I would give but two weeks of medicinal treatment, and if nothing resulted, operate. But should good, ever so little, result, keep on with the medicines. It has sometimes occurred that the blood has coagulated. When the cl;t is found to be firm, he is criminal who does not remove it by operation. Care must be taken that we do not confound haematocele with hernia, or chronic hydrocele. Many of the symptoms and signs are similar to hernia, and haematocele of the spermatic cord, as it is apt to result from a strain, the similarity is very striking; but as Erichsen says, "the more diffuse character of the swelling, its irregular feel, and semi-fluctuating sensation, might enable the diagnosis to be made." Haematocele of the cord, can be readily distinguished from that of the tunica vaginalis ; in the former the testicle is not implicated, while in the latter it is felt surrounded by the fluid. Treatment. — Among the allopaths there is a custom, which many of our own faith are adopting, of strapping the scrotum with strips of adhesive plaster in cases of orchitis, which is very hurtful and useless. Trust to remedies and some simple appliances. It is of prime importance to keep the patient quiet in bed, room not too hot, covered lightly with bed clothes, with a bent hoop to keep their weight off; if the scrotum is greatly enlarged, a light suspen- sory bandage may be used, but it must exercise no constriction ; use no washes, or any topical application, and let the diet be light, forbidding coffee or any spiritous liquors. In the case of Hydrocele, the strapping process is very useful if too much compression is not exercised; that is, not enough to endanger the testes ; it is preferable to bandaging, as the latter can only with difficulty be kept smoothly applied. When the tumor is large, painful, and the remedies act but slowly, not pre- senting a constant accumulation of fluid, tapping may be resorted to as a temporary expedient, never with any hopes of effecting a cure by such means. Special Therapeutics. 239 Hczrnatocde should never be compressed by bandages or straps. If the cause is a rupture of some large vessel, that vessel has to be obliterated; if pressure will not check the hemorrhage, it must be exposed, and ligated. Varicocele, as it is an important subject, I shall speak of a little more in extenso. When called to see a case of this kind, first discover the cause, and then direct your treatment to the removal of that cause first ; thus, if an accumulation of feces is the direct cause, have that removed by injections, or other mechanical means. One of the first indications is to afford artificial support to the over-distended veins by judicious bandaging, which will be found in nearly all cases quite indispensable. The only topical treatment I would advise, is the watery extract of Hamamelis virg., and then only at such times as the same remedy is being administered internally. It is not good homoeopathy, indeed to my mind is not homoeopathy at all, to use one remedy internally, and a different one topically; it is nothing but alternation, and that we know is heresy. The remedies may be arranged as follows : Orchitis: Aeon., Aur. met., Nux vom. ; Ars., Clem., Lye, Merc, Nit. ac, Spong., Staph., Zinc. from Strains or Bruises. — Am., Con., Ruta, Puis. from Suppressed Gonorrhoea. — Puis. ; Aur., Clem., Merc, Nit. cue. from Metastasis of Mumps. — Merc, Nux v., Puis. Hydrocele: Am., Ars., Chin., Con., Dig., Graph., Hell., Hepar s., Merc, Nux v., Puis., Sil., Sulph. Varicocele: Hama. virg. ; Aeon., Am., Ars., Carbo v., Graph., Lach., Lye, Nux v., Puis., Sep., Sulph. Hematocele : Am., Con., Ruta, Sulph. j Erigeron. Aconite nap. Fever of an inflammatory character, with red cheeks, headache restlessness and followed by a profuse perspir- ation; dry, burning fever at night, with thirst, and delirium; fever ushered in by coldness and shivering ; fear and apprehen- sion of death; diarrhoea, with nausea and sweat; retention, or else difficult and scanty emission of urine, with painful urging; inflam- mation and itching of the scrotum; pain in the scrotum as if contused; tingling of the genitals; after a walk, (in cases of varicocele), the scrotum is painful, and the veins are much dis- tended ; inflammation of the scrotum, and inolterable pain along 240 Surgical Diseases — Scrotum and Testicles. the course of the cord ; stinging pains ; the scrotum, being inflamed, feels burning to the patient, and dry and hot to the hand; loss of appetite, amounting often to aversion of food ; loose stools, with much straining; pain in the rectum; numbness and lameness of the left thigh. Worse in the evening, and at night ; also when lying on the left side, in a warm room, and when rising from the seat or bed. Better in the open air. Right side. Arnica mon. Orchitis arising from a bruise or contusion; a sense of dull pain, or aching, in the testicle ; the fever comes on in the morning, is of a dry, burning character, no thirst with the fever; yawning before the fever, accompanied by a great deal of thirst ; frequent small and slimy stools, or stools consisting solely of slime ; tenesmus of the neck of the bladder ; stitches in the urethra; brown urine, with brick- red sediment; small quantities of yellow-red urine ; red-blue swelling of the scrotum, and inflam- matory swelling of the testicles ; painful swelling of the spermatic cord, with lancinations from the testicles into the abdomen; varicocele without pain, a dull tingling sensation, or an uneasy feeling in the swelling. Worse in the morning, evening, and at night ; also from moving, and on being touched. Better when lying down. Right side. Arsenicum alb. The pains are felt at night when sleeping, and do not wake the patient up ; dry, burning fever; the patient complains of feeling cold, but to the hand the surface is warm ; thirst during the fever, but only drinks a mouthful at a time ; dry, burning inter- nal heat ; emaciation and weakness ; diarrhoea of a putrid smell, profuse and watery; retention, or involuntary emission of urine! burning in tne urethra; swelling of the scrotum, with heat, red- ness, or a red-blue color; pain very severe; varicocele in persons who have had their health broken with Quinine ; veins enormously distended, of a deep blue color extending to the whole scrotum ; burning steady pain in the scrotum ; loss of appetite. Worse at night; also from cold, when lying on the affected side, and when the head is low. Better from heat, or warm applications, and when lying with the head high. Either side. Alinim fol. Orchitis produced by the abuse of Mercury " regu* larly ;" very sensitive to cold and drafts; thinks constantly of Special Therapeutics. 241 suicide, and has thoughts of attempting it; quarrelsome and peevish; turbid urine; yellow, thick, white urine almost like gon- orrhceal discharge; dull cutting, and lancinations in the urethra diarrhoea, or constipation, with burning in the rectum ; the external border of the rectum is swollen and painful ; nightly erections and pollutions, with itching of the scrotum; on touching or rubbing the testicle, aching pain. I have cured so many cases of orchitis with this remedy, that I almost began to think it a specific. The symptoms I have oftenest met that were cured by its use, are as follows : Tense, smooth, shining swelling of the scrotum, more on the left side ; dragging pain in the scrotum and along the sper- matic cord ; pain on the slightest motion, on straightening out the leg of that side, when turning in bed, from talking or laughing; small scales on the lower point of the scrotum on the left side, coming off entire ; scanty emission of hot urine ; little thirst, no appetite; fever, restlessness and sleeplessness at night. Worse in the morning; also from cold. Better from warmth. Right side, (Bcenninghausen). Left side (Gilchrist). Clematis erecta. Swelling and induration of both testicles, or of only the right ; pain as if bruised on touching the testes ; drawing pain in the testes and spermatic cord, from below upwards ; painful sensitiveness of the testes; swelling of the scrotum; loose stool; hemorrhoids; fever at night; dry heat; chilliness on being uncovered. Worse at night ? also from the heat of the bed, and from washing. Better from pressure ? Right side. CarbO Veg. Loss of appetite; constipation, with hard stool every two or three days ; discharge of blood with the stool ; sore- ness of the perineum ; swelling of the scrotum, which is also hard to the touch ; pressing in the testicles. Worse in the morning, and forenoon; also from cold air, and before the fever. Better after lying down. China Off. Drawing in the testicles; swelling of the spermatic cord; urine dark, turbid and scanty. Worse at night ; also from touching the parts if ever so softly. Better from warmth, in general. Generally the left side, though it may be either. Conium mac. Pains, of a very severe character, come on at 16 242 Surgical Diseases — Scrotum and Testicles. night while the patient is sleeping and waken him ; restlessness and constant desire to change the position; orchitis from a con- tusion ; swelling of the testes. Worse at night ; also when standing, or when at rest. Better from moving and walking. Right side. Digitalis pur. Great distension of the scrotum, until the skin looks as thin as a bladder; dropsical swelling of the genitals; contusive pain in the right testicle; fever, with internal chilliness, and external heat. Feels rather better in the forenoon, though there is but little change all day. Erigeron can. One of Hale's " new remedies," and the char- acteristic symptoms are unreliable. It is used empirically a great deal for hemorrhages of all kinds (except arterial), and has proved very valuable. Useful in hematocele in the first stages. Graphites. Feeling of great tension in the parts ; constipation, with burning in the rectum ; white mucus mixed with the stool ; the prepuce is dropsical. Worse at night; also from cold. Better from pressure ? Either side. Hamamelis Virg. The list of symptoms of this most important remedy are very meagre. I have used it very much, and have been obliged to do so in an empirical way, but have found it the very best remedy I have used in the treatment of varicocele. I have never used higher than the twelfth. The external use of the fluid extract is the common method of administration. HelleborilS nig. Hydrocele after suppressed eruptions; sup- pression of the sexual desire. Worse in the evening; also in the cold, and from bodily exertion. Better in the warm air. He feels better in the open air, but feels as if he had been sick for a long time. Either side. Hepar SUlphuris. Long-standing hydrocele; large swelling of the scrotum, containing fluid which is dark and thick; throbbing in the scrotum ; humid soreness on the genitals, and on the thighs between them and the scrotum ; discharge of prostatic fluid during urination, or when passing the hard stool. Worse at night ; also from the cold air, when lying on the painful side, from pressure, and when touching the parts. Better from warmth. Right side ? Lycopodium. Fever in the evening; burning heat, with short breath, pale face, and starting from the sleep ; ineffectual urging Special Therapeutics. 243 to stool; contractive pain in the perineum; violent, but short, drawing pain in the forepart of the urethra; chronic orchitis; pain in the perineum when sitting; passage of blood from the rectum; soreness between the scrotum and the thighs ; dropsical swelling of the genital organs. Worse in the afternoon and evening; also from lying down, when sitting, from the pressure of the clothes, and while urinating. Better from cold. Right side. MerClirillS. Violent thirst; continual coldness of the hands and feet ; great fever at night ; profuse perspiration which affords no relief; sweat with nausea and languor; desire for stool every minute, with tenesmus but no passages; diarrhcea; flow of milky- urine ; red, brown or turbid urine ; sour smelling urine ; bloody urine; discharge of pure blood from the urethra; drawing, with pressure in the testicles ; drawing pain in the testicles and in the groin; drawing in the spermatic cord; shining redness of the scrotum ; swelling of the scrotum ; pain intolerable. Worse at night, and from the heat of the bed. Better from cold, and while sitting. Right side. Nitric acid. Orchitis from abuse of Mercury; cold skin over the whole body; chilliness, especially in the evening; night- sweats, sometimes every night, at other times every other night ; foetid perspiration ; constipation, or diarrhoea ; discharge of blood from the rectum during stool ; painful suppression of urine ; draw- ing pain in the testicles ; testicles painful when touched ; violent itching of the scrotum ; lacerating in the spermatic cord ; painful when touched. Worse in the evening, and at night; also on touching the parts, and on rising from the seat. Better on getting warm. Left side. NlIX vomica. Chilliness, with heat of the head; fever in the afternoon or evening; burning sensation, or one of internal heat through the body ; morning sweats ; constipation, with ineffectual urging to stool ; painful spasmodic stricture of the anus ; painful and ineffectual desire to urinate , burning or itching in the urethra ; lacerating or burning in the neck of the bladder ; itching of the scrotum ; heat in the testicles ; inflammation of both testicles, with swelling, hardness, and drawing of them up; sticking and spas- modic choking sensation, rising into the spermatic cord. Worse in the morning; also from motion, and slight touch. 244 Surgical Diseases — Scrotum and Testicles. Better irom strong pressure. Right side. Pulsatilla. Coldness; shuddering; feeling of chilliness, with trembling; fever comes on in the afternoon or evening; dry heat of the body at night ; morning sweat ; diarrhoea stools, mixed with mucus ; stools consisting of nothing but mucus mixed with blood ; retention or incontinence of urine ; colorless, watery urine ; swell- ing of the scrotum; lacerating pain in the testes; drawing and drawing-tension from the abdomen through the spermatic cord to the testicles; inflammation and swelling of the testicles, with swelling of the scrotum after suppressed gonorrhoea; burning in testicles without swelling. Worse in the evening, and the forepart of the night ; also when lying on the painless side, while moving, and from warmth. Better in the open air, and from cold. Right side. Ruta graveolens. Have used it for varicocele following a severe strain. Silicea. Continuous urging to urinate, with scanty discharge ; itching, humid spots on the scrotum ; discharge of prostatic fluid when urinating and during stool ; increased sexual desire ; hydro- cele. Worse in the night ; also in the open air, from cold, from getting wet, and from pressure. Better from warmth. Either side. Sulphur. Retention of urine ; or frequent micturition, only of drops ; hemorrhage from the urethra ; discharge of prostatic fluid after micturition; the testicles hang down loosely; offensive perspiration around the genitals; soreness and moisture of the scrotum ; soreness between the scrotum and the thighs. Worse in the evening, and at night ; also on getting warm in bed, from talking, on standing, from touching the parts, and from water and washing. Better during motion, and from heat. Right side. Operations. Varicocele is to be cured (when by operation) by the obliteration of the veins. This may be done either by ligation, or pressure exerted on the vein directly. When the former plan is pursued, use the same procedures and precautions as in the case of arteries. When the latter, the best plan is to insert hair-lip pins Diseases of the Uterus, 245 under the veins, and twist silk or wire around them in a figure-of- eight manner. Hydrocele is often tapped, either under the mistaken belief that such a procedure will cure it, or as a palliative measure. It does not cure any more than amputation cures gangrene; it only destroys the parts. The trocar and canula should be small, and care must be taken not to wound the testicle. These operations are but seldom called for in our practice, and the time will soon be here when they will never be performed ; of this I am confident SURGICAL DISEASES OF THE FEMALE GENITALIA. DISEASES OF THE UTERUS — OVARIAN TUMORS — VAGINAL FISTULA. Diseases or the Uterus are many, but a great majority of them are more strictly obstetrical, and need not to be mentioned in a work of this character. The diseases we shall speak of are as follows: (a) Hydrometra; (0) physometra; (c) foreign bodies in uterus ; (d) cancer of the uterus ; (e) ulceration ; (/) gangrene. (a J. Hydrometra. — Dropsy of the uterus never sets in until the catamenia are regularly established, or seldom after their final cessation. The causes are various : a blow, miscarriage, suppres- sion by some means of the lochia, leucorrhcea, menstruation, etc. Often the cause depends upon, or exists in connection with, some disease of the womb. Among these may be classed, scirrhous, hydatids, or tubercular disease. It may readily be confounded with pregnancy. We hear three varieties spoken of: the uterine, hydatids, and the dropsy common to pregnant women. 1st. Ascites. This is a simple accumulation of fluid in the cavity of the uterus. Jahr speaks of it as being either "persistent or periodical." The symptoms in the former case are as follows : suppression of the menses, with pain in the back and abdomen, swelling of the abdo- men, and, in those cases which simulate pregnancy, swelling of the 246 .Surgical Diseases of the Female Genitals. breasts with discharge from them of a milky substance. Months or years may elapse, the abdomen swelling steadily, and at last a fall, blow, or some other cause, will result in an expulsion of the fluid by a process closely resembling labor. The patient com- plains of uterine pains, the mouth of the uterus dilates, and the fluid is expelled. The point of difference, then, between the two varieties, " peristent " and " periodical " is, that in the former a cure follows, the fluid is not re-secreted; whilst in the latter, it again accumulates. 2d. Hydatids. — In appearance resemble cysts; multilocular generally, and give rise to very nearly the same symptoms as ascites. They are expelled as in confinement, the expulsion being followed by hemorrhage and weakness. In appearance the only difTerence from ascites is, that the former is not enclosed in a separate investment. 3d. The dropsy seen in pregnant women has no connection with our subject. I consider it to be merely an excess of the amniotic fluid. (b). Physometra. — Sometimes this is called " tympanitis " of the uterus. It is simply an accumulation of gas in the cavity of this organ. The most common cause is, probably, the decomposition of coagula, or from some portions of the placenta, or from a dead foetus. It may be generated by the walls of the uterus. (c). Foreign bodies in the uterus. — They are moles, hydatids, calculi, and the like. Moles are a shapeless, fleshy mass, the result of imperfect conception. Hydatids when existing in large num- bers, are frequently spoken of as moles. Concretions. — "These are the sanguineous and lymphatic concretions formed in the womb. The sanguineous concretions are a species of coagula, which might be compared to the polypus concretions in the heart and larger vessels, although the coagula in the womb are more consistent, and show more signs of organization ; often they are surrounded by a fibrinous layer of a grayish-whitish color which envelope them like a membrane, and increase this organized appearance ; but in dissecting them carefully, this appearance disappears, and no cavity with smooth walls is found in their interior, as is the case with fleshy moles. * * * * The formation of these coagula takes place most frequently in women who menstruate copiously, and whose lochia do not flow regularly ; even young unmarried females are attacked by such disorders. When such concretions Diseases of r the Uterus, 247 take place, the menses cease." — Jahr. The expulsion of these bodies resembles the natural process of labor closely, and may be speedy or gradual ; when the latter the hemorrhage is very severe. " Lymphatic concretions," says Jahr, " are membraneous bodies of integumentous consistence, and of a dirty-white color resem- bling the membranes in croup. They are formed in the uterine cavity, and are afterwards expelled, either shaped as a sac or as a bursa, the external surface of which is studded with filaments, and the internal is smooth and moistened with a serous liquid." These formations are sometimes simple patches, at others a com- plete cast of the womb. They are rarely reproduced after being expelled. Uterine polyps differ in no material degree from the same bodies elsewhere. Calculi or Fibrous bodies in uterus, are tumors, frequently of the polyp shape , and may be of almost any texture, from a simple sarcoma, to almost hard bone. When sarcomatous, I should call them polyp. They may be of any size, from that of a pea to a fist, or as in one case, large enough to weigh thirty pounds. Unmarried women are more subject to them than the married, and also those who have been childless, than those who have had sev- eral children. In fact among the married, the immunity increases in proportion to the number Of children borne. Jahr and others consider the different textures of which they have been found to be composed, to be indicative of their age. Thus bone or calcareous matter is the natural composition, and the sarcomatous and fibrous forms, are but steps to the complete formation. (d). Cancer of the Uterus. — The same remarks apply to this disease as to polypi : a cancer is the same everywhere. Most of the older authors, in the language of Jahr, considers cancer of the uterus to be " every affection, which at the same time as it changes the tissues of the uterus, naturally tends to spread all around, and to destroy itself by ulceration in the centre." (e). Ulceration of the Uterus. — Ulcers of this organ are quite common, and may be classified the same as the cuticular varieties. They may be classified in this place in reference to the cause, complications and appearance, as follows : Superficial erosions, deep-seated ulcers, herpetic ulcers, scorbutic, scrofulous, syphilitic and cancerous. See " Ulcers." (f). Gangrene of the Uterus. — This is a terrible accident, and 248 Surgical Diseases of the Female Genitals. one that promises but little hope for the sufferer. Acute metritis, or any intense inflammation may culminate thus. The mortality is partially due to the fact, of the almost utter impossibility ot diagnosing the condition, until after death. When the case is serious the diagnosis may be made out from the symptoms, pains in the hypogastrium which had existed until then, disappear ; a brownish liquid of a fetid odor, is discharged from the vulva; a diarrhoea of a cadaverous smell, sets in, and a cold and clammy sweat breaks out, either over the whole body, or only on some parts ; the pulse becomes frequent, small and intermittent ; the features are deeply altered, the extremities become colder, and the patient sinks into syncope, or a prolonged coma, with or without delirium. Ovarian Tumors. Ovarian Tumors are more commonly met after the climacteric period, though they may exist at any age after puberty. I believe they are never seen, or if so very rarely, before the catamenia are established. They may be cystic, or solid in form, though it is a question with many, if the solid" form be not an advanced stage of the cystic. Like all cysts, they may be single or multiple; some of the older writers speak of the " binocular," but we now call them all multilocular when there is more than one cyst on the pedicle. The contents of these cysts may be thick and albumin- ous, or thin and watery, and the same variety is found in the color ; the fluid may be colorless like water, or brown, or even black. In consistency then, it may be anything between a fluid and a semi-solid, and in color, from watery to black. Not un- frequently, we find the contents to be made up of hair, portions of bone, and in one case a complete lower jaw furnished with a full set of teeth. These are evidently the remains of a blighted ovum, or may be the result of ovular impregnation. The causes that may operate to produce these formations are many, though some direct violence is the most common. They are never cured spontaneously, always progressing more or less slowly to a fatal termination, unless arrested or removed. They may be of almost any size. Vaginal Fistula. Vaginal Fistula. There are several varieties of fistula, which we will briefly notice, premising the remark, that in spite of Vaginal Fistula. 249 what many oi us have been taught, they are all more or less curable by internal treatment, save one variety, the first we shall notice. (a). Enter 0- Vaginal Fistula. — This affection is so rare, that I will simply quote Erichsen : " It is a communication set up between the small intestine and the vagina, an artificial anus in fact. These cases, may indeed be looked upon as incurable ; for though some of the French surgeons, as Roux and Cassamayor, have endeavored to establish by a deep and difficult dissection a communication between the small and large intestine, the opera- tion, as might have been expected, has proved fatal to the patient." The only thing to be done apparently, is to let it alone. What if the fistula should be closed ? as there is no other outlet for the feces, an artificial anus would have to be made somewhere else, and might prove as fatal as the French attempts. I believe this condition is nearly always congenital. (b). Recto- Vaginal Fistula. — Is a very disgusting complaint, and one that is common at all times of life. The causes are various. One of the most common is, the long impaction during labor of the head of the child in the vagina, and consequent upon the contusion, inflammation, gangrene, terminating in sloughing. Cases have occurred from perineal laceration extending into the vagina, partially healed, when an adhesion was set up between this canal and the rectum, followed by inflammation, ulceration and sloughing. (c). Urinary- Vaginal Fistula, may also be due to the long im- paction of the child's head during labor, and like the other variety may be caused by direct personal violence. A kick, by produc- ing congestion and ultimate sloughing, or by lacerating the parts is, among a certain class, often the cause. The urethral opening from that canal into the vagina, is by far the most common, as the point of resistance furnished by the pubic bone, renders this passage more obnoxious to injurious pressure. When the opening is through the bladder itself, it is spoken of as vesico- vaginal, which is larger, more ragged and more difficult to treat than the other. This is usually the result of abscess or some disease, as their position precludes the possibility of compression during labor being exercised to that extent, and they are too far back to be the result of an injury, unless it be one produced by attempting abortion. 250 Surgical Diseases of the Female Genitals. Treatment. — In the cure of physotnetra, it is well to see to it that the expulsion of the gas is complete and the mechanical cause removed. In the case of foreign bodies in the uterus, they must be expelled, not absorbed. In cancer, and the same remarks apply to ulceration, no caustics, or any kind of local treatment must be allowed, farther than is necessary to complete cleanliness ; trust to remedies. In the treatment of " ovarian tumors" paracentesis, or tapping, is not good surgery, neither is it good Homoeopathy ; at the first it is merely palliative and commonly it produces aggravation. It the remedies do not act well, or all other measures fail to relieve, I should operate at once. Unrelieved the patient will surely die, and an operation promises much. In cases of " vaginal fistula" of all kinds, I am much inclined to think that local treatment will be found that which promises best ; but of course this depends upon the cause; if from a blow, treat it as ordinary contusions. In the case of all fistulse, save the entero and vesico-vaginal, an operation seems to be the safest, best, and most speedy way of effecting a cure. In urinary fistulae, one main indication is to prevent the urine from entering the vagina ; for this purpose wear a catheter constantly, or until the opening is closed. In all these fistulse the examination must be thorough, both digital and ocular, by means of a speculum. The remedies we find most useful may be arranged as follows : Hydrometra : Ars., Bell., Chin., Hell., Merc, Sulph., Bry., Calc, Con., Ferr., Jod., Kali, Lach., Lye, Puis., Ruta., Sabin., Sepia. after miscarriage. — Bell., Sabin., Secale, Sep., Bry., Calc, Chin., Fer., Kali, Puis., Sulph. after blows on the Hypogastrium. — A?-n., Con., Puis., Rhus, Bry., Jod., Lach., Phos., Ruta., Sulph. with Hydatids. — Canth., Merc. with Endometritis. — Merc, Puis., Sep., Amm., Calc, Chin., Con., Ferr., Lye, Sabin., Sepia, Sulph with suppressed Leucorrhcea. — Bry., Chin., Nux v., Puis., Sulph., Aeon., Ars., Bell., Lach. with suppressed Lochia. — Bell., Nux v. Puis., Secale, Hyos., Verat. with suppressed menses. — Con., Kali., Lye, Puis., Sulph. Special Therapeutics, 251 Physometra: Phos ac, Sang. can., Bell., Chin., Calc, Hyos., Lye, Magn, e Nux v. Sepia. Moles : Puis., Secale, Canth., Calc, Sil. Hydatids: Calc, Sulph., Sil., Merc, Aeon., Ars. t Chin., Per., Graph. Sanguineous Concretions: Nit. ac, Phos., Stront. Lymphatic Concretions : Sulph. acid. Cancer of Uterus : Graph., Kreos, Sep. ; Ars., Sil, Sulph., Merc. Scirrhous : Carbo an., Sep.; Aur., Bell., Chin., Staph. Fungus of Uterus: Graph j Ars., Carbo an., Kreos., Lye, Sep., Staph., Thuja, Bell., Carbo v., Lach., Merc, Nit. ac, Phos., Sabin., Sil., Sulph. Bloody : Bell., Carbo an., Chin., Graph., Kreos., Sep.; Aur., Carb. v., Lach., Merc, Sil., Sulph. Medullary: Bell., Phos., Sil., Sulph.; Ars., Carbo an., China, Graph., Kreos., Merc, Sep. Ulceration of the Uterus. — See chapter on Ulcers. Gangrene of the Uterus: Secale ; Ars., Kreos., Carbo v. Ovarian Tumors: Acid .phos., Apis mel., Apocyn. can.; Ars., Canth., Chin., Colch., Dig., Dulc, Plater., Graph., Hell., Lod., Kali hyd., Lye, Merc, Plat., Prun., Sep., Scilla, Staph., Thuja., Uva ursi. Fistula: Puis., Sil., Lye, Calc; Assa., Carbo v., Bell , Nit. ac, Con. Aconite nap. I know of no local symptoms of any importance, save the profuse and long-lasting catamenia. Ammonia Carb. Itching, burning and swelling of the pu- denda ; fluor albus, burning, acrid and watery. Worse in the evening; also on bending down, and during wet weather. Better when lying on the stomach, or right side, lying on the painful side, from warmth, and in dry weather. Apis mel. Burning — stinging pain in the ovarian tumor; feeling in the bowels as if diarrhoea were coming on ; abdomen swollen and tender, with swollen feet and scanty secretion of urine, external tenderness even to the pressure of the bed clothes; bear- ing-down pain, as if the menses would come on, with aching and pressing in the hypogastrium ; coldness and anasarcous swelling of lower extremities; sharp, cutting, stinging pain in the swollen ovary, worse during menstruation; pressing-down pain in the 252 Surgical Diseases of the Female Genitals. uterus ; dropsy of the uterus ; menstruation suppressed or dimin- ished, with congestion to the head. Worse in the morning; also from heat, and when in a warm room. Better from cold ; (cold water.) Arnica mon. Soreness and bruised feeling in the parts, as if after a difficult labor: useful in diseases arising from blows or falls. Arsenicum alb. For open cancer of the uterus, with burning and agonizing pains, secretion of fetid, brownish or blackish ichor ; fainting fits ; excessive debility, and rapid sinking of strength ; emaciation; burning pains, even felt while sleeping at night; general anasarca ; restless sleep, and frequent starting as if fright- ened ; the whole abdomen is painful, excessively so at night ; swel- ling and distension of the abdomen with burning pain ; frequent urging to urinate, with burning during micturition ; profuse acrid or corroding menses ; weakness and painful stiffness of the small of the back ; cramps in the legs ; weakness and debility of the lower extremities ; corroding and acrid leucorrhcea. Worse at night ; also from cold, and when lying on the painful side. Better from heat in general, and when lying with the head high. Asamm europeum. Nervous irritability; over-sensitiveness of the nerves, the scratching of linen or silk is insupportable ; sen- sation of lightness in the limbs, when she walks she feels as if she were gliding through the air. Worse in the evening ; also in cold and dry weather. Better from wetting the part. Aurum fol. In the beginning of cancer of the uterus, when there is falling of the womb, and pressure on the fundus of the bladder; alternate peevishness and cheerfulness; very sensitive to pain, and the cold air. Worse in the morning ; also on getting cold. Better from motion, while walking, and from warmth. Belladonna. In cancer, frequent hemorrhages from the womb, painful pressure on the parts, violent pains in the small of the back, and nervous excitement ; great pressure at the genitals as if everything would protrude ; stitches in the genitals ; dryness of the vagina ; congestion and inflammation of the uterus and labia ; intense cramp-pains in the small of the back and os coccyx. Worse in the afternoon and at night ; also on moving, and from the lightest touch on the parts. Special Therapeutics. 253 Better while standing. Bryonia alba. Despair of recovery, irritable, and inclined to be angry ; swelling and inflammation of the left labia majora ; stitches in the hip-joint extending to the knee ; swelling of the lower extremities ; yellow skin. Worse in the evening ; also from motion, bodily exertion, and from heat. Better on getting warm in bed. Calcarea Carbon. Easily frightened or offended; stiches in the os uteri ; itching or pressing in the vagina; varices on the labia ; fluor albus like milk ; or, burning, itching, in starts, during mictu- rition, or before the catamenia ; pain in the small of the back as if sprained, can scarcely rise from his seat after being seated ; great weakness and debility from a short walk, or from talking ; fainting with loss of sight and coldness; sensation of coldness or dryness in inner parts. Worse in the morning and evening ; also in wet weather, in cold air, and from the pressure of the clothes. Better from loosening the garments. Cantharis. Excessive debility, trembling of all the limbs ; ver- tigo ; frequently a loss of thirst for days at a time ; aversion to every kind of drink; increase of appetite, though at times complete anorexia ; inclination to vomit ; cutting and heat in the abdomen ; violent pain in the abdomen ; sensitiveness of the abdomen to the touch ; sometimes constipation, and sometimes diarrhoea ; painful- ness and inflammation of the bladder; scanty secretion of hot urine ; constant ineffectual urging to urinate ; copious urination, attended by pain and burning ; gnawing in the small of the back ; " going to sleep " of the lower extremities ; inflammation of the ovaries ; swelling of the neck of the uterus ; over-sensitiveness of all the parts. Worse in the afternoon and at night ; also after drinking coffee. Better when lying down. Carbo animalis. In scirrhus of the uterus, with pressive pains in the loins, groins and thighs ; distension of the abdomen ; flatulence, frequent eructations, and desire to vomit ; fluor albus leaving yellow stains on the linen ; numbness of the limbs. Worse in the evening and at night ; also in the open air, and from cold. Better from warmth. 254 Surgical Diseases of the Female Genitals. Carbo Vegetab. Restlessness and anxiety; sensitiveness and irritability ; nausea in the morning , itching, burning and soreness of the parts ; apthae and itching at the pudendum ; thick yellow- ish-white leucorrhcea ; varices of the vulva ; rheumatic tearing in the back ; painful stiffness in the back in the morning when rising; numbness of the limbs, they " go to sleep easily ; " great debility on making the least exertion. Worse in the forenoon ; also from cold. Better from warmth. China Off. The lower limbs become numb when lying on them ; tingling and numbness of the limbs ; some patients have a great increase of appetite, and others a complete aversion to all kinds of food ; inclination to vomiting and eructations after a meal ; oppressive and spasmodic pains in the stomach after a meal ; fre- quent urination ; scanty, dark-colored urine ; insupportable pain in the small of the back as if bruised or beaten to pieces ; weak- ness and lameness of the lower extremities ; congestion of the uterus, with feeling of fullness and painful pressing to, and sense of heaviness of the genitals, particularly when walking ; discharge of bloody urine from the vagina, alternating with discharge of pus ; painful induration in the vagina. Worse at night ; also from being touched if but lightly. Better after rising from the bed or seat. CoCCUlllS ind. Aversion to food; paroxysms of nausea, with tendency to faint ; tremor in the back : paralytic pain and paraly- sis of the back and small of the back ; the thighs feel paralyzed and bruised; disposition to tremble; great debility from slight exertion, and inclination to faint. Worse in the evening and at night ; also in the open air, and from talking. Better when lying down. ColchiClim aut. Sudden sinking of strength ; the legs feel as if they would drop off; loss of appetite; this aversion to food is increased on seeing it, still more on smelling it; great thirst; nausea with inclination to vomit; violent vomiting; oppression at the pit of the stomach; pain in the whole abdomen; colicky pains; great distension and swelling of the abdomen ; stools exceedingly painful, with disposition to diarrhoea; pain in the anus; increased secretion of brownish urine ; lacerations and lancinations in the back; cedematous swelling of the legs and feet. Special Therapeutics. 255 Worse in the morning, and at night ; also while walking. Better when sitting or reposing. Conium mac. In cancer of the uterus, intolerable lancinating pains; frequent nausea, vomiting; fancy for odd things to eat, as in pregnancy ; inclination to start as if with fright ; acrid and burn- ing leucorrhcea, preceded by pinching pains in the abdomen ; pain as from a sprain, in the left side of the back ; sensation of debility in the morning when in bed ; sudden loss of strength while walk- ing. Worse in the morning and at night ; also while standing and when at rest. Better from moving about and when walking. Digitalis pur. General weakness and fainting fits ; want of appetite, nausea and inclination to vomit; vomiting in the morning ; vomiting of the ingesta, or of mucus ; lancinations from the pit of the stomach to the sides and back ; anxious tightness and con- striction about the hypochondria; pressure on the bladder; unsuc- cessful desire to urinate ; emission of only a few drops of urine after a great effort ; pain in the thighs and legs, with weakness and lassitude of the lower extremities. Dulcamara. Emaciation; lassitude; violent desire for cold drinks ; eructations and nausea after a meal ; vomiting of mucus in the morning ; a sense of inflation at the pit of the stomach ; cutting or pinching pain in the abdomen quickly passing away ; pinching around the umbilicus ; a stinging pain in the umbilical region ; slimy diarrhoea, looseness of the bowels with evacuations of white mucus ; painful micturition ; turbid whitish urine ; lame- ness of the small of the back as if from a cold ; bloatedness of the lower limbs ; weakness of the lower extremities. Worse in the evening ; also in the cold air, in wet weather, and when at rest. Better from moving about, after rising from a seat, and when walking in the warm air. Elaterium. Discharge from the bowels of frothy water ; dull olive-green discharges. Better from perspiration. A remedy that is little used, and of which, I think, as little is known. Ferrum met. Quarrelsome, disputative; vomiting of the ingesta as soon as she eats ; hemorrhage from the uterus, with labor-like pains in the abdomen and glowing heat in the face ; the blood is 256 Surgical Diseases of the Female Genitals, partly pale and partly clotted ; painfulness in the vagina during an embrace ; swellings and indurations in the vagina ; prolapsus of the vagina; great emaciation ; so weak that she has to lie down ; restlessness of the limbs. Graphites. Emaciation; weakness of the limbs; excessively tired and drowsy ; oppressive headache early in the morning, when awakening bitter taste in the mouth, with little or diminished appe- tite; sleepiness after dinner; nausea and vomiting of theingesta; pressure in the stomach; stitches in both hypochondria; constipa- tion ; burning in the rectum, and itching of the anus ; passage of a quantity of white mucus mingled with the stool ; frequent emis- sion of turbid, urine; soreness of the pudendum; profuse white leucorrhoea ; violent pains in the small of the back as if from a bruise ; heaviness in the lower limbs ; Jahr adds to these, (in can- cer uteri,) warmth and painfulness of the vagina, engorgement of lymphatic vessels and mucous follicles, hardness of the neck of the womb, which is swollen and covered with fungous excrescen- ces ; heaviness of the abdomen, with exacerbation of the pains, and fainting when standing ; retarded and painful menses, with discharge of black, coagulated and fetid blood ; stitches through the thighs and hypogastrium, like electric shocks ; burning pains, constipation, earthy complexion, sadness and restlessness. Lippe adds, soreness of the vagina; painful swelling of the left ovary. Worse at night ; also from cold, and during and after menstrua- tion. Better after lying down. HelleborUS. Great increase of appetite ; vomiting of a green- ish-black substance ; intensely painful burning in the stomach ; bowels loose, with nausea and colic ; tendency to hemorrhoids ; frequent micturition, with small emissions ; stiffness and tension of the muscles of the thighs ; great weakness of the thighs and legs ; suppressed sexual desire. Worse in the afternoon and evening ; also in the cold air, and from bodily exertion. Better in the warm air. HyoscyaiTlUS nig. Voracious appetite and thirst; vomiting of blood and bloody mucus; distension of the abdomen, with pain when touched ; pain as from soreness in the abdominal walls when coughing; frequent desire to urinate, with scanty emission; men- struation too profuse with delirium ; before menstruation hysterical Special Therapeutics, 257 spasms, with uninterrupted loud laughing ; metrorhagia, the blood pale with convulsions ; cramps in the anterior part of the thigh ; uncommon sinking of strength; repeated attacks of fainting; subsultus tendinum. Worse in the evening; also during menstruation. Better by stooping. lodill-m. Numb feeling in the thighs and legs; emaciation with hectic fever; extreme emaciation; sleeplessness; excessive canine hunger; in other cases want of appetite'; empty eructations; nausea, with vomiting of bile ; pressure in the region of the liver, the spot is painful to the touch; incarceration of flatulence; constipation, or irregular stools, sometimes loose, then costive; retention of urine ; stitches in the small of the back ; heaviness of the limbs; menstruation irregular sometimes too early, sometimes too late; leucorrhoea corroding the linen, acrid and profuse; induration and swelling of the uterus and ovaries ; great irritability of the whole nervous system ; trembling of the limbs. Worse in the evening, and at night; also from lying on the painful side, from pressure, from warmth, and in a warm room. Better from cold. Kali carb. Vexed and irritated mood, trifles vex one, noise is disagreeable; nausea as if she would faint; tension across the abdomen ; hard, distended abdomen, with tenderness of the umbilical region to the touch ; suppressed menstruation ; supres- sion of menses with anasarca and ascites ; the menstrual blood is acrid, makes the thighs sore, and covers them with an eruption ; yellowish, burning leucorrhoea, with pain in the small of the back, labor-like pains, and itching and burning in the pudendum ; a short walk is very fatiguing. Worse in the morning; also from cold air, and when lying on the side. Better on getting warm. Kali hydriod. Every little noise makes one start; the food has no taste; tastes like straw; cutting and burning around the umbilicus ; suppressed menstruation ; frequent urging to urinate when the menses appear; thin, watery, acrid, corrosive leucor- rhoea ; discharge of mucus from the vagina ; irresistible desire to go into the open air. KreaSOte/ Swelling of the labia, with itching in the vagina; stitches through the thighs like electric jerks; dark coagulated 258 Surgical Diseases of the Female Genitals. menstrual discharges, followed by an ichorous and corrosive dis- charge ; painful pressure on the parts ; itching in the vagina in the evening, inducing rubbing, succeeded by smarting, swelling, heat and induration of the external parts, with soreness in the vagina when urinating; on the neck of the uterus a hard lump, and ulcer- ative pain during an embrace; during an embrace burning in the parts, and followed next day by menstrual discharge of dark blood; leucorrhcea, mild, corrosive, debilitating; pain as if the small of the back would break; pain in the small of the back like labor pains ; strong pressure to urinate, and ineffectual desire to go to stool ; pain in the back at night, worse on lying down ; humming and buzzing in the lower extremities ; faintness in the morning when rising too early; sensation of soreness, as if bruised. Worse in the morning; also in the open air, and on moving about. Better from warmth. Lachesis. Nervous irritability; nausea and vomiting of food ; vomiting of bile or mucus ; heat in the abdomen ; great discomfort from having the clothes tight around the waist; menstruation suppressed ; the uterus feels as if the os were open ; redness and swelling of the external parts, with discharge of mucus ; swelling, induration, pain and other anomalies of the left ovary; sexual desire excited ; pain in the os coccygis, when sitting down one feels as if sitting on something sharp ; trembling of the legs ; severe weather, either hot or cold, causes great debility. Worse in the evening ; also after sleep, and periodically. LyCOpodium Clav. Stiffness of the joints; weariness, extreme weakness and emaciation, with tremor of the limbs ; sleeps poorly ; starts on falling asleep ; hunger at times excessive, and again diminished ; nausea and vomiting ; nausea before breakfast every morning ; nightly vomiting of bile ; tension in the lower part of the region of the liver ; sore aching in the right hypochrondria ; drawing pain in the abdomen; gurgling in the abdomen; in- effectual urging to stool ; hemorrhage from the rectum ; frequent and painful urination ; urine has a reddish, brick-dust sediment ; pain in the small of the back ; stiffness and aching, or drawing pain in the back ; chilliness of the small of the back ; cold and heavy feeling in the limbs ; for open cancer with tearing stitches ; burning pains in the vagina after intercourse ; warmth and dryness in the vagina; bloody leucorrhcea. Special Therapeutics. 259 Worse in the evening; also on lying down, while sitting, on beginning to walk, and from the pressure of the clothes. Better on getting cold, (and in the open air.) Magnesia Carb. Sad mood, with indisposition to talk; cutting and pinching in the abdomen; secretion of urine increased, is pale, watery, or green ; white sediment in the urine ; pressing towards the pelvis as if menstruation would come, with cutting in the abdomen ; menses too late, or suppressed ; menstrual blood thick, dark like pitch ; fluor albus of acrid white mucus, preceded by colic; pain in the back, and small of the back, at night, as if broken; sensation of being tired, especially in the feet, and when sitting; a short walk tires much. Worse at night ; also when at rest. Better from walking about. MerCUrillS. Disgust of life, great indifference to anything; sweat at every motion ; great inclination to sleep in the day time ; late and unrefreshing sleep at night; pain in the abdomen, the least touch aggravates it unbearably ; desire to urinate ; urine scanty, fiery-red, and of a sour smell ; griping or bruised pain in the small of the back; painful pressure in the thighs; menstruation too profuse, with anxiety and colic ; suppressed menstruation ; congestion of blood to the uterus ; swelling, heat, and shining redness of the labia; inflammation of the ovaries and uterus ; prolapsus vaginae ; fluor albus, purulent and acrid. Worse in the evening, and at night ; also from the heat of the bed, during perspiration, and when exercising. Better when at rest, when lying down, and from cold. Nitric acid. Irritable disposition ; vexed at trifles ; incontinence of urine ; urine is discharged cold ; soreness of the genitals ; menses too early, or suppressed menstruation; leucorrhcea acrid, offensive, like brown water; great debility, with heaviness and trembling of the limbs, especially in the morning. Worse in the evening, and at night ; also on awaking, and on touching the parts. Better when riding in a carriage. NlIX Vomica, Inclined to find fault and scold, morose and stubborn ; cannot bear the clothes tight about the hypochondria ; strangury, painful, ineffectual urging to urinate ; menses too early and profuse, with dark-black blood; congestion to, and bearing down of the uterus; inflammation of the uterus, and external 260 Surgical Diseases of the Female Genitals, parts; pain as if bruised in the small of the back and back, so violent that she cannot move ; numbness, stiffness, and tension in the legs ; great debility of the nervous system, with over-sensi- tiveness of all the senses ; inclination to lie down, or to sit, with aversion to move about, or to the open air. Worse in the morning, and at night ; also from motion, and on being touched. Better from pressure, and when lying down. Phosphorus. Great excitability, becomes easily vexed and angry, from which she suffers afterwards ; soreness of the abdomen to the touch when walking; increased secretion of watery, pale urine; menstruation too early and too profuse, and of too long duration ; or, too early and too scanty, and watery ; stitches upward in the vagina, into the pelvis ; leucorrhcea acrid, drawing blisters and excoriating; great emaciation and nervous debility, and trembling in all the limbs from the least exertion ; over-sensi- tiveness of all the senses. Worse in the evening, in the night, and in the forenoon ; also when lying on the back, or left side. Better when lying on the right side, and after sleeping. Phosphoric acid. Perfect indifference : the uterus is bloated, as if filled with wind ; weakness of the legs ; great drowsiness. Worse in the morning and evening ; also from talking, and when at rest. Better from motion. Platina met. No appetite ; much thirst ; empty eructations in the morning ; continual nausea, with great languor ; anxiousness, with a trembling sensation through the whole body ; a writhing sensation around the umbilicus ; constipation ; difficult stool ; red urine ; pain in the small of the back as if broken ; feeling of weak- ness with tremulous uneasiness in the thighs ; pain in the thighs as if they were bruised; painful sensitiveness of the genitals, in- ternally and externally ; bearing down to the genitals, and pressing down in the abdomen ; unnatural excitement of the sexual desire, with voluptuous tingling in the external and internal sexual organs ; induration of the uterus ; menstruation too early and too profuse, lasting but a short time, with clotted dark blood ; metrorrhagia, with great excitability of the sexual system ; paralytic weakness in the limbs, especially when at rest. Worse in the evening ; also when at rest. Special Therapeutics. 261 Better during motion. PrUflUS Spinosa. Cutting across the abdomen; tenesmus of the bladder; pain in the small of the back when sitting; tickling- itching in the region of the ovaries, not relieved by scratching or rubbing; menstruation too early, with violent pain in the small of the back ; metrorrhagia of thin, pale blood, becoming more watery the longer it lasts ; leucorrhcea excoriating, turning the linen yellow. Pulsatilla. Peevishness, which increases to tears ; menstruation too late, and too scanty, and of too short duration, with cramps in the abdomen; blood thick, black, clotted, or thin and watery; suppressed menstruation; metrorrhagia, with coagulated clotted blood, with false labor-pains, now stopping, and then stronger again ; leucorrhcea acrid, burning, like milk, and painless ; pains in the back, and chilliness from suppressed menstruation ; attacks of fainting, with great paleness of the face. Worse in the evening ; also from warmth. Better from cold, and in the open air. Rhus tox. Absence of mind; visible contraction in the abdo- men above the navel; frequent urging to urinate day and night, with increased secretion; diminished secretion of urine, although a great deal is drank ; bearing-down pain when standing ; cata- menia too early, too profuse, and too protracted; hemorrhage of clotted blood, with labor-like pains ; soreness and stitches in the vagina ; menstrual blood acrid ; pain in the small of the back when sitting still or lying; great debility, weakness and soreness, espe- cially when sitting, and when at rest. Worse in the morning; also when at rest, while lying down, during wet weather, when the weather changes, and from cold in general. Better when walking, from continued motion, and from warmth. Ruta graveolens. Inclination to quarrel and contradict ; gnaw- ing and eating pain about the navel ; frequent pressure to urinate, with scanty emission of green urine ; pressure on the bladder as if continually full, the pressure to urinate continues after micturi- tion ; menstruation irregular, followed by leucorrhcea ; corrosive leucorrhcea after the menstruation has ceased; pain in the back and on the os sacrum, as if bruised ; stitches in small of the back when sitting, walking or stooping ; sensation of soreness of the parts on which one lies. Worse in the afternoon? also during rest, and in cold we* weather. 262 Surgical Diseases of the Female Genitals, Better from motion. Sabina. Low-spirited and joyless; soreness of the abdominal muscles ; pressing down towards the genitals ; frequent and violent urging to urinate, with profuse discharge ; menstruation too early and too profuse ; hemorrhages with partly pale-red, partly clotted, or of very thin, discolored, offensive smelling-blood ; very offensive- smelling leucorrhcea, after suppressed menstruation ; stitches deep in the vagina ; increased sexual desire almost amounting to nympho- mania ; labor-like pains, drawing down into the groins ; twitching pulsation in the blood vessels. Worse in the morning, and in the evening ; also on motion, or when standing up. Better when lying perfectly still. Sangumaria can. Angry irritability, moroseness ; pain in the left hypochondria, worse when coughing, and better when lying on that side, or from pressure ; frequent and copious nocturnal urina- tion, urine clear as water ; menstruation too early, with a discharge of black blood ; amenorrhcea ; uterine hemorrhage ; flatulent dis- tension of the abdomen in the evening, with escape of flatus from the vagina, the os uteri being dilated ; bruise-like'pain in the thigh, alternating with burning and pressure in the chest; great debility, with weakness in the limbs while walking in the open air ; weak- ness with palpitation of the heart, fainting weakness. Worse in the morning, and in the evening ; also from motion. Better when lying still. Scllla maritima (Squilla). Restless sleep; complete loss of appe- tite ; empty eructations ; hard, scanty feces ; great desire to urinate, with rather scanty emission; the thighs feel as if bruised; jerking of the limbs when sitting; painful sensitiveness of the abdomen, in the region of the bladder. Worse in the morning ; also from motion. Secale COmiltum. Great anxiety; pains in the groins, as from false labor-pains ; urinary secretions suppressed ; pale, watery urine ; menstruation profuse, and of too long duration ; hemor- rhage from the uterus of black liquid blood ; swelling of, and warts on the half-open uterus ; inflammation of the uterus from sup- pressed lochia, or menstruation ; tingling in the back, which is numb, devoid of feeling, extending to the tips of the fingers. Worse at night ; also from motion, on touching the parts, from walking, from warmth, and on getting warm in bed. Special Therapeutics. 263 Better in the open air, and whilst standing. Sepia. For soft (?) scirrhous ; with painful pressure downwards, with burning in the parts, eruptions on the inside of the labia, soreness and redness of the vulva; lancinating jerks, from the fundus of the vagina to the umbilicus ; frequent bloody discharges between the periods, especially after intercourse ; putrid leucor- rhcea, (Jahr). Pressure at the genitals as if everything would protrude; induration of the neck of the uterus; violent stitches in the vagina upwards ; redness, swelling, and itching humid erup- tion on the labia ; catamenia too early and profuse, or too scanty or suppressed ; leucorrhcea of yellow or greenish water, like pus, or bad smelling fluids ; weakness of the small of the back when walking; pulsation in the small of the back; heaviness in the body ; a short walk fatigues much ; aversion to the open air ; want of natural heat ; weakness of the joints. Worse in the forenoon, and in the evening ; also when at rest, when sitting, from sexual excesses. Better from warm air, and from violent exercise Staphisagria. Weakness of memory; sensation of weakness in the abdomen, as if it would vanish ; profuse discharge of watery, pale urine, with much urging; painful sensitiveness of the sexual organs, especially when sitting; violent stitches upwards in the back; pulsative pain in the region of the hip-joint as in commenc- ing suppuration ; stiffness and sensation of fatigue in all the joints in the morning. Worse in the morning, forenoon, and at night ; also from sexual excesses, and from touching the parts. Better while lying down in bed. Strontiana Carb. Ill-humor, with inclination to anger and impetuosity; urine pale, strongly smelling of ammonia; menstrua- tion retarded, the discharge being serous at first, later clots of blood are passed; sensation of being bruised in the back and sacrum ; great emaciation. Worse in the evening, and at night ; also from cold. Better in the open air, in the sun, and from warmth in general. Sulphur. Peevishness, irritability, restless, quick temperament; movements in the abdomen as from the fist of a foetus ; retention of urine; frequent micturition at night; discharge of urine only by drops; foetid urine, with a greasy pellicle on it; menstruation too late, of too short duration, too scanty or suppressed; men- 264 Surgical Diseases of the Female Genitals. strual blood acrid, corroding the thighs, smelling sour, or else too pale ; bearing-down in the pelvis, congestion to the uterus ; leucor- rhcea of yellow mucus, corroding, preceded by pains in the abdomen ; pain in the small of the back, on rising from a seat ; gnawing pain in the small of the back ; pain in the small of the back not permitting one to stand erect ; weakness of the joints. Worse in the evening, or after midnight ; also on getting warm in bed, from exertion of the body, from talking, while at rest, when standing, and from touching the parts. Better during motion, when lying on the right side, from heat, and in dry weather. Sulphuric acid. Restlessness and irritability; Jahr says, in most cases, (of cancer) at the onset, especially in open cancer, with violent burning pain in the vagina. Lippe : Pain in the abdomen like labor, extending to the hips and back ; menstruation too early and too profuse; impotence, with too early and too pro- fuse menstruation; leucorrhcea acrid or burning, or like milk; stiffness of the back on rising in the morning ; painful weakness of the knees ; weakness of the whole body, with a sensation of trembling. Worse in forenoon, evening, and at night; also in the open air. Thuja Occident. Movements in the abdomen as if from some- thing alive, or as if the muscles were pushed out by the arm of a foetus, but painless ; profuse perspiration before menstruation ; foaming urine, the foam remaining a long time; beating and pulsating in the back ; when walking the limbs feel as if made of wood. Worse in the evening, and at night ; also from cold-wet, and from the heat of the bed. Better from warm-wet, and from turning from the left to the right side. Uva UPSi. The indications are not characteristic, and of very doubtful authority. I presume it is used empirically. Veratrum album. Great sensitiveness of the abdomen to the touch ; suppressed urinary secretion ; continuous urging to urinate : catamenia too early, and too profuse ; suppressed menstruation ; on appearance of the menses, diarrhoea, nausea, and chilliness; before mentruation headache, vertigo, night sweat, and epistaxis ; during the menses, morning headache, nausea, ringing in the ears, thirst, and pain in all the limbs ; suppressed lochia, with delirium; nymphomania of lying-in women ; back and small of back feel Special Therapeutics. 265 sore as if bruised ; sudden sinking of strength ; continuous weak- ness and trembling. Worse in the morning ; also during perspiration and after sleep. Better after perspiration. Operations. Entero-vaginal fistula had better be let alone. All the other varieties of fistula opening into (or from) the vagina, are curable by operation. The main object in these operations is, to prevent the passage of feces or urine through the vagina. For this pur- pose the fistula must be made to heal from the bottom. If the opening be circular or oval, the shape must be changed. Introduce a bivalve speculum into the canal, and with a long-handled knife remove an elliptical-shaped piece of the coats through the entire thickness of the walls ; this must include the hard callous edges ; draw the freshened edges together. One of the greatest difficulties formerly, was the impossibility of getting the sutures to hold long enough for the wound to unite. Dr. Marion Sims has overcome this, by the introduction of his "button suture." When a stitch is passed through in the ordinary way, there is constant danger of its cutting its way out before union has been established ; by his method, the two ends are passed through the holes of an ordinary button, and if wire, are then twisted together by forceps; if of silk, a split shot is applied with pliers. The after treatment will consist in the administration of Stafihisagria, and enjoining perfect cleanliness on the part of the patient and nurse, with perfect quiet on that of the patient. The bowels must be kept perfectly im- movable, and in urinary fistula, a catheter must be constantly worn, Ovarian tumors are removed by making an incision through the linea alba, from the umbilicus nearly down to the pubis. The cysts are then emptied with a trocar and canula, one at a time, and, for the sake of accuracy in keeping your " notes," the fluid is measured as it comes away. A carbolized cat-gut ligature may be passed through the pedicle of the mass doubled, and tied tightly on both sides, or the vessels closed by torsion. The whole is then removed, by some with the knife, but by many others with the ecraseur. The same precautions about dividing the fascia and peritoneum are to be observed as in hernia. Avoid all unnecessary handling of the exposed parts, as peritonitis, inflammation of other tissue, and gangrene are very commonly met with, and fre- quently carry off vour patient. 266 Surgical Diseases of the Joints, SURGICAL DISEASES QF THE JOINTS. SYNOVITIS, ARTHRITIS, WHITE-SWELLING, ANCHY- LOSIS, HIP-DISEASE, ENLARGED BURS^E, GAN- GLIONS, WOUNDS, DISLOCATIONS, STRAINS. Synovitis. This is an inflammation of the synovial membrane. It may be acute or chronic, traumatic or (so-called) idiopathic. The causes are exposure to cold, or some direct injury. To the first cause rheumatic and syphilitic persons are peculiarly liable. The syn- ovial fluid is not only increased in quantity, but also in fluidity ; and when the swelling is great it is known as hydrarthrosis. The simple form usually terminates in resolution, but may result in an abscess. The gravity depends upon the size of the joint. Sup- puration is the one thing to be dreaded in all cases. The symp- toms are, pain, heat, redness and fluctuation. The pain is usually severe, not admitting of pressure, motion, or even the lightest touch. In rheumatic synovitis, the pain is of a gnawing character. Arthritis. Gout is an inflammatory condition of the structures of a joint. The pathological conditions are interesting as pathology, but can aid us but little in treatment. The cartilages are primarily and most severely affected, and anchylosis often results. It is often hereditary, and when not so rarely makes its appearance before the 'age of thirty-five, though if transmitted, it may, and usually does, appear much earlier. It is not confined to any particular locality of the body, although the joints are principally affected. Some, or any of the internal organs may be so diseased by metas- tasis, but rarely primarily. Among the exciting causes, when there is arthritic tendency, may be enumerated wounds, strains, exposure to cold, etc. Frequently concretions form, which may force themselves through the skin, and are usually composed of Wh ite - Swelling. 267 urate of soda. Nodosites also are a usual occurrence. Several joints may be affected at the same time, and the pain, without pos- itively intermitting, has a periodical aggravation, and partial remis- sion. In common, there is pain, heat, and swelling. The pain is throb- bing and tensive, and is very acute ; the slightest touch or motion is excruciating, so that heavy walking, the jarring of the bed, or the rumbling of vehicles in the street is insupportable. The suffer- ings are usually more severe at night. The pain is felt more particularly at certain spots in the joint, as the inner and under side of the knee, or the outer side of the hip. The swell- ing is uniform, including the whole joint ; while in synovitis, it projects in certain parts. Unlike synovitis again, there is no fluc- tuation, but the part has a doughy feel and is soft. This swelling, however, sometimes increases rapidly, and is due, perhaps, to the presence of pus in the joint, or to an, increase of the synovia. Abscesses sometimes form, from the effects of which the synovial membrane gives way, and we have an enormous diffuse abscess, which burrows for a long distance. I have seen one formed in the hip and point in the popliteal space. As in hip-disease, the joints involved sometimes become spontaneously luxated. The positions of the limb are also peculiar, being that which will afford the most relief, as the knee flexed and thigh abducted, and the elbow bent. One of the most important conditions is to preserve a perfect rest, and avoid all stimulating or heating diet. Rest, perfect and abso- lute is the prime indication, and without it any treatment will be abortive. White-swelling. By this term we understand a thickening of the joint, colorless swelling, weakness, with little or no pain ; the remainder of the limb atrophied, and the whole appearance indicating the presence of struma. Any joint in the body may be affected by this disease but the knee is oftenest the chosen seat. The termination is rarely by resolution ; oftener the cartilages are destroyed, caries or necro- sis of the bone are the result, with unhealthy suppuration and consequent destruction of the articulation. Like many other dis- eases of this nature, the occurrence is rarely idiopathic, but usually the amount of injury sustained is so slight that its traumatic origin is not suspected. Liston and Gross, considering it a symptom of scrofula, discarded the term from surgical nomenclature. 268 Surgical Diseases of the Joints ANCHYLOSIS. • By this we understand an immovable joint. It may be partial or complete. When the former, it may be ligamentous, or if care be taken in the examination, it may be found to be contraction of the muscles. When complete it is osseous, and I believe incur- able, by any kind of treatment, except possibly, by an operation. The causes for this condition have been referred to in the preced- ing pages. Hip-disease. " Coxalgia," or " morbus coxaria," is an inflammation of the hip joint, with destruction of the cartilages, spontaneous dislocation, and destruction of the joint. I am unable to see in what respect this disease differs from white-swelling just considered. The effects and causes are identical, as far as I can learn, and certainly the treatment, as far as we are concerned, is not changed in con- sequence of its having a new name. The symptoms, then, are not at all peculiar. They are pain, swelling, and inflammation ; per- haps suppuration and shortening of the limb, real or apparent. The pelvis may be distorted, or the spine curved, and these parts must be well looked to before pronouncing an opinion. In the early stages, pain is often felt in the knee ; but as this joint looks healthy while the hip does not, there need be no confusion. Abscesses form at various points in the vicinity, and from their extent and severity frequently carry off the patient from exhaus- tion. Enlarged burs^e. BurSjE from pressure or long continued misuse of the part upon which they are situated, become inflamed, forming painful and fluctuating tumors, oval in shape. After a time they become harder from a solidification of their contents, and resemble ordi- nary tumors. Not unfrequently they suppurate and are destroyed in that way ; but when recent the pain is very severe, although there is a considerable amount of pain at all times. Those tumors known as bunions are a common variety of this affection. Ganglions. These bodies are found in the vicinity of tendons, their chosen position being the wrist. They are smooth, globular and elastic, Wounds of the Joints. 269 and quite movable. Usually there is no pain, unless they are handled or pinched, when a dull pain is felt. If a nerve be pressed upon by them, however, pain and the symptoms usually resulting from such pressure will be felt. They may be simple or compound. When simple, (which variety is the most common,) they consist of a cyst filled with a clear transparent fluid, and varying in size from a pea to that of an ordinary cherry. The contents are usually yellow in color, and varying in consistency from a thin water to a substance like jelly. Compound ganglia are a mere distension of the sheaths of the tendon, and are con- sequently more irregular and attain a larger size. Wounds of the Joints. Wounds of joints are troublesome injuries to treat; anchylo- sis, and a train of evils consequent upon opening a joint, are all of them very obstinate. If we notice the escape of the synovial fluid, we may be certain the joint is opened; in many very severe cases, we find the articulation exposed. The symptoms of these injuries are very severe, and of course depend in a great measure upon the size of the joint opened; that of the knee is the most serious; anchylosis, suppuration of the joint, necrosis, or even death may follow ; but in the case of the fingers, but little impair- ment of function will follow. The nature and extent of the wound also must be taken into consideration, in forming a prognosis. Incised wounds are not as formidable as punctured, although they look much more so ; an incised one can be healed right up, and we have a better chance to prevent suppuration. In this variety, close it immediately, and use pins, or silver wire in preference to silk ; keep the part wet with cold water, and give Aeon. 6, in water, one spoonful every hour. After this treatment has been employed for twenty-four hours, suspend it, and use the topical Staphisagria treatment. If this is insufficient to keep the inflammation in check, Staphisagria 30, internally, will be the remedy. I have sometimes had good results from the external use of crude Petroleum, but am not inclined to recommend its general use. As an exception to the general rule, if suppuration threatens, do not by any means pro- mote the secretion of pus j exhaust the Materia Medica in trying to prevent it. Should it come, however, the only chance of saving the joint is to lay it open, and commence de novo. By this means we 270 Surgical Diseases of the Joints. ensure a stiff joint, but lessen the danger of caries or necrosis. The best remedies for this danger are : From incised wounds. — Calend., Staph., Rhus. From punctured wounds. — Calend., Merc, Ruta; Petrol., Stram. In the case of punctured wounds, Calend. is not as useful as some other remedies. Stram. is more in favor with the profession. Of late the crude Petroleum, not the white, gummy substance, but the black, pitch oil, just as it comes from the wells, has been used with very good results. Dilute it, in the proportion of one to ten, with Sulphuric ether, and use it as a lotion. The question of amputation is a serious one in these cases ; it is too often resorted to by some, and too little by others. When the joint is large, the patient has not a strong constitution, the injury extensive, accompanied by lacerations, fractures, disloca- tions, amputation, except in some rare cases, is imperatively demanded. Blows and kicks are often productive of serious bruises about the joints. , Dislocations. Dislocations, otherwise called luxations, are displacements of two or more bones. A dislocation may be accidental, from external violence, or spontaneous, from disease. It may also be incomplete, in which case the displacement is but partial, and not necessarily conjoined with rupture of the ligaments : or complete when the lig- aments are torn, and the bones completely out of their natural relations. When an external wound exists at the same time, it is called a compound dislocation ; and if arteries or nerves are torn, or a bone fractured, it is termed complicated. It is frequently the case that a very slight force will induce a dislocation of a large joint, so that caution must be used in mak- ing a diagnosis. A boy was struck on the hip by an apple falling from a tree. The blow was a slight one, but careful examination revealed a complete dislocation of the femur. The most constant signs are pain, immobility more or less com- plete, and distortion of the limb. Pain is often more violent in inverse proportion to the amount of injury sustained, or rather to the completeness of the luxation. Thus there is oftentimes more pain in a partial dislocation of the semi-lunar cartilages of the knee-joint, than in a complete luxation of the hip. Immobility, on Disloca tions, 271 the contrary, seems to be greater the more complete the displace- ment. This is true also of deformity. ' Having correctly diagnosed the case, let us consider the indica- tions to be fulfilled in curing it. These indications are reduction, retention, and restoration of the joint. Reduction is to be accomplished with the least possible exertion of force — violent effort, as the use of pulleys, only complicates the case, as the irritability of the muscles is much increased, and injury may be inflicted on the muscles, bloodvessels, or even the bones, very readily. A thorough knowledge of the mechanism of the joint is indispensable. By producing profound anaesthesia, gentle manipulations will invariably, almost, return the bone — of course these manipulations vary in the different joints, and cannot be given here, but this general rule may be laid down : First place the limb in such a position that the muscles are thoroughly relaxed ; then fixing the shaft near the luxated extremity, over some fixed point, (or if none exists, over the hand,) the shaft is converted into a lever, and the extremity lifted or rotated — as the case may be — into its proper place. Having thus reduced the luxation, we must now consider the means to be used to accomplish retention. They must be as simple as is consistent with safety. I make it a rule, in all cases except the shoulder perhaps, to dispense with bandages, or any heating and unyielding dressings or splints. Secure extension and coun- ter-extension, and lay a bran or sand-bag on each side of the limb. A. limited amount of motion is valuable in place of being hurtful. The luxation has now been reduced, and the joint retained, but we have still to cure our case ; that is to restore the tonicity of the parts involved, or to heal any lesions they may have sustained. Rest does a good share of this, but well-selected remedies hasten it. Rhus and Ruta are oftenest indicated in partial dislocations. R/ius, when, joined to the usual symptoms of a sprain, there is irritation of the skin, a fine vesicular rash, and a feeling as if at every motion of the joint {ankle f) the bones spread apart. Should there be much laceration of the soft parts, Calend. is the remedy. In fracture complications, Syinphyt. Should an artery be torn, it must be tied of course. It is a matter of considerable difficulty to detect this injury, and fortun-r ately it but rarely occurs. Should gangrene threaten, from a wounded artery cutting off the supply of blood, and the tissues in 272 Surgical Diseases of the Joints. the neighborhood being much torn or contused, Ars. or Lack, in connection with external heat may save the limb. I recommend the use of all these remedies in the higher attenuations, and inva- riably trust to them alone without any external medicated lotions. A serious question sometimes arises in complicated dislocations, viz : whether the limb can be saved or not. It is a question of such magnitude, that it is not safe to act on your own opinion when counsel can possibly be had. Two facts must always be borne in mind : 1 st. — It is as much an error to neglect to amputate when needed, as to perform it when it might be avoided. 2nd. — Nature can and does perform some most wonderful cures in what would seem to be the most hopeless cases, when aided by rational treatment. Let me cite one case to support this : A carpenter fell from the roof of a building, sustaining a com- plete complicated dislocation of the right ankle — the sole of the foot looked almost directly upwards, integument torn so the joint was open, all the internal ligaments upturned, and the fibula frac- tured. Reduced. Treated with Calendula, followed by Sympht. Recovering with an anchylosis of course, but a singular compen- sation occurred. He has a complete joint at the meta tarso phalangeal articulation. Strains. Injuries to Muscles and Tendons consist in rupture or strain. The rupture of a muscle or tendon, is quite a common thing, and may occur in all degrees of severity. A partial rupture is not readily diagnosed, but when it is complete, the question is quickly decided. When an accident of this kind occurs, perfect rest, and a position that will ensure complete relaxation of the muscles, is necessary. The subsequent treatment is that for repairing severed parts after sub-cutaneous operations. Calendula 30th, or even higher, will be found very useful in this connection. There is but little risk of any unpleasant consequences, save the danger of contraction of the muscles, which a good position during the treatment will avoid. These injuries are nothing but an aggra- vated form of sprain. Strains are violent twisting of the soft parts surrounding a joint; they may be a stretch of the muscles only, or of the tendons, the ligaments, or even a partial dislocation. The accident is most Strains, 2 73 commonly met with in the ginglymoid joints, and in some people is an accident frequently repeated. It has happened sometimes, that one of the vessels of the joint has been ruptured, thus pro- ducing heat, ecchymosis, and other troubles of a like nature. I am opposed to local treatment in any cases save those of wounds alone. I should recommend then, to maintain perfect quietness on the part of the patient, and the internal use of remedies alone. The remedies most frequently used are, Arnica, Bryonia, Conium, Natrum mur., Petroleum, Rhus fox., Ruta g., Sulph. Arnica. Hot, hard, and shining swelling of the part affected ; red, blue, and yellow spots, like ecchymosis ; painful lameness in the joints; disagreeable sense of dull tingling, or dull pain in the affected part. Bryonia. Heaviness, and weakness in the limb; trembling of the limbs, when rising from a recumbent posture ; stiffness of the joints; weakness; loss of strength on making the least effort ; red- ness of the part, with pain as if luxated, or sprained by lifting, or wrenching ; ecchymosis, with swelling, and stinging. Conium mac. Crampy, and spasmodic pain in the part; violent pain as if from bruises in the limbs ; lacerating in the sprained part; pulsative jerking; want of animal heat; chilliness. Natrum mur. Sprains with apparent shortening of the tendons ; drawing and pressure in the part ; inflamed and smarting ; feeling as if the flesh were detached by blows ; feeling as if the part had gone to sleep ; on stepping on floor, feels as if he were walking on red-hot coals. Petroleum. Cracking of the joints, with stiffness; paralytic drawing with pressure; the arms and legs go to sleep easily; weakness of the joints ; pains in the limbs as if bruised ; stitching pain, or as if from a splinter in the part. RHUS tOX. Some time ago, I had a patient who, whenever she had her ankle sprained, suffered with a peculiar pain, which lasted for days, or even one or two weeks ; this pain I removed any time in twenty-four hours. It is a symptom that you will not find in the Materia Medica; sensation as if the bones of the ankle were split, and spreading apart when she stepped on that foot, closing again on raising it; other indications are: swelling of the parts, with inflammation and stinging ; the pains are worse on beginning to move ; go off after motion ; stitching in the joints ; lacerating draw- ing in the parts ; lameness of the ioints. 18 274 Surgical Diseases of the Joints. Rllta graveolens. Bone pains, burning and gnawing in the periosteum ; pains in the joints as after a fall, or contusion ; pain in the bones of the wrist joint, as if bruised, both during rest and motion ; heaviness, and weakness of the limbs. Sulphur. Drawing pain in the limbs in the evening; sticking pains in the joints ; violent drawing and lacerating in the knees ; pains with great swelling ; also pains with no swelling ; redness, numbness, or burning of the parts ; itching, stinging, smarting, and swelling. Treatment. — In conducting the treatment of diseases of the bones and joints, there must be no frittering away of important time with topical treatment; use the remedies internally alone. In diseases of the joints consult the following : Synovitis: from Cold. — Aeon., Bell., Bry., Cham., Chin., Dulc., Graph., Lye., Merc., Nux v., Puis., Phos., Rhus, Sep., Sulph., Verat. from Injury. — Arn., Baryt., Con., Hep., Rhus, Ruta, Staph. , Sulph. from Syphilis. — Apis, Ars., Hep., Merc., Nil. ac., Sulph. , Thuja. from Scrofula. — Ant. e, Apis, Ars., Aur., Baryta, Bell. y Calc. c, Car bo v., Dulc, Hep., Iod., Kali, Lye, Merc, Nit. ac, Nux v., Phos., Puis., Rhus, Sep., Sil., Sulph. Arthritis: Aeon., Bry., Puis.; Arg., Am., Aur., Calc, Clem., Colch., Coloc, Con., Guaj., Hep., Iod., Kali, Led., Lye, Mang., Mezer., Phos., Rhod., Sabin. Arthritis Vaga : Am., Asa/., Mang., Nux mos., Plumb., Puis., Rhus. Nodosities. — Agn. c, Ant. c, Aur., Bry., Calc, Calc. phos.. Graph., Led., Lye, Phos., Rhod., Sabin, Sep., Sil., Staph., Zinc. Contractions. — Bry., Calc, Coloc, Guaj., Rhus, Sil., Sulph. from Working in Water. — Calc, Puis., Sarsap., Sulph.; Ars., Ant. c, Dulc, Nux v., Rhus. — Precursory Symptoms. — Nux v. — Recent Metastasis. — Bell. White Swelling : Aeon., Apis, Am., Ars., Bell., Calc, Con. Graph., Hep., Iod., Lye, Merc, Nux v., Phos., Puis., Rhus, Ruta, Sil., Sulph. Anchylosis: Aeon., Am., Ars., Borax, Bell., Bry., Kali, Mere, Rhus, Ruta, Sil., Sulph. Special Therapeutics. 275 Hip Disease; Am., Ars., Bell., Bry. y Calc, Coloc, Hep., Merc, Puis., Rhus, Sulph. Enlarged Burs^e : Apis, Ars., Bell., Hep., Merc., Sil., Sulph. Ganglions: Apis, Am., Ars., Baryta, Bell., Con., Kali., Merc, Ruta, Sulph., Thuja. Aconite. Swelling and burning heat of the joint; bruised pain in shoulder and hip-joint ; drawing pain in elbow joints ; weakness in region of head of femur, with inability to walk, and a feeling as if it had been crushed, particularly after lying down and sleeping ; unsteadiness of the knees, they totter* and give way when walk- ing; tearing in the knees as if from a jerk in the inner side; the joints feel painful as if attacked with inflammatory rheumatism; swelling and burning heat of the skin of the affected parts ; burn- ing, tingling, and piercing jerks in the lower jaw; painful boring to the left of the lumbar vertebrae ; aching pains in the left half of the cervical vertebrae. Worse in the evening, and at night; also in the warm room, and when rising. Better in the open air, and when at rest. AgnilS C. Lacerating pain in the joints of the arms; swelling of a finger-joint, with lacerating pain; pain in right hip-joint, violently increased during motion, with debility and weariness; shooting-drawing in the knees and muscles ; tearing in the anterior joints of the left toes. Worse in the evening; also on motion. Better from strong pressure. Antimonium Crud. Red, hot swelling of the joint; blotches and vesicles as if from the stings of insects, in joints ; drawing pain in the finger-joints ; also in hip-joint ; stiffness of knee. Worse at night; also from heat of the sun. Better when at rest. Left side. Apis mel. (Have cured the following: Arm painless; elbow swollen, red, erysipelatous; fine burning-pricking in the skin; hand looks like wax, and on attempting to lift it, it trembles so that it must be held ; inability to move the shoulder-joint ; swelling extends for some distance above and below the joint). Sensitive- ness to the touch ; coldness and swelling of the legs ; oedematous swelling of the joints. Worse in the morning, and at night; also from heat. Better from cold water. Left side. 276 Surgical Diseases of the Joints, Argentum met. Feeling of lameness in the elbow -joint; lameness in the hip-joint and thigh, when walking; cramp-like lacerating in the knees ; pain as if bruised, and throbbing in the joints of the feet. Worse at noon ; also from motion. Better when at rest. Arnica mon. Heaviness in all the limbs, with painfullness in the joints as if bruised ; pain as from a sprain in the wrist-joint * also in the hip ; stitches in the knee ; pricking in the knee when touched ; lacerating in the joints of the leg ; hot, hard and shining swelling of the affected parts ; painful concussions in the limbs when riding in a carriage, or when stepping hard on the ground. Worse in the morning, and at night ; also on moving, from being touched, and from cold. Better from warmth. Arsenicum alb. Drawing and lacerating in the joints of the arms, particularly at night; lacerating in the hips; tearing or drawing lacerating in the knee-joints, and tarsus ; stiffness of the knees and feet ; tearing in the bones ; burning in the bones ; pain as if the bone were swollen, or interstitially distended ; pain as if from an ulcer in the bone. Worse in the morning, and at night; also from cold. Better from warmth. Asafoetida. Intermittent, pinching, pulsative, or oppressive darting pains ; also lacerating pains from within outwards, either relieved by touching the parts, or transformed into different kinds of pains ; dark-red, hot swelling of the parts ; stitches in the shoulder ; also in the elbow ; lacerating around the hip-joint when walking ; inflammation of, with curvature of the bones ; scraping and boring in the periosteum ; violent painfulness of the bone to the touch. Worse in the afternoon and evening; also to the touch, and while sitting. Better in the open air. Left side. Alirum met. Dropsical swelling of the joint ; fine stitches in the shoulder ; lacerating pain in the wrist ; lameness and pain in the hip-joint, only when raising from a seat, and walking ; pain in the knees as if tightly bandaged. Nightly bone-pains ; inflam- mation and ulceration of the bones; bony tumors on the head, arms and legs; the bones of the skull are painful when lying Special Therapeutics. 277 down ; small exostosis on the head, with boring pain, increased when tumor is touched ; the right nasal bone, and adjoining parts of the upper jaw, are painful when touched ; violent lacerating in the malar bones ; caries of the palate, with bluish ulcers. Worse in the morning ; also from cold, and when reposing. Better when moving, and from warmth. Baryta Carb. Pain in the elbow, as if from a contusion. Bone- pain at a small spot on the upper arm, as if an ulcer would form there ; lacerating and tension in the bones of the lower extremi- ties down to the heel ; drawing pains in the bones of the legs. Worse at night ; also when sitting, and when lying on the painful side. Better when walking in the open air. Belladonna. Erysipelatous swelling of the parts, with heat, redness and inflammation ; lacerating with pressure in the shoul- der-joint; lameness and lacerating in the wrist-joint; burning- stinging in the hip-joint ; stiffness of the hip-joint ; stiffness and immobility of the limbs ; tingling in the part. Pain as if bruised in the bones ; burning and lacerating pain in the left frontal emi- nence ; violent gnawing pain in the region of the frontal eminences ; lacerating and drawing below the malar bones ; lancinations from without inwards in the lumbar vertebrae, like stabs with a knife ; lacerating in the tibiae. Worse at night ; also when moving, from touching the parts but softly. Better while lying down. Right side. Bryonia alba. Stiffness of all the joints ; stitches in the joints when moving or touching them; shining red swellings, or pale col- orless swellings of the part ; swelling of the elbow-joint ; pain in the wrist-joint as if sprained ; tension in the ankle-joint, with hot, red, inflammatory swelling of the feet. Corrosive gnawing of the bones of the head ; tension and painful stiffness of the joints. Worse in the evening; also from motion, and from heat. Better from reposing, when still, and on getting warm in bed. Right side. Calcarea Carbon. Pain in the shoulder and elbow-joint, as after great fatigue ; pain as if from a sprain in the right wrist joint ; stitches in hip-joint when stooping ; stitches in the knee ; feeling as if something in the right wrist joint had been contused. Worse in morning and night ; also from cold, and pressure of the clothes. 278 Surgical Diseases of the Joints. Better from warmth, on loosening the garments, and on drawing up the limbs. Right side. Calcarea acet. Cutting in the acetabulum when sitting. Calcarea phos. Pain in the joints with every storm ; exostosis. Cantharides. Lacerating in the joint affected ; swelling, heat, redness, or even gangrene of the part ; drawing pain in shoulder- joint ; boring in the knee, with contraction of the lower limbs. Worse in the morning; also every seven days. Better when lying down. Right side. Carbo veg. Bruised feeling in the joints ; paralytic weakness of the shoulder and whole arm ; pain as if from contusion in the elbow-joint ; drawing in the metacarpal bones ; lacerating in the wrists ; drawing pain in the hip-joint that extends down the thigh ; burning about the knee ; lameness of the knee-joint. Lacerating in the bones of the head ; burning in bones ; drawing pain in the upper and lower jaw; lacerating jerks in the right upper jaw; spasmodic pain in the lower jaw. Worse in forenoon ; also in the open air, from poultices and pressure. Better after lying down. Chamomilla. Bruised pain in all the joints, as if they were worn out ; cracking of the knee when moved ; sensation of numb- ness in the affected extremity. Worse at night ; also when lying down, and from touch. Better when rising. Left side. China Off. Pain in the joints as if bruised; stiffness of the joints ; pain with lameness or weakness of the affected part ; dart- ing lacerating pains, hot swelling of the right knee, with drawing, lacerating pains ; darting lacerating pains in the metatarsal and phalangeal joints, increased by contact, not changed by motion. Worse at night ; also from the slightest touch. Better in the room. Left side. Clematis. Arthritic nodosities in the finger joints; shooting, lacerating in the knee. Worse from the heat of the bed, and from washing. ColchiCUITI. Lacerating in the elbows, in the direction of the upper arm ; lacerations in finger-joints. Tearing pains in both muscles and joints. Pains wander from part to part. They feel as if in the periosteum, and are accompanied by a paralytic feel- ing, together with a loss of muscular power approximating paralysis. Special Therapeutics. 279 The action of Colch. is more marked on the small joints than on the large. Worse in the evening and at night ; also from motion and contact. Better while reposing. Right side. ColOCynth. Flying pains in the shoulder ; stiffness of the knees ; darting pains in the ankles ; stitches in the knee-joints ; burning pain in the affected part. Worse in the afternoon and evening ; also when lying on pain- less side. Better when lying on painful side, and moving. Right side. Conilim mac. The shoulder feels as if pressed sore ; paralytic, drawing pain in the wrist-joint ; drawing pain in the hip-joint ; dull pain in the knee when stepping ; arthritic pain around the knee- joint ; pain as if from fatigue in the knee ; dull pain in the tarsus ; cracking in wrist-joint. Bones of the extremities feel as if in a tight band ; cancer in the middle of the long bones ; drawing pain in the temporal bones ; aching of the facial bones ; stitches in the small of the back, with drawing through the lumbar vertebrae when standing; periostitis, with throbbing and burning pain, as if from an ulceration. Worse in the morning and at night ; also when standing, lying down, and when lifting the affected part. Better from letting the affected limb hang down, from moving, and walking. Right side. Digitalis. Piercing pain in the joints; pale swellings ; dull sen- sation in elbow-joint ; stiffness in the joints 01 the lower limbs ; the knees feel as if greatly fatigued ; swelling of the knee with a stinging pain ; pain in the hip-joint ; grating nodosities. Worse after breakfast and dinner. Dulcamara. Corrosive gnawing in the outer side of the elbow; weariness of the knees. Painful stitches in the middle of the dorsal spine when breathing; boring in temples; painful weari- ness in tibia. Worse in the evening ; also when at rest, from cold air, and in wet weather. Better from moving about. Left side. Eupatorium. Painful soreness in both wrists, as if broken or dislocated : painful soreness in right parietal protuberance ; pain in the bones as if broken. Graphites. Stiffness in the joints of the arms and knees, with 280 Surgical Diseases of the Joints. liability to become strained ; stitches in the elbow and shoulder joints; paralytic pressure in the elbow-joint; pain as if sprained in joint of thumb ; arthritic lacerating in hip-joint ; tension in the bends of the knees ; pain as if from bruises in knee. Pain in the periosteum of all the bones ; gnawing pain in the bones of the forearm ; drawing pain in the bones of the thigh ; the malleoli painful to the touch. Worse at night ; also from cold. Better from warmth. Guaiacum. Drawing pain in knee, terminating in a stitch. Dull ache in the left jaw ; drawing and lacerating along the right side of the vertebral column ; lancinating lacerations in the bor- ders of the scapulae ; painful drawing and lacerating in the arm. Worse in morning and forenoon ; also in the open air, and from contact. Left side. Hepar SUlph. Stitches in the joints; hip-joint feels sore and painful as if sprained when walking; pain as if from bruises in the knees. Bone diseases from abuse of Mercury. Nasal bones are painful to the touch ; contractive sensation in the nose ; sharp pressure and pain, as if from burns in the lumbar vertebrae ; pain as if from bruises in the humeri. Worse at night ; also from colds, when lying on painful side, from pressure, and on touching the parts. Better from warmth. lodium. Lancinating in joints ; rough, dry skin over the joint affected ; violent stitches in shoulder-joint, even when at rest ; tensive pain in finger-joints when bending them ; inflammatory swellings of the knee, with violent pains and suppuration ; drop- sical swelling of the knee. Worse in the evening and at night ; also when lying on the pain- ful side, from pressure, and from warmth. Better from cold, and after rising from the bed. Right side. Kali Carb. Stitches in the joints and tendons ; stiffness of the joints of the arm ; lacerating in elbow and wrist-joints ; painful lameness of the joints of the arm ; crampy lacerating in the hip- joint ; lacerating in knee-joints ; pain in hip-joint as if from a bruise; paralytic sensation in knee; spasmodic lacerating in ankle- joint ; frequent lacerating in the tarsal bones ; lacerating in the phalangeal joints of the toes. Worse in the morning ; also in cold air, and when lying on the side. Special Therapeutics, 281 Better from warmth. Kreasote, Pains in the joint as if sore and ulcerated; as if bruised or contused ; frequent pains in the elbow-joint ; drawing pains in the fingers ; darting pain in and above the knee. Worse in the morning; also in the open air, and on moving. Better from warmth. Left side. Lachesis. Contraction and stiffness of the joints, with lacer- ating in the limbs ; lacerating pain in the elbow; pain in the wrist- joints as if they were sprained ; lacerating in the hip ; stinging, or lacerating in the knees. Throbbing in the bones in the neighbor- hood of the ear; drawing in the bones of the nose; drawing in the malar and jaw bones; lacerating in the jaw; pain in arm bones; lacerating in the bones of the legs. Worse in the evening; also in the open air, and from cold. Better from warmth ? Right side. Ledum pal. Lancinating pain in the joints ; painful hard tuber- cles and tophi in the region of the joint ; painful sticking in the shoulder-joint on lifting the arm ; pressure in both shoulder-joints, more violent during motion ; pressure in the elbow; laming, rheu- matic pain in hip-joint; pressure in the region of the hip-joint; weakness in the knee-joint, and lacerating pressure in those joints when walking; swelling with tensive and pricking pain in the knee when walking. Worse in the evening and at night ; also from heat and motion. LyCOpodium. Drawing and pressure in all the joints, more especially the knees; stiffness of the joints lacerating pain in shoulder and elbow-joints ; paralytic pain in shoulder-joints • bruised pain in shoulder-joints ; fingers stiff from arthritic nodosi- ties ; finger-joints swollen and inflamed ; rheumatic tension in the hips ; paralytic pain in the hip-joint ; pain as if from a sprain in the hip-joint; stiffness of the knee-joint; tension around the knee ; lacerating in the knees and ankles ; pain as if from a sprain in the knee-joint ; swelling of the knees ; swelling of the ankle. Bones are painful when touched ; lacerating in the malar bone and upper jaw; drawing in the jaws; drawing or lacerating at times in the lower jaw ; pain as if from bruises in the scapulae, shoulders and upper arm ; nightly bone pains. Worse in the evening ; also when lying down, when rising from a seat, and from the pressure of the clothes. Better on getting cold. Right side. 282 Surgical Diseases of the Joints. Manganum. Drawing, lacerating stitches; soreness and cracks in the bends of the joints ; tensive pain in the arm and carpal joints ; darting pain above the knee. Worse at night; also on stooping, and to the touch. Better : The symptoms which appear in the room, disappear upon going into the open air ; and vice versa. Right side. MerClirillS. Arthritic pain and swelling of the joints; arthritic pain attended by very copious sweat, which does not afford any relief; sweat at every motion ; cracking in the shoulder and elbow- joints ; lacerating in the shoulder-joint, humerus and wrist-joint ; painful stiffness of the wrist-joint ; lacerating in the hip-joint ; the knee-joints are painful, and feel as if broken; lacerating in knee- joint. Bones ache under all circumstances, and no position affords relief; pain in the joints, almost uninterrupted, as if squeezed, broken, and sprained all at the same time ; abscess in the joints ; the whole of the skull is painful to the touch; lacerating pain in the bones of the head; exostosis on the head; swelling of the bones of the nose ; boring and drawing pain in the tibia. Worse at night; also from the heat of the bed. Better when at rest, and when lying down. Mezereum. The joints feel painful as if bruised ; drawing, with excessive weariness in the joints; hot dartings, and paralytic drawing pains; pain in shoulder-joint as if it would tear, with throbbing; tension in shoulder-joint; tensive lameness in the elbow-joint on raising the arm ; darting pain in the hip-joint down to the knee. Bone diseases from the abuse of Mercury, also from syphilis; inflammation of bones, with caries. (Periostitis of the tibia consequent upon an ulcer of the leg, the parts being covered with a brown, dry skin, and being surrounded with reddish-blue spots, with violent burning pains caused by the pressure of the fingers ; swollen periosteum, the violent pain preventing from tread- ing on the foot, and cramps in the calves of the legs. — (From Noack and Trincks). Ulcers of the bones, with morbid inter- stitial growth of the soft parts, even in the case of fistula; bone pains in the skull. Worse in the evening, and at night; also from contact and motion. Better when walking in the open air. Nitric acid. Pressure in the right shoulder; painful stiffness of the knees, feeling as if the bends of the knees were swollen. Special Therapeutics. 283 Inflammation of the periosteum, and of the bones ; caries from syphilis, or the abuse of Mercury *; caries of the bones of the skull; the whole right side of the skull is painful ; aching of bones ; draw- ing and aching pain ; bones of the face are painful ; tearing in the malar bones. Worse in the evening, and at night; also on rising from the seat, and from touch. Better on getting warm ? NlIX mOSCh. Paroxysms of drawing in the arms, with frequent boring through the elbows; pain in the right knee as if sprained. Worse in the forenoon and evening; also from cold, in wet weather, and from lying on painful side. Better from warm air, in dry weather, and in the room. NlIX Vomica. Pains in the joints as if bruised; inflammation of joints, with burning- stinging; sensations in bends of knees as if they were too short ; arthritic inflammation and swelling of the knees. Worse in the morning: also from motion, and light touch. Better from strong pressure. Right side. Petroleum. Ulcerative pains in both sides of the head ; draw- ing and tension in the jaw below the ear ; drawing, with pressure in the bones ; paralytic drawing in left tibia and forearm, with pressure. Worse in the morning and evening. Better from warmth. Phosphorus. Pressure and drawing in the shoulder ; pain in the elbow-joint as if broken ; lacerating in the wrist-joint ; pain in the left hip-joint ; pain in hips as if sprained ; arthritic stiffness in the knees ; drawing pain from the knees to the feet. Beating and gnawing in the right parietal bone ; shining, painless, unin- flamed tumor on the forehead, with violent headache over the eyes ; tickling in the periosteum around the eyes ; sticking in the malar bone ; painful drawing and tearing in the lower jaw toward the chin; jerking in the lower jaw, almost like toothache; stitches in the right clavicle ; soreness of the clavicle, whether touched or not; pain in the os coccygis, as if ulcerated ; unceasing stitches in the spinal column; stitches in the lumbar vertebrae; feeling as if a plug had lodged in the left scapula; bruised pain in left humerus; gnawing pain in elbow, extending towards the shoulder ; painful pressure in the periosteum of the humerus and radius ; tearing 284 Surgical Diseases of the Joints. and drawing in the elbow-joint; shocks and jerking in the tuber- osities of both arms ; pain as if bruised in the periosteum of the tibia, painful to touch. Worse in the evening, and at night ; also from motion. Better from rubbing, and after sleeping. Phosphoric acid. Bone pains from the abuse of Mercury j intense pain in the periosteum, as if scraped with a knife ; purulent discharge from the nose ; painful drawing in the dorsal vertebrae as if bruised; burning in the elbow-joint; nightly burning-lacer- ating in the tibia. Worse at night ; also from talking, and when at rest. Better from motion. Plumbum acet. Contractions in the joints ; stiffness of the knees, with swelling of the feet. Pulsatilla. Erratic, wandering pains, moving from one joint to another, with swelling and redness of the limbs ; pain as if bruised, or as if from sub-cutaneous inflammation on touching the part; continuous lacerating pain in the shoulder-joint ; bruised pain in elbow-joint; painful stiffness of the wrist-joint; lacerating pains in the knees, like jerks ; swelling of the knee, inflammatory and hot; (or painless?); swelling of knee, with stinging; lacerating pain in elbow-joint on attempting to move it. Curvature of the bones ; interstitial distention of the dorsal vertebrae nearest the neck ; drawing-lacerating pain in the bones of the forearm ; pain in the bones of the thigh as if bruised; tibia is painful when touched ; pain as if bruised in the tibia, especially when raising the leg; drawing in bones of leg. Worse in evening; also from warmth and motion. Better from cold. Right side. Rhododendron. Cramp-like drawing pain ; pains quickly gone; cedematous swelling of joints ; lacerating in the shoulder, or violent beating and drawing pain; pain in the hip as if sprained; white swelling of the knee ; cold uninflamed swelling of the right knee, with raging pain extending to the leg, in bed, and during rest ; digging-up, or drawing pain in the wrist-joint ; cedematous swell- ing of legs and feet. Worse in the morning ; also during rest, from cold, and wet. Better from motion, and warmth. Rhus tox. Sticking in the joints during rest; pains as if sprained ; lacerating and burning in the shoulder, with lameness Special Therapeutics. 285 in the arm ; lacerating in the joints of all the ringers ; pain as if sprained in the joints of the lower extremities. Pressure with drawing in the periosteum, as if the bone were scraped; red, shining swelling, with stinging or sore pain when touched ; bones swollen ; drawing and lacerating in the eye-brows and malar bone ; pain in the articulation of the jaw as if bruised; painful bony swelling in the small of the back ; curvature of the dorsal verte- brae ; bony swelling on the arm, with burning and ichorous ulcers ; the skin covering bony tumors is red, inflamed, and covered with little blisters. (Feeling in the bones of the leg, as if they were split and spreading apart when stepping. G). Worse in the morning, and at night; also on beginning to move. Better from motion. Right side. Rllta grav. Pains in the joint, as after a bruise, fall, or contu- sion ; pain as if sprained, with stitches in the wrist-joint. Pains in the bones of the hips as if bruised; pains at all times in the bones of the wrist and dorsum of the hands, as if bruised, both during rest and motion ; burning and gnawing in the periosteum ; stitching, drawing pain, from the frontal to the temporal bone ; cramp-like lacerating in the malar bones, with stupefying pressure in the forehead ; a spot on the sternum is painful when touched ; pains in the lumbar vertebrae, as if they were bruised ; dull lacer- ating in the long bones of the arms; burning and corrosive pains in the bones of the feet during rest. Worse in the afternoon; also during rest, and in wet, cold weather. Better from motion. Left side. Sabina. Lancinations in the joints, with sensation as if they were swollen, accompanied with drawing stitches through the long bones ; paralytic pain in the joints, especially after any exertion ; lacerating in the finger joints ; painful drawing in the joints of the toes. Painful pressure in both upper arms near the elbow-joint; aching or burning pains in the swollen periosteum ; paralytic pain in the region of the malar bone ; aching in the region of the malar bone ; intermittent stitches in the clavicle ; lacerating pain, with pressure, in the metacarpus. Worse at night ? also from contact, and from the heat of the bed. Better from cold? Left side. Sarsaparilla. Lacerating in almost all the joints and limbs ; paralytic pain in shoulder-joint; paralytic weariness in elbow- 286 Surgical Diseases of the Joints. joint ; pain as if sprained in wrist-joint ; lacerating in the knees ; swelling and stiffness of the knees with stitching pain ; paralytic and bruised feeling in hip-joint. Worse in afternoon ; also from cold. Better from warmth. Right side. Sepia. Rigidity of the joints of the arms and fingers, as if too short ; stitches in the wrist-joints on moving the hand ; stiffness of the elbows ; tensive pains in the metacarpal joints ; arthritic drawing in the finger-joints ; coxalgia, with lancinating pains ; cramp pain in the hip-joint; drawing pain in the knees ; also stiff- ness. Swelling above the temple ; aching pain in the malar and nasal bones ; cramp pain in the facial bones. Worse in the morning and evening ; also when stretching the limb, and when at rest. Better from violent exercise, and warmth. SHiC6a. Nightly sticking in all the joints ; stitches from the wrist-joint through the arm ; joints are painful when pressing on them ; painful feeling of stiffness in the knees ; weakness of the knees ; inflammatory swelling of the knee ; lacerating in the knees. Drawing pains in the bones ; gnawing pains in the bones of the nose; caries and swelling of the lower jaw; curvature and swell- ing of vertebrae ; bruised pain in scapulae ; is more or less useful in all cases of caries. Worse in the night ; also from cold, wet, and when sitting. Better from motion and warmth, and when wrapped up warmly. Right side. Staphisayria. Dull sticking pain in region of shoulder-joint ; violent aching pain in shoulder-joint ; paralytic drawing pain in phalangeal joints ; dull stitches in knee-joint near the patella ; hip disease. Mercurial bone diseases ; pains in bones, with debilitated feeling in joints ; swelling of the bones ; inflammatory pains in the malar bones ; boring stitch in the right tibia ; drawing, with pres- sure, in the outer part of the tibia. Worse, all times alike, except in the evening, when he ; s better on being touched. Better after breakfast. Right side. Sulphur. Erratic gout ; arthritic pains, with or without swell- ing; sticking pains in the joints, with stiffness; violent drawing and lacerating through the knees and tibia ; cracking in the joints, particularly in the knee and elbow ; drawing pain in the shoulder- Sp ecia I Therap etc tics. 287 joint, and in the arms ; lacerating in the shoulder-joint ; lacerating pains in the wrist-joints ; stiff, red finger-joints, as if frozen; drawing pain in the left hip ; pain in the knee as if stiff; the bends of the knees are rigid ; inflammatory, thick, shining swelling of the knees ; dropsy of the knee-joints. Inflammation, swelling, and curvature of the bones ; pressure and burning in the malar bones ; painful swelling of the jaw. Worse in the evening, and at night ; also on waking, on getting warm in bed, from bodily exertion, when at rest, and from touch. Better from drawing up the limbs, from motion and heat. Left side. Thuja. Painful difficulty of moving either arm, as if it had no synovia ; throbbing in the elbow-joint, like pulsations ; pain in elbow and wrist-joints as if dashed to pieces and crumbling; lacerating in the wrist-joint ; dull tingling pain in the outer side of the knee ; painful pressure in the inner side of the knee. Boring pain in the region of malar bone, diminished by contact. Worse in the evening, and at night ; also from cold wet, and the heat of the bed. Better from warm wet. Veratrum. First the right, then the left hip-joint feels par- alytic; icy-coldness of the feet, and cramps through the tarsal joints. Seldom indicated in these diseases. Operations. For the relief of the various affections, we either resect or ampu- tate. In the treatment of scarcely any other class of diseases is the old adage so true that " amputation is the reproach of surgery." The difficulty lies, however, in the fact of our seldom seeing these cases in their incipiency, more rarely until they are fully developed. In anchylosis, forcible extension is much resorted to, but to me it seems, to say the least, a useless procedure, for an additional inflammation is set up, and if my notions are true the extension of an inflammation already existing will be of the same character, i. e., suppuration, adhesive, gangrenous, or cancerous, as the case may be, the result is apt to be an increase of immobility. I should say, in the partial form, trust to remedies ; in the complete, 288 Surgical Diseases of the Bones. remove a wedge-shaped piece of bone, if the position of the limb is inconvenient, and give it the required position. Hip disease may require operation ; if so, resect. But as this is an important operation, my limits forbids its consideration. Enlarged bur see may be removed by dissection ; and Ganglions had best be ruptured by a sudden blow with some heavy object. SURGICAL DISEASES OF THE BONES. Periostitis, Osteitis, Caries, Hypertrophy, Rickets, Fra- gilitas ossium, tubercles, exostosis, osteo-sarcoma, Hydatids of Bone, Osteo-Aneurism, Fractures. Periostitis. This is an inflammation of the periosteum, and is generally described as being simple or complicated, acute, chronic, idio- pathic, or traumatic. I cannot subscribe to these divisions, inas- much as it does not seem possible that a disease can be local, or exist alone, without any other complications. It must depend upon some constitutional taint, such as scrofula, syphilis, or the abuse of mercury. I should prefer, then, to call the varieties traumatic, syphilitic, scorbutic, or medicinal. They may be either acute or chronic in any variety. The symptoms are swell- ing of the limb, sometimes, though not always, redness, puffiness and hardness of the part, tenderness on pressure, and usually on motion ; the swelling is circumscribed in a measure, though not always so. The symptoms in very many particulars closely re- semble rheumatism, but attention to the fact of the pain being deeper will be sure to prevent an error of diagnosis. Osteitis. This is an inflammation of the substance of the bone. Like periostitis, it may be acute or chronic, traumatic or cachectic. When acute, the bone is swollen and softened. In the chronic form the bone is enlarged, but very hard, like ivory. Sometimes Caries. 289 there is considerable elongation of the bone, without any thicken- ing, so that one limb may be larger than the other by one or two inches ; this is most common in the chronic form. The symptoms of this disease are : an enlargement of the bone, aggravation of the symptoms in wet weather, or when the weather changes, pain, swelling, tenderness on pressure, and on motion, and some fever and redness of the skin in the acute form. This inflammation is the accompaniment of, or precedes or follows, all other diseases of the bone, caries, necrosis, suppuration, etc., hence the importance of a correct diagnosis, and prompt treatment, to prevent the development of something worse. One common re- sult of osteitis is suppuration of bone, or the formation of an abscess in some portion of it. It is not unfrequently seen following am- putation, and is then known as osteo-pyelitis. In this form, which also constitutes the acute variety, the medullary canal is the part primarily invaded, and the cancellated structure shows signs of in- flammation and increased vascularity. Often osteo-myelitis, or gangrene of bone, occurs, and is to be dreaded, among other reasons, from the fact that pyemia or phlebitis may be set up. The symptoms of suppuration of bone are sudden and deep- seated pain, swelling, tension, and oedema of the part ; the secre- tions of the stump are arrested, and the wound takes on a slough- ing character, with rigors. Chronic suppuration is of a circum- scribed form, and is the result of inflammation, terminating in abscess. Like the acute form, it is oftenest found in the heads of the long bones, and cancellated structure generally. Soon after the receipt of an injury, the bone is observed to be painful, swollen, and hard ; the skin does not change its color as a rule, though it sometimes assumes a red, glazed, and, cedematous ap- pearance. The pain may be lancinating and severe, or dull and aching, and is not apt to be steady, but may remit for even days at a time. However free from pain the patient may be during these remissions, there will be found one spot on the swollen bone that is painful to pressure. There can be no question, to my mind, but that a free and early evacuation of the pus by the application of the trephine, is the proper treatment to pursue. Caries. Formerly this was supposed to be a disease of the bone analo- gous to ulceration of the soft parts, but it is not so, at least in all 19 290 Surgical Diseases of the Bones, varieties. We have one variety, chiefly occurring in syphilitic cases, in which the disease as regards the line is superficial, only being denuded of periosteum, and this is the true ulceration of bone. The bone in caries becomes more vascular, softens, and finally becomes disintegrated. It usually manifests primarily in the centre of a bone, and is always well-established before any external sign is presented. The skin becoming involved last, we are often unable to form our diagnosis until the disease is fully established. After the limb has become inflamed, a swelling forms over the seat of the disease, ultimately forming an abscess, which opens, leaving a fistulous ulcer which will not heal. On introducing a probe into this fistula, we find the bone bare and rough, and its surface full of cavities and depressions, which, how- ever, break down readily under the pressure of the probe, and emit during this process a peculiar sound, likened to the crushing of sugar. When the shaft of the long bones is involved, there is some tendency to deformity of the limb, which must be combated by the use of splints, as in fracture, to resist the injurious con- traction of the muscles. Necrosis. This disease corresponds to gangrene of the soft parts, and, as Erichsen says, diners from caries " in the fact that caries may be regarded as the granular disintegration, or molecular death, of the osseous tissues, conjoined with suppuration of the surrounding healthy parts, while necrosis must be looked upon as death of the osseous tissue as a whole." Caries is, again, more frequently seen in the articular ends, or the interior of the bones, while necrosis oftener, indeed always, affects the compact portion. When some cachexia is not the predisposing cause, any injury which denudes the bone of its periosteum will produce it. Workers in Phospho- rus, as those who manufacture matches, are more subject to these diseases than others ; and from traumatic causes, whitlow or felon, or a disease which destroys the periosteum, are the most common. The local and general symptoms are nearly identical with those of caries, and vary mostly in intensity. When the large bones, as the thigh, are involved, the suppuration may be the cause of death if very extensive ; hence, if the sequestrum be fully formed, this would constitute a chief indication for its removal immediately. Fragilitas Osszum. 291 In thro.wing off a central sequestra, nature provides for it by a thickening of the outer laminae, and the formation of apertures, called clocae, through which the dead tissue is extruded, and either carried away by the discharges, or else is in a more favorable position for removal by the surgeon. Hypertrophy. As a distinct disease, unconnected with other conditions of the bones, this is not very amenable to treatment. It is simply an increase in size, in every way — in length, thickness, density, and weight. It is the opposite condition of atrophy, in which the con- verse of all this is true. Some hypertrophy is due to an abnormal nutrition, or development : there are no new deposits, and no pre- ponderance of one element of healthy bone over another. Rickets. This is a softening of the bone, due to a deficiency of the earthy material, from which reasons the osseous structure is more properly cartilaginous, and not capable of sustaining the weight of the body. It is a disease peculiar to infancy, and those who are of a scrofulous tendency. Fragilitas Ossium. This is a disease directly opposite to the last mentioned, and is different, also in being peculiar to adults, particularly women. In this the bones, in addition to being easily bent, as easily break ; the slightest force being sufficient to produce this. In the early stages the disease resembles rheumatism so closely that it is almost impossible to tell them apart. The patient complains, in the first instance, of pains of a wandering character about the limbs and trunk; these assume usually a rheumatic character, though they have been observed to be of a much more severe, persistent, and intractable nature, than in any form of that affec- tion. The patient becomes debilitated, unfitted for exertion, and emaciated. Spontaneous fracture now occurs in some bones under the most trivial causes ; others become bent, and the whole body, consequently, greatly mis-shapen and distorted, occasion- 29 2 Surgical Diseases of the Bones, ally in the most wonderful manner. The urine will be observed to present enormous quantities of phosphate of lime, diverted from the bones, and death eventually results from general ex- haustion. Tubercles of Bone. Tuberculous deposits seem to be as common in bone as in other parts of the human body. When found here they usually appear in the case of children, particularly those of a strumous cachexy, although adult age is not exempt. The cancellated structure, particularly the articulating ends of the long bones, are peculiarly liable to this invasion, and by their presence the most intractable bone-diseases are frequently caused. The spine, and the short bones of the tarsus and carpus are also liable, and here it usually leads to necrosis. When tubercle becomes decomposed, and forms an abscess, it is circumscribed or diffused according to circumstances. The abscess in finding an opening im- plicates the neighboring soft parts, and forms a sinus leading to the cavity of the bone, through which pus, of an unhealthy curdy character, mixed with the broken-down remains of the tubercle, is discharged. The diagnosis is even more obscure than in fragilitas, and is of just as little importance to us ; whether it be caries, necrosis, or tubercle, or all three, the symptoms guide us, and they alone. However, if you ever operate for either, re- move all suspicious spots. Exostosis. This means a tumor growing directly from the bone. The causes necessary for its production are remotely constitutional ones, such as struma or syphilis, and directly the reception of injury. Two varieties are recognized by pathologists — the one called hard or ivory> and the other the soft or cancellous. The diagnosis is sufficiently easy when the tumor is found on the out- side of the bones ; when on the inner surface of the skull, ribs, pelvis, or scapulae, they are not readily discovered ; save from their pressure effects, there are no symptoms of tumor, and these, even, are common to all tumors in situations where it is possible for them to compress organs. Fractures, 293 Osteo-Sarcoma. This term is an unfortunate one, as generally applied, as it is customary to include under this title cystic tumors of various kinds growing from bones, whether they be benign or malignant and in consequence of this much confusion exists in surgical lit- erature. They may be single or multiple, and contain fluid, or be of solid formation. When the cysts are single, they are apt to contain solid matter, and when multilocular, are filled with fluid. The walls are thin and osseous, and cannot be mistaken for any- thing else, unless they are deep-seated. Those with fluid con- tents attain a larger size, and grow more rapidly than the others. Spina vcntosa is a term often used synonymously. Hydatids. The bones are sometimes found with cavities in their sub- stance, which are filled with these bodies. The signs of their presence are not to be distinguished from other diseases. Osteo-Aneurism. This is frequently spoken of as pulsating tumor of bone, and the term is preferable, as they are really not aneurismal. In structure and appearance they vary greatly — at times they are cancerous, and often mere vascular growths. They commence like other tumors of bone — feel elastic, grow slowly, without discoloration of the integument, and communicate to the hand a pulsation almost identical with that of aneurism. Two things must be guarded against in forming an opinion; do not confound it with true aneurism, and be sure that it is not some other tumor which has a pulsation derivable from some large neighboring artery. As these tumors are immovable, but little difficulty will ordinarily be experienced in determining their true character. There are other tumors of bone that need no special mention, such as cancer and sanguineous cyst. Fractures. Not being, in any sense of the word, a disease, we must dispose of the subject of fracture in a merely general sense. The term 294 Surgical Diseases of the Bones. means, literally, a break, and in surgery, usually, a broken bone. In the case of the long bones, the direction of the fracture, so to speak, maybe transverse, or, as the French say, en rave — i.e., radish- like — oblique, or bec-de-flute (like tne mouth-piece of a flageolet) ; comminuted, impacted, or partial. In most of these varieties it can in nowise affect the treatment, as we will show, whether it be one or the other. In the impacted form, unless there is considerable deformity, we need do nothing, as it is already sufficiently " set." In the comminuted, the fragments, if too small to be placed in proper relation to each other, and the soft parts are not too ex- tensively injured, there are no special indications. If, on the contrary, the fragments are too small and numerous to offer any hope of reunion, they must be removed, and the case treated as one of ordinary resection. What was said of impacted fracture applies with equal force to the partial, or incomplete, variety. Bear in mind, however, that in the latter form our prognosis must be very cautious, as death frequently results after such in- juries, according to Malgaigne and others, without our being able to assign any reason for it. There may be a wound of the soft parts and integuments lead- ing down to the seat of fracture, or a protrusion of one or both of the extremities of the bone. In this case we have a grave complication, and call the variety a compound fracture. If a large blood-vessel or nervous trunk is also injured, whether there be an external wound or not, it is called a complicated fracture. These remarks apply in general to fracture of the long bones. In the flat or irregular bones, we have other terms, which suf- ficiently explain themselves — depressed, stellate, pe7'f orate, and ser- rated fractures. Treatment. — First be sure it is a fracture. The means to be used to determine this are not dwelt upon, as it is not properly in- cluded in our present plan. Having ascertained this, our next step is to reduce the fracture, keep the fragments in position, and facili- tate their union. The first procedure we leave untouched for similar reasons to those given above. To retain the fragments in posi- tion, position is the first thing to be considered. This position must be one that will completely relax any of the muscles that may tend to displace the fragments if not relaxed. To keep them in place, we may need splints, but surely very rarely, as they cause much uneasiness to the patient, cause jactitation, and, as frequent experience has taught many of us, do not always preserve the Special Therapeutics. 295 position of the fragments. Wherever it can be done, the following procedure is one I adopt : Place the limb in such a position that the muscles which might keep the fragments asunder are com- pletely relaxed. Apply counter-extension in the usual way, by means of long strips of adhesive plaster attach a weight to the opposite extremity, and support the limb with bags of bran or sand, or pack it in loose sand. For the first twenty-four or forty-eight hours give Aeon, about once in two or three hours. After this time administer a dose of Symphytum, not lower than the 30th, once or twice a day. When consolidation has fairly begun, apply a plaster-of-Paris dressing, and allow the patient to move about on crutches. In the case of compound fracture, the method is but little modified. The extension and counter-exten- sion is made as usual, but Calendula will be required to heal the wound. When this is done, proceed as in a simple fracture. Occasionally, after we have done all that seems called for, the fragment will not unite. The treatment depends upon the cause. Should there be a tenden, or any foreign substance, interposed between the fragments, it must be removed. Should it be from inefficient reparative power, the fault is to be corrected by proper medicinal treatment, and not by any of the popular methods, such as exsection, ivory pegs, etc. Such a complication can but rarely occur under homoeopathic treatment, unless in the case of the very aged. From the great variety of symptoms that have to be considered in such cases, it is next to impossible to point out in this place any line of treatment. Suffice it to say, should Symphy- tum fail, recourse may be had to Calc. c, Cale. phos., Sil., or Sulph., among the more prominently indicated remedies. More special indications for the selection of the remedies in these diseases has been placed under Diseases of the Joints to save space, and inasmuch as the diseases of bones and joints are so intimately associated; also see Ulcers and Tumors. The brief " index " following will suffice for this place : — Bones of the Head : Mere., Petrol., Phos., Sabin., Sil. ; Aeon. Bell., Cale., Car bo v., Hep. s., Lye., Mezer, Nit. ac., Phos. ac., Puis., Sep., Sulph., Thuja. Face : Aur. m.. Nit. ac.; Con., Ars. Arm : Asa/., Rhus, Staph ; Arn., Pry., Lye., Merc., Me- zer, Phos., Puis., Ruta, Sil., Sulph., Thuja. Bones of the Legs: Lye., Merc., Phos., Puis., Ruta, Sil., Staph.; Am., Calc, Con., Hep., Nit. ac., Phos. ac, Rhus, Sep. Sulph. 296 Surgical Diseases of the Bones. Mercurial Bone Diseases : Aur., Hep., Nit. acj Asa/, Lack., Lye, Mezer, Phos. ac, Puis., SiL, Staph., Sulph. Scorbutic : Ars., Baryta, Calc, Graph., Hep., Lye, Phos., Puis., Sep., SiL, Sulph. Syphilitic : Con., Merc, Nit. ac, Sulph., Thuja j Ars. Aur. Bell., Bry., Carbo v., Lach., Lye., Mezer, Phos., Rhus, Sil. Traumatic : Am., Con., Ruta ; Aeon., Ars., Bry., Rhus, Sil. Idiopathic : Aeon., Bell., Bry., Carbo v., Dulc., Eupat., Guaj., Hep., Lach., Lye, Merc, Petrol., Phos. ac, Rhus, Sabin., Sep., Staph., Thuja ; Am., Ars., Asa/., Aur., Calc, Con., Graph., Merc, Nit. ac, Phos., Puis., Ruta, Sil., Sulph. Periostitis : Aeon., Ars., Aur., Bell., Bry., Calc, Con., Eupat., Graph., Hep., Lye, Merc, Mez., Nit. ac, Phos., Phos. ac, Puis., Rhus, Ruta, Sep., Sil., Staph., Sulph. Osteitis : Aeon., Ars., Asa/., Aur., Bell., Bry., Calc, Carbo v., Col., Dulc, Eupat., Graph., Hep., Lach., Lye, Merc, Mez. Nit. ac, Phos., Puis., Rhus, Ruta, Sep., Sil., Staph., Sulph. Suppuration of Bone: Hep., Merc, Sil; Ars., Calc, Lye, Nit. ac, Sulph. Caries : Am., Ars., Aur., Baryta, Calc, Hep., Merc, Sabin. Sil., Sulph. Necrosis : Aeon., Aur., Bell., Bry., Calc Mezer, Nit. ac, Phos., Ruta g., Sil., Sulph. Hypertrophy : Asa/, Am., Aur., Baryta, Calc, Con., Merc Nit. ac, Phos., Ruta, SiL, Thuja. Rickets : Asa/., Ars., Baryta, Bell., Calc, Lye, Merc, Mez., Nit. ac, Petrol., Phos., Phos. ac, Rhus, SiL, Staph., Sulph. Fragilitas : Asa/., Calc, Dulc, Lye, SiL Exostosis : Asa/, Aur., Calc, Dulc, Guaj., Lye, Mere, Me- zer., Phos , Phos. ac, Rhus, Ruta, Sabin., SiL, Staph., Sulph. Osteo-Sarcoma : Aeon., Am., Ars., Asa/, Aur., Baryta, Bell., Bry., Calc, Con., Dulc, Eupat., Graph., Hep., Lach., Lye, Mez., Mere, Nit.ac, Phos., Phos. ac, Rhus, Ruta, SiL, Staph., Sulph. Osteo- Aneurism : Aeon? Am? Ars? Con? Dulc? Hep? Merc? The operations for the treatment of these various diseases are generally those of excision. When there is a choice between amputation and resection, resect, by all means. In resection we look for a more certain preservation of life, and an absence, total or partial, of deformity. The operation is too well understood to need detailing here. In -Growing Toe Nails, 297 SURGICAL DISEASES OF THE NAILS. ONYCHIA, IN-GROWING TOE NAIL. Onychia. The nails are infrequently diseased, and usually in one of three ways ; the nail alone is affected ; the matrix alone ; or both the nail and the matrix. In the case of elderly people, or those of a broken-down constitution, the nails often become dry, scaly, enor- mously thickened, of a greenish or gray color, and a rough irregu- lar appearance. The most common disease of the nails is Onychia^ which is due to an inflammation of the matrix. It may be simple or specific. Simple Onychia is characterized by redness, heat and swelling, set up usually on one side of the nail, in the angle of the tissue in which it is implanted. There is no discharge of pus, and the nail gradually loosens, becomes dark-colored, shrivelled, and at last is completely detached. A new nail soon makes its appear- ance, but is liable to be badly shaped. In the simplest form of the disease, Am., Silic, or Sulph., are probably the remedies most frequently indicated. When occurring traumatically, in the absence of specific taint, Am. is the remedy. Specific Onychia is also known as "malignant." It is produced by injury inflicted on a finger while the system is contaminated by syphilis, scrofula, or cancer poison. In this form there is a forma- tion of pus, ulceration at the sides of the nail, and inflammation with a dark color of the skin. The nail is finally destroyed, and the new one imperfectly developed. The treatment of this form will but seldom be called for except in connection with the general disease ; then, of course, the remedy that cures the patient cures the nail. In-Growing Toe Nail. This is caused by wearing badly shaped shoes, which crowd the toes together, or from cutting the nail too square, leaving a sharp corner which is a constant irritation to the neighboring soft parts. 298 Surgical Diseases of the Nails. From long-continued pressure from this sharp corner, an ulcer is at last formed, which becomes filled with immense granulations, hiding in many cases, the whole nail, and secreting an offensive pus. The pain is usually considerable, and prevents walking when fully developed. Of course all attempts to cure this ulcer as long as the cause which first produced it remains, must prove futile. The treatment must be mainly local for obvious reasons. In the first place, when the granulations are very large, they must be removed. Any strong astringent will do this temporarily. Next, the corner of the nail must be cut off, and its direction altered so that it will grow over the soft parts in place of into them. This is best effected by removing a very thin shaving from the corner of the nail every day. By drawing the edge of a sharp knife lightly from the root to the angle of the nail every day, (only once a day,) and only once at one operation, a thin shaving is easily removed. In a short time this corner will turn up. The ulcer must be treated as other ulcers, but in most cases Calendula will be found sufficient. Should it fail consult the chapter on " Ulcers." The ulcer cured, and. the direction of the nail changed, a repetition of the trouble must be guarded against by altering the shape of the boot. Should, however, all these measures fail, the only resource is the removal of the whole nail, and by properly constructed wax moulds favor the development of a perfect new one. Varix. 299 SURGICAL DISEASES OF THE BLOOD- VESSELS. PHLEBITIS, VARICES, PYEMIA, ANEURISMS, ANEUR- ISM BY ANASTOMOSIS, ARTERITIS, FATTY DE- GENERATION OF THE ARTERIES, CALCIFICATION, NEVUS, WOUNDS. Phlebitis. The veins are more predisposed to inflammatory affections than the arteries, and particularly is this the case in persons of enfee- bled constitutions ; prominent among the causes are wounds, con- tusions, or the presence of a ligature when the vein is designedly tied, or is included in the ligature embracing the artery. Under some circumstances it is an exceedingly fatal condition, and in all cases is a disease of much gravity, demanding the most careful treatment. The pathology may be summed up as follows : the vein becoming inflamed from some cause, thickens at the point at which the injury is inflicted ; the outer coat particularly so. This inflammation is followed by an effusion of lymph from the internal coat of the vessel, producing an occlusion more or less complete, owing to the lymph organizing, and the existence of coagulated blood, " forming a solid mass." The next feature is the formation of pus, "not" says Erichsen, "produced by the transformation of the contained blood, but by effusion from the coats of the vessel" Any vein, or any portion of a vein, is liable to become thus affected, and the disease may invade it to any extent. Three varieties or stages are recognized by modern pathologists, 1st — Adhesive phlebitis; 2nd — Suppurative, and 3rd — Diffusive Varix. Of all diseases of the circulatory apparatus, this of varix, or varicose veins, is by far the most common. It consists in a weak- ening of the walls of the vein, followed by an irregular distension, 300 Surgical Diseases of the Blood- Vessels. in some places in the form of sacs or pouches, while in others it seems to be a uniform enlargement in calibre. Anything which would weaken or lacerate one of the coats of the veins, will pro- duce this condition. Long standing, or constriction exercised on a vein, as in the case of tight garters, are among the more frequent causes. In this disease the valves seem to be obliterated and the blood collects in these pouches, and may in time become coagu- lated. The lower extremities, and the veins of the rectum and vicinity, seem to be the most obnoxious to this condition. Those of the scrotum are often so, and it is then known as varicocele. The part so affected is found to be cedematous, and more or less numb, sometimes an almost complete loss of power is noticed. There is seldom any pain, unless it be from pressure exerted on some nerve. These pouches or bunches sometimes open spontaneously, though very rarely ; and are sometimes broken by accident, when a very- intractable ulcer results, which, under some methods of treatment, is very properly considered incurable. Phlebitis may occur as a concomitant, though in a bad form it is very rare. Hemorrhoids, are, in my opinion, a true varix,.and nothing else. The superficial veins are the oftenest affected in this manner, and may attain a great size. Pyaemia. Pyaemia, is a supposed admixture of pus with the blood. It has also been called "purulent infiltration," and is a very serious, often fatal disease. Erichsen says it has never occurred idio- pathically, but is either subsequent to a wound that has been inflicted upon a person of a cachectic, readily suppurating consti- tution, or it is seen allied with the lowest and worst forms of erysipelas. " Pyaemia is characterized especially by two series of phenomena : The first is a great depression of the powers of the system ; the second, the formation of abscesses in various parts of the body. The symptoms are as follows : The patient is seized with rigors, usually of a very severe and continuous character, but occasionally short and transient, sometimes occurring irregularly ? at others repeated almost periodically, twice or thrice in the twenty- four hours, for some days in succession ; in some cases these rig- ors are not attended by any sensation of cold, but in others they are, and then alternating with much febrile disturbance, resemble very closely an ague fit ; any open wound that may exist at this Wounds of Blood- Vessels. 301 time usually becomes foul, sloughy, and ceases to secrete pus, though I have seen healthy granulations continue throughout the disease. The skin is hot, and has a burning pungent feel, the breath has a peculiar sweetish, saccharine, or fermentative smell that is commonly noticed in all febrile diseases of a low type ; this odor of the breath, and indeed of the body generally, often occurs early in the disease, and must then be taken as a very unfavorable sign. The secretions are arrested, the pulse is quick and feeble, the face is usually pale, with a very anxious drawn look, but some- times flushed, and the eyes bright ; there is hebetude and dullness of the mind, with slight nocturnal delirium, but perfect conscious- ness on being spoken to ; about this period, patches of an erratic erysipelas frequently make their appearance on the surface, and the skin assumes a dull, sallow, and earthy, or a bright yellow icteric tint, which may extend even to the conjunctiva. The symp- toms now indicate an extreme depression of the vital powers, the pulse becoming small and fluttering, the tongue brown, with sordes about the teeth, and low delirium ; usually from the sixth to the tenth day, but sometimes earlier, diffusive suppuration begins to take place in different tissues, joints and organs. This may occur in the viscera without occasioning any material pain ; if seated in the cellular tissue, or in the substance of muscles, there is much doughy swelling with some redness ; if in the joints, the swelling is often considerable, the pain usually intense, and of a very super- ficial or cutaneous character, the patient screaming loud with the agony he suffers." In addition to the formation of pus in nearly every organ and part of the body, the blood is found loaded with cells, that are without doubt pus cells. It is a terrible disease, and the prognosis may always be unfavorable. Wounds of Blood- Vessels. Wounds of blood-vessels, including the procedure for tying them, or otherwise arresting the flow of blood, form a very import- ant chapter in surgery. Veins, when wounded, are not usually attended with fatal results, unless it should be some large and important trunk. Pressure in nearly every instance will be suffi- cient to effect a cure. Ligation, as in the case of arteries, would be easily done, but the results are doubtful, and may lead to 2,02 Surgical Diseases of the Blood- Vessels. mortifying and fatal consequences. I would advise the acupres- sure plan of Sims. He uses an ordinary hair-lip pin, with a large head; this he passes through the skin, under the vessel, and brings it out on the other side through the skin. For vessels of a little smaller calibre, the placing of a soft compress over the vein, is the best plan. Torsion or twisting the ends of the vessel may be resorted to. When either of these methods fail, styptics had best be resorted to. Of these I know of none so permanent in its effect as Erigeron can.; a piece of lint saturated with the tincture and applied to the bleeding vessel, will in many cases arrest the bleeding instantly. When the effect does not seem to be strong enough, others may be tried, as the Per-chloride of iron, which is a powerful styptic, but is not long-lasting as compared to Erigeron. Wounds of arteries are a very different affair. Here the treatment must be prompt, and the artery must be closed. This may be by ligation, by the use of the acupressure needle, or by torsion, i. e., twisting the end of the vessel till the canal is completely obliterated. After the operation, give for one or two days, two doses daily of Aeon. 200; if the wound has been handled much, use Arnica 200 in place of Aeon. Afterwards use the Staphisagria lotion. If a large vessel, the main one of a limb, has been tied, keep the part warm, the patient in the recum- bent position, with the limb carefully laid on soft pillows. After operating on any vessel, large or small, keep the patient quiet. Treatment. — In determining the course to be pursued in the treatment of phlebitis, the character of inflammation — whether traumatic or idiopathic — must be taken into consideration, and, if it be referable to the former, the character of the injury. Before giving the names of remedies that are recommended, let me borrow from Erichsen something of the symptoms usually present. Adhe- sive, and consequently suppurative, phlebitis, commonly has a traumatic origin, and is generally ushered in by a hard, knotty, and painful swelling of the vein, " the knots constituting distinct enlargements opposite the valves." If the vessel be a superficial one, the color changes to a reddish-purple, and the limb becomes stiff, to a certain extent. There is not, usually, much pain, but a tenderness all along the course of the vessel.. One of the earliest, and in the case of deep-seated veins, the most certain indication of this disease is an oedematous condition of the part, which becomes hard and tense, pitting readily on pressure. In other cases the limb suddenly swells up without any oedema being Special Therapeutics. 303 present. As the inflammation subsides, these symptoms disappear, unless suppuration intervenes, when they do not undergo any, or but little change. The most common termination, unaided by medicine, is the perforation of the vein, and the formation of an abscess; more particularly is this the case in the suppurative stage. This abscess must be opened at once, or pyaemia may result from this cause alone. The plug of lymph and blood may give way, or in its turn be perforated, and pysemia then be produced. In diffuse phlebitis, the symptoms are very similar to those already noticed, only the general symptoms are much more severe. Later the fever assumes more of a typhus character, sordes collect on the teeth, the tongue is brown and dry, delirium, vomiting, " diarrhoea, and death." " These (later) symptoms are indeed due to the formation of pus in the vein, its admixture with the blood, and consequent poisoning of the system." The prospects are not very favorable, but much may be done with our remedies. Of pyemia, mild cases may be as effectually treated as scrofula or abscess ; but the severe ones certainly seem hopeless. Varix, we homceopathists consider perfectly amenable to treat- ment by use of medicines administered internally; but an external application which (when they are strictly medicinal) is the same thing as the internal remedy, is not mal-apropos. The full and distended vessels demand as a primary indication, that they shall have some additional support to that which the integument or the walls of the veins afford. This is best secured by the use of an elastic band, or stocking, and when this is not attainable, judicious bandaging. It will not do to neglect this by any means. The remedies to be consulted in all their detail, local and con- stitutional, for these conditions, are as follows : Acetic ac, Aeon., Aloes, Ambra g., Ant. c, Apis m., Am., Ars., Asa/., Aur., Baryta, Borax, Bell., Bry., Cactus c, Calc, Carbo v., Caust,, Cham., Chin., Coloc, Con., Digit., Ferr., Graph., Guaj., Hama., Hep. s., Hyos., Ign., Iod., Kali c, Kreos., Lach., Lach. v., Lauro., Led., Lye, Mang., Merc, Mur. ac, Nat. m., Nit. ac, Nux vom., Phos., Plat., Puis., Rhus, Ruta,- Sep., Spig., Staph., Sulph., Tart, em., Thuja, Verat., Zinc. The index may be arranged as follows : Phlebitis : from Contusion. — Am., Con., Hep. from Varices. — Ham., Chin., Puis., Merc. from Injury. — Aeon., Am., Hep., Rhus. 304 Surgical Diseases of the Blood- Vessels. Phlebitis: with OEdema. — Ars., Chin., Merc, Puis., Rhus, Apis. with Suppuration. — Hep., Merc.; Apis, Am., Con. with Typhoid Symptoms. — Ac. mur., Apis. with Vomiting. — Ars., Puis., Verat. Pyemia : Am., Asa/., Aur., Baryta, Bell., Bry., Cak., Car bo v., Cham., Con., Graph., Hep., Hyos., Iod., Kali c, Lauro., Led., Lye, Mang., Merc, Nit. ac, Nux v., Phos., Puis., Rhus, Ruta g., Sep., Sil., Staph., Sulph., Tart, em., Varix: Aeon., Aloes, Amb. g., Ant. c, Am., Ars., Bell., Calc. c, Carbo v., Caust., Chin., Coloc, Ferr., Graph., Hamam., Hep. s., Ign., Kreos., Lach., Lye, Nat. m., Nux v., Plat., Puis., Sep., Spig., Sulph., Zinc. Aconite nap. Vertigo when rising, with nausea, vanishing of sight, and bleeding of the nose ; face is yellow, or red and pale alternately ; trembling and stammering speech ; aversion to food ; burning, unquenchable thirst; coldness of the feet up to the ankles; sudden, great sinking of strength; burning in internal parts; painful sensitiveness of the body to contact; he does not wish to be touched. Worse at night ; also when lying on the left side, when rising, in a warm room, and from the heat of the bed. Better in the open air, and when sitting still. Left side. Aloes SOC. Giddiness, with anxiety when moving; lameness in all the limbs ; cold hands with warm feet ; sensation of weak- ness in the joints of the hands and feet. Worse in the afternoon ; also from standing, and from motion. Better from cold water. Ambra gris. Great restlessness ; flushes of heat to the face ; entire thirstlessness ; sensation of coldness in the abdomen on one side ; numbness of the whole body in the morning ; weakness in the morning, and at night when awaking; spasms and twitches in the muscular parts ; sleep disturbed by coldness of the body and coldness of the limbs. Worse in the evening; also while sleeping, on awaking, and when lying in a warm place. Better when lying on the painful part or side, and when walking slowly in the open air. Either side. Antimon. crud. Giddiness with nausea, or bleeding at the nose; sad countenance; thirst at night; rheumatic pains in the legs or Special r _ Therapeutics. 305 arms; painful stiffness of the knee; very sleepy during the day, especially in the forenoon. Worse at night ; also in the heat of the sun. Better during rest, or in the open air. Left side. Apis mel. Giddiness when sitting, standing, lying, or when closing the eyes, with nausea and headache; burning, stinging heat in the face, with purple color ; thirstlessness ; cold legs, with cedematous swelling, as well as of the feet and ankles ; great debility, as if he had worked hard ; great sensitiveness to touch and to pressure. Worse in the morning, evening, and at night ; also from heat. Better from cold water. Left side. Arnica mon. Giddiness, with nausea when moving or rising ; sunken, pale face ; redness of one cheek ; vomiting of dark, clotted blood ; tingling in the legs ; sensation of soreness in the legs ; over-sensitiveness of the whole body ; sleepiness, with inability to sleep during the day; drowsiness with delirium. Worse in the morning, at night, and in the evening; also on moving, from cold, and on being touched. Better from warmth. Left side. Arsenicum alb. Restlessness; color of the face pale, or earthy, or yellowish, with blue rings around the eyes ; distorted features ; death-like countenance; violent, unquenchable, burning thirst, with frequent drinking, but of little at a time ; varix, with hard, burning, shining swelling of the feet ; sudden sinking of strength ; fainting, with weakness, and scarcely perceptible pulse. Worse at night ; also from cold, when lying on the affected side, and when lying with the head low. Better in the open air. Left side. Asafetida. Sense of rigor ; twitching and jerking in the mus- cles ; much inclined to sleep. Worse in the afternoon, and in the evening; also when sitting. Better in the open air. Left side. Alirum met. Sensation as if a current of air were passing through the head if it be not kept warm ; bloated, shining face ; immoderate thirst; over-sensitiveness to all pain, and to the cold air; great ebullitions, with congestions to the head and chest, and palpitation of the heart. Worse in the morning ; also from cold, and while reposing. Better from moving, and on getting warm. Right side. 20 306 Surgical Diseases of the Blood- Vessels. Baryta C. Dark redness of the face, with congestions ; feeling as if the face were covered by spider-webs ; heaviness of the body ; sleepiness day and night. Worse at night ; also when sitting, and when lying on the painful side. Better in the open air. Left side. Belladonna. Vertigo, with stupefaction, vanishing of sight, and great debility ; purple, red, hot face, or yellow color of the face ; face pale, with distorted, anxious countenance ; alternate redness and paleness of the face; excessive burning thirst, with con- stant desire to drink ; drinks hastily ; over-excitability of all the senses. Worse in the afternoon, and at night ; also on moving, and pain on touching the parts, even softly. Better while lying down. Right side. Bryonia alba. Unconsciousness ; giddiness, with sensation of looseness in the brain when stooping, and when raising up the head ; yellow paleness of the face ; hot, bloated, red face ; does not drink often, but much at a time ; swelling of the lower extremities, with redness and pain on motion. Worse in the evening; also from motion. Better when sitting, and on getting warm in bed. Right side. Calcarea Carb. Fullness and heaviness in the head ; internal and external sensation of coldness of one side of the head, as if a piece of ice were lying there, with pale and puffed face ; con- tinued and violent thirst for cold drinks ; varices on genitals of women, the labiae particularly ; coldness and deadness of the feet ; heaviness and stiffness of the legs ; great weakness and debility from talking ; tongue dry ; very sensitive to cold air. Worse in the morning, and evening ; also from cold and wet, and on awaking. Better from warmth. Right side. CarbO vegetab. Periodical weakness of the memory ; when moving the head, giddiness ; greenish color, or great paleness of the face ; tongue coated white, or yellow-brown ; excessive thirst ; varices on the female genitals ; heaviness in the lower extremi- ties ; the legs go to sleep ; numbness in the limbs ; burning pains ; great debility and weakness as soon as he makes the least exertion. Worse in the forenoon, and at noon ; also in the open air, and from pressure. Special Therapeutics. 307 Better after lying down. Either side. CaustlCUm. Giddiness, with sensation of weakness in the head ; yellowness of the face ; semi-lateral paralysis of the face ; dry tongue ; paralysis of the tongue ; distortion of the tongue and mouth when talking ; violent thirst for cold drinks ; marbled skin on the legs ; swelling of the feet ; cold feet ; paralytic, trembling weakness of the limbs. Worse in the evening ; also in the open air. Better in bed, and from heat. Right side. Chamomilla. Hot, clammy perspiration on the scalp and fore- head ; bloated face ; redness and burning heat of the face, par- ticularly of one cheek, while the other is pale ; tongue dry, red and cracked ; or thick yellow or white coating on the tongue ; convulsive movements of the tongue ; thirst for cold water ; burn- ing in the soles of the feet ; sensation of numbness of the toes, over-sensitiveness of the nerves and senses. Worse at night ; also from cold, and when lying down. Better on rising. Left side. China Off. Nervous irritation, with slowness of ideas ; face pale and sunken, with pointed nose, and eyes sunken, with a blue margin ; pale, sickly appearance, as after excesses ; bloated, red face ; black coating of the teeth ; tongue is coated white or yellow; thick, dirty coating of the tongue ; blackish, parched tongue ; no desire for eating or drinking ; sometimes, violent thirst for cold water (or wine) ; drinking often, but little at a time ; icy-coldness of one hand, while the other is warm ; swelling of the feet ; un- easiness in the legs, obliging him to curve and draw them up ; over-sensitiveness of the nerves ; numbness of the parts on which one lies ; veins are much enlarged. Worse at night ; on touching the parts, after drinking, (and on motion ?). Better in the room. Left side. ColOCynth. Aversion to talk ; disinclined to answer questions; face pale and relaxed, with sunken eyes ; dark redness of the face ; swelling of the face, with redness and heat of one cheek ; burning at the tip of the tongue ; tongue coated white or yellow ; intense thirst ; sensation of coldness in the knees ; the feet go to sleep — first one, and then the other ; swelling of the feet ; faint- ness, with coldness of the extremities ; burning pains. 308 Surgical Diseases of the Blood- Vessels. Worse in the afternoon and evening ; also while lying down in bed, or when lying on the painless side. Better from motion, and lying on the painless side. Right side. Conium mac. Giddiness when looking around ; heat in the face ; stiff, swollen, painful, and dry tongue ; sensation of debility in the morning in bed ; sudden loss of strength while walking. Worse in the morning, and at night ; also while standing, or lying down. Better when the affected limb is hanging down, and from motion. Right side. Ferr. met. Sickness at the stomach when walking, with sensa- tion as if the head would constantly incline to the right side ; congestion of blood to the head, with pulsation and hammering ; heat and redness of the face, with enlarged veins, and sensitive- ness of the head to the touch; earthy, jaundiced color of the face, or pale and bloated face, with red spots ; fiery red face, with enlarged veins ; swelling of the hands and feet ; with numbness of the thighs ; great emaciation ; restlessness in the limbs. Worse in the morning ; also when at rest, more especially when sitting still. Better from slow exercise. Left side. Graphites. Pain in the head, as if it were numb and pithy ; pale yellow color of the face ; flushes of heat in the face ; con- tinued feeling as of a cobweb on the face ; tongue much coated, with bitter taste in the mouth ; numbness and stiffness of the thighs and toes ; coldness of the feet in the evening when in bed ; great emaciation; the limbs go to sleep readily; pulsation through the whole body whenever he moves. Worse at night ; also from cold. Better from warmth. Either side. Hamamelis Virg. This has proved a very useful remedy to me in many cases of varix, and I am sorry that I can say no more of it than has already been said in other places (Vari- cocele, Hemorrhoids). I have used the first or third attenua- tions, and the fluid extract, topically, and, from an unpardon- able neglect in recording symptoms, am unable to give you a single indication, save that empirical one of Hale's — " Varicosed veins." Hepar SUlph. Over-sensitiveness and irritability, with quick, Special Therapeutics. 309 hasty speech ; heat, and fiery redness of the face ; yellow color of the face, with blue border around the eyes; deadness and tingling of the fingers ; swelling of the feet around the ankles ; weakness in all the limbs — they feel bruised. Worse at night ; also from cold, from pressure, and when lying on the painful side. Better from warmth. Either side. HyOSCyamilS nig. Delirium without consciousness ; has no want except thirst ; when spoken to the answer is properly given, but he immediately relapses into unconsciousness and de- lirium ; vertigo, with obscuration of sight, as from intoxication ; heat and redness of the face ; thirst, drinking but little at a time ; distension of the abdomen, with pain when touched ; slow, rat- tling breathing ; painful numbness of the hands ; trembling of the arms ; swelling of the hands ; uncommon sinking of strength ; cold, sour-smelling perspiration ; hot, dry, and brittle skin. Worse in the evening ; also after eating or drinking. Better by stooping. kjnatia am. Intolerance of noise : heaviness in the head ; sore, bruised sensation in the head ; alternate redness and pale- ness of the face ; clay-colored, sunken face, with blue margin around the eyes ; nausea, without vomiting ; impeded breathing, with suffocating attacks ; sensation of numbness in the arms at night when in bed, with feeling as if something living were run- ning in the arm ; heaviness of the feet ; the feet are cold, extend- ing even to the knees ; trembling of the limbs ; great sensitive- ness of the skin to a draft of air. Worse in the evening, and in the morning ; also from taking coffee, tobacco, or brandy. Better when lying on the back, or when changing the position. Jodilim. Restlessness, with constant desire to move about, not permitting one to sit or sleep ; feeling as if a tape, or a band, were drawn tightly around the head ; throbbing in the head at every motion ; the white of the eye is of a dirty yellow color ; alternate canine hunger and want of appetite ; gastric derangements, with constipation ; coldness of the hands ; cedematous swelling of the feet; great emaciation, even with good appetite; great debility — even talking causes perspiration ; internal dry heat, with external coldness. Worse at night, and in the evening; also when fasting, from 3 1 o Surgical Diseases of the Blood- Vessels. lying on the painful side, from pressure, from warmth, and when walking quickly. Better from cold ; after eating. Kali carb. Trifles vex one ; noise is disagreeable ; giddiness, as if proceeding from the stomach ; the white of the eye is red, the capillaries being injected ; sensation of coldness in the eyelids; face bloated, of a yellow color ; weakness, loss of strength in the arms ; cold hands ; restlessness of the legs in the evening ; swell- ing of the feet up to the ankles ; a short walk fatigues much. Worse in the morning ; also when at rest. Better in the open air, and while exercising. KreOSOte. Constipation ; stools hard and dry, and only ex- pelled with difficulty ; stitches in rectum, extending towards left groin ; cedematous swelling of both feet ; livid complexion, with swelling of cervical glands ; great drowsiness, with frequent yawn- ing ; tossing about all night, without any apparent cause ; faint- ness when rising too early in the morning ; restlessness of the body while reposing. Worse in morning , in the open air on moving ; from eating cold food. Better from warmth. Lachesis. Constipation, with ineffectual effort to evacuate ; stools very offensive ; sensation as if there was a plug in the anus ; hemorrhoidal tumors protrude after the stool, with constriction of the sphincter ; large hemorrhoidal tumors ; dark-colored piles ; uneasiness of lower limbs ; trembling of the legs ; sensation as if a hot iron were going through the knee-joints; swelling of the knees ; coldness and swelling of the feet ; tearing, pricking, or pulsating pains ; inclination to lie down, and averse to moving. Worse in the evening, and periodically ; also in open or cold air, after sleep, or drinking acids or alcoholic drinks. Better from warmth ? Left side principally. LauroceraSUS. Dullness of senses ; inability to collect one's ideas ; insensibility, and complete loss of sensation ; loss of con- sciousness, with loss of speech and motion ; painless paralysis of the limbs ; want of energy of the vital powers, and want of reac- tion. Worse in the evening. Better at night, and in the open air. Ledum pal. Desire for solitude ; the least covering is intoler- Special Therapeutics. 311 able to the head ; glandular swelling under the chin ; constipa- tion, the stool being mixed with blood ; diarrhoea, the stool mixed with mucus and blood ; swelling, tension, and stitches in the knee ; swelling of feet up to the knee ; hot swelling of the leg, with stinging, drawing pain ; dryness of the skin, and want of perspiration ; burning in the limbs ; lack of vital heat. Worse in the evening, and at night ; also from the heat of the bed. Better when keeping still. Ly CO podium. Small stool, in constipation, with feeling as if some were not expelled ; haemorrhage from the rectum, even after a soft stool ; fullness in the rectum, continuing after a copious evacuation ; stitches in the rectum ; painful closing of the anus ; protrusion of the varices ; distension of the haemorrhoids ; swell- ing of the feet around the ankles, with cold perspiration ; weeping mood, extremely sensitive and irritable ; numbness of the limbs, feeling as if the circulation had ceased ; great emaciation, and in- ternal debility ; the whole body feels bruised ; faintishness at cer- tain hours during the day ; disposition to take cold ; uneasiness, or longing for the open air. Worse in the evening ; also when lying down, or sitting, or be- ginning to walk, eating or drinking cold things, and from the pressure of the clothes. Better on getting cold, on continuing to walk, and from warm food and drink. Manyanum. Out of humor, low-spirited, and reflective ; con- tractive pain in rectum when sitting ; red, shining swellings of the affected parts ; inflammatory swellings and suppurations ; every part of the body feels sore when touched. Worse at night ; also on stooping or being touched. Better. Symptoms that are worse in the room are better in the open air, and vice versa. MerCUrillS Viv. Indifference to everything ; continuous moan- ing or groaning ; fainting after sweetish rising in the throat, fol- lowed by sleep; vertigo, as if one were in a swing; great debility and weakness, with trembling and ebullitions from the least exer- tion ; inflammations, ending in suppurations and exudations ; great tendency to perspiration ; perspires with every movement. Worse in the evening, and at night ; also before falling asleep, during perspiration, when exercising, and from the heat of the bed. 312 Surgical Diseases of the Blood- Vessels. Better in the morning, when at rest, and when lying down. Muriatic acid. Sadness, peevish, irritable; vertigo, with tot- tering gait ; hemorrhoidal tumors, swollen, blue, with burning soreness; great debility as soon as he sits down, the eyes close, lower jaw hangs down ; he slides down in the bed ; great sensi- tiveness to damp weather ; wakens early in the morning with a chill. . Worse in the afternoon ; also when sitting down. Better from motion. Natrum mur. Indifference, taciturn, tendency to start ; sad and weeping ; difficulty of thinking ; hemorrhoidal tumors, with stinging pain; stools hard and dry, crumbling like sheep's-dung ; great weakness and relaxation of all bodily and physical powers, from the least exertion ; disinclination to move and walk after rising ; great emaciation ; pulsations in the whole body from the least exertion; restlessness in the limbs — they have to be moved constantly. Worse in the forenoon ; also from exertion, talking, using acids, and from anger. Better while fasting, when lying on the back, and after lying down. Nitric acid. Irritable; sadness, despondency; vertigo, more especially in the morning, obliging one to lie down ; varices of the anus, swollen, burning, and bleeding after every evacuation ; pricking pains as if from splinters, especially from contact ; great debility, with heaviness of the limbs, especially in the morning ; trembling of the limbs ; sleepiness during the day, from debility, with vertigo. Worse in the evening, and at night ; also on touching the parts, on walking, and on rising from a seat. Better from warmth. NlIX vomica. Over sensitive to external impressions, as noise, smells, light, and music ; the time passes too slow ; laziness and aversion to occupy himself; painful blind piles; great debility of the nervous system ; sensation of heaviness of the body, alter- nating with sensation of lightness; feeling of soreness all over the body in bed in the morning; disposition to take cold, with great sensitiveness to the open air, and aversion to drafts of air, at- tacks of fainting. Worse in the morning; from noise, eating, and light touch. Special Therapeutics. 313 Better from strong pressure. Platina met. Low-spirited, inclined to shed tears ; indiffer- ence ; tension in the limbs, as if they were wrapped up tightly ; numbness and stiffness, with paralytic sensation in the limbs. Worse in the evening ; also when at rest. Better from motion. Pulsatilla. Gloomy, melancholy, weeps easily; piles with great soreness ; tension in inner parts and joints ; inflammation of inter- nal organs, with disposition to suppurate ; pulsations through the whole body ; frequent anxious trembling of the limbs ; attacks of fainting with great paleness of the face ; inflamed varices. Worse in the evening, and at night ; also from warmth, on begin- ning to move, and when lying on the left or painless side. Better from slow motion, in the open air, or from cold. Rhus tOX. Absence of mind ; inclination to weep, with desire for solitude ; great debility, weakness, and soreness ; painless par- alysis of the limbs ; numbness in the extremities, with previous twitching and tearing in them ; the parts on which one lies go to sleep; restlessness of the body, with inclination to move the affected parts ; hard swelling of the affected parts. Worse in the morning; also when at rest, on beginning to move, when the weather changes, and from cold. Better from motion and from warmth. Ruta grav. Anxious and low-spirited, with mental dejection; sensation of soreness in the part on which one lies. Worse in the afternoon ; also during rest, in cold weather. Better from motion. Sepia. Sadness with weeping; great indifference; restless, fidgety ; heavy flow of ideas, and weak memory ; piles protrude ; discharge of blood with the stool ; mucus from the rectum, with stinging burning; heaviness in the body; inflammatory swellings; tingling in outer parts ; limbs go to sleep easily after manual labor, vibrations like dull tingling in the body ; a short walk fatigues much; aversion to the open air; weakness of the joints. Worse in the forenoon and evening ; also from mental exertion, and when at rest. Better from warm air. Spigelia. Difficulty in thinking, and disinclination to mental exertion ; weakness of memory ; heaviness and soreness of the body when rising from a seat ; painful sensitiveness of the body to 314 Surgical Diseases of the Blood- Vessels. the touch, with chilliness of the parts touched, or with tingling running through the body. Worse in the night and in the forenoon ; also from the least movement, from touching the parts, and when walking in the open air. Better after lying down. Staphisayria. Weakness of memory; twitches at night; the muscles are painful to the touch, and the joints on motion ; skin is hard to heal. Worse from motion strong mental emotions and touch. Better in evening, and after breakfast. Sulphur. Dullness ; difficulty of thinking, misplaces or cannot find the proper words when he speaks ; piles oozing or bleeding ; feeling of tension in outer parts and in joints ; feeling of heaviness in inner parts ; feeling of fullness in inner parts ; feeling as if a hoop or a band were around parts ; trembling and shaking of outer parts ; the limbs go to sleep ; great debility and trembling ; talking fatigues ; aversion to washing. Worse in the evening, and periodically ; also from bodily exer- tion, on getting warm in bed, while at rest, and from touch. Better from motion and from -heat. Tartar em. Lethargy ; hilarity in the day, anxious and timid in the evening ; attacks of fainting ; internal trembling ; heaviness of all the limbs, with debility ; pulsation in all the blood-vessels. Worse in the evening ; also when sitting, and from warmth. Better in the open, cold air. Thuja. Has a clinical reputation for Nevus. Veratrum. Sudden sinking of strength; continuous weakness and trembling ; numbness and tingling in the extremities ; attacks of fainting from the least exertion ; coldness of the skin, which is wrinkled. Worse in the morning ; also during perspiration. Better after perspiration. ZillCUm. Aversion to talking or working; weakness of the memory ; pulsations through the whole body ; violent trembling and twitching of the whole body; Worse in the afternoon and evening ; also in a warm room. Better in the open air. Special Therapeutics. 315 Operation for Varix. The operation is performed by sticking a hair-lip pin through the integument under the vein, and twisting silk or wire around it in a figure-of-eight form. ARTERITIS. Arteritis is an inflammation of the arteries, and, like phlebitis, is caused either by injury as from a ligature, or is idiopathic, or rather, is caused by some constitutional taint, of a nature with which we are entirely unacquainted. The two varieties recognized by surgical writers, are adhesive or limited, and diffuse or erysipeloid. The former may be acute or chronic, idiopathic, or of a traumatic origin ; the latter is always the result of injury. In adhesive or limited arteritis, from the pressure of tumors, or long-continued pressure of any sort, the coats become thickened and fused together, finally forming an imperforate cord. This is very common in the chronic variety. The result may be the estab- lishment of a collateral circulation, the absorption of the clot and consequent re-establishment of the circulation, or, in connection with the collateral circulation, a necessary obliteration of the main trunk. Diffuse Arteritis differs from the preceding variety, in that the disease extends over a wider extent of surface, and is attended by plastic exudation. One of the most to be dreaded results is that of gangrene, which may be very readily set up if a large arterial trunk be the seat of the disease, and the diseased action should progress rapidly ; particularly is this to be dreaded if a plug should form suddenly. The symptoms are, pain, depending on the situation of the vessel — either superficial or deep, tenderness to pressure, and coldness of the limbs. The artery can be felt pulsating in jerks. The point immediately below the inflamed portion is always the most susceptible to pressure or touch, and this is sometimes excessively acute ; this is most always the case when the artery is superficial, and is then attended with some loss of muscular power, and the pain is of a neuralgic character. When the artery is deep-seated, the pain is an intense burning, and is felt along the course of the branches of the vessel. When the plug is forming, there are 3 1 6 Surgical Diseases of the Blood- Vessels. many symptoms which point to the difficulty to be apprehended. The pulsations below that point become gradually weaker, until at last when it is completely formed, it ceases altogether, and the limb, which all along had been falling in temperature, becomes cold and discolored, while the sensibility continues. Gangrene may invade the part in one of two forms, the senile or dry, and the moist; the former if the arteries alone are affected, and the latter when there is a complication of phlebitis ; the sensibility in both instances of course, diminishing as the gangrene advances. When gangrene is fully formed, of course destruction of the limb ensues, and amputation is the last resort. Fatty Degeneration of Arteries. This consists in the deposit of fat in the coats of the vessel. The diagnosis is not at all certain during life. The circulation is feebler from the want of elasticity of the vessel, and from the fact of its being incapable of providing the requisite amount of blood for the parts it supplies, atrophy,.or even death of the part ensues. This disease is only or chiefly of interest from a pathological point of view. Calcification. This is a deposit of calcareous material on the inner coat of the vessel, which may assume almost any shape, exist in any quantity, and affect any extent of the vessel, which, in some instances, may be converted into a firm, unyielding tube. It is exceedingly diffi- cult to determine positively the nature of the disease, and this will materially obscure the plan of treatment. We should be guided by the few pathognomonic indications, and good common sense. Aneurisms. This is an enlargement or dilatation of an artery, either of all the coats, to a certain extent, or of only one, with a rupture of the others. Erichsen gives us three varieties : the fusiform, saccu- lated, and dissecting, sub-dividing the second class into two varieties, the true and the false. (i.) The Fusiform, the whole of the vessel at one point is pre- ternaturally dilated, each of the coats uniformly, and is sometimes Special Therapeutics 317 known as the "tubular" The aorta is the vessel usually the seat of this variety, but it is occasionally met with elsewhere. The disease does not consist alone in a simple dilatation, but in addi- tion to all the coats being thickened and elongated, the outer one is particularly so, the middle has lost its elasticity, and the internal studded with deposits. (2.) Sacculated aneurism proceeds often from the former variety. It consists of a tumor bulging out at the side of an artery, formed of its coats. Circumscribed sacculated aneurisms are those in which the blood is contained in the sac, no matter how large the sac may be. The diffused form are those in which the sac has burst, the blood poured out into the surrounding cellular tissue, but still being limited by a condensation of this tissue. Previous to one of the coats giving way, the coat so ruptured becomes firmly attached to the one remaining intact, so that the blood does not find its way between them, but when this does not occur, by reason of this failure we have another variety, called the (3.) Dissecting aneurism, that is, the blood passes between two of the coats, separating them from each other. The terminations of this condition may be, the blood, after forcing itself for some distance, will burst through the external coat, and become effused into the surrounding parts ; or, the external coat being too firm, it will open again through the internal coat, and thus an apparent septum be formed in the vessel; or, finally, both the internal and external coats being too strong to admit of an open- ing being formed, a sac may form in the very substance of the vessel, closing it up internally, and finally one or more coats will give way, and either a false sacculated aneurism result, or all the coats giving way, except external or internal, the blood be poured out into the neighboring parts, or form the second variety by opening into the cavity of the artery again. In determining upon the treatment you must take into consid- eration, first, the locality; second, the effect that pressure would produce upon the neighboring parts; and third, as near as possible the form. The pressure exerted by these tumors on neighboring parts, is a very important phenomena to study, as these effects often are the only means we have for forming a correct diagnosis. Important veins are not unfrequently thus compressed, and varix, phlebitis, or even complete obliteration ensue ; so also the nerves, air passages, or other arteries. The injurious effect of such pres- 3 1 8 Surgical Diseases of the Blood- Vessels, sure on bones is fully shown in the disorganization and absorption they undergo. Aneurismal tumors on superficial vessels may generally be very readily detected by their shape and the pulsation communicated to the touch. Pulsation alone will not be suffi- cient ; a tumor may rest upon an artery, and the pulsation in the latter be communicated to the former; raising the tumor will detect it, if such is the case, unless the artery pass through it. But the surest plan is to compress the artery firmly above the tumor, and if the pulsation in it ceases, joined to the other manip- ulations, you may consider the case made out. In diagnosing a deep or " internal " aneurism, the chief attention is to be paid to the " pressure effects," and to the sound of the beat at that point, which is louder than normal and of a rasping or scraping char- acter. If, however, the aneurism is of the sacculated variety, and that with a small neck, this sound will not be heard, and hence a difficulty will be experienced in determining whether it be an aneurism or some other tind of tumor. I should not waste much time in use of remedies, but tie the vessel, or keep up continuous pressure. Aneurism by Anastomosis. This is perhaps the most dangerous of all the varieties of aneu- rism. It consists in a condition of the arteries resembling varix, and the resemblance is further shown, as the coats of the vessel are very thin, as well as the course being marked with a number of pulsating little pouches, looking like the valvular enlargements of the veins. They are usually found at a distance from large trunks ; the tumors externally are of a bluish color, warmer than the surrounding skin; the beat is synchronous with the heart; they are irregular in shape; of a doughy feel; not circumscribed; and large tortuous vessels are felt running into them from various directions. On compressing the tumors the beating is partially suspended, and, on remitting it, the blood returns into it with an expansive beat, and sometimes with some violence as if ejected from a syringe. The beating, however, is not a regular pulsation, but rather a thrill. The sound of this circulation is usually loud> though it may be soft and blowing. Nevus. This disease, though not strictly an arterial one, is inserted here because it is more intimately associated with this class ofdiseases Special Therapeutics. 319 than any other. It may be arterial, capillary, or venous in its form. Arterial nevi are simple aneurisms by anastomosis in miniature. The disease, in all of its forms, is essentially an excessive devel- opment of the vascular tissue of the part. Capillary nevi are slightly elevated, but flat spots on the skin; in color are bright- red or purplish, and larger vessels can be seen ramifying on their surface, which is slightly roughened. They are congenital, and vary greatly in size, from that of a pea, to as large as a hand, or larger. Their seat is usually on the head or neck, the face often- est, although they may be found on any part of the body. If left alone they may be removed spontaneously, frequently by a sort ot an ulceration that produces more deformity than pre-existed, from the resulting cicatrix. The haemorrhage from them is not at all alarming, being a mere trickling. Venous nevi are quite large in some positions, and differ materially from the other varieties in not being compressible, and in color, which is a dark-brown. They are not at all painful, and apart from the blemish, are not trouble- some. Sometimes they are soft, and compressible to a slight degree, and on being submitted to pressure are quite flat, but fill up again quickly when the pressure is removed. I consider them quite amenable to treatment. Treatment. — Arteritis: Aeon., Am., Ars., Bell., Bry., Calc., Chin., Con., Hep. s., Lack., Lye., Merc., Nux vom., Phos., Puis., Rhus, Ruta, Sil., Sulph., Thuja. Arteritis: From Ligature and Injury. — Aeon., Am., Bell., Bry., Hep. s., Rhus. Idiopathic. — Aeon., Bell., Bry., Calc., Chin., Lach., Merc, Nux v., Phos., Puis., Rhus, Ruta, Sil., Sulph., Thuja. Adhesive. — Aeon., Am. Ars., Bell., Bry., Chin., Con., Lach., Merc., Nux v., Puis., Rhus, Sil., Sulph. Diffuse. — Aeon., Am., Ars., Bell., Chin., Hep., Lye, Merc, Rhus, Sil., Thuja. — Gangrene from. — Ars., Bell., Lach., Rhus, Sulph. Fattv Degeneration: Aeon., Ars., Aur., Borax, Calc, Chin., Caust., Ferr., Nux v., Phos., Puis., Sulph. Calcification: Calc. c, Dig., Ferr., Kali c, Phos., Rhus, Sil., Sulph. Aneurism: Ambra., Arn., Ars., Bry., Cact. g., Calc, Car bo v., Caust, Con., Dig., Ferr., Graph., Guaj., Lach., Lad., Lye, Nat. m., Phos., Puis., Rhus, Ruta, Sil., Spig., Sulph., Zinc. 320 Surgical Diseases of the Nerves, Aneurism of the Aorta particularly. — Ars., Cact. g., Calc, Carbo v., Dig., Graphs Lack., Lye, Nat. mur., Puis., Rhus, Spig., Sulph., Zinc. by Anastomosis. — Acetic ac, Aeon., Bell., Cact. g., Dig., Phos., Rhus, Sulph. Nevus: Acetic ac, Ars., Borax, Calc, Hep. sul., Iod., Lach., Lye, Merc, Si/., Sulph., Thuja. Operations. Aneurism is the only one of the true arterial diseases that admits of an operation. The mechanical means in most common use are ligation and pressure. The ligatures must be placed on the vessel at some distance from the tumor. Of late years the treatment by pressure has been much and successfully practiced, and will undoubtedly in time supercede all others. This is effected either by an apparatus, like a hernia truss, or else by the fingers of assistants. Nevi are usually treated by passing silk backwards and forwards through their substance, and thus strangulating them. Some excise them; and some again destroy them by active escharotics. The best of all is to remove them by remedies. SURGICAL DISEASES OF NERVES. NEURALGIA, NEURITIS, NEUROMA, TETANUS, WOUNDS. Neuralgia. Neuralgia is a condition which, when neglected, becomes neuritis. One is an irritation, and the other an inflammation subsequent to it. The development of neuralgia is almost always due to some local irritation. Pressure of some foreign material upon the nerve, or any cause that induces nervous prostration may induce it. The disease may affect almost any part of the body. The symptoms are these ; pain in the course of the nerve, of all degrees of severity, which is sometimes so very Neuritis. — Neuroma. 321 severe that the strongest persons are totally incapacitated from performing any of their ordinary occupations. It may come on gradually, or suddenly like an electric shock, and be accompanied with increased secretions from the part affected, or a partial or total suppression. The pain may be prickling, burning, shooting, throbbing, or steady. The skin is extremely sensitive to touch, but is sometimes not so much so to strong and continued pressure. When it becomes chronic, I consider the disease to have changed its nature, and become Neuritis. This is an inflammation of a nerve, and is commonly seen after some direct injury inflicted on the nerve, as in operations. It also follows rheumatism and strains. It results in softening of the nerve substance. The pain is similar to that of neuralgia, but is not intermittent, and is not apt to recur after it has disappeared. The skin is not so sensitive to pressure, but there is tenderness along the track of the nerve, and some swelling. The only points of difference between the two forms, is, that one is acute, the other chronic ; one periodic, the other not. Neuroma. These are tumors of a fibrous consistence, connected with the nerves, but not composed of nerve tissue. They are most com- mon in connection with the nerves of the spinal system, although they are occasionally seen in connection with those of the gan- glionic. In structure they resemble very closely the neuromatous tumor, and are found to be surrounded by nervous filaments, some few of which may pass through its substance. The nerve, of course, is more or less affected when the tumor presses upon it, but above and below it is normal in appearance, at all events. When they occur singly, or when only one or two are found, they are extremely painful, but — and it is a remarkable fact — that when there are great numbers of them, they are entirely pain- less. They may give rise to neuralgia, followed by neuritis. In shape they are usually oblong, with their long axis parallel to the course of the nerves, and may be freely moved in any direction save that in the course of the nerve. In size they may be from 31 322 Surgical Diseases of the Nerves, that of a mustard-seed to as large as the fist, or larger. They may also exist in any number, from one to several hundred, and are more apt to attain a large growth when single, than when in great numbers. When these tumors follow operations, and occur in the divided extremity of a nerve, it is due to a ragged or lacerated wound, or to some abnormal condition of the nerve. The pain in such tumors is excruciating, and has frequently called for re- amputation, or exsection of the nerve. Tetanus. This is one of the most formidable looking diseases to treat imaginable, but a careful selection of the remedy will prove it otherwise. We have four recognized varieties, each of which is usually ushered in by the appearance of the first mentioned. They are — ist, Trismus, or, as it is commonly called, " locked-jaw ; " 2nd, Opisthotonos, in which the body is bent backwards, so that it rests on the heels and occiput ; 3rd, Emprosthonos, in which it is similarly curved forward ; and 4th, Pleurosthotonos, in which it is bent to one side. In all the varieties, the body is rigid, and the face drawn into an expression of the most intense agony. Unlike most spasms, the muscles after once becoming rigid do not relax again until the disease is removed. The principal symptoms are as follows : — Closing of the jaws, which cannot be opened ; difficult, or impossible deglutition ; rigidity and immo- bility of the limbs and trunk. Wounds of Nerves. The degree of danger is dependent upon the size of the nerve, and its importance in the economy. If the pneumogastric nerve is severed, or materially injured, so that its function is destroyed, it is followed by death. Other nerves of motion, more particularly if injured give rise to a paralysis of all muscles below the seat of injury. When a portion of a nerve is entirely removed, of course paralysis of the parts it supplies will follow; but it sometimes hap- pens that the portion so removed is small, and a subsequent imperfect union of the cut ends follows, followed again by just as imperfect a restoration of junction. Dr. McClellan, of Philadel- phia, operated for the removal of a parotid gland ; he found the Special Therapeutics. 323 pneumogastric, spinal accessory nerve, and portia dura, involved in the diseased mass. The tumor was excised, and with it a por- tion of the pneumogastric two inches in length; "strange to say, scarcely any impediment to respiration was experienced, and the patient recovered." This case is reported to show that there are exceptions to the above rule, in which the important functions ot the pair, can be carried on by one alone. When the nerve has been divided, partially or completely, or when a vein has been excised, Staphisagria, internally and exter- nally, will prove the quickest remedy in promoting a union of the cut ends. Calend. may be found more useful in cases of excision, and is to be given in the same way. When pricks from sharp instruments, bruises, or neuralgia from these causes is the trouble, Arnica, or Conium will be the best remedy. For external applica- tion, the tincture is always to be understood, ten drops to an ounce of water. Internal administration, the 30th is to be understood, and when another attenuation is desirable it will be named. " Treatment. — In selecting a list of remedies to consult for the treatment of these affections, I am almost afraid that they will confuse rather than aid, but it is impossible to abbreviate ; indeed, it is much easier to add to the indications. Neuritis : Aeon., Apis., Ars., Bell., Bry., Canth., Caps., Chin., Con., Dig., Euph., Lye., Merc., Nux v., Puis., Rhus, Sep., Sil., Sulph., Verat., Zinc. Neuralgia: Aeon., Anac, Am., Ars., Asa/., Aur., Baryta, Bell, Bry., Camph., Carbo v., Caust., Cham., Chin., Cimicifuga, Cina., Coff., Coloc, Con., Cypripedium, Elaterium, Ferr., Gels., Graph., Hep., Hyos., Ignat., Ipec., Kali e, Kalmia lat., Lach., Lye, Magnes., Mangan., Merc, Mezer., Nit. ac, Nux v., Oleand., Petrol, Phos., Phytol., Plat., Puis., Rhus t., Rhus r., Sabad., Sep., Sil, Spig., Stan., Staph., Teucri., Thuja, Valer., Verat. Neuroma — Idiopathic: Aeon., Am., Bell, Calend., Calc, Lye, Merc, Rhus, Ruta, Sil, Thuja. traumatic: Am., Aeon., Bell, Bry., Calend., Con., Chin., Rhus, Ruta, Sulph. (sub-cutaneous tubercle) : Aeon., Arn., Ars., Aur., Calc, Dig., Lye, Merc, Nux v., Puis., Rhus, Ruta, Sil., Sulph. Tetanus: Aeon., Ammo. e.,Angust, Arn., Camph., Cham., Cie v., Cocc, Gels., Hyos., Ign., Lye, Merc, Nat. m., Opi, Phos., Rhus, Staph., Stram., Sulph., Verat., Canth., Cin., Gratiola, Ipec, Nux v., Plat., Secale, Stan. 324 Surgical Diseases of the Nerves. Trismus: Angus?., Bell., Cicuta v., Hyos., Lack., Merc, Stan., Aeon., Ammo, c, Am., Ign., Opi., Sir am. Opisthotonos: Bell., Hyos., Ign., Op', Rhus Viper a redi. Emprosthotonos : Coloc, Ign.. Hyos., Stan. Pleurosthotonos : Aeon., Bell, Bry., Hyos., Phos., Sir am., Stan. Aconite. Vertigo on rising up in bed; crampy sensation at root of nose, making her feel as if going crazy ; feeling as if the whole brain would press out at the forehead ; she fears to be in a place of excitement or confusion. Insupportable pains, especially at night ; shooting or pulsating pains ; thirst ; redness of the cheeks ; small and quick pulse ; great sensitiveness of the whole nervous system, especially of the organs of sight and hearing. Worse in the evening and at night ; also from warmth. Better when at rest and in the open air. Ammonium Carb. Feeling as if the head would burst; anxiety, with inclination to weep ; discharge of sharp, burning water from the nose; pale, bloated face; much thirst; debility, compelling one to lie down ; great sensitiveness to cold ; tearing and burning pains ; pulse hard, tense and frequent ; attacks of chilliness in the evening ; during the day and in the morning, perspiration, principally about the joints. Worse in the evening ; also from wet poultices and pressing the teeth together. Better from pressure and warmth. Anacardium. Loss of memory: fluent coryza; loss of taste; diminished sensibility, particularly of smell, sight and hearing; sensation as if a hoop or band were around the parts ; pulse accel- erated, with beating in the veins ; coldness internally, with exter- nal heat ; clammy perspiration of palms of the hands. Worse in morning, periodically ; also from rubbing. Better during dinner. Left side. Angustura. Excited; easily starts; heat and bluish redness of the face ; tension in the muscles of the face ; the lips are drawn back showing the teeth; thirst, but no desire to drink; pulse accelerated, spasmodic, intermitting, and at times irregular. Worse in the morning ; also from touching the parts. Apis mel. Restlessness ; twitching of the eye-balls ; cedema- tous swelling of the lids; redness and swelling of both ears; burning or stinging heat in the face, with purple color ; oedematous swelling of the face; thirstlessness ; tension over the eyes, behind Special Therapeutics. 325 the ears and in the neck; pulse full and rapid, or small and trembling; intermitting pulse ; chilliness from the least movement, with heat of the face and hands ; sharp pains like a bee-sting. Worse in the morning, evening, and at night ; also from heat. Better from cold. Left side. Arnica. Crawling, pricking in the part ; agitation and restless- ness, which compel the patient to move the parts continually ; great sensitiveness to noise; heat of face, cold body; hot, red, shining swelling of one cheek ; burning, hot, cracked lips ; thirst, desire for cold water; longing for alcoholic drinks; pulse very variable, mostly hard, full, and quick; internal chilliness, with external heat ; perspiration smelling very sour, sometimes cold. Worse in the morning, evening, and at night ; also on moving, being touched, and from cold. Better from warmth. Arsenicum. Burning or tearing pains, felt even during sleep; pains become insupportable, so that he becomes furious, and de- spairing; great anguish; excessive weakness, so that he has to lie down ; intermission of the pain, when sensation of coldness in the part affected ; the pain is so great that the patient is contin- ually moving from room to room, or place to place ; swelling and burning of the nose; fluent coryza of burning, sharp, excoriating water ; puffiness of the face, especially around the eyes ; distorted features ; lips black, dry and cracked ; longing for cold water, acids, and alcoholic drinks; sudden sinking of strength; pulse frequent in the morning, slower in the evening; skin dry, like parchment. Worse at night, and in morning; also from cold, when lying on the affected side. Better from heat in general. Asaftetida. Hysterical restlessness and anxiety ; sensation of numbness of the bones of face; twitching and jerking in muscles; pulse small, rapid, and unequal. Worse in the afternoon and evening. Better in the open air. Left side. Alirum met. Melancholy mood, dejected, inclined to weep, and longing to die ; almost driven to suicide ; fiery sparks before the eyes ; roaring in the ears ; very sensitive smell ; bloated, shining face; immoderate thirst; hysterical spasms with laughing and crying alternately ; pulse is small, but accelerated. 326 Surgical Diseases of the Nerves. Worse in the morning ; also from cold. Better from motion and warmth. Baryta C. The light hurts the eyes ; in the dark he sees spots before them ; dark redness of the face ; tension on the face as if it were covered with spider's webs ; flushes of heat ; pulse weak, but accelerated. Worse at night ; also when thinking of it. Better in open air. Belladonna. Nervous anxiety and restlessness ; eyes sparkling, red and glistening; looks wild, unsteady; inflammation of the ear; dullness of hearing ; inflammation and redness of the nose ; sense of smell preternaturally acute ; purple-red and hot face ; alternate redness and paleness of the face; spasmodic distortion of the mouth ; violent cutting pains ; the upper lip is swollen ; excessive burning thirst ; inability to swallow ; pulse accelerated, often full, hard and tense ; sometimes soft and small ; if slow the pulse is full ; dry heat, with thirst ; perspiration on the head, or only on those parts that are covered ; the patient seems to be in a stunned or stupid condition. Worse at night ; also from the least touch, from light, or noise. Better while lying down. Right side. Bryonia. Exceedingly irritable, inclined to be angry ; burning in the eyes, and edges of the eyelids ; the eyes feel as if pressed out of the head; the upper lids are particularly swollen; does not drink often, but much at a time ; swelling of the affected parts, with inability to move them ; pulse full, hard, and tense ; perspira- tion profuse, and very easily excited ; desire to keep very still. Worse in the evening ; also from motion, or sitting up in bed, and from heat. Better on getting warm in bed. Right side. Calendula Off. Provings of this remedy are very incomplete, but the little use I have made of it justifies me in recommending its use, topically at all events, in neuritis resulting from a lacerated wound. Camphora. Great anguish and discouragement; confusion of ideas ; aversion to light ; usually thirstlessness ; sometimes violent thirst; sudden and great sinking of strength; death-like paleness of the face, alternating with redness ; icy-cold face, purple or pale; distorted countenance; foam at the mouth; icy-coldness of whole body, with paleness of face; pulse small, weak and slow; cold perspiration, often clammy, and always very debilitating. Special Therapeutics. 327 Worse at night; also from cold. Better when thinking of it. Cannabis ind. (From Hale.) Heat of the skin ; copious per- spiration; pulse very slow, with nausea; general restlessness; desire to sleep, but inability to do so; dry mouth and thirst. Even these few unimportant symptoms are, I fear, far from being reliable. They are all I can find, however. CantharideS. Anxious restlessness, ending in rage; eyes pro- truding; fiery, sparkling, staring look; death-like appearance; expression of terror and despair; hot, red, and swollen face; thirst, but yet an aversion to all fluids ; pulse hard, full, and rapid ; burning heat, with anxiety and thirst ; cold perspiration, smelling like wine. Worse in the afternoon and night ; also from coffee. Better from lying down. Right side. Capsicum. Peevish, easily offended; redness of the cheeks without heat, often changing to paleness ; swollen and cracked lips; thirstlessness ; pulse irregular, and often intermitting; heat, with perspiration and no thirst. Worse in the evening, and at night; also when eating or drink- ing, or beginning to exercise. Better from continued exercise. CarDO veg. Sensitiveness and irritability; burning and press- ing in the eyes; pulsations in the ears; great paleness of the face , swollen face and lips; greenish color of the face; excessive thirst; numbness of the limbs (and parts affected) ; burning pain ; pulse small, weak, imperceptible; uneven or intermitting pulse. Worse in the morning and forenoon ; also in the open air, from poultices and pressure. Better after lying down. Causticiim. Melancholy, peevish, low-spirited; buzzing and roaring in the ears and head; painful swelling of the external ear; yellowness of the face, especially the temples; spasmodic sensa- tion in the lips ; sensation of tightness and pain in the jaws, making it very difficult to open the mouth or to eat ; violent thirst for cold drinks ; pulse only accelerated towards evening; flushes of heat ; sensation of internal chilliness, followed by perspiration without previous heat ; perspiration is sour. Worse in the evening ; also in the open air. 328 Surgical Diseases of the Nerves, Better from heat. Chamomilla. Ill-humor, taciturn ; aversion to a bright light ; sensitive hearing and smell; bloatedness of the face; swelling, with hardness and blueness of one cheek; heat of the face while the rest of the body is cool ; great thirst, with longing for cold water; great prostrating debility as soon as the pain begins; pulse small, tense, and accelerated; heat, with occasional chills; heat, with anxiety, and perspiration of the face and scalp. Worse at night ; also while down, and during sweat. Better while fasting, and on rising. Left side. China Off. Indifference and apathy; serous irritation; hum- ming in the ears ; heat and redness of the nose ; violent thirst for cold water; drinks often, but very little at a time; face pale and sunken ; red and bloated face ; the lips are swollen ; pulse small, hard, and rapid, or irregular; over-sensitiveness of the nerves from loss of fluids. Worse at night ; also from the slightest touch, after drinking. Better in the room. Cicuta VIP. Hardness of hearing ; deadly paleness of the face, with coldness of the face and hands ; red face ; grinding of the teeth ; the throat feels closed ; inability to swallow ; violent thirst ; spasms of the muscles, especially of the neck and chest ; pulse is weak, slow, and trembling; internal heat. Worse in the afternoon ; also from cold. Better when in bed, and from warmth. Cimicifllga, (Hale.) Severe pain in left jaw; heat on one side of face, with lassitude all over ; very severe pain in the face, more in under jaw, lower teeth, and articulation of lower jaw; pains in head and face constant, and very severe ; pain in right superior maxillary bone and teeth. Cilia. Disposition to be offended by trifling jests ; bloated, pale face, with blueness around the mouth ; pale, cold face, with cold perspiration; increased thirst; the body is stretched out, and becomes rigid; dull stitches in different parts of the body; the limbs twitch, and are distorted ; pulse small, hard, and rapid. Worse at night ; also from external pressure. Better after lying down. Left side. CoCClllllS. Pain in the eyes, as if they were torn out of the head ; hardness of hearing, with noise as of rushing water ; heat in the face, and redness of the cheeks ; sensation of extreme Special Therapeutics. 329 weakness ; disposition to tremble ; trembling of all the limbs ; pulse small and spasmodic, sometimes it cannot be felt ; perspira- tion of the parts affected. Worse in the evening ; also from talking, sleeping, drinking, and in the cold air. Better from pressure and warmth. Coflfea. Over-sensitiveness ; weeping mood ; sense of hearing more acute; dry heat in the face, with red cheeks; nightly thirst; the pains are intense, driving to despair ; twitching of the limbs ; chilliness increased by every movement ; head feels contracted and too small. Worse at night; also from the open air. Better from cold water. ColOCytlth. Aversion to talk; disinclined to answer questions; pulsation and rushing in the ears ; fluent coryza ; face pale and relaxed, with sunken eyes ; dark redness of the face ; tearing, or burning, or stinging pain on the left side, extending to the ear and head ; swelling of the face, with redness and heat of one cheek ; twitching of the muscles ; faintness with coldness of the extremi- ties ; burning pains ; pulse full, hard, and accelerated ; internal heat ; attacks of flushes of heat. Worse in afternoon and evening; also when lying down, and lying on painless side. Better when lying on painful side, and from motion. Conium mac. Inclination to start as if with fright ; great and painful sensitiveness of hearing; roaring and humming in both ears ; excessively acute smell ; heat in the face ; stinging-tearing faceache ; dry and scaly lips ; sensation of debility ; sudden loss of strength when walking ; pulse irregular, generally slow and full, alternating with small and frequent beats. Worse in the morning and night ; also when eating, standing, or at rest. Better from motion. Right side. Cypripedilim. (Hale.) This author makes the following char- acteristic remark : " In many cases of neuralgia ' the pain is the disease.' In such instances the Cypripedium will be found curative in many cases " ! ! ! Digitalis. Great anxiety, and inclination to shed tears ; gloomy and peevish; blueness of the eyelids; swelling of the lower lids; hissing before the ears, like boiling water, with hardness of hear- 330 Surgical Diseases of the Nerves. ing ; pale face, with blueish hue under the pale skin ; convulsions on the left side of the face ; faintness and debility with perspira- tion ; great nervous weakness ; pulse is very slow, especially when at rest; pulse irregular and intermitting; while moving about the pulse is accelerated ; internal chilliness with external heat ; chilli- ness with heat and redness of the face ; sudden flushes of heat, followed by great debility. Worse after dinner. Better when lying down. Elaterium. Depression of spirits , fever with violent tearing pain throughout the head. Better from perspiration. Euphrasia. Taciturn, disinclined to talk; swelling of the lower eyelids ; redness of the face ; stitches and stiffness in the cheek and lower jaw when talking or chewing ; crawling as of a fly in one or other of the limbs, from below upwards in a straight line, with numbness of the part. Worse in the evening ; also when wet. Left side. Ferrum. Anxiety, as after committing a crime ; quarrelsome disposition ; inflammation and redness of the eyes, with burning and stinging ; pale bloated face, especially around the eyes ; fiery redness of the face, the veins are enlarged ; pale face with red spots ; unquenchable thirst ; longing for acids ; weakness of the body almost paralytic ; so weak that she must lie down ; pulse full and hard ; violent ebullitions. Worse in the morning ; also when at rest Better from slow exercise. Left side. Gelseminum. Great irritability, does not wish to be spoken to; aversion to light, particularly candle-light ; heat in face, with ful- ness in head, and cold feet ; stiffness of the jaws — they are locked ; pulse slow, accelerated by motion. Worse at night ; also on waking. Graphites. Melancholy, with inclination to grief; easily vexed ; pressure and stinging in the eyes, with lachrymation ; feeling as if the ear was filled with water ; pale, yellow color of face ; continued feeling as if from a cobweb over the face ; vio- lent thirst, early in the morning ; pulsation through the whole body whenever he moves ; pulse full and hard, but not accelera- ted ; inability to perspire. Worse at night ; also from cold. Special Therapeutics. 331 Better from warmth, and on getting warm in bed. Gratiola. Serious, taciturn, absorbed in reverie ; burning heat in the face ; face feels swollen : violent thirst ; physical and men- tal depression ; great languor and prostration ; tetanic spasms, feeling bruised on recovery. Worse in the afternoon; also when sitting, and after eating. Better from contact. Hepar SUlph. The slightest cause irritates him, and makes him vehement; dejected, sad, with inclination to shed tears; in- flammation of the eyes and lids ; darting pains in the ears ; red- ness and heat of the nose; heat and fiery redness of the face; yellow color of the face, with blue borders around the eyes ; faint- ing from slight pain ; weakness of all the limbs, they feel bruised ; pulse full, hard, and accelerated, at times intermittent ; flushes of heat, with perspiration. Worse at night ; also from cold, and on touching the parts. Better from warmth. , HyOSCyamUS. Red, sparkling eyes ; heat and redness of the face ; swollen, brown-red face ; distorted bluish face, with the mouth wide open ; repeated attacks of fainting ; subsultus tendi- num ; pulse full, hard, and accelerated ; distension of the arteries ; cold, sour-smelling perspiration. Worse in the evening ; also after eating or drinking. Better by stooping. Hypericum perf. Sensation as if the head became elongated ; stitches in the right eye ; shooting through the ear; the face feels hot and bloated ; tension in the cheek ; thirst, with feeling of heat in the mouth ; violent thirst ; feeling of weakness and trembling in all the limbs ; pulse hard and accelerated. • Worse in the afternoon ; also after eating. {Vide Lippe, p. 294, symp. 39, for lacerated wounds of nerves especially.) Ignatia. The slightest contradiction irritates ; intolerance of noise ; cannot bear the glare of light ; alternate redness and pale- ness of the face ; redness and heat of one cheek and ear ; perspira- tion only on face ; trembling of the limbs ; pulse hard, full, and frequent, or very variable ; flushes of heat externally. Worse in the morning and evening ; also when lying down, from coffee, tobacco, and brandy. Better when lying on the back, and from a change of position. Ipecacuanha. Irritability, restlessness, impatience ; cannot 33 2 Surgical Diseases of the Nerves. bear the least noise ; pale face, with blue margins around the eyes; convulsive twitches in the muscles of the face and lips ; opistho- tonos, and emprosthotonos ; great weakness, and aversion to all food ; over-sensitiveness to heat and cold ; twitching in the limbs ; the body is stretched out stiff; pulse very frequent, but at times scarcely perceptible ; damp coldness of the hands and feet. Worse at night. Right side. Kali Carb. Angry .and irritable ; easily startled, especially if touched ; painful sensitiveness of the eyes to the light of day ; dullness of hearing ; dullness of smell ; face bloated ; yellow color of the face ; swelling and redness of the cheeks ; twitching of the muscles ; pulse very variable ; strong pulsations in the arteries ; internal heat, with external chilliness ; the perspiration is fetid, or smells sour. Worse in the morning ; also in cold air, and when lying on the side. Better from warmth. Kali bich. Ill-humor, low-spirited, indifferent ; sudden attacks of giddiness on rising from the seat; eyelids burning, inflamed, and much swollen ; cedematous swelling of the eyelids ; sensitive painfulness of the bones of the face, as if bruised ; perspiration on the upper lip ; increased thirst ; stiffness of the neck when bend- ing the head forward ; quickly moving, wandering pains, from one part of the body to the other; great debility, with desire to lie down ; pulse small and accelerated ; hot, dry skin. Worse in the morning, and periodically ; also from cold, and after eating. Better from warmth. Kalmia lat. Sensation of stiffness around the eyes, and in the lids ; coryza, with increased sense of smell ; paleness of the face ; stitches and tearing in the lower jaw ; pulse slow and weak ; heat, with burning and pain in the back and loins ; cold perspira- tion ; dry skin. Worse in the evening ; also in the open air, and from motion. Better when lying down. LacheSJS. Nervous irritability ; paleness, yellowness, or lead- like color of the face ; heat and redness of the otherwise pale face ; great thirst ; stiffness of the neck ; tearing, pricking, and pulsating pains ; inclination to lie down, and aversion to move ; pulse small and weak, but accelerated, or else unequal and in- Special Therapeutics. 333 termittent, or alternately full and small pulse; skin of the part bluish-red. Worse in the evening; also in the open air, from cold, and after sleep. Better from warmth. Right side. LyCOpodilim. Low-spirited, taciturn, melancholy; over sensi- tiveness of hearing ; the same in regard to smell ; paleness of the face; flushes of heat in the face; spasmodic twitching in the muscles of the face ; the lower jaw hangs down ; painful stiffness and soreness of one side of the neck ; involuntary alternate con- traction and extension of the muscles in different parts of the body ; sensation as if the circulation stood still ; want of natural heat; violent perspiration from the least exertion. Worse in the evening ; also when lying down, from the pres- f. ure of the clothes, and strong smells. Better from cold. Right side. Magnesia Carb. Anxious, with perspiration all day ; sad mood, with indisposition to talk ; sensitiveness to noise ; pale face ; earthy, sickly complexion ; alternate redness and paleness of the face ; desire for acid drinks ; stiffness of the neck ; pain- fulness of the whole body; pulse slightly accelerated during the night. Worse at night ; also from talking, or mental emotion. Better. — Symptoms are better from walking, which come on while sitting, and vice versa. Ma rig a num. Out of humor, low-spirited, and reflective ; eye- lids swollen, and painful to the touch ; face pale and sunken ; twitching stitches from lower jaws to temples when laughing ; cramping pain in the upper and lower jaw after eating ; no thirst ; stiffness of the nape of the neck ; pulse very uneven and irregu- lar; sudden flushes of heat in the face, chest, and over the back; profuse perspiration, with short, anxious breathing. Worse at night ; also on stooping, and on being touched ever so lightly. Better. — Symptoms better in the open air, which came on in the room, and vice versa. MerCUrillS. Copious perspirations, which do not afford any re- lief ; sweat at every motion ; violent thirst ; swelling, redness and closing of the eyelids; feverish heat and redness of the face; swelling of the cheeks; almost complete immobility of the jaw; 334 Surgical Diseases of the Nerves. swollen and stiff neck, with difficulty of turning the head ; pain- ful closing of the jaws. Worse in the evening and night ; also from the heat of the bed, and when exercising. Better when at rest, and when lying down. Mezereum. Restlessness when alone, and longing for com- pany ; twitching of the muscles around the eyes ; visible twitching on the root of the nose ; gray, earthy complexion ; frequent troublesome twitching of the muscles in the middle of the cheek ; face and forehead hot and red, with great restlessness and peevish- ness ; tension of the muscles ; twitching of muscles ; pulse full and hard, in the evening accelerated ; sensitive to touch. Worse in the evening, and at night ; also from contact and motion. Better when walking in the open air. MoschllS. Great anxiety, with palpitation of the heart; ver- tigo as soon as the head is moved ; pale face, with perspiration ; the right cheek is red without heat, the left pale and hot ; heat in the face without redness ; tension in the facial muscles as if too short ; movement in the lower jaw as if he were chewing ; great dryness of the mouth ; pulse full and accelerated, with ebul- litions, or weak pulse. Worse in the afternoon ; also in cold air. Better from warmth. Natrum mur. Great tendency to start ; difficulty of thinking ; face shining, as if greasy ; heat in the face ; swollen face ; ting- ling and numbness of the lips; tension and drawing in the back; stitches in the neck and back part of the head ; painful stiffness of the neck; twitching in the muscles and the limbs; pulse very irregular ; beating of heart shakes the whole body. Worse in the morning ; also from physical exertion. Better when fasting, and after lying down. Nitric acid. Sadness, despondency; vexed at trifles; eyes dull and sunken, with pale face ; swelling of the cheeks ; violent thirst ; stitches in and between the shoulder-blades, with stiffness of the neck ; flushes of heat, with perspiration on the hands ; pulse very irregular, one normal beat often is followed by two small and rapid beats, the fourth beat entirely intermitting ; al- ternate hard, rapid, and small beats. Worse in the evening, and at night ; also on waking, and from touch. Special Therapeutics. 335 Better from warmth. NlIX VOITl. Over-sensitiveness to external impressions, such as noise, light, and smell ; reeling vertigo on rising from a seat or the bed, or on raising the head ; yellowness around the mouth and nose, or around the eyes ; red, swollen face ; burning redness of the face, with heat; the muscles of the face twitch in the evening when lying down ; trismus ; longing for brandy, but aversion to water ; tension between the shoulder-blades ; sensation in the small of the back, as if lame ; heaviness and stiffness of the neck ; stitches in jerks through the whole body ; pulse full, hard, and accelerated, or small and rapid, or every fourth beat intermits ; general internal heat. Worse in the morning ; also from motion and slight touch, on waking in the morning, and after eating. Better from strong pressure. Right side. Oleander. Absence of mind, want of attention; vertigo on rising from the bed, or on looking fixedly at an object, or when looking down when standing ; alternate paleness and dark redness of the face ; numbness of the upper lip ; much thirst, especially for cold water; fainting as if from weakness, relieved by per- spiration ; pulse very changeable and irregular. Worse at night ; also when rising from the bed, and when eat- ing. Better when lying down, and from perspiration Opium. Stupid indifference; stupefying vertigo, compelling one to lie down ; the eyes are half open and turned upwards ; swelling of the lower lids ; the eye feels too large for the orbits ; the face is bloated, dark-red, and hot; bluish face; trembling, twitching, and spasmodic movements of the muscles of the face ; corners of the mouth twitch ; distortion of the mouth ; hanging down of the lower jaw ; the veins of the face are distended ; vio- lent thirst ; the body is spasmodically bent backwards ; rigidity of the whole body ; pulse varies very much ; heat with damp skin. Worse at night ; also on rising, during and after sleep. Better from moving. Petroleum. Excited, irritable, with inclination to anger ; yel- low complexion ; twitching in the limbs ; great debility, with trembling; pulse full, and accelerated from every motion ; flushes of heat. • Worse in the morning and evening. 336 Surgical Diseases of the Nerves, Better from warmth. Right side. Phosphorus. Great excitability, easily vexed and angry ; pale, hypocratic countenance ; the color of the face is very change- able ; bloated face, puffiness under the eyes ; eyes are sunken, with a blue ring around them ; thirst; stiffness in the neck ; over- sensitiveness of all the senses ; ebullitions and congestions ; pulse generally accelerated. Worse in the evening, and at night ; also when alone, and from strong smells. Better in the dark, from rubbing, and after sleeping. Phytolacca. Great indifference ; shooting pain from left eye to vertex ; vertigo and dimness of vision ; pale face ; the pains are pressing, shooting, and sore. Platina. Low-spirited, inclined to tears, great indifference; spasmodic twitching and trembling of the eyelids ; redness and burning heat in the face, with violent thirst towards evening ; sen- sation of coldness, tingling, and numbness in the face ; pale, sunken countenance ; thirstlessness ; stiffness of the neck ; weak- ness, tension, and numbness in the neck ; pulse small, feeble, fre- quently it is tremulous ; objects appear smaller than they really are. Worse in the evening ; also when at rest. Better during motion. Pulsatilla. Peevishness, which increases to tears, with chilli- ness and thirstlessness ; vertigo, as if intoxicated, when rising from the seat, when stooping, or when lifting up the eyes ; swelling and redness of the eyelids ; alternate redness and paleness of the face ; face bloated, purple ; painful sensitiveness of the skin of the face ; stitches in the small of the back ; burning-stinging pains ; pulsa- tion through the whole body ; fainting, with great paleness of the face ; pulse weak and small, but accelerated. Worse in the evening ; also from warmth, and being in a warm room. Better from cold, and in the open air. Right side. Rhus tox. Restlessness which does not permit one to be quiet, and compels him to toss about in bed ; swelling of the eyelids ; aversion to light ; face pale and sunken, with blue rings around the eyes, and pointed nose ; stiffness in the articulations of the jaws ; thirst ; inflammatory swellings ; pulse irregular, generally faster, but weak. Special Therapeutics. 337 Worse in the morning, and at night : also when beginning to move, when at rest, and from cold. Better from motion and warmth. Right side. Rhus rad. Excessive debility; restless nights; pulse fre- quent and small ; confusion of the head ; redness and swelling of the eyelids, with itching and burning ; burning in the face, with redness and itching ; vesicles on the face ; thirst at night ; pain and rigidity in the posterior lumbar region ; muscles of the neck pained by movement, and sensitive to pressure. Worse when beginning to move. Better when walking in the open air. When the Rhus tox fails to cure, although well indicated, I advise the use of this variety. Rllta grav. Anxious and low-spirited; inclination to quarrel and contradict ; great heat in the head, with much restlessness ; spasms of the lower eyelids ; violent thirst in the afternoon ; pulse only accelerated during the fever; heat in the face, with red cheeks, and cold hands and feet. Worse in the afternoon; also in cold weather, when sitting, during rest. Better from motion. Left side. Sabadilla. Anxious restlessness, startled by noise; burning heat and redness of the face ; great debility, with relaxation or heaviness of the body ; pulse small and spasmodic. Worse in the forenoon, and at night ; also from cold. Better from warmth. Secale. Great anxiety ; distortion of the eyes ; dark-redness of the face ; spasmodic distortion of the mouth and lips ; violent, unquenchable thirst; convulsive twitching in the limbs; pulse unchanged, even in the most violent attacks ; violent, and long- tinued dry heat, with great restlessness and violent thirst. Worse at night ; also from warmth, touch, and motion. Better from cold, and rubbing. Right side. Sepia. Sadness, with weeping ; anxiety, with flushes of heat ; neuralgic pains from abuse of tobacco ; swelling of the upper lip; stiffness in the small of the back and neck; pulsations in the small of the back ; inflammatory swelling ; vibrations like dull tingling in the body ; the pulse is full and quick, accelerated by motion and anger ; pulsation in all the blood vessels. 23 / 338 Surgical Diseases of the Nerves. Worse in the forenoon and evening ; also from mental emotions, when at rest, and after eating. Better from warm air, and violent exercise. Silicea. Pale, earth-colored face ; jaws spasmodically closed ; spasmodic pain in the small of the back, which does not allow one to rise ; twitching of the limbs day and night ; pulse small, hard, and rapid ; the circulation is easily excited ; perspiration only on the head. . Worse in the night ; also in the open air, from cold, and pres- sure Better from warmth. Right side. Spiyelia. Difficulty of thinking, and disinclination to mental exertion ; giddiness when looking downwards ; vertigo with nau- sea ; sensation as if the eyes were too large ; pale, bloated, and distorted face ; perspiration on the face ; periodical face-ache ; pains, burning, and tension, especially in the cheek-bones, above the eyebrows, in the eyeball, and in the left side ; violent thirst ; pulse irregular, generally strong, but slow ; trembling pulse ; cold perspiration. Worse in the forenoon, and at night ; also from noise, move- ment, touch, and stooping. Better after lying down. Left side. Stan num. Great anxiety and restlessness; vertigo; it seems as if all objects were too far off; burning-stitches in the eyelids; pale, sunken face, with deep-sunken eyes ; pulse small and quick ; anxious sensation of heat from the least movement ; pains which increase gradually to the maximum, and then gradually decrease. Worse in the evening ; also after moving, and from talking. Better from loosening the garments, and when lying on the back. Left side. Staph asayria. Weakness of memory ; countenance sunken, with sunken eyes, and peaked nose; blue margins around the eyes ; violent upward stitches in the back ; twitches at night ; pulse very fast, but small and trembling. Worse. — About the same all times of day, except Better in evening. Right side. Strammonium. Very changeable disposition; red, inflamed, swollen eyes ; contortion of the eyes and eyelids ; red, swollen, and turgid face ; stupid, distorted countenance ; anxiety and fear is expressed in the countenance ; distortion of the mouth ; vio Special Therapeutics, 339 lent thirst, drinking large quantities ; body bent backwards, with distorted countenance ; pulse very irregular, generally small, hard, and quick ; hot, red face, with cold hands and feet. Worse in the morning ; also after sleep, from touch, and when alone. Better from bright light. Sulphur. Peevish and irritable ; face pale ; circumscribed red spots on the face ; red blotches on face ; sunken eyes, with blue margins ; trembling and twitching of the lips ; cold perspiration on the face ; constant thirst ; stiffness in the neck ; drawing in the back ; pain in the small of the back, not permitting one to stand erect ; great debility and trembling, talking fatigues ; pulse full, hard, and quick, at times intermitting ; swollen veins ; cold nose, hands, and feet ; dry heat, with thirst ; flushes of heat ; perspira- tion easily excited, or want of perspiration. Worse in the evening ; also on waking, or getting warm in bed, from bodily exertion, talking, when at rest, and from being touched. Better from motion. Left side. Teucrium. Great sensitiveness and excitability; pale face; frequent feeling of flushes of heat, without redness ; nervous ex- citability ; trembling sensation in the whole body. Worse in the forenoon, and at night ; also on stooping, and to the touch. Right side. Thuja. Over-excited ; becomes angry at trifles ; vertigo on closing the eyes, disappears on opening them ; heat and redness of the whole face, with fine nets of veins, looking as if marbled ; circumscribed burning redness of the cheeks ; greasy skin of the face ; swelling of the temporal arteries ; neuralgia, originating in the left cheekbone, near the ear, extending through the teeth to the nose, through the eyes into the temples, and into the head, the painful places burn like fire, and are very sensitive to the rays of the sun ; violent thirst ; beating and pulsating in the back ; jerking in the upper part of the body ; pulse in the morning slow and weak, in the evening accelerated and full ; in the evenings, violent pulsation ; swelling of the veins. Worse in the morning, evening, and at night ; also from cold- wet and the heat of the bed. Better from warm-wet, and on turning from the left to the right side. 340 Surgical Diseases of the Nerves. Valerian. Very changeable disposition: redness and heat of the cheeks, especially in the open air ; over-sensitiveness of all the senses ; pulse irregular. Worse in the forenoon, and towards evening ; also while repos- ing, when standing, and in the sun. Better in the light, and from motion. Veratrum. Vertigo, with cold head; perspiration on the fore- head ; face pale, bluish, cold, disfigured like death ; blue or green circles around the eyes ; spasms of muscles when masticating ; violent, unquenchable thirst, particularly for cold water; back and small of the back feel sore and bruised ; sudden sinking of strength ; shocks in the limbs, as from electricity ; spasms, with convulsive motions of the limbs ; tetanic stiffness of the body ; pulse irregular, generally small and thread-like, and weak ; slow pulse, often it cannot be felt at all ; perspire easily from the least exertion. Worse in the morning; also after sleep, and during perspira- tion. Better after perspiration. Vipera Redl. Opisthotonos; cold sweat; restlessness; frequent vertigo ; protruded eyes ; face swollen ; oppression of chest. Zincum, Very variable mood ; paleness of the face; stiffness and tension of the neck; pulsations through the whole body; violent trembling, twitching of the body; pulse small and rapid in the evening, slower in the morning and during the day ; pulse at times intermitting ; violent pulsations in the veins ; flushes of heat, with trembling, and short, hot breath ; badly-smelling per- spiration ; perspire easily during the day, and on exercising. Worse in the afternoon and evening ; also after eating, and in the warm room. Better in the open air. Suppuration, 341 SUPPURATION. ABSCESSES, SINUS, FISTULA. Suppuration. Suppuration is the termination of inflammation by the forma- tion of pus. This change is known by the chills, remission total or partial, of a hitherto sharp and acute pain, followed by a dull one, with throbbing or pulsation ; there is also a sense of weight in the part, and finally, fluctuation; that is, if pressure be made lightly with the finger on one side of the tumor, and a finger be placed at the opposite, if there be fluid contents, a sense of fluctu- ation will be felt; similar to what a mass of fluid would be supposed to make. So many tumors with fluid contents present themselves, that it is of the utmost importance that a correct diag- nosis should be made. This test by fluctuation reveals fluid only ; now it may be blood, water, or some other secretion. The best test is, the use of an exploring needle. Of late we have a delicate trocar and canula, for this purpose, made small enough to carry in the pocket case, and it is an instrument that will prove very useful in many other cases. If pus is present, what shall we do ? 1st. In nearly every variety of suppuration, there is but little probability of the pus being absorbed. The cold or chronic abscess is the only one that I believe to be an exception. Pus cannot be absorbed without doing the patient more or less injury. 2nd. "Nature finds an outlet for it." — Granted. Suppose we have an abscess in a prominent part, on the face, particularly if the patient be a lady ; scarring of the worst kind is almost inevit- able if it be allowed to discharge itself spontaneously. If a person applies to us with a whitlow on the finger, we give remedies to hasten this suppurative process, if it has commenced. It opens itself and the bone necroses and exfoliates. What have we achieved by not at once opening it, and thereby preventing all 34 2 Abscesses, that mischief? This is an every-day occurrence, and not " far- fetched." If it is the infliction of pain that is dreaded, how much more pain does the patient suffer when going about for days in that condition ? Suppose medicine does remove a felon in a week, what is gained? an early opening before pus has formed, will cause but a moment's pain, and cures it in twenty-four hours. If pus has formed, we save the bone. yd. The imprisoned matter, if unable to make a ready exit, will burrow in all directions, dissecting and destroying all the parts, until some point is reached where the tissues are not so dense. Psoas abscesses have been known to point under the tendo Achilles. How much better, as the pus has got to come out, to have let it out as soon as it showed itself in the groin. 4th. The danger apprehended by many of inflammation of the sac from the admission of air, is not without foundation ; but there is no reason why this admission should take place. Open it under water, by a valvular incision, and then if inflammation follows, Calend. or Aeon, will make all right Pus is just as much a foreign material as is a splinter in the finger, and no man gives medicine to remove that. Nature is a bad physician ! some there are who tell us that in following her leading we do right. Hahnemann says we do wrong. In the " Organon" page 42, he says — "The ordinary school of medicine regarded the means which the organ- ism employs to relieve itself, in those patients who make no use of medicine, as perfect models for imitation ; but they were greatly mistaken. The miserable and very imperfect attempts which the vital powers make to assist themselves in acute diseases, is a spec- tacle that ought to excite man to use all the resources of his wisdom and learning to put an end, by a real cure, to this torment which nature herself inflicts." Perhaps I have said too much already on this subject, but as it is one that has excited almost as much controversy as high and low dilutions, it is one of much interest to us all. The majority consider pus an alteration due to some existing disease of normal secretions. Erichsen holds to this belief, and says of it, " pus-cells have been shown by recent observers to be modified or degenerated exudation corpuscles, and the fluid in which they float, to be of a serous character." Paget practically demonstrates the same theory. According to Conheim, they are white blood-cells. Pus forming on a free surface is called &puru- Abscess. 343 lent secretion, and when in deeper structures, an abscess. In whatever situation it occurs, it presents pretty much the same general characters. Pure pus we call laudable or healthy ; when mixed with blood, grumous ; when acrid or corroding, or thin and watery, the word used as designating the appearance, is applied to them as a name. These last varieties are commonly mixed with the debris of bone, muscular tissue, etc. Abscess. Abscess is a term applied to a collection of pus in any cavity of the body, or in the substance of a part. A part becomes inflamed and tender, subsequently indurated, and with a feeling of weight. A chill, more or less severe, according to the extent of the injury, follows, with a remission of pain, followed by a beating and throb- bing, which is also followed by softening of the tumor, without any diminution in bulk, and as the disease progresses palpation or the trocar will reveal the character of the fluid, whether pus or not. From the great distension of the skin, and consequent pres- sure exerted upon it, that part which is the weakest, will event- ually give way, and an outlet being thus formed, the exertion of proper care will readily conduct it to a successful termination. One point on the body of the swelling will be noticed to be a little elevated above the surrounding skin, and gradually losing its red color, will take on a yellowish-white one. This we call " pointing," and it indicates the position of the opening. These symptoms constitute what we call the acute abscess, which is a type of all the others. On examining carefully the cavity, emptied of its contents, we find a limiting membrane lining it throughout, formed of lymph, which is called the pyogenic membrane; this Delpech thought to be the secreting membrane of pus, and many, I fear, still hold to that belief. The extension of an abscess beyond these original limits, I suppose, is owing to an imperfect formation of this membrane, or the extension of the primary inflammation beyond it. Chronic abscess differs from the others, as it is more insidious during its formative existence ; slower in its course, little or no pain, and no discoloration of the integuments. They are very apt to remain stationary for years, and sometimes never discharge, but gradually become reabsorbed. A close observance of the patient 344 Abscesses. will, however, show that the health is gradually giving way, and death will in most cases follow unless relief be speedily afforded. This variety is the one above all others we are told not to open. Now can any sane man believe or teach that the patient derives any actual benefit from this disease ? What danger do we run in opening it, that our remedies cannot probably arrest ? I say open them. The pus is usually laudable, though I have seen cases in which it was flaky and curdled. Absorption of such pus must be followed by injurious results. Cold abscess is also known as lymphatic, though I do not recognize any distinction between them and the chronic. It occurs with but few if any premonitory symptoms, and usually unaccompanied by pain at any time. Cachectic individuals, scrofulous principally, are particularly prone to it, and the first intimation they have of it, is a large, fluctuating tumor appearing suddenly in the groin, axilla, or iliac fossa. The contained fluid is thin, purulent, offen- sive matter. Again, I say, open early. Diffused abscesses are such as occur in the cellular tissue, after erysipelas or inflammation, and extend rapidly in all directions, forming sinuses, and burrowing to a great extent. I doubt whether the pyogenic membrane be fully formed in these cases, indeed if it is formed at all. Probably the transformation of the lymph is so rapid that but little time is given it for even the imperfect organization requisite. The tympanitic or emphysematous abscesses, are those sometimes found in. the mucous passages, more frequently in the abdomen, and take their name from the fact of their being partly filled with gas, and partly with pus. Sinus and Fistula. As the results of suppuration, we have the formation of sinus and fistula. Sinus is a term used synonomously with fistula by many, but I consider it faulty. By sinus I understand a track leading from an abscess, burrowing in different directions, and not communicating with the air ; as in erysipelas, which has produced suppuration, we find long tracks leading off for some distance. These sinuses may result in fistula, when from some reason they do not heal, Sinus and Fistula. 345 and eventually open through the skin, or into some organ or cavity. Fistula is a canal leading from the skin into the abscess. From some cause, the abscess after opening, either by the knife or spon- taneously, sometimes refuses to close up ; this cause may be the presence of a foreign body, as a piece of bone, or bullet, or the constant passage of irritating discharges, saliva flowing through a wound in the cheek will produce salivary fistula. Whatever the cause may be, a canal is formed, permanently open, which event- ually has the sides converted into fibrous material, and is a source of constant annoyance. Treatment. — In treating these diseases, one point must be borne in mind. When the character of the pus is bad, the remedy is to be given to change the character of this pus to a healthy one, and then it will heal naturally. Do not change the remedy if the quantity of pus is increased, if the color and consistency is be- coming correspondingly better. But if the pus is unhealthy, and the remedies seem to produce a total suppression, without first making it laudable, there is danger! Excite its reappearance by using poultices and Hep. s. in a very low attenuation. In treating sinus and fistula, in addition to the proper remedy, use constant pressure by judicious bandaging, or some of the modern appliances much in use. It may become necessary to operate. If the char- acter and position of the fistula will admit of it, pass a probe- pointed bistoury through it, and rapidly divide it, with all the muscles and structure in its neighborhood, taking care to avoid the arteries. At other times it is well, if the canal is short, and division will endanger vessels, to dissect out the fibrous lining entirely. The remedies in common use are : Abscess: Am., Ars., Baryta, Bell, Bry., Cole, c., Calend., Car bo v., Cham., Chin., Con., Dulc, Graph., Hep., Lye, Merc, Bhos. f Puis., Rhus, SiL, Spong., Sulph. Fistula : See Anal and Vaginal Fistula. Arnica montana. General sinking of strength ; pricking pains ; dull stitches in the part ; dull, heavy pain in the part ; hot, hard, and shining swelling. Worse in the morning, evening, and at night ; also on raising the part affected, on moving, from being touched, and during walking. 346 Abscesses. Better from lying down, rubbing, and from warmth. Left side. Arsenicum alb. Burning in the affected part ; the skin cover- ing the induration is of a shining red color, or red with a tinge of blue ; muscular prostration, trembling, and sleepless restlessness. Pus copious, bloody, corroding or ichorous, watery, and of a putrid smell. Worse in the evening, and at night; also from cold, and when lying down. Better on getting warm in bed, and from Warmth in general. Either side. Baryta carb. Induration followed by suppuration of the glands, particularly the sub-maxillary, and the parotid; stitches in the part ; tingling and burning of the skin ; constant inclination to lie, or sit down ; great weariness. Pus scanty. Worse at night ; also from cold, particularly cold air, raising the part affected, from pressure, and while sitting. Better from warmth. Left side. Belladonna. Great sensitiveness to cold air; burning, sting- ing and tingling in the part ; scarlet redness, and hot swelling ; painful glandular swelling ; induration, followed by suppuration of the tonsils. Pus scanty. Worse in the afternoon, evening, and at night ; also from cold in general, on getting heated, on raising the part, from moving, and from wet poultices ; also from being touched, and when walk- ing. Better when lying down, or standing. Right side. Bryonia alba. Tense, hot, pale, or red swelling ; swelling and induration of the glands ; hard knots in various places, resembling indurated cutaneous glands ; hot, inflammatory swelling of the hands and feet. Pus putrid, and brownish, and yellow. Worse in the evening, and at night ; also from the cold air, on moving the part, on being touched, from walking, and on getting warm in the open air. Better from cold, when lying down, and on getting warm in bed. Right side. Calcarea Carb. The skin is painful to the touch ; in the even- ing when in bed there is a violent itching of the affected part; hot skin, with an itching, vesicular eruption ; great heat and thirst, with but little appetite. Pus may be either copious or scanty, of a putrid smell, and yellowish in color, or white and thin like milk. Special Therapeutics, 347 Worse in the morning, and at night ; also from cold air, and from using poultices. Better on rising up and moving about, after sitting or lying some time. Right side. Calendula Off. When induration occurs after surgical opera- tions, followed by suppuration, the wound becomes raw and inflamed, is painful in the morning, as if beaten, with stinging, followed by throbbing, as if it would suppurate. CarbO Veg. Burning of the skin, with indurated, glandular swellings ; lymphatic swellings and abscess, with burning pain ; swelling, with a beating, throbbing pain ; aching in the lower part of the back ; throbbing pains in the hands, with swelling and in- flammation. Pus bloody, ichorous, or corroding, and of a yellow- ish color. Worse in the morning, and in the forenoon ; also when in the open air, on getting heated, from poultices, pressure, and from warmth. Better in the afternoon, and evening. Either side. Chamomilla Vlllg. Pain in the periosteum of the part, with a paralytic weakness ; hardness, and blue-redness of the skin ; swell- ing and induration of the parotid and sub-maxillary glands. Pus is corroding. Worse in the evening, and at night ; also in the open air, on lying down, when moving the part, from poultices, on being touched, and on getting warm in bed. Better from cold. Left side. China Off. Heaviness and emaciation ; yellowish color of the skin ; hard, red swellings ; stinging, pulling, and burning, or titil- lation in the skin ; painfulness, and excessive sensitiveness of the skin ; swelling of the glands of the throat, with pain during de- glutition ; suppuration and painful swelling of the joints, par- ticularly of the knee. Pus ichorous and putrid. Worse at night ; also in the open air, and on moving the part. Better, sometimes, from moving the part. Left side. Conilim mac. Swelling and induration of the glands; blue, or bluish-black color of the skin ; burning stitches ; painful burn- ing. Pus putrid and viscid. Worse in the morning, and at night ; also in the open air, from cold, and when standing. Better when moving the affected parts, from pressure, and when walking. Right side. 348 Abscesses. Dulcamara. The parts feel heavy ; bruised feeling ; dryness, heat, and burning of the skin , cold tumors ; inflammation, and in- duration of the inguinal glands; tensive, drawing pain. Pus scanty and yellow. Worse in the evening, and at night ; also from cold, and when lying down. Better from warmth. Left side. Graphites. Red, hard swelling ; sensitive when touched ; scrof- ulous swelling ; tremor and slight twitchings in particular muscles ; strumous indurations. Pus corroding, watery, scanty, and very putrid ; smells like herring-brine. Worse in the fore part of the night; also on moving, while walking, and on getting warm in bed. Better from pressure, and from warmth in general. Either side. Hepar S 111 ph. Drawing pains in the limbs and joints ; lacerat- ing and pricking pains in the tumors ; throbbing and beating in the abscess; tremor, and slight twitching in particular muscles; the skin over the abscess is highly inflamed, hard, hot, and swell- ing ; suppurations and tumors, brought on by the excessive use of mercury ; sleepiness, dull, and drowsy. Pus scanty, bloody, corroding, and smelling like old cheese. Worse in the evening, and at night ; also from cold, on moving, from pressure, on being touched, and on walking. Better from warmth, and on getting warm in bed. Either side. Lycopodilim. Induration of the glands, with cramping and cutting ; inflammation, with a pressing pain, terminating in sup- puration ; tearing, tensive, jerking pains ; burning, red, or yellow skin. Pus bloody, corroding, and putrid, or of a whitish, milky appearance. Worse in the evening, and at night ; also from the cold air, on lying down, from wet poultice, from pressure, on being touched, and on getting warm in bed. Better from cold, when moving the affected part, when walking, and from warmth in general. Right side. MerClirillS SOl. Burning, redness of the skin ; pricking and tickling of the skin ; indurated, inflamed, swollen, and painful glands ; pressing from within, outwards ; pulsation, swelling of the glands ; hard, hot, and inflammatory glandular swellings. Pus copious, bloody, corroding, thin and watery, or all these charac- ters, but scanty. Special Therapeutics. 349 Worse in the evening, and at night ; also in the cold air, from poultices, while walking, and on getting warm in the open air. Better on falling asleep, from rubbing, and while sitting. Either side. Phosphorus. Lymphatic abscesses, full of flstulae; callous feeling ; hectic fever. Pus copious and yellow. Worse in the morning, evening, and at night ; also on moving. Better in the open air, while standing, and from warmth. Right side. Pulsatilla. Erysipelatous swelling, hard, burning heat, and stinging when moving or touching the part ; blue-red swelling, with heat, burning, or throbbing ; painful inflammatory induration of the glands, with jerking and itching ; bluish, hard, and hot swelling, with a pricking, or sensation of tension in the parts. Pus bloody and copious, greenish or yellow. Worse in- the evening, and at night ; also on moving the part, from rubbing, while standing, and on being touched. Better in the open air, from cold, moving the part, wetting the part, and from the use of poultices. Right side. Rhus tox. Smooth, red and shining swellings; the inflamed skin is puffy like a bladder, or is covered with little painful white vesicles ; indurated glandular swellings ; swelling and suppuration of the eyelids ; feeling of contusion in the glands. Pus copious, corroding and watery. Worse in the evening, and at night ; also from cold, on lying down, from poultices, when standing, and on being touched. Better when moving, from pressure and from warmth. Right side. Silicea. Scrofulous engorgement and induration of the glands, particularly those of the neck, with or without inflammation; pains are either burning, cutting, itching, prickling, or pulsative ; hot, inflammatory swelling of the glands, either painful or painless. Pus is copious or scanty, and may be bloody, brownish, corroding, gelatinous, greenish or gray, putrid, thin and watery, or yellow. Worse in the forenoon, afternoon, evening, and at night ; also from cold, in the open air, on lifting the part, from pressure, on rubbing, and on being touched. Right side. Spongia tosta. Scrofulous engorgement and induration of the glands of the neck ; sensation as if air passed through them ; a sensation as if something living were in the glands, or a gnawing 350 Abscesses, and itching ; painful pressing from within out ; also a sensation of swelling, tension, and titillation; dryness of the skin; with heat? Pus scanty. Worse in the night ; also when ascending an eminence, and in a warm room. Better when descending an eminence. Either side. Sulphur. Inflammation of the glands ; painful pressing, pul- sating, red, hot, and hard swellings; flashes of heat; biting and burning in the skin ; external coldness, perceptible to the hand ; crawling, pricking, itching and gnawing ; aching as if sore. Pus is thin and blackish, and of a sour or putrid smell. Worse in the evening, and at night ; also from poultices, while standing, being touched, and on getting warm in bed. Better from cold, and when rubbing. Left side. The operations that may be necessary in the treatment of these diseases are very simple. Sinuses are to be opened their whole length. Insert a grooved director, and with a probe-pointed knife, slit them up. Fistula may be opened in the same manner, but there is a better proceeding, — care must be taken, as is said in a previous para- graph, to avoid all arteries of a size sufficient to require ligation. A probe is necessary to determine the extent and character of the passage. To avoid inflicting unnecessary pain, an instrument has been devised, by which the exploration, and if necessary, the incision can be made with one introduction of the instrument. It is a probe, somewhat longer than common, one end of which is a knife, narrow at its junction with the probe, and rapidly widening to the extent of four or five inches, when it is over three inches broad. When the probe is introduced, if it be found practicable to divide the fistula, in place of withdrawing it, and then subjecting the patient to a fresh torture in introducing the director, draw the probe entirely through, by this means dividing the tissues with one operation Ulcers. 351 ULCERS. Ulcers. Among Homceopathists (?) there are many who entertain the conviction that in common with the old -school, dominant no longer, the only rational mode of treating ulcers, is by topical applications ; and that the totality of symptoms in such cases, is of but little importance. This great error may be in part accounted for, from the fact that our surgical literature is very deficient in all points, but more especially in this one particular. An ulcer is but a local manifestation of a generally diseased organism : and to cure it radically, as well as scientifically, we are obliged to address our remedies to the general constitutional, as well as the local condition of the person under treatment. That this is the treatment to be pursued, my experience teaches me. Having made these cases a special study, I have treated and seen great numbers, and with the exception of some few cases in the earlier part of my practice, have treated them all on the strict Hahnemannian principles. An ulcer may be defined to be, a solution of continuity of the substance of the skin, and may be either idiopathic, traumatic or specific. Idiopathic ulcers are those that appear without any apparent cause, and are uncomplicated with any other disease. Those called traumatic, are such as are produced by some injury, but nevertheless owe their continuance to some abnormal condition of the system. Specific sores are those that are peculiar to such disease as syphilis, or struma. Erichsen considers their exist- ence, or rather their continuance, to be due to a faulty condition of the absorbents. Thus one of these conditions are concerned : 1 st. Where deposition is normal, but absorption too active. 2nd. Where absorption is normal and deposition deficient. 3rd. Or, a simple detachment, or elimination of spoiled dead matter. Ulceration is always preceded by more or less inflammation, the intensity, character and duration of which must all be taken 35 2 Ulcers. into consideration in determining which of these conditions exist. Paget thinks that when the inflamed part is denuded of its epithe- lium only, it is a simple abrasion; and ulceration consists in a removal of proper or vascular tissue ; thus thinking, the process of ulceration is an ejectment, and not depending on faulty absorp- tion. Erichsen's proposition that they are producible either by absorption or elimination, strikes me as being the best. Apart from the three grand divisions of these most important lesions we have several sub-divisions ; all of which will claim a few words of passing notice. With the specific ulcers, syphilitic, cancerous, and scorbutic, we have nothing to do now; each receives proper attention in its appropriate place. Of the different varie- ties then, we have the simple, weak, indolent, inflamed, sloughing, varicose, irritable and hemorrhagic ulcers. Simple ulcer is a type of the whole class ; and is nothing more than an open sore, oval or circular in form, shallow, covered with heathy granulations and discharging true or laudable pus. This form has a constant tendency to heal, and needs but little treat- ment. Weak Ulcer : This is a sore of the former variety badly treated. The granulations become flabby, the pus changes to a thin, watery fluid, or is suppressed entirely ; the edges are pale and not uncommonly elevated. The granulations sometimes attain an immense size, and look like jelly. This form, although usually the result of neglect on the part of the patient, or ignorance and bad treatment on that of the surgeon, commonly proceeds from the simple variety; yet sometimes they take on this character from the beginning. Inflamed Ulcer : This is also the result of too-long continued or badly selected use of topical stimulating treatment, and may occur in the treatment of either of the other varieties. The edges and surrounding skin in these cases are much inflamed and tender ; pus is thick and very offensive, often streaked with blood ; and though the granulations are large, they are firmer than in the last form. It is not, however, uncommon for the granulations to be entirely or nearly destroyed. Indolent Ulcer : These are the most obstinate affairs that can well be imagined, and will try the patience of the surgeon more than almost any other disease. These sores are chronic, and may be caused by bad treatment or neglect of any of the former Ulcers. 353 varieties, or appear in its proper character from the first. In these the skin is much indurated, and appears to be firmly adher- ent to the bone; the surrounding integument is much discolored, and is often found to be scaling off, or coming away in the shape of little scabs, which are being constantly reproduced. They are not at all painful, indeed they are often without sensation of any kind. The edges are elevated and callous, the outline ragged and irregular, and the base or floor flat ; they are dry, and exude a bad-smelling, unhealthy sanies ; the granulations are few, irregu- lar in size and shape, and widely separated. These ulcers are commonly known as " old men's sores," and are chiefly found on the leg, midway between the ankle and the knee. Sloughing Ulcer : This is an aggravated form of the inflamed ulcer, and usually caused by bad treatment, though it often results from no treatment at all. In a previously inflamed ulcer, the edges become sharp-cup and discolored ; the pus changes to a thinner fluid, ichorous and putrid ; the base becomes grayish and painful ; the inflammation rapidly extends, and is accompanied by considerable fever ; the edges break down, and the ulcerative action extends rapidly. These ulcers require close watching. Irritable Ulcer : This is a small ulcer, confined mostly to women, and among them to those of a nervous or bilious temper- ament, and about the middle period of life. They are small; edges are irregular but flat, not elevated ; the surface covered with a tough, gray slough, and the discharge thin and acrid. They are very painful and exceedingly sensitive to the touch. I have seen just such sores produced by the excessive use of Mercury. Varicose Ulcer : This variety by the old school is considered incurable, or next to it ; by us they are not so considered, but on the contrary have proved to be very amenable to treatment. They are more readily known by the history of the case than by their appearance. The appearances are those of any of the other forms, and they may be inflamed, indolent, irritable, or sloughing, according to the peculiar circumstances of the case. Hemorrhagic Ulcer : This is a small ulcer of a purplish color, " and," says Erichsen, " usually occurs in women suffering from amenorrhcea ; " and, as its name indicates, usually oozes blood at the catamenial periods. It is very similar to the irritable ulcer, and can only be established as hemorrhagic by the elicitation of the above facts. 23 354 Ulcers, These are the most common varieties of ulcers, as noticed by authors, but the practical value of this nomenclature is not much. Homoeopathists, young in surgery, think old-school books our standard in surgical practice; and really from the want of homoeopathic literature on the subject, we have no where else to turn. This fact must be borne in mind, that because we have no such book, is the best reason in the world why we should throw over allopathy, and make them. Let not the fear of the charge ot presumption deter us from recording our successes, with remedies^ in the treatment of those diseases hitherto untouched by our writers ; pile up the cases until we have a complete system of our own. The causes which may produce ulceration are manifold, and yet I consider them only as exciting forces. Continued pressure, impoverished vitality, direct injury, the application of specific poison, all may aid in producing a simple ulcer. When the gen- eral system is perfectly healthy, this sore heals at once spontane- ously; when there is some disease one of the other varieties results. Many people have small sores on their body, that they are taught to believe are safety-vents, and when these become closed they feel ill. Always close such sores at once ; and if they heal readily under your treatment the presumption is the cure is radical. Closing ulcers by the topical use of astringents is like curing vomiting by sewing up the mouth ; or cutting out the spots in small- pox. An ulcer can never be called cured which has been closed by such measures. Therefore, an ulcer can never be healed until we remove the morbific cause, which is only to be reached by rational internal medication. Throw away all salves, lotions and ointments ; they do more harm than good by retard- ing, yes, in many cases, preventing a cure. These remarks apply to all the forms of ulceration, with a modified application to the varicose variety. These are directly caused by a rupture of a varicosed vein ; indirectly they are kept open, by the disease producing varix. The treatment, according to strict homoeopathic principles, presupposes a thorough knowledge of the law of similars, and demands on the part of the surgeon great care and judgment in selecting the proper remedy. Although topical applications are forbidden, strapping, and as much quiet as can be obtained, will aid very materially in perfecting a cure. I have succeeded Special Therapeutics. 355 frequently in curing these lesions with the patient going about his or her accustomed occupation. Nevertheless, when practicable, enjoin upon them perfect quiet, and an elevated position of the member. The leg will be found more commonly the seat of these sores. The remedy, when selected, should be given alone, without any alternation and at long intervals. My custom is to use the higher potencies, to give but one dose ; not to be repeated until improve- ment ceases. When the ulcer commences healing from the centre, the healing process will not be continued to completion ; before this reaches the circumference it will break down again. Closing should begin from the edges. The first indications of a proper natural process in healing will be a flattening of the edges ; cessation or diminution of pain ; change of the discharge to a laudable pus, detachment of the slough ; firm granulations, and not unfrequently an itching and biting of the skin. Supposing, then, the sore to be on the leg: bandage the limb tolerably firmly, leaving the ulcer exposed ; keep the foot elevated on a chair, and free of pressure or irritation of any kind. If this is not possible, and the patient is absolutely compelled to move about to attend to his business, use in place of a bandage strips of adhesive plaster from one to two inches wide, and apply them obliquely, slightly overlapping each other, to the middle of the foot below, and as far as the knee above the ulcer, leaving the sore itself exposed. Avoid stimulating diet and keep the parts clean. Treatment. — The list of remedies I shall give is a large one, but it really does not embrace all that may be indicated ; more would probably be confusing, and so they have been cut out. Some few of those retained have not acted as well in my hands as was expected, and I have taken the liberty of adding an interroga- tion mark to the name. The remedies are these : Acid mur., Acid nit., Acid sulph., Ambra gris., Amm. c, Ammo, m., Ant. c, Argent, nit., Arnica mon., Ars. alb., Aur. met., Baryta c, Bell., Bovista, Bry., Calc. carb., Calc. phos., Canth., Car bo an., Car bo v., Caust., Cham., Chelid., China, Clematis, Con. mac., Cupr. acet., Dulc, Euphras, Eupator, Graph., Hep. s., Kali c, Kreos., Lach., Lye, Merc, Mezer., Natr. c, Natr. mur., Nux v. Petrol., Phos., Phos. ac, Pulsat., Ranunc, Rhus rad., Rhus tox., Ruta grav., Sabin., Secale, Sepia, Silicea, Staph., Sulph., Tartar emet., Thuja, Verat., Zinc. To this list, large as it is, I would add : Kali bich., Hama. virg., Hydrastis can., and Apis mel. 356 Ulcers. Simple Ulcers: Ambrag., Amm. m., Am., Ars., Bovista, Bry., Calc. c, Calend., Car bo v., Caust, Chin., Clem., Con., Cuprum, Dulc, Hep. s., Kreos., Merc, Mezer., Natr. c, Nux v., Puis., Ranune, Rhus tox., Rhus rad., Ruta g., Staph., Verat. Weak Ulcers: Ant. e, Ars., Baryta, Calend., Carbo v., Causi. Cham., Chin., Con., Cuprum, Graph., Merc, Mezer., Nux v., Petrol., Puis., Sep., SiL, Sulph., Thuja, Zinc. Indolent Ulcers: Acid mur., Acid phos., Amb. gris., Ant. c, Am., Ars., Baryta, Bell., Bry., Calc. c, Calend., Carbo v., Caust., Cham., Chelid., China, Clem., Cuprum, Dulc.,Euphorb., Graph., Iod., Kali, Lach., Lye, Merc, Mezer., Nux v., Petrol., Phos., Puis., Rhus rad., Rhus tox., Sabin., Secale, Sep., Sil., Sulph., Thuja, Verat., Zinc Irritable Ulcers: Acid mur., Ac. nit, Ac sulph., Am., Ars., Baryta, Bell., Calend., Canth., Carbo v., Caust., Cham., Chin., Con., Cuprum, Dros., Euphorb., Graph., Hep., Hyos., Iod., Lye, Kali c, Merc, Nux v., Petrol., Rhus rad., Rhus tox., Sepia, Sil., Sulph. Inflamed Ulcers : Acid mur.., Ac. nit., Amm. c, Apis, Arg. nit., Am., Ars., Aur., Bell., Bovista, Calend., Canth., Carbo v., Caust., Clem., Hep. s., Hyos., Kali c, Kreos., Lye, Merc, s., Natr. c, Natr. m., Phos., Ruta, Sep., Sil., Staph., Thuja. Sloughing Ulcers: Acid nit., Ac. sulph., Arg. nit., Ars., Aur., Bry., Calc c, Calend., Canth., Carbo v., Caust., Cham., Chelid., Chin., Con., Euphorb., Hep. Lach., Merc s., Ranunc, Rhus tox., Secale, Sil., Tart. em. Varicose Ulcers: Hama. virg., Amm. mur., Arn., Ars., Calend., Carbo v., Chin., Merc, Sulph., Tart, em., Verat. Hemorrhagic Ulcer: Acid phos., Amm. c, Ars., Bovista, Calc c, Calend., Carbo v., Caust., Cham., Graph., Kali c, Kreos,, Lye, Merc, Natr. m., Nux v., Puis., Sulph., Sep. ? Pus: Black. — Sulph., Chin. — — Bloody. — Ars., Hep., Merc, Carbo v., Caust., Lye, Nit. ae, Puis., Sil. Pus: Brownish. — Bry., Sil., Ars., Carbo v. — Grayish. — Caust, Sil. — — Greenish. — Caust, Puis., SiL, Aur., Clem., Merc, Nux v., Rhus, Sep. ' Whitish. — Calc. c, Lye, Amm. e, Ars., Sep., Sil., Sulph. — Yellow. — Puis., Calc. c, Carbo v., Caust, Clem., Merc., Phos., Sep., Sil., Staph. Special Therapeutics. 357 Pus: Copious.— Puis., Sep., Ars., Calc, Merc, Phos., Rhus, Sil. Scanty. — Calc. c, Lack., Merc, SiL, Bell, Cupr., Dulc, Hep., Sep., Verat. — Corroding. — Ars., Caust., Merc, Rhus, Sil, Carbo v., Hep., Lye, Nit. ac, Ranunc bul Ichorous. — Ars., Carbo v., Merc, Nit. ac, Rhus, Sil, Caust., Chin., Staph. Cheesey. — Merc. Gelatinous. — SiL, Arg., Merc, Sep. Thin. — Caust., Merc, Sil, Sulph. Viscid. — Merc, Bovista, Con. Watery. — Caust., Merc, Ars., Ranunc, Rhus, Sil. Putrid. — Hep., Phos. ac, Sulph., Ars., Calc, Chin., Graph., Lye, Merc, Sep., Sil — Sour smell. — Hep., Merc, Sulph. — Smelling like herring brine. — Graph. — Smelling like old cheese. — Hep., Sulph. — Like tallow. — Merc. Ulcers from Abuse of Mercurius: Aur., Bell, Carbo v., Hep. s., Lach., Lye, Nil. ac, Phos. ac, Sep., Sil, Sulph., Thuja. Acid mur. Stinging, itching, and painful ulcers ; foetid odor in the ulcer, although it is covered with a scurf; when touched there is a stinging pain ; putrid ulcers, with a burning pain or heat in the edges ; jerking pains. Pus, foetid and scanty. Worse in the afternoon, and during the forepart of the night ; also from cold, on lying down, on trying to lift any heavy weight, and in windy weather. Better from pressure, and on scratching. Left side chiefly. Acid nit. Drawing pain in the ulcers, which are very sensitive, and have an offensive odor ; burning pain and heat in the edges ; shooting and pricking pains ; superficial ulcers ; ulcers produced by Mercury. Pus, foetid. Worse in the morning, evening, and at night ; also from bathing in cold water, on awakening from sleep, when lying on the affected side, and from being touched. Better in dry weather. Left side. (Since writing the notes from which this is copied, the following additional symptoms have been found, and proven reliable in one or two cases : Readily- bleeding deep ulcers; fistulous ulcers difficult to heal; pricking in the ulcers. Pus, copious, bloody, corroding, or ichorous.) 358 Ulcer, Acid phos. Inveterate ulcers ; itching ; indented base ; burn- ing pain ; ulcers without much feeling ; painless ulcers ; putrid, sensitive ulcers, with some pain. Pus, foetid and dirty-colored. Worse after midnight, and in the morning; also when lying on the painful side, before menstruation, from being touched, and on getting warm in bed. Better on changing the position, and moving about. Either side. Acid Slllph ? Gangrenous ulcer ; corrosive sensation in the ulcer; biting and cutting in the ulcer. Pus is corrosive. Worse in the forenoon, and in the evening ; also on getting up after lying down. Right side generally. Ambra grisea ? Burning or itching in the ulcer ; painless ; chronic ulcers worse every spring; stinging in the ulcer. Pus f grayish, or salty ichor. Worse in the evening ; also on lying down, or when awaking, and getting up after sleep. Better on getting up and moving about after sitting some time. Either side. Ammonia Carb. Putrid ulcers; flat ulcers, with a pungent sensation. Pus, white and putrid. Worse in the evening; also on awakening from sleep, from cold, when lying on the painful side, after lying down, before the cata- menia, and from wet poultices. Better from keeping the limb elevated, and outward pressure. Either side. Ammonia mur ? Ulcers with, for the first few days, an itching in and around them, followed by a burning. Worse in the morning and evening. Either side. Antimonium Crud. Fistulous, deep or flat ulcers ; pain as if they were burnt ; spongy ulcers with an itching or pricking ; ulcers with high exuberant granulations ; spongy ulcers with a sore pain in them. Pus, scanty. Worse in the evening ; also from bathing them, on getting heated near the fire, and on turning the part. Better in the open air. Left side. Argentum met. Boring pain in the ulcer. Pus, copious, gela- tinous, bloody or yellow, and sometimes corrosive. Worse in the forenoon, and in the afternoon ; also when lying down in bed, and on descending an eminence. Special Therapeutics. 359 Better in the open air, on ascending an eminence, and on rising from the seat and moving about. Left side chiefly. Arnica mon. Jerking pain in the ulcer ; bluish ulcers ; readily- bleeding ulcers ; indurated ulcers ; induration of the surrounding skin ; inflamed and itching ulcers ; painless ; pricking, pulsative, and sensitive ulcers ; swollen ulcers with shocks, and feeling ot tenseness. Pus, bloody or gelatinous. Worse in the evening, and at night ; also from any bodily exer- tion, walking and moving, or turning the affected part. Better from warmth, when letting the limb hang down, from pressure, and when lying down. Left side. Arsenicum alb. Burning in the interior of the ulcer; pains are felt while sleeping; burning as if the ulcer were on fire; mortify- ing, putrid ulcers, with high edges, and shining redness of the sur- rounding skin; the base of the ulcer is either of a black-blue color, or has the appearance of lard ; foetid ichor, and proud flesh in the ulcer; thin scurf on the surface, it bleeds slightly on bandaging it ; flat, gangrenous, or inflamed ulcers ; the surrounding skin is of a dusky-red, or rather of a purple color. Pus, copious, bloody, ichorous or corrosive, putrid, thin and watery. Worse at night ; also before falling asleep, and again on awaking, from the cold, and in cold weather, any exertion of the body, lying on the painful side, on ascending an eminence, after moving about, from drinking liquors, and in windy weather. Better from warmth, on getting warm in bed, lying on the sound side, descending, and on rising from the bed. Either side. Asafcetida. Ulcers with intermittent, pinching pain. Aurum met. Mercurial ulcers; itching, shooting, or burning pains ; bluish-red, deep, fistulous, swollen and painful ulcers. Pus is yellow and foetid. Worse in the morning; also during rest. Better from motion, and while lying down in bed. Right side. (Low-spirited, sad, and constant thoughts of suicide.) Baryta Carb. Gnawing pain ; burning, or a pain as if burnt in the ulcer ; corroding pains ; scabby, crusty ulcers ; indurated ulcers, difficult to heal; inflamed, itching ulcers; painless ulcers; pricking and pulsating; swollen ulcers, with a feeling of tenseness. Pus scanty, or totally wanting ; gelatinous and scanty. Worse in the night ; also from cold, lying on the sore side, lifting the part affected, and from pressure. 360 Ulcers. Better when lying on the sound side. Left side. Belladonna. Desire to remain still; dread of motion; burning in the ulcers on touching them ; soreness and inflammation around the edges, with a black crust of blood in the center ; deep, scabby ulcers with cutting pains ; fistulous indurated ulcers, with indura- tion of the surrounding skin ; painless, though inflamed ulcer, or those with pricking, redness, and inflammation of the skin, for some distance around them; inflamed, sensitive, and swollen ulcers. Pus scanty, bloody and ichorous. Worse at night ; also on motion, however little, and from the lightest touch. Better while standing. Right side. Bovista ? Itching and burning in the ulcers ; scabby ulcers ; inflamed, itching ulcers ; painless ulcers ; pricking or pulsating in the ulcers. Pus scanty, ichorous, putrid, viscid, or yellow. Worse in the morning and evening. Left side chiefly. Bryonia alba. Ulcers with a smarting pain; stinging when moving ; throbbing in the ulcers ; induration of the edges. Pus brownish. Worse at night, after midnight, and in the morning; also before falling asleep, from exertion of the body, on getting heated, when lying on the sound side, on going up an eminence, from motion, or motion of the part, from making pressure on the side of the limb opposite to the ulcer, on rising from the seat or the bed, in summer and winter, when the weather changes, and during walking. Better when descending an eminence, lying on the sore side, from scratching, and while sitting still. Right side. Calcarea Carb. Unwholesome, readily- ulcerated skin; scrofu- lous ulcers ; fistulous ulcers, with redness, hardness, and swelling of the surrounding skin ; carious ulcers ; cutting pain ; inflamed or putrid ulcers ; high and feeble granulations, without much pain ; painful soreness ; tearing and throbbing in the ulcers ; the ulcers are white or yellow. Pus scanty and albuminous. Worse in the mornings ; also just before falling asleep, on awaking, when letting the limb hang down, before menstruation, from wet poultices, in the spring of the year, when turning the part, and in wet weather. Better when keeping the limb elevated, in dry weather, and from rubbing or scratching. Right side. Special Therapeutics 361 Calcarea phos? Carious ulcers; sensitive, easily excited, ill- humor, and want of disposition to do anything. The warmth of the room is intolerable. Calendula Off. Excessive secretion of pus; inflamed ulcers; painful as if beaten ; surrounding parts are red ; stinging in the ulcer during fever. Worse at night, with some fever. Cantharides. Ulcers with itching and lacerating; burning in the ulcers; smarting and stinging in the ulcer. Pus copious, inodorous, slightly yellow, and sometimes tinged with blood. Worse in the afternoon, and at night ; also from drinking coffee, from rubbing, and from scratching. Belter when lying down. Right side. CarbO veg. Pressure and tension around the ulcer in the leg; an ulcer which has become cured breaks out again, and instead of pus, emits a bloody lymph ; the surrounding parts are hard to the touch ; burning in the ulcer. Pus brownish, foetid, or foetid sanies ; cadaverous-smelling and corroding scanty secretion. Worse in the morning, and at night before midnight ; also in the open air, evening air, before menstruation, and from warmth. Either side. Causticum. Bleeding ulcers, with blisters on the surrounding skin; boring and burning in the ulcers ; burning in the edges ; pain as if burnt ; sensitive ulcers, with pustules around them ; swollen, with a feeling of tenseness in them. Pus is bloody and corroding, greenish or gray, ichorous and thin as water, sometimes yellow. Worse in the afternoon, and sometimes during the forepart of the night; also from cold, on just waking up, from drinking coffee, from rubbing or scratching, in clear, dry weather, and in a north wind. Better in damp weather, and on wetting the ulcer. Right side. Chamomilla VUlg. The skin is unhealthy, and every cut or abrasion ulcerates; an existing ulcer hitherto painless, suddenly becomes painful ; darting or lacerating, smarting or burning pain at night ; creeping in the ulcer, with excessive sensitiveness to the touch ; great sensitiveness to the currents of air, and to the wind. Worse at night; also in the open air, during menstruation, from motion of the affected part, wet poultices, pressure on the side of the limb opposite to the ulcer, on rising from the seat or bed, from drinking coffee, from the heat of the bed, and in windy weather. 362 Ulcers. Better from cold. Left side principally. Chelidonilim. Old, putrid, spreading ulcers ; when lying in bed at night there is a chill with a warm body ; deep, fistulous, spread- ing, itching ulcers. Worse in the morning; also in the open air, on turning the part, and when walking. Better from a firm pressure. Either side. ■ China Off. Boring, with painful sensitiveness in the ulcer; beating pain, only when moving the part ; burning and pressing, or digging; foetid, flat and gangrenous ulcers. Pus bloody, ichor- ous and foetid. Worse at night; also in the open air, from motion, from the lightest touch, and in windy weather. Left side chiefly. Clematis erecta. Burning, creeping, jerking, throbbing or shooting in the ulcer; shooting pain in the ulcer, only when touched ; scabby, deep ulcers ; indurated ulcers, with high elevated edges, difficult to heal ; itching in, and around about the ulcer. Pus serous, yellow, acrid or ichorous ; scanty secretion, or total sup- pression of pus. Worse at night; also from poulticing. Better when washing the sore. Left side. Conilim mac. Pains at night which rouse the patient from sleep; bleeding ulcers ; the edges become black ; gangrene of part of the ulcer ; creeping, with a tensive pain ; ulcers which are blue- ish, have a livid appearance and are tumid ; pain in the part as if it were being beaten to pieces ; burning, crusty and deep ulcers ; painless, hard and fistulous; swollen ulcers, hard to heal; inflamed ulcers, with a feeling of tenseness. Pus fetid, watery and ichorous. Worse at night ; also on descending an eminence, on beginning to move, before menstruation, pain from rubbing or scratching, or when either sitting or standing a long time. Better on ascending an eminence, on letting the limb hang down, from motion, and from pressure. Right side. Cuprum met? Old ulcers, with a feeling of contraction in the surrounding skin ; fat ulcers ; hard and inflamed ulcers, with a jerking pain ; sensitive ulcers, with redness of the areolar. Pus scanty and corroding. Left side. Dulcamara. Insensible, painless ulcers; hard, sensitive and swollen ulcers ? Pus scanty and yellowish. Worse in the night; also from cold or wet, and when the weather changes. Special Therapeutics. 363 Better from motion, and movement of the part. Left side chiefly. Drosera rotund ? Bleeding, burning ulcers; cutting pain ; Pus bloody, thin and watery, and ichorous. Worse in the morning and during the latter part of the night ; also when lying on the sore side, when sitting, and when getting warm in bed. Better from cold, from rubbing, and while walking. Right side. Eliphorbilim Off. Old, torpid ulcers ; lancinating and lacerat- ing pains ; ulcers turning black; insensible ulcers; biting in the ulcer; gangrenous ulcers. Worse in the morning; also on getting heated near the fire, lying down, when changing the position, on beginning, to move, while sitting, and when touching them. Better from motion and walking. Left side; though may be either side. Graphites. Unhealthy ulcers ; proud flesh in the ulcer; tear- ing ; crusty or scabby ulcers ; hard itching ulcer, difficult to heal ; sensitive sore spongy ulcers, that emit a salty flux. Pus bloody, watery acrid and corroding; putrid pus, or smelling like herring- brine. Worse at night, before midnight ; also during and after menstru- ation, and on moving. Better when lying down, and from pressure. Right side. Hepar SUlph. Mercurial ulcers ; burning in the ulcers ; burn- ing in the night only ; pains resembling recent excoriation ; throb- bing and shooting; ulcers with jagged edges, and surrounded by pustules ; bluish bleeding ulcers, with a burning pain in them, and surrounded by blisters. Pus may be laudable, acrid, or san- guineous; smells like old cheese; or it may be fetid and ichorous. Worse at night, and in the morning; also on first waking up, from cold, when lying on the sore side, from pressure, on touching them ; in clear dry weather, and in a north or east * wind. Better when lying on the sound side, and in damp weather. Left side chiefly. HyoSCyamus nig. Inflamed ulcers, the surrounding skin being of a bright vermillion redness ; large pustules around the ulcers. Worse in the evening; also during menstruation, and on touch- ing it. Better when getting warm. Left side. * In Germany, from whence we get this proving, an east wind is a dry one. 364 Ulcers. Jodium. Bleeding ulcers; destitute of feeling; hard, spongy and sensitive ulcers ; swollen ulcers, with a feeling of tenseness or soreness; Pus copious, bloody and corroding; or thin, watery and yellow. Worse at night ; also when lying down on the sore side, from pressure, on getting warm in the open air, from bodily exertion, and from rapid walking. Better from cold, and when lying on the sound side. Either side may be affected. Kali bich. Ulcers dry, form oval; have overhanging edges, a bright red inflamed areolar, hard base ; movable on the sub-jacent tissues, dark spot in the center ; after healing, the cicatrix remains depressed ; the ulcers corrode and become deeper, but without spreading in the circumference ; ulcers on the previously inflamed feet ; ulcers on the fingers, with carious affections of the bones. Worse in the morning ; also from cold, and during the summer. Better from heat. Either side. (Lippe.) Kali carb. Gnawing in the ulcer ; bleeding, burning, boring, corroding ulcers. Pus copious, bloody, and ichorous; or thin and watery. Worse at night, after midnight, and in the morning ; also from cold, on getting heated, during menstruation and after moving. Better from getting warm. Either side. KreoSOte. Burning, or pain as if burnt in the ulcer; putrid ulcers ; sensitive ulcers ; spongy ulcers. Pus acrid or ichorous, fetid or yellow. Worse in the morning; also after menstruation. Left side chiefly. Lachesis. The ulcer is large, and has a tendency to extend rapidly ; surrounded by smaller ulcerations or pustules ; consider- able swelling, with a mottled, dark-blue or purple color of the surrounding skin ; burning pain only when touching the sore ; ulcers which are smooth, but have jagged edges, are surrounded by papillae, and are bluish or livid in appearance. Pus scanty. Worse in the evening, and at night before midnight; also in windy weather, in the open air, on changing the position, from pressure, while sitting, and in wet weather. Better when lying down, on rising from the seat, and in wet weather. Right side usually. Lycopodium. Fistulous ulcers, with hard, red, shining and Special Therapeutics. 365 inverted edges; inflammatory swelling of the affected part; itching in them only or chiefly at night ; also when touching them ; gnawing, shooting or tearing pain ; tumid ulcers, with elevated and indurated edges ; surrounded by papillae. Pus copious and albu- minous ; or sanious, gray, yellow, or acrid. Worse in the afternoon and in the evening; also while lying down on the sore side, before menstruation, on beginning to move, from pressure, while sitting, on being touched, and on beginning to walk. Better from cold, on motion, and on getting warm in bed. Right side chiefly. MerCUrillS SOl. Spreading ulcers; spongy, readily-bleeding ulcers ; ulcers are exceedingly painful, and sensitive to the slight- est touch; unequal elevations and depressions; (neither hot nor cold applications allay the intolerable darting, lancinating pain,G.) ; gnawing or throbbing pain ; ulcers of a bluish or livid appearance, with hard, elevated and jagged edges; superficial ulcers, of a whitish appearance. Pus may be scanty or copious, and of almost any appearance, (save laudable, G.) Worse in the evening, and at night ; also in the evening air, from or during walking or motion, from the slightest touch, on getting warm in bed, and in wet weather. Better from cold (?), while lying down, and while sitting. Left side mostly. Mezereum. Pain of a burning character, or feeling as if from a recent excoriation ; .shooting pains ; biting pains ; pricking in the ulcer, or soreness ; feeling of tenseness in the ulcer. Pus scanty or totally suppressed. Worse in the evening, and in the night before midnight ; also from rubbing, from scratching, and from being touched. Better in the open air. Left side. Natmm Carb. Burning ulcers ; pricking and pulsating in the ulcers. Pus corroding, acrid, putrid and yellow. Worse in the forenoon ; also when lying down. Better from pressure, on getting up after sitting, and from rub- ring or scratching. Left side principally. Natrum mur. Superficial ulcers ; red, angry-looking, smarting ulcers, surrounded by vesicles. No suppuration. Worse in the morning, and in the forenoon ; also from bodily exertion, before and after menstruation, from motion, and on mak- ing pressure. 366 Ulcers. Better while and after lying down. Right side. NlIX vomica. Raised ulcers with pale red edges; pain as if being beaten to pieces; burning pain as if burnt; jerking pain; prurient itching; sensitive, sore ulcers, with a feeling of tenseness; Pus greenish and corroding. Worse in the morning, and at night ; also in the open air, after menstruation, while lying on the back, on moving the part, when touching the ulcer, when drinking liquor or coffee, when walking, in clear dry windy weather, and in winter. Better when lying on the sound side, when sitting, and in damp weather. The right side chiefly. Petroleum. Fistulous ulcers; rapidly spreading; shooting pain, with elevated, indurated edges ; deep or flat ulcers that are difficult to heal ; pricking in the ulcer's edges, or areolar ; proud flesh in them ; redness of the areolar ; painful, sensitive and spongy ulcers. Pus scanty, acrid and corroding ; sanious and watery. Worse in the morning ; also in the open air, from cold in general, and in winter. Right side. Phosphorus. Fistulous ulcers, with callous edges ; gnawing pain ; hectic fever. Pus fetid and badly colored ; scanty, and again is easily secreted. Worse in the evening and at night before midnight ; also before falling asleep, on awakening, when the weather changes, and in the wind. Better on awakening. Right side generally. Pulsatilla. Flat, putrid carious ulcers ; fistulous ulcers ; itch- ing, burning or excoriated feeling in the ulcers ; smarting and shooting pains ; the surrounding parts are discolored ; indurated and elevated edges ; ulcers surrounded by papillae. Pus copious, albuminous and yellow ; also bloody, or green. Worse in the evening, in the afternoon, and at night before mid- night ; also on changing the position, while lying on the sound side, after lying down, during menstruation, on beginning to move ; also after moving, on pressure on the side of the limb opposite to the ulcer, on rubbing or scratching, while sitting, and in windy or win- try weather. Better in the open air, from cold in general, motion, on walking, and on wetting the affected part. Right side. Ranunculus bulb. Itching or burning in the ulcer; shooting pains ; smooth ulcers ; boring in the ulcers ; flat, superficial ulcers, with pricking in them. Pus sanious and acrid. Special Therapeutics. 367 Worse in the morning, afternoon, and evening, and at night before midnight ; also from cold in general, and on being touched. Better while standing. Either side. Rhus rad. Hard red edges, and itching of the ulcers ; sore, inflamed ulcers ; itching-smarting, or itching-biting in the ulcer ; feeling as if salt were in the ulcer ; erysipelatous inflammation and swelling of the surrounding skin ; the skin in the neighbor- hood was covered with itching, burning vesicles, smarting on scratching them. Worse in the evening, and at night ; also from cold, on begin- ning to move, from drinking cold water, and when the weather changes. Better from motion. Either side. RhllS tOX. Small vesicles, turning to putrid, gangrenous and spreading ulcers ; violent fever ; tingling and smarting as if from salt in the ulcers ; burning, creeping or crawling sensation, with a pain resembling a recent excoriation ; smarting and soreness ; ulcers surrounded by papillae. Pus sanious and acrid. Worse in the morning, evening, and at night after midnight; also before falling asleep, in the autumn and spring, from bathing in cold water; also from exertion of the body, when lying down, from poultices, when the weather changes and in wet weather. Better from motion, and motion of the affected part, while walk- ing, and in dry weather. Either side may be affected ; chiefly, however, the left. Ruta grav. ? Gnawing, jerking pains. Pus sanious. Worse in the afternoon ; also in damp weather, and while he is sitting or lying still. Better on motion. Left side chiefly. Sabina. ? Deep ulcers; pricking, feeling of tenseness in the ulcer. Worse in the morning, and in the evening ; also from exertion of the body, from being touched, and on getting warm in bed. Better in the open air, from cold, and on raising or elevating the limb. Left side. Secale COr, Bleeding ulcers ; ulcers becoming black ; feeling as if burnt ; painless ulcers ; pricking, producing a prurient secre- tion. Pus putrid. Worse at night ; also from being touched, and on getting warm in bed. 368 Ulcers. Better from cold. Right side. Sepia. Ulcers with blisters around them ; pain as if burnt ; deep, crusty (scabby) ulcers ; flat ulcers with digging pain ; desti- tute of feeling ; fistulous, hard ulcers ; high elevated edges ; hard to heal; jerking, itching or pricking; proud flesh in them; pustules around the ulcer, with redness of the areolar; sensitive, sore, spongy or swollen ulcers ; swelling of the edges, with tearing in the ulcer. Pus is copious, corroding, gelatinous, greenish or ichorous ; or it may be scanty, putrid, viscid, sour-smelling, and whitish or yellow ; thin salty ichor. Worse in the morning, forenoon and evening ; also before falling asleep, and on awaking, while sitting, and from being touched. Better on awaking, and when rising from the seat. Right side. Silicea. Aching pain in the ulcer; it becomes black at the base, or on the edges ; bleeding from the base or edges ; boring or burn- ing in the edges, or in the areolar ; sensation of coldness in the ulcer; deep or flat, crusty ulcers; destitute of feeling; hard, fistul- ous or gangrenous ulcers ; ulcers with high, hard edges ; difficult to heal ; jerking and itching in or round about the ulcers; pricking in the edges and areolar; proud flesh in the ulcer; pulsating, putrid ulcers, with redness of the areolar; sensitive edges; spongy ulcers, or only spongy on the edges; swollen ulcers with white spots and tearing pain. Pus copious, brownish, corroding, gelatin- ous; or grayish, bloody, or ichorous; scanty, putrid, thin, and watery and yellow. Worse in the forenoon, afternoon, in the evening, and at night ; also in the open air, when lying on the painful side, from pressure, and when the weather changes. Better when lying on the sound side. Either side. Staphisagria. Itching or burning in the ulcer; gnawing, jerk- ing, shooting or tearing pains ; smarting in the ulcer. Pus excessive, acrid, ichorous and fetid ; or scanty. Worse in the morning, forenoon, in the afternoon, and at night ; also on moving, from pressure, and on being touched. Better in the evening and when lying down in bed. Principally the right side. Sulphur. Readily - bleeding ulcers; ulcers with raised and swollen edges ; surrounded by pimples ; fistulous ulcers ; stinging and lacerating in the ulcers ; proud flesh in them ; violent bleed- ing of old ulcers; irregular jagged edges; cedematous swelling, Special Therapeutics. 369 and reddish-brown discoloration of the skin. Pus thick, yellow, and foetid ; or thin and foetid. Worse in the evening, and at night; also on awaking, from bodily exertion, while lying down in bed, before menstruation, from poultices, from being touched, and on getting warm in bed. Better from cold, on rubbing or scratching, and in dry weather. Left side. Thuja. Ulcers with indurated edges ; elevated jagged edges ; surrounded by blisters containing pus ; deep, burning and fistulous ulcers; itching, pricking, and proud flesh in the ulcers; pulsating, spongy ulcers, or only spongy on the edges ; feeling of tenseness in the ulcers ; ulcers with serrated edges. Pus yellow. Worse in the afternoon ; also on rising from the bed. Better from rubbing or scratching. Either side. Tartar emetic. Deeply-penetrating, malignant ulcers; broad and deep sloughing ulcers; gangrenous ulcers, with hectic fever; ulcers are surrounded by black pustules, which break down into deep ulcers. Pus, absent ; merely an oozing of foetid humor. Worse in the morning. Either side. Veratrum album. Bluish ulcers ; hard, indurated ulcers ; itch- ing, painless ulcers, but with redness of the areolar. Pus scanty. Worse in the morning; also in the autumn or winter, when standing, and on getting warm in bed. Better on rising from the bed, and in dry weather. Either side may be affected, though the right side is usually so. Zincum met. Herpetic ulcers ; bleeding and burning ulcers ; destitute of feeling ; itching ; redness of the surrounding skin ; sore ulcers ; tearing, and feeling of tenseness of the ulcer, and the surrounding parts. Pus bloody and corroding. Worse in the afternoon and evening; also on getting heated near the fire. Better from rubbing or scratching. Left side. In the last few years, a number of " new remedies " have been introduced to the profession, that are as yet, however, hardly established enough to warrant their insertion here. The mass of them have not been tested by myself in these cases, and those only that I have used will be noticed ; and among them, only such as have proved curative. Apis mel. This remedy has been used in perhaps five cases, and cured promptly the following symptoms and conditions; small 24 370 Ulcers. ulcers ; large, spreading ulcers, that are surrounded by pimples ; redness and heat in the areolar; pricking in the ulcer; stinging in the ulcer and in the areolar ; high florid granulations. Pus thick, white, acrid, and corroding. Worse in the morning ; also from heat. Better from cold water applications, and from pressure. Left side. Hydrastis Can. This remedy has been used but once by me, and acted very satisfactorily, though the result could not be called a cure properly. It seems to be closely analogous to Mercury. I plead guilty, however, to having departed from my usual practice and teaching in this case, by using it as a topical application. The reason for this was, that there was no opportunity at the time of getting a tincture or dilution, and a preparation of the dried root steeped in water was only available. The symptoms were as follows: they were all cured except the pain — ulcer closed and all — and this was removed by one dose of Cham. 6. Ulcers on the legs ; dry, superficial, and angry-looking ; covered by a yellow scab; pain was stinging, or stinging-burning; areolar inflamed, and covered by pimples, which frequently degenerate into ulcers ; faint-fetid odor ; circular shape, with flat edges ; one of the ulcers had high and thick edges. No pus. Worse at night ; also from the warmth of the bed, on motion, or on touching them. Left side. Hamamelis Virg, This is one of the best remedies in our whole Materia Medica for the treatment of varicose ulcers. I am almost tempted, in spite of homoeopathy, to call it a specific. It has cured in my hands probably ten ulcers of that description. The symptoms are: deep, circular, flat ulcers; ulcers that are very dark, almost black at the base ; the surrounding skin is bluish- black; oozing of blood; burning and stinging, or biting in the ulcer; the edges are on a level with the surrounding skin, and are sharp cut. Pus very thin and Watery, bad smelling; more an ichor than pus. Operations. The operations that are occasionally required for the cure of obstinate ulcers, are two in number, viz. : plastic operations, and amputation. The former of these is one of the most beautiful pro- cedures in our art, and is one that requires a good eye, and consid- Special Therapeutics. 371 erable skill in its performance. Still, like many other "beautiful " things, it lacks in usefulness. It often fails. Nor can we wonder at this. On turning to the opening pages of this chapter, we see that the existence of an ulcer depends upon a diseased state of the the whole system, that renders the formation of new healthy material, and firm cicatrization equally impossible. How can we then expect a transplanted portion of the integument diseased itself, to adhere to these old diseased surfaces, that have not vital- ity enough to resist the continued encroachments of the malady? When an ulcer has been healed, but leaves an ugly scar, or from the contraction due to this process gives rise to considerable inconvenience and deformity, then an operation of this nature is admirable. But under other circumstances, when the ulcer remains open, and the diseased action is consequently not sus- pended, all such methods are worse than useless, inasmuch as they give no relief, and only subject the patient to additional suffer- ing that is entirely uncalled for. In some severe cases of sloughing or phagedenic ulcer, it may possibly be found necessary, on purpose to save life, to amputate. This is the last resort and should not be thought of. No ulcer is actually incurable. We may not cure it, but it only proves our imperfect knowledge of our remedies, and not their powerlessness. In such cases, amputation is truly " the reproach of surgery," and is a measure I cannot conceive of ever being the only one left. If remedies do fail, even use styptics, acids, anything but this cruel operation. The method of performing either of these operations is fully developed in works of a different character. tf2 Gangrenous Diseases. GANGRENOUS DISEASES. MORTIFICATION, BED-SORES, SLOUGHING PHAGE- DCENA, CARBUNCLES, BOILS. Mortification. Mortification, or gangrene, is the death of a part, and is usu- ally applied to death of soft parts. Dunglison says, that in the incipient stages, or when recovery is possible, gangrene is the proper term ; when the part, however, is totally destroyed, he calls it sphacelus. Erichsen gives a different meaning to the terms. Death of any part, according to his teaching, is gangrene, whether bone, or soft parts. But when the soft parts are alone involved, it is sphacelus. This nomenclature is the one I have adopted, and is that usually applied by the profession at large. Gangrene is spoken of as " acute " or " chronic," " traumatic " or "idiopathic," "hot" or "cold," "dry" or "humid." Old- school authors divide these into two grand divisions, " constitu- tional" and " local." The last condition is a merely suppositious and impossible one, unless they mean gangrene confined to one part — as a finger, or the nose ; even then the fault lies deeper than that one point. It must be a constitutional disease. *When occurring in elderly people, from deficient or impaired nutrition, we speak of it as " senile." The causes of gangrene are numerous. It may result from a mechanical injury, as an interruption of the circulation from a severance of a large arterial trunk, from deficient circulation in elderly people, or from impeded circulation — ist, structural dis- eases of the arteries, as calcification, or ossification ; 2nd, sudden arrest of the flow of blood by ligature after operations ; 3rd, return of the blood by the veins being obstructed by strangulation, as when a bandage is applied so tightly that constriction of these vessels follows ; 4th, by the long-continued pressure of some foreign body on the main arterial trunk — as from tumors, bullets, or Mortification. 373 hard compresses ; finally, intense inflammation, by engorging the vessels, and impeding the flow of. blood, or the application ot specific poisons. Other causes there may be, but they all, to a greater or less extent, exert their influence by an interruption or obstruction of the circulation, both arterial and venous. In regard to the curability of gangrene, much might be said, but the whole question depends upon the cause, the age, the habits of the patient, and the nature of each particular case. There seems to be some considerable division of opinion on this subject, one party saying because it is gangrene, it can never be cured, and the others that it is always amenable to treatment. Both parties are partly right ; for if the case is at all favorable, it can cer- tainly be cured ; but the assertion that it is always curable, is too broad, and consequently not true. The conditions under which a cure by medicinal agents may be hoped for, are as follows : The surface, or part implicated, is small in extent, the disease is rapid in its progress, accom- panied by more or less pain, moist inflammation of the surround- ing parts moderate, occurring in young people, and ordinarily when resulting from mechanical injury. A cure is almost hope- less when its invasion is slow, but steady, part dry, when the disease results from intense inflammation, no pain, or very little, when occurring in old people, from the calcification or ossifica- tion of arteries, and from injuries to persons of a debilitated constitution. Although these conditions are unfavorable, yet they are only that, and so nothing should be left untried, ere resorting to amputation. "When should we operate?" is a question often propounded. When remedies prove themselves to be utterly powerless. Some few suggestions about the indications for an operation may be given here. Mortification, when it has reached its limit, forms an ulcerated line, separating it from the living tissues. This is called the "line of demarkation." It is a rule among surgeons to wait until this line has formed before amputating, as (they say) gangrene will very likely invade the stump. Under homoeo- pathic treatment it has been proven to me three times, that in traumatic cases, at least, no such precaution is necessary. Idio- pathic cases had best be allowed to wait for this line. As soon as remedies, when well-selected, give unmistakable evidence that they are powerless to arrest the disease, amputate at once, and 374 Gangrenous Diseases. in the majority of cases no trouble will be experienced in the subsequent treatment. Why, if the line of demarkation has not formed, how can we tell but what it may form only after the whole limb has been diseased ? and if we amputate, and gangrene then invades the stump, is the patient in any worse condition than if we had waited until it had got past that point ? We have given him a chance, and us more time to test the remedies ; and as the limb would have to come off anyhow, there is no " unne- cessary maiming done." One case may be cited here to prove the truth of this assertion: On the 22nd of September, 1865, was called to see a boy who had his left foot badly crushed between the bumpers of two coal cars. Under allopathic treatment, and under the care of one who dare not amputate before the gan- grene set in, his foot from the toes half-way up to the ankle was mortified — foot black, moist, and painless. The surround- ing skin was much inflamed, and the gangrene evidently progress- ing. Having had a case some four weeks before, in which gan- grene followed a simple fracture, and was cured by Lack., against the advice of my colleague, Dr. D. S. Trites, I removed a por- tion of the foot, below the ankle-joint. The great toe, and the one next to it, not being involved, were left in place. The line of the gangrene was so irregular, that it was found impossible to save the toes unless a portion of this gangrene was left on the foot. The piece left was about as large as a silver half-dollar. Six days afterwards this spot sloughed out, and under the use 01 Lack. 200, dry, on the tongue every third day, the further invasion of the disease was stopped. This was in every way in direct violation of all standard teaching, as the amputation was not above a joint, and was performed before the disease was checked. Still the boy recovered, with a useful foot, in as short a time as could be expected. At the bottom of the record of this case, in my "case-book" for 1865, occurs this passage, which will bear repeating : " A perfect cure resulted, and another great fact is thus fully proved — viz., that allopathic surgery, and allopathic rules, are only suitable to allopathic medicine; what we can do in surgery, we do not yet know." Gangrene of external parts, one would suppose, is always easily diagnosed, but such is not the case. Strange as it may appear, eminent surgeons have actually mistaken bad cases of ecchymosis for gangrene. But of course this does not often Bed- Sores. 375 occur. Gangrene may generally be known by a change of color in the part, it becoming generally first livid, then darker, until it reaches black, or almost so. There is always more or less loss of sensibility, and usually absence of pain, although, as noticed when speaking of the curable condition, there may be a little pain, or, to speak more properly, there is that indescribable sense ot uneasiness, or that dull, indistinct pain, noticed when speaking of congestion. But this all relates to gangrene of external parts. Gangrene of internal organs may result from a contusion, from congestion, inflammation, etc., pretty much as in external parts, under nearly all circumstances ; its existence is more properly suspected than determined. One of the first signs or symptoms of its approach is a total or partial disappearance of an already existing pain, but with no corresponding improvement in the patient's general health. This, of course, is not a reliable sign, as the same thing occurs in the invasion of an internal organ by suppuration, only in this instance a throbbing or pulsating pain succeeds to the former. The patient in these cases grows weaker and weaker, and unless relieved speedily dies. The diagnosis, then, is usually sufficiently easy, but it may, and has occurred, that a part is condemned and amputated when in reality the vitality is only lost to outward appearances, and ulti- mate recovery might ensue from a more persistent use of reme- dies. Do not be in too great a hurry to pronounce an unfavor- able opinion in these cases. The prognosis, of course, in nearly all of these cases, is apt to • be extremely unfavorable ; the chances for recovery are often slim, and though the patient may not require an operation, yet it is well to keep the possibility of such an event being necessary constantly before him, so that it will not be altogether unex- pected. Bed - Sores. Bed-sores are very troublesome affairs that are quite common, and will be found very difficult to manage. They may occur in spite of any precautionary measures, but can often be prevented by attention to cleanliness, and the avoidance of long-continued pressure. One indispensable thing, is to keep the bed dry ; this requires careful nursing. Bed-ridden people are those oftenest 376 Gangrenous Diseases, affected ; by this I mean those who have been confined to the bed for a long time, and mostly in cases where one position has been long maintained. Here the natural discharges require con- stant attention to the bed-clothing. They are ulcers, then, caused by a long-continued pressure. on one point. In appearance they are an inflamed patch of skin, becoming soft and doughy, until finally a tough, grayish-looking slough is formed, which exudes thin, corrosive pus. On the elimination of this slough an ulcer is formed, commonly deep, but sometimes shallow, taking on the healing process slowly. They are not of the indolent variety of ulcer, but seem rather to depend upon the low state of the general system necessary to their formation. Cases have occurred in which the muscles, and even the bones, are exposed. Such cases are more serious than ulcers of the same size under other condi- tions, chiefly from the low state of the general health. There are few diseases that will be found so difficult to cure as this ; it requires patience and perseverance. Allopathy recommends numerous washes and ointments, which are adopted by many homceopathists ; they ought to. know that the cure is actually retarded by such means. Use remedies in attenuation, and give them internally, and the higher the better. ' The first thing to be done is to devise means for the relief of the pressure exerted on the part. If it can be procured, a water or air-bed is the best thing known. Should the patient be unable to get one, pillows and clothes should be so disposed that the end in view may be attained. Many other preventive measures have been published, prominent among them is the application of borax and spirits of wine, under the supposition that it hardens the skin. This seems doubtful to me ; I should rather think it would favor the forma- tion of such sores. Never touch them with caustic, the knife, or any instrument ; no good can come of it. Caustics are particu- larly objectionable, as they form a new slough, which, on separa- ting, leaves the original ulcer larger. Phagedena. Sloughing phagedena is also known as hospital gangrene, and in civil practice is extremely rare. I have never seen but one case, and that being a dispensary patient, was lost sight of. The characteristics are unknown to me from personal experi- Phagedena. 377 ence, and so shall quote Erichsen rather extensively. It " is a disease characterized by a rapidly destructive and spreading ulcer, covering itself, as it extends, by an adherent slough, and attacking open sores and wounds. It used formerly to desolate civil hos- pitals, but thanks to the sanitary measures that are now so generally adopted in these institutions, it has almost disappeared from them, though still an outbreak of it occasionally takes place." " When sloughing phagedsena invades a wound that is previously perfectly .healthy, the surface of the sore becomes covered with gray soft points of slough, which rapidly extend, until the whole of the ulcer is affected. At the same time it increases rapidly in superficial extent, and commonly in depth ; the surrounding integument becomes oedematous, swollen, and of a livid red color ; the edges of the ulcer are everted, sharp-cut, and assume a cir- cular outline, and its surface is covered with a thick, pulpy, grayish-green, tenacious mass, which is so firmly adherent to the sore, that it cannot be wiped off from it, being merely moved or swayed to-and-fro when an attempt is made to clean it. There is usually some dirty, yellowish-green, or brownish discharge, and occasionally some bleeding; the pain is of a severe burning, stinging, and lancinating character, and the fcetor from the surface is considerable. The ravages of this disease, when fully devel- oped, are very extensive. The soft parts, such as the muscles, cellular tissue, and vessels, are transformed into a gray, pulpy, mass, and the bones are denuded or necrosed. The larger blood- vessels resist the progress of the disease longer than any other parts, but may at last be exposed, pulsating at the bottom of the deep and foul chasm. There is little risk of hemorrhage taking place, however, in the early stages; but when the sloughs are separating, an artery may give way, and bleeding to a dangerous or fatal extent may ensue. Blackader has described an ulcer- ated form of this affection, in which a vesicle containing a bloody ichor forms, with a hot, stinging pain ; this breaks, leaving a cir- cular ulceration about the size of a split pea. The ulceration once formed, rapidly extends by sharp-cut edges into the sur- rounding integument. "The constitutional symptoms are inflammatory in the first instance, with a tendency to asthenic and irritative fever as the disease advances." Some authors dispute this, claiming that the local symptoms occur first. Mr. Erichsen, however, seems to 378 Gangrenous Diseases. have the mass of the profession agreeing with him ; at all events that is the homoeopathic doctrine. Carbuncle. Carbuncle is a disease peculiar to people of a debilitated, broken-down constitution, and attacks them usually about or past the middle period of life. It is but seldom seen on the extremi- ties, or what is more singular, on the anterior surface of the body. The back of the neck is the usual seat. When it is situated on or near the head, or when it is of large size, the patient may die, passing into a typhoid condition. Carbuncle begins with inflammation, swelling, and some pain; the swelling is flat, circular, and of a dusky red hue ; usually it is but very slightly elevated above the surrounding skin. When sloughing is about to occur, the skin covering it becomes darker, undermined, and finally breaks down around the edges, leaving fissures through which exudes a thin, badly-colored, unhealthy pus. The points of distinction between boils and carbuncles are sufficiently well marked to prevent the possibility of confusion. Boils have a small slough, and copious discharge of pus ; carbun- cles have an immense slough, while the suppurative action is mild or deficient. Again, boils are elevated above the surrounding integument considerably, and are of a conical shape ; carbuncles are nearly always on a level with, or but slightly raised above the skin, and are flat. These formations vary in size from one or two inches in diameter, to six, or even more. They seldom attack young people, or those of a robust habit. In spite of the homoeopathic authorities against it, there is noth- ing so effectual when conjoined with proper treatment — as early crucial incisions, passing through the whole extent, depth and breadth of the mass. Boils. Boils are well known to all physicians, and need but little mention. They are sometimes called " furunculus " or " abscess nucleata" According to Laurie, "a boil is a round, or rather cone-shaped, hard elevation, of different sizes, slowly inflaming Special Therapeutics. 379 and suppurating, discharging matter generally at first tinged with blood, but still retaining a portion of morbidly altered cellular tissue, which may form the nucleus of other elevations after those which have appeared first have healed." The causes are a pecu- liar constitutional tendency. Boils are, however, frequently critical, as in gout, following acute fevers, in eruptive diseases, and sometimes forming the termination of chronic exanthemata. Treatment. — In the treatment of the sloughing phagedena, it may be necessary to employ Nitric acid to stay the further exten- sion of the ulcerative process. I should be more inclined, how- ever, to trust to my remedies alone. Boils, I believe, should be opened as soon as you see them, whether there be pus or not. Should suppuration follow, an outlet being already made, there will be less pain. It has been my experience that when a boil is opened in the earliest stages, before the formation of pus has commenced, the swelling will subside and a cure result very often. The remedies that are oftenest used, are as follows : Gangrene: Humid. — Chin., Hell., Phos. Hot. — Aeon., Ars., Bell., Muriat. acid, Sabin., Secale. Cold. — Ars., Asa/., Euphorb., Lach., Plumb. , Secale, S/l., Squilla, Bell., Con., Merc, Ranunc. bulb. of the Nose. — Secale. of the Buccal Cavity. — Ars., Lach. of the Sexual Parts. — Ars., Canth., Plumb. , Secale. of the Scrotum. — Plumb. of the Penis. — Canth., Plumb. of the Uterus. — Secale. of the Arms. — Secale, Ranunc. of the Lower Limbs. — Secale. (Lach., G.) Sloughing Phagedena : Ars., Aur., Hep. s., Lach., Mere, Mezer., Nit. ac., Tart, em., Sil., Sulph. of the Nose. — Aur., Merc. on the Chest. — Mezer., Sulph. on the Back. — Ars., Merc. Sil., Sulph. on the Arms (upper). — Ars., Mezer. on the Arms (lower). — Merc. on the Hands. — Merc, Sil., Sulph. on the Fingers. — Merc, Sil., Sulph., on the Thigh. — Merc, Mezer. 380 Gangrenous Diseases. Sloughing Phagedena : on the Leg. — Mere, Mezer^ Sil. on the Foot. — Ars., Si'/., Sulph. Boils: Aeon., Am., Bell., Hefiar. s., Mere., Sulph. Carbuncle : Ars., Am., Bell., Lack., Merc., Sulph. Bed-sores: Am., Ars., Lack., Plumb. Aconite nap. Deadly paleness of the countenance, and shud- dering ; the part first swells, and then assumes a blackish color ; sleeplessness, tossing about from side to side; chilliness if uncov- ered in the least ; excessive thirst ; slight perspiration, and hard accelerated pulse ; cool sweat in the palms of the hands ; coldness of the feet as high as the malleoli, with sweat on the toes and soles of the feet. Arnica mon. Hard, hot, and shining swelling of the parts affected ; gangrene following contused wounds ; thirst before the fever; pain in the periosteum of all the bones, as intermittent fever ; pain in the cartilage of the ear, as if the parts had been contused ; swelling of the nose, with a feeling as if from ulceration in the nostrils; tendency to boils, frequently returning; carbuncle with fine pricking of the skin. Arsenicum alb. Great weakness, and emaciation ; cannot take even a few steps without sinking ; carbuncle which is the seat of a deep burning pain, and particularly useful just before the slough- ing process is commencing; anasarca, or cedematous swelling of the part; general coldness with parchment-like dryness of the skin ; thirst, drinking little at a time, but often ; gangrene accom- panied by fetid diarrhoea; carbuncle arising from contagion; coldness followed by heat. Asafteiida. Dark-red and hot swellings; cold swellings; bright raw appearance of the wounds, covered with a crust of tenacious lymph, with transparent lymph-like pus, and sensitive to the touch ; coldness and dryness of the skin, with accelerated pulse. Alirum met. Gangrenous diseases with cedematous swelling of the part ; very sensitive to cold ; low-spirited, with desire to commit suicide. Belladonna. Fiery redness of the swelling, and of the sur- rounding skin, even erysipelas ; dry, hot skin, thirst and headache ; erysipelatous swellings, becoming indurated, and afterwards mor- tifying, accompanied by glandular swellings ; extreme sensitiveness to the slightest touch ; secretion of bloody ichor. China Off. Emaciation; naturally attenuated limbs, which Special Therapeutics. 381 become bloated and swollen ; hard, red swellings ; putrid ichor ; pale, sunken or clay-colored face ; bed-sores in people who are much debilitated from excessive though natural discharges. CantharideS. Ulceration and gangrene after exanthematous diseases ; frequent paroxysms of feverish coldness ; pulse hard and full, or small and frequent ; nervous irritable ; loss of thirst. Conilim mac. Exhausted and faint, as if paralyzed ; gangrene from contusions ; the glands are swollen and indurated ; feeling ot heat in the whole body; perspiration all over; pulse unequal; depression of spirits. Euphorbilim. Inflammation and swelling, followed by cold gan- grene ; chilliness of the whole body, shuddering. Helleborus nig. Pale color of the skin; sensation in the smaller parts as if too heavy and as if pressed asunder ; general perspira- tion ; slow pulse ; constrictive sensation in the nose. Hepar SUlph. Boils on the head and neck, very sore on con- tact, and when lying on them ; hard, full and accelerated pulse ; perspiration easily excited; unhealthy readily-suppurating skin. This remedy is invaluable in promoting or hastening the secretion of pus. Lachesis. Sensation as if hot air were pouring through the knee-joints ; gangrenous ulcers on the legs ; pulse is small and weak, but accelerated ; internal sensation of heat with cold feet; skin changes to bluish, red or yellow; carbuncles with pur- ple colored surroundings, and many smaller boils around them ; gangrenous ulcers and blisters. MercurillS Viv. Inflammation and swelling of the glands of the neck; pulse irregular; boils, and carbuncles; carbuncles that are very foul and destructive ; cannot bear the heat of the bed ; the pains are not ameliorated by either hot or cold applications, both seeming to increase the sufferings. Before suppuration begins in a boil, this remedy will often cause the swelling to dis- appear. Mezereum. Burning of internal parts, with external chilliness; sensitiveness to the cold air; pulse full and hard; perspiration during sleep, followed by a chill, with no previous heat. Muriatic acid. Putrid, gangrenous ulcers on the lower extrem- ities ; great sensitiveness to the dampness ; pulse weak and slow ; chilliness and shuddering; "blood-boils"; oedema of the part. Plumbum. Carbuncle on the back of the neck, with tension 3§2 Gangrenous Diseases. when moving the head ; oedema ; pulse very variable ; chilliness ; perspiration cold and clammy; small wounds easily suppurate; sensitiveness of the skin to the open air. Ranunculus bulb. I can find no indications for the use ot this remedy, notwithstanding it is recommended by many of our writers. Sabina. Red shining swelling of the affected part ; pulse is unequal ; violent beating of the veins ; insupportable burning heat, with restlessness in the whole body. Secale COr. Inflammation and gangrene of the uterus ; gan- grenous deadness of the fingers ; swelling of the hands with black pustules; senile gangrene of the feet; pulse remains unchanged; gangrenous blood vessels. Silicea. Boils on the neck and in the arm-pits, with glandular swellings and suppuration ; " blood-boils " and warts on the arms ; also on the thighs and calves; pulse small, hard and rapid; carbuncles, and bed-sores. Squill a marit. Has been used with some success in cold gangrene. Sulphur. Bed-sores with gnawing pain ; red-shining swelling of the toes ; pulse full, hard and quick ; sensation as of a band around the part; putrid ulcers, turning to gangrenous sores, and sloughing phagedsena. Tartar emet. Has been used occasionally for sloughing pha- gedaena. The indications above given are, of course very meagre. In selecting the remedy, compare this chapter with that on ulcers. Note. — A gentleman informs me that he has frequently aborted boils and felons by applying the bruised blue-flag, (Iris vers.) using the whole plant. Tumors 38 TUMORS INNOCENT TUMORS, SEMI-MALIGNANT TUMORS, CANCEROUS TUMORS. Tumors in general are described by Dunglison to be "a rising, or prominence, of a greater or less size, developed by a morbific cause in some part of the body." I have italicized the con- cluding portion of this quotation, to show that the idea of a " local disease " is a visionary one. The whole subject has been divided into three great classes — 1st, Innocent; 2nd, Semi-malignant; 3rd, Malignant. Innocent tumors are sometimes known as " benign," or "non- malignant." We have three general varieties of these tumors — 1st, the encysted form; ?nd, those formed by a simple increase in size of already existing structures. These differ from simple hypertrophy, in having a distinct outline, and being prominent above the remainder of the part, involving only a portion. Hypertrophy, on the contrary, is a uniform enlargement of the whole part or limb, still retaining its proper shape. 3rd. Those formed by a growth of an existing structure, but never found normally in the situation occupied by the tumor. Among the first class we number the " atheromatous " and " cystic " tumors. Under the second, " warts," "polypi," " glandular," "fatty," "vas- cular," " nervous," and " bony " tumors. The third variety em- braces the different " fibrous " tumors. Some of these, however, are semi-malignant, as will be shown in the second section. This class of tumor derives its name of innocent, or benign, from the fact that they do not contaminate nor implicate neigh- boring structures, do not return after having been removed, and do not cause death or inconvenience, only (1st) when they com- press vessels or canals, (2nd) when by their pressure the bones or other tissues in the vicinity are absorbed, and (3rd) when their great size and weight wear out the patient. The different varieties we will mention are eleven in number, as follows : — " Atheroma," 384 Tumors. "cysts," "warts," "condylomata," "sarcoma," "hcematoma," " polypi," " glandular," " fatty," " fibro-cellular," and " fibrous." 1. Atheromatous Tumors. — This is a tumor formed of a cyst, and containing matter like pap, or "bouillie." They are met with in almost any part of the body, but are most common on the head. They may exist in any number, as many as thirty or forty being found in one case on the head ; the size may be from that of a pin's head, to that of an ordinary orange. They are painless, but, as Erichsen says, they may occasion uneasiness by compress- ing neighboring nerves. Usually they grow slowly, but occasion- ally, after remaining nearly stationary for a long time, they sud- denly grow rapidly. The contents are not invariably such as has been stated above ; sometimes it is cheesy, again creamy, dry, and laminated, or it may be semi-fluid, and of a brown, green, or blackish color. They sometimes terminate by inflammation, suc- ceeded by suppuration, which in turn is followed by the formation of a large ulcer, which will be found very obstinate and trouble- some to treat. The so-called " horns " are frequently the result of these tumors ; the process by which they are formed is thus described by Erichsen : " If left untouched, it occasionally, though rarely happens, that the sebaceous matter exuding through an aperture on its surface, forms a kind of scab or crust, which, by a process of sub-deposition, becomes conical ; and being gradually pushed up from below at the same time that it assumes by exposure a dark-brown color, forms an excrescence that looks like a horn, and is usually considered to be of that character." This is no doubt true of horns formed by these tumors, though the same formation has been met with in other diseases, and seems then to be due to some other process. 2. Cysts. — These are sacs without any outlet, that may be ap- parently new formations, or normal ones abnormally distended. It may then be caused by the accumulation of fluids in such cavi- ties that are unprovided with an opening; the bursas are frequently enlarged from this cause. The structure and density of the walls of these cysts varies greatly ; they may be as thin as the arach- noid, or dense and fibrous. This form of tumor is most common in those parts where bursse naturally exist. When they are of a new formation, the sheaths of the tendons, and the celk ular tissue are their chosen seat. They vary in size from that of a mustard-seed to one weighing many pounds, as in the case of Tumors. 385 "ovarian cysts." The contents may be fluid, semi-fluid, or jelly- like, and even solid; the same variety exists in regard to color — from a limpid, colorless fluid, to brown, or even black. We recog- nize two forms of cysts, the " simple " and the "multilocular." The simple, or, as they are sometimes called, " serous cysts," are found in almost any part of the body ; they are composed of a thin wall, and filled with fluid. Multilocular cysts are those composed of a number of simple cysts, joined together in one of two ways : one form is a number of simple ones pressed together, the other is one large cyst, with a number of smaller ones growing directly from it. The ovaries are more constantly the seat of these formations than any other part of the body. The contents vary greatly, as said when speaking of cysts in general. It is in the simple form only that we find colorless fluid ; in the other, the contents may be — anything. "Compound" and " proliferous " are terms applied synonymously to the multilocular cysts. Old authors speak of the "binocula," but modern writers include them all in one term. 3. Hcematoma. — This is a cyst, differing, however, from those mentioned above, in containing fluid blood. Sometimes a vein becomes occluded, and from the consequent distension of its walls, a haematoma is formed. Transfusion of blood into an already existing cyst is frequently met with. Transformation from a nevus is also often the cause. These cysts are often, from their peculiar appearance, mistaken for cancer of the encephaloid variety ; it requires some care, then, to make a correct diagnosis. These three tumors should not be called separate diseases ; the only difference that I am able to discover is in the contents. They should be considered as different forms of the same disease. 4. Warts — Condylomata. These two terms apply to the same diseases in reference to their locality ; when the skin is the seat, they are termed warts ; when situated on the mucous surfaces, the latter term is employed. Speaking of warts, Erichsen says, "these essentially consist of an increased deposit of laminated cuticle, usually with some augmented vascularity of the cutis." Warts are hard, horny, and usually conical projections, rarely sen- sitive, and occurring on any part of the body, and in almost any number at one time. Occasionally they appear as large flat clus- ters, and are rather painful ; sometimes again they are soft, but usually they present the characteristics noted above. The hands 386 Tumors, are oftener affected than any other part. Condylomata, as said before, are found on the mucous surfaces, are soft, flatter and usu- ally of a whitish color, are occasionally sensitive, and likewise occur in great numbers. These tumors are very vascular, and bleed readily on the slightest touch. They are sometimes spoken of as "mucous tubercle." Dunglison says that "condylomata arises from the application of syphilitic virus." Erichsen appears to think differently. The general impression at this day is, that syphilis is not the only cause for their appearance ; they occur in many cases spontaneously, and then again from a multitude of other diseases. There is a variety, however, which is known as venereal condylomata. Cheloidis a growth closely allied to warts ; Erichsen says, "it is a peculiar pinkish-white fibro- vascular tissue, which is commonly met with in old cicatrices as an outgrowth of these, and not unfre- quently recurs after removal." 5. Sarcomatous tumors. These growths are nothing more than a hypertrophy of " fibro-cellular element," and are moderately rapid in their growth. Abernethv had made these tumors a study, and has given us a long list of varieties, which would take up too much space to mention. Actually, they are fleshy tumors ; on examina- tion they look like muscle or skin, depending upon their situation. They have attained an enormous size ; one case is reported in which a mass of this kind was removed that weighed one hundred pounds. They are painless, smooth, a little doughy in feeling, non- elastic, movable, and sometimes pendulous or pedunculated. Pendulous sarcomas is the character of the tumor usually known as a " wen. " In the earlier stages of their formation; when quite small, pressure will frequently cause their disappearance, but this is not practicable when they have attained any size. In Novem- ber, 1865, I removed a tumor from a lady's thigh, that was so different from anything I had ever seen, that it was hard to tell what it was. It is in my " case-book" for that year as a " medul- lary sarcoma," (Abernethy's classification.) It was a pyriform shaped body, as large as a good-sized fist, and of a dark-blue color; very vascular, and warmer than the surrounding skin. It hung by a pedicle as large as the little finger in diameter, and about two inches long. After removal, the section showed it to be composed of a number of fat globules, enclosed in a fibrous net- work, which in turn was enclosed in a thin membrane. These were surrounded Tumors. 387 by the skin, but had no attachment to it whatever ; merely laying loosely in it. It was nourished by a large artery nearly as large as the digital branches, and accompanied by a vein. There was no return of the disease, 6. Polypi. This form of tumor is a pendulous and pedunculated mass springing from the mucous membrane ; it may be found on any mucous surface, but is most common in the nasal fossae and the uterus. Dunglison says that they may be innocent or malig- nant in their character, the latter degenerating into true cancer, and readily distinguished from the benign by their being quite painful, readily bleeding, etc. The innocent or benign class is divided by authors into a great number of varieties, the names of which indicate the characteristics quite easily. This sub-division is of but little importance to us, or even to the allopaths ; Erich- sen himself only noticing two of them. In speaking of polypus, he says, " the true mucous or gelatinous polypus is composed of the elements of this membrane expanded and spread out, and consists of a loose fibrous stroma covered by epithelium more or less dis- tinctly ciliated, the cilia being often beautifully seen, when recent specimens are examined under the microscope. The so-called fibrous or medullary polypus consists of other forms of tumor grow- ing from and covered by mucous membrane." From this it would appear that polypi are not a class of tumor made up of several varieties, but a distinct form of tumor found on the mucous sur- faces. All polypi grow rapidly, the mucous or true variety espec- ially so. This is spongy, soft, bleeding readily when touched, and causing extensive mischief by its pressure, to the bones and other neighboring parts. The true polypus then, without being cancer, is a malignant tumor, as it recurs after removal: although not contam- inating neighboring parts with any specific poison, it still injures them if in no other way, by pressure. They are generally described as being a " brown or reddish-purple " mass, but they may also be black or gray. The black variety is not common ; I have seen but one or two cases, and considered the color to be dependent upon some change that might be going on, and not its proper color. Occasionally they have been seen as a bluish tumor. Although of but little importance, the classification of Dunglison may not be unappropiate. He calls them hard, soft, spongy, vascular, granular, mucous, fibrous, fleshy, carcinomatous or schirrous, etc. 7. Glandular Tumors. — These tumors are nothing more nor less 388 Tmnors. than a chronic enlargement and induration of the glands, in whole or in part. For this reason the consideration of them ought to be referred to the chapter on scrofula, as they are more of a hyper- trophy than a tumor. They are produced by inflammation usually, though it has been said that they have been unaccompanied or preceeded by this condition. It seems, however, to be an impos- sibility. 8. Fatty Tumors. — These are the most common of all the forms of tumors, and constitute a very important class of these diseases. They may be found in nearly any part of the body, at almost any age, and of all sizes. The cause (remote) is usually obscure; a blow, the pressure of some article of clothing, as the suspenders, or any long-continued pressure will be usually found the exciting cause. A case I operated on three years ago had one on the shoulder that was congenital, and probably hereditary, as her mother had one of the same character. These tumors have been divided into two great classes : the " circumscribed," or true fatty tumors (lipoma), and the " adipose," or diffused. This last form is not a disease, nor is it a tumor, properly so-called. It is quite amenable to homoeopathic treatment. It is nothing more than masses of fat in situations already sufficiently well supplied and distinguished from the normal quantity only by knotty protuber- ances not well defined in outline. The true or " circumscribed " form has been divided into two varieties, the " lipoma? and " cholesteatoma. " The former is the most common form of this tumor, and is made up of yellow, oily fat, and cellular tissue more or less firm, invested in a thin cap- sule, not adherent, but lying loosely and unattached. In form they are more or less lobulated, and not unusually send out irreg- ular prolongations in different directions. Sometimes these lipoma slip down into other situations from that they originally occupied. Although these tumors are usually found to be unattached to the capsule or surrounding parts, it sometimes is found otherwise. A lady came under my care four years ago, with a lipoma on the cap of her right shoulder. She had been under the care of a " cancer doctor," and it being pronounced cancer, was " duly and legally cauterized " and poulticed. On removing the mass, the base and a portion of the edge was found to be tightly adherent to the skin and muscles, requiring considerable dissection to free it. This, perhaps, was to be credited to the " active treatment " she had undergone. Tumors. 389 The cholesteatoma is " a smooth, laminated, white and dry fatty- mass, contained in a cyst, and apparently composed of crystalline fat enclosed in meshes of cellular tissue." 9. Fibro-Cellular Tumor. — These tumors are found in the case of persons who in other respects are perfectly healthy. They form rapidly, and grow to enormous sizes. The scalp, scrotum, labia and thighs are the usual seat of the affection. They are painless, soft, elastic, round and smooth, of a yellow color, con- taining a large amount of serous fluid, which can be squeezed out in large quantities, and are invested in a thin capsule. 10. Fibrous Tumors. — With these tumors I have had no expe- rience, having never seen but one case, and that occurring in the practice of a friend, it will be more satisfactory if I quote at length from Erichsen, he giving the best description I can find in the smallest space: "They are met with in various situations, as in the testes and mamma, uterus and antrum, about joints, in the perios- teum, in the subcutaneous cellular tissue, and in connection with nerves. The situations in which they are most frequent, and where their structure is most typical, are in the neck, especially in the parotid region, in the uterus, and in the antrum. In shape these tumors are irregularly rounded or oval ; they are smooth, painless and movable ; they grow slowly, but may attain an enor- mous size, equal to that of a cocaonut or watermelon. * * * They have been found, however, weighing as much as seventy pounds. They are almost invariably single, and when cut into present a white, glistening, ligamentous structure, being composed of neucleated fibres like those of ligamentous tissue. These tumors may remain stationary for years, and this is the condition in which they are oftenest presented to the surgeon. Eventually, however, they are apt to undergo disintegration, becoming infil- trated, oedematous and softening in the center, or at various points of the circumference; they then break down into a semi-fluid mass, the integuments covering them inflame, slough, and an unhealthy suppuration, mixed with the disorganized portions of the tumor, is poured out, leaving a large and unhealthy slough chasm from which fungus sprouts may shoot up ; readily bleeding on the slightest touch, and giving the parts a malignant appear- ance ; the patient eventually falling into a cachectic condition, and becoming exhausted from the haemorrhage and discharges. In other cases again, these tumors may degenerate into a spongy, 390 Tumors, calcareous mass of a brownish color, and hard consistence, but they never undergo proper ossification. More rarely the interior of these growths softens and undergoes absorption, so as occasion- ally to form cysts of large size, containing fluids of various shades of color." Semi-Malignant Tumors. Semi-Malignant Tumors are those which, while they are innocent in appearance, are malignant in their course. That is, they are apt to return after removal in the same place or in some other, and may contaminate or implicate adjacent structures. This is the usual classification, but I speak of semi-malignant tumors as those which do recur, and are malignant in everything save the presence of cancer cells. Cancers are malignant tumors, and are nothing else in my opinion. The varieties included in this class are : the malignant fibrous, recurring fibroid, the fibro- plastic, and enchondromatous. i. Fibro-Plastic Tumors. — Sometimes termed "myeloid," and is the " albuminous sarcoma " of Abernethy. These are com- monly without pain, elastic in feeling, smooth, occurring in young people, and are not apt to return after removal. On examination of a recent specimen, it will be found that on section they are trans- lucent, shining, of a greenish-gray, blue or pink color, and in most cases spotted by marks varying in color from a blood-red to a brownish, or sometimes of a livid hue. When these spots are in great numbers the appearance is one that would justify the term of sarcoma (or fleshy) applied to them by Abernethy. 2. Recurring Fibroid Tumor. — In appearance, these tumors closely resemble the non-malignant fibroid ; they are, however, painful, and very often return after removal. If a microscopical examination be made, there will be seen to be a great difference from the non-malignant tumor. Every succeeding recurrence of the tumor will be found to be more aggravated in malignity than the preceding. Paget says the examination of a tumor of this kind which resulted in the death of the patient, presented " very narrow, elongated, caudate, and oat -shaped neucleated cells, many of which had sub-divided terminal processes. " They usually appear on the extremities, and may attain such an immense size, that amputation will be found necessary. Malignant Tumors, 391 3. Enchondroma. — These tumors are often called " cartilagin- ous " tumors, and indeed are more commonly known by that name ; they may be either non or semi-malignant in their char- acter. When benign, they are small, hard, smooth, elastic, ovoid, round or flattened in shape, seldom attaining dimensions larger than an ordinary orange, and growing slowly and painlessly. The semi-malignant are widely different from the preceding, and do not as frequently occur. They may terminate in ossification, or break down into a soft fistulous tumor, discharging jelly-like matter, and assuming a sloughing character ; the integument covering it becoming inflamed, discolored and breaking down into fluctuating masses, which may be easily mistaken for cysts, and have fre- quently been opened under this impression. They may occur with or without connection with the bones, but most often the latter. The bones of the carpus and metacarpus, and sometimes the corresponding bones of the feet, are the most often affected ; when situated in these places, they spring from the interior of the bones ; when found in connection with, or growing from the short bones, they are seldom seen larger than a pigeon's egg, but if found on the larger long bones, as the femur, they may attain an enormous size. When cut into, they bear a strong resemblance to foetal cartilage, and this appearance gave them their name. The non-malignant variety are not apt to undergo this disintegration, usually becoming indurated, and eventually becoming ossified. Malignant Tumor. Cancer is one of the most terrible of all diseases ; under old- school management it is utterly incurable, neither their remedies nor the use of the knife are in the least successful. Homoeopathy has cured — and probably will again — many cases of all kinds of cancer, and though not certain in its results, it has done, and can do more than the other systems or so-called schools can do alto- gether. One reason, perhaps, why the treatment of cancer by medicine has not been oftener attempted by us, is the want of suf- ficient instruction, or rather literature, on the subject. It is true that enough has been written and published by different men on the subject, but it is scattered through our journals, and in its present shape is of little use to the profession at large. To collect the best of this material has been my task; and I would then 392 Tumors. acknowledge my indebtedness to these writers for the material used in writing this section. Nothing remains to be done when your remedies fail; the knife can never eradicate the disease except in some form of encephaloid cancer. You only subject the patient to additional and unnecessary pain, and instead of giving him a " last chance" for his life, oftener take from him any chance at all ; the disease is almost certain to re-appear, and each time with more virulence than the preceding. Before going on to speak of the varieties of cancers, let us for a moment only con- sider the question of operation in such cases. It is the first duty of the surgeon to prevent the necessity for instrumental interfer- ence arising ; and if this is attempted to be done by medicine, and it fails, it is then too late to operate. On the other hand, if an operation be resorted to in the very beginning, extirpation of the tumor may be followed by a cure of the disease. For two reasons this operation is apt to be neglected: ist, difficulty of diagnosis at such a stage, and 2nd, the fact that patients rarely apply until the disease has made some progress. But if a removal of the tumor is determined upon, never by any means use plasters or caustics ; they are the weapons of the empiric and quack, and are, I may say, never successful. Sometime since I had a controversy with a physician who claimed to have cured a number of cases by these means, and in proof of his success cited two cases ; one of these he admitted had suffered from a return of the tumor, and the second came into my hands, and ultimately died from second- ary cancer, by glandular infiltration. When you operate, use the knife j cut wide of the apparent boundaries of the disease. The doctrine that denies the possibility of local disease, is strongly upheld in these cases ; the most careless student can readily see that the tumor is but the local manifestation or symptom of a gen- erally diseased body. But to proceed. Malignant tumors (or cancer ), are those which contaminate neighboring structures, return after removal, are accompanied by pain, and destroy life. Cancers have been divided into five vari- eties ; scirrhus, encephaloid, melanosis, colloid and the epithelial. It is a point to be borne in mind, that one or more of these forms of cancers may exist, not only in the same person at one time, but in one tumor. Thus scirrhus and encephaloid have been found in one carcinomatous breast. Let me say a word here on the nomenclature of these diseases. Homoeopathic writers very often Malignant Tumors, 393 confound the words scirrhous and carcinomatous, either through carelessness or ignorance. We speak of cancers in general as car- cinomatous tumors, whether they be of one variety or the other. Laurie and many others, speak of scirrhus as being the tumor, and only employ the distinctive name to designate the ulcer. Now scirrhus is a distinct form of cancer. 1. Scirrhus. Gross, in 1845, gave the following description of this tumor, and on examination, I have been unable to find one that is any better at this day : — " It is a hard, crisp, opaque sub- stance, of a light grayish color, with dull, yellowish, fibrous intersections, organized, liable to lancinating pain, occurring for the most part after the middle period of life, and passing sooner or later into ulceration." In short, it is a hard brawny-feeling tumor, calculated not only to destroy the tissues around it, but even the life of the individual. Erichsen's description is as follows : " A hard, craggy, incompressible and nodulated tumor, at first mova- ble and unconnected with the skin, but soon acquiring deep-seated attachments, and implicating the integument. It grows slowly, seldom attaining a larger size than an orange." It has a course to run, presenting two conditions, called the "occult" and "open." The ulcer resulting from scirrhus is a foul, fetid, destructive sore, progressing rapidly, accompanied by great increase of pain. Death results from a secondary deposit, either in the glands, when it is a reproduction of the scirrhus, or insome of the viscera, when it is of the encephaloid kind. Fleshy or young people, and women, die much sooner from it than the old, or lean persons. Scirrhus may occur singly, or in several parts of the body at the same time ; both conditions are common. An examination of a recent speci- men, will disclose the following peculiarities : It creaks under the knife ; on taking off a thin slice, it is found to be laminated, flexi- ble and elastic, and if dried, resembles horn. The extreme hardness of these tumors is not so perceptible when handled after removal, as they were when in situ; this is accounted by Walshe in " the escape of the fluids, and consequent loss of turgescence" Fibrous looking lines are seen to run all through these masses, starting from the center, and by Gross are said to be "the remains of the cellular substance of the affected part;" and this is probably correct. A creamy fluid is also observed on making a section, which is one of the most distinctive marks of its carcinomatous origin. When softened, the tumor resembles a yel- 394 Tumors, lowish-brown, semi-transparent jelly. I have had but one case in which a scirrhus returned after removal, that any notes were made of, and from them I find on comparing them with others, that the method of reproduction is about as follows : When the glands are the seat of secondary deposit, the tumor is reproduced. But if the disease returns in the cicatrix, it is in the ulcerated form. A scar which has all along looked healthy, takes on a purplish appearance, and soon becomes swollen or raised above the surrounding skin. Later elevations, from the size of a pea to that of a walnut, appear in the substance of the scar, and along its edges ; these are of a light pinkish color, and are covered by a very thin, transparent skin, through which small vessels are seen branching out in every direc- tion. Shortly these elevations — which are cone-shaped — become flat on top, turn a greenish gray color, and become depressed ; a slough is thrown off, a deep ulcer of a fetid odor is formed, which, spreading rapidly, merges into the next one until all these small ulcers are joined in one large one ; or with several large ones, divided by narrow strips of skin. The pus is usually scanty, and thick; sometimes, however, thin and profuse. As these smaller ulcerations increase in diameter, they likewise increase in depth. 2. Encephaloid, or Fungous Hozmatodes. — This is the most com- mon form of secondary cancer, and is likewise the most malignant, disgusting, and rapid in its growth. It has been met with in nearly every part of the body, but is most commonly found in the eye, ends of bones, testicles, and mamma. It commences as a tumor, which is usually soft and semi-fluctuating from the begin- ning, or, at all events, soon becomes so ; it is soft, elastic, lobu- lated, grows rapidly, and the skin enclosing it is covered with swollen, tortuous, blue veins. At first the skin is loosely attached, or quite non-adherent, but it shortly becomes adherent, and com- mences to change color; it becomes livid, inflames, assumes a dark color, and finally gives way. From out of this fissure spring fungous growths, attaining an enormous size, and bleeding pro- fusely. This may be considered the last stage of the disease, for death rapidly ensues. After these granulations spring up, the whole course of the cancer is more rapid, the secondary effects or deposits more marked, and the exhaustion consequent upon the hemorrhage, together with the speedily-developed cachexia, soon wears out the patient. As the deposits of scirrhus are apt to be encephaloid under certain conditions, so the deposits of encepha- Malignant Tumors. 395 loid are often scirrhous. Erichsen says : " After removal, the tumor is found to be very vascular, displaying, on injection, a close network of vessels. On a section being made, it commonly pre- sents a soft, pulpy, white mass, closely resembling cerebral sub- stance. In other cases, again, its section has been compared to that of a boiled potato, or a piece of boiled udder. On a closer examination, its tissue will be found to consist of a stroma of deli- cate fibres, supporting the soft medullary, or brain-like structure ; this may be seen to be composed, in a great measure, of large quantities of corpuscles — nucleated, compound, and granular, fusi- form, angular, clubbed, or caudate, often with two terminations. This form of cancer is met with at any age, and in both sexes, neither is it peculiar to the human species, but is found in animals occasionally, as the horse, dog, and cow. It may exist alone, or be found with tubercle, scirrhus, melanosis, hydatids, and many other morbid growths. The encephaloid matter is deposited in the viscera, either primarily or secondarily, in three distinct forms — viz., the tuberoid, stratiform, and infiltrated. These, for general purposes, are sufficiently well described by the mere mention of the name ; at all events, want of space forbids entering too deeply into a description. Gross says : " It is very common to observe the successive, or simultaneous development of this disease in a number of organs or parts ; in fact, there is occasionally a marked encephaloid diathesis." There are some peculiarities about the appearance of this disease in the eye, that demands attention. Walton (" Ophthalmic Surgery ") says of it : " The earliest symp- tom that generally attracts attention is a shining, yellowish, and deep-seated reflection from the bottom of the eye, as if it contained a piece of metal ; this is best seen in particular lights, and some- what resembles the peculiar appearance of a cat's eye when seen in the dark. * * * As the disease advances, the cause of the metallic reflection becomes evident. It is now seen to be owing to a tumor, springing up apparently from the fundus of the eye, of an irregularly rounded form, generally divided superficially into two or three lobes, and traversed by one or two small blood- vessels, which ramify on its surface ; in color it varies from a deep orange hue to nearly white, the most usual being, perhaps, a bright canary yellow. This growth gradually increases in size, approaches the front of the eye, causing absorption of the vitreous humor, and presses upon the lens, which becomes opaque, and in 396 Tumors. most instances is ultimately absorbed. * * * Towards the conclusion of this stage the eye is undergoing considerable tension from the internal pressure ; it feels hard, its motions are limited. * * * The cornea expands and becomes opaque, the sclerotica, thinned by absorption, allows the dark-colored choroid to shine through it, and is irregular in outline, rising into small, dark- colored knobs where the pressure has been most severe, or the absorption most rapid. In many instances it is so densely covered with large varicose vessels, that no alteration in color is percepti- ble. The eyelids now become oedematous, and the eyeball promi- nent, and, apparently, greatly enlarged in size. * * * This stage terminates in the escape of the fungus from the interior of the eye, and this may take place either through the cornea or the sclerotica. * * * The tumor, now released from pressure, rapidly increases in bulk, so as in a short time to distend the orbit and eyelids, and efface all appearance of the eye." Instances are recorded in which this tumor has attained a size equal to that of the head ; half as large as the head on which it is situated is a common size. 3. Melanosis. — This form of cancer is closely allied to the en- cephaloid — that is, the minute structure is similar to encephaloid, but there is an abundance of pigmentary material, and the fungus masses are black, or nearly so. It is rarely seen as a tumor, but as a deposit in internal parts ; the eye, skin, sub-cutaneous cellular tissue, and sometimes, though rarely, the bones, are the places in which it is oftenest found. Gross says of it, quoting in part from Ljennec : " It is a homogeneous substance, very similar in its structure and consistence to a bronchial gland, of a deep black color, opaque, humid, and slightly unctuous to the touch. This substance; after a while, has a tendency to become soft ; the pro- cess by which this is affected commencing generally in the center, and gradually proceeding towards the circumference, until it is entirely broken up and dissolved. When this is accomplished, nature sets up an eliminating effort, the surrounding parts take on inflammation, and the heterologous matter is finally expelled, thus leaving a corresponding cavity, which either continues open, is lined with lymph, or else completely obliterated." It appears from this that this form of cancer is the most innocent, and is even rarely attended by a fatal result. He goes on to say : " No age nor sex seems to be exempt from this disease, though it is, without Malignant Tumors. 397 doubt, much more frequent in the old than in the young. Nor is it confined exclusively to the human subject. * * * What is remarkable, this substance is much more common in white than in colored horses; and the same is true, I have reason to believe, in regard to cattle. * * * The color of melanosis, as might be expected, is considerably influenced by accidental circumstances, as the quantity of cruor and cellular tissue entering into its com- position. It may be said always to incline to black ; but not un- frequently it presents various shades of brown and yellow. * * * In its consistence, melanosis varies from the fluidity of ink to the density of fibro- cartilage." Erichsen, quoting from Sir Robert Carswell, says : " He arranged under the heads ot punctiform melanosis, in which the dark pigmentary matter occurs in the shape of minute points or dots scattered over a considerable extent of surface. The tuberiform, occurring in tumors which vary in bulk from the size of a millet-seed to an egg or an orange, always assuming a globular, ovoid, or lobulated shape, and being principally met with in the cellulo-adipose tissue, or on the surface of serous membranes. The stratiform and liquiform melanosis, which takes place principally upon serous membranes, or in acci- dental cavities, when the black pigmentary matter looks not unlike Indian ink." 4. Colloid. — This is also called gelatinous, or alveolar cancer. These tumors are rarely seen as a distinct tumor, chiefly occurring in connection with scirrhus, or in some internal organ, hence it is rarely seen except on post-mortem examination. These tumors are made up of cells, the walls of which are of a fibrous character, and are filled with a clear, semi-transparent, yellowish, jelly-like substance, resembling honey. The jelly-like contained matter is very soft, but the whole colloid mass is firm and resisting ; it does not attain a very large size, but grows rapidly ; it is seldom seen in children. These tumors are sometimes developed in the bones, and also in the ovaries. The most common seat for them, how- ever, is the stomach, and, indeed, all through the alimentary canal. 5. Epithelial. — This is called by many eminent men a malignant growth, but to me it has always appeared to partake of the semi- malignant form ; or, rather, from the fact that they very rarely are accompanied by secondary deposits, and may be removed without much fear of a recurrence, I consider them to be not true cancer. 398 Tumors. However, as many of our best surgeons consider them malignant, it does not become me to differ from them. Like cancer, it has a tendency to ulceration, glandular complications, and may induce a cachexia ; but, on the other hand, it is comparatively painless, may be removed with safety, and does not cause secondary visceral deposits. It is frequently met with on the mucous surfaces, outlets of the body, and sometimes, though rarely, on the skin. They are usually pedunculated, and on section show epithelial scales, packed together in a globular, or a compact form. These cancers occasionally, indeed frequently, rapidly ulcerate, leaving a small, foul ulcer, which seems for a time to be as nearly as possible local. Treatment. — Tumors of either of the three classes are very amenable to treatment in the great majority of cases. It was some time before I could believe that treatment by remedies could ever be successful; that is, Xht power of our remedies to do this I did not doubt, but could not see how we could find symptoms enough to guide us in selecting that remedy. Now this has been made clear to me. You must leave the tumor as much as possible out of sight ; the symptoms of the tumor itself are few, and not worth much — the patient's ordinary habits, and the departure from the natural performance of all his bodily functions, the dis- position, and appearance, must all be taken into consideration. Use no external applications of any kind. And I have found the high attenuations the best ; in fact, from the poor success I have had with the lower in these cases, I have no hesitation in saying the low (d, 3d and 6th) cannot cure a tumor. As it is difficult to find many distinguishing local symptoms, I will give a rather larger " index " than usual : Non-Malignant Tumors: Cystic— Apis., Lach., Calc, Graphs Hep., Sil. Hcematoma. — Am., Ars., Rhus. Warts. — Thuja, Caust., Con., Lye, Merc, Natr. mur., Sulph. Condylomata. — Thuja; Cinnabaris ? Sarcoma. — Phos., Phos. ac., Calc, Sulph. Polypi. — Calc. c, Calc. phos., Am., Pry., Dulc, Graph., Led., Lye, Sulph. Glandular. — Pell, Lye, Merc, Nit. ac, Phos., Rhus, Sulph., Ars., Paryta, Pry., Calc, Cham., Con., Dulc, Graph., Hep., Kali c, Nat. c, Puis., Sil., Thuja, Special Therapeutics. 399 Non-Malignant Tumors: Lipoma.— Calc. carb., Calc. phos. Cholesteatoma.— Baryta c, Calc. carb., Calc. phos., Lye. Fibro-cellular — Ac. acet., Ac. nit., Bell., Dulc, Merc, Sil. Fibrous. — Phos., Phos. ac. Semi-Malignant Tumors: Fibro-Plastic. — Ars., Bry., Loch., Merc, Sulph. Recurring-Fibroid. — Ars., Lach., Calc, Dulc, Sil. Enchondroma. — Sil., Baryta, Calc, Graph., Hep., Led., Sep., Sulph. Malignant Tumors : Scirrhus. — Bell., Con., Sep., Sil., Carbo an., Carbo v., Nux vom., Staph., Sulph. Encephaloid. — Acetic acid, Am., Ars., Artem., Carbo an., Caust., Chelid., Chin., Kreos., Nux v., Puis., Rhus, Sep., Squilla, Tart, em., Zinc. Melanosis. — Acet. acid, Arg. nit., Ars., Chelid., Jod., Kreos., Lach., Merc, Nit. ac, Petrol., Sil., Squilla. Epithelial. — Acet. acid, Arg. nit., Aur., Chelid., Puis., Sulph., Thuja. Carcinomatous Ulcers. — Apis, Ars., Hep., Sil., Sulph., Lach., Merc, Sep. Tumors on the Head. — Ars., Calc, Merc, Rhus, Sil., Staph, j Chel., Graph., Hep., Petrol., Phos., Sep. Eyes. — Bell., Calc, Hep., Sulph. j Am., Ars., Bry., Caust., Cham., Con., Kali, Lye, Merc, Nux v., Phos., Puis., Rhus f Sep., Sil., Staph., Thuja. Nose. — Aur., Caust., Kali c, Merc, Nat. c, Phos. ac, Puis., Rhus, Calc. c, Nat. m., Thuja. Face. — Bell., Nux v., Ars., Aur., Carbo an., Caust., Chin., Con., Hep., Kreos., Merc, Nil. ac, Puis., Rhus, Sep., Sil., Staph., Sulph. Mouth. — Bell., Merc, Nux v., Phos.j Calc carb., Carbo v., Cham., Chin., Lach., Nit. ac. Puis., Sep., Sulph., Zinc. Neck. — Calc. carb., Calc. phos., Caust., Merc, Nit. ac, Sulph. Arms. — Am., Bell., Caust., Puis., Rhus, Sep., Sil., Sulph. Chest. — Apis, Am., Bell., Carbo an., Lach., Nit. ac, Nux v., Puis., Rhus, Sil., Sulph.- Back. — Sil., Am., Ars., Carbo an., Caust., Chin., Con., Hep., Nux v., Puis., Rhus, Sulph., Tart em. 400 Tumors. Malignant Tumors : Stomach and Viscera. — Ars., Artem., Hep. Sulph., Tart. em. (See Colloid, Scirrhus, and Enceph- aloid.) Legs. — Ars., Bell., Hep. s., Lack., Nit. ac, Nux v., Puis., Rhus, Sep., St'/., Sulph., Zinc ? Male Genitals. — Arn., Mere., Nit. ac., Nux v., Puis., Sulph., Thuja j Ars., Graph., Kali c, Lye., Phos. ac., Rhus, Sep., Staph. Tumors on Female Genitals. — Kreos., Nux v., Puis., Sep., Sulph., Thuja j Am., Bell., Calc, Carbo an., Carbo v., Cham., Chin., Con., Graph., Kali, Lye, Merc, Nit. ac., Rhus, Staph. from a Blow. — Arn., Con., Staph. Acetic acid. Face pale and waxen; eyes surrounded by a dark circle ; cramps and colic in the stomach and abdomen ; ema- ciation. Is recommended by J. C. Peters, the apostate, for the treatment of warts. It is also the only agent known that will dis- solve cancer cells. Argentum nit. Discolorations of the skin, from a blue-gray to violet, or bronze-colored tinges to the real black ; swelling of the mouth, with epithelial cancer. Worse in the forenoon, and in the afternoon. Left side. Apis mei. Cancerous ulcer ; small ulcers, deep and gray run- ning into one another ; burning-itching pain ; pus is light yellow and scanty ; erysipelatous inflammation of the surrounding skin ; dark purple color of old cancerous scars ; thirst increased, drink- ing often, but little at a time. Worse in the morning, evening and at night ; also from warmth. Better from cold water, and from pressure. (Left side, G.) Arnica mon. Cancer following a blow; dull tingling pain in an indurated part ; red, blue and yellow spots like ecchymosis ; vomiting of coagulated or dark-colored blood ; feeling of repletion in the stomach, accompanied by loathing ; pressure, as if a stone were lying in the stomach. Pus bloody. Worse in the morning, evening, and at night ; also when blow- ing the nose, from bodily exertion, when moving, on raising the part, and on turning the part. Better when letting the limb hang down, and from rubbing. Left side. Arsenicum alb. Foul, destructive, easily bleeding, cancerous ulcers ; black pustules ; burning and corrosive pain in the interior Special Therapeutics. 401 of the affected part, or of the tumor ; the pains are felt at night even when sleeping; black blisters, burning and very painful, changing to cancerous ulcers; (probably lupoid, G.) burning in the ulcer or in the margin, or with a lacerating pain when the parts become cold ; spreading ulcers, and suppurating crusts on the hairy scalp; cancer of the nose, with ulceration of the nostrils high up, and discharge of fetid and bitter-tasting ichor ; cancer of the face with bluish lips, or black color about the mouth ; spreading, carcinomatous ulcer on the lips ; tumor covered with a hot, and bluish-red skin, turning black and sloughing. Pus copious, watery, bloody, corroding and fetid. Worse in the evening and at night ; also from cold, from exer- tion of the body, and in winter. Better from warmth. Either side. Artemesia VUlg. This remedy has been recommended by Noack and Trincks for cancer of the stomach. I have had no experience with it, and can find no case cured with it that is unde- niably cancer. Aurum met. Cancer of the palate, and nasal bones; cancer of the nose, and cancerous ulcers. (Lupoid? G.) ; low-spirited. Pus greenish, ichorous and putrid. Worse in the morning, and at night ; also on getting cold, while reposing. Better from warmth, while walking, and from moving. Right side. Baryta carb. Swelling of the sub-maxillary glands, with indu- ration ; sensation of soreness of the stomach, while eating it feels as if the food had to force itself through some raw places ; sar- coma in the neck, with burning. Pus scanty. Worse in the night ; also when sitting, and when lying on the sore side. Better when walking in the open air. Left side. Belladonna. Scirrhous indurations; cancerous ulcers, burning when touched ; black crust of blood in the bottom of the ulcer. Pus scanty. Worse in the evening, and at night ; also from cold, on lifting the part, on moving, from poultices, from pressure, in the summer, on touching the part, and on walking. Better when letting the limb hang down, when standing, and from warmth. Right side. 26 402 Tumors. Bryonia alba. Swelling of the nose, with very sore pain when touched; nodosities, and indurations on the face; vomiting of solids and not of fluids ; burning in the stomach and pit of the stomach, especially when moving; sensitiveness of the pit of the stomach to touch and pressure ; the ulcers are putrid, and feel cold. Pus scanty, yellow, and fetid. Worse in the evening, and in the morning ; also from motion, and from heat. Better when lying on the sound side, on getting warm in bed, and when sitting. Right side. Calcarea Carb. Tumors and suppurating boils on the head ; polypus in the ear, nose, and uterus ; inflamed, swollen, and red nose ; pit of the stomach is swollen and painful to pressure ; poly- pus in the bladder. Pus copious, putrid and yellowish or whitish. Worse in the morning, evening, and the latter part of the night ; also in the cold air, and in wet weather. Better when the garments are loosened. Right side. Calcarea phos. Violent pains in the stomach, with great debility, headache and diarrhoea ; the pains are excited by intro- ducing the smallest particle of food into the stomach. Carbo animalis. Scirrhous cancer on the forehead; sudden and short aching from colloid cancer in the pit of the stomach, on taking a deep inspiration; clawing and griping in the stomach. Dry ulcers. Worse in the evening, and at night ; also, in the open, cold, or dry air. Better from warmth ? Either side. Carbo Veg. Pressure and tension around the ulcer; the place is hard and painful to the touch ; an ulcer which had been (appar- ently) cured, breaks open again, and instead of pus emits a bloody lymph : complexion becomes a gray-yellow ; paleness of the face, and a drawing pain in the jaws ; vomiting of blood ; cannot bear any tight clothing around the waist and abdomen. Pus bloody, corroding, or yellow. Worse in the morning, and in the forenoon ; also in the open air, on getting heated, from pressure, and in the spring and sum- mer. Better from loosening the clothes. Either side. Causticum. The patient cannot bear the pressure of the clothes on the stomach ; the lightest food, or even the smallest Special Therapeutics. 403 quantity, causes a violent lancinating pain in the stomach ; scir- rhus of the lips, with itching and soreness, which when ulcerated has a violent burning pain. Pus bloody, or greenish, and corrod- ing ; or thin and watery and yellow. Worse in the evening, and at night ; also after eating, from pres- sure on the sound side of the limb, or of the body, from rubbing, and in clear dry weather. Better when lying down, on loosening the garments, on getting warm in bed, and in damp wet weather. Right side. Chamomilla Vlllg. Swelling, with hardness and blueness of one cheek ; vomiting of the food ; oppression of the stomach, as if a stone were pressing downwards ; ulcers with darting and lancin- ating pain at night, and excessive sensitiveness to the touch. Pus corroding and scanty. Worse in the evening and at night ; also in the open air, from poultices, and from being touched. Better when turning the part. Left side. Chelidonium majUS. Old, spreading, putrid carcinomatous ulcers ; the pain in the stomach is of a gnawing or digging char- acter; nausea, with sensation of heat in the stomach; burning in the stomach. Pus scanty, corroding and putrid. Worse in the morning ; also in the open air, and when walking. Better from pressure. Either side. China Off. Boring, with painful sensitiveness in the ulcer; beating pain in the ulcer, only when moving the part; putrid- smelling ulcers, with burning and pressing; black and swollen lips ; oppression of the stomach after every meal, with spasmodic pains. Pus copious, ichorous, and fetid. Worse in the night ; also in the open air, on moving the part, and on being touched. Better from warmth, and in dry weather. Left side. Cinnabaris. Soreness in the stomach, with dizziness and light- ness of the head and tightness in the temples. Worse in the evening, and at night ; also after sleeping. Better in the open air. Conium mac. Bleeding of the ulcers, with a secretion of fetid ichor; a portion becomes gangrenous; concealed cancer of bone ; cancerous swelling and induration of glands ; (secondary deposit) ; cancer on the lips; spreading cancerous ulcer on the face; con- tractive spasmodic pains in the stomach ; cancers and cancerous ulcers after contusion. 404 Tumors, Worse in the morning, and at night ; also in the open air, during and after eating, from being uncovered, from pressure, from rub- bing, while standing, and on beginning to walk. Better when lying down, when moving the part, and from warmth. Right side. Dulcamara. Warts on the face, and on the hands. Worse in the evening ; also when at rest, cold air, and in damp weather. Better from moving about. Left side. Graphites. Smooth, large wens on the hairy scalp, the scalp being hot, and itching very much when walking in the open air j nausea and vomiting after each meal ; pulsation through the whole body whenever he moves. Pus scanty, and smelling like herring- brine. Worse at night ; also from cold. Better from pressure. Either side. Hepar sulphur. Corrosive pain in a cancerous ulcer, that bleeds at the slightest touch; yellow skin and complexion; erup- tions around the mouth, lips and chin, which become converted into cancerous ulcers, rapidly spreading; pressure and dull aching pain in the stomach, after moderate eating; cancerous ulcer of the mamma, with stinging-burning of the edges ; tumors on the head, sore to the touch; burning in the stomach. Pus copious or scanty, and of almost any character ; smelts like old cheese. Worse in the night ; also in the cold air, when lying on the painful side, from pressure, and from being touched. Better from warmth. Either side. Iodine. Complete prostration of strength, and general emacia- tion; secondary cancerous deposits; dirty, yellow color of the skin ; violent vomiting, renewed by eating ; spasmodic pains in the stomach, renewed by eating; pulsations in the pit of the stomach. Worse in the evening, and at night ; also when lying on the painful side, from pressure, from warmth, and when walking quickly. Better from cold, after eating. Right side. Kali carbonicum. Painful tumors on the scalp, like the begin- ning of blood-boils, more painful from pressure and motion, and less so from external heat, accompanied by itching as if in the bones of the head, with great dryness of the hair; nausea as if he would faint ; itching warts. Special Therapeutics. 405 Worse in the morning, evening, and at night ; also from cold, and when lying on the side. Better on getting warm. Either side. KreaSOtum. Tightness of the stomach, and of the pit of the stomach, the tight clothing is insupportable; painful, hard place in the left side of the stomach. Pus corroding, yellow and putrid. Worse in the morning ; also in the open air, on moving, and on eating cold food. Better from warmth. Left side. Lachesis. Melanosis, colloid, or encephaloid cancer; small ulcers are scattered about, with pain in old cicatrices; violent burning; gangrenous spots; cancer of the breast, with lancinating pain; the pit of the stomach is very painful to the touch ; inclina- tion to lie down, and aversion to move ; ulcers, with great sensi- tiveness to the touch; ichorous and offensive discharge, and burning when touched, especially around the lower extremities; around it are many smaller ulcers, or small pimples, on a purple skin; pain in old cicatrices. Worse in the evening, or at night ; also in the open air, from pressure, and after sleep. Better in dry weather. On the right side. Ledum pal. Burning as if from red-hot coals in the nose; pressure in the stomach after eating a small quantity; painful tumors on the joints ; hot, tensive and hard tumors, with tearing pains. Worse in the evening, and at night; also from heat, on motion, and on getting warm in bed. Better from cold. Either side. Lycopodium. Swelling of the upper lip, with a large ulcer on the vermillion border of the lower one; vomiting of food, bile, coagulated blood and matter; tension in the hypochondria as if from a hoop; great emaciation, and internal debility. Worse in the evening, and at night (?) ; also when lying down, from poultices, and from the pressure of the clothes. Better from cold. Right side. Mercurius. Cancerous ulcers, with a severe shooting and lan- cinating pain, not relieved by either hot or cold applications ; great aggravation of pain from, and sensitiveness to, draughts of air; spreading ulcers ; spongy, readily-bleeding and extremely painful ulcers; unequal elevations and depressions in the floor of the 406 Tumors, ulcer ; swelling of the whole, or only the tips of the nose, accom- panied by pain and inflammation, followed by cancer ; great pain in the stomach and pit of the stomach, after a meal and on pres- sure ; nausea after a meal. Pus thin, ichorous, and acrid. Worse in the evening, and at night ; also from motion, on being touched, from heat, and on getting warm in bed. Better from cold, from rubbing, and in dry weather. Either side. Natrum Carb. Red nose, with white pimples on it ; swelling of the upper lip ; sensitiveness of the pit of the stomach to the touch, and when talking; warts which are painful to the touch. Worse in the forenoon ; also from any exertion, before eating, and from talking. Better after eating, and from pressure. Right side. Nitric acid, Pain and swelling of the sub-maxillary gland, with induration, ultimately becoming scirrhous ; burning sensa- tion in the stomach ; tumors caused by an excessive use of mer- cury. Pus bloody and corroding. Worse in the evening, and at night ; also when awaking, and from touching the part. Better (pain in stomach) after eructation. Left side. NlIX Vomica. Ulcers, with pale-red, elevated edges ; a painful, though small, scirrhous tumor on the forehead ; vomiting of sour- smelling mucus, and dark- clotted blood; great inclination to lie down, or sit ; aversion to move about, and to the open air. Worse in the morning, and at night ; also from motion, and being touched. Better from strong pressure. Right side. Petroleum. Swelling of the nose, with discharge of pus, and pain at the root of it; sensation of fullness or swelling of the pit of the stomach, with soreness when touched ; pain in the pit of the stomach, with sensation as if something were tearing off. Worse in the morning, and in the evening ; also when walking in the open air. Better from warmth. Right side. Phosphorus. Swelling and redness of the nose ; polypus, nose bleeding readily ; painfulness of the stomach to the touch, and when walking. Worse in the evening, and at night ; also after eating anything warm, when lying on the back, or on the side. Special Therapeutics. 407 Better from rubbing, and after eating something cold. Right side Phosphoric acid. Discharge of bloody pus from the nose; swelling of the dorsum of the nose ; with red spots. Worse in the morning, and evening. Better from motion, and from pressure. On either side. Pulsatilla. Tumors on the scalp, suppurating and affecting the skull ; the nose feels sore internally and externally. Pus is copious and yellow. Worse in the evening, and at night ; also when beginning to move, when lying on the left or sound side, in a warm room, and from warmth. Better in the open air, when moving, walking slowly. Right side. RhllS tox. Discharge of green, offensive pus from the nose ; sensation as if something were torn off in the abdomen; tumors which become inflamed, and followed by erysipelas. Worse in the morning, and at night ; also during the winter, when at rest, on stepping heavily on the ground, when the weather changes, in wet weather, and from cold in general. Better from motion, and from warmth. Right side. Scilla maritima. Pressure in the stomach, as from a stone. Worse in the morning, also from motion. Left side. Sepia. Tumor on one side of the head above the temple, with itching, sensation of tearing and coldness in it, painful on its being touched ; nose is swollen and inflamed ; nausea and vomiting after eating ; aversion to the open air ; want of natural heat. Worse in the forenoon, and in the evening ; also from stretch- ing out the affected limb, when at rest, and after eating. Better from warm air, and from exercise. Either side. Silicea. Painful dryness of the nose ; scirrhus induration of the upper lip and face ; continuous nausea and vomiting ; vom- iting whenever he drinks ; sensitiveness of the pit of the stomach to pressure ; blood-boils and warts on the arms ; the lower limbs " go to sleep " easily. Pus thin ; putrid, acrid ichor. Worse in the night ; also in the open air, from cold, on getting wet, after eating, when lying on the painful side, from pressure, and when the weather changes. Better from warmth. Right side. Staphisagria. Scurfy, and burning painful lips, with pain in 408 Tumors. the sub-maxillary glands, with or without swelling ; cutting pain in the abdomen after eating and drinking. Worse in the morning, forenoon, in the afternoon, and at night ; also when moving, and from pressure. Better when lying down in bed, and after lying down. Right side. Sulphur. Swelling, inflammation ; and dryness of the nose ; the region of the stomach becomes very painful to the touch, even to the weight of the bed-clothes. Worse in the evening, and the night ; also on getting warm in bed, when walking quickly, from bodily exertion, when resting, when standing, from wet poultices, and on touching the part. Better during motion, on getting warm, and in dry weather. Left side. Tartar emet. Face pale and sunken ; continuous desire to vomit ; pulsation in the pit of the stomach. Worse in the evening ; also when sitting, and from warmth. Better in the open, or cold air. Left side. Thuja Occident. Warts on the nose; lips pale and swollen; swelling of the pit of the stomach ; emaciation and deadness of the affected limbs ; condylomata large and seedy, and frequently on a pedicle. Worse in the evening, and at night; also in cold and wet weather, and from the heat of the bed. Better in wet weather, if warm. Left side. Zincum met. Pressure at the root of the nose, as if it would be pressed into the head ; the nose feels sore internally ; pale face ; vomiting of blood, and burning in the stomach. Worse in the evening ; also after eating, and in the warm room. Better in the open air. Operations. The operations may be summed up in a few words : Of course all operations in surgery should be the last resort ; in no other class of diseases is this so important as in this. Innocent tumors may be perhaps always removed, semi-malignant ones rarely, and cancer, with the exception of epithelial, never. The conditions calling for a removal of a tumor are — ist, when the growth is of large size, and has been present for a long time ; 2nd, when Special Therapeutics. 409 the pressure is causing an absorption of neighboring parts ; 3rd, when important vessels, nerves, or canals are being compressed, such as the trachea, oesophagus, etc. ; 4th, when your remedies do no good, after a reasonable time has elapsed. The instruments absolutely necessary are a scalpel and dis- secting forceps ; but for fear of accidents, or unlooked-for adhe- sions, the following had better be added to the list : Tumor- and artery- forceps, metallic retractors, tenaculum and aneurism needle. All varieties of encysted tumors which are subcutaneous, and all others, whether encysted or not, except those that are in one of the large so-called cavities, are removed in the following manner : — If the tumor is large, make an elliptical incision (0) sufficient to take up the superabundant integument, and if possible, eneu- cleate the mass with the finger or the handle of the scalpel ; this is easily accomplished if the tumor is encysted, or non-adherent. Should the opposite of this be the case, the edge of the knife must be used very sparingly. When vessels are wounded, and the dissection is apt to be a prolonged one, it will be best to ligate them as soon as cut ; in general it may be left until the last. When the tumor is small, as there will be no loose skin, a simple crucial incision (+), or a longitudinal one, will be the best. Polypi may be excised, ligated, or twisted off. The two last are the best procedures. Other tumors need no special mention, excepting ovarian cysts, and these have been spoken of in the proper chapter. After removing the tumor, wash out the cavity thoroughly with Calendula and water (one-third of the drug), and see that all hemorrhage is arrested. Leave the wound open until this occurs, and then close it with stitches close together, bandage quite firmly, and give one or two doses of Rhus. On the second day give Staph. 6, in water, about three times a day, and if sup- puration threatens, use Calend. in place of it. Should pus form, give Hep. sul. 6. 4IO Effects of Heat and Cold. EFFECTS OF HEAT AND COLD. BURNS AND SCALDS The application of heat may produce either a burn or a scald. Of burns we recognize five distinct varieties — simple inflamma- tion ; blistering of the skin ; charring of the skin ; charring of skin, fascia, and soft parts ; and complete destruction of the whole limb or part. I?iflammation is of little moment, unless some of the mucous pas- sages are involved. Usually the use of Urtica urens, either topi- cally or internally, will relieve the pain instantly If the inflam- mation, however, should be intense, Aeon, or Bell, may be called for. In blistering of the skin the treatment is the same. Never open the blisters, nor use any oil or grease at any stage of the treat- ment. Indeed, this applies with equal force in the case of any of the varieties. In charring of the skin, we are sure to have a slough, and the sooner the better. Aid, then, this process by the use of poultices. When the slough is nearly ready to come away, tear it off, and dress the ulcer with Calendula. The pain, which at first is quite severe, can be very materially abated by the use of Urtica urens before applying the poultice, or even adding it to the poultices. After the separation of the slough, in addition to using Calend. topically, give the same remedy at least as high as the 6th, inter- nally. As deformity is liable to occur during the process of cica- trization, have the parts lightly bandaged, thoroughly excluded from the air, and dressed at very long intervals. Charring of the skin, fascia, and muscles usually calls for am- putation at once. There is no time for delay or consultation, if the main arteries are destroyed, as every moment adds to the patient's danger. Waiting for a " line of demarcation " is useless if the case is seen within, say, an hour after the accident. Make the incision, however, in healthy skin far removed from the limits of the accompanying inflammation. ' When the trunk is so injured, death will probably ensue ; it will almost certainly follow if opiates Effects of Heat and Cold. 41 1 or anaesthetics are used. The pain can be much relieved, perhaps entirely, by the use of the appropriate remedies — Aeon., Bell., Canth., or Urtica urens, according to circumstances. One prime condition for immediate amputation is, that as charr- ing does not permanently close the vessels, the process of slough- ing causes a sudden hemorrhage which will likely prove fatal. Should this not occur, but the arteries be destroyed and occluded, the limb is to be condemned from loss of nutrition. Of course, in complete destruction of a limb, there is nothing to be done but amputation, if possible. Scalds are to be treated in the same manner as burns, as they produce the same destruction, minus the charring. Treatment. — After all that has been said on this subject, it is evident to nearly every one that the first indication is the total exclusion of air. How this is to be done is a different matter. Cotton batting, complicated bandages, etc., are to be prohibited, from the heat they induce. The use of linseed oil, petroleum, etc., are equally bad, as greasy substances are not very favorable to rapid recovery. We need a light, dry, and air-tight dressing. Nothing fulfils this necessity as well as chalk, or flour, or white of eggs, mixed to a thin paste. After the first treatment to allay pain, apply this dressing, and never remove it until it becomes offensive, or the healing process is fairly established. In either event, remove a small portion only at a time, and re-apply it before removing more. Cold. The immediate effect of severe cold is commonly known as "frost-bite." The part so affected is usually actually frozen, and may, if severe, be followed by gangrene. Under the best of cir- cumstances unpleasant sequelae remain, such as itching from heat {Fragaria vesca, Puis.), bunions {Ant. c, Apis, Ars., Calc, Graph., Lye), or chronic inflammations {Agaric, Apis, Ars., Canth., Caps., Graph., Lye, Merc, Nat. m., Rhus, Sulph.). The immediate effect may be successfully removed by brisk friction with snow, or immersion in ice-cold water, with a prefer- ence for the former. Avoid warmth, or taking the patient into a warm room ; have him carried into a shed or stable, or, if that is impracticable, treat him in the open air. When life returns into the frozen member, there may be a great deal of burning pain, which may be readily controlled with Arsen. or Car bo veg. Should 412 Effects of Heat and Cold, mortification occur, and amputation seem necessary, do not wait for a line to form. Recent experience has taught me this : If the gangrene is general — i.e., involves the whole part, as a foot or hand — it must be amputated. If allowed to detach itself, you will have a tender, sensitive stump, almost beyond the reach ot cure. If only partial, never amputate, treat with Ars. or Lack., and the slough will soon be cast off, and granulations restore the part — partially, at least. As regards the numerous sequelae spoken of, one of the follow- ing remedies will usually much relieve, if not affect a thorough cure : — AgaricUS m. Pains are diminished and removed by move- ments ; pains come on, or are worse, when sitting ; burning, itch- ing, and redness of the fingers ; small white pimples are brought out by scratching a burning-itching place, and are followed by scaling off of the skin ; itching, burning, and redness of the toes, followed by desquamation of the cuticle. Arsenicum alb. When sitting, or on lying down, the pains become intolerable ; amelioration on standing, by moving the part and from warmth ; sometimes relief is experienced by firmly com- pressing the part ; hands stiff and insensible ; on the tips of the fingers burning ulcers ; pains in the feet ; hot, shining and burn- ing swelling of the feet ; ulcerating and spreading blisters on the feet; (bluish redness of the sides of the feet). Itching burning of the chillblains in damp, thawing, spring weather. Worse on being touched. Better from firm pressure, and from heat of the fire. Belladonna. Pains worse at night, and aggravated by the least movement ; erysipelatous inflammations and red spots as if from flea-bites ; lameness and drawing pain in the elbows and fingers ; burning and digging sensation in the soles of the feet ; stinging pains in the soles of the feet ; pain as if from a bruise in the heel when treading upon it ; very considerable inflammation of a bluish-red color, attended with a creeping or tingling sen- sation. Carbo veg. Drawing in the metacarpal bones ; lacerating in the palm of the hands and wrists ; itching, fine eruption on the hands ; lacerating in the fingers ; burning in the soles of the feet, which are also painful when walking ; swelling and redness of the toes ; stitches of the toes ; tips of the toes are ulcerated. Follows well after Arsenic. Effects of Heat and Cold, 413 Fragaria Vesca. Pain in the chillblains during the hot season. (Lippe). This remedy, when it can be procured, is oftener used by applying a befry to the part, retaining it with a light bandage. Lachesis. Swelling of the hands, with itching and tingling; vesicles, with itching and burning, on the hands and fingers ; stinging and also burning in the tips of the fingers ; gangrenous ulcers on the fingers ; small itching vesicles on the fingers ; lacer- ating in the feet ; swelling of the feet ; small, white, hard, deep vesicles, preceded by violent itching ; cracked skin, between and on the toes ; inflammation, and suppuration of old chillblains. Muriatic acid. A common empirical prescription, often suc- cessful, is to bathe the feet every night and morning, in water medicated with the acid, about the proportion of ten drops of the acid to a pint of water. Nitric acid. Itching and swelling of the hands and fingers; feet swollen and painful, with fetid sweat; stitch in the heel on stepping ; painful sensitiveness of the toes, and of the soles of the feet. Nat rum mur. Although no connection can readily be seen in the symptoms, yet many cases have been cured by me who had intense burning and tenderness of the soles of the feet, painful when walking, with stinging vesicle on the tip of the tongue and sensation as if a hair were lying on the tongue. Petroleum. Pain in the wrist-joint as if sprained ; burning of the palms of the hands ; rough, chapped finger-tips, with stitches and cutting pains ; swelling of the feet, with blisters on the heels and between the toes. Phosphorus. Tremor and itching of the hands ; the tips of the fingers feel numb and insensible ; periodical contraction of the fingers like cramps ; paralysis of the fingers. Pulsatilla. Inflammation of a livid hue ; itching and beating in the part ; painful stiffness in the wrist-joint, or numbness as if sprained ; hot swelling of the feet that extends as far as the calves; tensive, burning pain, increasing to stitching pain when standing; itching and tingling in the toes ; chillblains worse in warm weather, and better from cold applications. Sulphur. Redness and swelling of the hands and fingers; lacerating in the fingers ; creeping and prickling in the ends of the fingers; deadness of the fingers in the morning; stiff, red finger-joints; cramps in the sole of the foot at every step; ulcer- ated vesicles on the soles of the foot ; swelling of the foot. INDEX. A. PAGE Abdomen: Contusions of 148 Emphysema of 149 Injuries of 148 Wounds of 149 Abscess 341 Chronic ._ 342 Cold . _ 342 Diffused 342 Tympanitic 343 of Frontal Sinus 75 of Gums 86 of Nose 75 of Perineum 206 of Prostate 203 of Tongue 84 Albuminous Sarcoma 390 Alveolar Cancer 397 Amaurosis 60 Aneurism . 316 by Anastomosis 318 Aneurism : Dissecting 317 Fusiform 316 Osteo . 292 Sacculated 317 Anchylosis 268 Anthrax _ __ 378 Antrum : Dropsy of 76 Suppuration of 76 Anus: Fistula of 170 Ulcer and Fissure of 169 Aphonia 104 Arteries: Inflammation of . 315 PAGE Arteries : Fatty Degeneration of . . 316 Calcification of 316 Arthritis ._ 206 Asphyxia 100 of the newly born 100 from Cold 101 from Drowning 101 from Gases 100 from Lightning 102 from Strangulation 100 B. Bed sores 375 Benign Tumors 383 Bladder: foreign bodies in 149 Rupture of 149 Blennorrhagic Epididymitis 235 Blood : Extravasation of, in Skull 25 Vessels: Wounds of 301 Boils. _ 378 Bones: Caries of 289 Hydatids of __ 292 Hypertrophy of 291 Inflammation of 288 Necrosis of 290 Tubercles of 292 Brain: foreign bodies in 25 Compression of _. 24 Concussion of 26 Hernia of 28 Inflammation of 27 Irritation of 27 Wounds of 28 416 Index. PAGE Breast : Hypertrophy of 125 Inflammation of 126 Neuralgia of 125 Tumors of 127 Bronchocele 107 Bubo 183 Burns .... 410 Bursas: Enlarged ...... 268 C. Calcification of Arteries 316 Calculi : Nasal 75 Renal -- 214 Uterine . .. 247 Vesical ... 214 Cancer . .... 391 of the Eye 52 Encephaloid 56 Melanotic . 57 Scirrhus . 57 of the Pharynx .... 103 of the Tongue 86 of the Uterus 247 Colloid 397 Encephaloid - 394 Epithelial 397 Melanosis.. . 396 Scirrhus. 392 Cancrum Oris ............. 103 Carbuncle ........ 378 Caries . ... 298 of Spine ... 135 Cartilaginous tumors . 392 Cerebral Hernia 28 Chancre 182 Cheloid 386 Chemosis 53 Chest: Injuries of . 123 Cholesteatoma 388 Chronic Abscess . 352 Cold Abscess . 352 Effects of 411 Asphyxia from . 101 Colloid Cancer 397 Comminuted fracture of Skull 24 PAGE Compound fracture of Skull 24 Compression of Brain 24 of Spinal cord 134 Concretions in Ear. 40 in Uterus 246 Concussion of Brain 2 26 of Spinal cord _ 134 Conjunctivitis 52 Condylomata _. 385 Contused wound of Scalp 23 Contusion of Abdomen 488 of Scalp 22 Cornea: Opacity of 53 Coxalgia 268 Cracks of Tongue 85 Cranium: fungus of 29 Curvature of Spine 136 Cystic Tumors . 384 D. Deafness .. 40 'Degeneration, fatty, of Arteries. . 316 Delirium : Nervous 20 Traumatic 20 Diffused Abscess 352 Dislocations 270 of Spine 133 Dissecting Aneurism 317 Dropsy of the Antrum 76 Scrotum 236 Drowning : Asphyxia from 101 Dura-mater: Fungus of .... 29 E. Ear : Foreign bodies in . 41 Concretions in .... 40 Inflammation of . 39 Suppuration of 39 Tumors of . 40 Ulcer of 40 Emphysema Thoracica 124 Empyema Abdominalis 149 Thoracica 125 Encephalitis, traumatic 27 Encephaloma 394 Index. 417 PAGE Encephaloma of the Eye 56 Enchondroma ._ 391 Enlarged Bursa? 268 Entero-Vaginal fistula. __ 249 Epididymitis: Blennorrhagic 235 Epistaxis ._ 74 Epithelial Cancer 397 Epulis 87 Esophagus: foreign bodies in 97 Stricture of _ 105 Wounds of _- 97 Esophogatomy 97 Exostosis . 292 Eye : Cancer of _ 56 Foreign bodies in 50 Wounds of_. 51 Eyelids: Inflammation of 52 (Edema of 53 Wounds of 51 F. Face: Wounds of 37 Fatty degeneration of Arteries 316 Tumors 388 Fibro-plastic Tumors 390 Cellular tumors 389 Fibrous Tumors 389 Recurring _. 390 in Uterus 247 Fissures of Anus 169 of Tongue 85 Fistula 353 in Ano 170 Lachrymalis _. 54 Salivary 38 Vaginal 248 Vaginal entero 249 Vaginal recto 249 Vaginal urinary 249 Fractures 292 of Skull 24 of Spine 133 Fragilitas ossium 291 Frontal Sinus : Abscess'of 75 Frost-bite 411 PAGE Fungous Haematodes 394 Fusiform Aneurism 316 G. Ganglions 268 Gangrene 372 of Uterus 247 Gases: Asphyxia from 100 Gelatinous Tumors 397 Glandular Tumors 387 Glossitis. __ 83 Glottis: foreign bodies in 99 Goitre 107 Gonnorrhcea _ 206 Gums ; Abscess of , 86 Ulceration of 87 H. Haematoma 385 Hematocele 335 Hemorrhagic Ulcer 302 Haemorrhoids 169 Head: Injuries to 23 Heat: effects of _ 410 Hernia _. 158 Cerebri 28 Humoralis 235 Hip-disease 268 Hydatids of Bones. 292 of Uterus _. 246 Hydrocele 236 Hydrometra 245 Hypertrophy of Bones 291 of Breast 125 of Prostate 205 I. Idiopathic Ulcer_ 359 Incised wound of Scalp 23 Indolent ulcer 361 In-growing toe nail 297 Inflamed ulcer. 360 Inflammation of Arteries 315 of Bone 2S8 4i8 Index. PAGE Inflammation of Brain 27 of Breast __ 126 of Ear * 39 of Eye _ 52 of Eyelids _ _ 52 of Iris 55 of Larynx 104 of Nerves 321 of Nose 75 of Prostate 203 of Spinal cord 135 of Tongue 83 of Urethra 206 of Veins. 299 Intestinal obstruction 160 Innocent Tumors 383 Introduction _ 17 Irritable ulcers 361 Irritation of Brain 27 Iritis r 55 J- Joints : Wounds of 269 L. Laceration of Scalp 23 of Perineum 150 of Urethra ._ 150 Lachrymal fistula __ 54 Laryngitis 104 Larynx: foreign bodies in 99 Concussion of 98 Paralysis of 99 Wounds of __ 98. Lateral curvature of Spine 136 Lightning: Asphyxia from 102 Lipoma 74> 3^8 Lungs: Injuries to 124 Lupus 75 Luxations _. 270 M. Malignant Tumors 391 Mastitis __ 126 Melanosis 396 of the Eye 57 PAGE Moles in the Uterus 246 Morbus Coxaria _ 268 Mortification 372 Mumps __ 106 Myelitis _. 135 Myeloid Tumors 390 N. Neck: tumors of 106 Nervous delirium 20 Neuralgia 320 of Breast _ 125 Neuritis _ 321 Neuroma 321 Nevus _ _._ 318 Non-malignant tumors 383 Nose : Abscess of. 75 Bleeding of_ _ 74 Calculi in _ 75 Cancer of. __ 75 Inflammation of _ 75 Lipoma of _ 74 Lupus of 75 Tumors of ; 75 O. Obstruction of Intestines. _ 160 (Edema of Eyelids 53 of Glottis. 99 of Larynx 104 Onychia 297 Opacity of Cornea 53 Ophthalmia 52 Orchitis 235 Osteitis 288 Osteo- Aneurism 292 Osteo-Sarcoma __ 292 Otitis 39 Otorrhoea _ 39 Ovarian tumors 248 P. Papulse Syphilitica 184 Paralysis of Larynx 99 Parotitis ". 106 Index. 419 PAGE Parotid: tumors of 106 Perineum: Abscess of 206 Laceration of 150 Periostitis 288 Phagedena 376 Phagedaenic Chancre. 183 Pharynx : Abscess of 102 Cancer of 103 Inflammation of 102 Polypi in 103 Phlebitis 299 Physometra 246 Piles 169 Pneumo-thorax 124 Pneumonia-traumatica _ 124 Polypi 287 of Ear 40 of Pharynx 103 of Nose 75 of Uterus 247 Prolapsus : Recti 171 of Tongue 85 Prostate : Abscess of 203 Hypertrophy of 205 Inflammation of 203 Tumors of _. 204 Psoriasis of Tongue. 85 Pterygium 53 Pyemia 300 R. Ranula 85 Recto-Vaginal fistula 249 Rectum : Prolapsus of 171 Renal calculi 214 Retinitis 55 Rhagades of tongue 85 Rhinolites 75 Rickets 291 Rupture of Bladder 149 Recurring fibroid tumors 390 S. Sacculated Aneurism 317 PAGE Salivary fistula 38 Sarcoma 386 Osteo 292 Scalds 411 of Mouth and Pharynx ._ 98 Scalp: Wounds of 22 Scirrhus _ 392 of Breast 127 of Eye 57 of Uterus 247 Scrotum: Dropsy of 236 Varix of 236 Semi-malignant tumors 390 Shock 19 Simple ulcer 360 Sinus 353 Frontal: Abscess of 75 Skull: Extravasated blood in 25 Fracture of 24 Sloughing 361 Phagedena 376 Specific ulcers 181-360 Spina-bifida 137 Spine; Caries of 135 Curvature of 136 Dislocation of 133 Injuries to 133 Fracture of 133 Spinal cord : Compression of 134 Concussion of 134 Inflammation of 135 Stone in Bladder 215 Strabismus 53 Strangulation: Asphyxia from 100 Stricture of Esophagus _ 105 of Urethra 208 Stunning 26 Suppuration, (see abscess) 349 Synovitis 266 Syphilis 181 Congenital 185 Primary 1S1 Secondary 183 Syphilitic Exanthema 184 Pimples 184 Tubercle of Tongue 86 420 Index, T. PAGE Testicle Swelled 235 Tetanus _ 322 Throat: Scalds of 98 Thyroid : Tumor of 107 Toe nail : In-growing 297 Tongue : Abscess of 84 Cancer of 86 Fissure of — 85 Inflammation of 85 Prolapsus of. 84 Psoriasis of_. 85 Syphilitic tubercle of 86 Tumors of — 85 Ulcer of 86 Tonsils: Hypertrophy of 107 Inflammation of 106 Trachea: Foreign bodies in 89 Dislocated cartilages 98 Wounds of 98 Tracheotomy- 100 Traumatic delirium 20 Encephalitis 27 Pneumonia 124 Tubercle of Bone 292 of Tongue, Syphilitic _ 86 Tumors ._ 383 of Breast 127 of Ear 40 of Eye _ 50 of Neck. 106 of Nose.. 75 of Ovaries 248 of Parotid.. 106 of Pharynx 103 of Prostate 204 of Thyroid 107 of Tongue 85 Innocent 383 Atheroma 388 Cheloid 386 Cholesteatoma _ 388 Condylomata 385 Cystic 384 Epulis 87 Fatty 388 ] PAGE Tumors: 247, 389 Fibrous: Fibro cellular 389 Glandular 387 Hematoma 385 Lipoma . 74,388 Polypi 387 Ranula 85 Sarcoma 40, 75, 103, 247, 386 Sarcoma Osteo 292 Warts 385 Semi-malignant 390 Albuminous Sarcoma 390 Cartilaginous 391 Enchondroma 391 Fibro-plastic 390 Myeloid ^.„ 391 Recurring-fibroid 390 Malignant 57, 127, 247, 391 Alveolar 397 Colloid 397 Encephaloid 56,394 Epithelial 397 Fungous Haematodes 394 Gelatinous 397 Melanosis 396 Scirrhus :_. 57,127,392 Tympanitic Abscess 353 U. Ulcers.. _ 359 of Anus -. 169 of Cornea 52 of Ear 40 of Gums 87 of Face 75 of Nose 75 of Tongue 86 of Uterus __ 247 Idiopathic _ 359 Indolent 361 Inflamed . 360 Irritable- 361 Hsemorrhagic _ 362 Phagedenic _ 361 Simple 360 Sloughing. 361 Index. 421 PAGE Ulcers: Specific 182,360 Traumatic 359 Varicose 361 Weak 360 Urethra: Inflammation of 206 Laceration of 150 Stricture of 208 Uterus: Diseases of 245 Calculi of 247 Cancer of 247 Concretions in 246 Fibrous tumors in 247 Gangrene of 247 Hydatids of 246 Hydi-ometra of 245 Moles in 246 Physometra of 246 Polypi of 247 Ulceration of 247 V. Vagina : foreign bodies in 150 Vaginal fistula _ 248 Entero 249 Rectal 249 Urinary 249 Varicose veins 299 PAGE Varicose Ulcer 361 Varicocele 236 Vesical calculi 214 W. Warts 385 Weak ulcer 360 White swelling 267 Wounds of Abdomen 149 of Bladder _ ._ 140 of Blood-vessels 301 of Brain _ 28 of Chest 123 of Cornea ._ 53 of Esophagus _. 97 of Eye 51 of Eye-lids 51 of Face 37 of Iris 55 of Larynx 98 of Lungs 24 of Nerves 322 of Perineum 150 of Scalp 22 of Spinal cord 135 of Trachea 98 of Urethra 150 w V X ■ c- V s <5r W *o o N (6 ^ ■' I) n L * \^ ^ . V 1 B , -^. " - ' <\\ . N C fi ' v> > ■*b X ^ A ,0 o ,^ N ,J c o x W S?^ r> ^ N !>" ^ V' .0 o tf .0 ■r. V- v L O ,\ ^ * / : ^ , G° ' A N a\ * V LIBRARY OF CONGRESS DDD1A42T524